Plymouth (UK) airport will never re-open Term Paper

Plymouth (UK) airport will never re-open - Term Paper Example However, this trend did not last long after 2009 (Great Britain 2010, p. 101). The airport was eventually officially closed on the 23rd of December 2011 after the owners coming to an agreement that this was the right decision to make at that particular moment. There are a number of reasons that are believed to have led to the closure of Plymouth City Airport. According to the management of the airport, closure was made inevitable due to the economic downturn and the problems that the UK aviation market was facing at that time. Just 6 months before the airport was closed the company had registered a loss of up to  £1m (Hynes 2010, p. 201). This was a simple sign that the airport was not going to do well under the same condition given the fact that the airport had more than 50 employees. If they decided to remain functional, they would have continued incurring losses because they would still have operational costs, compensation of their employees being included. The situation at Plymouth Airport was made worse by the withdrawal of Air South West’s flights to London. This meant that the airport no longer had any London passengers going through it. This was a big blow to the airport. The management tried all they could to find a replacement for Air South West, but they were not successful. This led to a situation whereby less than 100 passengers were flying from this airport every day. This was a simple implication that the airport was no longer commercially viable. Much of the services that were offered did not earn the airport any profits due to the situation that had developed as a result of the withdrawal of Air South West, the economic turn-down, and the problems that the UK aviation industry was facing at that time (Pavlyuk 2014, p. 22). This can be explained by the fact that by the month of April 2011, Sutton Harbour Holdings had already announced that the airport would be closed down by the end of 2011. In fact, the

Financial Modelling and forecasting Essay Example | Topics and Well Written Essays - 1000 words

Financial Modelling and forecasting - Essay Example They are used for propose of measuring the performance of the firm and also to measure hoe stable is a firm financially. They are also used for future planning, determining whether a firm is able to borrow loans and service them, and also evaluating the performance of the firm under different models. Most models are based on sales volume This paper will seek to analyze the financial statement of JB Hi-Fi by use of historical data to predict the future.I will therefore forecast the years 2013, 2014 and 2015 using the year 2012 as my base year. Ratio analysis of relevant sales ratios will be used for the analysis. Financial statement analysis is the use balance sheet and income statement data to come up with values for financial interpretation and identification of the strengths and weaknesses of an organization (Stickney et al., 2006). Various techniques of financial statement analysis are: trend analysis, comparative statements, common size percentages, ratio and fund analysis as well as changes in working capital changes (Libby et al., 2004). For the purpose of analyzing JB Hi-Fi, relevant sales ratio analysis will be undertaken. For a successful financial analysis, comparison has to be made using consistent percentages through the years of analysis. The use of the sales ratios to analyze the years will reveal their similarities, trends, as well as differences in the company (Palepu & Healy, 2007). As Gregory (2008) notes, the stakeholders of the information contained in a financial statement include, potential investors, creditors, managers, shareholders, the government and creditors and they require the information for different reasons. Use of historical data is a major limitation of ratio analysis as it is therefore assumed that it reflects on the future trends whereas no one could be certain of the future (Palepu & Healy, 2007). Resvine et al (2004) explains that another limitation of using financial statements in analysis is that GAAP allows

Natural selection Assignment Example | Topics and Well Written Essays - 500 words

Natural selection - Assignment Example Evidently, the process of natural selection has been shown to play a role in seasonal variations in homozygotes and heterozygotes. To this end, it has been ascertained that carriers for different chromosomal variations occur at different frequencies at different seasons. Such genetic constitutions can be passed on to offsprings. This leads to some offsprings that are better suited to environmental disparities, while others are least suited to prevailing environmental conditions. In this article, the variations in seasonal adaptability among natural populations of Drosophila pseudoobscura are analyzed. Basically, the article unveils a study targeted towards determination of the impact of the gene combinations on the third chromosome of Drosophila pseudoobscura in their adaptation to varied environmental setup. It aims to show that natural selection plays an integral role in determining the survival of organisms with specific gene combinations. The study was prompted by the observations that seasonal variations occurred within the populations of the organisms. More specifically, it was observed that while certain seasons favored heterozygotes, other seasons were more favorable to homozygotes. To test the hypothesis to ascertain the heritability of seasonal adaptation, the research uses experimental designs which involved parent-offspring comparisons under artificial environment, in a population cage. Through this comparison, the study was able to show differential death rates with inversion heterozygotes more favored than homozygotes. Further, this study involved use of specifically selected eggs representative of heterozygote or homozygote states exclusively. Such eggs were produced through well-programmed breeding. Despite the conduct of the experiment in artificial setting, the study confidently outlines that the determination of the artificial experiment is an accurate account of the developments in natural habitat. It

Declining Portable Water Essay Example for Free

Declining Portable Water Essay â€Å"Water of life†. This is a famous Christianity word that reflects how important water is to our life. As we know, most drinkable water comes from the river, thus making river the main sources of potable water. However global warming is getting more and more serious nowadays causing a global rise in temperature and melt the ices at mountain’s peak. In the book ‘Pillar of Sand’ by Sandra Postel, Postel says that major Asia’s rivers like Ganges, Indus and Yellow river depends on the snowpack mountains for their flow. Despite that, the rises in temperature has causes the snow to melt faster and an increase in rainfall, drying up the river especially during dry season. Even the famous Andes, Rockies and Alps rivers is said to soon face this problem which mean there will be a worldwide water shortage should these rivers dry up. Therefore, this essay will talk about what will happen when there is a decline in potable water. Global water pollution caused by sewage and animal waste has resulted in overdose of nutrients and sediments in rivers, lakes and sea.(Tasha Eichenseher, March 2010) This causes eutrophication which is a situation where algae growth increases; resulted in lack of oxygen in the river. That eventually decreases the values of the rivers, lakes and esturaries for recreation, fishing, hunting and aesthetic enjoyment. In addition to that, health problems can occur where eutrophic condition interferes with drinking water treatment. To sum it up, water pollution caused by sewage and animal waste is the root of the decline in drinkable water as it pollutes the rivers and also the treated water. In addition to the above, polluted water is also said to be the causes of diseases. According to the World Health Organization, up to half of humanity has one of the six main diseases – diarrhea, schistosomiasis, trachoma, infestation with ascaris, guinea worm, or hookworm at any time because of poor drinking water and inadequate sanitation. This shows that lack of safe drinking water, as water are polluted, can causes various dangerous spreadable diseases w hich can endangered our life. For example, it is predicted by Amin Zakaria in his column in The Star on July 9, 2008, that in 2009, diarrhea death toll will be like four jumbo jets of children crashing every day. Therefore, it is not exaggerating to say that human waste is the ultimate weapon of mass destruction as lack of adequate sanitation in usable water for more than a third of the Earth’s population is one of the biggest scandals in the last 50 years. This lack of clean water situation is further worsen when there is a decline in clean water. According to Tan Ee-Beng on 2008 in the Environmental Health Perspectives, of a population of roughly 6.1 billion, more than 1 billion lack access to potable water. His statement is further proven when a report from UNESCO on 2009 says that China currently has less than an estimated 49 billion cubic meters of renewable water resources when in the decades before 2000, this country owns an average of about 66 billion cubic meters of renewable water resources. In conclusion, knowing that there is a decline in clean water, the best way is to combat this issue soonest possible. Government should also urges the public to save water by increasing the water bill after the usual 50 liters usage. In addition to that, government should also increase the capacity of the water reservoir in the country. For example the current Selangor water issue between Peter Chin and Selangor state Government should be resolve soonest possible so that Langat 2 can be built and provide water for people of Selangor till 2025. We as citizen should also play a part by not wasting these precious water as to lessen the need to treat the water to be use again.

Nazi Germany in the 1930s Essay Example for Free

Nazi Germany in the 1930s Essay Jews faced several problems that made life very difficult and strenuous during the mid-1930s. People who were Jewish were often persecuted and treated as the worst class of people when it comes to social hierarchy. Throughout this time, there were many things happening to Germany that were of and related to government, which destroyed the ability for a Jewish citizen to have a positive life. There were several hardships and problems faced by Jews regarding emigration out of Europe. Also, Jewish people during this time period suffered from government and social ridicule, losing many rights and necessities that should be given to every human being upon birth. During the mid-1930s, Germany tried to persecute Jews by forcing their emigration from the country. This was caused by the anti-Semitic legislation in Germany. Jews were not allowed to take with them any more than $4 and very few belongings. Along with that, trying to get to another country was nearly impossible. With the terrible great depression that was occurring, other countries were afraid that immigrants would threaten local job opportunities, thus emigration out of Germany was very difficult for Jews (Obstacles to Immigration). All the documents required to leave the country were also nearly impossible to obtain. Jews often called these â€Å"Bureaucratic Hurdles†. These were up to 15 documents that could include 5 visa applications, 2 local citizen sponsorships, tax and financial documents, police conduct documents and evaluations, a physical, and proof of a booked passage to the new country(Documents Required to Obtain a Visa). According to Ann Jacobson , when she emigrated out of Austria, when it became part of the Reich, her father was only allowed to take $80 and they had extreme difficulty finding all the documents required to move (â€Å"Flight From the Reich†). This was extremely fortunate for her to be able to get the opportunity to move, because for most Jews, obtaining such documents was nearly impossible. Overall, trying to emigrate out of a Nazi occupied territory in the mid-1930s was almost impossible, due to the legal and social restrictions posed by people and the government. Jewish lifestyle was often full of being discriminated against and mistreatment by non-Jewish citizens and government affiliated people during this time period. Many Jewish people lost their jobs and children were taken from schools (â€Å"Flight from the Reich†). With the little things available for Jews to take with them due to confiscation and newfound poverty, Jews were figuratively chased out of Germany by Nazis (â€Å"1938 Propaganda Poster†). Poverty is caused by lack of work, and Jews definitely were forced into poverty. An example of somebody being forced out of their job was Elisabeth Abegg. She was a teacher who was forced out of the position in 1933 for being of the Jewish religion (Rescue and Resistance 1). With no money, jobs, or hope for help from others, anybody would have struggled for shear survival. That is what these Jews were being denied during this time. They were forced out of a normal lifestyle, and constantly had to be looking over their shoulders for the government. A citizen in any country should never feel threatened or attacked by their own government. For the Jews trying to survive in this time period, the case was practically opposite. The government was brutal, and forcibly making Jewish people evacuate the country, yet made immigration to other countries nearly impossible. This is what made life so difficult for Jews during this time period. Eventually there was an establishing of the Nuremburg Laws, which caused Jews to lose citizen rights in Germany (â€Å"Jews in Nazi Germany† 1). Some people tried to resist the movement, but were quickly dealt with. In 1933, Karl Barth opposed pro-Nazis and based his opposition on his biblical theology (Rescue and Resistance 11). He was expelled from Germany for his â€Å"unruly behavior† in 1935. When people got on boats to sail to new countries, the exit of Europe did not always guarantee complete freedom from the Reich. If Jews were to get on a Germany controlled ship, they were technically on German land wherever they were. It was best to get on an American controlled ship, so that Germans had no control over what happened to it or its passengers while in operation (â€Å"Flight from the Reich†). If an emigrant was on a German controlled ship, like the St. Louis, problems could have occurred. This boat consisted to 900 or more people trying to go to Cuba. The government in Germany knew that Cuba had changed its mind about accepting these people yet they did not inform the passengers. When the boat got to Cuba, it was turned around with only 28 people admitted onto the island . The rest were sent back to Europe. Only half of those people sent back ended up surviving through the Holocaust (Voyage of the St. Louis). With the difficulty posed by the inability to obtain documents, and the process it actually took to get to a new country, emigration for Germans during this time period was seemingly impossible. Altogether, this time period was probably the most difficult time for a certain persecuted group of people to live. They were treated with utmost disrespect and extremely persecuted. Even though I am not a Jew myself, I feel extreme remorse for the Jews during this time period. Being able to relate to what these people went through is nearly impossible for anybody who would ever try to give themselves the task. These people are an example of how little wrong one must do in society to be treated in the most malicious of ways. The human race itself will always be the leading factor in the prevention of development, and this time period demonstrates this more than most others. When humans do and think like the Nazis did in the mid-1930s is when our race will reach ultimate failure. People do not deserve to be persecuted or mistreated, unless it is an earned treatment for negative behavior or acts. These Jews did nothing wrong, yet were treated worse by the Reich than any other people on the planet at the time. When looking for something to take away from this, one could take away the knowledge to know how destructive a simple persecution could become. It is not wise to single out any one group of people in any social context, due to the harmful global impacts made when this happened to the Jews. Humans are all born equally, and unfortunately are unable to treat each other as such. People should always be treated and given the title and rights they were born with. That title is a human being.

Nazi Germany in the 1930s Essay Example for Free

Nazi Germany in the 1930s Essay Jews faced several problems that made life very difficult and strenuous during the mid-1930s. People who were Jewish were often persecuted and treated as the worst class of people when it comes to social hierarchy. Throughout this time, there were many things happening to Germany that were of and related to government, which destroyed the ability for a Jewish citizen to have a positive life. There were several hardships and problems faced by Jews regarding emigration out of Europe. Also, Jewish people during this time period suffered from government and social ridicule, losing many rights and necessities that should be given to every human being upon birth. During the mid-1930s, Germany tried to persecute Jews by forcing their emigration from the country. This was caused by the anti-Semitic legislation in Germany. Jews were not allowed to take with them any more than $4 and very few belongings. Along with that, trying to get to another country was nearly impossible. With the terrible great depression that was occurring, other countries were afraid that immigrants would threaten local job opportunities, thus emigration out of Germany was very difficult for Jews (Obstacles to Immigration). All the documents required to leave the country were also nearly impossible to obtain. Jews often called these â€Å"Bureaucratic Hurdles†. These were up to 15 documents that could include 5 visa applications, 2 local citizen sponsorships, tax and financial documents, police conduct documents and evaluations, a physical, and proof of a booked passage to the new country(Documents Required to Obtain a Visa). According to Ann Jacobson , when she emigrated out of Austria, when it became part of the Reich, her father was only allowed to take $80 and they had extreme difficulty finding all the documents required to move (â€Å"Flight From the Reich†). This was extremely fortunate for her to be able to get the opportunity to move, because for most Jews, obtaining such documents was nearly impossible. Overall, trying to emigrate out of a Nazi occupied territory in the mid-1930s was almost impossible, due to the legal and social restrictions posed by people and the government. Jewish lifestyle was often full of being discriminated against and mistreatment by non-Jewish citizens and government affiliated people during this time period. Many Jewish people lost their jobs and children were taken from schools (â€Å"Flight from the Reich†). With the little things available for Jews to take with them due to confiscation and newfound poverty, Jews were figuratively chased out of Germany by Nazis (â€Å"1938 Propaganda Poster†). Poverty is caused by lack of work, and Jews definitely were forced into poverty. An example of somebody being forced out of their job was Elisabeth Abegg. She was a teacher who was forced out of the position in 1933 for being of the Jewish religion (Rescue and Resistance 1). With no money, jobs, or hope for help from others, anybody would have struggled for shear survival. That is what these Jews were being denied during this time. They were forced out of a normal lifestyle, and constantly had to be looking over their shoulders for the government. A citizen in any country should never feel threatened or attacked by their own government. For the Jews trying to survive in this time period, the case was practically opposite. The government was brutal, and forcibly making Jewish people evacuate the country, yet made immigration to other countries nearly impossible. This is what made life so difficult for Jews during this time period. Eventually there was an establishing of the Nuremburg Laws, which caused Jews to lose citizen rights in Germany (â€Å"Jews in Nazi Germany† 1). Some people tried to resist the movement, but were quickly dealt with. In 1933, Karl Barth opposed pro-Nazis and based his opposition on his biblical theology (Rescue and Resistance 11). He was expelled from Germany for his â€Å"unruly behavior† in 1935. When people got on boats to sail to new countries, the exit of Europe did not always guarantee complete freedom from the Reich. If Jews were to get on a Germany controlled ship, they were technically on German land wherever they were. It was best to get on an American controlled ship, so that Germans had no control over what happened to it or its passengers while in operation (â€Å"Flight from the Reich†). If an emigrant was on a German controlled ship, like the St. Louis, problems could have occurred. This boat consisted to 900 or more people trying to go to Cuba. The government in Germany knew that Cuba had changed its mind about accepting these people yet they did not inform the passengers. When the boat got to Cuba, it was turned around with only 28 people admitted onto the island . The rest were sent back to Europe. Only half of those people sent back ended up surviving through the Holocaust (Voyage of the St. Louis). With the difficulty posed by the inability to obtain documents, and the process it actually took to get to a new country, emigration for Germans during this time period was seemingly impossible. Altogether, this time period was probably the most difficult time for a certain persecuted group of people to live. They were treated with utmost disrespect and extremely persecuted. Even though I am not a Jew myself, I feel extreme remorse for the Jews during this time period. Being able to relate to what these people went through is nearly impossible for anybody who would ever try to give themselves the task. These people are an example of how little wrong one must do in society to be treated in the most malicious of ways. The human race itself will always be the leading factor in the prevention of development, and this time period demonstrates this more than most others. When humans do and think like the Nazis did in the mid-1930s is when our race will reach ultimate failure. People do not deserve to be persecuted or mistreated, unless it is an earned treatment for negative behavior or acts. These Jews did nothing wrong, yet were treated worse by the Reich than any other people on the planet at the time. When looking for something to take away from this, one could take away the knowledge to know how destructive a simple persecution could become. It is not wise to single out any one group of people in any social context, due to the harmful global impacts made when this happened to the Jews. Humans are all born equally, and unfortunately are unable to treat each other as such. People should always be treated and given the title and rights they were born with. That title is a human being.

Treatment for Hypothyroidism

Treatment for Hypothyroidism Levothyroxine sodium is a synthetic thyroxine (T4) hormone, and is the mainstay of treatment for hypothyroidism and the suppression of thyroid stimulating hormone (TSH) in patients with thyroid cancer or after thyroidectomy.1 Two main properties of levothyroxine have contributed to a turbulent regulatory history. First, levothyroxine targets a narrow therapeutic range of T4 hormone and requires careful titration to a safe and effective dose.2 Second, levothyroxine is relatively unstable and its degradation is accelerated in response to environmental factors and in the presence of some inert product ingredients.3,4 Between 1991 and 1997 there were at least 10 recalls of different levothyroxine products mostly due to sub-potency or uncertain potency, comprising 150 lots and 100 million tablets.5 Although major regulatory changes were implemented to improve the quality and safety of levothyroxine products in 1997 and again in 2007,5-7 concerns persist about bioequivalence and variation in product potency.8 In a previous study of generic drug use from a nationally representative sample of commercial claims data in late 2013, we found that generic utilization of thyroid agents, mostly comprising levothyroxine, was 61%,9 despite the availability of generic preparations for >10 years. This utilization rate is markedly low given that overall generic uptake is approaching 90% in U.S.10 To encourage use of generic levothyroxine, more information is needed about the healthcare provider and patient barriers to uptake of generic preparations. We used a large electronic health records (EHR) database from a healthcare delivery system to evaluate measurable determinants of, and unexplained variation in, outpatient generic prescribing of levothyroxine. We hypothesized that both patient and provider factors contribute to generic levothyroxine prescribing and that residual variation in providers generic prescribing would persist after accounting for measurable factors. METHODS Race and ethnicity were captured by self-report during routine clinical practice in accordance with U.S. Census standards.13 We identified TSH laboratory results for each patient in the 12 months prior to the index prescription. In the case of multiple measurements, we chose the one closest to (but not after) the date that the index prescription was ordered. We also extracted information on other patient characteristics, including use of concomitant medications, insurance type, and clinical diagnoses. Insurance type was categorized as fee-for-service or preferred provider organization (FFS/PPO), health maintenance organization (HMO; including Medicare Advantage), Medicare, Medicaid, and unknown (including self-pay). For each patient, we calculated a Charlson Comorbidity Index (CCI) score based International Classification of Disease-9 encounter and problem-list diagnoses documented in the 12 months prior to the index prescription.14 We used 2010 U.S. Census block information to deter mine the median householdincome of the Census track in which patients reside as a proxy for socioeconomic status. We used information from the EHR database to characterize the index levothyroxine prescription. We classified the encounter at which the index prescription was ordered as an office or online/telephone encounter. The index prescription was classified as incident if there were no active prescriptions or pharmacy claims for this drug in the 12 months prior; otherwise it was classified as a renewal. For each patient, we quantified the duration of index prescription (recorded start date to the imputed end date, as determined by the prescribed daily dose, quantity dispensed, and number of refills). We quantified healthcare providers prescribing volume of levothyroxine by calculating the average number of levothyroxine prescriptions written per week in the three months prior to the index prescription for each patient. We also quantified healthcare providers total patient volume by calculating the average number of office encounters per week in the three months prior to the index prescription per patient. Statistical Methods We used mixed-effects multivariable logistic regression models to assess the relationship between generic prescribing of levothyroxine (dependent variable) and patient and prescription factors (level-1 predictor variables), and healthcare provider factors (level-2 predictor variables) (see Table 1). We assumed that patients with prescriptions from the same healthcare provider were more alike in their propensity to receive a generic than patients from different providers. Accordingly, we included random-effects (i.e., random intercepts) in our models for each prescribing healthcare provider of the index levothyroxine prescription (N=941). To quantify between-cluster variation, we calculated the intra-class correlation coefficient (ICC) in the absence of covariates (variance-components model) and in the presence of patient, prescription, and provider fixed-effect covariates (mixed-effects multivariable models). These models were also fitted separately by provider type (PCP and endocrin ologist). Odds ratios (OR) and 95% confidence intervals (CIs) were calculated for fixed-effect covariates. We derived predicted probabilities of receiving generic levothyroxine for each fixed-effect covariate from post-hoc estimation of adjusted means, holding all other variables constant.15 We included interaction terms in the mixed-effects multivariable model to examine effect modification by provider type for patient age, sex, race/ethnicity. When interactions were present, we calculated predicted probabilities of receiving generic levothyroxine for the covariate of interest stratified by provider type. Due to multiple comparisons within models, a P-value 220 days vs. 74% for prescriptions à ¢Ã¢â‚¬ °Ã‚ ¤60 days). Patients and providers may have been more accepting of generic levothyroxine when it would be taken for longer periods of time, reflecting lower cumulative out-of-pocket drug cost. The predicted probability of receiving generic levothyroxine was also higher for renewals than incident prescriptions (83 vs. 73%) and for online/telephone encounters versus office encounters (81% vs. 72%). These factors are related, as patients with a renewal more frequently receive levothyroxine during an online/telephone encounter than those with an incident prescription, yet they remained independent predictors of generic prescribing in the multivariable model. Among patients with a renewal, 84% received generic levothyroxine prior to the index prescription and, of those, the vast majority (92%) received a renewal for generic levothyroxine. It follows that patients were less likely to have been prescribed brand levothyroxine if they were already taking a generic. In a study of 36,832 older adults (à ¢Ã¢â‚¬ °Ã‚ ¥65 years) in the U.S. initiating narrow therapeutic index drugs, of which warfarin (48%) and levothyroxine (29%) were the most prevalent, predictors of higher generic drug initiation, included older age, male sex, higher comorbidity, lower Census block median household income, and prior generic utilization. These findings from a Medicare population are overall consistent with our results.23 In our study, bivariate analyses showed that HMO and Medicare beneficiaries were more likely to receive generic levothyroxine; however, this association was mitigated in the presence of other factors in multivariable analyses. We found that provider type was an effect modifier for the relationship between patient sex and generic prescribing of levothyroxine in multivariable models. In stratified analyses, while the predicted probability of receiving generic levothyroxine from a PCP was similar among women and men (81%, each), the probability of receiving a generic from an endocrinologist was disproportionately lower for women (63% vs. 71% for men). Because lower prescribing of generic levothyroxine was observed for endocrinologists but not PCPs, this occurrence is likely driven by provider rather than patient preferences. Future studies are warranted to understand these prescribing practices among endocrinologists. The results of this study should be interpreted in the context of several limitations. The retrospective, observational nature of this study prevents causal inferences. Furthermore, rates of generic prescribing of levothyroxine may overestimate generic utilization of this drug, as some patients may not consent to generic substitution at the pharmacy. Although California has a permissive generic substitution law, patients can still refuse a substitution. In the absence of pharmacy claims, we cannot know whether a generic or branded product was actually dispensed. Nevertheless, in a previous study we showed that our algorithm used to determine brand versus generic prescribing measured by EHR data performs well in predicting actual dispensing patterns.12 Thestudy setting is a healthcare delivery system in Northern California, and we cannot know if our findings are generalizable to other parts of the U.S.; however, the organization is a mixed-payer system, and operates much like other pr ovider-based delivery systems in the nation, without a single drug formulary. As such, we are confident that our findings are relevant to other similar health systems in the U.S. This study has several strengths. We used a relative large cohort of patients from a mixed-payer healthcare delivery system over a four-year period to examine patterns in and determinants of generic prescribing of levothyroxine. We leveraged extensive information from the health systems EHR database, including disease and medication history, TSH levels, and providers levothyroxine prescribing and patient volume. To our knowledge, this is the first study to quantify variation in generic prescribing of levothyroxine between healthcare providers. The presence of residual variation between providers in generic prescribing of levothyroxine, after controlling for important measurable confounders, indicates potential unwarranted variation due to prescribing preferences. Such variation, which may also be influenced by patient beliefs and preferences, can be the target of provider interventions or patient education aimed at improving levothyroxine generic uptake.