State- and payer-specific estimates of annual medical expenditures attributable to obesity

The goal of this study is to expand prior analyses by presenting current state-level estimates of the costs of obesity in total and separately for Medicare and Medicaid. Quantifying current Medicare and Medicaid expenditures attributable to obesity is important because high public sector costs of obesity have been a primary motivation for publicly funded obesity prevention efforts at the state level. We also present estimates of the obesity-attributable fraction (OAF) of total, Medicare, and Medicaid expenditures and the percentage of total obesity costs within each state that is funded by the public sector. We used the 2006 Medical Expenditure Panel Survey, nationally representative data that include information on obesity and medical expenditures, to generate an equation that predicts annual medical expenditures as a function of obesity status. We used the 2006 Behavioral Risk Factor Surveillance System, state representative data, and the equation generated from the national model to predict state (and payer within state) expenditures and the fraction of expenditures attributable to obesity for each state. Across states, annual medical expenditures would be between 6.7 and 10.7% lower in the absence of obesity. Between 22% (Virginia) and 55% (Rhode Island) of the state-level costs of obesity are financed by the public sector via Medicare and Medicaid. The high costs of obesity at the state level emphasize the need to prevent and control obesity as a way to manage state medical costs.     

The impact of altered precipitation variability on annual weed species

? Premise of the study: Climate change models predict increasing variability in precipitation across the globe, with an increase in the incidence of large precipitation events but decreasing overall event frequency. Research with annual species in arid and semiarid ecosystems has demonstrated that precipitation variability can influence plant community dynamics; however, less is known about the impact of precipitation variability in less water-limited ecosystems, including economically important agricultural systems. ? Methods: We conducted three greenhouse experiments to determine how variation in total precipitation and the interval between precipitation events affected emergence and growth of two common annual midwestern weed species, Chenopodium album (Chenopodiaceae) and Setaria faberi (Poaceae). ? Key results: Both species responded to precipitation variability; however, the effect depended on life stage and precipitation amount, indicating that responses are highly context-dependent. Emergence of both species increased with longer intervals between precipitation events at low total precipitation, but species' responses varied under typical precipitation amounts. Individual seedling biomass of both species depended on interactions between total water and intervals, but species' responses differed; Setaria faberi biomass was reduced with longer intervals, but Chenopodium album had either a positive or no response. ? Conclusions: Our results suggest that changes in precipitation variability likely will affect the composition and relative abundance of agriculturally important weeds. These results are important for understanding how changes in the temporal variability of precipitation due to global climate changes could impact plants in non-arid communities.     

Chemical proteomics and its impact on the drug discovery process

Despite the rapid growth of postgenomic data and fast-paced technology advancement, drug discovery is still a lengthy and difficult process. More effective drug design requires a better understanding of the interaction between drug candidates and their targets/off-targets in various situations. The ability of chemical proteomics to integrate a multiplicity of disciplines enables the direct analysis of protein activities on a proteome-wide scale, which has enormous potential to facilitate drug target elucidation and lead drug verification. Over recent years, chemical proteomics has experienced rapid growth and provided a valuable method for drug target identification and inhibitor discovery. This review introduces basic concepts and technologies of different popular chemical proteomic approaches. It also covers the essential features and recent advances of each approach while underscoring their potentials in drug discovery and development.     

Effect of generic drug competition on the price of prescription drugs in Ontario.

OBJECTIVE: To analyse the potential effect of generic drug competition on prices in Ontario to assess the costs and benefits associated with Bill C-22 (An Act to amend the Patent Act). DESIGN: Comparison of the cost of the least and most expensive versions of all products sold by more than one manufacturer in 1991. The number of brand-name and generic drug companies marketing each of the products was recorded. RESULTS: Of 1599 products 437 (27.3%) were made by more than one company. Almost half (44.6%) of the 437 were sold by two companies. The more companies that sold a drug the greater the difference in price between the least and most expensive versions. Similarly, as the proportion of generic drug companies in competition increased, the greater the price difference. When competition was between generic drug companies only, the price spread was smaller than when it was between brand-name drug companies only. CONCLUSIONS: Generic drug competition can result in savings to the Ontario Drug Benefit Plan. A more in-depth analysis of the potential savings is necessary to fully assess the costs and benefits associated with Bill C-22.     

