Alright I'm brand new to RoleplayGateway and while I wait to find a nice group to join I figured I'd offer up some little plot bunnies I'd be willing to roleplay. Most of these ideas are 1x1s but I'd be willing to go to small groups is enough people are interested.
Things to Know About Me.
I try to post about one to two paragraphs per post. I can go up to four on the high end. I try to reply once every other day or once every three days I can play either gender and a wide variety of ages. I prefer not to roleplay explicit content (violence or romance) nothing against it just a personal preference. I love love love chatting in the ooc and working with my partner(s) to expand my roleplay worlds.
Plot Bunnies: *pink are ones I'm craving*
1. Quirky Magical Creature In the Real World - not so much a detailed plot as just an idea. Basically working on the assumption that magical creatures/monsters live in a world where they can interact with humans relatively unscathed. Just a slice-of-life on what it's like to be a quirky monster. Characters I Can Play: Dream Weaver (female sandman) ;; Ditsy Succubus ;; Bratty Witch ;; (others upon request)
2. Hero/Villain - a roleplay based on the evolving relationship of a hero and villain.
3. Magical Mayhem - witches in training getting into all kinds of shenanigans as they work to harness their skills.
4. Resurrection (zombie) based roleplay revolving around the idea of someone taking a resurrection potion prior to death and dealing with their new life as the un-dead.
5. I'm A Monster - new monsters adjusting to life (vamps, werewolves, etc.)
6. Modern vs. Old gods - basically the era of the old gods is waning and they must do battle with the modern gods in order to find a place in the modern world.
Plot: Corrupted Magical Girl
Based on ideas borrowed from several different sources the basic idea is thanks to spookyscaryskeletons on chickensmoothie and used with permission.
Anyway the idea is that in this world magical girls are not sparkling warriors of virtue and purity chosen by destiny but rather girls that are recruited either on the brink of death or just after they've died. They are recruited by cute-sy animals called Mascots, who have the task of finding these girls and giving them each a second chance at life by signing a magical contract. The contract allows the girls a second chance at life as magical girls who fight demons, monsters, and the occasional criminal. There is a catch however in that each of the girls is between 12 and 16 when they're recruited and as they near their 17th birthday they become more and more violent until one day (close to their eighteenth birthday) they drop dead and a new girl is recruited. At least that's the story they're told. The reality is that as the girls get older and older they start to lose their humanity until the point near their eighteen birthday where they completely lose their humanity and turn into demons to be hunted down by their former compatriots.
The only one's who know the true extent of the magical girls contracts are the Mascots who themselves carry as secret. Each of the mascots was in fact once a human girl themselves. Instead of being found on the brink of death however these girls made a contract with some magical power as a part of a suicide attempt. The magical power agreed to relieve the girls of their pain and give them a chance at a better life in return for them recruiting innocent girls to be magical girls. The Mascots must recruit a specific number of girls and at the end of it they are allowed the chance to finally rest in peace.
TORONTO (Reuters) - Canada's main stock index capped a stellar week with further gains on Friday, extending a two-year peak as industrial and resource stocks gained on data showing the Chinese economy, the world's second-biggest, grew at its fastest pace this year.
Adding to the rosy view for stocks, investors are betting that the U.S. Federal Reserve will delay trimming its stimulus measures due to the economic damage inflicted by the partial U.S. government shutdown that ended on Thursday.
"A lot of Canadian money managers have been sitting on their hands watching what's been happening south of the border and, that having been sorted out, at least in the short term, they are back in the market," said David Cockfield, managing director and portfolio manager at Northland Wealth Management.
"I think this trade deal is encouraging people as well," he added, referring to the signing of a multibillion-dollar trade pact between Canada and the European Union.
The deal will make Canada the only Group of 8 country to have preferential access to the world's two largest markets, the EU and the United States, home to about 800 million people.
The Toronto Stock Exchange's S&P/TSX composite index <.gsptse> closed up 99.73 points, or 0.77 percent, at 13,136.09, its highest level since July 2011. It gained 1.9 percent on the week, its best weekly performance since July.
Air Canada rose 4.6 percent to $5.19. The airline, which reached a deal to expand its main hub in Toronto, has risen sharply in recent months amid a major expansion push and solid traffic growth.
