ABSTRACT: BACKGROUND: The healthcare expenditure on self-monitoring of blood glucose (SMBG) test strips under the Nova Scotia Seniors' Pharmacare Program (NSSPP) has increased significantly in recent years. The objective of this study was to identify the frequency and cost of claims for blood glucose monitoring test strips by NSSPP beneficiaries in the fiscal year 2005/06 and to explore the variation in the use of test strips by type of treatment, age and sex. METHODS: Retrospective analysis was conducted using pharmacy administrative claims data for NSSPP beneficiaries. Study subjects were aged 65 years and above on October 1, 2004, received SMBG test strips in the 110 days prior to April 1, 2005, and were alive throughout the twelve month study period. Subjects were categorized into four groups: insulin only, oral antihyperglycemic agents (OAA) only, both OAA and insulin; and no reimbursed diabetes medications. Statistical analysis was performed to identify differences in expenditure by medication group and in frequency of SMBG test strips claimed by medication group, age, and sex. RESULTS: Of 13,564 included beneficiaries, 13.2% were categorized as insulin only, 53.5% OAA only, 7.2% both OAA and insulin, and 26.0% no reimbursed diabetes medications. Over half (58.7%) were female. The insulin only category had the highest mean [SD] number of SMBG test strips claimed per day 2.0[1.5] with a mean annual total cost of $615[441]/beneficiary. Beneficiaries aged 80 years and above claimed fewer test strips than beneficiaries below 80 years. CONCLUSION: This population based study shows that in Nova Scotia the SMBG test strips claimed by the majority of seniors were within Canadian guidelines. However, a small proportion of beneficiaries claimed for SMBG test strips infrequently or too frequently, which suggests areas for improvement. The provincial drug plan covers the majority of the costs of test strip utilization, suggesting that the majority of test strips claimed did not exceed the maximum allowable cost (MAC) established in the program's MAC policy. Drug insurance programs need to work with healthcare providers to determine if patients are using test strips optimally; and to determine their impact on patient outcomes. In addition, they need to determine the cost effectiveness of their SMBG test strip reimbursement policies.

OBJECTIVE: To measure family practice patients' adherence to statin medications and to identify factors associated with adherence to these medications. DESIGN: Cross-sectional study using a mailed self-report survey sent to 400 patients. SETTING: Two academic family practice clinics in Halifax, NS. PARTICPANTS: A total of 284 patients aged 40 or older who were prescribed statin medications by their family physicians, either for the first time or as a renewal during a 20-month period. MAIN OUTCOME MEASURES: Level of adherence to statin medications as measured by patients' self-report on the Morisky scale; association between high adherence on the Morisky scale and 38 patient-reported factors. RESULTS: Response rate was 82.5%. Average age of patients was 65 years, 57% were men, 62% had been on statin medications for more than 2 years, and 97% reported that their family physicians managed their cholesterol levels. More than 63% of patients reported high adherence as measured by the Morisky scale. On multiple logistic regression, being older than 65, taking 4 to 6 other prescribed medications, and having a lifestyle that included regular exercise or a healthy diet were significant independent predictors of high adherence scores on the Morisky scale. CONCLUSION: Almost two-thirds (63%) of patients who were prescribed statins by their family physicians reported high adherence to the medications. Strategies to improve adherence would best be directed at patients who are younger or taking fewer than 4 or more than 6 other prescribed medications. Patients should be encouraged to maintain a lifestyle of regular exercise and a healthy diet, as this was associated with better adherence to statin medications.

In late December 1990, a new radio source appeared near the center of our galaxy rivaling the intensity of Sgr A(*)(the compact radio source at the galactic center). Following its first detection, the flux density of the galactic center transient (GCT) increased rapidly to a maximum 1 month later, and then declined gradually with a time scale of about 3 months. Surprisingly, the GCT maintained a steep radio spectrum during both its rising and decay phases. The neutral hydrogen (HI) absorption shows similar absorption to that in front of Sgr A(*); this indicates that the GCT lies near the galactic center. Furthermore, both HI and OH observations show an additional deep absorption at +20 kilometers per second with respect to the local standard of rest. Thus, the GCT is either embedded in or located behind a molecular cloud moving with that velocity. The cloud can be seen on infrared images. Its opacity is shown to be inadequate to conceal a supernova near the galactic center. It is argued that the GCT was probably transient radio emission from synchrotron-radiating plasma associated with an x-ray binary system.

