Objective: In Australia, subsidized psychiatric consultation items in the Medicare Benefits Schedule (MBS) provide essential private psychiatric services. Seasonality in service utilization may affect health care planning. This study examined the seasonal patterns of overall MBS psychiatric consultations and MBS telehealth psychiatric consultations in pre- and postpandemic periods. Methods: Medicare Item Reports for face to-face and telehealth psychiatric items from 2016 to 2023 were retrieved and compiled. The quarterly time series for total (face-to-face and telehealth) and telehealth psychiatric consultations were analyzed descriptively, using the January-March quarter as the baseline. Linear regression analyses were performed to detect significant seasonal variations by gender and age groups. A sensitivity analysis of the impact of the post-COVID-19 increase in consultations on seasonality was also conducted. Results: A seasonal pattern was present for total consultations before and after the expansion of telehealth items in the first quarter of 2020. There were peaks in psychiatric consultations in July-September and troughs in January-March, except in patients ≥65 years old. Total consultations were significantly higher in April-June (P = .010) and July-September (P < .001) than in January-March. Seasonal variations were the largest among young patients aged 0-24 years. Seasonality was mostly unaffected by the increase in psychiatric consultations postpandemic. However, seasonality was absent for telehealth consultations. Conclusion: The seasonality of MBS psychiatric consultations, which was more prominent in young people, may have a practical impact on psychiatric service planning. The lack of seasonal variation in telehealth consultations and its relationship to emergency presentations warrant further research. Prim Care Companion CNS Disord 2025;27(3):24m03898. Author affiliations are listed at the end of this article.

ObjectiveAttention-deficit hyperactivity disorder (ADHD) medication prescriptions in Australia have grown sharply in recent years. We examined the association between online interest in ADHD and prescriptions.MethodsMonthly Pharmaceutical Benefits Scheme (PBS) and Repatriation PBS (RPBS) Item Reports of ADHD prescriptions and Australian ADHD-related Google Trends (GT) data (2004-2023) were sourced. We modelled the lagged effect of GT on ADHD medication prescriptions, using an autoregressive moving average model with autoregressive conditional heteroskedasticity, adjusting for COVID-19 lockdown effects. Results were compared to a model of GT for pain-related searches and PBS/RPBS opioid prescriptions, and counterfactual alternatives: (1) ADHD-related GT and opioid prescriptions and (2) pain-related GT and ADHD prescriptions. We descriptively analysed additional ADHD-related online news data.ResultsAnnual prescriptions doubled from 1,424,904 in 2020 to 3,112,072 in 2023. ADHD medication prescriptions and ADHD-related GT considerably increased since the COVID-19 pandemic. GT had a statistically significant positive lagged association with ADHD prescriptions. Comparator models did not show statistically significant associations between GT and prescriptions. Online news data supported recently increased public interest in ADHD.ConclusionsADHD-related online interest predicts increased ADHD prescriptions, which was accentuated during the pandemic. Studies are needed to evaluate causal pathways, health information quality and sociodemographic determinants.

ObjectiveWe aimed to examine the associations of telepsychiatry consultations with the Medicare Benefits Schedule (MBS) telehealth policy changes (pandemic-related expansion and subsequent consolidation).MethodsWe performed a time series analysis of MBS telepsychiatry usage (January 2016-December 2023) using state/territory-level Medicare panel data. Linear regression analyses with panel-corrected standard error and autocorrelation were performed for telepsychiatry consultations (overall and age and sex subgroups). Telehealth policies, rural psychiatrist availability (rural psychiatrists per 100,000 population) and their interaction were the independent variables. The models were adjusted for pandemic lockdown severity (Stringency Index) and population size.ResultsTelehealth expansion and consolidation were associated with substantial increases in telepsychiatry consultations, with larger increases in the consolidation phase. Given the telehealth policy changes, lower per capita rural psychiatrists were associated with more telepsychiatry consultations. Males and older people (>65 years) showed greater relative consultation increases. Policy change-related telepsychiatry increases varied amongst states and territories.DiscussionThere was sustained telepsychiatry usage when it became more readily available, beyond the direct impact of acute pandemic lockdowns. Telehealth-enabling policies may contribute to fulfilling unmet mental health needs and improving access to psychiatric care amongst Australians. Further in-depth research in this area is needed.

