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The article offers information on the Canadian national pharmacare which is a public drug plan that is universal, comprehensive, evidence-based, and sustainable. The topics addressed include details on the options for raising the money in new tax revenue needed to implement national pharmacare comprising personal income taxes, corporate income taxes, the Goods and Services Tax (GST), and premiums.

Abstract: The Intermittent Upwelling Hypothesis (IUH) posits that subsidies of larvae and phytoplankton to intertidal communities should vary unimodally along a gradient of upwelling from persistent upwelling to persistent downwelling with most subsidies occurring where upwelling is of intermediate strength and intermittent. Furthermore, the hypothesis states that larvae and phytoplankton are transported far offshore by strong, persistent upwelling and fail to subsidize nearshore communities, whereas weak upwelling or downwelling reduces nutrients for phytoplankton production limiting food for larvae and nearshore communities. We review studies conducted at sea and onshore and reanalyze published data to test the IUH and evaluate alternative hypotheses. To test the hypothesis, we examine five predictions that must hold if the IUH is true. (1) Larvae should inhabit the surface Ekman layer where they are transported offshore during upwelling. Larvae of many intertidal taxa occur deeper in the water column where currents flow shoreward during upwelling. (2) Larvae of nearshore species should occur farther offshore during upwelling than during relaxation or downwelling. Larvae of many nearshore species remain within several kilometers of shore during both conditions. (3) Larval settlement in intertidal communities should be lower during upwelling than relaxation or downwelling. Daily larval settlement has not observed to be higher during relaxation or downwelling events; settlement has most often been seen to vary with the fortnightly tidal cycle likely due to onshore larval transport by internal tides. (4) Larval settlement and recruitment in intertidal communities should be lower in areas of strong, persistent upwelling than where upwelling is weaker and less persistent. Recruitment of mussels and barnacles to artificial and natural substrates did not vary with the strength of upwelling, but did vary inversely with two measures of desiccation potential, and directly with indicators of surf zone hydrodynamics; larval recruitment was higher where surf zones were more dissipative with rip currents. (5) Phytoplankton subsidies to nearshore communities should be highest where upwelling is moderate and intermittent. Like larval subsidies, phytoplankton subsidies varied spatially with surf zone hydrodynamics rather than upwelling. This reconsideration of the evidence for the IUH finds the hypothesis unsupported. [ABSTRACT FROM AUTHOR]

Surf zone hydrodynamics vary along shorelines potentially affecting the delivery of larvae and zooplankton subsidies to intertidal communities, and, hence, the intensity of postsettlement interactions, growth and reproduction of filter-feeding foundation species and planktivorous fishes. We investigated the ability of zooplankton assemblages to enter the wide surf zone of the rip-channeled, more dissipative beach at Sand City, California, and the narrow surf zone of the steep reflective beach at nearby Carmel River State Beach. Every day for a month, we surveyed zooplankton inside and outside the surf zone and concomitant larval settlement of the dominant invertebrate onshore at each site in this upwelling regime. At the more dissipative surf zone, all zooplankters were far more concentrated inside than outside the surf zone. Many taxa increased in the surf zone and the predominant invertebrate on beaches, Emerita analoga, settled abundantly when prevailing northwesterly winds relaxed and waves were small. At the reflective surf zone, concentrations of zooplankters of most taxa were far greater outside than inside the surf zone, and many taxa increased in the surf zone when waves were small. Twice as many taxa were positively correlated inside and outside the surf zone at the dissipative than the reflective surf zone, indicating that zooplankters were more freely exchanged although behavior also played a role. Thus, spatial and temporal variation in surf zone hydrodynamics may regulate subsidies of zooplankton food and larval recruits to nearshore communities with potential cascading effects on community dynamics and structure. [ABSTRACT FROM AUTHOR]

The article discusses the private-public drug insurance system implemented by Quebec. Topics explored include the improved medicine access of working-age Quebec residents, brief details about its development, structure, and challenges faced such as the opposition of insurance and pharmacy sectors, and the comparison of cost-related non-adherence to prescription medications in Quebec, Australia, and New Zealand.

Background: Advances in pharmaceuticals offer improved health outcomes for a wide range of illnesses, yet medicines are often inaccessible for many patients worldwide. One potential barrier to making medicines available to all is the cost of product registration, the fees for regulatory review and licensing for the sale of medicines beyond the cost of clinical trials, if needed. Methods and findings: We performed a cross-sectional analysis of pharmaceutical registration fees in low-, middle-, and high-income countries. We collected data on market authorization fees for new chemical entities and for generic drugs in 95 countries. We calculated measures of registration fee size relative to population, gross domestic product (GDP), and total health spending in each country. Each of the 95 countries had a fee for registering new chemical entities. On average, the ratio of registration fees to GDP was highest in Europe and North America and lowest in South and Central America. Across individual countries, the level of registration fees was positively correlated with GDP and total health spending, with relatively few outliers. Discussion: We find that, generally speaking, the regulatory fees charged by medicines regulatory authorities are roughly proportional to the market size in their jurisdictions. The data therefore do not support the hypothesis that regulatory fees are a barrier to market entry in most countries. [ABSTRACT FROM AUTHOR]

Larvae in the coastal ocean are transported toward shore by a variety of mechanisms. Crossing the surf zone is the last step in a shoreward migration and surf zones may act as semipermeable barriers altering delivery of larvae to the shore. We related variation in the structure of intertidal barnacle populations to surf zone width (surf zone hydrodynamics proxy), wave height, alongshore wind stress (upwelling proxy), solar radiation, and latitude at 40 rocky intertidal sites from San Diego, California to the Olympic Peninsula, Washington. We measured daily settlement and weekly recruitment of barnacles at selected sites and related these measures to surf zone width. Chthamalus density varied inversely with that of Balanus, and the density of Balanus and new recruits was negatively related to solar radiation. Across the region, long-term mean wave height and an indicator of upwelling intensity and frequency did not explain variation in Balanus or new recruit densities. Balanus and new recruit densities, daily settlement, and weekly recruitment were up to three orders of magnitude higher at sites with wide (>50 m), more dissipative surf zones with bathymetric rip currents than at sites with narrow (<50 m) more reflective surf zones. Surf zone width explained 30-50% of the variability in Balanus and new recruit densities. We sampled a subset of sites <5 km apart where coastal hydrodynamics such as upwelling should be very similar. At paired sites with similar surf zone widths, Balanus densities were not different. If surf zone widths at paired sites were dissimilar, Balanus densities, daily settlement, and weekly recruitment were significantly higher at sites with the wider, more dissipative surf zone. The primary drivers of surf zone hydrodynamics are the wave climate and the slope of the shore and these persist over time; therefore site-specific stability in surf zone hydrodynamics should result in stable barnacle population characteristics. Variations in surf zone hydrodynamics appear to play a fundamental role in regulating barnacle populations along the open coast, which, in turn, may have consequences for the entire intertidal community. [ABSTRACT FROM AUTHOR]