Assessing the impact of predictive biosimulation on drug discovery and development

Systems biology is creating a context for interpreting the vast amounts of genomic and proteomic data being produced by pharmaceutical companies in support of drug development. While major data collection efforts capitalize on technical advances in miniaturization and automation and represent an industrialization of existing laboratory research, the transition from mental models to predictive computer simulations is setting the pace for advances in this field. This article addresses current approaches to the mathematical modeling of biological systems and assesses the potential impact of predictive biosimulation on drug discovery and development.     

Comparison of the EGFR resistance mutation profiles generated by EGFR-targeted tyrosine kinase inhibitors and the impact of drug combinations

Recent clinical data indicates that the emergence of mutant drug-resistant kinase alleles may be particularly relevant for targeted kinase inhibitors. In order to explore how different classes of targeted therapies impact upon resistance mutations, we performed EGFR (epidermal-growth-factor receptor) resistance mutation screens with erlotinib, lapatinib and CI-1033. Distinct mutation spectra were generated with each inhibitor and were reflective of their respective mechanisms of action. Lapatinib yielded the widest variety of mutations, whereas mutational variability was lower in the erlotinib and CI-1033 screens. Lapatinib was uniquely sensitive to mutations of residues located deep within the selectivity pocket, whereas mutation of either Gly(796) or Cys(797) resulted in a dramatic loss of CI-1033 potency. The clinically observed T790M mutation was common to all inhibitors, but occurred with varying frequencies. Importantly, the presence of C797S with T790M in the same EGFR allele conferred complete resistance to erlotinib, lapatinib and CI-1033. The combination of erlotinib and CI-1033 effectively reduced the number of drug-resistant clones, suggesting a possible clinical strategy to overcome drug resistance. Interestingly, our results also indicate that co-expression of ErbB2 (v-erb-b2 erythroblastic leukaemia viral oncogene homologue 2) has an impact upon the EGFR resistance mutations obtained, suggesting that ErbB2 may play an active role in the acquisition of drug-resistant mutations.     

Waiting times for nursing-home placement: the impact of patients' choices.

OBJECTIVE: To identify patient characteristics and characteristics of long-term care facilities that significantly affect the waiting time for transfer from hospital to nursing home. DESIGN: Cohort study. PARTICIPANTS: All patients designated to be transferred from four Winnipeg hospitals between June 1, 1988, and May 31, 1989. The patients were followed up until placement, death or May 31, 1990. MAIN OUTCOME MEASURE: Length of time waiting for nursing-home placement and relative rates of placement. RESULTS: The variable found to shorten the waiting time the most was the patient''s choice of a for-profit or nonprofit secular facility; other significant variables were male sex, age of 75 to 84 years and occupancy of an acute care bed during the wait. CONCLUSION: The province has three policy options: it can increase the proportion of secular nursing-home beds when new facilities are built; it can require that hospital patients accept an interim nursing-home placement pending transfer to the nursing home of their choice; or it can tie the sponsorship of new facilities to a formula based on the ethnoreligious distribution of the population currently aged 55 to 64 years.     

Effects of computer generated reminder charts on patients' compliance with drug regimens.

OBJECTIVE--To investigate whether a reminder chart improved patients'' compliance with their drug regimen after discharge from hospital. DESIGN--Patients were randomly allocated to one of four groups. Two groups received the reminder chart: one also received routine counselling from a nurse and the other received structured counselling from a pharmacist, which included an explanation of the reminder chart. The other two groups received only counseling, either from a nurse or from a pharmacist. Patients were visited about 10 days later: they were questioned about their drug regimen, and their compliance was measured by tablet counting. SETTING--The pharmacy in a district general hospital and patients'' homes. PATIENTS--197 patients being discharged from hospital who were regularly taking two or more drugs. INTERVENTION--An individualised reminder chart, which listed each person''s medicines and when they were to be taken and was automatically generated by a medicine labelling computer. MAIN OUTCOME MEASURES--Patient''s compliance with and knowledge of their drug regimen. MAIN RESULTS--Of the patients who received the reminder chart, 83% (95% confidence interval 74% to 90%) correctly described their dose regimen compared with 47% (37% to 58%) of those without the chart (p < 0.001). The mean compliance score was 86% (81% to 91%) in both groups not given the reminder chart; 91% (87% to 94%) in the group given the chart without an explanation; and 95% (93% to 98%) in the group given the chart and an explanation. A mean compliance score of > 85% was achieved by 63% (53% to 73%) of patients without a reminder chart and by 86% (78% to 93%) of those receiving the chart (p < 0.001). CONCLUSIONS--An automatically generated reminder chart is a practical and cost effective aid to compliance.     