BACKGROUND:Obesity is a risk factor for osteoarthritis and total hip/knee joint replacement and can lead to poorer outcomes following surgical interventions. AIM:This work aimed to determine the preliminary efficacy of a self-management programme versus usual care in improving health-related quality of life in obese patients with osteoarthritis awaiting joint replacement. METHODS:This was a two-group parallel randomised trial involving patients with obesity and osteoarthritis who were awaiting hip or knee arthroplasty. Patients were randomly allocated to the Flinders Program of self-management support plus usual care or usual care alone groups. Primary outcomes at 10 months were Short-Form Health Survey (SF-36) and Osteoarthritis of Knee/Hip Quality of Life (OAKHQoL). RESULTS:Ninety-five patients were randomised to either intervention (n = 48) or usual care (n = 47) and analysed in an intent-to-treat analysis. While there was no intervention effect in SF-36, evidence was in favour of intervention for OAKQoL improved social support (d = 0.43, 95% CI: 0.01-0.83) versus usual care (d = -0.01, 95% CI: -0.41 to 0.42) (p = 0.03). Similarly, intervention patients experienced larger improvements for social activity (d = 0.47; 95% CI: 0.05-0.89) versus usual care (d = -0.16; 95% CI: -0.58 to 0.25) (p = 0.005). CONCLUSION:The intervention warrants examination in a larger trial to establish effectiveness among patients with obesity and osteoarthritis awaiting arthroplasty. TRIAL REGISTRATION:Australian New Zealand Clinical Trials Registry ACTRN12615000674538.

Objective: To investigate associations between patients with borderline personality disorder (BPD)–related symptoms and their hospital presentations as well as the effect of inpatient length of stay (LOS) on time to hospital re-presentation. Methods: A retrospective cohort design was used to investigate mental health emergency department (ED) visits and inpatient admissions. The cohort comprised 13,320 men and 12,290 women with a follow-up period between January 1, 2014, and December 31, 2019. Results: Across all presentations in the study period, approximately 4% of mental health patients were discharged from ED or inpatient admission with primary diagnosis of BPD. Both male and female patients with BPD were at higher risk of hospital re-presentation when compared to patients with any other type of mental disorder (P < .01). Patients with BPD who had LOS > 14 days in their first inpatient admission were, on average, more likely to experience a repeat ED or inpatient presentation 58 days sooner than patients who had LOS < 2 days (P = .036). Conclusions: Findings suggest the need for (a) more accurate recording of BPD and related presentations, (b) more in-depth investigations of BPD care pathways, and (c) identifications of subpopulations who may benefit from a specific inpatient length of stay. Prim Care Companion CNS Disord 2024;26(1):23m03559 Author affiliations are listed at the end of this article.

Objective: To investigate associations between patients with borderline personality disorder (BPD)-related symptoms and their hospital presentations as well as the effect of inpatient length of stay (LOS) on time to hospital re-presentation. Methods: A retrospective cohort design was used to investigate mental health emergency department (ED) visits and inpatient admissions. The cohort comprised 13,320 men and 12,290 women with a follow-up period between January 1, 2014, and December 31, 2019. Results: Across all presentations in the study period, approximately 4% of mental health patients were discharged from ED or inpatient admission with primary diagnosis of BPD. Both male and female patients with BPD were at higher risk of hospital re-presentation when compared to patients with any other type of mental disorder (P < .01). Patients with BPD who had LOS > 14 days in their first inpatient admission were, on average, more likely to experience a repeat ED or inpatient presentation 58 days sooner than patients who had LOS < 2 days (P = .036). Conclusions: Findings suggest the need for (a) more accurate recording of BPD and related presentations, (b) more in-depth investigations of BPD care pathways, and (c) identifications of subpopulations who may benefit from a specific inpatient length of stay. Prim Care Companion CNS Disord 2024;26(1):23m03559. Author affiliations are listed at the end of this article.