Investors pushed aircraft maker Bombardier up 1.8 percent to C$5.08 after it said a Chinese company may double its total order of new jetliners.
"No question the worst is over in China. Things have stabilized and are now on the upswing and that is very important for worldwide growth," said Barry Schwartz, a portfolio manager at Baskin Financial Services.
Third-quarter growth in China, the world's second-biggest economy, was 7.8 percent from a year ago, its quickest pace for the year, thanks largely to investment.
All of Canada's ten main sectors advanced except materials, which was weighed down by retreating gold miners. Some of the biggest gains came from the heavyweight financial and energy sectors.
"If you are sitting on a bunch of cash, you probably slide back into the utilities, the big financials," Northland's Cockfield said.
The financial subgroup rose 0.7 percent, powered by Royal Bank of Canada . The bank rose 1.1 percent to C$69.53, pushing its market capitalization above C$100 billion, a first for a Canadian lender.
RBC, which along with other Canadian banks has been boosted lately by signs that Canada's housing sector is stabilizing, is currently Canada's largest publicly traded company.
Royal, Toronto-Dominion Bank
, Bank of Nova Scotia and National Bank of Canada all hit record highs.
Baskin's Schwartz said Canada's banks and real estate investment trusts (REITs) have room to rally further.
"Interest rates are now back to where they were before the taper talk, yet the REITs aren't," he said.
Riocan Real Estate Investment Trust gained 1.6 percent to C$25.75 and Dundee Real Estate Investment Trust added 1.6 percent to C$29.52.
Schwartz said that after the distraction of the U.S. debt crisis, investors should be focused on interest rates, inflation and stock valuations, and that each factor was looking prime for improvement in Canada.
"Stocks are still the shiniest gold coin in a tarnished box of treasure," he said.
The heaviest fall belonged to Athabasca Oil Corp , which plunged 12 percent to C$6.13 after a court ruled that an aboriginal group could appeal the approval of an oil sands project.
(Additional reporting by Cameron French and Solarina Ho; Editing by Kenneth Barry)
FILE - In this Monday, June 15, 2009, file photo, Rober Shiller, a professor of economics at Yale, participates in a panel discussion at Time Warner's headquarters in New York. Americans Shiller, Eugene Fama and Lars Peter Hansen have won the Nobel Memorial Prize in Economic Sciences, Monday, Oct. 14, 2013. (AP Photo/Mark Lennihan, File)
FILE - In this Monday, June 15, 2009, file photo, Rober Shiller, a professor of economics at Yale, participates in a panel discussion at Time Warner's headquarters in New York. Americans Shiller, Eugene Fama and Lars Peter Hansen have won the Nobel Memorial Prize in Economic Sciences, Monday, Oct. 14, 2013. (AP Photo/Mark Lennihan, File)
This undated photo provided by the University of Chicago shows Eugene Fama, 74, of the University of Chicago. On Monday, Oct. 14, 2013, the Royal Swedish Academy of Sciences in Stockholm announced that Fama was one of three Americans to win the Nobel Memorial Prize in Economic Sciences. (AP Photo/Courtesy of the University of Chicago)
This undated photo provided by the University of Chicago shows Lars Peter Hansen, 60, of the University of Chicago. On Monday, Oct. 14, 2013, the Royal Swedish Academy of Sciences in Stockholm announced that Hansen was one of three Americans to win the Nobel Memorial Prize in Economic Sciences. (AP Photo/Courtesy of the University of Chicago)
FILE - In the Tuesday, Oct. 26, 2010, file photo, Robert Shiller, professor of economics at Yale, speaks at the Buttonwood Gathering, in New York. Americans Shiller, Eugene Fama and Lars Peter Hansen have won the Nobel Memorial Prize in Economic Sciences, Monday, Oct. 14, 2013. (AP Photo/Mark Lennihan, File)
FILE - In this Tuesday, April 22, 2008, file photo, economist, author and Yale University Professor Robert Shiller talks about the economy in New Haven, Conn. Americans Shiller, Eugene Fama and Lars Peter Hansen have won the Nobel Memorial Prize in Economic Sciences, Monday, Oct. 14, 2013. (AP Photo/Douglas Healey, File)
Ordinary investors don't stand much chance of beating the market. It moves way too fast and efficiently. Or it behaves in ways that make no sense at all.