Background: Managing expenditures on pharmaceuticals is important for health systems to sustain universal access to necessary medicines. We sought to estimate the size and sources of differences in expenditures on primary care medications among high-income countries with universal health care systems.Methods: We compared data on the 2015 volume and cost per day of primary care prescription drug therapies purchased in 10 high-income countries with various systems of universal health care coverage (7 from Europe, in addition to Australia, Canada and New Zealand). We measured total per capita expenditure on 6 categories of primary care prescription drugs: hypertension treatments, pain medications, lipid-lowering medicines, noninsulin diabetes treatments, gastrointestinal preparations and antidepressants. We quantified the contributions of 5 drivers of the observed differences in per capita expenditures.Results: Across countries, the average annual per capita expenditure on the primary care medicines studied varied by more than 600%: from $23 in New Zealand to $171 in Switzerland. The volume of therapies purchased varied by 41%: from 198 days per capita in Norway to 279 days per capita in Germany. Most of the differences in average expenditures per capita were driven by a combination of differences in the average mix of drugs selected within therapeutic categories and differences in the prices paid for medicines prescribed.Interpretation: Significant international differences in average expenditures on primary care medications are driven primarily by factors that contribute to the average daily cost of therapy, rather than differences in the volume of therapy used. Average expenditures were lower among single-payer financing systems that appeared to promote lower prices and the selection of lower-cost treatment options. [ABSTRACT FROM AUTHOR]

Recent mass mortalities of two predatory sea star species provided an unprecedented opportunity to test the effect of predators on rocky intertidal prey. Mass mortalities provide insight that manipulative experiments cannot because they alter ecosystems on a larger scale, for longer time periods, and remove both organisms and their cues from the environment. We examined shifts in population size structure, vertical zonation, and use of emersed refuge habitats outside tidepools by the abundant herbivorous black turban snail Tegula funebralis, both before and after the successive mortalities of two predatory sea stars. The small cryptic predator Leptasterias spp. suffered a localized but extreme mortality event in November 2010, followed by two mass mortalities of the keystone predator Pisaster ochraceus in August 2011 and autumn 2013. After the local extinction of Leptasterias, the population size of Tegula more than doubled. Also, since Leptasterias primarily inhabited only mid to low intertidal tidepools at this site, small and medium sized snails (which are preferred by Leptasterias) shifted lower in the intertidal and into tidepools after the mortality of Leptasterias. After the mortality of Pisaster in August 2011, large snails did not shift lower in the intertidal zone despite being preferred by Pisaster. Small and medium sized snails became denser in the higher zone and outside tidepools, which was not likely due to Pisaster mortality. Previous studies concluded that Pisaster maintained vertical size gradients of snails, but our data implicate the overlooked predator Leptasterias as the primary cause. This natural experiment indicated that (1) predators exert top-down control over prey population sizes and lower limits, (2) vertical zonation of prey are dynamic and controlled in part by prey behavior, and (3) predators exert the strongest effects on more vulnerable individuals, which typically inhabit stressful habitats higher on the shore or outside tidepools to avoid predation. Because the mass mortalities of two predators drastically reduced both the predation pressure and the chemical cues of predators in the environment, we were able to investigate both the effects of predators on prey populations and the effects on mobile prey behavior. [ABSTRACT FROM AUTHOR]

Nearly all of our understanding of rocky inter-tidal ecology comes from studies conducted at low tide. To study inter-tidal organisms at high tide, we anchored waterproof digital GoPro® video cameras in wave-exposed tidepools and recorded the daytime movements of the black turban snail, Tegula funebralis, over the tidal cycle between May and August 2012 near Bodega Bay, California. Overall, snails moved more quickly and presumably foraged more during low tides and on days with warmer air and perhaps water temperatures. This is similar to other ectotherms that exhibit increased metabolic rates, movement and foraging in warmer conditions. Snails also moved less during flood and high tides, may have moved downward in tidepools at flood tides, and showed evidence of reduced activity on days with larger waves. This inactivity and refuge seeking may have been a strategy to avoid dislodgment by waves. Analysis of snail trajectories showed foraging bouts indicated by alternating zig-zagging and straight movement. There was no effect of temperature, wave height, or tidal phase on distribution of snail turning angles, suggesting that they may have foraged consistently but moved faster during warm conditions and low tides, thereby grazing a larger area. This is one of few direct recordings of inter-tidal organisms on wave-exposed rocky shores during high tide. The methods used here are easily transferable to other studies, which are needed to increase our understanding of behaviors that structure rocky shore communities during high tide. [ABSTRACT FROM AUTHOR]

Background: Canada's universal health care system does not include universal coverage of prescription drugs. We sought to estimate the effects of adding universal public coverage of an essential medicines list to existing public drug plans in Canada.Methods: We used administrative and market research data to estimate the 2015 shares of the volume and cost of prescriptions filled in the community setting that were for 117 drugs on a model list of essential medicines for Canada. We compared prices of these essential medicines in Canada with prices in the United States, Sweden and New Zealand. We estimated the cost of adding universal public drug coverage of these essential medicines based on anticipated effects on medication use and pricing.Results: The 117 essential medicines on the model list accounted for 44% of all prescriptions and 30% of total prescription drug expenditures in 2015. Average prices of generic essential medicines were 47% lower in the US, 60% lower in Sweden and 84% lower in New Zealand; brand-name drugs were priced 43% lower in the US. Estimated savings from universal public coverage of these essential medicines was $4.27 billion per year (range $2.72 billion to $5.83 billion; 28% reduction) for patients and private drug plan sponsors, at an incremental government cost of $1.23 billion per year (range $373 million to $1.98 billion; 11% reduction).Interpretation: Our analysis showed that adding universal public coverage of essential medicines to the existing public drug plans in Canada could address most of Canadians' pharmaceutical needs and save billions of dollars annually. Doing so may be a pragmatic step forward while more comprehensive pharmacare reforms are planned. [ABSTRACT FROM AUTHOR]

Larvae of intertidal species develop at sea and must return to adult habitats to replenish populations. Similarly, nutrients, detritus and plankton provide important subsidies spurring growth and reproduction of macroalgae and filter-feeding invertebrates that form the foundation of intertidal communities. Together, these factors determine the density and intensity of interactions among community members. We hypothesized that spatial variation in surfzone hydrodynamics affects the delivery of plankton subsidies. We compared entire zooplankton communities inside and outside the surf zone daily while monitoring physical conditions for one month each at two shores with different surfzone characteristics. Opposite cross-shore distributions of larvae and other zooplankters occurred at the two sites: zooplankton was much more abundant inside the mildly sloping dissipative surf zone (DSZ) with rip currents and was more abundant outside the steep reflective surf zone (RSZ). Biophysical numerical simulations demonstrated that zooplankters were concentrated in rip channels of the DSZ and were mostly unable to enter the RSZ, indicating the hydrodynamic processes behind the observed spatial variation of zooplankters in the surf zone. Differences in the concentration of larvae and other zooplankters between the inner shelf and surf zone may be an underappreciated, key determinant of spatial variation in inshore communities. [ABSTRACT FROM AUTHOR]

