This paper examines an approach to coping with persistent hallucination and delusion that the author has found to be more effective than standard ‘reality-testing’. The approach, characterized as a form of intellectual humility, involves making rapid judgments about one’s experiences, alongside a ready willingness to change those judgments as needed. The approach thus bears some connection to reality-testing, but may also be seen as partially overlapping with, and emerging from, the consideration of Pyrrhonian skepticism as a path to ‘tranquility’. The paper addresses an obvious objection to this approach, namely, that it is epistemically irresponsible and inconsistent with a genuine concern for truth.

The main goal of this essay is to propose and make plausible a framework for developing a philosophical account of musical notation. The proposed framework countenances four elements of notation: symbols (abstract objects that collectively constitute the backbone of a ‘system’ of notation), their characteristic ‘forms’ (for example, shapes, understood abstractly), the concrete instances, or ‘engravings’, of those forms, and the meanings of the symbols. It is argued that these elements are distinct. Along the way, several preliminary arguments are given for how one ought to understand them—for example, it is suggested that engravings represent symbols rather than instantiate forms, although they are characteristically seen to represent a symbol by being seen to instantiate an associated form. Having proposed this framework, the essay explores the nature of musical instructions, as the meanings of symbols, and offers an argument in favor of the commonly held (but recently challenged) view that those meanings are imperative. Specifically, composites of musical notation (paradigmatically, musical scores) primarily express instructional meaning, and denote something like ‘sonic structures’ only secondarily, in virtue of their primary, imperative, meaning.

**Background:** Many persons with severe mental illness qualify for Medicaid coverage. However, under federal law, states must either suspend or terminate eligibility once they are incarcerated. We hypothesize that prompt re-acquisition of Medicaid eligibility following release from incarceration lowers the risk of re-incarceration. **Objective:** To assess the relationship between Medicaid eligibility and risk of re-incarceration among previously incarcerated schizophrenia diagnosed subjects. **Methods:** Study subjects were selected between January 1, 2006 and September 30, 2011 from a single state Medicaid database that was combined with department of corrections data. Subjects were included if they had a schizophrenia diagnosis (International Classification of Diseases, 9th Revision, Clinical Modification [ICD- 9-CM] code 295.xx), were between the ages of 18 and 62, and had been released from incarceration. Covariates included age, race, gender, marital status, and reason for incarceration. Time to Medicaid eligibility after release from incarceration, cumulative days of eligibility, and whether they were eligible on the re-incarceration date were evaluated in independent models. One and three-year Cox Regression models analyses (p<0.05) were used to evaluate the hazard for re-incarceration. **Results:** The 932 subjects were 26.5% white, 73.7% male and were, on average, 37.6 years old on their index date (i.e., incarceration release date). They were 73.5% single or divorced and 12.7% were incarcerated for a substance abuse violation. In the 1-year follow-up period, 110 subjects (11.8%) were re-incarcerated. In the 3-year follow-up period 209 (22.4%) were re-incarcerated. Age (in years) was the only significant predictor of re-incarceration for the 1-year models (hazard ratio [HR]=0.976; confidence interval [CI]=0.957, 0.994). Eligibility was a significant predictor in the 3-year follow-up models. A longer ‘time to first eligibility’ (HR=1.046; CI=1.017, 1.075 was associated with a greater hazard for re-incarceration. Being eligible at the time of re-incarceration (HR=0.659; CI=0.498, 0.870) was associated with a lower hazard, and the cumulative number of months of eligibility (HR=0.978; CI=0.958, 0.997) and age were associated with a lower hazard for re-incarceration (HR=0.986; CI=0.973, 0.999). **Conclusions:** Access to Medicaid health services post-release may reduce the risk of re-incarceration.

I consider the fact that there are a number of interesting ways to 'reconstruct' quantum theory, and suggest that, very broadly speaking, a form of 'instrumentalism' makes good sense of the situation. This view runs against some common wisdom, which dismisses instrumentalism as 'cheap'. In contrast, I consider how an instrumentalist might think about the reconstruction theorems, and, having made a distinction between 'reconstructing' quantum theory and 'reinventing' quantum theory, I suggest that there is an adequate (not 'cheap') instrumentalist approach to the theory (and to these theorems) that invokes both.