The increasing prevalence of chronic diseases globally has resulted in increased healthcare utilization. Patients’ self-management of chronic diseases is important for efficient healthcare and improving patient health outcomes. This study aims to evaluate the psychometric properties of the Partners in Health (PIH) scale in a representative, multi-ethnic sample of patients with chronic diseases in Singapore and examine factors that can contribute to chronic disease self-management. A cross-sectional household survey included the PIH scale administered to 502 patients aged 40 and above who reported having at least one chronic condition. Bayesian Confirmatory Factor Analysis was applied to evaluate the factor structure and gender measurement invariance of PIH. The results suggested that a four-factor structure fit the Singaporean sample and had approximate measurement equivalence between males and females for most of the PIH items. The PIH scale and subscales also demonstrated criterion validity by having expected correlations with conceptually relevant constructs. Finally, sociodemographic characteristics and satisfaction with healthcare are significantly related to self-management based on the PIH scale. Satisfaction with healthcare also attenuated the reduction of self-management in patients from minority ethnic groups or those with lower education. This suggested that those groups can benefit from high satisfaction towards care providers in enhancing their disease management. In conclusion, this study demonstrated that PIH can be a promising tool for assessing patient self-management in the Singaporean population.

Background: Congestive heart failure (CHF) is a complex chronic disease, and it is associated with a second comorbid condition in more than half of cases. Self-management programs can be specific to CHF or generic for chronic diseases. Several tools have been validated for CHF. Presently, there are no established generic instruments that are validated for measuring self-management in CHF. Objective: This study aims to evaluate the internal reliability and construct validity (psychometric properties) of the Partners in Health (PIH) scale for patients with congestive heart failure, a generic chronic disease self-management tool. Methods: The study included 210 adult CHF patients [120 with heart failure with reduced ejection fraction (HfrEF), 90 with preserved ejection fraction (HfpEF)], from Community Cardiology Outpatients in West Melbourne, Australia, who were treated in community cardiology and were included between May 2022 and Jan 2024. The screened patient population were diagnosed with CHF and were eligible for an SGLT-2 inhibitor. Cohort analysis used the Bayesian confirmatory factor analysis to evaluate the a priori four-factor structure. Omega coefficients and 95% credible intervals (CI) were used to assess internal reliability. Results: In the CHF (HFrEF) and preserved ejection fraction (HFpEF) cohorts, participants' mean [standard deviation (SD)] age was 66.8 (13.5) and 71.3 (9.76) years. Description of study sociodemographics highlighted that 88% and 52% of patients were male, there was a BMI > 50% in both cohorts, eGFR > 60 mL/min were 59% and 74%, and LVEF < 40% and > 50% were 99% and 100%, respectively. Model fit for the hypothesised model was adequate (posterior predictive p = 0.073) and all hypothesised factor loadings were substantial (>0.6) and significant (p < 0.001). Omega coefficients (95% CI) for the PIH subscales of Knowledge, Partnership, Management and Coping were 0.84 (0.79-0.88), 0.79 (0.73-0.84), 0.89 (0.85-0.91) and 0.84 (0.79-0.88), respectively. Conclusion: This study is original in confirming the dimensionality, known-group validity, and reliability of the PIH scale for measuring generic self-management in outpatients with CHF syndrome.

Objective: To analyze emergency department (ED) mental health presentations over a 7-year period to estimate the timing and magnitude of the seasonal effect across Australia.Methods: We analyzed data collected by the Australian Institute of Health and Welfare (AIHW) from 2014-2015 to 2020-2021, which included all public hospital ED presentations in Australia that received a mental health diagnosis per the Australian Modification of ICD-10. The data were divided into 4 sequential quarters (Q1 = July-September, Q2 = October-December, Q3 = January-March, Q4 = April-June) and analyzed by sex and age (youth: 18-24 years, adult: 25-64 years, and older adult: > 65 years). Regression analysis was used to assess seasonal variation.Results: On average, mental health ED presentations were 9% higher in October-December than April-June, which had the lowest rates of mental health ED presentations for males and females. The peak continued into January-March, most prominently for females. Seasonality was evident in the 18-24 and 25-64 age groups. There were increased ED psychiatry presentations in October-December of 14.4% (males) and 9% (females) in the group aged 18-24, as well as increases of 10.3% (males) and 10.1% (females) in those aged 25-64. In January-March, there was an increase in presentations for females of 7% (aged 18-24) and 10.3% (aged 25-64). For adults aged > 65, there were increased presentations in July-September compared to April-June of 4.9% (males) and 3.9% (females).Conclusions: We found strong, statistically significant peaks in mental health ED presentations in spring and summer. Mental health services need to plan for significantly higher ED mental health demand during these seasons. Further research is required to estimate the size of the mental health seasonal effect in acute hospital settings.Prim Care Companion CNS Disord 2024;26(1):23m03629.Author affiliations are listed at the end of this article.