Several studies on trait-mediated indirect interactions ( TMIIs) have shown that predators can initiate trophic cascades by altering prey behaviour. Although it is well recognized that individual prey state alters antipredator and foraging behaviour, few studies explore whether this state-dependent prey behaviour can alter the strength of the ensuing tritrophic cascade. Here, we link state-dependent individual behaviour to community processes by experimentally testing whether hunger level and body size of prey altered antipredator behaviour and thus changed the strength of trophic cascades between predators and primary producers., In rocky intertidal tide pools on the California Coast, waterborne cues from the predatory seastar Leptasterias spp. (Stimpson) can cause the herbivorous snail Tegula (Chlorostoma) funebralis (A. Adams) to reduce grazing and flee tide pools, resulting in positive indirect effects on tide pool microalgae., However, we show that the strength of this behaviourally-mediated cascade may be contingent on prey hunger level and body size. During short field experiments at low tide, medium-sized snails that were either newly collected from the field or fed for 1 week in the laboratory mediated strong TMIIs because they grazed less when seastars were present. In contrast, no TMIIs occurred when medium-sized snails had been starved for 1 week because they continued grazing regardless of seastar presence. Newly collected small snails fled from seastars but did not mediate cascades because they ate little algae. Despite reaching an apparent size refuge from predation, many newly collected large snails fled from seastars, but those individuals that remained tended to graze the algae more quickly, resulting in unexpected negative indirect effects of seastars on algae cover. The implication of this pattern for the natural system is unclear., Because average hunger level and size of snails vary over time and space in nature, a mosaic of TMII strength may exist., Overall, the strength of tritrophic TMIIs in tide pools depended on individual prey state, supporting model predictions and adding to sparse empirical evidence. This outcome suggests that patterns occurring system-wide over the long term may be influenced by the state-dependent decisions made by the individuals present. [ABSTRACT FROM AUTHOR]

Objectives: to measure sex differences in the risk of receiving potentially inappropriate prescription drugs and to examine what are the factors that contribute to these differences. Design: a retrospective cohort study. Setting: community setting of British Columbia, Canada. Participants: residents of British Columbia aged 65 and older (n = 660,679). Measurements: we measured 2013 period prevalence of prescription dispensations satisfying the American Geriatrics Society's 2012 version of the Beers Criteria for potentially inappropriate medication use in older adults. We used logistic regressions to test for associations between this outcome and a number of clinical and socioeconomic factors. Results: a larger share of women (31%) than of men (26%) filled one or more potentially inappropriate prescription in the community. The odds of receiving potentially inappropriate prescriptions are associated with several clinical and socioeconomic factors. After controlling for those factors, community-dwelling women were at 16% higher odds of receiving a potentially inappropriate prescription than men (adjusted odds ratio = 1.16, 95% confidence interval = 1.12-1.21). Much of this sex difference stemmed from women's increased odds of receiving potentially inappropriate prescriptions for benzodiazepines and other hypnotics, for tertiary tricyclic antidepressants and for non-selective NSAIDs. Conclusion: there are significant sex differences in older adults' risk of receiving a potentially inappropriate prescription as a result of complex intersections between gender and other social constructs. Appropriate responses will therefore require changes in the information, norms and expectations of both prescribers and patients. [ABSTRACT FROM AUTHOR]

Background: Many medications pose greater health risks when prescribed for older adults, compared with available pharmacologic and nonpharmacologic alternatives. We sought to quantify the frequency and cost of potentially inappropriate prescribing for older women and men in Canada. Methods: Using data for 2013 from the National Prescription Drug Utilization Information System database, which contains prescription claims from publicly financed drug plans in all provinces except for Quebec, we identified the frequency of prescribing and cost of potentially inappropriate medications dispensed to provincial drug plan enrollees aged 65 years or more. Potentially inappropriate prescriptions were defined with the use of the American Geriatrics Society's 2012 version of the Beers Criteria for potentially inappropriate medication use in older adults. Results: For the 6 provinces with relatively complete data coverage (British Columbia, Alberta, Saskatchewan, Manitoba, Ontario and Prince Edward Island), 37% of older people filled 1 or more prescription meeting the Beers Criteria. A higher proportion of women (42%) than men (31%) filled potentially inappropriate prescriptions. The highest rates of prescribing of potentially inappropriate medications were among women aged 85 or more (47%). Benzodiazepines and other hypnotics were the leading contributors to the overall frequency of and sex differences in prescribing of potentially inappropriate drugs among older adults. We estimated that $75 per older Canadian, or $419 million in total, was spent on potentially inappropriate medications outside of hospital settings in 2013. Interpretation: Prescribing of potentially inappropriate medications for older adults is common and costly in Canada, especially for women. Multipronged and well-coordinated strategies to reduce the use and cost of potentially inappropriate drugs would likely generate significant health system savings while simultaneously generating major benefits to patient health. [ABSTRACT FROM AUTHOR]

Most harmful algal blooms (HAB) originate away from the shore and, for them to endanger human health, they must be first transported to shore after which they must enter the surf zone where they can be feed upon by filter feeders. The last step in this sequence, entrance into the surf zone, depends on surf zone hydrodynamics. During two 30-day periods, we sampled Pseudo-nitzschia and particulate domoic acid (pDA) in and offshore of a more dissipative surf zone at Sand City, California (2010) and sampled Pseudo-nitzschia in and out of reflective surf zones at a beach and rocky shores at Carmel River State Beach, California (2011). At Sand City, we measured domoic acid in sand crabs, Emerita analoga . In the more dissipative surf zone, concentrations of Pseudo-nitzschia and pDA were an order of magnitude higher in samples from a rip current than in samples collected just seaward of the surf zone and were 1000 times more abundant than in samples from the shoals separating rip currents. Domoic acid was present in all the Emerita samples and varied directly with the concentration of pDA and Pseudo-nitzschia in the rip current. In the more reflective surf zones, Pseudo-nitzschia concentrations were 1–2 orders of magnitude lower than in samples from 125 and 20 m from shore. Surf zone hydrodynamics affects the ingress of Pseudo-nitzschia into surf zones and the exposure of intertidal organisms to HABs on the inner shelf. [ABSTRACT FROM AUTHOR]

Background: Domperidone is commonly used off-label to stimulate milk production in mothers who have low milk supply. The aim of this study was to describe trends, patterns and determinants of postpartum domperidone use. Methods: This is a retrospective, population-based study involving all women with a live birth between Jan. 1, 2002, and Dec. 31, 2011, in the province of British Columbia. We examined administrative data sets containing person-specific information on filled prescriptions and use of medical services, and we used logistic regression to examine associations between domperidone use and maternal characteristics. Results: The study population consisted of 225 532 women with 320 351 live births. The prevalence of postpartum domperidone use more than doubled between 2002 and 2011. In 2011, 1 in 3 women with a preterm birth and 1 in 5 women with a full-term birth were prescribed domperidone in the first 6 months postpartum. Women who were older, had a higher body mass index, had a chronic disease, were first-time mothers, delivered more than 1 baby (multiple pregnancy), had a preterm birth or had a cesarian delivery were more likely to fill a postpartum domperidone prescription. Interpretation: We found an increase in postpartum domperidone use over a 10-year period. More research is needed on maternal and infant health outcomes. [ABSTRACT FROM AUTHOR]

Larvae of benthic marine organisms are released amid high densities of suspension feeding and predatory adults and are highly subject to being consumed, even by conspecifics or their own parent. During laboratory feeding trials conducted in June 2006, female shore crabs ( Hemigrapsus oregonensis) from Stege Marsh in San Francisco Bay (37°54.530′ N, 122°19.734′ W) that released their larvae during the previous 24 h ate fewer conspecific larvae than females that had not recently released larvae, though the behavior was not repeated during similar trials in 2007. Additionally, the number of larvae eaten increased with increasing starvation time, and hungrier females showed a trend toward eating more larvae from a different species ( Carcinus maenas) than larvae of conspecifics. Thus, suppression of suspension feeding may reduce conspecific predation of newly released larvae, but this response partially depends on hunger level. This is the first time crabs have been shown to suppress feeding to reduce cannibalism of larvae, and this behavior could affect reproductive success and population dynamics. [ABSTRACT FROM AUTHOR]