To assess the impact of not screening for prostate cancer among a hypothetical population of men > 55 years of age. Sample included PLCO Screening Trial intervention participants without cancer at T0 (n=33,709) through 2011. Inclusion criteria: age ≥ 55 years, and adequate PSA or DRE exam at entry. Cancer was considered clinically significant if patient had confirmed PCa with Gleason score ≥ 7. Estimated PCa expenditures were based on Medicare costs. Results were projected to SEER incident population (n=202,500 with localized cancer). Among 2,580 PLCO men identified and treated for PCa after T0, estimated total expenditures were: $61.5 million, with $23,804 per treated patient. Among 377 PLCO men with clinically significant cancers who received treatment, estimated total expenditures were $8.6 million (mean, $22,742 per patient). Among 549 PLCO men with clinically non-significant PCa identified and treated after T0, estimated total expenditures were $13.6 million ($24,831 per case). Extrapolated nationally to 96,000 clinically significant PCas annually, annual initial diagnosis/ treatment costs would be $2.4 billion. Adopting draft USPHSTF recommendations would result in $2.4 billion in initial savings ($23,804/patient). Many of these men will subsequently present with clinically significant PCa, will require systemic therapy, and will die from PCa, with total costs far exceeding $2.4 billion. The 2011 USPHSTF Task Force draft policy currently grades PCa screening as “(D)- do not discuss with patients.” A more rational policy would be to screen appropriate men for PCa and to treat early clinically significant PCa with surgery or radiation.

I explore an agent-based model of the development and dissemination of scientific theory that makes very little use of any pre-defined social structure (such as partnerships or collaborations). In these models, under a broad range of values of the parameters, widespread (but not universal) agreement about scientific theory emerges. Moreover, the residual disagreement turns out to be important to developing new theories in the face of new evidence.

The smallest object that the human eye can detect has dimensions of around 50 microns. So there is a sense in which a sphere that is, say, 10 microns in diameter, is invisible to us. Some philosophers have argued that the invisibility, to us, of a 10 microns sphere has epistemological significance that, in particular, our knowledge about and our understanding of such things may be qualitatively different from our knowledge and understanding of directly observable objects. Along with many other philosophers, I find this view untenable. It seems clear that although they are not directly observable to us, 10 microns spheres are nonetheless the same sort of thing as their larger cousins (the 50 microns spheres). Indeed, there are creatures whose visual apparatus works more or less as ours does that can directly see 10 microns spheres.

Guido Bacciagaluppi and Antony Valentini, Quantum Theory at the Crossroads: Reconsidering the 1927 Solvay Conference. Cambridge: Cambridge University Press (2009), 530 pp., $135.00 (cloth). - Volume 79 Issue 1

To examine sources of error in claims-based adherence calculations for LAI antipsychotics with potentially invalid days' supply (DS) values and evaluate the assumption that quantity-dispensed (QD) values are in product units. Pharmacy claims for single-dose LAI antipsychotics dispensed between January 1, 2009 and December 31, 2010 were selected from a large US database. Frequency distributions were generated for observed DS and QD values for each product and dose. Observed QD values on premixed LAI antipsychotic claims were divided by the product's volume to test the assumption that QD was entered in milliliters rather than units. After adjustment to QD for premixed LAI antipsychotic claims, duration of therapy per injection was calculated for all LAI antipsychotics as DS/QD. Calculated therapy duration was compared with the dosing interval in the product's package insert (PI). Percentage of claims with duration of therapy per injection within the product's PI range was calculated as a measure of the validity of the observed DS value. For the 611,325 LAI antipsychotic claims analyzed, observed QD values ranged from 0.01 to 117, suggesting values that did not always represent product units. After adjustment to QD for premixed LAI antipsychotics, 98.5% of claims had an integer value for calculated quantity in product units, supporting the assumption that premixed LAI antipsychotics' quantities were entered in milliliters. After adjustment, 21.5% of claims had a calculated therapy duration per injection outside the PI range. Percentage of claims with calculated therapy durations outside the PI ranged from 10.6% to 39.1% for paliperidone palmitate, 7.6% to 13.1% for risperidone long-acting injection, and 3.1% to 10.8% for olanzapine pamoate. Results raise concerns regarding potentially invalid values in DS and QD fields. Algorithms for appropriate use of LAI antipsychotic pharmacy claims in adherence calculations, quality measurement, and cost analyses are recommended.

The objective of this analysis was to compare two commonly used adherence calculations for multiple sclerosis patients prescribed disease modifying drugs (DMDs) in a national managed care population. Patients with pharmacy claims for self-injectable DMDs were selected from 2007-2008 Thomson MedStat data. Adherence was calculated across all DMDs for 12 months after the first DMD claim (i.e., index date) using two different adherence calculation methods. Traditional medication possession ratio (TMPR) was calculated by summing the days supply from the first to the last prescription and dividing by the time between the last prescription date plus the days supply on the last prescription and the first prescription date. The MMPR used the same numerator but divided by the 365 days of the follow-up period. The TMPR was calculated based on available data (no eligibility requirements) while MMPR requires continuous eligibility for the 12-month follow-up period. The mean adherence value for TMPR (n=3,405) was 90.5% whereas the mean adherence value for MMPR (n=2,145) was 78.0%. Based on TMPR, 82.3% of patients were considered adherent (≥80%) while this value decreased to 63.7% for MMPR. The MPR is often used to describe patient adherence. This adherence measure, however, can be calculated using different time periods in the denominator. These results demonstrate the importance of understanding the adherence calculation method and the population in which the measure is generated, and the potential implications to patient care.