Three Americans won the Nobel prize in economics Monday for their sometimes-contradictory insights into the complexities of investing.
Eugene Fama and Lars Peter Hansen of the University of Chicago and Robert Shiller of Yale University were honored for shedding light on the forces that move stock, bond and home prices — findings that have transformed how people invest.
Fama's research revealed the efficiency of financial markets: They absorb information so fast that individual investors can't outperform the markets as a whole. His work helped popularize index funds, which reflect an entire market of assets, such as the Standard & Poor's 500 stock index.
"Fama's work was incredibly fundamental in the '60s and '70s," said David Warsh, who follows economists at his Economic Principals blog. "It led to enormous practical change in terms of people not buying particular stocks but buying index funds."
Shiller's research examined asset prices from a contrasting angle. He showed that in the long run, stock and bond markets can behave irrationally, reaching prices that are out of whack with economic fundamentals.
Shiller, 67, predicted the dot-com crash of the early 2000s and the implosion of home prices in 2007. He has also been a pioneer in the field of behavioral economics, or how human emotions, biases and preferences can collectively influence financial markets.
Using mathematical tools like the well-known Case-Shiller index of home prices, Shiller has expanded the available information on asset prices.
Meb Faber, chief investment officer at Cambria Investment Management, said his firm uses a model developed by Shiller to seek stock bargains around the world.
Hansen has focused on statistical models, creating ways to test competing theories of why asset prices move as they do.
Fama and Shiller "provide the ends of the spectrum" between those who believe financial markets are efficient and those who think them deeply flawed, with Hansen "in the middle doing the math," said Allen Sanderson, a University of Chicago lecturer in economics.
The three economists share the $1.2 million prize, the last of this year's Nobels to be announced.
"Their methods have shaped subsequent research in the field, and their findings have been highly influential both academically and practically," the Royal Swedish Academy of Sciences said in Stockholm.
Fama, 74, and Hansen, 60, became the 11th and 12th professors from the University of Chicago to win a Nobel in economics, the most for any university. Harvard is second, with six laureates.
Hansen said he received the phone call from Sweden while on his way to the gym Monday morning. He said he was "still working on taking a deep breath."
Fama was preparing to teach his first class as a Nobel laureate Monday. Asked whether his students would get a break, he said: "We'll see, but they're going to get an exam tomorrow, anyway. They paid their money; they're going to get the full pill."
The Nobel prizes in medicine, chemistry, physics, literature and peace were created by Swedish industrialist Alfred Nobel in 1895. Sweden's central bank added the economics prize in 1968 as a memorial to Nobel.
Americans have dominated the Nobel in economics in recent years. The last time there was no American among the winners was 1999.
Collectively, Fama, Shiller and Hansen didn't create a simple, unified theory of how financial markets work. Rather, they worked like "blind men feeling an elephant" — each finding a bit of the truth in a vast and complicated field, Sanderson said.
Fama's work drew criticism after the financial crisis of 2007-09 seemed to prove that financial markets were anything but efficient. Housing prices, after all, had scaled great heights and then crashed.
But David Backus, an economist at New York University, said "people completely misunderstand" what Fama was arguing.
"He said that information out there will be reflected in (asset) prices. That is completely different from saying financial markets work well," Backus said.
It was striking that Monday's prize went to both Fama and Shiller, who emphasizes not market efficiency but market failures and inefficiencies.
"The committee covered all the bases," George Mason University economist Tyler Cowen quipped on his blog, Marginal Revolution.
Still, the University of Chicago's Sanderson said Fama, with his belief that investors can't outsmart the market, and Shiller, with his study of financial excess, would probably offer similar investment advice.
"Both would probably say: 'Don't spend a whole lot of time listening to your stockbroker.'"
___
Wiseman reported from Washington, Ritter from Stockholm. Associated Press writers Malin Rising in Stockholm, Stephen Singer in Hartford, Conn., and Don Babwin and Ashley Heher in Chicago, contributed to this report.
