Current Awareness in Aging Research (CAAR) Report #503 -- September 3, 2009

CAAR (Current Awareness in Aging Research) is a weekly email report produced by the Center for Demography of Health and Aging at the University of Wisconsin-Madison that helps researchers keep up to date with the latest developments in the field. For more information, including an archive of back issues and subscription information see:

http://www.ssc.wisc.edu/cdha/caar.html

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Note: There will be no CAAR Report next week (Sept. 10, 2009). The next weekly report will be sent out on Sept. 17, 2009.

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I. Data:

1. MEDICAL EXPENDITURE PANEL SURVEY DATA RELEASE: The US Agency for Healthcare Research and Quality has released a new MEPS data file (August 2009, data in .zip or self decompressing [.exe] ASCII text and SAS Transport format, with documentation in HTML and .pdf format, and SAS and SPSS programming statements in ASCII format).

- MEPS HC-110H: 2007 Home Health File

http://www.meps.ahrq.gov/mepsweb/data_stats/download_data_files_detail.jsp?cboPufNumber=HC-110H

- MEPS HC-110C: 2007 Other Medical Expenses

http://www.meps.ahrq.gov/mepsweb/data_stats/download_data_files_detail.jsp?cboPufNumber=HC-110C

- HC-110B 2007 Dental Visits

http://www.meps.ahrq.gov/mepsweb/data_stats/download_data_files_detail.jsp?cboPufNumber=HC-110B

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II. Reports and articles:

2. US SOCIAL SECURITY ADMINISTRATION, OFFICE OF POLICY REPORT: "SSI Annual Statistical Report, 2008," (September 2009, HTML, .pdf, and Excel format, 155p.).

http://www.ssa.gov/policy/docs/statcomps/ssi_asr/2008/index.html

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3. US GOVERNMENT ACCOUNTABILITY OFFICE REPORT: "Medicare Physician Payments: Fees Could Better Reflect Efficiencies Achieved When Services Are Provided Together," (GAO-09-647, July 2009, .pdf format, 35p.).

http://www.gao.gov/products/GAO-09-647

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4. PENSION BENEFIT GUARANTY CORPORATION COMPENDIUM: _Pension Insurance Data Book 2008_ (August 2009, .pdf format, 114p.).

http://www.pbgc.gov/docs/2008databook.pdf

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5. CONGRESSIONAL BUDGET OFFICE LETTER: "The Estimated Change in Medicare Part D Premiums from Provisions in H.R. 3200, America's Affordable Health Choices Act of 2009," (August 2009, .pdf format, 4p.).

http://www.cbo.gov/doc.cfm?index=10543

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6. BUREAU OF LABOR STATISTICS ARTICLE: "Alternatives to Frozen Defined Benefit Pension Plans," by Scott F. Curtin (_Compensation and Working Conditions Online_, August 2009, HTML format).

http://www.bls.gov/opub/cwc/cm20090826ar01p1.htm

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7. US DEPARTMENT OF HEALTH AND HUMAN SERVICES, OFFICE OF INSPECTOR GENERAL REPORTS:

A. "Power Wheelchairs in the Medicare Program: Supplier Acquisition Costs and Services," (OEI-04-07-00400, August 2009, .pdf format, 43p.).

Summary:

Medicare and its beneficiaries paid almost four times the average amount paid by suppliers to acquire standard power wheelchairs during the first half of 2007. Suppliers purchased standard power wheelchairs for an average of $1,048 and reported performing an average of five services in conjunction with supplying them. Because Medicare allowed an average of $4,018 for standard power wheelchairs, Medicare and its beneficiaries paid suppliers an average of $2,970 beyond the suppliers' acquisition cost to perform an average of five services and cover general supplier business costs. The beneficiary's average copayment covered 77 percent of the supplier's average acquisition cost for a standard power wheelchair. Medicare and its beneficiaries paid almost two times the average amount paid by suppliers to acquire complex rehabilitation power wheelchair packages during the first half of 2007. Suppliers purchased complex rehabilitation power wheelchair packages for an average of $5,880 and reported performing an average of seven services in conjunction with supplying them. Because Medicare allowed an average of $11,507 for complex rehabilitation power wheelchair packages, Medicare and its beneficiaries paid suppliers an average of $5,627 beyond the suppliers' acquisition cost to perform an average of seven services and cover general supplier business costs.