Background/Objective: Heart failure (HF) is a complex syndrome, with multiple causes. Numerous pathophysiological pathways are activated. Comprehensive and guideline-derived care is complex. A multidisciplinary approach is required. The current guidelines report little evidence for chronic disease self-management (CDSM) programs for reducing readmission and major adverse cardiovascular events (MACE). CDSM programs can be complex and are not user-friendly in clinical settings, particularly for vulnerable patients. The aim of this study was to investigate whether a simplified one-page CDSM tool, the SCReening in Heart Failure (SCRinHF), is comparable to a comprehensive Flinders Program of Chronic Disease Management, specifically in triaging self-management capabilities and in predicting readmission and MACE. Methods:SELFMAN-HF is a prospective, observational study based on community cardiology. Eligible patients, consecutively recruited, had HF with left ventricular ejection fraction <40% and were placed on sodium-glucose co-transporter-2 inhibitors (SGLT2-i) within 3 months of recruitment. SGLT2-i is the newest of the four HF treatment pillars; self-management skills are assessed at this juncture. CDSM was assessed and scored independently via the long-form (LF) and short-form (SF) tools, and concordance between forms was estimated. The primary endpoint is the 80% concordance across the two CDSM scales for predicting hospital readmission and MACE. Results: Of the 117 patients, aged 66.8 years (+/- SD 13.5), 88 (75%) were male. The direct comparisons for SF versus LF patient scores are as follows: "good self-managers", 13 vs. 30 patients (11.1% vs. 25.6%); "average", 46 vs. 21 patients (39.3% vs. 17.9%), "borderline", 20 vs. 31 patients (17.1% vs. 26.5%), and "poor self-managers" (vulnerable), 38 vs. 35 patients (32.5% vs. 29.9%). These findings underscore the possibility of SF tools in picking up patients whose scores infer poor self-management capabilities. This concordance of the SF with the LF scores for patients who have poor self-management capabilities (38 vs. 35 patients p = 0.01), alongside readmission (31/38 vs. 31/35 p = 0.01) or readmission risk for poor self-managers versus good self-managers (31/38 vs. 5/13 p = 0.01), validates the simplification of the CDSM tools for the vulnerable population with HF. Similarly, when concurrent and predictive validity was tested on 52 patients, the results were 39 (75%) for poor self-managers and 14 (27%) for good self-managers in both groups, who demonstrated significant correlations between SF and LF scores. Conclusions: Simplifying self-management scoring with an SF tool to improve clinical translation is justifiable, particularly for vulnerable populations. Poor self-management capabilities and readmission risk for poor self-managers can be significantly predicted, and trends for good self-managers are observed. However, correlations of SF to LF scores across an HF cohort for self-management abilities and MACE are more complex. Translation to patients of all skill levels requires further research.