Edward Sharpe and the Magnetic Zeros frontman Alex Ebert is reassuring himself as much as he’s boasting about the second most visible attraction of the inaugural Big Top festival. Front and center is the actual big top -- a traditional circus tent complete with sawdust and bold primary colors -- under which the 12-member band will perform on a rotating stage.
Outside on the grounds of Los Angeles Historic State Park, food vendors, magicians and performers of all stripes will entertain the hundreds expected to show, bringing to life a dream Ebert has been mulling since founding his band in 2007. Now 35, it turns out Ebert attended an actual circus for the first time only a couple years ago.
“My primary relationship with the circus is through Dumbo,” he explains to The Hollywood Reporter on Big Top eve, acknowledging that, while one of the saddest animated movies of all-time, it was also “the best -- Dumbo had a major impact on me.”
The idea for the four-day fest, which Ebert and Co. curated, falls in line with the classic big top trope. “The idea is to come into a town and simmer a bit,” says Ebert. “To hang out and eat lunch and play piano randomly in a saloon and then meet the families and see the shows. Then say sayonara and get on your camel and ride.”
Indeed, there will be plenty to see and hear at the Big Top -- although no animals -- where more than 25 bands are slated to appear. Among them: such under-the-radar acts as Torque Method, Fool’s Gold and Henry Wolfe. The criteria for bookings, says Ebert, was straightforward: they needed to be local, have previously played on a bill with Sharpe or “have a similar emotional and spiritual availability” to the concept of “the ideal music troupe experience.”
That includes the in-the-round performance Sharpe and crew have devised. On the night THR visited the band’s dress rehearsal (see photo below), they were testing out a stellar cover of Paul Simon’s “Graceland” as the players all faced each other (another cover planned: Nina Simone's "Ain't Got No"). “It may seem a bit exclusionary -- having our backs to the audience -- but for us to be able to face each other and also for the audience to catch every member's face as they turn around. ... It's fun.”
You could say Edward Sharpe, perhaps more than any other current band, has made untraditional venues a staple of its tours. “As much as we could,” Ebert half-apologizes – though there’s no need; the band has staged shows inside a train and in the London tunnels. Although, if Ebert had his druthers, he adds, “I would play no place -- just parking lots and parks and houses and rooftops and do it very DIY.”
On the other hand, Ebert also has grand plans for his Big Top run, including a DVD or film to document the event and, hopefully down the road, creating “an entire town with its own money and commerce, with animals everywhere and people camping. A highly immersive collaborative experience.”
Ambitious much? Or just a big dreamer. If you’re Alex Ebert, likely a little bit of both. "This is supposed to be a traveling thing at some point," he adds.
But first things first: now that the tent is erected, freak show posters are positioned and vendors are taking their places -- all of which is being filmed for a future DVD release -- it's about appreciating what's directly in front of you.
"I'm blown away that we're doing this," says Ebert, who credits Zeros manager Bryan Ling for seeing the project through. "It's a huge undertaking and [takes] a lot of force of will. Because you don't have to do this. It's not a terribly big money maker, so why do it? The reason is to create a sense of being alive."
Prescription drug use among Medicare patients highly inconsistent
Public release date: 17-Oct-2013 [
| E-mail
| Share
]
Contact: Annmarie Christensen annmarie.christensen@dartmouth.edu 603-653-0897 Dartmouth-Hitchcock Medical Center
First-ever Dartmouth Atlas report on prescriptions finds wide variation in the use of both effective and potentially harmful medications across US
Lebanon, N.H. (October 15, 2013) A new report from the Dartmouth Atlas Project shows that the use of both effective and risky drug therapies by Medicare patients varies widely across U.S. regions, offering further evidence that location is a key determinant in the quality and cost of the medical care that patients receive.
In their first look at prescription drug use, Dartmouth researchers also find that the health status of a region's Medicare population accounts for less than a third of the variation in total prescription drug use, and that higher spending is not related to higher use of proven drug therapies. The study raises questions about whether regional practice culture explains differences in the quality and quantity of prescription drug use.