Background: With the exception of Canada, all countries with universal health insurance systems provide universal coverage of prescription drugs. Progress toward universal public drug coverage in Canada has been slow, in part because of concerns about the potential costs. We sought to estimate the cost of implementing universal public coverage of prescription drugs in Canada. Methods: We used published data on prescribing patterns and costs by drug type, as well as source of funding (i.e., private drug plans, public drug plans and out-of-pocket expenses), in each province to estimate the cost of universal public coverage of prescription drugs from the perspectives of government, private payers and society as a whole. We estimated the cost of universal public drug coverage based on its anticipated effects on the volume of prescriptions filled, products selected and prices paid. We selected these parameters based on current policies and practices seen either in a Canadian province or in an international comparator. Results: Universal public drug coverage would reduce total spending on prescription drugs in Canada by $7.3 billion (worst-case scenario $4.2 billion, best-case scenario $9.4 billion). The private sector would save $8.2 billion (worst-case scenario $6.6 billion, best-case scenario $9.6 billion), whereas costs to government would increase by about $1.0 billion (worst-case scenario $5.4 billion net increase, best-case scenario $2.9 billion net savings). Most of the projected increase in government costs would arise from a small number of drug classes. Interpretation: The long-term barrier to the implementation of universal pharmacare owing to its perceived costs appears to be unjustified. Universal public drug coverage would likely yield substantial savings to the private sector with comparatively little increase in costs to government. [ABSTRACT FROM AUTHOR]

Fundamental knowledge of mortality during the planktonic phase of the typical marine life cycle is essential to understanding population dynamics and managing marine resources. However, estimating larval mortality is extremely challenging, because the fate of microscopic larvae cannot be tracked as they develop for weeks in ocean currents. We used a two-pronged approach to provide reliable estimates of larval mortality: (1) frequent, long-term sampling where the combination of larval behaviors and recirculation greatly reduces larval transport to and from the study area, and (2) an improved method of calculating larval mortality that consists of a vertical life table with a negative binomial distribution to account for the notorious patchiness of plankton. Larval mortality rates of our study species (barnacles and crabs) were ≤0.14 larvae/d, which produce survivorships over an order of magnitude higher than commonly determined for marine larvae. These estimates are reliable because they were similar for species with similar dispersal patterns. They are conservative because they were conducted in a highly advective upwelling system, and they may be even lower in other systems using our approach. Until other systems can be tested, our improved estimates should be used to inform future models of population dynamics and the evolution of life histories in the sea. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined the print media framing of the issue of prescription drug financing in Canada in 1990-2010. Topics discussed include the universal comprehensive public health insurance offered in the country, the role played by policy elites in media coverage of health reforms and the proposed expansions to public coverage of health issues. Also mentioned are the implications of media framing for the motivation for reform among politicians.

Abstract: The timing of vertical migrations by newly-hatched larvae determines the extent of transport away from adult populations and exposure to predatory fishes, but it is largely unknown whether larval swimming behavior is a fixed trait or changes adaptively in response to different ocean conditions that are encountered between habitats. We determined whether larvae of the shore crab, Pachygrapsus crassipes, hatched in the San Francisco Estuary and those hatched nearby on the outer coast undertake tidal and diel vertical migrations. Vertical swimming of larvae that were released by females collected from the two locations were recorded in the laboratory for up to four days in constant darkness without a tidal cycle to detect the presence of endogenous tidal and diel vertical migrations. P. crassipes larvae from the outer coast population did not exhibit rhythmic vertical migrations, remaining near the surface throughout the day, whereas larvae from the estuarine population did undertake complex vertical migrations relative to tidal and diel cycles. Although current patterns differ on the open coast and in the estuary, remaining in surface waters at both locations would favor seaward transport of larvae to offshore nursery areas. However, undertaking tidal vertical migrations in estuaries would expedite seaward transport while increasing the risk of fish predation during the daytime. The differences in behaviors are likely phenotypic, because larvae came from neighboring populations and intermingle in offshore larval nursery areas. This spatial variation in larval swimming behavior among habitats enhances transport to offshore nursery areas. [Copyright &y& Elsevier]

Background: Confidential product listing agreements (PLAs) negotiated between pharmaceutical manufacturers and individual health care payers may contribute to unwanted price disparities, high administrative costs, and unequal bargaining power within and across jurisdictions. In the context of Canada's decentralized health system, we aimed to document provincial policy makers' perceptions about collaborative PLA negotiations. Methods: We conducted semi-structured telephone interviews with a senior policy maker from nine of the ten Canadian provinces. We conducted a thematic analysis of interview transcripts to identify benefits, drawbacks, and barriers to routine collaboration on PLA negotiations. Results: Canadian policy makers expressed support for joint negotiations of PLAs in principle, citing benefits of increased bargaining power and reduced inter-jurisdictional inequities in drug prices and formulary listings. However, established policy institutions and the politics of individual jurisdictional authority are formidable barriers to routine PLA collaboration. Achieving commitment to a joint process may be difficult to sustain among heterogeneous and autonomous partners. Conclusions: Though collaboration on PLA negotiation is an extension of collaboration on health technology assessment, it is a very significant next step that requires harmonization of the outcomes of decision-making processes. Views of policy makers in Canada suggest that sustaining routine collaborations on PLA negotiations may be difficult unless participating jurisdictions have similar policy institutions, capacities to implement coverage decisions, and local political priorities. [ABSTRACT FROM AUTHOR]

Background: Increasing attention is being paid to variations in the use of prescription drugs because their role in health care has grown to the point where their use can be considered a proxy for health system performance. Studies have shown that prescription drug use varies across regions in the US, UK, and Canada by more than would be predicted based on age and health status alone. In this paper, we explore the determinants of variations in the use of prescription drugs, drawing on health services theories of access to care. Methods: We conducted a cross-sectional analysis using population-based administrative health care data for British Columbia (BC), Canada. We used logistic and hierarchical regressions to analyze the effects of individual- and area-level determinants of use of prescriptions overall and rates of purchase of prescriptions from five therapeutic categories representing a range of indications: antihypertensives, statins, acid reducing drugs, opioid drugs, and antidepressants. To indicate the relative scale of regional variations and the importance of individual- and area-level variables in explaining them, we computed standardized rates of utilization for 49 local health areas in BC. Results: We found that characteristics of individuals and the areas in which they live affect likelihood of prescription drug purchase. Individual-level factors influenced prescription drug purchases in ways generally consistent with behavioral models of health services use. Contextual variables exerted influences that differed by type of drug studied. Population health, education levels, and ethnic composition of local areas were associated with significant differences in the likelihood of purchasing medications. Relatively modest regional variations remained after both individual-level and area-level determinants were taken into account. Conclusions: The results of this study suggest that individual- and area-level factors should be considered when studying variations in the use of prescription drugs. Some sources of such variations, including individual- and area-level socioeconomic status, warrant further investigation and possible intervention to address inequities. [ABSTRACT FROM AUTHOR]