ObjectivePrevious research suggests that the use of statin is associated with lower risk of severe outcomes among patients infected with the SARS-CoV-2 virus, but this has not been evaluated in a low-income Medicaid population. This study assessed the association between antecedent statin use and COVID-related hospitalization and all-cause death in Medicaid-enrolled patients with COVID-19.MethodsA retrospective cohort study was conducted using Mississippi Medicaid claims data from June 2019 to September 2021. Individuals between 18-64 years of age with a confirmed COVID-19 diagnosis (index date) were included. Continuous eligibility for 9 months pre-index through 3 months post-index period was required. Beneficiaries with antecedent statin use were identified based on records of statin prescription in the 90-day prior to the index date through pharmacy claims. Outcomes were all-cause mortality and hospitalization in 30 days, 60 days, and 90 days post index. Propensity score matching was performed to match statin users with non-users 1:1, based on age, sex, race, comorbidities, and medication use. Multivariable conditional logistic regression was conducted, adjusting for index month, cancer diagnosis and long-term care residency, to estimate the association of statin use with outcomes of interests.ResultsA total of 10,792 beneficiaries met the inclusion criteria with 1,415 (13.1%) statin users. A total of 2,214 beneficiaries were included in the matched cohort. Unadjusted rates of COVID-related hospitalization and all-cause death in the matched cohort were 21.9% and 4.8% for statin users, and 21.5% and 7.4% for statin non-users, respectively. Multivariable logistic regression showed no significant difference in odds of hospitalization for matched statin users and non-users. Statin users have lower odds of mortality within 30 days (OR:0.51, 95%CI:0.32-0.83), 60 days (OR:0.56, 95%CI:0.37-0.85) and 90 days (OR:0.55, 95%CI:0.37-0.82) after diagnosis of COVID-19.ConclusionCOVID-19 beneficiaries with antecedent statin use might have lower odds of death after COVID infection. ObjectivePrevious research suggests that the use of statin is associated with lower risk of severe outcomes among patients infected with the SARS-CoV-2 virus, but this has not been evaluated in a low-income Medicaid population. This study assessed the association between antecedent statin use and COVID-related hospitalization and all-cause death in Medicaid-enrolled patients with COVID-19. Previous research suggests that the use of statin is associated with lower risk of severe outcomes among patients infected with the SARS-CoV-2 virus, but this has not been evaluated in a low-income Medicaid population. This study assessed the association between antecedent statin use and COVID-related hospitalization and all-cause death in Medicaid-enrolled patients with COVID-19. MethodsA retrospective cohort study was conducted using Mississippi Medicaid claims data from June 2019 to September 2021. Individuals between 18-64 years of age with a confirmed COVID-19 diagnosis (index date) were included. Continuous eligibility for 9 months pre-index through 3 months post-index period was required. Beneficiaries with antecedent statin use were identified based on records of statin prescription in the 90-day prior to the index date through pharmacy claims. Outcomes were all-cause mortality and hospitalization in 30 days, 60 days, and 90 days post index. Propensity score matching was performed to match statin users with non-users 1:1, based on age, sex, race, comorbidities, and medication use. Multivariable conditional logistic regression was conducted, adjusting for index month, cancer diagnosis and long-term care residency, to estimate the association of statin use with outcomes of interests. A retrospective cohort study was conducted using Mississippi Medicaid claims data from June 2019 to September 2021. Individuals between 18-64 years of age with a confirmed COVID-19 diagnosis (index date) were included. Continuous eligibility for 9 months pre-index through 3 months post-index period was required. Beneficiaries with antecedent statin use were identified based on records of statin prescription in the 90-day prior to the index date through pharmacy claims. Outcomes were all-cause mortality and hospitalization in 30 days, 60 days, and 90 days post index. Propensity score matching was performed to match statin users with non-users 1:1, based on age, sex, race, comorbidities, and medication use. Multivariable conditional logistic regression was conducted, adjusting for index month, cancer diagnosis and long-term care residency, to estimate the association of statin use with outcomes of interests. ResultsA total of 10,792 beneficiaries met the inclusion criteria with 1,415 (13.1%) statin users. A total of 2,214 beneficiaries were included in the matched cohort. Unadjusted rates of COVID-related hospitalization and all-cause death in the matched cohort were 21.9% and 4.8% for statin users, and 21.5% and 7.4% for statin non-users, respectively. Multivariable logistic regression showed no significant difference in odds of hospitalization for matched statin users and non-users. Statin users have lower odds of mortality within 30 days (OR:0.51, 95%CI:0.32-0.83), 60 days (OR:0.56, 95%CI:0.37-0.85) and 90 days (OR:0.55, 95%CI:0.37-0.82) after diagnosis of COVID-19. A total of 10,792 beneficiaries met the inclusion criteria with 1,415 (13.1%) statin users. A total of 2,214 beneficiaries were included in the matched cohort. Unadjusted rates of COVID-related hospitalization and all-cause death in the matched cohort were 21.9% and 4.8% for statin users, and 21.5% and 7.4% for statin non-users, respectively. Multivariable logistic regression showed no significant difference in odds of hospitalization for matched statin users and non-users. Statin users have lower odds of mortality within 30 days (OR:0.51, 95%CI:0.32-0.83), 60 days (OR:0.56, 95%CI:0.37-0.85) and 90 days (OR:0.55, 95%CI:0.37-0.82) after diagnosis of COVID-19. ConclusionCOVID-19 beneficiaries with antecedent statin use might have lower odds of death after COVID infection. COVID-19 beneficiaries with antecedent statin use might have lower odds of death after COVID infection.