"There is no good reason why heart attack victims living in Ogden, Utah, are twice as likely to receive medicine to lower their cholesterol and their risk of another heart attack than those in Abilene, Texas, but this inconsistency reflects the current practice of medicine in the United States," said Jeffrey C. Munson, M.D., M.S.C.E., lead author and assistant professor at The Dartmouth Institute for Health Policy & Clinical Practice.
"This report demonstrates how far we still have to go as a nation to make sure people get the care they need when they need it," said Katherine Hempstead, Ph.D., M.A., senior program officer at the Robert Wood Johnson Foundation, a longtime funder of the Dartmouth Atlas Project. "Instead of varying widely, patterns of care should be nearly uniform across the country for non- controversial drug therapies with a strong evidence for their use."
The new report offers an in-depth look at how prescription drugs are used by Medicare beneficiaries in the program's Part D drug benefit, which had 37 million enrollees in 2012. The report separates the country into 306 regional health care markets and examines variations among them in the quantity and quality of prescription drug use, spending, and use of brand name drugs. To examine the quality of care, the report looks at prescription use in three categories:
Drug therapies proven to be effective for patients who have suffered heart attacks, have diabetes, or have broken a bone;
Discretionary medications, which have less clear benefits, but may be effective for some patients who take them; and
Potentially harmful medications, for which risks generally outweigh benefits.
"We need to learn from regions that consistently provide high-quality care, and focus attention on regions that appear to offer the worst of both worlds: high-risk and discretionary medications and, in relative terms, low use of effective drug therapies," said Nancy Morden, M.D., M.P.H., report co- author and associate professor at The Dartmouth Institute for Health Policy & Clinical Practice. "This will help us understand and ultimately improve prescribing quality for all Medicare beneficiaries."
Total use of prescription medications
The average Medicare Part D patient filled 49 standardized 30-day prescriptions in 2010. At the high end, patients in Miami, filled an average of 63 prescriptions, compared to patients in Grand Junction, Colo., who filled 39 prescriptions per year. Other high-use regions included Lexington, Ky., (59 prescriptions) and Huntington, W.Va., (58), compared to low-use regions in Albuquerque, N.M., (40) and San Mateo County, Calif. (41).
Use of effective prescription care
The report examines the use of proven drug therapies, including the use of beta blockers and statins in the months after a heart attack and the use of osteoporosis drugs after bone fractures.
Nearly eight in 10 heart attack survivors (78.5%) filled at least one prescription for a beta blocker in the seven to 12 months following a hospital discharge in 2008 or 2009. The results ranged from San Angelo, Texas, (91.4%) to Salem, Ore., (62.5%). The pattern of statin use after a heart attack was similar to that of beta blocker use, with 72 percent of heart attack survivors filling a statin prescription in the second six months after leaving the hospital. The results for statin use ranged from a high in Ogden, Utah, (91.3%) to a low in Abilene, Texas (44.3%). The regions that excelled in beta blocker use did not necessarily achieve similar results with statin therapy, despite the fact that both beta blocker therapy and strict control of cholesterol levels are recommended by the National Committee for Quality Assurance (NCQA) for the same condition in the same patients. No single region was in the top 10 regions for highest rates of use for both measures.
NCQA also recommends that survivors of a fracture resulting from osteoporosis should receive drugs that reduce the risk of subsequent fractures. However, only 14.3 percent of fragility fracture survivors received a drug to combat osteoporosis within six months of their fracture. The use of osteoporosis drugs across regions ranged from Honolulu, Hawaii, (28%) to Newark, N.J. (6.8%).
Use of potentially harmful medications
More than one in four Medicare Part D beneficiaries (26.6%) filled at least one prescription in 2010 for medications that have been identified as high-risk for patients over age 65, such as skeletal muscle relaxants, long-acting benzodiazepines, and highly sedating antihistamines. Patients in Alexandria, La., (43%) were more than three times as likely to receive at least one high-risk medication as patients in Rochester, Minn. (14%). More than 6 percent of Medicare patients filled a prescription for two or more different high-risk medications, including 14.6 percent of patients in Alexandria, La.
Total prescription drug spending
Spending on prescriptions by the Part D drug plans and their patients totaled $2,670 per beneficiary. Spending varied nearly threefold across regions, with a $2,968 difference between the lowest-spending regionSt. Cloud, Minn. ($1,770)and the highest spending region, Miami ($4,738).
