The Yoakum Canyon is the largest of the Gulf Coast Eocene erosional gorges and is interpreted as a buried submarine channel. It can be traced for 67 miles from the Wilcox fault zone, which defines the position of the early Eocene shelf edge, nearly to present outcrop. This paper expands on previously published descriptions of the canyon using a more extensive subsurface data base. Decompaction of the canyon shale-fill reveals that original depths of the canyon exceeded 3500 ft (1067 m). Apparent canyon wall slump scarps and a peripheral chaotic zone, interpreted as an incipient slump feature, are comparable to similar features of the late Quaternary Mississippi submarine canyon. The Yoakum canyon formed within the Garwood subembayment to the west of and adjacent to the Middle Wilcox continuation of the Rockdale delta system. Quantitative mapping of facies adjacent to the Yoakum shale indicate the following sequence of events: 1) Muddy, distal deltaic and shelf facies of the lower Middle Wilcox were deposited during a retrogradation. 2) A resurgence of progradation deposited the upper Middle Wilcox deltaic sands atop the unconsolidated, lower Middle Wilcox continental margin muds creating a density inversion which initiated slump failure of the continental margin sediments. 3) Headward erosion of the canyon across the shelf occurred contemporaneously with a subsidence-induced transgression caused by a decrease in the sediment supply. The Yoakum canyon was excavated by a combination of slumping and current scour. 4) The canyon was filled with hemipelagic and prodelta muds. 5) Progradation of the Upper Wilcox (Carrizo) deltaic sands capped the sequence. / text

Antipsychotic medications are effective in the treatment of psychotic disorders. Monotherapy (MT) with antipsychotics is consistently recommended as the treatment of choice by several guidelines yet antipsychotic polypharmacy (APP) is widespread in clinical practice. The objectives of this study were to evaluate the incidence of APP, identify predictors of APP, and compare adherence, health resource utilization, and costs between patients on MT and APP using prescription and medication claims from Texas Medicaid (2006 to 2011). Patients newly initiated on antipsychotics were followed for 12 months and categorized into the APP (exposure to two or more antipsychotics for a defined time interval) and MT (no evidence of APP during the study period) groups. This sample of patients was used to evaluate incidence and predictors of APP and compare medication adherence and persistence between the MT and APP groups using multiple, logistic, and Cox proportional hazards regressions. Patients in the MT and APP groups were then matched based on their duration of exposure to antipsychotics and all-cause healthcare utilization and costs were compared using logistic and generalized linear models regression (negative binomial, Poisson, and gamma). Regression analyses for patients matched on duration of antipsychotic exposure accounted for the correlation between matched pairs. The incidence of APP was 5.4%. Several demographic, clinical, physician, and prior utilization characteristics were associated with APP. Medication adherence and persistence were better in the APP group. Length of hospital stay and medical, drug, and total costs were higher for the APP group. Sensitivity analyses were conducted for psychiatric-related costs and varied overlap and gap periods. The results for most of the sensitivity analyses were similar to the base case. Patients prescribed APP had higher medical, drug and total costs and also higher healthcare utilization i.e. increased drug costs were not offset by decreased medical costs. Long-term APP raises concern as state Medicaid agencies are allocating their limited resources to this expensive treatment which has very scarce data supporting its use. More effectiveness research on APP is needed to help provide prescription guidance to clinicians for patients who do not respond well to treatment with a single antipsychotic. / text

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