There were initial concerns that the COVID-19 pandemic might significantly increase worldwide suicide rates, due to the combined effects of economic recession, rising unemployment, job insecurity, income shock, social isolation, possible barriers to receiving mental health treatment, increased alcohol use, strained relationships, increased levels of national anxiety and distress.1,2 Also, if the COVID-19 pandemic were to trigger another 1929–1930s “Great Depression” and raise unemployment by potentially 15–20%, suicide rates could increase by at least 15%, with working age men being the highest risk group.1 Stuckler et al3 reported that within European Union countries between 1970 and 2007, every 1% increase in unemployment rate was associated with a 0.79% increase in suicide rate for those aged under 65. Pirkis et al4 recently published the early impacts of the COVID-19 pandemic on suicide rates in mainly high-income and upper middle-income countries. They found that suicide rates were either stable or reduced compared with the pre-pandemic period. Pirkis et al also analysed New Zealand suicide rates during the COVID-19 pandemic and found that there was a statistically significant decrease in New Zealand suicide rates in both primary analysis between 1 April and 31 July 2020 (rate ratio: 0·79; 95% CI: 0·68−0·91) and sensitivity analysis between 1 April and 31 October 2020 (rate ratio: 0.81; 95% CI: 0.72–0.90), compared with the pre-pandemic period.4 In the context of the unexpected fall in New Zealand suicide rates during the COVID-19 pandemic, we have investigated whether the early phase of a previous pandemic—the “Spanish Flu” pandemic of 1918–1920—was associated with decreased New Zealand suicide rates. If so, we hypothesise that the longer-term effects of the Spanish Flu pandemic on New Zealand suicide rates might be indicative of the longer-term effects of the COVID-19 pandemic on future New Zealand suicide rates. The Spanish Flu (1918–1920) killed 40 million people worldwide (ie, 2.1% of the world population), equivalent to 150 million deaths at current world population levels.5 The significant estimated flu-generated worldwide gross domestic product (GDP) decline was c.6–8%.5 The Spanish Flu was also New Zealand’s most severe disaster event and is estimated to have killed 9,000 people.6

To quantify the healthcare expenditures associated with oral glucocorticoids-related-adverse events (OGCs-AEs), among patients in the US with giant cell arteritis (GCA) using claims data from MarketScan® Commercial and Medicare Supplemental Databases. Patients age ≥50 years with GCA and at least one OGC prescription fill, during 1/1/2009-6/30/2014 (first OGC claim after GCA diagnosis date = index date) were selected. Cumulative dose of OGCs was measured during the 1-year post-index period. Patients were stratified in four cohorts (>0-≤2,607 mg, >2,607-≤4,800 mg, >4,800-≤7,200 mg, >7,200 mg) based on the distribution of OGC exposure. Incidence of potential AEs and AE-related direct healthcare costs (2016 USD) were also assessed during the 1-year post-index period. A generalized linear model with log link and gamma distribution was used to evaluate the association between the log of cumulative dose of OGCs and AE-related direct healthcare costs, adjusting for baseline characteristics. RESULTS The 1,602 GCA patients (mean age, 73, 69% females) had a mean cumulative OGC dose post-index of 5,806 mg (median=4,800 mg), with most exposure occurring in the first 6 months. The proportion of patients with any potential OCGs-AEs was 36.5% overall (n=584) and increased as cumulative dose increased (30.7%-45.3% across quartiles). Unadjusted mean AE costs for patients with an AE was $12,818 (median=$1,844). In the multivariable model, increasing OGC dose was associated with increasing AE-related healthcare costs (cost ratio=1.38 (95% CI 1.16-1.64) per 1 unit increase in log(cumulative OGC dose), p<0.001). Mean (median) predicted AE costs for the dosing quartiles were: $4,389 ($2,749) for >0-≤2,607 mg, $5,176 ($3,009) for >2,607-≤4,800 mg, $5,576 ($3,633) for >4,800-≤7,200 mg, $6,609 ($4,447) for >7,200 mg. Rates of OGCs-AEs tended to increase with an increase in cumulative OGC dose, which resulted in increased healthcare costs. These results highlight the need for efficacious therapies that reduce the exposure and potential risks with OGCs.