Prescriptions filled with brand name products
When available, generic medications are generally equally effective and less costly than their brand-name counterparts. Thus, the relative use of brand-name products offers one view of prescribing efficiency. Overall, 26.3 percent of prescriptions were filled as a brand-name product in 2010. Patients in Manhattan (36%) were more than twice as likely to fill a prescription for a brand- name product than patients in La Crosse, Wis. (16.5%).
###
The full report, The Dartmouth Atlas of Medicare Prescription Drug Use, and complete data tables can be found at http://www.dartmouthatlas.org.
Methodology
Overall prescription drug use, spending for prescription drugs, and the use of brand-name medications were measured for Medicare beneficiaries age 65 and over who were continuously enrolled in a stand-alone Part D plan in 2010 (based on a 40% random sample). High-risk and discretionary medication use were also measured in this population. High-risk medications examined were those identified by NCQA as generally conferring more risk than benefit in older people. Discretionary medications were defined as those commonly prescribed in situations with higher diagnostic and therapeutic uncertainty. Effective prescription drug use measures were based on widely accepted, evidence-based prescribing guidelines. Effective drug use was studied for three groups of Part D beneficiaries: patients who had a heart attack, patients ages 65-75 with treated diabetes, and patients with a fragility fracture (a fracture of the hip, wrist, or shoulder commonly resulting from osteoporosis). For some effective care measures, earlier years were included in order to increase the sample size to allow for more accurate estimation of utilization in disease-specific cohorts.
About the Dartmouth Atlas Project
For more than 20 years, the Dartmouth Atlas Project has documented glaring variations in how medical resources are distributed and used in the United States. The project uses Medicare data to provide information and analysis about national, regional, and local markets, as well as hospitals and their affiliated physicians. This research has helped policymakers, the media, health care analysts and others improve their understanding of our health care system and forms the foundation for many of the ongoing efforts to improve health and health systems across America.
About the Robert Wood Johnson Foundation
The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable, and timely change. For 40 years, the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. Follow the Foundation on Twitter or Facebook.
See more at: http://tdi.dartmouth.edu/press/press-releases/prescription-drug-use-among-medicare-patients-highly-inconsistent#sthash.EDaub79q.dpuf
[
| E-mail
| Share
]
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Prescription drug use among Medicare patients highly inconsistent
Public release date: 17-Oct-2013 [
| E-mail
| Share
]
Contact: Annmarie Christensen annmarie.christensen@dartmouth.edu 603-653-0897 Dartmouth-Hitchcock Medical Center
First-ever Dartmouth Atlas report on prescriptions finds wide variation in the use of both effective and potentially harmful medications across US
Lebanon, N.H. (October 15, 2013) A new report from the Dartmouth Atlas Project shows that the use of both effective and risky drug therapies by Medicare patients varies widely across U.S. regions, offering further evidence that location is a key determinant in the quality and cost of the medical care that patients receive.
In their first look at prescription drug use, Dartmouth researchers also find that the health status of a region's Medicare population accounts for less than a third of the variation in total prescription drug use, and that higher spending is not related to higher use of proven drug therapies. The study raises questions about whether regional practice culture explains differences in the quality and quantity of prescription drug use.
"There is no good reason why heart attack victims living in Ogden, Utah, are twice as likely to receive medicine to lower their cholesterol and their risk of another heart attack than those in Abilene, Texas, but this inconsistency reflects the current practice of medicine in the United States," said Jeffrey C. Munson, M.D., M.S.C.E., lead author and assistant professor at The Dartmouth Institute for Health Policy & Clinical Practice.
"This report demonstrates how far we still have to go as a nation to make sure people get the care they need when they need it," said Katherine Hempstead, Ph.D., M.A., senior program officer at the Robert Wood Johnson Foundation, a longtime funder of the Dartmouth Atlas Project. "Instead of varying widely, patterns of care should be nearly uniform across the country for non- controversial drug therapies with a strong evidence for their use."