We collected documentation of the prices suppliers paid to purchase a sample of standard and complex rehabilitation power wheelchairs that Medicare beneficiaries received in the first half of 2007. We also collected documentation of the services performed prior to, during, and over an average of 9 months after delivering the power wheelchairs.

Medicare's average allowed amount for standard power wheelchairs in the first half of 2007 ($4,018) was 383 percent of suppliers' average acquisition cost. In comparison, Medicare's average payment under the Competitive Bidding Acquisition Program ($3,073) would have been 293 percent of suppliers' average acquisition cost. Although Medicare's fee schedule amount was reduced to $3,641 to offset the Competitive Bidding Acquisition Program's delay, the 2009 fee schedule amount exceeds the average competitively bid price by $568.

Medicare's fee schedule amounts include reimbursement for the acquisition cost of the power wheelchair and also for supplier services, such as assembling and delivering the power wheelchair and educating the beneficiary about its use. We found that suppliers performed most services prior to and during, rather than after, the wheelchairs' delivery. Suppliers of complex rehabilitation power wheelchair packages reported performing twice as many services as suppliers of standard power wheelchairs at times other than the day of delivery. Suppliers reported performing required services most of the time, as well as other services as needed.

We recommend that CMS determine whether Medicare's standard and complex rehabilitation power wheelchair fee schedule amounts should be adjusted by using information from the Competitive Bidding Acquisition Program, seeking legislation to ensure that fee schedule amounts are reasonable and responsive to market changes, or by using its inherent reasonableness authority. CMS concurred with our recommendation and, with respect to our suggested methods for determining whether fee schedule amounts should be adjusted, stated that it plans to use information from the Competitive Bidding Acquisition Program and will carefully consider seeking legislation to ensure that fee schedule amounts are reasonable and responsive to market changes. However, CMS noted that it is not likely to use its inherent reasonableness authority until the results of the supplier bids for power wheelchairs under the Competitive Bidding Acquisition Program have been assessed.

http://www.oig.hhs.gov/oei/reports/oei-04-07-00400.pdf

B. "Beneficiary Utilization of Albuterol and Levalbuterol Under Medicare Part B," (OEI-03-07-00440, August 2009, .pdf format, 28p.).

Summary:

We found that utilization patterns among beneficiaries prescribed albuterol and levalbuterol fluctuated noticeably between 2003 and 2007-almost always shifting toward the drug that was most favorable for the supplier from a reimbursement perspective. In 2003 and 2004, albuterol and levalbuterol were included in the same payment code and had the same Medicare payment amount, which was based on the median average wholesale price of all versions of both drugs. Effective January 1, 2005, CMS established separate payment codes and payment amounts for these drugs. At the same time, under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), Medicare reimbursement for an inhalation drug was set at 106 percent of the drug's average sales price (ASP). These changes increased the payment amount for levalbuterol but decreased the payment amount for albuterol. Effective July 1, 2007, CMS recombined albuterol and levalbuterol into a single code and began to base payment on the volume-weighted ASP for both drugs. However, as of April 1, 2008, CMS again reestablished separate payment codes and payment amounts for these two drugs.

Medicare reimbursement favored albuterol in 2003 and 2004 (from a supplier's reimbursement perspective), and nearly all beneficiaries (97 percent) received that drug. However, as a result of payment and coding changes that took effect on January 1, 2005, reimbursement became much more favorable for levalbuterol. Twenty-five percent of beneficiaries who were on albuterol in 2004 were changed to levalbuterol between January 1, 2005, and June 30, 2007. Physicians in our sample typically cited clinical reasons for changing beneficiaries from albuterol to levalbuterol during this time. Despite the move to ASP, average per-beneficiary spending on albuterol and levalbuterol actually increased above pre-MMA levels. Between January 1 and June 30, 2007, Medicare paid an average of $600 per beneficiary for both albuterol and levalbuterol, or $94 more per beneficiary than in the first half of 2003.

However, a July 1, 2007, payment and coding change made albuterol more favorable from a supplier's perspective; two-thirds of beneficiaries in our sample were changed from levalbuterol to albuterol between July 1 and December 31, 2007. Physicians in our sample typically cited financial reasons for changing beneficiaries from levalbuterol to albuterol in the second half of 2007.

When Congress and CMS make reimbursement and coding decisions, it is important they take into consideration that new policies may affect what drug a beneficiary is prescribed and, in some cases, limit access to a potentially more effective product or drive utilization to a more expensive product that offers no clinical advantage. In its comments to the draft report, CMS stated that the agency is aware of the impact that changes in payment methodologies can have on access to prescription drugs and will continue to monitor spending and utilization for albuterol and levalbuterol.

http://www.oig.hhs.gov/oei/reports/oei-03-07-00440.pdf

C. "Payments for Ambulance Transportation Provided to Beneficiaries in Skilled Nursing Stays Covered Under Medicare Part A in Calendar Year 2006," (A-01-08-00505, August 2009, .pdf format, 24p.).

http://www.oig.hhs.gov/oas/reports/region1/10800505.asp

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8. HEALTHREFORM.GOV REPORT: "Strengthening the Health Insurance System: How Health Insurance Reform Will Help America's Older and Senior Women," (September 2009, .pdf and HTML format, 13p.).

http://healthreform.gov/reports/seniorwomen/

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9. AUSTRALIAN DEPARTMENT OF HEALTH AND AGEING PRESS RELEASE: "$4.9 Million Dementia Respite Care Unit to Help Carers Get a Well Deserved Break," (August 28, 2009, .pdf and HTML format, 1p.).

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr09-je-je099.htm

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10. EUROSTAT COMPENDIUM: _Health statistics - Atlas on mortality in the European Union_ (August 2009, .pdf format, 205p.).

http://epp.eurostat.ec.europa.eu/cache/ITY_OFFPUB/KS-30-08-357/EN/KS-30-08-357-EN.PDF

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11. INSTITUTE FOR FISCAL STUDIES [LONDON, UK] REPORT: "The expenditure experience of older households," by Andrew Leicester, Cormac O'Dea and Zoe Oldfield (August 2009, .pdf format, 107p.).

http://www.ifs.org.uk/publications/4600

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12. ALZHEIMER'S AUSTRALIA REPORT: "Keeping Dementia Front of Mind: Incidence and Prevalence 2009 - 2050," (August 2009, .pdf format, 96p.).

http://www.alzheimers.org.au/upload/Front_of_Mind_Full_Report1.pdf

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13. INSTITUTE FOR RESEARCH AND INFORMATION IN HEALTH ECONOMICS (IRDES) [PARIS, FRANCE] REPORT: "Self-assessed health of individuals aged 55 and over in France and Quebec: differences and similarities," by Jocelyne Camirand, Catherine Sermet, Valeriu Dumitru, and Stéphanie Guillaume (in Questions d'economie de la Sante No. 142, May 2009, .pdf format, 8p).

http://www.irdes.fr/EspaceAnglais/Publications/IrdesPublications/QES142.pdf

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14. WORLD ECONOMIC FORUM REPORT: "Transforming Pensions and Healthcare in a Rapidly Ageing World: Opportunities and Collaborative Strategies," by Chiemi Hayashi, Heli Olkkonen, Bernd Jan Sikken, and Juan Yermo (September 2009, .pdf format, 76p.).

http://www.weforum.org/en/initiatives/Scenarios/StrategicOptionsFDS/index.htm

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15. PEW RESEARCH CENTER REPORT: "America’s Changing Workforce: Recession Turns a Graying Office Grayer," (September 2009, .pdf format, 34p.).

http://pewsocialtrends.org/pubs/742/americas-changing-work-force

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16. CENTER FOR RETIREMENT RESEARCH AT BOSTON COLLEGE ISSUE BRIEF: "Older Americans On The Go: How Often, Where, and Why?" by Kelly Haverstick and Natalia A. Zhivan (IB No. 9-18, September 2009, .pdf format, 9p.).

http://crr.bc.edu/briefs/older_americans_on_the_go_how_often_where_and_why_.html

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17. URBAN INSTITUTE ARTICLE: "Automatic Enrollment in IRAs: Costs and Benefits," by Benjamin H. Harris and Rachel M. Johnson (August 2009, .pdf format, 12p.).

http://www.urban.org/publications/1001312.html

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18. FAMILY CAREGIVER ALLIANCE PERIODICAL: _Caregiving PolicyDigest_ (Vol. 9, No. 17, Sept. 2, 2009).

http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=467

More information about FCA:

http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=509

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19. _PROCEEDING OF THE NATIONAL ACADEMY OF SCIENCES_ ARTICLE ABSTRACTS:

A. "Structure-neurotoxicity relationships of amyloid {beta}-protein oligomers," by Kenjiro Onoa, Margaret M. Condrona, and David B. Teplow (Vol. 106, No. 35, September 1, 2009, p. 14745-14750).

http://www.pnas.org/content/106/35/14745.abstract

B. "Collapse of proteostasis represents an early molecular event in Caenorhabditis elegans aging," by Anat Ben-Zvi, Elizabeth A. Miller, and Richard I. Morimoto (Vol. 106, No. 35, September 1, 2009, p. 14914-14919).

http://www.pnas.org/content/106/35/14914.abstract

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20. _BRITISH MEDICAL JOURNAL_ ARTICLE: "Association between radiographic features of knee osteoarthritis and pain: results from two cohort studies," by Tuhina Neogi, David Felson, Jingbo Niu, Michael Nevitt, Cora E, Lewis, Piran Aliabadi, Burt Sack, James Torner, Lawrence Bradley, and Yuqing Zhang (BMJ 2009;339:b2844, August 29, 2009).

http://www.bmj.com/cgi/content/abstract/339/aug21_1/b2844

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III. Working Papers:

21. UNIVERSITY OF WISCONSIN CENTER FOR DEMOGRAPHY AND ECOLOGY : "Infant mortality during the 1920s-1940s in Puerto Rico and the health of older Puerto Rican adults," by Mary McEniry (Working Paper 2009-3, June 2009, .pdf format, 47p.).

Abstract:

Infant mortality at birth may help illuminate the usefulness of season of birth as an indicator of early life exposures. We obtained data for infant mortality rates (IMR) at the county (municipio) level during the late 1920s-early 1940s in Puerto Rico using historical records and linked IMR with individual birth year and place using the PREHCO (Puerto Rican Elderly: Health Conditions) study. We classified PREHCO respondents into two groups according to high or low infectious disease load, corresponding to lower or higher proportion endogenous mortality in the year respondents were born. We estimated the effects of IMR (using continuous, logit, quartile, Box-Cox transformations) and season of birth on adult heart disease and diabetes for all respondents and then by subgroups, controlling for age, gender, obesity, respondent's educational level, adult behavior (smoking, exercise) and other early life exposures (childhood health, knee height, childhood SES). Findings: (1) no significant associations between IMR and heart disease or diabetes but significant associations between high IMR and low knee height, low education, older age and no rigorous exercise as an adult; (2) stronger effects of season of birth on adult health among respondents born in years with lower infectious disease loads; (3) strong effects of season of birth even after controlling for other childhood and adult factors. Conclusions:(1) effects of poor environmental conditions during the first year of life on adult health may be mediated by other life course factors; (2)season of birth is a useful indicator of early life exposures under restricted conditions; (3) in this population of older Puerto Rican adults, season of birth provides (weak) evidence in support of the importance of in utero (endogenous) causes affecting adult heart disease and diabetes.

http://www.ssc.wisc.edu/cde/cdewp/2009-03.pdf

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22. WHARTON PENSION RESEARCH COUNCIL (UNIVERSITY OF PENNSYLVANIA): Note: WPRC requires free registration before providing working papers. "Constructing New Retirement Systems: Choosing between Insurance and Investment, Choice and Default," by Emily Kessler (WP2009-10, August 2009, .pdf format, 46p.). Links to the abstract and full-text can be found at:

http://www.pensionresearchcouncil.org/publications/document.php?file=803

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23. POPULATION AGING RESEARCH CENTER (PARC) [UNIVERSITY OF PENNSYLVANIA]: "Pension Payouts in Chile: Past, Present, and Future Prospects," by Olivia S. Mitchell and Jose Ruiz (August 2009, .pdf format, 33p.). Links to the abstract and full-text can be found at:

http://repository.upenn.edu/parc_working_papers/26/

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24. INSTITUTE OF BEHAVIORAL SCIENCE [UNIVERSITY OF COLORADO, BOULDER]: "Headship of Older Persons in the Context of HIV/AIDS in Rural South Africa," by Enid Schatz and Sangeetha Madhavan (POP2009-05, August 2009, .pdf format, 33p.).

Abstract:

This paper examines older persons' living arrangements in the Agincourt sub-district of Mpumalanga Province, South Africa-an area with 32% HIV-prevalence. We concentrate on headship as a measure of older persons' position in rural households. We focus on the role of South Africa's non-contributory old-age pensions as a collective household asset to hypothesize effects on headship. Using descriptive statistics, we examine the presence of pension-age eligible adults (women age 60+, men age 65+) across and within households, compare the characteristics of households across age and sex headship types, and explore how households’ composition and experience of a death differ across headship types. While there are some significant differences in household composition across headship types, this analysis does not point to a significantly greater presence of HIV/AIDS deaths in households headed by older persons over the period. These findings are an important starting point for further investigations aimed at understanding how HIV/AIDS is impacting the lives of older persons.

http://www.colorado.edu/ibs/pubs/pop/pop2009-0005.pdf

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25. WORLD BANK POLICY RESEARCH PROGRAMME: "The long-run impacts of adult deaths on older household members in Tanzania," by Achyuta R. Adhvaryu and Kathleen Beegle (WPS No. 5037, September 2009, .pdf and ASCII text format, 40p.). Links to the abstract and full-text can be found at:

http://econ.worldbank.org/external/default/main?pagePK=64165259&piPK=64165421&theSitePK=469382&menuPK=64166093&entityID=000158349_20090902155306

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26. PENSIONS INSTITUTE [CITY UNIVERSITY, LONDON, UK]: "Pension Plan Decisions," by Alistair Byrne, David Blake and Graham Mannion (Discussion Paper PI-0903, September 2009, .pdf format, 32p.).

Abstract:

We examine the contribution and investment decisions made by members of a large UK based DC pension plan. We find that many employees appear to be relatively financially sophisticated and follow approaches consistent with economic and financial theory in terms of savings rates and investment strategies. However, there are also many less sophisticated employees who stick with plan default arrangements and/or follow simple rules of thumb in saving and investing. The challenge for corporate sponsors of pension plans is in designing arrangements and communication strategies that reduce the chances of these less sophisticated plan members making mistakes - in the sense of systematic deviations from optimal behaviour.

http://www.pensions-institute.org/workingpapers/wp0903.pdf

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27. PERSONAL SOCIAL SERVICES RESEARCH UNIT [UK]: "Analysing the costs and benefits of social care funding arrangements in England: technical report," by Julien Forder and José-Luis Fernández (Discussion Paper 2644, July 2009, .pdf format, 51p.). There is no abstract for this paper.

http://www.pssru.ac.uk/pdf/dp2644.pdf

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IV. Journal Tables of Contents (check your library for availability):

28. Journal of the American Geriatrics Society (Vol. 57, No. 9, September 2009).

http://www3.interscience.wiley.com/journal/117995531/home

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29. AMEDEO MEDICAL LITERATURE: Note: "AMEDEO has been created to serve the needs of healthcare professionals, including physicians, nurses, pharmacists, administrators, other members of the health professions, and patients and their friends. They can easily access timely, relevant information within their respective fields... All AMEDEO services are free of charge. This policy was made possible thanks to generous unrestricted educational grants provided by AMGEN, Berlex, Eisai, Glaxo Wellcome, Novartis, Pfizer, Roche, and Schering AG."

A. Osteoporosis: Literature for the week of August 31, 2009:

http://www.amedeo.com/medicine/ost.htm

B. Alzheimer's Disease: Literature for the week of August 31, 2009:

http://www.amedeo.com/medicine/ad.htm

C. Parkinson's Disease: Literature for the week of August 31, 2009:

http://www.amedeo.com/medicine/pd.htm

D. Prostate Cancer: Literature for the week of August 31, 2009:

http://www.amedeo.com/medicine/prc.htm

E. Stem Cell Research: Literature for the week of August 31, 2009:

http://www.amedeo.com/medicine/stc.htm

F. Ophthalmology: Literature for the week of August 31, 2009:

http://www.amedeo.com/medicine/eye.htm

AMEDEO Literature Guide:

http://www.amedeo.com/index.htm

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V. Funding Opportunities:

30. US NATIONAL INSTITUTES OF HEALTH NOTE: "Clarification of Specific Research Objective in PAR-09-224, Improving Diet and Physical Activity Assessment (R01)," (NOT-CA-09-032, August 26, 2009, National Institute on Aging, in conjunction with other agencies).

http://grants.nih.gov/grants/guide/notice-files/NOT-CA-09-032.html

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31. AMERICAN SOCIETY ON AGING AWARDS:

A. "Graduate Student Research Award," (deadline is October 15, 2009). "The ASA Graduate Student Research Award is presented annually to a graduate student for research relevant to aging and applicable to practice."

http://www.asaging.org/asav2/awards/description_grad.cfm?submenu1=grad

B. "The ASA Hall of Fame Award," (deadline is October 15, 2009). "The ASA Hall of Fame Award is presented to an individual age 65 or older who has, through lifetime advocacy and leadership, enhanced the lives of older adults."

http://www.asaging.org/asav2/awards/description_fame.cfm?submenu1=fame

C. "The Gloria Cavanaugh Award for Excellence in Training and Education," (deadline is October 15, 2009). "This Award is presented annually by ASA to an individual or organization demonstrating continued excellence in training and education in the field of aging."

http://www.asaging.org/asav2/awards/description_gloria.cfm?submenu1=gloria

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VI. Conferences:

32. US ADMINISTRATION ON AGING: AoA has recently released a list of selected conferences for September 2009.

http://www.aoa.gov/AoARoot/Press_Room/events/events.aspx

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VII. Websites of Interest:

33. UNIVERSITY OF MARYLAND-BALTIMORE: The Geri-ed Program at the University of Maryland-Baltimore is offering an online educational module titled "Medication Management in Assisted Living Facilities." The module features four presentation by:

- Nicole Brandt, PharmD, University of Maryland School of Pharmacy;
- Jackie Pinkowitz, MEd, Futurage, Inc.;
- Barbara Resnick, PhD, University of Maryland School of Nursing
- Richard Stefanacci, DO, University of the Sciences in Philadelphia.

For more information, go to:

http://geri-ed.umaryland.edu/index.aspx

Thanks,

Charlie

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Charlie Fiss
Information Manager
Data and Information Services Center
Rm. 3329 Social Science Bldg
1180 Observatory Drive
Madison, WI 53706-1393
Phone: (608) 265-9240
Fax: (608) 262-8400
Email: fiss@ssc.wisc.edu

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