To estimate patient adherence with once-a-day (QD) vs. twice-a-day (BID) chronic medications following hospital discharge for ACS. A retrospective cohort study of patients discharged between 1/1/2007 and 4/30/2009 with an ACS diagnosis was performed using a large hospital and pharmacy claims dataset. Two chronic medications dispensed for QD and BID utilization, carvedilol and metformin, were analyzed for adherence measures [persistency, days on therapy, compliance (medication possession ratio, MPR), total # of dispensed prescriptions, gap (days) between refills] over a 12 month post-index period. Included patients had first dispensed prescription of carvedilol or metformin within 60 days of discharge (index prescription) and had Rx activity for any drug ≥ 12 months post-index. Persistence was defined as percentage of patients without a therapy lapse of > 30 days from last dispensed day's supply. Persistency with carvedilol QD vs. BID (N=168 vs. 2086) at 6 months was 44.0% vs 43.7% and at 12 months was 24.4% vs. 25.5%. Persistency with metformin QD vs. BID (N=136 vs. 614) at 6 months was 50.7% vs 53.7% and at 12 months was 28.7 vs. 35.0%. The average days on therapy for carvedilol QD vs. BID at 6 months was 120.5 vs. 121.9 and at 12 months was 196.7 vs. 203.0. Average days on therapy for metformin QD vs. BID at 6 months was 123.6 vs. 136.2 and at 12 months was 206.1 vs. 237.7. Compliance (MPR) with QD vs. BID carvedilol at 12 months was 84.2% vs 80.7% and for metformin was 77.6% vs 81.6%. Additional adherence metrics were consistent for QD vs. BID dosing. In ACS patients, no clinically meaningful differences on adherence measures were observed between QD versus BID dosing formulations over a 12 month follow-up period. Results indicate potential opportunities to improve persistency with chronic therapies in ACS patients.

As part of an audit of the processing of autologous bone marrow, we found that marrow was often contaminated with organisms potentially pathogenic to neutropenic recipients. One of 14 marrows studied was found to be contaminated before the processing stage and five others became contaminated during processing. The organisms isolated at these stages were Propionibacterium sp., coagulase-negative staphylococci, Staphylococcus aureus and coryneforms, suggesting that the skin was the likely source of contamination. Five out of the 11 marrows returned to patients were found to be contaminated after thawing. Two of these were marrows previously shown to be contaminated with coagulase-negative staphylococci before freezing, and from these coagulase-negative staphylococci were isolated again, in one case the strains were indistinguishable. New organisms isolated after thawing included Bacillus sp. and Corynebacterium sporogenes suggesting contamination from the environment. No infections attributable to these organisms were demonstrated in any of the patients studied.

Abstract A CO2 pattern flood was initiated in a west Texas (Permian Basin), sandstone reservoir as a tertiary recovery process in 1989. This paper is an overview of the development and management of the North Ward Estes CO2 Flood. The primary objective of managing the CO2 flood has been to maximize oil recovery for maximum profitability. This has been accomplished by maintaining a consistent water-alternating-gas (WAG) process, optimizing CO2 utilization, and maintaining a proper balance between patterns. Reservoir modeling, which is emphasized in this paper, has also been critical in the development and management of this flood.

High-resolution electron microscopy (HREM), with a resolution below 2Å, is the best tool for observing the actual detailed structure for ML. This gives direct atomic scale information about the film structure, including the bilayer thickness, the crystalline structure and the roughness of the individual layers and the interlayers.