The new report offers an in-depth look at how prescription drugs are used by Medicare beneficiaries in the program's Part D drug benefit, which had 37 million enrollees in 2012. The report separates the country into 306 regional health care markets and examines variations among them in the quantity and quality of prescription drug use, spending, and use of brand name drugs. To examine the quality of care, the report looks at prescription use in three categories:
Drug therapies proven to be effective for patients who have suffered heart attacks, have diabetes, or have broken a bone;
Discretionary medications, which have less clear benefits, but may be effective for some patients who take them; and
Potentially harmful medications, for which risks generally outweigh benefits.
"We need to learn from regions that consistently provide high-quality care, and focus attention on regions that appear to offer the worst of both worlds: high-risk and discretionary medications and, in relative terms, low use of effective drug therapies," said Nancy Morden, M.D., M.P.H., report co- author and associate professor at The Dartmouth Institute for Health Policy & Clinical Practice. "This will help us understand and ultimately improve prescribing quality for all Medicare beneficiaries."
Total use of prescription medications
The average Medicare Part D patient filled 49 standardized 30-day prescriptions in 2010. At the high end, patients in Miami, filled an average of 63 prescriptions, compared to patients in Grand Junction, Colo., who filled 39 prescriptions per year. Other high-use regions included Lexington, Ky., (59 prescriptions) and Huntington, W.Va., (58), compared to low-use regions in Albuquerque, N.M., (40) and San Mateo County, Calif. (41).
Use of effective prescription care
The report examines the use of proven drug therapies, including the use of beta blockers and statins in the months after a heart attack and the use of osteoporosis drugs after bone fractures.
Nearly eight in 10 heart attack survivors (78.5%) filled at least one prescription for a beta blocker in the seven to 12 months following a hospital discharge in 2008 or 2009. The results ranged from San Angelo, Texas, (91.4%) to Salem, Ore., (62.5%). The pattern of statin use after a heart attack was similar to that of beta blocker use, with 72 percent of heart attack survivors filling a statin prescription in the second six months after leaving the hospital. The results for statin use ranged from a high in Ogden, Utah, (91.3%) to a low in Abilene, Texas (44.3%). The regions that excelled in beta blocker use did not necessarily achieve similar results with statin therapy, despite the fact that both beta blocker therapy and strict control of cholesterol levels are recommended by the National Committee for Quality Assurance (NCQA) for the same condition in the same patients. No single region was in the top 10 regions for highest rates of use for both measures.
NCQA also recommends that survivors of a fracture resulting from osteoporosis should receive drugs that reduce the risk of subsequent fractures. However, only 14.3 percent of fragility fracture survivors received a drug to combat osteoporosis within six months of their fracture. The use of osteoporosis drugs across regions ranged from Honolulu, Hawaii, (28%) to Newark, N.J. (6.8%).
Use of potentially harmful medications
More than one in four Medicare Part D beneficiaries (26.6%) filled at least one prescription in 2010 for medications that have been identified as high-risk for patients over age 65, such as skeletal muscle relaxants, long-acting benzodiazepines, and highly sedating antihistamines. Patients in Alexandria, La., (43%) were more than three times as likely to receive at least one high-risk medication as patients in Rochester, Minn. (14%). More than 6 percent of Medicare patients filled a prescription for two or more different high-risk medications, including 14.6 percent of patients in Alexandria, La.
Total prescription drug spending
Spending on prescriptions by the Part D drug plans and their patients totaled $2,670 per beneficiary. Spending varied nearly threefold across regions, with a $2,968 difference between the lowest-spending regionSt. Cloud, Minn. ($1,770)and the highest spending region, Miami ($4,738).
Prescriptions filled with brand name products
When available, generic medications are generally equally effective and less costly than their brand-name counterparts. Thus, the relative use of brand-name products offers one view of prescribing efficiency. Overall, 26.3 percent of prescriptions were filled as a brand-name product in 2010. Patients in Manhattan (36%) were more than twice as likely to fill a prescription for a brand- name product than patients in La Crosse, Wis. (16.5%).
###
The full report, The Dartmouth Atlas of Medicare Prescription Drug Use, and complete data tables can be found at http://www.dartmouthatlas.org.