Comparison of maintenance energy expenditures and growth yields among several rumen bacteria grown on continuous culture

Anabaena inaequalis was sensitive to mercuric ion (Hg2+) in the ppb (nanogram per milliliter) range. Growth was inhibited significantly at concentrations of metal ion as low as 2 ppb, and 100 ppb was required to inhibit photosynthesis and acetylene reduction. Low levels of Hg2+ stimulated acetylene reduction and photosynthesis. The lysis of vegetative cells was the primary action of mercuric ions, resulting in the inhibition of growth, photosynthesis, and nitrogenase activity. There was a linear relationship between numbers of cells and the amount of Hg2+ required to induce culture lysis. Calculated on the basis of equivalent cell numbers, Hg2+ was toxic to A. inaequalis at 0.006, 0.009, and 0.100 micrograms of Hg2+ per 10(5) cells for photosynthesis, growth, and acetylene reduction, respectively.     

Assessing the value-adding impact of diagnostic-type tests on drug development and marketing

OBJECTIVE AND METHODS: We explore the cash value of the companion diagnostics opportunity from the perspective of the pharmaceutical partner. Cashflow-based modeling is used to demonstrate the potential financial benefits of key relationships between the pharmaceutical and diagnostics industries. RESULTS: In four scenarios, the uplift in the net present value (NPV) of a proprietary medicine can exceed $US1.8 billion. By simple extrapolation, the uplifted NPV calculations allow realistic and plausible estimates of the companion diagnostic opportunity to be in the region of $US40 billion to $US90 billion. CONCLUSION: It is expected that such market valuation could drive a macroeconomic change that shifts healthcare practice from reactionary disease-treatment to proactive health maintenance.     

The impact of litter and annual plants on recruitment from the seed bank of a lacustrine wetland

In an experimental marsh complex, 2 years of high water (1 m above normal) killed most of the emergent vegetation. During 1983, the first year of a 2-year drawdown, immediately following this period of high water, field experiments involving the removal of fallen emergent, filamentous algal and mixed (algal and emergent) litter were established at 6, 4 and 7 sites, respectively. All three indicated that the removal of litter significantly increased the number of species and the number of individuals of a species recruited from the seed bank. During 1984, the number of species and number of individuals in the removal treatment at emergent- and mixed-litter sites was again significantly higher than in the controls, but there was no longer a difference at algal litter sites.The addition of a mat of Typha litter in June 1983, at five sites that were free of litter, reduced seedling recruitment from the seed bank almost completely in both 1983 and 1984.The removal of 1982-standing litter, from sites at higher elevations that were invaded by Typha or Phragmites during the high water period, also increased the number of species and the number of individuals of a species compared with the controls in 1983.Removal of seedlings of the mudflat annual, Atriplex patula L., increased the number of grass shoots significantly in both 1983 and 1984. Grasses in the seedling removal treatment were also taller and flowered in 1983, the first year of the drawdown.     

河北省年均降水量插值方法比较

以河北省及临近区域120个气象观测站点1971～2000年均降水量数据为基础,选择其中的40个作为检验站点,其余站点分别取80、40、20个作为插值站点,采用局部插值、整体插值、多元线性回归、综合模拟等多种插值模型讨论了降水空间插值问题,主要结论如下:插值站点数、模型类型、模型参数都会影响插值精度.局部插值模型相对误差最小值出现在Spline、IDW模型中,其次为Kridging模型,而整体模型Trend、多元线性回归模型误差均较大,但综合了局部插值模型和统计模型的综合模型一定程度上能改善插值精度及误差分布.河北省80和40个站点的最优插值模型为综合模型,20个站点的最优插值模型为IDW2.