Over the past decade, our physical understanding of gamma-ray bursts (GRBs) has progressed rapidly, thanks to the discovery and observation of their long-lived afterglow emission. Long-duration ( greater, similar2 s) GRBs are associated with the explosive deaths of massive stars ('collapsars', ref. 1), which produce accompanying supernovae; the short-duration ( less, similar2 s) GRBs have a different origin, which has been argued to be the merger of two compact objects. Here we report optical observations of GRB 060614 (duration approximately 100 s, ref. 10) that rule out the presence of an associated supernova. This would seem to require a new explosive process: either a massive collapsar that powers a GRB without any associated supernova, or a new type of 'engine', as long-lived as the collapsar but without a massive star. We also show that the properties of the host galaxy (redshift z = 0.125) distinguish it from other long-duration GRB hosts and suggest that an entirely new type of GRB progenitor may be required.

Over the past decade, long-duration gamma-ray bursts (GRBs)-including the subclass of X-ray flashes (XRFs)-have been revealed to be a rare variety of type Ibc supernova. Although all these events result from the death of massive stars, the electromagnetic luminosities of GRBs and XRFs exceed those of ordinary type Ibc supernovae by many orders of magnitude. The essential physical process that causes a dying star to produce a GRB or XRF, and not just a supernova, is still unknown. Here we report radio and X-ray observations of XRF 060218 (associated with supernova SN 2006aj), the second-nearest GRB identified until now. We show that this event is a hundred times less energetic but ten times more common than cosmological GRBs. Moreover, it is distinguished from ordinary type Ibc supernovae by the presence of 10(48) erg coupled to mildly relativistic ejecta, along with a central engine (an accretion-fed, rapidly rotating compact source) that produces X-rays for weeks after the explosion. This suggests that the production of relativistic ejecta is the key physical distinction between GRBs or XRFs and ordinary supernovae, while the nature of the central engine (black hole or magnetar) may distinguish typical bursts from low-luminosity, spherical events like XRF 060218.

OBJECTIVE: To document the potential for drug interactions in seniors with osteoarthritis and to consider the usefulness of computerized support for detecting clinically important interactions. DESIGN: Self-administered mailed survey. One question requested a list of all medications (prescribed drugs and self-care products, including herbal and "natural" health products) taken in the last 7 days. Interactions among all medications were assessed using an on-line software package. SETTING: Three urban primary care practices in Nova Scotia. PARTICIPANTS: Questionnaires were sent to 244 patients aged 65 years and older with physician-confirmed osteoarthritis. MAIN OUTCOME MEASURES: Number of potential interactions and level of clinical significance associated with each. RESULTS: Response rate was 78%(n = 191); 174 respondents (92%) supplied information on medications. Respondents took an average of 4.7 products of which 2.8 were prescription medications and 1.9 were self-care products. A total of 214 potential interactions were identified; 30 (14%) of these were clinically significant. Most interactions involved nonprescription products, most frequently acetylsalicylic acid. Recommendations in 29 of these 30 clinically significant interactions were cautionary, advising such measures as closer monitoring of blood tests, observation for toxic effects, or making patients aware of side effects. Only 1 interaction prompted a recommendation for avoidance. Respondents reported use of 7 different herbal and natural health products; these products were associated with 5 clinically insignificant interactions. CONCLUSION: Risk of drug interactions in seniors might be high, but few interactions are clinically significant. Only 1 found in our study carried a recommendation for avoidance. The on-line program reported all significant interactions, but the high proportion of insignificant interactions (6 : 1) also reported could lead physicians to override computer-generated alerts.

OBJECTIVE: To explore with seniors what influences their choice of medication for osteoarthritis. DESIGN: Qualitative study using semistructured in-depth interviews. SETTING: Interviews were conducted in patients' homes in two cities in Nova Scotia. PARTICIPANTS: Seniors with a physician-confirmed diagnosis of osteoarthritis. METHOD: Interviews were audiotaped and transcribed verbatim. A grounded-theory approach was used. Key words and phrases were identified independently by all members of the research team who then collectively grouped the data into conceptual categories. MAIN FINDINGS: FOUR THEMES EMERGED FROM DISCUSSIONS ABOUT MEDICATION CHOICES: the role of family physicians in influencing use of cyclooxygenase-2 inhibitors, the effect of fear of making medication choices, the reasons for discontinuing cyclooxygenase-2 inhibitors, and views on other information sources. Distribution of free samples, family physicians' recommendations, and fear of side effects influenced seniors' choices of osteoarthritis medications. They claimed not to be influenced by direct-to-consumer advertising or the fact that cyclooxygenase-2 inhibitors are more expensive than other classes of drugs for osteoarthritis. CONCLUSION: Because seniors' choice of medications for osteoarthritis is often influenced by physicians' recommendations and distribution of free samples, further research into how distribution of free samples affects medication choices in family practice is needed.

The pituitary glycoprotein hormones, luteinizing hormone (LH) and follicle-stimulating hormone (FSH), act through their cognate receptors to initiate a series of coordinated physiological events that result in germ cell maturation. Given the importance of FSH in regulating folliculogenesis and fertility, the development of FSH mimetics has been sought to treat infertility. Currently, purified or recombinant human FSH are the only FSH receptor (FSH-R) agonists available for infertility treatment. By screening unbiased combinatorial chemistry libraries, using a cAMP-responsive luciferase reporter assay, we discovered thiazolidinone agonists (EC50's = 20 micromolar) of the human FSH-R. Subsequent analog library screening and parallel synthesis optimization resulted in the identification of a potent agonist (EC50 = 2 nM) with full efficacy compared to FSH that was FSH-R selective and dependent. The compound mediated progesterone production in Y1 cells transfected with the human FSH-R (EC50 = 980 nM) and estradiol production from primary rat ovarian granulosa cells (EC50 = 10.5 nM). This and related compounds did not compete with FSH for binding to the FSH-R. Use of human FSH/TSH receptor chimeras suggested a novel mechanism for receptor activation through a binding site independent of the natural hormone binding site. This study is the first report of a high affinity small molecule agonist that activates a glycoprotein hormone receptor through an allosteric mechanism. The small molecule FSH receptor agonists described here could lead to an oral alternative to the current parenteral FSH treatments used clinically to induce ovarian stimulation for both in vivo and in vitro fertilization therapy.

Despite a rich phenomenology, gamma-ray bursts (GRBs) are divided into two classes based on their duration and spectral hardness--the long-soft and the short-hard bursts. The discovery of afterglow emission from long GRBs was a watershed event, pinpointing their origin to star-forming galaxies, and hence the death of massive stars, and indicating an energy release of about 10(51) erg. While theoretical arguments suggest that short GRBs are produced in the coalescence of binary compact objects (neutron stars or black holes), the progenitors, energetics and environments of these events remain elusive despite recent localizations. Here we report the discovery of the first radio afterglow from the short burst GRB 050724, which unambiguously associates it with an elliptical galaxy at a redshift z = 0.257. We show that the burst is powered by the same relativistic fireball mechanism as long GRBs, with the ejecta possibly collimated in jets, but that the total energy release is 10-1,000 times smaller. More importantly, the nature of the host galaxy demonstrates that short GRBs arise from an old (> 1 Gyr) stellar population, strengthening earlier suggestions and providing support for coalescing compact object binaries as the progenitors.

The final chapter in the long-standing mystery of the gamma-ray bursts (GRBs) centres on the origin of the short-hard class of bursts, which are suspected on theoretical grounds to result from the coalescence of neutron-star or black-hole binary systems. Numerous searches for the afterglows of short-hard bursts have been made, galvanized by the revolution in our understanding of long-duration GRBs that followed the discovery in 1997 of their broadband (X-ray, optical and radio) afterglow emission. Here we present the discovery of the X-ray afterglow of a short-hard burst, GRB 050709, whose accurate position allows us to associate it unambiguously with a star-forming galaxy at redshift z = 0.160, and whose optical lightcurve definitively excludes a supernova association. Together with results from three other recent short-hard bursts, this suggests that short-hard bursts release much less energy than the long-duration GRBs. Models requiring young stellar populations, such as magnetars and collapsars, are ruled out, while coalescing degenerate binaries remain the most promising progenitor candidates.