6027 Background: To estimate US rates of neutropenic complications per annum in inpatient settings over time, among discharges of all patients, patients with any cancer diagnosis, and patients with lung cancer, non-Hodgkin lymphoma (NHL), and female breast cancer. Methods: This descriptive, cross-sectional analysis used data from 1989-2007 from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS). Neutropenic complications were defined by a neutropenia diagnosis code (ICD-9- CM=288.0X) only, or the combination of neutropenia and infection diagnosis codes. Rates of neutropenic complications per 10,000 discharges were calculated for all discharges, cancer discharges (140.XX-208.XX), lung cancer (162.XX), NHL (NHL, 201.XX and 202.XX) and female breast cancer (174.XX). Discharges for patients < 18 years of age and for patients receiving therapeutic radiology (92.2X) or stereotactic radiosurgery (92.3X) were excluded. Results: The estimated annual number of U.S. hospital discharges ranged from 28 to 33 million from 1989-2007. Cancer discharges accounted for 2.3-2.7 million discharges per year. The rates of neutropenic complications per 10,000 cancer discharges increased through 1999 and stabilized or declined after 1999. The rate of neutropenia discharges per 10,000 cancer (female breast cancer, lung cancer, and NHL only) discharges was 288.9 (95% CI 265.7-312.1) in 1989. The rate increased to 560.4 (95% CI 533.3-581.4) by 1999, and then declined to 495.0 (95% CI 469.4-520.7) in 2007. Trends of neutropenic complications within cancer types were similar. Neutropenia complication rates in patients with lung cancer and NHL peaked in 1997 and then declined through 2007; however, neutropenia rates in female breast cancer did not decline as much as in NHL or lung cancer in the more recent years. Conclusions: After 1999, rates of neutropenic complications among breast cancer, lung cancer, and NHL patients stabilized or declined. Further research is needed to understand whether this is the result of policy changes influencing hospitalization decisions or changing treatment patterns for cancer and the management of treatment toxicity. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Amgen Amgen Amgen Amgen

PND22 COMPARISON OF MEDICATION ADHERENCE TO INTERFERON BETA-1B AND INTERFERON BETA-1A SUBCUTANEOUS IN MULTIPLE SCLEROSIS PATIENTS Meletiche DM, Kozma C, Dickson M EMD Serono, Inc, Rockland, MA, USA, University of South Carolina, West Columbia, SC, USA, University of South Carolina, Columbia, SC, USA OBJECTIVES: To compare medication adherence to interferon beta (IFN )-1b and IFN -1a subcutaneous (SC) in patients with multiple sclerosis (MS). METHODS: This was a retrospective analysis of patients with a diagnosis of MS in a national managed care database that had 1 outpatient DMD claim during the 7/1/2002 to 12/31/2005 selection period. Eligible patients were continuously enrolled for 6 months before and 24 months after their initial drug claim (index date) and were between 18 and 65 years of age. Medication possession ratios (MPRs) were calculated as the percentage of ambulatory days during the 24-month post-index period from the date of fi rst use of the index DMD. The primary analysis was logistic regression predicting likelihood of adherence (MPR 85%) by treatment group (IFN -1b versus IFN -1a SC), including covariates of age, sex, and region of the country. RESULTS: A total of 530 MS patients (IFN -1b, n 206, IFN -1a SC, n 324) met the study criteria. Patients had a mean age of 43.6 years, 77.2% were women, 49.0% were located in the Midwest, and 94.2% had commercial insurance. Average 2-year MPRs were 57.9% and 63.7% (P 0.020) for IFN -1b and IFN -1a SC, respectively. The percentage of patients who were adherent (MPR 85%) was 39.3% for IFN -1b vs 49.4% for IFN -1a SC. A logistic regression using categorical MPR as the dependent variable found that IFN 1a SC patients were signifi cantly more likely to be adherent than IFN -1b patients (OR 1.603, P 0.0110). Older age (in 10 year increments) was also a signifi cant predictor of adherence (OR 1.301, P 0.0037). Sex and region of the country were not statistically signifi cant. CONCLUSIONS: In this retrospective analysis, patients using IFN -1a SC were more likely to be adherent with their DMD therapy over a 2year period than patients using IFN -1b, while controlling for age, sex, and region of the country.