Abstract: Larvae of intertidal species develop in the coastal ocean, and the last body of water they must cross while migrating back to shore is the surf zone. We hypothesized that the surf zone is a semipermeable barrier to this shoreward migration and that differences in water exchange across the surf zone result in temporal and spatial variation in larval delivery to the shore. We tested the hypotheses that larval delivery 1) should increase with larger waves and 2) should be higher on more dissipative beaches than on more reflective beaches. We found a significant positive correlation between the daily averaged ratio of wave height to wave period (H/T) and daily cyprid settlement at Dike Rock, California and Bastendorff Beach, Oregon, USA. We tested the second hypothesis by comparing populations of barnacles, limpets, and benthic algae on rocks on four more dissipative and six more reflective sandy beaches in northern California and southern Oregon. Newly recruited barnacles and limpets were significantly more abundant at more dissipative than reflective beaches, and the higher abundance was most likely due to differences in settlement rather than post-settlement mortality. The density and percent cover of barnacles and the density of limpets were significantly higher at more dissipative beaches. In contrast, the density and percent cover of algae were significantly higher at more reflective beaches. The results are consistent with the hypothesis that the surf zone is a semipermeable barrier to the shoreward migration of larvae and that differences in water exchange across the surf zone as function of the beach hydrodynamics result in temporal and spatial variation in larval delivery to the shore. [ABSTRACT FROM AUTHOR]

Background: Granting dispensing pharmacists the authority to prescribe has significant implications for pharmaceutical and health human resources policy, and quality of care. Despite the growing number of jurisdictions that have given pharmacists such privileges, there are few rigorous evaluations of these policy changes. This study will examine a January 2009 policy change in British Columbia (BC), Canada that allowed pharmacists to independently adapt and renew prescriptions. We hypothesize this policy increased drug utilization and drug costs, increased patient adherence to medication, and reduced total healthcare resource use. Methods/Design: We will study a population-based cohort of approximately 4 million BC residents from 2004 through 2010. We will use data from BC PharmaNet on all of the prescriptions obtained by this cohort during the study period, and link it to administrative billings from physicians and hospital discharges. Using interrupted time series analysis, we will study longitudinal changes in drug utilization and costs, medication adherence, and shortterm health care use. Further, using hierarchical modelling, we will examine the factors at the regional, pharmacy, patient, and prescription levels that are associated with prescription adaptations and renewals. Discussion: In a recent survey of Canadian policymakers, many respondents ranked the issue of prescribing privileges as one of their most pressing policy questions. No matter the results of our study, they will be important for policymakers, as our data will make policy decisions surrounding pharmacist prescribing more evidence-based. [ABSTRACT FROM AUTHOR]

The ability of miniscule larvae to control their fate and replenish populations in dynamic marine environments has been a long-running topic of debate of central importance for managing resources and understanding the ecology and evolution of life in the sea. Larvae are considered to be highly susceptible to offshore transport in productive upwelling regions, thereby increasing dispersal, limiting onshore recruitment, and reducing the intensity of community interactions. We show that 45 species of nearshore crustaceans were not transported far offshore in a recruitment-limited region characterized by strong upwelling. To the contrary, 92% of these larvae remained within 6 km from shore in high densities throughout development along two transects sampled four times during the peak upwelling season. Larvae of most species remained nearshore by remaining below a shallow Ekman layer of seaward-flowing surface waters throughout development. Larvae of other species migrated farther offshore by occurring closer to the surface early in development. Postlarvae evidently returned to nearshore adult habitats either by descending to shoreward-flowing upwelled waters or rising to the sea surface where they can be transported shoreward by wind relaxation events or internal waves. Thus wind-driven offshore transport should not limit recruitment, even in strong upwelling regions, and larvae are more likely to recruit closer to natal populations than is widely believed. This study poses a new challenge to determine the true cause and extent of recruitment limitation for a more diverse array of species along upwelling coasts, and thus to further advance our understanding of the connectivity, dynamics, and structure of coastal populations. [ABSTRACT FROM AUTHOR]

The ability of microscopic larvae to control their fate and replenish populations in dynamic marine environments has been a long-running topic of debate of central importance to understanding the ecology and evolution of life in the sea and managing resources in a changing global environment. After decades of research documenting behaviors that keep larvae close to natal populations, it is becoming apparent that larval behaviors in a broader spectrum of species promote long-distance migrations to offshore nursery grounds. Larvae must exert considerable control over their movements. We now show that larval emigration from estuaries is favored even over minimizing visibility to predators. An endogenous tidal vertical migration that would expedite seaward migration of Uca pugilator larvae was maintained experimentally across two tidal regimes. The periodicity of the rhythm doubled to match the local tidal regime, but larvae ascended to the surface during the daytime rather than at night. This process would conserve larval emigration but increase the visibility to predators across part of the species range. The periodicity of tidal vertical migration by Sesarma cinereum larvae failed to double and was inappropriately timed relative to both environmental cycles in the absence of a diel cycle. The timing system regulating tidally timed behaviors in these two species of crabs evidently differed. Phenotypic plasticity can conserve larval transport of both species when tidal and diel cycles are present. It may be widespread in the sea where diverse habitats are encountered across extensive species ranges. [ABSTRACT FROM AUTHOR]

Chemical fingerprinting techniques recently have been used to track larval dispersal of estuarine species that bear calcified structures, but the applicability of this important approach may be limited on the open coast where chemical signatures may be less distinctive and for the many species that do not retain calcified structures throughout development. Externally brooded embryos of the porcelain crab, Petrolisthes cinctipes, and inductively coupled plasma mass spectrometry were used to determine whether fine-scale variation in trace-elemental composition occurred along an open coast. Embryos were collected from 16 sites from 37.8° to 39.5° north latitude along the Pacific Coast of California, USA during late January and early February 2003. Discriminant function analysis revealed that collection sites, many separated by only a few kilometers along an open coast, could be differentiated with an overall accuracy of 73%, and combining the sites into three regions increased the accuracy to 88%. Thus, distinctive elemental signatures can be detected in open coast species even at a fine scale raising the possibility that larval tags can be developed for many more species than previously thought possible. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The purpose of this research was to measure prevalent and incident statin use in the population of British Columbia from 1996 to 2004 across specific patient characteristics (sociodemographic and clinical). Methods: Statin utilization and demographic data were assessed with the use of prescription drug claims. Medical and hospital claims for statin users were examined for evidence of ischemic heart disease (IHD), diabetes mellitus (DM), atherosclerosis, cerebrovascular disease, peripheral vascular disease (PVD), and disorders of lipid metabolism during the 3 years before the first statin prescription. Results: Statin prevalence increased from 1996 to 2004 (1.28 %-6.59%). The greatest use was among those aged 65 to 84 years. Prevalent use of atorvastatin, simvastatin, and rosuvastatin increased over time. There were 211,964 new statin users between 1999 and 2004. Quarterly incident statin use increased over time from 1999 to 2004 (0.29%-0.49%). A socioeconomic gradient, whereby use was greater in those with low socioeconomic status, was observed for incident statin use. Incident atorvastatin use increased over time; simvastatin, cerivastatin, and rosuvastatin peaked and then declined; and new use of other statins decreased. Among 211,964 incident statin users, 74,542 (35.17%) had evidence of IHD only; 43,257 (20.41%) had DM but no IHD; 9781 (4.61%) had no DM or IHD but had atherosclerosis, cerebrovascular disease, or PVD; 47,634 (22.47%) had disorders of lipid metabolism only; and 36,750 (17.34%) had none of the medical conditions evaluated. Conclusions: Prevalent use (1996-2004) and incident use (1999-2004) of statins in an entire population have increased dramatically. Although many statin users (60.19%) had evidence of medical conditions that indicate appropriate statin use, 39.91% of users were at low risk for cardiovascular disease, and therefore the benefit of statins in this group remains small. [Copyright &y& Elsevier]

Objective. To provide detailed demographic profiles of prescription drug utilization and expenditures in order to isolate the impact of demographic change from other factors that affect drug expenditure trends. Data Sources/Study Setting. Demographic information and drug utilization data were extracted for virtually the entire British Columbia (BC) population of 1996 and 2002. All residents had public medical and hospital insurance; however their drug coverage resembled the mix of private and public insurance in the United States. Study Design. A series of research variables were constructed to illustrate profiles of drug expenditures and drug utilization across 96 age/sex strata. Data Collection/Extraction Methods. Drug use and expenditure information was extracted from the BC PharmaNet, a computer network connecting all pharmacies in the province. Principal Findings. Per capita drug expenditures increased at an average annual rate of 10.8 percent between 1996 and 2002. Population aging explained 1.0 points of this annual rate of expenditure growth; the balance was attributable to rising age/sex-specific drug expenditures. Conclusions. Relatively little of the observed increase in drug expenditures in BC could be attributed to demographic change. Most of the expenditure increase stemmed from the age/sex-specific quantity and type of drugs purchased. The sustainability of drug spending therefore depends not on outside forces but on decisions made by policy makers, prescribers, and patients. [ABSTRACT FROM AUTHOR]

Many countries have centralized the clinical and economic assessments necessary for evidence-based drug coverage policy. We analyze such processes in Australia, Canada, New Zealand, and the United Kingdom. These countries apply comparable approaches to the assessment and appraisal of evidence but apply the processes to different types of drugs and use the reviews within different decision-making contexts. Review processes applied to all medicines and clearly tied to coverage decisions appear to influence national drug use. Rigor of process and transparency of data and rationale are believed to be important for maximizing the impact and political acceptability of the processes. [ABSTRACT FROM AUTHOR]

Discusses issues related to the extension of prescription drug coverage for senior citizens in Canada. Drug coverage for nonseniors; Policies to control prices; Policies to manage utilization.

Objective: To quantify the relative and absolute importance of different factors contributing to increases in per capita prescription drug costs for a population of Canadian seniors.Data Sources/study Setting: Data consist of every prescription claim from 1985 to 1999 for the British Columbia Pharmacare Plan A, a tax-financed public drug plan covering all community-dwelling British Columbians aged 65 and older.Study Design: Changes in per capita prescription drug expenditures are attributed to changes to four components of expenditure inflation: (1) the pattern of exposure to drugs across therapeutic categories; (2) the mix of drugs used within therapeutic categories; (3) the rate of generic drug product selection; and (4) the prices of unchanged products.Data Collection/extraction Methods: Data were extracted from administrative claims files housed at the UBC Centre for Health Services and Policy Research.Principal Findings: Changes in drug prices, the pattern of exposure to drugs across therapeutic categories, and the mix of drugs used within therapeutic categories all caused spending per capita to increase. Incentives for generic substitution and therapeutic reference pricing policies temporarily slowed the cost-increasing influence of changes in product selection by encouraging the use of generic drug products and/or cost-effective brand-name products within therapeutic categories.Conclusions: The results suggest that drug plans (and patients) would benefit from more concerted efforts to evaluate the relative cost-effectiveness of competing products within therapeutic categories of drugs. [ABSTRACT FROM AUTHOR]

Presents study to determine and compare hatching times of ten species of intertidal crabs. Largest-amplitude nocturnal high tides of lunar months as safest time for crabs to release larvae; Reproduction synchronized by predation on all three life stages of crabs; Variation of timing of larval release with vulnerability of larvae to planktivorous fishes.

Studies plasticity in reproductive timing to identify proximate and ultimate causes of the timing of larval release by intertidal brachyuran crabs. Determination of timing of larval release by the same or sibling species of crabs that live in semidiurnal and mixed semidiurnal tidal environments; Diversity of reproductive patterns; Isolation of proximate factors.

The effect of planktivory on life history patterns of estuarine crabs was studied by determining preferences of common estuarine fishes for crab larvae in the laboratory and the upper Newport River estuary, North Carolina. Plankton samples (68) and fishes were collected from an upstream and downstream site, on spring and neap low tides, and during the day and night. Over 99.6% of the plankters collected were decapod larvae, copepods, barnacle nauplii, and cyprids. Predominant fishes in the upper estuary were silversides, Menidia menidia, anchovies, Anchoa mitchelli, and killifish, Fundulus heteroclitus, as is typical for other estuaries on the east coast of the United States. Gut contents of 1861 fishes 15-100 mm long were analyzed. Silversides and anchovies preyed upon crab larvae more often than did killifish, and are most likely to influence the life history patterns of crabs inhabiting upper estuaries. Fishes that eat crab larvae are more abundant in estuaries than coastal waters during summer. Fishes in the estuary and the laboratory showed strikingly similar preferences for prey. In order to descending preference, natural populations of fishes preferred copepods, crab larvae that are exported from estuaries (Uca, Sesarma cinereum), and decapod larvae that develop in estuaries (Sesarma reticulatum, Palaemonetes, Rhithropanopeus harrisii). In the laboratory, juvenile and adult silversides and killifish preferred Artemia nauplii to crab larvae, they fed randomly on Uca larvae, and they avoided R. harrissii larvae. These planktivores preferred zoeae that are exported to coastal waters over those that are retained because exported larvae are smaller and have shorter spines. While the large size and spines of retained larvae protect them from their predators in estuaries, vulnerable zoeae may emigrate from estuaries to coastal waters because the rate of encounter with predators offshore is less than in estuaries. The risk of predation also appears to vary spatially and temporally within the estuary. Predation generally was greatest upstream in shallow, narrow areas of the upper estuary on diurnal neap tides. The spatial gradient in predation apparently was due largely to the great abundance of fishes, and particularly small zooplanktivorous fishes, occurring upstream. In contrast, temporal patterns of planktivory were not due to differences in fish size and abundance, but to diurnal foraging of fishes and changes in the availability of prey. Resident zooplankters generally were preyed upon more during neap tides, perhaps because they remained nearer to the substrate on spring tides to prevent being swept downstream. Uca and S. cinereum zoeae were eaten in similar numbers during diurnal neap and spring tides because most zoeae had been transported downstream before dawn when fishes resumed feeding. Estuarine crabs may have responded to predictable trends in planktivory by dispersing newly hatched zoeae downstream on nocturnal ebb tides, regardless of where larvae develop. Small vulnerable zoeae eventually disperse offshore, whereas large well-defended zoeae apparently remain in estuaries. Peak hatching on spring high tides may not have evolved to expedite transport to coastal waters, but instead may facilitate dispersal of larvae of semiterrestrial crabs from the shore where mortality may be high. This study suggests that predation pressure exerted by planktivorous fishes is predictable in time and space, and the timing of larval release, dispersal patterns, and larval morphologies of estuarine crabs have evolved together to reduce the risk of planktivory regardless of whether zoeae develop offshore or in estuaries. [ABSTRACT FROM AUTHOR]

A variety of criteria may influence the efficacy of networks of marine protected areas (MPA) designed to enhance biodiversity conservation and provide fisheries benefits. Meta‐analyses have evaluated the influence of MPA attributes on abundance, biomass, and size structure of harvested species, reporting that MPA size, age, depth, and connectivity influence the strength of MPA responses. However, few empirical MPA evaluation studies have used consistent sampling methodology across multiple MPAs and years. Our collaborative fisheries research program systematically sampled 12 no‐take or highly protective limited‐take MPAs and paired fished reference areas across a network spanning 1100 km of coastline to evaluate the factors driving MPA efficacy across a large geographic region. We found that increased size and age consistently contributed to increased fish catch, biomass, and positive species responses inside MPAs, while accounting for factors such as latitude, primary productivity, and distance to the nearest MPA. Our study provides a model framework to collaboratively engage diverse stakeholders in fisheries research and provide high‐quality data to assess the success of conservation strategies. [ABSTRACT FROM AUTHOR]

• Oceanographic conditions and the larval assemblage varied seasonally in Monterey Bay, CA, USA. • Upwelling and relaxation dynamics affected the phytoplankton and larval assemblages. • Nearshore larval taxa and diatoms were abundant during strong upwelling conditions. • Offshore larval taxa and dinoflagellates were more abundant with the influx of offshore water. • Source water variation and meroplankton composition may provide insight into larval supply dynamics. Understanding sources of variability in larval supply and transport is integral to the dynamics, structure and effective management of marine populations and communities. Yet, a barrier to this understanding is the high variability in the supply and transport of marine larvae, especially in upwelling regions where wind forcing causes dynamic circulation. Since larvae of many species complete development close to shore, resolving the relationship between oceanographic processes and nearshore larval assemblages is essential to better understand larval transport in highly productive upwelling regions. The goal of our study was to examine the effects of variation in upwelling and relaxation dynamics on the nearshore larval assemblage in northern Monterey Bay. To determine how seasonal and daily upwelling and relaxation dynamics influence the nearshore larval assemblage, we surveyed distributions of marine larvae and physical, environmental factors along a cross-shelf transect in northern Monterey Bay, USA, during August and October of 2013. Conditions in August and October differed in temperature, salinity, stratification, and chlorophyll- a fluorescence. Richness and diversity of the larval assemblage did not change appreciably, but the abundance and composition of species shifted after the influx of offshore waters. Specifically, nearshore taxa were more abundant during August, which was characterized by strong upwelling conditions, and especially more abundant with increased wind forcing leading to a retentive upwelling shadow in the northern bay. Conversely, offshore taxa were more abundant during October, which was characterized by weakened upwelling and the persistent influx of offshore water. Our study suggests that relationships between larval taxa, life history characteristics, and water types provide insights into water mass history, circulation and larval recruitment in highly dynamic upwelling regions. [ABSTRACT FROM AUTHOR]

The article offers information on an agreement between drug manufacturers and Canadian governments concerning noncompetitive generic drug pricing system that will delay competitive generic pricing for at least five years in the nation. Topics discussed include impact of failure to implement tendering for generic drugs on its prices; need to ensure the security of supply by the manufacturers; and effects of shortage in supply of a patented drug on the profits.

We demonstrate an apparent trait-mediated indirect interaction (TMII) of predators on primary producers in a natural community by altering prey behavior over short and long time scales. Small predatory sea stars (Leptasterias spp.) caused herbivorous snails (Tegula funebralis) added to rocky intertidal tidepools to quickly flee into refuge microhabitats outside tidepools within days, and this was associated with a 58% increase in microalgal growth after 2 weeks. Similarly, removing sea stars caused snails to increase use of tidepools for 1-10 months. After adding sea stars to tidepools, snails quickly fled and then consistently increased use of refuges outside tidepools for 10 months. This was associated with average increases of 59% for microalgal growth over 1 month and 254% for macroalgal growth over 8 months inside tidepools. In 63 unmanipulated tidepools, densities of sea stars and snails were negatively correlated. High densities of snails were associated with unpalatable algal species and bare rock, while high densities of sea stars were associated with palatable algal species, suggesting that this apparent TMII may have community-level impacts. Though multiple lines of evidence suggest TMIIs were likely operating in this system, it was not possible to experimentally partition the relative contributions of TMIIs and density-mediated indirect interactions (DMIIs), so further caging experiments are necessary to distinguish their relative strengths. Overall, we suggest that predators can benefit primary producers by changing prey behavior even when predators and prey are unrestrained by cages or mesocosms, embedded in complex communities, and observed over multiple time scales. [ABSTRACT FROM AUTHOR]

Fronts are boundaries between distinct water masses that can aggregate or segregate flotsam, detritus, phytoplankton and zooplankton. Studies of large-scale offshore fronts (widths 100–1000 m) that persist for days show that frontal aggregations affect ecological processes by concentrating prey for diverse planktivores and delivering larval recruits to settlement habitats. However, less is known about small-scale (widths 1–10 m), ephemeral (persisting <1 d) fronts that occur commonly along exposed coasts. While propagating fronts associated with river plumes or internal waves have been shown to be important for the many animals that live or forage in nearshore and tidal waters, fixed nearshore fronts associated with shoreline topography have received little attention. We characterized hydrodynamics and the plankton community across a nearshore front attached to a small headland on the northern California coast using a Tucker trawl, CTD profiler, satellite imagery, and timelapse photography between June and October over two years. The front, made visible by a foam line, forms during separation of northward flow, primarily during periods of relaxation following upwelling events. Aggregation of plankton was not observed along the front, consistent with weak cross-frontal density difference. However, the front acted as a boundary separating plankton, including the larvae of bivalves, barnacles (Chthamalus spp.), and copepods as well as adult cladocerans. The front occurred regularly north of the headland and similar fronts have been observed at numerous other small headlands along Californian and other upwelling coasts. In general, small-scale topographic fronts may play an unrecognized role in structuring plankton communities and influencing dispersal where alongshore flow is disrupted by coastal promontories. • Timelapse, high-frequency radar, and high-resolution coastal surveys were employed to characterize a topographic front • The weak, ephemeral shear front occurred regularly on the poleward side of a small headland during upwelling relaxation • Plankton did not accumulate at the front due to a lack of surface convergence and weak cross-frontal density gradients • The front acts as a boundary between nearshore and offshore waters influencing the distribution of some plankton species [ABSTRACT FROM AUTHOR]

Evolutionary responses to opposing directions of natural selection include trade-offs, where the phenotype balances selective forces, and compensation, where other traits reduce the impact of one selective force. Zooplankton pigmentation protects from ultraviolet radiation (UVR) but attracts visual predators. This trade-off is understudied in the ocean where planktonic larvae in surface waters face ubiquitous UVR and visual predation threats. We tested whether crab larvae can behaviorally reduce UVR risk through downward swimming or expansion of photoprotective chromatophores. Then we examined whether more pigmented larvae are more heavily predated by silverside fish under natural sunlight in the tropics in three UVR treatments (visible light, visible + UVA, visible + UVA + UVB). Lastly, we tested the behavioral chromatophore response of larvae to predation threats in two light treatments. Armases ricordi avoided surface waters after exposure to sunlight with UVR. Armases ricordi, Armases americanum, and Eurypanopeus sp. consistently expanded chromatophores in UVR or visible light, while Mithraculus sculptus and Mithraculus coryphe showed no response. Fish preferred pigmented larvae on sunnier days in visible light lacking UVR. Lastly, both M. coryphe and M. sculptus unexpectedly expanded chromatophores in fish cues, but responses were inconsistent over trials and across light treatments. The more consistent larval responses to UVR than to predator cues and the lack of predator preferences in natural light conditions suggest that UVR may have a stronger influence on pigmentation than predation. This study improves our understanding of planktonic adaptation to countervailing selection caused by visual predation and exposure to UVR. [ABSTRACT FROM AUTHOR]

Morphological defences of plankton can include armour, spines and coloration. Spines defend from gape‐limited fish predators, while pigmentation increases visibility to fishes but defends from ultraviolet radiation (UVR).Planktonic crab larvae (zoeae) exhibit inter‐ and intraspecific variability in the lengths of defensive spines, extent of pigmentation and body size. The determinants of this variability and the relationships among these traits are largely unknown.Larvae may employ generalized defences against the dual threats of UVR and predation or specialized defences against their primary threat, with an unknown role of allometric or phylogenetic constraints. Generalization would result in longer spines compensating for the increased predation risk imposed by darker pigments, while specialization would lead to more investment in either defence from predation (long spines) or UVR (dark pigments), at the expense of the other trait.We examined (a) the relationship between spine lengths and pigmentation, (b) the scaling of spine lengths with body size, and (c) phylogenetic constraint in spine lengths, pigmentation, and body size, among and within 21 species of laboratory‐hatched and 23 species of field‐collected crab larvae from Panama and California.We found a negative relationship between spine length and pigmentation among species from laboratory and field. Within species, we found a marginally significant negative relationship among field‐collected larvae.Spine lengths showed positive allometric scaling with carapace length, while spine and carapace lengths, but not pigmentation, had significant phylogenetic signals.The negative relationship we observed between pigmentation and spine length supports our defence specialization hypothesis.Positive allometric scaling of spine lengths means larger larvae are better defended from predators, which may indicate that larvae face greater predation risk as they grow larger.Phylogenetic constraint may have arisen because related species encounter similar predation threats. Conversely, phylogenetic constraint in the evolution of spine lengths may induce convergent behaviours resulting in related species facing similar predation threats.Our results improve understanding of the evolution of the larval morphology of crabs, morphological defences in the plankton and evolutionary responses of morphology to multiple spatially segregated selective forces. A free Plain Language Summary can be found within the Supporting Information of this article. [ABSTRACT FROM AUTHOR]

Larval transport by marine organisms is regulated by a combination of vertical swimming behavior and seasonal reproductive timing, but recent studies suggest horizontal swimming behaviors may also be important. Larvae in highly productive coastal upwelling regions are especially vulnerable to offshore transport and must employ effective dispersal “strategies” to return onshore to suitable settlement sites. Using a primitive-equation numerical model, we investigate how horizontal swimming affects nearshore larval supply and potential settlement and connectivity during climatological spring and summer in central California, a region of persistent coastal upwelling within the California Current System. The addition of shoreward swimming with speeds of 1–7 cm s −1 increases nearshore larval supply by a factor of 1.4–13, depending on the speed, timing of its onset, and the vertical swimming behavior of the larvae, which included both diel and ontogenetic vertical migrations. Nearshore larval supply increases approximately linearly with swimming speed integrated over the pelagic larval duration. While pelagic connectivity increases with shoreward swimming for all vertical behaviors investigated, spatial patterns of connectivity, when standardized by nearshore larval supply, are similar with and without horizontal behavior. Onshore swimming broadens the alongshore extent of areas that can act as effective source regions in central California, increasing potential dispersal distances 11–26%. A related statistic, the reverse pelagic connectivity, reveals Monterey Bay and the Gulf of the Farallones as important source regions that should be considered when adaptively managing California's network of marine protected areas. [ABSTRACT FROM AUTHOR]

Background: Out-of-pocket drug costs lead many Canadians to engage in cost-related nonadherence to prescription medications, but our understanding of other consequences such as borrowing money remains incomplete. In this descriptive study, we sought to quantify the frequency of borrowing to pay for prescription drugs in Canada and characteristics of Canadians who borrowed money for this purpose. Methods: In partnership with Statistics Canada, we designed and administered a cross-sectional rapid-response module in the Canadian Community Health Survey administered by telephone to Canadians aged 12 years or more between January and June 2016. We restricted our analyses to participants who responded to the question regarding borrowing money to pay for prescription drugs and used logistic regression to identify characteristics associated with borrowing. Results: A total of 28 091 Canadians responded to the survey (overall response rate 61.8%). The weighted proportion of respondents who reported having borrowed money to pay for prescription drugs in the previous year was 2.5% (95% confidence interval 2.2%–2.8%), an estimated 731 000 Canadians. The odds of borrowing were higher among younger adults, people in poor health and people lacking prescription drug insurance. Other factors associated with increased adjusted odds of borrowing were having 2 or more chronic conditions, low household income and higher out-of-pocket prescription drug costs. Interpretation: Many Canadians reported borrowing money to pay for out-of-pocket prescription drug costs, and borrowing was more prevalent among already vulnerable groups that also report other compensatory behaviours to address challenges in paying for prescription drugs. Future research should investigate policy responses intended to increase equity in access to prescription drugs. [ABSTRACT FROM AUTHOR]

Discusses the rapid growth in expenditures on prescription drugs in Canada. Factors contributing to shifts from old to new products; Criteria for "breakthrough," "me-too," and "vintage generic" drugs; Methods used in the study which took data from the annual reports by the Canadian Patented Medicine Prices Review Board to explain the 80% increase in drug expenditure in British Columbia between 1996 and 2003; Finding that increased spending is on new drugs introduced in established chemical subclasses.

Focuses on prescription drug benefit programs in the U.S. as of November 2003. Response of drugmakers towards reference pricing; Comparison of prescription spending in British Columbia with that of in Canadian provinces.

Background: Confidential product listing agreements (PLAs) negotiated between pharmaceutical manufacturers and individual health care payers may contribute to unwanted price disparities, high administrative costs, and unequal bargaining power within and across jurisdictions. In the context of Canada's decentralized health system, we aimed to document provincial policy makers' perceptions about collaborative PLA negotiations.Methods: We conducted semi-structured telephone interviews with a senior policy maker from nine of the ten Canadian provinces. We conducted a thematic analysis of interview transcripts to identify benefits, drawbacks, and barriers to routine collaboration on PLA negotiations.Results: Canadian policy makers expressed support for joint negotiations of PLAs in principle, citing benefits of increased bargaining power and reduced inter-jurisdictional inequities in drug prices and formulary listings. However, established policy institutions and the politics of individual jurisdictional authority are formidable barriers to routine PLA collaboration. Achieving commitment to a joint process may be difficult to sustain among heterogeneous and autonomous partners.Conclusions: Though collaboration on PLA negotiation is an extension of collaboration on health technology assessment, it is a very significant next step that requires harmonization of the outcomes of decision-making processes. Views of policy makers in Canada suggest that sustaining routine collaborations on PLA negotiations may be difficult unless participating jurisdictions have similar policy institutions, capacities to implement coverage decisions, and local political priorities. [ABSTRACT FROM AUTHOR]