Methodology
Overall prescription drug use, spending for prescription drugs, and the use of brand-name medications were measured for Medicare beneficiaries age 65 and over who were continuously enrolled in a stand-alone Part D plan in 2010 (based on a 40% random sample). High-risk and discretionary medication use were also measured in this population. High-risk medications examined were those identified by NCQA as generally conferring more risk than benefit in older people. Discretionary medications were defined as those commonly prescribed in situations with higher diagnostic and therapeutic uncertainty. Effective prescription drug use measures were based on widely accepted, evidence-based prescribing guidelines. Effective drug use was studied for three groups of Part D beneficiaries: patients who had a heart attack, patients ages 65-75 with treated diabetes, and patients with a fragility fracture (a fracture of the hip, wrist, or shoulder commonly resulting from osteoporosis). For some effective care measures, earlier years were included in order to increase the sample size to allow for more accurate estimation of utilization in disease-specific cohorts.
About the Dartmouth Atlas Project
For more than 20 years, the Dartmouth Atlas Project has documented glaring variations in how medical resources are distributed and used in the United States. The project uses Medicare data to provide information and analysis about national, regional, and local markets, as well as hospitals and their affiliated physicians. This research has helped policymakers, the media, health care analysts and others improve their understanding of our health care system and forms the foundation for many of the ongoing efforts to improve health and health systems across America.
About the Robert Wood Johnson Foundation
The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable, and timely change. For 40 years, the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. Follow the Foundation on Twitter or Facebook.
See more at: http://tdi.dartmouth.edu/press/press-releases/prescription-drug-use-among-medicare-patients-highly-inconsistent#sthash.EDaub79q.dpuf
[
| E-mail
| Share
]
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
This week sees the release of Batwoman #24, the final issue in the series from the writing team of W. Haden Blackman and J.H. Williams III -- although not the final issue as they had originally intended it. Both Blackman and Williams had originally intended #26 to be their last, bringing an end to the various storylines they'd been crafting for the last two years.
"Issue 24 was already written and being drawn by the time fallout came from our decision to leave the title. There had already been an issue 25 written by us and turned in, but at this point I don’t think this will ever be published," Williams wrote on his blog yesterday. "Issue 26 was to be the final chapter of the arc and is left unwritten by us currently. So DC isn’t publishing the end of the arc. Or at least not in any way we intended. If there is ever an offering of a conclusion to the last 7 months of storytelling, it most likely will be by the hands of others, and we have no idea how exactly that direction will proceed."
He went on, "What saddens me about it is that our issue 26 two months from now would have ended in a place that would serve as an adequate end cap to our run in a lot of ways. We knew how we were going to wrap things by issue 26, and felt we would have done so in a satisfying manner, or so we hoped."
Amongst the many resolutions and developments teased were revelations about the connection between Department of Extranormal Operations Director Bones and Batwoman's alter ego Kate Kane, some hints about how Kate's sister Beth became her arch-nemesis Alice, and events that would "bring the entire family to some form of a beginning to heal." According to Williams, "we would’ve been able to end our run at good spot for the next creative team. But that must only be happening in some parallel world."
Marc Andreyko takes over as the new writer on the series with November's #25.
Verizon's Samsung Galaxy S4 has a new update pushing out for it right now, bringing a couple of new features, tweaks and bug fixes. The 150MB update to software version VRUDMI1 is rolling out over the air and through Samsung's Kies software, though as always it may take a little time before it filters through to everyone.
The main new addition for Verizon GS4 owners is Samsung's Optical Reader app, which can create contacts from business cards using the rear camera and optical character recognition, in addition to translating printed text between languages. Other major changes and tweaks include improved Wifi connectivity, S Memo bug fixes, support for three-way calling when roaming on the Bluegrass network, and roaming support for TELUS in Canada.
If you're upgrading your Verizon Galaxy S4 to the new firmware today, hit the comments and tell us how you're getting on.
![[ Back to EurekAlert! ]](https://lh3.googleusercontent.com/blogger_img_proxy/AEn0k_tnLPSUW04tTy0_0f2-uPoEgpVSIwJ7FHD87h3_FicVB19ZnD3uERQ_uaegxinlD6OaSOO2sqw9QAN1K-j4sEDAVLK8EoY9OmUPesvNHGE=s0-d){kind=small}
Share
Source: