Science.gov

Sample records for afforded substantial protection

  1. Immunologic protection afforded by sunscreens in vitro.

    PubMed

    Davenport, V; Morris, J F; Chu, A C

    1997-06-01

    Several studies have suggested a lack of correlation between sunscreen sun protection factor and protection of the skin immune system, potentially allowing greater damage to the skin by removing the natural protective erythemal response to sun exposure. Despite this, routine testing of immune protection afforded by sunscreens is not performed by industry. Current laboratory methods for investigating the efficacy of sunscreen protection of epidermal immune function use the induction of contact hypersensitivity or epidermal cell alloantigen presentation. Animal models, cell culture systems, and in vivo human studies are commonly employed, but all these systems have significant drawbacks for use in routine testing. The purpose of this study was to develop an in vitro system for testing the immunologic protection afforded by sunscreens in human skin. Five test sunscreens plus a vehicle control were tested in a "blind" fashion for their in vitro level of immune protection. Creams were applied in a standard manner to human whole skin explants and were irradiated over a range of physiologic doses using an Oriel solar simulator. A mixed epidermal lymphocyte reaction was used to quantify epidermal alloantigen-presenting capacity, in the presence or absence of test cream, for five explants. Results consistently demonstrated that all the test sunscreens protected beyond their designated sun protection factors, whereas the vehicle conferred no protection. The explant-mixed epidermal lymphocyte reaction system gave consistent, reproducible results and may prove useful for the allocation of an immune protection factor to all sunscreens. PMID:9182811

  2. Crashworthy Seats Would Afford Superior Protection

    NASA Technical Reports Server (NTRS)

    Gohmert, Dustin

    2009-01-01

    Seats to prevent or limit crash injuries to astronauts aboard the crew vehicle of the Orion spacecraft are undergoing development. The design of these seats incorporates and goes beyond crash-protection concepts embodied in prior spacecraft and racing-car seats to afford superior protection against impacts. Although the seats are designed to support astronauts in a recumbent, quasi-fetal posture that would likely not be suitable for non-spacecraft applications, parts of the design could be adapted to military and some civilian aircraft seats and to racing car seats to increase levels of protection. The main problem in designing any crashworthy seat is to provide full support of the occupant against anticipated crash and emergency-landing loads so as to safely limit motion, along any axis, of any part of the occupant s body relative to (1) any other part of the occupant s body, (2) the spacecraft or other vehicle, and (3) the seat itself. In the original Orion spacecraft application and in other applications that could easily be envisioned, the problem is complicated by severe limits on space available for the seat, a requirement to enable rapid egress by the occupant after a crash, and a requirement to provide for fitting of the seat to a wide range of sizes and shapes of a human body covered by a crash suit, space suit, or other protective garment. The problem is further complicated by other Orion-application-specific requirements that must be omitted here for the sake of brevity. To accommodate the wide range of crewmember body lengths within the limits on available space in the original Orion application, the design provides for taller crewmembers to pull their legs back closer toward their chests, while shorter crewmembers can allow their legs to stretch out further. The range of hip-support seat adjustments needed to effect this accommodation, as derived from NASA s Human Systems Integration Standard, was found to define a parabolic path along which the knees

  3. Medicaid 'welcome-mat' effect of Affordable Care Act implementation could be substantial.

    PubMed

    Sonier, Julie; Boudreaux, Michel H; Blewett, Lynn A

    2013-07-01

    The Affordable Care Act will have important impacts on state Medicaid programs, likely increasing participation among populations that are currently eligible but not enrolled. The size of this "welcome-mat" effect is of concern for two reasons. First, the eligible but uninsured constitute a substantial share of the uninsured population in some states. Second, the newly eligible population will affect states' Medicaid caseloads and budgets. Using the Massachusetts 2006 health reforms as a case study and controlling for other factors, we found that among low-income parents who were previously eligible for Medicaid in Massachusetts, Medicaid enrollment increased by 16.3 percentage points, and Medicaid participation by those without private coverage increased by 19.4 percentage points, in comparison to a group of control states. In many states the potential size of the welcome-mat effect could be even larger than what we observed in Massachusetts. Our analysis has potentially important implications for other states attempting to predict the impact of this effect on their budgets. PMID:23804584

  4. Patient Protection and Affordable Care Act

    THOMAS, 111th Congress

    Rep. Rangel, Charles B. [D-NY-15

    2009-09-17

    03/23/2010 Became Public Law No: 111-148. (TXT | PDF) (All Actions) Notes: H.R.4872 makes a number of health-related financing and revenue changes to this bill. Read together, this bill and the health care-related provisions of H.R.4872 are commonly referred to as the Affordable Care Act (ACA). Tracker: This bill has the status Became LawHere are the steps for Status of Legislation:

  5. Combined Regional Investments Could Substantially Enhance Health System Performance And Be Financially Affordable.

    PubMed

    Homer, Jack; Milstein, Bobby; Hirsch, Gary B; Fisher, Elliott S

    2016-08-01

    Leaders across the United States face a difficult challenge choosing among possible approaches to transform health system performance in their regions. The ReThink Health Dynamics Model simulates how alternative scenarios could unfold through 2040. This article compares the likely consequences if four interventions were enacted in layered combinations in a prototypical midsize US city. We estimated the effects of efforts to deliver higher-value care; reinvest savings and expand global payment; enable healthier behaviors; and expand socioeconomic opportunities. Results suggest that there may be an effective and affordable way to unlock much greater health and economic potential, ultimately reducing severe illness by 20 percent, lowering health care costs by 14 percent, and improving economic productivity by 9 percent. This would require combined investments in clinical and population-level initiatives, coupled with financial agreements that reduce incentives for costly care and reinvest a share of the savings to ensure adequate long-term financing. PMID:27503969

  6. 77 FR 33133 - Patient Protection and Affordable Care Act; Data Collection To Support Standards Related to...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-05

    ... HUMAN SERVICES 45 CFR Part 156 RIN 0938-AR36 Patient Protection and Affordable Care Act; Data Collection... the Patient Protection and Affordable Care Act (Affordable Care Act), which directs the Secretary of... Services (the Secretary). The Affordable Care Act directs that the EHB reflect the scope of...

  7. New affordable options for infrastructure and asset protection

    SciTech Connect

    2009-09-15

    Securitas is one of the leaders evolving with technology and delivering new forms of affordable security for mining facilities. It was called in to protect a large mothballed coal mine in the central USA, the victim of repeated thefts. First, Mobile Surveillance Units (MSUs) were installed but thefts continued. Later, a new wireless video security system called Videofied which used MotionViewers which use infrared detectors to detect movement and send a 10 second clip of the intrusion to an operator. This led to the thieves being caught. 2 photos.

  8. 77 FR 70643 - Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-26

    ... Protection and Affordable Care Act; Standards Related to Essential Health Benefits, Actuarial Value, and... Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits, Actuarial... Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation...

  9. 77 FR 31513 - Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-29

    ... HUMAN SERVICES 45 CFR Parts 155, 156, and 157 RIN 0938-AQ67 Patient Protection and Affordable Care Act... Federal Register on March 27, 2012, entitled ``Patient Protection and Affordable Care Act; Establishment... rule regarding the codification of section 1413(c) of the Affordable Care Act. To align the...

  10. 78 FR 15553 - Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-11

    ... Care Act; Establishment of Exchanges and Qualified Health Plans; Proposed Rule, 76 FR 41866 (July 15...) Requirements Under the Patient Protection and Affordable Care Act; Interim Final Rule, 75 FR 74864, 74918-20... of the Patient Protection and Affordable Care Act and the Health Care and Education...

  11. Measuring the skin dose protection afforded by protective apparel with a beta spectrometer

    SciTech Connect

    Martz, D.E.; Rich, B.L.; Johnson, L.O. )

    1986-10-01

    This paper reports that the protective apparel worn by radiation workers to avoid skin contamination also provides measurable protection against external beta sources. The beta contribution to the skin dose rate depends on the residual energy spectrum of the beta particles after they have penetrated the protective apparel. The shift in the beta energy spectra and consequent reduction in the shallow dose rates afforded by various items of protective apparel were investigated for a few laboratory beta sources using a beta spectrometer that is capable of dose calculations. The results presented here indicate that significant dose rates to the skin can occur despite the presence of protective apparel if high energy beta emitting isotopes are present.

  12. 78 FR 25591 - Patient Protection and Affordable Care Act; Establishment of the Multi-State Plan Program for the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-02

    ... MANAGEMENT 45 CFR Part 800 RIN 3206-AM47 Patient Protection and Affordable Care Act; Establishment of the... Protection and Affordable Care Act; Establishment of the Multi-State Plan Program for the Affordable... 11, 2013 (78 FR 15560) and the final rule correction published March 26, 2013 (78 FR 18246)...

  13. 78 FR 18246 - Patient Protection and Affordable Care Act; Establishment of the Multi-State Plan Program for the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-26

    ... MANAGEMENT 45 CFR Part 800 RIN 3206-AM47 Patient Protection and Affordable Care Act; Establishment of the..., entitled ``Patient Protection and Affordable Care Act; Establishment of the Multi-State Plan Program for... defined in section 1402(b) of the Affordable Care Act.'' 8. On Web page 15568, in the third column,...

  14. Bioassay of thermal protection afforded by candidate flight suit fabrics.

    PubMed

    Knox, F S; Wachtel, T L; McCahan, G R

    1979-10-01

    The United States Army Aeromedical Research Laboratory (USAARL) porcine cutaneous bioassay technique was used to determine what mitigating effect four thermally protective flight suit fabrics would have on fire-induced skin damage. The fabrics were 4.8-ox twill weave Nomex aramide, 4.5-oz stabilized twill weave polybenzimidazole, 4.8-oz plain weave experimental high-temperature polymer (HT4), and 4.8-oz plain weave Nomex aramide (New Weave Nomex or NWN). Each fabric sample was assayed 20 times in each of four configurations: as a single layer in contact with the skin; as a single layer with a 6.35 mm (0.25 in) air gap between fabric and skin; in conjuction with a cotton T-shirt with no air gaps; and, finally, in conjuction with a T-shirt with a 6.35 mm air gap between T-shirt and fabric. Bare skin was used as a control. A JP-4 fueled furnace was used as a thermal source and was adjested to deliver a mean heat flux of 3.07 cal/cm2/s. The duration of exposure was 5 s. Four hundred burn sites were graded using clinical observation and microscopic techniques. Used as single layers, none of the fabrics demonstrated superiority in providing clinically significant protection. When used with a cotton T-shirt, protection was improved. Protection improved progressively for all fabrics and configuration when an air gap was introduced. The experimental high-temperature polymer consistently demonstrated lower heat flux transmission in all configurations, but did not significantly reduce clinical burns. PMID:518445

  15. 16 CFR 1061.8 - Information on the heightened degree of protection afforded.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Information on the heightened degree of protection afforded. 1061.8 Section 1061.8 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL APPLICATIONS FOR EXEMPTION FROM PREEMPTION § 1061.8 Information on the heightened degree of protection...

  16. The Patient Protection and Affordable Care Act's Effect on Emergency Medicine: A Synthesis of the Data.

    PubMed

    Medford-Davis, Laura N; Eswaran, Vidya; Shah, Rohan M; Dark, Cedric

    2015-11-01

    This review synthesizes the existing literature to provide evidence-based predictions for the future of emergency care in the United States as a result of the Patient Protection and Affordable Care Act, with a focus on emergency department (ED) visit volume, acuity, and reimbursement. Patient behavior will likely be quite different for patients gaining Medicaid than for those gaining private insurance through the Marketplaces. Despite the threat of the individual mandate, not all uninsured patients will enroll, and those who choose to enroll will likely be a different population from those who remain uninsured. New Medicaid enrollees will be a sicker population and will likely increase their number of ED visits substantially. Their acuity will be higher at first but will then revert to the traditionally high number of low-acuity visits made by Medicaid patients. Most patients enrolling through the Marketplace are choosing high-deductible health plans, and they will initially avoid the ED because of high out-of-pocket costs but may present later and sicker after self-rationing their care. Most patients gaining health coverage through the Affordable Care Act will be shifting from uninsured to either Medicaid or private insurance, both of which reimburse more than self-pay, so ED collections should increase. Because of the differences between Medicaid and Marketplace plans, there will be a difference in ED volume, acuity, and financial outcomes, depending on states' current demographics, whether states expand Medicaid, and how aggressively states advertise new options for coverage in Medicaid or state health insurance Marketplaces. PMID:25976250

  17. What Criteria Do Child Protective Services Investigators Use to Substantiate Exposure to Domestic Violence?

    ERIC Educational Resources Information Center

    Coohey, Carol

    2007-01-01

    The primary purpose of this study is to determine whether child protective services investigators apply a recognizable set of criteria to substantiate batterers and victims of battering for exposing their children to domestic violence. Although domestic violence occurred in 35% of the 1,248 substantiated incidents of child maltreatment, only 31…

  18. 78 FR 75581 - Patient Protection and Affordable Care Act; Establishment of the Multi-State Plan Program for the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-12

    ... MANAGEMENT Patient Protection and Affordable Care Act; Establishment of the Multi-State Plan Program for the... Affordable Care Act; Establishment of the Multi-State Plan Program for the Affordable Insurance Exchanges... Act of 2008; Technical Amendment to External Review for Multi-State Plan Program'' (78 FR 68240)....

  19. 78 FR 76212 - Patient Protection and Affordable Care Act; Maximizing January 1, 2014 Coverage Opportunities

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-17

    ...; Exchange Standards for Employers (77 FR 18310),\\1\\ hereinafter referred to as the Exchange Establishment...; Exchange Standards for Employers, 77 FR 18310 (March 27, 2012). \\2\\ Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review, 78 FR 13406 (February 27, 2013), hereinafter...

  20. The Patient Protection and Affordable Care Act: The Role of the School Nurse. Position Statement

    ERIC Educational Resources Information Center

    Combe, Laurie G.; Sharpe, Susan; Feeser, Cynthia Jo; Ondeck, Lynnette; Fekaris, Nina

    2015-01-01

    It is the position of the National Association of School Nurses (NASN) that the registered professional school nurse (hereinafter referred to as school nurse) serves a vital role in the delivery of health care to our nation's students within the healthcare system reshaped by the Patient Protection and Affordable Care Act of 2010, commonly known as…

  1. 78 FR 65045 - Patient Protection and Affordable Care Act; Program Integrity: Exchange, Premium Stabilization...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-30

    ... Programs, and Market Standards'' (78 FR 37032), which was published in the Federal Register on June 19... Federal Register on March 11, 2013 (78 FR 15541), related to risk corridors and cost-sharing reduction..., 77 FR 18310 (March 27, 2012). \\2\\ Patient Protection and Affordable Care Act; Standards Related...

  2. 78 FR 13405 - Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-27

    ... Care Act; Health Insurance Market Rules; Rate Review'' (77 FR 70584). These standards apply to health... Essential Health Benefits, Actuarial Value, and Accreditation'' (77 FR 70644), herein referred to as the EHB.... Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review; Final Rule...

  3. 77 FR 28790 - Medical Loss Ratio Requirements Under the Patient Protection and Affordable Care Act

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-16

    ... Patient Protection and Affordable Care Act (75 FR 34538) published on June 17, 2010, it was estimated that... on May 5, 2010 (75 FR 24470) relating to the Federal health care reform insurance Web Portal... Federal Register on April 14, 2010 (75 FR 19297). On December 1, 2010, the Department of Health and...

  4. Comments on "How Child Protective Services Investigators Decide to Substantiate Mothers for Failure-to-Protect in Sexual Abuse Cases"

    ERIC Educational Resources Information Center

    Shadoin, Amy L.; Carnes, Connie N.

    2006-01-01

    This commentary discusses the decisions of child protective service (CPS) investigators to substantiate mothers for failure-to-protect (FTP) in child sexual abuse cases. Four areas are identified in which the scientific literature remains inadequate to fully inform child maltreatment researchers, CPS practitioners and child welfare policymakers on…

  5. Patient Protection and Affordable Care Act; program integrity: Exchange, SHOP, and eligibility appeals. Final rule.

    PubMed

    2013-08-30

    This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act). Specifically, this final rule outlines Exchange standards with respect to eligibility appeals, agents and brokers, privacy and security, issuer direct enrollment, and the handling of consumer cases. It also sets forth standards with respect to a State's operation of the Exchange and Small Business Health Options Program (SHOP). It generally is finalizing previously proposed policies without change. PMID:23991479

  6. Women's Awareness of Their Contraceptive Benefits Under the Patient Protection and Affordable Care Act.

    PubMed

    Chuang, Cynthia H; Mitchell, Julie L; Velott, Diana L; Legro, Richard S; Lehman, Erik B; Confer, Lindsay; Weisman, Carol S

    2015-11-01

    The Patient Protection and Affordable Care Act mandates that there be no out-of-pocket cost for Food and Drug Administration-approved contraceptive methods. Among 987 privately insured reproductive aged Pennsylvania women, fewer than 5% were aware that their insurance covered tubal sterilization, and only 11% were aware that they had full coverage for an intrauterine device. For the Affordable Care Act contraceptive coverage mandate to affect effective contraception use and reduce unintended pregnancies, public awareness of the expanded benefits is essential. PMID:26447910

  7. Women’s Awareness of Their Contraceptive Benefits Under the Patient Protection and Affordable Care Act

    PubMed Central

    Mitchell, Julie L.; Velott, Diana L.; Legro, Richard S.; Lehman, Erik B.; Confer, Lindsay; Weisman, Carol S.

    2015-01-01

    The Patient Protection and Affordable Care Act mandates that there be no out-of-pocket cost for Food and Drug Administration–approved contraceptive methods. Among 987 privately insured reproductive aged Pennsylvania women, fewer than 5% were aware that their insurance covered tubal sterilization, and only 11% were aware that they had full coverage for an intrauterine device. For the Affordable Care Act contraceptive coverage mandate to affect effective contraception use and reduce unintended pregnancies, public awareness of the expanded benefits is essential. PMID:26447910

  8. Opportunities for oncology in the Patient Protection and Affordable Care Act.

    PubMed

    Patel, Kavita K; Tran, Lisa

    2013-01-01

    The Patient Protection and Affordable Care Act (ACA) contains within it three significant legislative constructs: to enhance access to health care, improve quality, and decrease cost. Also known as the Triple Aim, these three simple, yet monumental, goals have been the object of actions to date as well as future implementation efforts. This article will identify sections of the legislation that would directly provide areas of opportunity to improve health and achieve the triple aim for the oncology profession. PMID:23714567

  9. The Patient Protection and Affordable Care Act - The Role of the School Nurse: Position Statement.

    PubMed

    2015-07-01

    It is the position of the National Association of School Nurses that the registered professional school nurse (hereinafter referred to as the school nurse) serves a vital role in the delivery of health care to our nation’s students within the health care system reshaped by the Patient Protection and Affordable Care Act of 2010, commonly known as the Affordable Care Act (ACA). This law presents an opportunity to transform the health care system through three primary goals: expanding access, improving quality, and reducing cost (U.S. Government Printing Office, 2010). School nurses stand at the forefront of this system change and continue to provide evidence-based, quality interventions and preventive care that, according to recent studies, actually save health care dollars (Wang et al., 2014). NASN supports the concept that school nursing services receive the same financial parity as other health care providers to improve overall health outcomes, including insurance reimbursement for services provided to students. PMID:25926418

  10. Undocumented and uninsured: aftereffects of the Patient Protection and Affordable Care Act.

    PubMed

    Agabin, Nataly; Coffin, Janis

    2015-01-01

    Although with the implementation of the Patient Protection and Affordable Care Act millions of previously uninsured American residents will gain access to healthcare coverage, millions more will remain uninsured due to the lack of mandatory state Medicaid expansion as well as mandates that forbid undocumented immigrants and legal residents of less than five years from purchasing insurance through the newly available market exchange. With limited options for healthcare coverage due to employment and lack of citizen status, undocumented immigrants rely heavily on funds provided by both Emergency Medicaid and Disproportionate Share Hospital programs. Through reevaluation of current funding, mandates forbidding access to market exchanges, and plans to further enable access to affordable health coverage, states have the unique opportunity to both aid their residents and relieve the financial burden on healthcare facilities and Emergency Medicaid funds. PMID:26062333

  11. Multidisciplinary Child Protection Decision Making About Physical Abuse: Determining Substantiation Thresholds and Biases

    PubMed Central

    Jent, Jason F.; Eaton, Cyd K.; Knickerbocker, Lauren; Lambert, Walter F.; Merrick, Melissa T.; Dandes, Susan K.

    2011-01-01

    The current study examined the threshold at which multidisciplinary child protection team (CPT) professionals substantiate physical abuse allegations and the extent that they utilize potentially biased constructs in their decision making when presented with the same case evidence. State legal definitions of child maltreatment are broad. Therefore, the burden of interpretation is largely on CPT professionals who must determine at what threshold physical acts by parents surpass corporal discipline and constitute child physical abuse. Biased or subjective decisions may be made if certain case-specific characteristics or CPT professionals’ personal characteristics are used in making physical abuse determinations. Case vignettes with visual depictions of inflicted injuries were sent to CPT professionals in Florida and their substantiation decisions, personal beliefs about corporal discipline, and coercive discipline were collected. Results of the study demonstrated relatively high agreement among professionals across vignettes about what constitutes physical abuse. Further, CPT professionals strongly considered their perceptions of the severity of inflicted injuries in substantiation decisions. Although case specific characteristics did not bias decisions in a systematic way, some CPT professional characteristics influenced the substantiation of physical abuse. Practice implications and future directions of research are discussed. PMID:21804681

  12. How the Patient Protection and Affordable Care Act affects Texas dentists.

    PubMed

    Oneacre, Lee P

    2012-10-01

    President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA) into law March 23, 2010 (P.L. 111-148), as arguably the most significant legislative health reform since the creation of Medicare and Medicaid in 1965 (1). Several PPACA provisions will impact dentists as both health care providers and small business owners and employers (2). Overall, the law significantly changes health care financing and facilitates competition in the health insurance market place through the creation of health insurance exchanges (HIX). PMID:23311030

  13. Does Breastfeeding Protect Against Substantiated Child Abuse and Neglect? A 15-Year Cohort Study

    PubMed Central

    Strathearn, Lane; Mamun, Abdullah A.; Najman, Jake M.; O'Callaghan, Michael J.

    2008-01-01

    Objectives Child maltreatment is associated with multiple adverse developmental outcomes in children. Surprisingly, the most frequently reported perpetrator is the biological mother. Understanding early relationship factors that may help prevent maltreatment is of utmost importance. We explored whether breastfeeding may protect against maternally-perpetrated child maltreatment. Methods 7223 Australian mother-infant pairs were followed prospectively over 15 years. In 6621 cases (91.7%), the duration of breastfeeding was analyzed with respect to child maltreatment (including neglect, physical abuse and emotional abuse), based on substantiated child protection agency reports. Multinomial logistic regression was used to compare no maltreatment with non-maternal and maternally-perpetrated maltreatment, and to adjust for confounding in 5890 cases with complete data (81.5%). Potential confounders included sociodemographic factors, pregnancy wantedness, substance abuse during pregnancy, postpartum employment, attitudes regarding infant caregiving, and symptoms of anxiety or depression. Results Of 512 children with substantiated maltreatment reports, over 60% experienced at least one episode of maternally-perpetrated abuse or neglect (4.3% of cohort). The odds ratio (OR) for maternal maltreatment increased as breastfeeding duration decreased, with the odds of maternal maltreatment in non-breastfed children 4.8 times the odds for children breastfed 4 or more months (95% Confidence Interval [CI] 3.3−6.9). After adjusting for confounding, the odds for non-breastfed infants remained 2.6 times higher (95% CI 1.7−3.9), with no association seen between breastfeeding and non-maternal maltreatment. Maternal neglect was the only maltreatment subtype independently associated with breastfeeding duration (adjusted OR 3.8, 95% CI 2.1−7.0). Conclusion Among other factors, breastfeeding may also help to protect against maternally-perpetrated child maltreatment, particularly child

  14. The Patient Protection and Affordable Care Act: what every provider of gynecologic oncology care should know.

    PubMed

    Duska, Linda R; Engelhard, Carolyn L

    2013-06-01

    The Patient Protection and Affordable Care Act (ACA) was signed into law by President Barack Obama in 2010. While initial implementation of the law began shortly thereafter, the full implementation will take place over the next few years. With respect to cancer care, the act was intended to make care more accessible, affordable, and comprehensive across different parts of the country. For our cancer patients and our practices, the ACA has implications that are both positive and negative. The Medicaid expansion and access to insurance exchanges are intended to increase the number of insured patients and thus improve access to care, but many states have decided to opt out of the Medicaid program and in these states access problems will persist. Screening programs will be put in place for insured patients but may supplant federally funded programs that are currently in place for uninsured patients and may not follow current screening guidelines. Both hospice and home health providers will be asked to provide more services with less funding, and quality measures, including readmission rates, will factor into reimbursement. Insured patients will have access to all phases of clinical trial research. There is a need for us as providers of Gynecologic Oncology care to be active in the implementation of the ACA in order to ensure that our patients and our practices can survive and benefit from the changes in health care reimbursement, with the ultimate goals of improving access to care and quality while reducing unsustainable costs. PMID:23500090

  15. Right-wing conspiracy? Socialist plot? The origins of the Patient Protection and Affordable Care Act.

    PubMed

    Quadagno, Jill

    2014-02-01

    On March 23, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act (ACA). Did the ACA signify a government takeover of the health care system, a first step on the road to socialism, as conservative critics charged? Or was it, rather, a sellout to the right wing, as liberal single-payer advocates proclaimed? The ACA's key provisions, the employer mandate and the individual mandate, were Republican policy ideas, and its fundamental principles were nearly identical to the Health Equity and Access Reform Today Act of 1993 (HEART), a bill promoted by Republican senators to deflect support for President Bill Clinton's Health Security plan. Yet the ACA was also a policy legacy of the Clinton administration in important ways that rarely are acknowledged, notably Medicaid expansion and insurance company regulation. Although the ACA departed from the liberal vision of a single-payer plan and adhered closely to the objectives of those who believed that the health care system should encourage the free market, it included provisions that will make coverage more affordable, reliable, and accessible. PMID:24193605

  16. Patient Protection and Affordable Care Act; establishment of exchanges and qualified health plans; Small Business Health Options Program. Final rule.

    PubMed

    2013-06-01

    This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act) related to the Small Business Health Options Program (SHOP). Specifically, this final rule amends existing regulations regarding triggering events and special enrollment periods for qualified employees and their dependents and implements a transitional policy regarding employees' choice of qualified health plans (QHPs) in the SHOP. PMID:23734400

  17. Patient navigator programs, cancer disparities, and the patient protection and affordable care act.

    PubMed

    Moy, Beverly; Chabner, Bruce A

    2011-01-01

    Patients in vulnerable population groups suffer disproportionately from cancer. The elimination of cancer disparities is critically important for lessening the burden of cancer. Patient navigator programs have been shown to improve clinical outcomes. Among its provisions relevant to disparities in cancer care, The Patient Protection and Affordability Care Act authorizes continued funding of patient navigator programs. However, given the current economic and political environment, this funding is in jeopardy. This article describes patient navigator programs and summarizes the elements of the health care law that are relevant to these programs. It is vital that the entire oncology community remain committed to leading efforts toward the improvement of cancer care among our most vulnerable patients. PMID:21804070

  18. The Patient Protection and Affordable Care Act of 2010: impact on otolaryngology practice and research.

    PubMed

    Sun, Gordon H; Davis, Matthew M

    2012-05-01

    The Patient Protection and Affordable Care Act (PPACA) was signed into law by President Barack Obama on March 23, 2010. Since its passage, the PPACA has led to increased health insurance coverage for millions more Americans, and it includes provisions leading to new avenues for clinical and health services research funding. The legislation also favors development of the primary care specialties and general surgery, increased training of midlevel health care providers, and medical training and service in underserved areas of the United States. However, the PPACA does not effectively engage otolaryngologists in quality improvement, despite modifications to the Physician Quality Reporting System. The legislation also levies a tax on cosmetic procedures, affecting both clinicians and patients. This article reviews the sections of the PPACA that are most pertinent to otolaryngologists and explains how these components of the bill will affect otolaryngologic practice and research over the coming decade. PMID:22282865

  19. The Patient Protection and Affordable Care Act and Reproductive Health: Harnessing Data to Improve Care

    PubMed Central

    Stulberg, Debra

    2013-01-01

    The Patient Protection and Affordable Care Act (PPACA) has great potential to improve reproductive health through several components: expanded coverage of people of reproductive age; required coverage of many reproductive health services; and insurance exchange structures that encourage individuals and states to hold plans and providers accountable. These components can work together to improve reproductive health. But in order for this to work, consumers and states need information with which to assess plans. This review article summarizes state contracting theory and argues that states should use this structure to require health plans to collect and report meaningful data that patients, providers, plans, payers, and third-party researchers can access. Now that the Supreme Court has upheld the PPACA and states must set up health insurance exchanges, populations can benefit from improved care and outcomes through data transparency. PMID:23262767

  20. A systems thinking approach to analysis of the Patient Protection and Affordable Care Act.

    PubMed

    Williams, John C

    2015-01-01

    The public health community is challenged with understanding the many complexities presented by systems thinking and its applications in systems modeling. The model presented encompasses multiple variables needed (eg, model building) for the construction of a conceptual system model of the Patient Protection and Affordable Care Act (ACA). The model tracks the ACA from inception, through passage, March 2010, to its current state. Justification for the need to reform the current health care system rests, in part, on the heels of social justice. Proponents of the ACA have long argued that health reform was needed by the millions of uninsured person who suffered from health disparities, took little advantage of health prevention advice, and faced issues of access to providers as well as insurers. In addition the ACA seeks to address our uncontrollable spending on health care delivery. This article highlights the ACA from a systems perspective. The conceptual model presented encompasses both health reform variables (eg, health care provisions, key legislative components, system environment) and system variables (eg, inputs, outputs, feedback, and throughput) needed to understand current health care reform efforts from a systems perspective. The model presented shows how the interrelationships and interconnections of elements of a system come together to achieve its purpose or goal. PMID:25414950

  1. Patient Protection and Affordable Care Act of 2010: a primer for neurointerventionalists.

    PubMed

    Manchikanti, Laxmaiah; Hirsch, Joshua A

    2012-03-01

    The Patient Protection and Affordable Care Act (the ACA, for short) became law on 23 March 2010. It represents the most significant transformation of the American healthcare system since Medicare and Medicaid. Essentials of ACA include: (1) a mandate for individuals and businesses requiring as a matter of law that nearly every American has an approved level of health insurance or pay a penalty; (2) a system of federal subsidies to completely or partially pay for the now required health insurance for ∼34 million Americans who are currently uninsured-subsidized through Medicaid and Exchanges; (3) extensive new requirements on the health insurance industry and (4) changes in the practice of medicine. The Act is divided into 10 titles. It contains provisions that went into effect starting on 21 June 2010 with many of the provisions going into effect in 2014 and later. The ACA goes well beyond insurance and payment reform. Practicing physicians will potentially be impacted by the Independent Payment Advisory Board and the Patient Centered Outcomes Research Institute. PMID:21990501

  2. Health Education Specialists' Knowledge, Attitudes, and Perceptions of the Patient Protection and Affordable Care Act.

    PubMed

    Strong, Jessica; Hanson, Carl L; Magnusson, Brianna; Neiger, Brad

    2016-03-01

    The changing landscape of health care as a result of the Patient Protection and Affordable Care Act (ACA) may provide new opportunities for health education specialists (HES). The purpose of this study was to survey HES in the United States on their knowledge and attitudes of the ACA and assess their perceptions of job growth under the law. A random sample of 220 (36% response rate) certified HES completed a 53-item cross sectional survey administered online through Qualtrics. Findings were compared to public opinion on health care reform. HES are highly favorable of the law (70%) compared to the general public (23%). A total of 85% of respondents were able to list a provision of the ACA, and most (81%) thought the ACA would be successful at increasing insured Americans. Over half (64.6%) believe job opportunities will increase. Those who viewed the law favorably were significantly more likely to score better on a knowledge scale related to the ACA. HES understand publicized provisions but are uncertain about common myths and specific provisions related to Title IV, "Prevention of Chronic Disease and Improving Public Health." Directed and continuing education to HES regarding the ACA is warranted. PMID:26272884

  3. The Patient Protection and Affordable Care Act: the victory of unorthodox lawmaking.

    PubMed

    Beaussier, Anne-Laure

    2012-10-01

    The 2010 Patient Protection and Affordable Care Act was a major legislative achievement of the 111th Congress. This law structurally reforms the US health care system by encouraging universal health care coverage through regulated competition among private insurance companies. When looking at the process for reform, what strikes an observer of US health care policy in the first place is that the Democratic majority was able to enact something in a political field characterized by strong resistance to change. This article builds on that observation. Arguments concentrate on the legislative process of the reform and support the idea that it may be partly explained by considering an evolution of US legislative institutions, mostly in the sense of a more centralized legislative process. Based on approximately one hundred semidirected interviews, I argue that the Democratic majority, building on lessons from both President Bill Clinton's health care reform attempt and the Republicans' strategy of using strong congressional leadership to pass social reforms, was able to overcome institutional constraints that have long prevented comprehensive change. A more centralized legislative process, which has been described as "unorthodox lawmaking," enabled the Democratic leadership to overcome multiple institutional and political veto players. PMID:22700946

  4. Racial and Ethnic Disparities in Services and the Patient Protection and Affordable Care Act

    PubMed Central

    Abdus, Salam; Mistry, Kamila B.

    2015-01-01

    Objectives. We examined prereform patterns in insurance coverage, access to care, and preventive services use by race/ethnicity in adults targeted by the coverage expansions of the Patient Protection and Affordable Care Act (ACA). Methods. We used pre-ACA household data from the Medical Expenditure Panel Survey to identify groups targeted by the coverage provisions of the Act (Medicaid expansions and subsidized Marketplace coverage). We examined racial/ethnic differences in coverage, access to care, and preventive service use, across and within ACA relevant subgroups from 2005 to 2010. The study took place at the Agency for Healthcare Research and Quality in Rockville, Maryland. Results. Minorities were disproportionately represented among those targeted by the coverage provisions of the ACA. Targeted groups had lower rates of coverage, access to care, and preventive services use, and racial/ethnic disparities were, in some cases, widest within these targeted groups. Conclusions. Our findings highlighted the opportunity of the ACA to not only to improve coverage, access, and use for all racial/ethnic groups, but also to narrow racial/ethnic disparities in these outcomes. Our results might have particular importance for states that are deciding whether to implement the ACA Medicaid expansions. PMID:26447920

  5. Childhood Cancer Survivors' Familiarity With and Opinions of the Patient Protection and Affordable Care Act

    PubMed Central

    Warner, Echo L.; Park, Elyse R.; Stroup, Antoinette; Kinney, Anita Y.; Kirchhoff, Anne C.

    2013-01-01

    Purpose: The Patient Protection and Affordable Care Act (ACA) offers avenues to increase insurance options and access to care; however, it is unknown whether populations with pre-existing conditions, such as cancer survivors, will benefit from the expanded coverage options. We explored childhood cancer survivors' familiarity with and opinion of the ACA to understand how survivors' insurance coverage may be affected. Materials and Methods: From April to July 2012 we conducted in-depth, semistructured telephone interviews with 53 adult survivors recruited from the Utah Cancer SEER Registry. Participants were randomly selected from sex, age, and rural/urban strata and were younger than 21 years at time of diagnosis. Interviews were recorded, transcribed, and analyzed with NVivo 9 by two coders (kappa = 0.94). We report on the 49 participants who had heard of the ACA. Results: Most survivors were unaware of ACA provisions beyond the insurance mandate. Few knew about coverage for children up to age 26 or pre-existing insurance options. Although one third believed the ACA could potentially benefit them via expanded insurance coverage, many were concerned that the ACA would lead to rising health care costs and decreasing quality of care. Survivors had concerns specific to their cancer history, including fears of future health care rationing if they developed subsequent health problems. Conclusion: Childhood cancer survivors have a low level of familiarity with the ACA and are unaware of how it may affect them given their cancer history. These survivors require targeted education to increase knowledge about the ACA. PMID:23943900

  6. Chemokine-adjuvanted electroporated DNA vaccine induces substantial protection from simian immunodeficiency virus vaginal challenge.

    PubMed

    Kutzler, M A; Wise, M C; Hutnick, N A; Moldoveanu, Z; Hunter, M; Reuter, M A; Yuan, S; Yan, J; Ginsberg, A A; Sylvester, A; Pahar, B; Carnathan, D G; Kathuria, N; Khan, A S; Montefiori, D; Sardesai, N Y; Betts, M R; Mestecky, J; Marx, P A; Weiner, D B

    2016-01-01

    There have been encouraging results for the development of an effective HIV vaccine. However, many questions remain regarding the quality of immune responses and the role of mucosal antibodies. We addressed some of these issues by using a simian immunodeficiency virus (SIV) DNA vaccine adjuvanted with plasmid-expressed mucosal chemokines combined with an intravaginal SIV challenge in rhesus macaque (RhM) model. We previously reported on the ability of CCR9 and CCR10 ligand (L) adjuvants to enhance mucosal and systemic IgA and IgG responses in small animals. In this study, RhMs were intramuscularly immunized five times with either DNA or DNA plus chemokine adjuvant delivered by electroporation followed by challenge with SIVsmE660. Sixty-eight percent of all vaccinated animals (P<0.01) remained either uninfected or had aborted infection compared with only 14% in the vaccine naïve group. The highest protection was observed in the CCR10L chemokines group, where six of nine animals had aborted infection and two remained uninfected, leading to 89% protection (P<0.001). The induction of mucosal SIV-specific antibodies and neutralization titers correlated with trends in protection. These results indicate the need to further investigate the contribution of chemokine adjuvants to modulate immune responses and the role of mucosal antibodies in SIV/HIV protection. PMID:25943275

  7. Chemokine Adjuvanted Electroporated-DNA Vaccine Induces Substantial Protection from Simian Immunodeficiency Virus Vaginal Challenge

    PubMed Central

    Hutnick, N A; Moldoveanu, Z; Hunter, M; Reuter, M; Yuan, S; Yan, J; Ginsberg, A; Sylvester, A; Pahar, B; Carnathan, D; Kathuria, N; Khan, A S; Montefiori, D; Sardesai, N Y; Betts, M R; Mestecky, J; Marx, P; Weiner, D B

    2015-01-01

    There have been encouraging results for the development of an effective HIV vaccine. However, many questions remain regarding the quality of immune responses and the role of mucosal antibodies. We addressed some of these issues by using a simian immunodeficiency virus (SIV) DNA vaccine adjuvanted with plasmid-expressed mucosal chemokines combined with an intravaginal SIV challenge in rhesus macaque (RhM) model. We previously reported on the ability of CCR9 and CCR10 ligand (L) adjuvants to enhance mucosal and systemic IgA and IgG in small animals. In this study, RhMs were intramuscularly immunized five times with either DNA or DNA plus chemokine adjuvant delivered by electroporation followed by challenge with SIVsmE660. Sixty-eight percent of all vaccinated animals (P=0.0016) remained either uninfected or had aborted infection compared to only 14% in the vaccine naïve group. The highest protection was observed in the CCR10L chemokines group, where 6 of 9 animals had aborted infection and two remained uninfected, leading to 89% protection (P=0.0003). The induction of mucosal SIV-specific antibodies and neutralization titers correlated with trends in protection. These results indicate the need to further investigate the contribution of chemokine adjuvants to modulate immune responses and the role of mucosal antibodies in SIV/HIV protection. PMID:25943275

  8. 78 FR 7348 - Patient Protection and Affordable Care Act; Exchange Functions: Eligibility for Exemptions...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-01

    ...; Exchange Standards for Employers'' (77 FR 18309). The provisions of the final rule, herein referred to as... affordability programs. We note that we expect to modify the proposed language in Sec. 155.227 (78 FR 4711) to... seeking exemptions. Similarly, we intend to modify the proposed language in Sec. 155.225 (78 FR 4710)...

  9. 78 FR 20581 - Patient Protection and Affordable Care Act; Exchange Functions: Standards for Navigators and Non...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-05

    ... a State Consumer Partnership Exchange (Consumer Partnership Exchange). \\1\\ See 77 FR 18310, 18325-26... 27, 2012 (77 FR 18310), and is codified at 45 CFR Sec. 155.210. Section 1311(i)(3) of the Affordable... Eligibility and Enrollment for Exchanges, Medicaid and CHIP, and Medicaid Premiums and Cost Sharing, 78...

  10. 77 FR 17219 - Patient Protection and Affordable Care Act; Standards Related to Reinsurance, Risk Corridors and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-23

    ... and the RFC, where relevant. On July 15, 2011, we published in the Federal Register (76 FR 41950-41956... Affordable Care Act; Standards Related to Reinsurance, Risk Corridors and Risk Adjustment; Final Rule #0;#0...; Standards Related to Reinsurance, Risk Corridors and Risk Adjustment AGENCY: Department of Health and...

  11. 78 FR 37031 - Patient Protection and Affordable Care Act; Program Integrity: Exchange, SHOP, Premium...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-19

    ...This proposed rule sets forth financial integrity and oversight standards with respect to Affordable Insurance Exchanges; Qualified Health Plan (QHP) issuers in Federally-facilitated Exchanges (FFEs); and States with regard to the operation of risk adjustment and reinsurance programs. It also proposes additional standards with respect to agents and brokers. These standards, which include......

  12. 78 FR 39493 - Patient Protection and Affordable Care Act; Exchange Functions: Eligibility for Exemptions...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-01

    ...This final rule implements certain functions of the Affordable Insurance Exchanges (``Exchanges''). These specific statutory functions include determining eligibility for and granting certificates of exemption from the individual shared responsibility payment described in section 5000A of the Internal Revenue Code. Additionally, this final rule implements the responsibilities of the Secretary......

  13. Patient Protection and Affordable Care Act; establishment of the Multi-State Plan Program for the Affordable Insurance Exchanges. Final rule.

    PubMed

    2014-02-24

    The U.S. Office of Personnel Management (OPM) is issuing a final rule implementing modifications to the Multi-State Plan (MSP) Program based on the experience of the Program to date. OPM established the MSP Program pursuant to the Affordable Care Act. This rule clarifies the approach used to enforce the applicable standards of the Affordable Care Act with respect to health insurance issuers that contract with OPM to offer MSP options; amends MSP standards related to coverage area, benefits, and certain contracting provisions under section 1334 of the Affordable Care Act; and makes non-substantive technical changes. PMID:25735057

  14. The Patient Protection and Affordable Care Act: A Primer for Hand Surgeons

    PubMed Central

    Adkinson, Joshua M.; Chung, Kevin C.

    2014-01-01

    The Affordable Care Act is the largest and most comprehensive overhaul of the United States healthcare industry since the inception of the Medicare and Medicaid. Contained within the 10 Titles are a multitude of provisions that will change how hand surgeons practice medicine and how they are reimbursed. It is imperative that surgeons are equipped with the knowledge of how this law will affect all physician practices and hospitals. PMID:25066853

  15. The impact of the Patient Protection and Affordable Care Act on radiology: beyond reimbursement.

    PubMed

    Krishnaraj, Arun; Norbash, Alexander; Allen, Bibb; Ellenbogen, Paul H; Kazerooni, Ella A; Thorwarth, William; Weinreb, Jeffrey C

    2015-01-01

    The 2014 ACR Forum focused on the noneconomic implications of the Affordable Care Act on the field of radiology, with specific attention to the importance of the patient experience, the role of radiology in public and population health, and radiology's role in the effort to lower overall health care costs. The recommendations generated from the Forum seek to inform ACR leadership on the best strategies to pursue to best prepare the radiology community for the rapidly evolving health care landscape. PMID:25557569

  16. Commentary on "How Child Protective Service Investigators Decide to Substantiate Mothers for Failure-to-Protect in Sexual Abuse Cases"

    ERIC Educational Resources Information Center

    Vieth, Victor I.

    2006-01-01

    As this author traveled around the country, many university professors and domestic violence advocates told him that prosecuting or even intervening with social services is morally "wrong" in cases in which parents fail to protect their children. There are two problems with these arguments. First, these arguments assume that mothers should "never"…

  17. Patient Protection and Affordable Care Act; establishment of exchanges and qualified health plans; exchange standards for employers. Final rule, Interim final rule.

    PubMed

    2012-03-27

    This final rule will implement the new Affordable Insurance Exchanges ("Exchanges"), consistent with title I of the Patient Protection and Affordable Care Act of 2010 as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The Exchanges will provide competitive marketplaces for individuals and small employers to directly compare available private health insurance options on the basis of price, quality, and other factors. The Exchanges, which will become operational by January 1, 2014, will help enhance competition in the health insurance market, improve choice of affordable health insurance, and give small businesses the same purchasing clout as large businesses. PMID:22479737

  18. Patient Protection and Affordable Care Act of 2010 and Children and Youth With Special Health Care Needs

    PubMed Central

    Buysse, Christina A.; Hubner, Lauren M.; Huffman, Lynne C.; Loe, Irene M.

    2015-01-01

    ABSTRACT: The Patient Protection and Affordable Care Act (ACA) was designed to (1) decrease the number of uninsured Americans, (2) make health insurance and health care affordable, and (3) improve health outcomes and performance of the health care system. During the design of ACA, children in general and children and youth with special health care needs and disabilities (CYSHCN) were not a priority because before ACA, a higher proportion of children than adults had insurance coverage through private family plans, Medicaid, or the State Children's Health Insurance Programs (CHIP). ACA benefits CYSHCN through provisions designed to make health insurance coverage universal and continuous, affordable, and adequate. Among the limitations of ACA for CYSHCN are the exemption of plans that had been in existence before ACA, lack of national standards for insurance benefits, possible elimination or reductions in funding for CHIP, and limited experience with new delivery models for improving care while reducing costs. Advocacy efforts on behalf of CYSHCN must track implementation of ACA at the federal and the state levels. Systems and payment reforms must emphasize access and quality improvements for CYSHCN over cost savings. Developmental-behavioral pediatrics must be represented at the policy level and in the design of new delivery models to assure high quality and cost-effective care for CYSHCN. PMID:25793891

  19. 77 FR 67865 - Enhancing Protections Afforded Customers and Customer Funds Held by Futures Commission Merchants...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-14

    ... Customer Funds and Funds Held in an Account for Foreign Futures and Foreign Options Transactions, 76 FR.... \\14\\ See 77 FR 6336 (Feb. 7, 2012). The Commission also included customer protection enhancements in... ] compliance with Commission requirements and the protection of customer funds. The Form 1-FR-FCM and...

  20. Plastic Surgery Practice Models and Research Aims Under the Patient Protection and Affordable Care Act

    PubMed Central

    Giladi, Aviram M.; Yuan, Frank; Chung, Kevin C.

    2014-01-01

    As the healthcare landscape in the United States changes under the Affordable Care Act (ACA), providers are set to face numerous new challenges. Although concerns about practice sustainability with declining reimbursement have dominated the dialogue, there are more pressing changes to the healthcare funding mechanism as a whole that must be addressed. Plastic surgeons, involved in various practice models each with different relationships to hospitals, referring physicians, and payers, must understand these reimbursement changes in order to dictate adequate compensation in the future. Here we discuss bundle payments and Accountable Care Organizations (ACOs), and how plastic surgeons might best engage in these new system designs. In addition, we review the value of a focused and driven health-services research agenda in plastic surgery, and the importance of this research in supporting long-term financial stability for the specialty. PMID:25626805

  1. Vectors Based on Modified Vaccinia Ankara Expressing Influenza H5N1 Hemagglutinin Induce Substantial Cross-Clade Protective Immunity

    PubMed Central

    Hessel, Annett; Schwendinger, Michael; Holzer, Georg W.; Orlinger, Klaus K.; Coulibaly, Sogue; Savidis-Dacho, Helga; Zips, Marie-Luise; Crowe, Brian A.; Kreil, Thomas R.; Ehrlich, Hartmut J.; Barrett, P. Noel; Falkner, Falko G.

    2011-01-01

    Background New highly pathogenic H5N1 influenza viruses are continuing to evolve with a potential threat for an influenza pandemic. So far, the H5N1 influenza viruses have not widely circulated in humans and therefore constitute a high risk for the non immune population. The aim of this study was to evaluate the cross-protective potential of the hemagglutinins of five H5N1 strains of divergent clades using a live attenuated modified vaccinia Ankara (MVA) vector vaccine. Methodology/Principal Findings The replication-deficient MVA virus was used to express influenza hemagglutinin (HA) proteins. Specifically, recombinant MVA viruses expressing the HA genes of the clade 1 virus A/Vietnam/1203/2004 (VN/1203), the clade 2.1.3 virus A/Indonesia/5/2005 (IN5/05), the clade 2.2 viruses A/turkey/Turkey/1/2005 (TT01/05) and A/chicken/Egypt/3/2006 (CE/06), and the clade 2.3.4 virus A/Anhui/1/2005 (AH1/05) were constructed. These experimental live vaccines were assessed in a lethal mouse model. Mice vaccinated with the VN/1203 hemagglutinin-expressing MVA induced excellent protection against all the above mentioned clades. Also mice vaccinated with the IN5/05 HA expressing MVA induced substantial protection against homologous and heterologous AH1/05 challenge. After vaccination with the CE/06 HA expressing MVA, mice were fully protected against clade 2.2 challenge and partially protected against challenge of other clades. Mice vaccinated with AH1/05 HA expressing MVA vectors were only partially protected against homologous and heterologous challenge. The live vaccines induced substantial amounts of neutralizing antibodies, mainly directed against the homologous challenge virus, and high levels of HA-specific IFN-γ secreting CD4 and CD8 T-cells against epitopes conserved among the H5 clades and subclades. Conclusions/Significance The highest level of cross-protection was induced by the HA derived from the VN/1203 strain, suggesting that pandemic H5 vaccines utilizing MVA vector

  2. Biochemical analysis of plant protection afforded by a nonpathogenic endophytic mutant of Colletotrichum magna

    SciTech Connect

    Redman, R.S.; Rodriguez, R.J. Univ. of Washington, Seattle, WA . Dept. of Botany); Clifton, D.R.; Morrel, J.; Brown, G. ); Freeman, S. . Dept. of Plant Pathology)

    1999-02-01

    A nonpathogenic mutant of Colletotrichum magna (path-1) was previously shown to protect watermelon (Citrullus lanatus) and cucumber (Cucumis sativus) seedlings from anthracnose disease elicited by wild-type C. magna. Disease protection was observed in stems of path-1-colonized cucurbits but not in cotyledons, indicating that path-1 conferred tissue-specific and/or localized protection. Plant biochemical indicators of a localized and systemic (peroxidase, phenylalanine ammonia-lyase, lignin, and salicylic acid) plant-defense response were investigated in anthracnose-resistant and-susceptible cultivars of cucurbit seedlings exposed to four treatments: (1) water (control), (2) path-1 conidia, (3) wild-type conidia, and (4) challenge conditions (inoculation into path-1 conidia for 48 h and then exposure to wild-type conidia). Collectively, these analyses indicated that disease protection in path-1-colonized plants was correlated with the ability of these plants to mount a defense response more rapidly and to equal or greater levels than plants exposed to wild-type C. magna alone. Watermelon plants colonized with path-1 were also protected against disease caused by Colletotrichum orbiculare and Fusarium oxysporum. A model based on the kinetics of plant-defense activation is presented to explain the mechanism of path-1-conferred disease protection.

  3. Biochemical Analysis of Plant Protection Afforded by a Nonpathogenic Endophytic Mutant of Colletotrichum magna1

    PubMed Central

    Redman, Regina S.; Freeman, Stanley; Clifton, David R.; Morrel, Jed; Brown, Gayle; Rodriguez, Rusty J.

    1999-01-01

    A nonpathogenic mutant of Colletotrichum magna (path-1) was previously shown to protect watermelon (Citrullus lanatus) and cucumber (Cucumis sativus) seedlings from anthracnose disease elicited by wild-type C. magna. Disease protection was observed in stems of path-1-colonized cucurbits but not in cotyledons, indicating that path-1 conferred tissue-specific and/or localized protection. Plant biochemical indicators of a localized and systemic (peroxidase, phenylalanine ammonia-lyase, lignin, and salicylic acid) “plant-defense” response were investigated in anthracnose-resistant and -susceptible cultivars of cucurbit seedlings exposed to four treatments: (1) water (control), (2) path-1 conidia, (3) wild-type conidia, and (4) challenge conditions (inoculation into path-1 conidia for 48 h and then exposure to wild-type conidia). Collectively, these analyses indicated that disease protection in path-1-colonized plants was correlated with the ability of these plants to mount a defense response more rapidly and to equal or greater levels than plants exposed to wild-type C. magna alone. Watermelon plants colonized with path-1 were also protected against disease caused by Colletotrichum orbiculare and Fusarium oxysporum. A model based on the kinetics of plant-defense activation is presented to explain the mechanism of path-1-conferred disease protection. PMID:9952476

  4. Biochemical analysis of plant protection afforded by a nonpathogenic endophytic mutant of Colletotrichum magna

    USGS Publications Warehouse

    Redman, R.S.; Freeman, S.; Clifton, D.R.; Morrel, J.; Brown, G.; Rodriguez, R.J.

    1999-01-01

    A nonpathogenic mutant of Colletotrichum magna (path-1) was previously shown to protect watermelon (Citrullus lanatus) and cucumber (Cucumis sativus) seedlings from anthracnose disease elicited by wild-type C. magna. Disease protection was observed in stems of path-1-colonized cucurbits but not in cotyledons, indicating that path-1 conferred tissue-specific and/or localized protection. Plant biochemical indicators of a localized and systemic (peroxidase, phenylalanine ammonia-lyase, lignin, and salicylic acid) 'plant-defense' response were investigated in anthracnose-resistant and -susceptible cultivars of cucurbit seedlings exposed to four treatments: (1) water (control), (2) path-1 conidia, (3) wild-type conidia, and (4) challenge conditions (inoculation into path-1 conidia for 48 h and then exposure to wild-type conidia). Collectively, these analyses indicated that disease protection in path-1 colonized plants was correlated with the ability of these plants to mount a defense response more rapidly and to equal or greater levels than plants exposed to wild-type C. magna alone. Watermelon plants colonized with path-1 were also protected against disease caused by Colletotrichum orbiculare and Fusarium oxysporum. A model based on the kinetics of plant-defense activation is presented to explain the mechanism of path-1-conferred disease protection.

  5. The tertiary structure of the four-way DNA junction affords protection against DNase I cleavage.

    PubMed Central

    Murchie, A I; Carter, W A; Portugal, J; Lilley, D M

    1990-01-01

    The accessibility of phosphodiester bonds in the DNA of four-way helical junctions has been probed with the nuclease DNase I. Regions of protection were observed on all four strands of the junctions, that tended to be longer on the strands that are exchanged between the coaxially stacked pairs of helices. The protected regions on the continuous strands of the stacked helices were not located exactly at the junction, but were displaced towards the 3' side of the strand. This is the region of backbone that becomes located in the major groove of the opposed helix in the non-crossed, right-handed structure for the junction, and might therefore be predicted to be protected against cleavage by an enzyme. However, the major grooves of the structure remain accessible to the much smaller probe dimethyl sulphate. Images PMID:2339051

  6. Patient Protection and Affordable Care Act; exchange and insurance market standards for 2015 and beyond. Final rule.

    PubMed

    2014-05-27

    This final rule addresses various requirements applicable to health insurance issuers, Affordable Insurance Exchanges (``Exchanges''), Navigators, non-Navigator assistance personnel, and other entities under the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act). Specifically, the rule establishes standards related to product discontinuation and renewal, quality reporting, non-discrimination standards, minimum certification standards and responsibilities of qualified health plan (QHP) issuers, the Small Business Health Options Program, and enforcement remedies in Federally-facilitated Exchanges. It also finalizes: A modification of HHS's allocation of reinsurance collections if those collections do not meet our projections; certain changes to allowable administrative expenses in the risk corridors calculation; modifications to the way we calculate the annual limit on cost sharing so that we round this parameter down to the nearest $50 increment; an approach to index the required contribution used to determine eligibility for an exemption from the shared responsibility payment under section 5000A of the Internal Revenue Code; grounds for imposing civil money penalties on persons who provide false or fraudulent information to the Exchange and on persons who improperly use or disclose information; updated standards for the consumer assistance programs; standards related to the opt-out provisions for self-funded, non-Federal governmental plans and related to the individual market provisions under the Health Insurance Portability and Accountability Act of 1996 including excepted benefits; standards regarding how enrollees may request access to non-formulary drugs under exigent circumstances; amendments to Exchange appeals standards and coverage enrollment and termination standards; and time-limited adjustments to the standards relating to the medical loss ratio

  7. High School Youth and Suicide Risk: Exploring Protection Afforded through Physical Activity and Sport Participation

    ERIC Educational Resources Information Center

    Taliaferro, Lindsay A.; Rienzo, Barbara A.; Miller, M. David; Pigg, R. Morgan, Jr.; Dodd, Virginia J.

    2008-01-01

    Background: Suicide ranks as the third leading cause of death for adolescents. Recent data from the Centers for Disease Control and Prevention (CDC) indicate that the adolescent suicide rate increased 18% between 2003 and 2004. Sport may represent a promising protective factor against adolescent suicide. This study examined the relative risk of…

  8. 78 FR 68505 - Enhancing Protections Afforded Customers and Customer Funds Held by Futures Commission Merchants...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-14

    ...The Commodity Futures Trading Commission (``Commission'' or ``CFTC'') is adopting new regulations and amending existing regulations to require enhanced customer protections, risk management programs, internal monitoring and controls, capital and liquidity standards, customer disclosures, and auditing and examination programs for futures commission merchants (``FCMs''). The regulations also......

  9. Creatine affords protection against glutamate-induced nitrosative and oxidative stress.

    PubMed

    Cunha, Mauricio P; Lieberknecht, Vicente; Ramos-Hryb, Ana Belén; Olescowicz, Gislaine; Ludka, Fabiana K; Tasca, Carla I; Gabilan, Nelson H; Rodrigues, Ana Lúcia S

    2016-05-01

    Creatine has been reported to exert beneficial effects in several neurodegenerative diseases in which glutamatergic excitotoxicity and oxidative stress play an etiological role. The purpose of this study was to investigate the protective effects of creatine, as compared to the N-Methyl-d-Aspartate (NMDA) receptor antagonist dizocilpine (MK-801), against glutamate or hydrogen peroxide (H2O2)-induced injury in human neuroblastoma SH-SY5Y cells. Exposure of cells to glutamate (60-80 mM) or H2O2 (200-300 μM) for 24 h decreased cellular viability and increased dichlorofluorescein (DCF) fluorescence (indicative of increased reactive oxygen species, ROS) and nitric oxide (NO) production (assessed by mono-nitrogen oxides, NOx, levels). Creatine (1-10 mM) or MK-801 (0.1-10 μM) reduced glutamate- and H2O2-induced toxicity. The protective effect of creatine against glutamate-induced toxicity involves its antioxidant effect, since creatine, similar to MK-801, prevented the increase on DCF fluorescence induced by glutamate or H2O2. Furthermore, creatine or MK-801 blocked glutamate- and H2O2-induced increases in NOx levels. In another set of experiments, the repeated, but not acute, administration of creatine (300 mg/kg, po) in mice prevented the decreases on cellular viability and mitochondrial membrane potential (assessed by tetramethylrhodamine ethyl ester, TMRE, probe) of hippocampal slices incubated with glutamate (10 mM). Creatine concentration-dependent decreased the amount of nitrite formed in the reaction of oxygen with NO produced from sodium nitroprusside solution, suggesting that its protective effect against glutamate or H2O2-induced toxicity might be due to its scavenger activity. Overall, the results suggest that creatine may be useful as adjuvant therapy for neurodegenerative disease treatments. PMID:26804444

  10. Blackberry subjected to in vitro gastrointestinal digestion affords protection against Ethyl Carbamate-induced cytotoxicity.

    PubMed

    Chen, Wei; Xu, Yang; Zhang, Lingxia; Su, Hongming; Zheng, Xiaodong

    2016-12-01

    Ethyl Carbamate (EC) was detected in many fermented foods. Previous studies indicated that frequent exposure to ethyl carbamate may increase the risk to suffer from cancers. Blackberry is rich in polyphenols and possesses potent antioxidant activity. This study aims to investigate the protective effect of blackberry homogenates produced before (BH) and after in vitro simulated gastrointestinal digestion (BD) on EC-induced toxicity in Caco-2 cells. Our results showed that blackberry homogenates after digestion (BD) was more effective than that before digestion (BH) in ameliorating EC-induced toxicity in Caco-2 cells. Further investigation revealed that BD remarkably attenuated EC-induced toxicity through restoring mitochondrial function, inhibiting glutathione depletion and decreasing overproduction of intracellular reactive oxygen species. Additionally, LC-MS result implied that the better protective capacity of BD may be related to the increased content of two anthocyanins (cyanidin-3-glucoside and cyanidin-3-dioxalyglucoside). Overall, the present study may give implication to prevent EC-induced health problem. PMID:27374576

  11. The Cardenolide Glycoside Acovenoside A Affords Protective Activity in Doxorubicin-Induced Cardiotoxicity in Mice.

    PubMed

    Ezzat, Shahira M; El Gaafary, Menna; El Sayed, Abeer M; Sabry, Omar M; Ali, Zeinab Y; Hafner, Susanne; Schmiech, Michael; Jin, Lu; Syrovets, Tatiana; Simmet, Thomas

    2016-08-01

    The current study aimed to investigate the protective effect of the cardenolide glycoside acovenoside A (AcoA) against doxorubicin-induced cardiotoxicity in mice. AcoA was isolated from the pericarps of Acokanthera oppositifolia to chemical homogeneity and characterized by means of one- and two-dimensional nuclear magnetic resonance spectroscopy. AcoA exhibited relatively low toxicity in mice (LD50 = 223.3 mg/kg bw). Repeated administration of doxorubicin induced cardiotoxicity manifested by reduced activity of myocardial membrane-bound ion pumps and elevated serum biomarkers of myocardial dysfunction, oxidative stress, and inflammation. Pretreatment of doxorubicin-exposed mice with AcoA (11.16 or 22.33 mg/kg bw, i.p.) for 2 weeks after 2 weeks of combined administration of AcoA and doxorubicin protected the animals dose dependently against doxorubicin-induced cardiotoxicity as indicated by normalization of the levels of different myocardial markers of oxidative stress (malondialdehyde, nitric oxide, total antioxidant capacity, and cardiac glutathione), serum myocardial diagnostic marker enzymes (serum cardiac troponin T, creatine kinase isoenzyme MB, aspartate aminotransferase, and lactate dehydrogenase), and inflammatory markers (c-reactive protein, tumor necrosis factor-α, and interleukin-6), as well as myocardial Na(+)/K(+)-ATPase activity. These effects were attributed to the negative impact of AcoA on transcription factors nuclear factor κB and interferon regulatory factor 3/7. Thus acovenoside A might act as a cardioprotective agent to prevent doxorubicin-induced cardiotoxicity. PMID:27247000

  12. KCNMA1 Encoded Cardiac BK Channels Afford Protection against Ischemia-Reperfusion Injury

    PubMed Central

    Soltysinska, Ewa; Bentzen, Bo Hjorth; Barthmes, Maria; Hattel, Helle; Thrush, A. Brianne; Harper, Mary-Ellen; Qvortrup, Klaus; Larsen, Filip J.; Schiffer, Tomas A.; Losa-Reyna, Jose; Straubinger, Julia; Kniess, Angelina; Thomsen, Morten Bækgaard; Brüggemann, Andrea; Fenske, Stefanie; Biel, Martin; Ruth, Peter; Wahl-Schott, Christian

    2014-01-01

    Mitochondrial potassium channels have been implicated in myocardial protection mediated through pre-/postconditioning. Compounds that open the Ca2+- and voltage-activated potassium channel of big-conductance (BK) have a pre-conditioning-like effect on survival of cardiomyocytes after ischemia/reperfusion injury. Recently, mitochondrial BK channels (mitoBKs) in cardiomyocytes were implicated as infarct-limiting factors that derive directly from the KCNMA1 gene encoding for canonical BKs usually present at the plasma membrane of cells. However, some studies challenged these cardio-protective roles of mitoBKs. Herein, we present electrophysiological evidence for paxilline- and NS11021-sensitive BK-mediated currents of 190 pS conductance in mitoplasts from wild-type but not BK−/− cardiomyocytes. Transmission electron microscopy of BK−/− ventricular muscles fibres showed normal ultra-structures and matrix dimension, but oxidative phosphorylation capacities at normoxia and upon re-oxygenation after anoxia were significantly attenuated in BK−/− permeabilized cardiomyocytes. In the absence of BK, post-anoxic reactive oxygen species (ROS) production from cardiomyocyte mitochondria was elevated indicating that mitoBK fine-tune the oxidative state at hypoxia and re-oxygenation. Because ROS and the capacity of the myocardium for oxidative metabolism are important determinants of cellular survival, we tested BK−/− hearts for their response in an ex-vivo model of ischemia/reperfusion (I/R) injury. Infarct areas, coronary flow and heart rates were not different between wild-type and BK−/− hearts upon I/R injury in the absence of ischemic pre-conditioning (IP), but differed upon IP. While the area of infarction comprised 28±3% of the area at risk in wild-type, it was increased to 58±5% in BK−/− hearts suggesting that BK mediates the beneficial effects of IP. These findings suggest that cardiac BK channels are important for proper oxidative energy supply

  13. The neurovascular protection afforded by delayed local hypothermia after transient middle cerebral artery occlusion.

    PubMed

    Kim, Jong-Heon; Seo, Minchul; Han, Hyung Soo; Park, Jaechan; Suk, Kyoungho

    2013-05-01

    Therapeutic hypothermia is a robust therapeutic tool in experimental stroke models but its clinical applications are limited. Furthermore, optimal conditions for therapeutic hypothermia, such as, temperature and the initiation and duration of cooling must be individualized. Here, we evaluated the therapeutic effects of delayed local hypothermia, administered for 44 hr after 4 hr of reperfusion in a rat model of transient middle cerebral artery occlusion (tMCAo), using a cooling device that allowed controlled local hypothermia (31 °C) in brain. Histological data revealed that local hypothermia significantly reduced infarct volumes and glial hypertrophic activation. Brain water contents, IgG leakage, and Evans Blue extravasation were notably reduced by local hypothermia. Furthermore, local hypothermia had strong vasculoprotective effects, as determined by immunohistochemistry and Western blot analyses for endothelial barrier antigen (EBA), laminin, aquaporin-4, and tight junction proteins in brain. Our data indicate that delayed/prolonged local hypothermia confers neurovascular protection, reduces brain edema, and inhibits inflammatory glial activation, and suggest that hypothermic conservation of vascular structures and functions account for the therapeutic effects of local hypothermia observed in this model of experimental stroke. PMID:23469955

  14. Keeping up with the Cadillacs: What Health Insurance Disparities, Moral Hazard, and the Cadillac Tax Mean to The Patient Protection and Affordable Care Act.

    PubMed

    Fletcher, Rebecca Adkins

    2016-03-01

    A major goal of The Patient Protection and Affordable Care Act is to broaden health care access through the extension of insurance coverage. However, little attention has been given to growing disparities in access to health care among the insured, as trends to reduce benefits and increase cost sharing (deductibles, co-pays) reduce affordability and access. Through a political economic perspective that critiques moral hazard, this article draws from ethnographic research with the United Steelworkers (USW) at a steel mill and the Retail, Wholesale and Department Store Union (RWDSU) at a food-processing plant in urban Central Appalachia. In so doing, this article describes difficulties of health care affordability on the eve of reform for differentially insured working families with employer-sponsored health insurance. Additionally, this article argues that the proposed Cadillac tax on high-cost health plans will increase problems with appropriate health care access and medical financial burden for many families. PMID:25132244

  15. Healthcare Reform and the Next Generation: United States Medical Student Attitudes toward the Patient Protection and Affordable Care Act

    PubMed Central

    Huntoon, Kristin M.; McCluney, Colin J.; Scannell, Christopher A.; Wiley, Elizabeth A.; Bruno, Richard; Andrews, Allen; Gorman, Paul

    2011-01-01

    Context Over one year after passage of the Patient Protection and Affordable Care Act (PPACA), legislators, healthcare experts, physicians, and the general public continue to debate the implications of the law and its repeal. The PPACA will have a significant impact on future physicians, yet medical student perspectives on the legislation have not been well documented. Objective To evaluate medical students' understanding of and attitudes toward healthcare reform and the PPACA including issues of quality, access and cost. Design, Setting, and Participants An anonymous electronic survey was sent to medical students at 10 medical schools (total of 6982 students) between October–December 2010, with 1232 students responding and a response rate of 18%. Main Outcome Measures Medical students' views and attitudes regarding the PPACA and related topics, measured with Likert scale and open response items. Results Of medical students surveyed, 94.8% agreed that the existing United States healthcare system needs to be reformed, 31.4% believed the PPACA will improve healthcare quality, while 20.9% disagreed and almost half (47.7%) were unsure if quality will be improved. Two thirds (67.6%) believed that the PPACA will increase access, 6.5% disagreed and the remaining 25.9% were unsure. With regard to containing healthcare costs, 45.4% of participants indicated that they are unsure if the provisions of the PPACA will do so. Overall, 80.1% of respondents indicated that they support the PPACA, and 78.3% also indicated that they did not feel that reform efforts had gone far enough. A majority of respondents (58.8%) opposed repeal of the PPACA, while 15.0% supported repeal, and 26.1% were undecided. Conclusion The overwhelming majority of medical students recognized healthcare reform is needed and expressed support for the PPACA but echoed concerns about whether it will address issues of quality or cost containment. PMID:21931604

  16. Final Rules for Grandfathered Plans, Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, Dependent Coverage, Appeals, and Patient Protections Under the Affordable Care Act. Final rules.

    PubMed

    2015-11-18

    This document contains final regulations regarding grandfathered health plans, preexisting condition exclusions, lifetime and annual dollar limits on benefits, rescissions, coverage of dependent children to age 26, internal claims and appeal and external review processes, and patient protections under the Affordable Care Act. It finalizes changes to the proposed and interim final rules based on comments and incorporates subregulatory guidance issued since publication of the proposed and interim final rules. PMID:26595941

  17. Protection afforded by pre- or post-treatment with 4-phenylbutyrate against liver injury induced by acetaminophen overdose in mice.

    PubMed

    Shimizu, Daisuke; Ishitsuka, Yoichi; Miyata, Keishi; Tomishima, Yoshiro; Kondo, Yuki; Irikura, Mitsuru; Iwawaki, Takao; Oike, Yuichi; Irie, Tetsumi

    2014-09-01

    -induced hepatotoxicity in mice. Although post-treatment with 4-PBA did not show any effects on hepatic Xbp1 mRNA splicing and JNK phosphorylation, it drastically attenuated the DNA fragmentation induced by APAP. The precise molecular mechanisms of the protection afforded by 4-PBA against APAP hepatotoxicity in mice are unclear, but they seem to involve inhibition of hepatocellular DNA fragmentation. We suggest that 4-PBA is a promising candidate as an antidote against APAP-induced liver injury. PMID:24951965

  18. 78 FR 15409 - Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2014

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-11

    ... parameters for these programs. \\1\\ 77 FR 17220 (March 23, 2012). Advance payments of the premium tax credit.../Av-csr-bulletin.pdf . \\3\\ 77 FR 18310 (March 27, 2012). Federally-facilitated Exchange user fees... Affordable Care Act'' (75 FR 74864) which established standards for the MLR program. Since then, we have...

  19. 77 FR 72581 - Patient Protection and Affordable Care Act; Establishment of the Multi-State Plan Program for the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-05

    ...-State Plan Issuer Requirements C. Premiums, Rating Factors, Medical Loss Ratios, and Risk Adjustment D... authority to negotiate with each MSP ``(A) a medical loss ratio; (B) a profit margin; (C) the premiums to be... the Affordable Care Act, the Director negotiates premiums, a medical loss ratio, a profit margin,...

  20. Patient Protection and Affordable Care Act of 2010: reforming the health care reform for the new decade.

    PubMed

    Manchikanti, Laxmaiah; Caraway, David L; Parr, Allan T; Fellows, Bert; Hirsch, Joshua A

    2011-01-01

    The Patient Protection and Affordable Care Act (the ACA, for short) became law with President Obama's signature on March 23, 2010. It represents the most significant transformation of the American health care system since Medicare and Medicaid. It is argued that it will fundamentally change nearly every aspect of health care, from insurance to the final delivery of care. The length and complexity of the legislation and divisive and heated debates have led to massive confusion about the impact of ACA. It also became one of the centerpieces of 2010 congressional campaigns. Essentials of ACA include: 1) a mandate for individuals and businesses requiring as a matter of law that nearly every American have an approved level of health insurance or pay a penalty; 2) a system of federal subsidies to completely or partially pay for the now required health insurance for about 34 million Americans who are currently uninsured - subsidized through Medicaid and exchanges; 3) extensive new requirements on the health insurance industry; and 4) numerous regulations on the practice of medicine. The act is divided into 10 titles. It contains provisions that went into effect starting on June 21, 2010, with the majority of provisions going into effect in 2014 and later. The perceived major impact on practicing physicians in the ACA is related to growing regulatory authority with the Independent Payment Advisory Board (IPAB) and the Patient Centered Outcomes Research Institute (PCORI). In addition to these specifics is a growth of the regulatory regime in association with further discounts in physician reimbursement. With regards to cost controls and projections, many believe that the ACA does not fix the finances of our health care system - neither public nor private. It has been suggested that the Congressional Budget Office (CBO) and the administration have used creative accounting to arrive at an alleged deficit reduction; however, if everything is included appropriately and

  1. A 129-kb Deletion on Chromosome 12 Confers Substantial Protection Against Rheumatoid Arthritis, Implicating the Gene SLC2A3

    PubMed Central

    Veal, Colin D; Reekie, Katherine E; Lorentzen, Johnny C; Gregersen, Peter K; Padyukov, Leonid; Brookes, Anthony J

    2014-01-01

    We describe a copy-number variant (CNV) for which deletion alleles confer a protective affect against rheumatoid arthritis (RA). This CNV reflects net unit deletions and expansions to a normal two-unit tandem duplication located on human chr12p13.31, a region with conserved synteny to the rat RA susceptibility quantitative trait loci Oia2. Genotyping, using the paralogue ratio test and SNP intensity data, in Swedish samples (2,403 cases, 1,269 controls) showed that the frequency of deletion variants is significantly lower in cases (P = 0.0012, OR = 0.442 [95%CI 0.258–0.755]). Reduced frequencies of deletion variants were also seen in replication materials comprising 9,201 UK samples (1,846 cases, 7,355 controls) and 2,963 US samples (906 controls, 1,967 cases) (Mantel–Haenszel P = 0.036, OR = 0.559 [95%CI 0.323–0.966]). Combining the three datasets produces a Mantel–Haenszel OR of 0.497 (P < 0.0002). The deletion variant lacks 129-kb of DNA containing SLC2A3, NANOGP1, and SLC2A14. SLC2A3 encodes a high-affinity glucose transporter important in the immune response and chondrocyte metabolism, both key aspects of RA pathogenesis. The large effect size of this association, its potential relevance to other diseases in which SLC2A3 is implicated, and the possibility of targeting drugs to inhibit SLC2A3, argue for further examination of the genetics and the biology of this CNV. PMID:24178905

  2. Affordable Care Act.

    PubMed

    Rak, Sofija; Coffin, Janis

    2013-01-01

    The Patient Protection and Affordable Care Act of 2010 (PPACA), although a subject of much debate in the Unites States, was enacted on March 23, 2010, and upheld by the Supreme Court on June 28, 2012. This act advocates that "healthcare is a right, not a privilege." The main goals of PPACA are to minimize the number of uninsured Americans and make healthcare available to everyone at an affordable price. The Congressional Budget Office has determined that 94% of Americans will have healthcare coverage while staying under the $900 billion limit that President Barack Obama established by bending the healthcare cost curve and reducing the deficit over the next 10 years. PMID:23767130

  3. 75 FR 60482 - Proposed Extension of Information Collection Request Submitted for Public Comment; Affordable...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-30

    ... Comment; Affordable Care Act Enrollment Opportunity Notice Relating to Dependent Coverage; Affordable Care Act Grandfathered Health Plan Disclosure and Recordkeeping Requirement; Affordable Care Act Rescission Notice; Affordable Care Act Patient Protections Notice; Affordable Care Act Enrollment Opportunity...

  4. Protective efficacy afforded by live Pasteurella multocida vaccines in chickens is independent of lipopolysaccharide outer core structure.

    PubMed

    Harper, Marina; John, Marietta; Edmunds, Mark; Wright, Amy; Ford, Mark; Turni, Conny; Blackall, P J; Cox, Andrew; Adler, Ben; Boyce, John D

    2016-03-29

    Pasteurella multocida is a major animal pathogen that causes a range of diseases including fowl cholera. P. multocida infections result in considerable losses to layer and breeder flocks in poultry industries worldwide. Both killed whole-cell and live-attenuated vaccines are available; these vaccines vary in their protective efficacy, particularly against heterologous strains. Moreover, until recently there was no knowledge of P. multocida LPS genetics and structure to determine precisely how LPS structure affects the protective capacity of these vaccines. In this study we show that defined lipopolysaccharide (LPS) mutants presented as killed whole-cell vaccines elicited solid protective immunity only against P. multocida challenge strains expressing highly similar or identical LPS structures. This finding indicates that vaccination of commercial flocks with P. multocida killed cell formulations will not protect against strains producing an LPS structure different to that produced by strains included in the vaccine formulation. Conversely, protective immunity conferred by vaccination with live P. multocida strains was found to be largely independent of LPS structure. Birds vaccinated with a range of live mutants belonging to the L1 and L3 LPS genotypes, each expressing a specific truncated LPS structure, were protected against challenge with the parent strain. Moreover, birds vaccinated with any of the five LPS mutants belonging to the L1 LPS genotype were also protected against challenge with an unrelated strain and two of the five groups vaccinated with live LPS mutants belonging to the L3 genotype were protected against challenge with an unrelated strain. In summary, vaccination with live P. multocida aroA mutants producing full-length L1 or L3 LPS or vaccination with live strains producing shortened L1 LPS elicited strong protective immunity against both homologous and heterologous challenge. PMID:26892738

  5. Constitutionally Protected or Substantially Disruptive?

    ERIC Educational Resources Information Center

    Taylor, Kelley R.

    2008-01-01

    The 2008 presidential campaign has, by all accounts, been extraordinary. Record numbers of voters expressed their views in historic primaries, and citizens across the country have been invigorated by debate about what policies and which politician will be best for this country. Equally noteworthy is the fact that young people have not been absent…

  6. Protection Afforded by Fluoroquinolones in Animal Models of Respiratory Infections with Bacillus anthracis, Yersinia pestis, and Francisella tularensis.

    PubMed

    Peterson, Johnny W; Moen, Scott T; Healy, Daniel; Pawlik, Jennifer E; Taormina, Joanna; Hardcastle, Jason; Thomas, John M; Lawrence, William S; Ponce, Cindy; Chatuev, Bagram M; Gnade, Bryan T; Foltz, Sheri M; Agar, Stacy L; Sha, Jian; Klimpel, Gary R; Kirtley, Michelle L; Eaves-Pyles, Tonyia; Chopra, Ashok K

    2010-01-01

    Successful treatment of inhalation anthrax, pneumonic plague and tularemia can be achieved with fluoroquinolone antibiotics, such as ciprofloxacin and levofloxacin, and initiation of treatment is most effective when administered as soon as possible following exposure. Bacillus anthracis Ames, Yersinia pestis CO92, and Francisella tularensis SCHU S4 have equivalent susceptibility in vitro to ciprofloxacin and levofloxacin (minimal inhibitory concentration is 0.03 μg/ml); however, limited information is available regarding in vivo susceptibility of these infectious agents to the fluoroquinolone antibiotics in small animal models. Mice, guinea pig, and rabbit models have been developed to evaluate the protective efficacy of antibiotic therapy against these life-threatening infections. Our results indicated that doses of ciprofloxacin and levofloxacin required to protect mice against inhalation anthrax were approximately 18-fold higher than the doses of levofloxacin required to protect against pneumonic plague and tularemia. Further, the critical period following aerosol exposure of mice to either B. anthracis spores or Y. pestis was 24 h, while mice challenged with F. tularensis could be effectively protected when treatment was delayed for as long as 72 h postchallenge. In addition, it was apparent that prolonged antibiotic treatment was important in the effective treatment of inhalation anthrax in mice, but short-term treatment of mice with pneumonic plague or tularemia infections were usually successful. These results provide effective antibiotic dosages in mice, guinea pigs, and rabbits and lay the foundation for the development and evaluation of combinational treatment modalities. PMID:21127743

  7. Protection Afforded by Fluoroquinolones in Animal Models of Respiratory Infections with Bacillus anthracis, Yersinia pestis, and Francisella tularensis

    PubMed Central

    Peterson, Johnny W; Moen, Scott T; Healy, Daniel; Pawlik, Jennifer E; Taormina, Joanna; Hardcastle, Jason; Thomas, John M; Lawrence, William S; Ponce, Cindy; Chatuev, Bagram M; Gnade, Bryan T; Foltz, Sheri M; Agar, Stacy L; Sha, Jian; Klimpel, Gary R; Kirtley, Michelle L; Eaves-Pyles, Tonyia; Chopra, Ashok K

    2010-01-01

    Successful treatment of inhalation anthrax, pneumonic plague and tularemia can be achieved with fluoroquinolone antibiotics, such as ciprofloxacin and levofloxacin, and initiation of treatment is most effective when administered as soon as possible following exposure. Bacillus anthracis Ames, Yersinia pestis CO92, and Francisella tularensis SCHU S4 have equivalent susceptibility in vitro to ciprofloxacin and levofloxacin (minimal inhibitory concentration is 0.03 μg/ml); however, limited information is available regarding in vivo susceptibility of these infectious agents to the fluoroquinolone antibiotics in small animal models. Mice, guinea pig, and rabbit models have been developed to evaluate the protective efficacy of antibiotic therapy against these life-threatening infections. Our results indicated that doses of ciprofloxacin and levofloxacin required to protect mice against inhalation anthrax were approximately 18-fold higher than the doses of levofloxacin required to protect against pneumonic plague and tularemia. Further, the critical period following aerosol exposure of mice to either B. anthracis spores or Y. pestis was 24 h, while mice challenged with F. tularensis could be effectively protected when treatment was delayed for as long as 72 h postchallenge. In addition, it was apparent that prolonged antibiotic treatment was important in the effective treatment of inhalation anthrax in mice, but short-term treatment of mice with pneumonic plague or tularemia infections were usually successful. These results provide effective antibiotic dosages in mice, guinea pigs, and rabbits and lay the foundation for the development and evaluation of combinational treatment modalities. PMID:21127743

  8. A mineral sunscreen affords genomic protection against ultraviolet (UV) B and UVA radiation: in vitro and in situ assays.

    PubMed

    Cayrol, C; Sarraute, J; Tarroux, R; Redoules, D; Charveron, M; Gall, Y

    1999-08-01

    Ultraviolet (UV) radiation has been shown to be responsible for different biological effects on human skin, including the initiation of photocarcinogenesis. Both UVB and UVA have been described as mutagenic, but the processes by which they alter the DNA are different. Although cells can repair DNA damage, some deleterious mutations nevertheless appear and can promote cancer. The risk of photocarcinogenesis is acknowledged and the frequency of photogenodermatosis is increasing. In order to evaluate the protection efficacy of a high sun protection factor (SPF) mineral sunscreen against UVB- and UVA-induced genomic alterations, we have followed two approaches. First, we have tested the sunscreen for its ability to decrease the unscheduled DNA synthesis response in vitro in human fibroblasts, as an indirect measure of UVB-induced lesions (0.005 and 0.01 J/cm2), and second, we have verified its ability to reduce the in situ end-labelling intensity in human skin as a direct measure of UVA-induced single-strand breaks (10 J/cm2). Microscopic analysis clearly demonstrated the protective effect of the sunscreen against UVB and UVA. A dose-dependent effect of mineral sunscreens was observed. There was also a relationship between the SPF and genomic protection. By limiting the accumulation of UV-induced lesions on DNA, this mineral sunscreen could limit the mutation frequency. PMID:10468796

  9. Bispecific Antibody Affords Complete Post-Exposure Protection of Mice from Both Ebola (Zaire) and Sudan Viruses

    PubMed Central

    Frei, Julia C.; Nyakatura, Elisabeth K.; Zak, Samantha E.; Bakken, Russell R.; Chandran, Kartik; Dye, John M.; Lai, Jonathan R.

    2016-01-01

    Filoviruses (Ebola and Marburg) cause severe hemorrhagic fever. There are five species of ebolavirus; among these, the Ebola (Zaire) and Sudan viruses (EBOV and SUDV, respectively) are highly pathogenic and have both caused recurring, large outbreaks. However, the EBOV and SUDV glycoprotein (GP) sequences are 45% divergent and thus antigenically distinct. Few antibodies with cross-neutralizing properties have been described to date. We used antibody engineering to develop novel bispecific antibodies (Bis-mAbs) that are cross-reactive toward base epitopes on GP from EBOV and SUDV. These Bis-mAbs exhibit potent neutralization against EBOV and SUDV GP pseudotyped viruses as well as authentic pathogens, and confer a high degree (in one case 100%) post-exposure protection of mice from both viruses. Our studies show that a single agent that targets the GP base epitopes is sufficient for protection in mice; such agents could be included in panfilovirus therapeutic antibody cocktails. PMID:26758505

  10. Bispecific Antibody Affords Complete Post-Exposure Protection of Mice from Both Ebola (Zaire) and Sudan Viruses.

    PubMed

    Frei, Julia C; Nyakatura, Elisabeth K; Zak, Samantha E; Bakken, Russell R; Chandran, Kartik; Dye, John M; Lai, Jonathan R

    2016-01-01

    Filoviruses (Ebola and Marburg) cause severe hemorrhagic fever. There are five species of ebolavirus; among these, the Ebola (Zaire) and Sudan viruses (EBOV and SUDV, respectively) are highly pathogenic and have both caused recurring, large outbreaks. However, the EBOV and SUDV glycoprotein (GP) sequences are 45% divergent and thus antigenically distinct. Few antibodies with cross-neutralizing properties have been described to date. We used antibody engineering to develop novel bispecific antibodies (Bis-mAbs) that are cross-reactive toward base epitopes on GP from EBOV and SUDV. These Bis-mAbs exhibit potent neutralization against EBOV and SUDV GP pseudotyped viruses as well as authentic pathogens, and confer a high degree (in one case 100%) post-exposure protection of mice from both viruses. Our studies show that a single agent that targets the GP base epitopes is sufficient for protection in mice; such agents could be included in panfilovirus therapeutic antibody cocktails. PMID:26758505

  11. 17beta-estradiol affords protection against 4-vinylcyclohexene diepoxide-induced ovarian follicle loss in Fischer-344 rats.

    PubMed

    Thompson, Kary E; Sipes, I Glenn; Greenstein, Ben D; Hoyer, Patricia B

    2002-03-01

    Repeated dosing with 4-vinylcyclohexene diepoxide (VCD) accelerates atresia via apoptosis in primordial and primary follicles in ovaries of rats. The mechanisms that control atresia and VCD-induced toxicity are unknown; however, they could involve 17beta-E2. Atresia slows as animals enter puberty, whereas circulating E2 levels increase with the the onset of cyclicity. This inverse relationship suggests that E2 may be involved in the control of atresia. Therefore, this study was designed to determine whether treatment of immature rats with E2 could protect follicles normally destroyed by VCD-induced apoptosis. Female F344 rats were treated daily with E2, ER analogs, and/or VCD for 15 d. VCD alone caused a 50% reduction in primordial and primary follicles. Coinjection of E2 (0.1 mg/kg) and VCD (80 mg/kg) selectively protected primary follicles from VCD-induced follicle loss. This protection was mimicked by an ER agonist, genistein (0.1 mg/kg), and prevented by an ER antagonist, 4-hydroxytamoxifen (2 mg/kg). VCD treatment increased caspase-3-like activity, whereas concurrent treatment with genistein and VCD restored caspase-3-like activity to control levels. VCD treatment had no effect on circulating E2 levels, uterine weight, or E2 binding to the ER, nor could it directly displace E2 from ERbeta. These observations support the idea that ER-mediated protection against VCD-induced follicle toxicity is obtained by reducing apoptosis in small preantral follicles, although VCD does not appear to directly interact with ER. PMID:11861533

  12. Achieving Public Health Goals Through Medicaid Expansion: Opportunities in Criminal Justice, Homelessness, and Behavioral Health With the Patient Protection and Affordable Care Act

    PubMed Central

    Klingenmaier, Lisa

    2013-01-01

    States are currently discussing how (or whether) to implement the Medicaid expansion to nondisabled adults earning less than 133% of the federal poverty level, a key aspect of the Patient Protection and Affordable Care Act. Those experiencing homelessness and those involved with the criminal justice system—particularly when they struggle with behavioral health diagnoses—are subpopulations that are currently uninsured at high rates and have significant health care needs but will become Medicaid eligible starting in 2014. We outline the connection between these groups, assert outcomes possible from greater collaboration between multiple systems, provide a summary of Medicaid eligibility and its ramifications for individuals in the criminal justice system, and explore opportunities to improve overall public health through Medicaid outreach, enrollment, and engagement in needed health care. PMID:24148039

  13. American Society of Clinical Oncology policy statement: opportunities in the patient protection and affordable care act to reduce cancer care disparities.

    PubMed

    Moy, Beverly; Polite, Blase N; Halpern, Michael T; Stranne, Steven K; Winer, Eric P; Wollins, Dana S; Newman, Lisa A

    2011-10-01

    Patients in specific vulnerable population groups suffer disproportionately from cancer. The elimination of cancer disparities is critically important for lessening the burden of cancer. The Patient Protection and Affordable Care Act provides both opportunities and challenges for addressing cancer care disparities and access to care. The American Society of Clinical Oncology (ASCO) advocates for policies that ensure access to cancer care for the underserved. Such policies include insurance reform and the reduction of economic barriers to quality health care. Building on ASCO's prior statement on disparities in cancer care (2009), this article summarizes elements of the health care law that are relevant to cancer disparities and provides recommendations for addressing major provisions in the law. It outlines specific strategies to address insurance reform, access to care, quality of care, prevention and wellness, research on health care disparities, and diversity in the health care workforce. ASCO is committed to leading efforts toward the improvement of cancer care among the most vulnerable patients. PMID:21810680

  14. Influenza A vaccines using linear expression cassettes delivered via electroporation afford full protection against challenge in a mouse model.

    PubMed

    Shen, Xuefei; Söderholm, Jonas; Lin, Feng; Kobinger, Gary; Bello, Alexander; Gregg, Derek A; Broderick, Kate E; Sardesai, Niranjan Y

    2012-11-01

    Alternative DNA vaccine constructs such as fully synthetic linear expressing cassettes (LECs) offer the advantage of accelerated manufacturing techniques as well as the lack of both antibiotic resistance genes and bacterial contaminants. The speed of manufacture makes LEC technology a possible future vaccination strategy for pandemic influenza outbreaks. Previously, we reported on a novel concept of DNA delivery to dermal tissue by a minimally invasive electroporation (EP) surface device powered using low voltage parameters. This device allows electroporation without penetration of electrodes into the skin. In addition to enhancing the delivery of traditional plasmid DNA vaccines, this device may also offer a safe, tolerable and efficient method to administer LECs. To assess immunogenicity and efficacy of EP-enhanced LEC delivery in mice, we designed and tested two influenza antigens in the form of LEC constructs delivered using the newly developed surface dermal EP device. Strong CTL and antibody responses were induced by the LEC versions of the DNA vaccine. When challenged with A/Canada/AB/RV1532/2009 viruses, mice immunized with LEC encoding the M2 and NP antigens recovered faster than naïve or mice immunized ID without EP. Mice immunized with equal-molar doses of LEC encoding the M2 and NP antigens demonstrated 100% survival following a lethal (100× LD50) challenge of the heterologuos and highly pathogenic H5N1 influenza virus (A/Vietnam/1203/04). These results suggest that influenza DNA vaccines based on LEC technology combined with the surface delivery platform are capable of fully protecting mice in a lethal challenge and the LEC based DNA constructs may serve as viable vaccine candidates. PMID:22406460

  15. Importance of Ca2+-dependent transamidation activity in the protection afforded by tissue transglutaminase against doxorubicin-induced apoptosis

    PubMed Central

    Datta, Sunando; Antonyak, Marc A.; Cerione, Richard A.

    2008-01-01

    Tissue transglutaminase II (TGase-II), which is capable of both GTP-binding and transamidation activities, has been implicated in a variety of biological disorders ranging from cancer to neurodegenerative diseases. Recent studies have suggested that the transamidation activity of TGase-II is necessary for the survival of cancer cells confronted with different stresses and cellular insults. When assayed in vitro, the transamidation activity of TGase-II is Ca2+-dependent. However, at present little is known regarding how the regulation by Ca2+ is manifested or if in fact it is important for the cellular functions of TGase-II. Here, we have set out to further examine the Ca2+-mediated regulation of TGase-II's transamidation activity, with our goals being to identify the Ca2+-regulatory sites on the protein and determine whether they are essential for TGase-II to confer survival to human breast cancer cells. Based on comparisons between the X-ray crystal structures for TGase-II and TGase-III, we identified three putative Ca2+-regulatory sites on TGase-II. Site-directed mutagenesis was performed to individually alter key residues at each of the sites. These substitutions did not affect the ability of TGase-II to bind guanine nucleotides, nor did they cause any obvious changes in its cellular localization. While substitutions at the different Ca2+-regulatory sites could either slightly enhance or markedly reduce the GTP hydrolytic activity of TGase-II, mutations at each of the three sites inhibited the Ca2+-responsive transamidation activity. We further showed that the same substitutions inhibited the ability of TGase-II to protect human breast cancer cells against the apoptotic activity of doxorubicin. Overall, these findings demonstrate that the Ca2+-mediated regulation of transamidation activity is essential for the ability of TGase-II to confer cell survival. PMID:17073438

  16. Mechanisms involved in protection afforded by L-arginine in ibuprofen-induced gastric damage: role of nitric oxide and prostaglandins.

    PubMed

    Jiménez, Dolores; Martin, M José; Pozo, David; Alarcón, Catalina; Esteban, José; Bruseghini, Leo; Esteras, Antonio; Motilva, Virginia

    2002-01-01

    L-Arginine (L-arg) exhibits multiple biological properties and plays an important role in the regulation of different functions in pathological conditions. Many of these effects could be achieved on this amino acid serving as a substrate for the enzyme nitric oxide synthase (NOS). At the gastrointestinal level, recent reports revealed its protective activities involving a hyperemic response increasing the gastric blood flow. The aim of this study was to characterize the relationship between NOS activity/expression and prostaglandin changes (PGs) in rats gastric mucosa, with L-arg associated resistance to the nonsteroidal anti-inflammatory drug (NSAID) ibuprofen (IBP). The protective effect of oral L-arg (100 mg/kg body wt), administerred together with IBP (100 mg/kg body wt, per os), was evident enough 90 min after drug administration, although a significant protection persisted for more than 6 hr. Pretreatment with N(G)-nitro-L-arginine (L-NNA) (40 mg/kg body wt, intraperitoneally), a competitive inhibitor of constitutive NOS, partly altered the protection afforded by the amino acid. In contrast, no changes could be observed after inducible NOS inhibition [aminoguanidine (AG) 50 mg/Kg body wt, intraperitoneally). L-arg, plus IBP, produced a significant increase of the cyclic GMP (cGMP) response in tissue samples from rat stomach, 90 min and 6 h after drug administration. iNOS activity and mRNA expression were higher in IBP-treated rats, and no differences were observed in inducible responses in the L-arg plus IBP group. No variations in the cNOS activity and expression were found among the different groups of animals assayed. The measurement of mucosal PGE2 content confirmed that biosynthesis of the eicosanoid is maintained by L-arg for over 90 min after IBP, while a total inhibition was observed 6 hr later. The mechanisms of the L-arg protective effect on the damaged induced by IBP could be explained by the different period after drug administration. The early

  17. 75 FR 81659 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Affordable...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-28

    ...; Affordable Care Act Enrollment Opportunity Notice--Prohibition on Lifetime Limits ACTION: Notice. SUMMARY... Administration (EBSA) sponsored information collection request (ICR) titled, ``Affordable Care Act Enrollment... INFORMATION: The Patient Protection and Affordable Care Act (the Affordable Care Act)......

  18. Investigation into the cardiotoxic effects of doxorubicin on contractile function and the protection afforded by cyclosporin A using the work-loop assay.

    PubMed

    Gharanei, Mayel; Hussain, Afthab; James, Rob S; Janneh, Omar; Maddock, Helen

    2014-08-01

    Doxorubicin is known to cause cardiotoxicity through multiple routes including the build-up of reactive oxygen species and disruption of the calcium homeostasis in cardiac myocytes, but the effect of drug treatment on the associated biomechanics of cardiac injury remains unclear. Detecting and understanding the adverse effects of drugs on cardiac contractility is becoming a priority in non-clinical safety pharmacology assessment. The work-loop technique enables the assessment of force-length work-loop contractions, which mimic those of the pressure-volume work-loops experienced by the heart in vivo. During this study we evaluated whether the work-loop technique could potentially provide improved insight into the biomechanics associated with drug-induced cardiac dysfunction. In order to do this we investigated the cardiotoxic effects of doxorubicin and characterised the protection afforded by the co-administration of cyclosporin A (CsA). This study provides detailed biomechanical in vitro insight into the cardiac dysfunction associated with Doxorubicin treatment, including reduction in peak force, force during shortening and power output. These effects were significantly abrogated in doxorubicin-CsA co-treatment studies. Closely mimicking the in vivo pressure-volume muscle mechanics, this assay provides a quick and easy technique to gain a better understanding of the detailed biomechanics of drug-induced cardiac dysfunction. PMID:24509045

  19. Freedom of conscience and health care in the United States of america: the conflict between public health and religious liberty in the patient protection and affordable care act.

    PubMed

    West-Oram, Peter

    2013-09-01

    The recent confirmation of the constitutionality of the Obama administration's Patient Protection and Affordable Care Act (PPACA) by the US Supreme Court has brought to the fore long-standing debates over individual liberty and religious freedom. Advocates of personal liberty are often critical, particularly in the USA, of public health measures which they deem to be overly restrictive of personal choice. In addition to the alleged restrictions of individual freedom of choice when it comes to the question of whether or not to purchase health insurance, opponents to the PPACA also argue that certain requirements of the Act violate the right to freedom of conscience by mandating support for services deemed immoral by religious groups. These issues continue the long running debate surrounding the demands of religious groups for special consideration in the realm of health care provision. In this paper I examine the requirements of the PPACA, and the impacts that religious, and other ideological, exemptions can have on public health, and argue that the exemptions provided for by the PPACA do not in fact impose unreasonable restrictions on religious freedom, but rather concede too much and in so doing endanger public health and some important individual liberties. PMID:23539432

  20. Commentary: Personalized health planning and the Patient Protection and Affordable Care Act: an opportunity for academic medicine to lead health care reform.

    PubMed

    Dinan, Michaela A; Simmons, Leigh Ann; Snyderman, Ralph

    2010-11-01

    The Patient Protection and Affordable Care Act of 2010 (PPACA) mandates the exploration of new approaches to coordinated health care delivery--such as patient-centered medical homes, accountable care organizations, and disease management programs--in which reimbursement is aligned with desired outcomes. PPACA does not, however, delineate a standardized approach to improve the delivery process or a specific means to quantify performance for value-based reimbursement; these details are left to administrative agencies to develop and implement. The authors propose that coordinated care can be implemented more effectively and performance quantified more accurately by using personalized health planning, which employs individualized strategic health planning and care relevant to the patient's specific needs. Personalized health plans, developed by providers in collaboration with their patients, quantify patients' health and health risks over time, identify strategies to mitigate risks and/or treat disease, deliver personalized care, engage patients in their care, and measure outcomes. Personalized health planning is a core clinical process that can standardize coordinated care approaches while providing the data needed for performance-based reimbursement. The authors argue that academic health centers have a significant opportunity to lead true health care reform by adopting personalized health planning to coordinate care delivery while conducting the research and education necessary to enable its broad clinical application. PMID:20844424

  1. Meeting the Tobacco Cessation Coverage Requirement of the Patient Protection and Affordable Care Act: State Smoking Cessation Quitlines and Cost Sharing

    PubMed Central

    Bailey, Linda; Leischow, Scott J.

    2015-01-01

    Objectives. We explored whether various key stakeholders considered cost sharing with state telephone-based tobacco cessation quitlines, because including tobacco cessation services as part of the required essential health benefits is a new requirement of the Patient Protection and Affordable Care Act (ACA). Methods. We analyzed qualitative data collected from interviews conducted in April and May of 2014 with representatives of state health departments, quitline service providers, health plans, and insurance brokers in 4 US states. Results. State health departments varied in the strategies they considered the role their state quitline would play in meeting the ACA requirements. Health plans and insurance brokers referred to state quitlines because they were perceived as effective and free, but in 3 of the 4 states, the private stakeholder groups did not consider cost sharing. Conclusions. If state health departments are going to initiate cost-sharing agreements with private insurance providers, then they will need to engage a broad array of stakeholders and will need to overcome the perception that state quitline services are free. PMID:26447918

  2. Assessing Protection Afforded to the Microbiological Quality of Bedrock Groundwater from the Impacts of Septic Tank Effluent by Irish Glacial Till: A Field Study

    NASA Astrophysics Data System (ADS)

    Orr, Alison; McCarthy, Valerie; Meehan, Robert; Flynn, Raymond

    2010-05-01

    The rural population of Ireland relies almost exclusively on on-site treatment systems for disposal of waste water. Septic tank systems, which discharge effluent to ground, constitute the dominant means of waste water disposal. Many of the areas that employ this technology rely on private or small group groundwater supplies, often located in close proximity of septic tanks. Since many of these water supplies provide raw groundwater to consumers, septic tank effluent (STE) can pose a significant hazard to the microbiological quality of drinking water. T-tests (infiltration testing) carried out prior to tank installation aim to assess the capacity of subsoils to receive STE. Tests completed across Ireland indicate that many existing septic tank systems are located in low permeability subsoils. These subsoils are assumed to afford significant protection to the microbiological quality of groundwater in the underlying bedrock units. A two year investigation in the Lough Muckno Catchment in Co. Monaghan, investigating the impact of STE on water quality, involved carrying out T-tests at three sites where effluent discharged to a dense, silty, ‘fractured' glacial till derived from the underlying bedrock and containing clasts of low grade metamorphic Ordovician and Silurian sandstone and shale. Analysis of groundwater samples collected from 28 piezometers straddling the water table within the till, down-gradient of septic tank systems at two sites, permitted faecal indicator microorganism (FIO) levels in near-surface groundwater to be established. Associated hydraulic conductivity tests (slug tests) at all three sites permitted an evaluation of the levels of horizontal hydraulic conductivity heterogeneity present in the till. Slug test results suggest that till median hydraulic conductivities range from 1.1x10-4 cm/s to 1.1x10-5 cm/s, with variability of up to 2 orders of magnitude across each site. On the other hand no significant differences in properties existed

  3. Caseworker judgments and substantiation.

    PubMed

    Cross, Theodore P; Casanueva, Cecilia

    2009-02-01

    Substantiation can have an important effect on what interventions are pursued for children investigated for maltreatment, but researchers lack knowledge about how the decision to substantiate is made. Using information from 4,515 children from a national probability study of children investigated for maltreatment, this study examined how caseworker judgments of harm, risk, and evidence predicted substantiation. The substantiation rate was 29.9%, but the majority of cases were substantiated when caseworkers reported at least moderate harm, at least moderate risk, and/or probably to clearly sufficient evidence. Each judgment variable significantly predicted substantiation in a multivariable model, with evidence the strongest predictor. Child gender and age were significant predictors beyond harm, risk, and evidence, suggesting that other judgments also influence substantiation. In 9 of 100 cases, reports were not substantiated despite moderate to severe harm. Thus, substantiation is generally based on judgments of harm, risk, and evidence but not exclusively. The findings underline previous researchers' conclusions that substantiation is a flawed measure of child maltreatment and suggest that policy and practice related to substantiation are due for a fresh appraisal by state child welfare service agencies. PMID:18794302

  4. Intermittent Preventive Treatment of Malaria Provides Substantial Protection against Malaria in Children Already Protected by an Insecticide-Treated Bednet in Burkina Faso: A Randomised, Double-Blind, Placebo-Controlled Trial

    PubMed Central

    Konaté, Amadou T.; Yaro, Jean Baptiste; Ouédraogo, Amidou Z.; Diarra, Amidou; Gansané, Adama; Soulama, Issiaka; Kangoyé, David T.; Kaboré, Youssouf; Ouédraogo, Espérance; Ouédraogo, Alphonse; Tiono, Alfred B.; Ouédraogo, Issa N.; Chandramohan, Daniel; Cousens, Simon; Milligan, Paul J.; Sirima, Sodiomon B.; Greenwood, Brian; Diallo, Diadier A.

    2011-01-01

    77%) (p<0.001) and that of moderately severe anaemia by 56% (95% CI 36%–70%) (p<0.001). IPTc reduced the risks of wasting (risk ratio [RR] = 0.79; 95% CI 0.65–1.00) (p = 0.05) and of being underweight (RR = 0.84; 95% CI 0.72–0.99) (p = 0.03). Children who received IPTc were 2.8 (95% CI 2.3–3.5) (p<0.001) times more likely to vomit than children who received placebo but no drug-related serious adverse event was recorded. Conclusions IPT of malaria provides substantial protection against malaria in children who sleep under an ITN. There is now strong evidence to support the integration of IPTc into malaria control strategies in areas of seasonal malaria transmission. Trial Registration ClinicalTrials.gov NCT00738946 Please see later in the article for the Editors' Summary PMID:21304925

  5. Establishing Substantial Equivalence: Transcriptomics

    NASA Astrophysics Data System (ADS)

    Baudo, María Marcela; Powers, Stephen J.; Mitchell, Rowan A. C.; Shewry, Peter R.

    Regulatory authorities in Western Europe require transgenic crops to be substantially equivalent to conventionally bred forms if they are to be approved for commercial production. One way to establish substantial equivalence is to compare the transcript profiles of developing grain and other tissues of transgenic and conventionally bred lines, in order to identify any unintended effects of the transformation process. We present detailed protocols for transcriptomic comparisons of developing wheat grain and leaf material, and illustrate their use by reference to our own studies of lines transformed to express additional gluten protein genes controlled by their own endosperm-specific promoters. The results show that the transgenes present in these lines (which included those encoding marker genes) did not have any significant unpredicted effects on the expression of endogenous genes and that the transgenic plants were therefore substantially equivalent to the corresponding parental lines.

  6. Transient Loss of Protection Afforded by a Live Attenuated Non-typhoidal Salmonella Vaccine in Mice Co-infected with Malaria

    PubMed Central

    Lokken, Kristen L.; Nanton, Minelva R.; Nuccio, Sean-Paul; McSorley, Stephen J.; Tsolis, Renée M.

    2015-01-01

    In immunocompetent individuals, non-typhoidal Salmonella serovars (NTS) are associated with gastroenteritis, however, there is currently an epidemic of NTS bloodstream infections in sub-Saharan Africa. Plasmodium falciparum malaria is an important risk factor for invasive NTS bloodstream in African children. Here we investigated whether a live, attenuated Salmonella vaccine could be protective in mice, in the setting of concurrent malaria. Surprisingly, mice acutely infected with the nonlethal malaria parasite Plasmodium yoelii 17XNL exhibited a profound loss of protective immunity to NTS, but vaccine-mediated protection was restored after resolution of malaria. Absence of protective immunity during acute malaria correlated with maintenance of antibodies to NTS, but a marked reduction in effector capability of Salmonella-specific CD4 and CD8 T cells. Further, increased expression of the inhibitory molecule PD1 was identified on memory CD4 T cells induced by vaccination. Blockade of IL-10 restored protection against S. Typhimurium, without restoring CD4 T cell effector function. Simultaneous blockade of CTLA-4, LAG3, and PDL1 restored IFN-γ production by vaccine-induced memory CD4 T cells but was not sufficient to restore protection. Together, these data demonstrate that malaria parasite infection induces a temporary loss of an established adaptive immune response via multiple mechanisms, and suggest that in the setting of acute malaria, protection against NTS mediated by live vaccines may be interrupted. PMID:26366739

  7. 40 CFR 725.94 - Substantiation requirements.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 31 2014-07-01 2014-07-01 false Substantiation requirements. 725.94 Section 725.94 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT REPORTING REQUIREMENTS AND REVIEW PROCESSES FOR MICROORGANISMS Confidentiality and Public Access to Information § 725.94...

  8. Establishing Substantial Equivalence: Metabolomics

    NASA Astrophysics Data System (ADS)

    Beale, Michael H.; Ward, Jane L.; Baker, John M.

    Modern ‘metabolomic’ methods allow us to compare levels of many structurally diverse compounds in an automated fashion across a large number of samples. This technology is ideally suited to screening of populations of plants, including trials where the aim is the determination of unintended effects introduced by GM. A number of metabolomic methods have been devised for the determination of substantial equivalence. We have developed a methodology, using [1H]-NMR fingerprinting, for metabolomic screening of plants and have applied it to the study of substantial equivalence of field-grown GM wheat. We describe here the principles and detail of that protocol as applied to the analysis of flour generated from field plots of wheat. Particular emphasis is given to the downstream data processing and comparison of spectra by multivariate analysis, from which conclusions regarding metabolome changes due to the GM can be assessed against the background of natural variation due to environment.

  9. Substantial evidence of effect.

    PubMed

    Gould, A Lawrence

    2002-02-01

    Pressures for rapid drug development, especially for treatments that may affect public health significantly, drive a need to reconsider what is necessary to establish the "substantial evidence" of efficacy and safety required for regulatory approval. The concept of substantial evidence of effect can be stated fairly simply in principle, but its application to the evaluation of findings from real clinical drug development programs can be quite complicated and depend on circumstances relating to the population studied and the condition being treated. This paper discusses a number of considerations that arise in attempting to address this issue. These include confirmation of efficacy/safety as opposed to replication of results, the use of surrogates for the clinical outcome, ethical considerations, the use of trials aimed at demonstrating equivalence or noninferiority instead of superiority of a new drug, and the balance between benefits and risks. Recent developments such as the International Conference on Harmonization (ICH) guidelines dealing with statistical principles and choice of control group, and Food and Drug Administration (FDA) guidances interpreting the 1998 Modernization Act identify useful alternative definitions of substantial evidence and also identify when a single study can be enough to demonstrate a clinically important effect. The primary difficulty with the use of noninferiority trials is the need to demonstrate assay sensitivity or validity, i.e., that the trial would have demonstrated the superiority of the active control treatment to placebo had the trial included a placebo group. Failure to demonstrate a significant difference between the presumed active treatments and an inactive control precludes a definitive conclusion of assay validity, but external evidence, e.g., from trials demonstrating the activity of the active control, may yet justify concluding that the trial was assay valid. Issues of interpretation of important unexpected

  10. Affordable Vehicle Avionics Overview

    NASA Technical Reports Server (NTRS)

    Cockrell, James J.

    2015-01-01

    Public and private launch vehicle developers are reducing the cost of propulsion for small commercial launchers, but conventional high-performance, high-reliability avionics remain the disproportionately high cost driver for launch. AVA technology performs as well or better than conventional launch vehicle avionics, but with a fraction of the recurring costs. AVA enables small launch providers to offer affordable rides to LEO to nano-satellites as primary payloads meaning, small payloads can afford to specify their own launch and orbit parameters

  11. Affordable Vehicle Avionics Overview

    NASA Technical Reports Server (NTRS)

    Cockrell, James J.

    2015-01-01

    Public and private launch vehicle developers are reducing the cost of propulsion for small commercial launchers, but conventional high-performance, high-reliability avionics remain the disproportionately high cost driver for launch. AVA technology performs as well or better than conventional launch vehicle avionics, but with a fraction of the recurring costs. AVA enables small launch providers to offer affordable rides to LEO to nano-satellites as primary payloads meaning, small payloads can afford to specify their own launch and orbit parameters.

  12. 75 FR 81662 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Affordable...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-28

    ...; Affordable Care Act Patient Protection Notice ACTION: Notice. SUMMARY: The Department of Labor (DOL) hereby... collection request (ICR) titled, ``Affordable Care Act Patient Protection Notice,'' to the Office of... Security Administration (EBSA). Title of Collection: Affordable Care Act Patient Protection Notice....

  13. Achieving health care affordability.

    PubMed

    Payson, Norman C

    2002-10-01

    Not all plans are jumping headlong into the consumer-centric arena. In this article, the CEO of Oxford Health Plans discusses how advanced managed care can achieve what other consumer-centric programs seek to do--provide affordable, quality health care. PMID:12391815

  14. Protection Afforded by a Recombinant Turkey Herpesvirus-H5 Vaccine Against the 2014 European Highly Pathogenic H5N8 Avian Influenza Strain.

    PubMed

    Steensels, M; Rauw, F; van den Berg, Th; Marché, S; Gardin, Y; Palya, V; Lambrecht, B

    2016-05-01

    A highly pathogenic avian influenza (HPAI) H5N8 (clade 2.3.4.4) virus, circulating in Asia (South Korea, Japan, and southern China) since the beginning of 2014, reached the European continent in November 2014. Germany, the Netherlands, the United Kingdom, Italy, and Hungary confirmed H5N8 infection of poultry farms of different species and of several wild bird species. Unlike the Asian highly pathogenic (HP) H5N1, this HP H5N8 also went transatlantic and reached the American West Coast by the end of 2014, affecting wild birds as well as backyard and commercial poultry. This strain induces high mortality and morbidity in Galliformes, whereas wild birds seem only moderately affected. A recombinant turkey herpesvirus (rHVT) vector vaccine expressing the H5 gene of a clade 2.2 H5N1 strain (rHVT-H5) previously demonstrated a highly efficient clinical protection and reduced viral excretion against challenge with Asian HP H5N1 strains of various clades (2.2, 2.2.1, 2.2.1.1, 2.1.3, 2.1.3.2, and 2.3.2.1) and was made commercially available in various countries where the disease is endemic. To evaluate the protective efficacy of the rHVT-H5 vaccine against the first German H5N8 turkey isolate (H5N8 GE), a challenge experiment was set up in specific-pathogen-free (SPF) chickens, and the clinical and excretional protection was evaluated. SPF chickens were vaccinated subcutaneously at 1 day old and challenged oculonasally at 4 wk of age with two viral dosages, 10(5) and 10(6) 50% egg infective doses. Morbidity and mortality were monitored daily in unvaccinated and vaccinated groups, whereas viral shedding by oropharyngeal and cloacal routes was evaluated at 2, 5, 9, and 14 days postinoculation (dpi). Serologic monitoring after vaccination and challenge was also carried out. Despite its high antigenic divergence of the challenge H5N8 strain, a single rHVT-H5 vaccine administration at 1 day old resulted in a full clinical protection against challenge and a significant reduction

  15. Establishing Substantial Equivalence: Proteomics

    NASA Astrophysics Data System (ADS)

    Lovegrove, Alison; Salt, Louise; Shewry, Peter R.

    Wheat is a major crop in world agriculture and is consumed after processing into a range of food products. It is therefore of great importance to determine the consequences (intended and unintended) of transgenesis in wheat and whether genetically modified lines are substantially equivalent to those produced by conventional plant breeding. Proteomic analysis is one of several approaches which can be used to address these questions. Two-dimensional PAGE (2D PAGE) remains the most widely available method for proteomic analysis, but is notoriously difficult to reproduce between laboratories. We therefore describe methods which have been developed as standard operating procedures in our laboratory to ensure the reproducibility of proteomic analyses of wheat using 2D PAGE analysis of grain proteins.

  16. Criteria for substantiating claims.

    PubMed

    Aggett, Peter J

    2007-01-01

    Claims are used to support public health advocacy and marketing. Their evidence base is variable. Claims are made on (i) nutrient content, (ii) comparative merits, (iii) health benefits, and (iv) medical benefits. Experience with therapeutic agents has aided the development of recommendations for the substantiation of health claims for foods and food components, with which dietary supplements would be included. An EU Concerted Activity, Functional Food Science in Europe, suggested that such claims should be based on the general outcomes of 'enhanced function' and 'reduced risk of disease'. A further EU Concerted Activity, The Process for the Assessment of Scientific Support for Claims on Foods, proposed that the evidence base should provide: a characterization of the food or food component to which the claimed effect is attributed; human data, primarily from intervention studies that represent the target populations for the claim; a dose-response relationship: evidence of allowing for confounders including lifestyle, consumption patterns, background diet and food matrix; an appropriate duration for the study; a measure of compliance; and have adequate statistical power to test the hypothesis. When ideal endpoints are not easily accessible for measurement, validated and quality assured markers of the intermediate or final outcomes could be used, as long as their relationship is well characterized. Overall, the totality and coherence of published and unpublished evidence should be considered. Assessments for substantiation need expert judgement, weighting of the strength of the claim, and intelligent use of the criteria applied on an individual basis with respect both to gaps in knowledge and to any need for new knowledge and data. PMID:17913223

  17. Severe Reduction in Number and Function of Peripheral T Cells Does Not Afford Protection toward Emphysema and Bronchial Remodeling Induced in Mice by Cigarette Smoke.

    PubMed

    De Cunto, Giovanna; Lunghi, Benedetta; Bartalesi, Barbara; Cavarra, Eleonora; Fineschi, Silvia; Ulivieri, Cristina; Lungarella, Giuseppe; Lucattelli, Monica

    2016-07-01

    The protein Lck (p56(Lck)) is a Src family tyrosine kinase expressed at all stages of thymocyte development and is required for maturation of T cells. The targeted disruption of Lck gene in mice results in severe block in thymocyte maturation with substantial reduction in the development of CD4(+)CD8(+) thymocytes, severe reduction of peripheral T cells, and disruption of T-cell receptor signaling with defective function of T-cell responses. To investigate the role of T lymphocyte in the development of cigarette smoke-induced pulmonary changes, Lck(-/-) mice and corresponding congenic wild-type mice were chronically exposed to cigarette smoke, and their lungs were analyzed by biochemical, immunologic, and morphometric methods. Smoking mice from both genotypes showed disseminated foci of emphysema and large areas of goblet cell metaplasia in bronchial and bronchiolar epithelium. Morphometric evaluation of lung changes and lung elastin determination confirmed that mice from both genotypes showed the same degree of emphysematous lesions. Thus, cigarette smoke exposure in the presence of severe reduction in number and function of peripheral T cells does not influence the development of pulmonary changes induced by cigarette smoke. The data obtained suggest that innate immunity is a leading actor in the early development of pulmonary changes in smoking mice and that the adaptive immune response may play a role at later stages. PMID:27157991

  18. Characterization of Protection Afforded by a Bivalent Virus-Like Particle Vaccine against Bluetongue Virus Serotypes 1 and 4 in Sheep

    PubMed Central

    Pérez de Diego, Ana Cristina; Athmaram, Thimmasandra N.; Stewart, Meredith; Rodríguez-Sánchez, Belén; Sánchez-Vizcaíno, José Manuel; Noad, Robert; Roy, Polly

    2011-01-01

    Background Bluetongue virus (BTV) is an economically important, arthropod borne, emerging pathogen in Europe, causing disease mainly in sheep and cattle. Routine vaccination for bluetongue would require the ability to distinguish between vaccinated and infected individuals (DIVA). Current vaccines are effective but are not DIVA. Virus-like particles (VLPs) are highly immunogenic structural mimics of virus particles, that only contain a subset of the proteins present in a natural infection. VLPs therefore offer the potential for the development of DIVA compatible bluetongue vaccines. Methodology/Principal Findings Merino sheep were vaccinated with either monovalent BTV-1 VLPs or a bivalent mixture of BTV-1 VLPs and BTV-4 VLPs, and challenged with virulent BTV-1 or BTV-4. Animals were monitored for clinical signs, antibody responses, and viral RNA. 19/20 animals vaccinated with BTV-1 VLPs either alone or in combination with BTV-4 VLPs developed neutralizing antibodies to BTV-1, and group specific antibodies to BTV VP7. The one animal that showed no detectable neutralizing antibodies, or group specific antibodies, had detectable viral RNA following challenge but did not display any clinical signs on challenge with virulent BTV-1. In contrast, all control animals' demonstrated classical clinical signs for bluetongue on challenge with the same virus. Six animals were vaccinated with bivalent vaccine and challenged with virulent BTV-4, two of these animals had detectable viral levels of viral RNA, and one of these showed clinical signs consistent with BTV infection and died. Conclusions There is good evidence that BTV-1 VLPs delivered as monovalent or bivalent immunogen protect from bluetongue disease on challenge with virulent BTV-1. However, it is possible that there is some interference in protective response for BTV-4 in the bivalent BTV-1 and BTV-4 VLP vaccine. This raises the question of whether all combinations of bivalent BTV vaccines are possible, or if

  19. 75 FR 77002 - Proposed Extension of Information Collection Request Submitted for Public Comment; Affordable...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-10

    ... for Public Comment; Affordable Care Act Internal Claims and Appeals and External Review Procedures for... Patient Protection and Affordable Care Act (Affordable Care Act) that are discussed below. A copy of the... collection requests (ICRs) contained in the rule described below that relates to the Affordable Care Act....

  20. Enhanced protective efficacy against Mycobacterium tuberculosis afforded by BCG prime-DNA boost regimen in an early challenge mouse model is associated with increased splenic interleukin-2-producing CD4 T-cell frequency post-vaccination.

    PubMed

    Kang, Han; Yuan, Qin; Ma, Hui; Hu, Zhi-Dong; Han, De-Ping; Wu, Kang; Lowrie, Douglas B; Fan, Xiao-Yong

    2014-12-01

    The development of improved vaccines and vaccination strategies against Mycobacterium tuberculosis has been hindered by a limited understanding of the immune correlates of anti-tuberculosis protective immunity. Simple measurement of interferon-γ frequency or production per se does not provide adequate prediction of immune protection. In this study, we examined the relationship between T-cell immune responses and protective efficacy conferred by the heterologous vaccination strategy, bacillus Calmette-Guérin (BCG) prime-Ag85A DNA boost (B/D), in an early challenge mouse model of pulmonary tuberculosis. The results demonstrated that mice vaccinated with the B/D regimen had a significantly reduced bacillary load compared with BCG-vaccinated mice, and the reduction in colony-forming units was associated with decreased pathology and lower levels of inflammatory cytokines in the infected lungs. Further analysis of immunogenicity showed that the superior protection afforded by the B/D regimen was associated with significantly increased frequency of splenic interleukin-2 (IL-2) -producing CD4 T cells and increased IL-2 production when measured as integrated mean fluorescence intensity post-vaccination as well. These data suggest that measurement of elevated frequency of IL-2-producing CD4 T cells or IL-2 production in the spleens of vaccinated mice can predict vaccine efficacy, at least in the B/D strategy, and add to the accumulating body of evidence suggesting that BCG prime-boost strategies may be a useful approach to the control of M. tuberculosis infection. PMID:24965530

  1. Friendly protection of houses by affordable isolation

    SciTech Connect

    Mazzolani, Federico M.; Mandara, Alberto; Froncillo, Salvatore

    2008-07-08

    The paper deals with a case of seismic isolation carried out in Campania (Italy), referring to the construction of a house building. The concerned case is a three-storey reinforced concrete frame building, in which the isolation system has been applied between the basement top and the first floor deck. The paper reports the main steps of this work, starting from the design, carried out according to the latest Italian seismic code, going throughout the construction stage, up to the extensive on-site testing program performed to evaluate the dynamic response of the building. Relevant technological solutions are illustrated and discussed. Both theoretical calculation and experimental measurements demonstrate the effectiveness of the solution adopted, not only from the technical point of view, but also in an economic perspective.

  2. Ergonomics: Injury Protection You Can Afford.

    ERIC Educational Resources Information Center

    Sturgeon, Julie

    1998-01-01

    Examines the physical health risks attributed to poor furniture and equipment ergonomics and looks at ways to help assure that furniture and equipment purchases and practices are ergonomically sound. Cautions to be wary wary of marketing hype that a company's furniture is ergonomically set, and acquire adjustable furniture and encourage students…

  3. Prime-boost vaccination with recombinant H5-fowlpox and Newcastle disease virus vectors affords lasting protection in SPF Muscovy ducks against highly pathogenic H5N1 influenza virus.

    PubMed

    Niqueux, Eric; Guionie, Olivier; Amelot, Michel; Jestin, Véronique

    2013-08-28

    Vaccination protocols were evaluated in one-day old Muscovy ducklings, using an experimental Newcastle disease recombinant vaccine (vNDV-H5) encoding an optimized synthetic haemagglutinin gene from a clade 2.2.1 H5N1 highly pathogenic (HP) avian influenza virus (AIV), either as a single administration or as a boost following a prime inoculation with a fowlpox vectored vaccine (vFP89) encoding a different H5 HP haemagglutinin from an Irish H5N8 strain. These vaccination schemes did not induce detectable levels of serum antibodies in HI test using a clade 2.2.1 H5N1 antigen, and only induced H5 ELISA positive response in less than 10% of vaccinated ducks. However, following challenge against a clade 2.2.1 HPAIV, both protocols afforded full clinical protection at six weeks of age, and full protection against mortality at nine weeks. Only the prime-boost vaccination (vFP89+vNDV-H5) was still fully protecting Muscovy ducks against disease and mortality at 12 weeks of age. Reduction of oropharyngeal shedding levels was also constantly observed from the onset of the follow-up at 2.5 or three days post-infection in vaccinated ducks compared to unvaccinated controls, and was significantly more important for vFP89+vNDV-H5 vaccination than for vNDV-H5 alone. Although the latter vaccine is shown immunogenic in one-day old Muscovy ducks, the present work is original in demonstrating the high efficacy of the successive administration of two different vector vaccines encoding two different H5 in inducing lasting protection (at least similar to the one induced by an inactivated reassortant vaccine, Re-5). In addition, such a prime-boost schedule allows implementation of a DIVA strategy (to differentiate vaccinated from infected ducks) contrary to Re-5, involves easy practice on the field (with injection at the hatchery and mass vaccination later on), and should avoid eventual interference with NDV maternally derived antibodies. Last, the HA insert could be updated according to

  4. 40 CFR Appendix C to Part 112 - Substantial Harm Criteria

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 22 2014-07-01 2013-07-01 true Substantial Harm Criteria C Appendix C to Part 112 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS OIL POLLUTION PREVENTION Pt. 112, App. C Appendix C to Part 112—Substantial Harm Criteria 1.0Introduction The flowchart provided in Attachment C-I...

  5. 40 CFR Appendix C to Part 112 - Substantial Harm Criteria

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 21 2010-07-01 2010-07-01 false Substantial Harm Criteria C Appendix C to Part 112 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS OIL POLLUTION PREVENTION Pt. 112, App. C Appendix C to Part 112—Substantial Harm Criteria 1.0Introduction The flowchart provided in Attachment C-I...

  6. 40 CFR Appendix C to Part 112 - Substantial Harm Criteria

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 23 2012-07-01 2012-07-01 false Substantial Harm Criteria C Appendix C to Part 112 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS OIL POLLUTION PREVENTION Pt. 112, App. C Appendix C to Part 112—Substantial Harm Criteria 1.0Introduction The flowchart provided in Attachment C-I...

  7. 40 CFR Appendix C to Part 112 - Substantial Harm Criteria

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 22 2011-07-01 2011-07-01 false Substantial Harm Criteria C Appendix C to Part 112 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS OIL POLLUTION PREVENTION Pt. 112, App. C Appendix C to Part 112—Substantial Harm Criteria 1.0Introduction The flowchart provided in Attachment C-I...

  8. 40 CFR Appendix C to Part 112 - Substantial Harm Criteria

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 23 2013-07-01 2013-07-01 false Substantial Harm Criteria C Appendix C to Part 112 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS OIL POLLUTION PREVENTION Pt. 112, App. C Appendix C to Part 112—Substantial Harm Criteria 1.0Introduction The flowchart provided in Attachment C-I...

  9. The U.S. health insurance marketplace: are premiums truly affordable?

    PubMed

    Graetz, Ilana; Kaplan, Cameron M; Kaplan, Erin K; Bailey, James E; Waters, Teresa M

    2014-10-21

    The Patient Protection and Affordable Care Act requires that individuals have health insurance or pay a penalty. Individuals are exempt from paying this penalty if the after-subsidy cost of the least-expensive plan available to them is greater than 8% of their income. For this study, premium data for all health plans offered on the state and federal health insurance marketplaces were collected; the after-subsidy cost of premiums for the least-expensive bronze plan for every county in the United States was calculated; and variations in premium affordability by age, income, and geographic area were assessed. Results indicated that-although marketplace subsidies ensure affordable health insurance for most persons in the United States-many individuals with incomes just above the subsidy threshold will lack affordable coverage and will be exempt from the mandate. Furthermore, young individuals with low incomes often pay as much as or more than older individuals for bronze plans. If substantial numbers of younger, healthier adults choose to remain uninsured because of cost, health insurance premiums across all ages may increase over time. PMID:25199512

  10. Local leadership and the Affordable Care Act.

    PubMed

    Williams, Stephen L; Nichols, Beverly L; Barton, M Katherine; De LaCruz, Maria; Hernandez, Benjamin

    2015-01-01

    Local health departments are in key positions to lead in the education and implementation efforts to advance the Patient Protection and Affordable Care Act. The first enrollment period is over, but the efforts to enroll the uninsured and advocate for expansion of Medicaid in the states that have not yet taken on this expansion will continue for years to come. Political climates may be unsupportive, but some actions may still be possible. PMID:25423062

  11. 75 FR 81662 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Affordable...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-28

    ...; Affordable Care Act Advance Notice of Rescission ACTION: Notice. SUMMARY: The Department of Labor (DOL... information collection request (ICR) titled, ``Affordable Care Act Advance Notice of Rescission,'' to the..._PRA_PUBLIC@dol.gov . SUPPLEMENTARY INFORMATION: The Patient Protection and Affordable Care Act...

  12. Breastfeeding and the Affordable Care Act.

    PubMed

    Hawkins, Summer Sherburne; Dow-Fleisner, Sarah; Noble, Alice

    2015-10-01

    Mothers who receive or qualify for the Women, Infants, and Children (WIC) program or have lower income are less likely to start and continue breastfeeding than their more advantaged counterparts. The Patient Protection and Affordable Care Act (ACA) requires employers to provide break time and space to express breast milk and requires insurance companies to cover breastfeeding support, supplies, and counseling at no cost to mothers. This ACA benefit does not extend to all Medicaid recipients or women in the WIC program. Legislative and regulatory efforts are needed to provide comprehensive coverage for all women and reduce disparities in breastfeeding. PMID:26318941

  13. Production of substantially pure fructose

    SciTech Connect

    Hatcher, H.J.; Gallian, J.J.; Leeper, S.A.

    1990-05-22

    This patent describes a process for the production of a substantially pure product containing greater than 60% fructose. It comprises: combining a sucrose-containing substrate with effective amounts of a levansucrase enzyme preparation to form levan and glucose; purifying the levan by at least one of the following purification methods: ultrafiltration, diafiltration, hyperfiltration, reverse osmosis, liquid--liquid partition, solvent extraction, chromatography, and precipitation; hydrolyzing the levan to form fructose substantially free of glucose and sucrose; and recovering the fructose by at least one of the following recovery methods: hyperfiltration, reverse osmosis, evaporation, drying, crystallization, and chromatography.

  14. Production of substantially pure fructose

    DOEpatents

    Hatcher, Herbert J.; Gallian, John J.; Leeper, Stephen A.

    1990-01-01

    A process is disclosed for the production of substantially pure fructose from sucrose-containing substrates. The process comprises converting the sucrose to levan and glucose, purifying the levan by membrane technology, hydrolyzing the levan to form fructose monomers, and recovering the fructose.

  15. 76 FR 52663 - Notice of Intent To Award Affordable Care Act Funding, DP-09-001

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-23

    ... Care Act Funding, DP-09-001 AGENCY: Centers for Disease Control and Prevention (CDC), Department of... Centers (U48).'' It is the intent of CDC to fund the applications with Patient Protection Affordable Care... 4002 of the Patient Protection and Affordable Care Act (Pub. L. 111-148.). DATES: The effective...

  16. An affordable humanitarian mine detector

    NASA Astrophysics Data System (ADS)

    Daniels, David J.; Curtis, Paul; Amin, Rajan; Dittmer, Jon

    2004-09-01

    This paper describes the further development of the MINETECT affordable humanitarian mine detector produced by ERA Technology with sponsorship from the UK Department for International Development. Using a radically different patented approach from conventional ground penetrating radar (GPR) designs in terms of the man machine interface, MINETECT offers simplicity of use and affordability, both key factors in humanitarian demining operations. Following trials in 2002 and reported at SPIE 2002, further development work including research on classifying mines, based on data from planned trials in the United Kingdom, is presented. MINETECT has the capability of detecting completely non-metallic mines and offers a considerable improvement in hand-held mine detection.

  17. The ethics of the affordability of health insurance.

    PubMed

    Saloner, Brendan; Daniels, Norman

    2011-10-01

    In this essay we argue that the concept of affordable health insurance is rooted in a social obligation to protect fair equality of opportunity. Specifically, health insurance plays a limited but significant role in protecting opportunity in two ways: it helps keep people functioning normally and it protects their financial security. Together these benefits enable household members to exercise reasonable choices about their plans of life. To achieve truly affordable coverage, society must be able to contain the overall cost of health care, and health insurance must be progressively financed, meaning that those who are best able to pay for coverage should pay the largest share. While the recently passed Patient Protection and Affordable Care Act (ACA) falls short on both of these counts, we argue that it makes important contributions toward household affordability through the use of subsidies and regulations. The main shortcoming of the ACA is an insufficient protection against burdensome cost sharing, which we illustrate using several hypothetical scenarios. We conclude with recommendations about how to make opportunity-enhancing expansions to the current coverage subsidies. PMID:22065686

  18. Developing Strategies for Affordable Bandwidth.

    ERIC Educational Resources Information Center

    Educause Quarterly, 2000

    2000-01-01

    Written by Educause's Net@EDU Broadband Pricing Working Group, this article discusses what institutions of higher education can do to develop good partnerships with broadband vendors in order to negotiate affordable pricing for increased bandwidth. Describes problems with the marketplace, examples from a few universities, and points to remember…

  19. Federal Home Visiting under the Affordable Care Act

    ERIC Educational Resources Information Center

    Strader, Kathleen; Counts, Jacqueline; Filene, Jill

    2013-01-01

    The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program is part of The Patient Protection and Affordable Care Act and provides $1.5 billion over 5 years to states, territories, and tribes with the goal of delivering evidence-based home visiting services as part of a high-quality, comprehensive early childhood system that promotes…

  20. An international analysis of cigarette affordability

    PubMed Central

    Blecher, E; van Walbeek, C P

    2004-01-01

    Objective: To investigate how affordable cigarettes are in developed and developing countries, and to calculate by how much the affordability of cigarettes has changed between 1990 and 2001; and secondly, to investigate the relation between cigarette affordability and consumption. Design: Affordability was defined as the cost of cigarettes relative to per capita income. Trends in cigarette affordability, and affordability elasticities of demand, were estimated using regression techniques. Subjects: Seventy countries were investigated, of which 28 are categorised as high income developed countries, while 42 are categorised as developing countries. Cigarette prices were obtained for the main city/cities in the countries. Results: Despite the fact that cigarettes are more expensive in developed countries, the high levels of income make cigarettes more affordable in these countries vis-à-vis developing countries. Of the 28 developed countries, cigarettes became more affordable in 11 and less affordable in 17 countries during the 1990s. Of the 42 developing countries, cigarettes became more affordable in 24 and less affordable in 18 countries. Based on a cross sectional analysis, a 1% increase in the relative income price (the inverse of cigarette affordability) is expected to decrease cigarette consumption by between 0.49–0.57%. Conclusions: Cigarette affordability, more than just the price, determines cigarette consumption. While cigarettes have become more affordable in many developing countries, some developing countries (for example, South Africa, Poland, and Thailand) have implemented strong and effective tobacco control policies, and have been able to decrease cigarette consumption as a result. PMID:15564616

  1. Optics learning through affordable kit

    SciTech Connect

    P, Anusha N E-mail: chitrashaji@gmail.com Shaji, Chitra E-mail: chitrashaji@gmail.com Sharan, Alok E-mail: chitrashaji@gmail.com

    2014-10-15

    An affordable kit which helps to understand some of the optical phenomena qualitatively and quantitatively is presented in this paper. It supplements optics taught in classes. The kit consists of equipments which are available in the market at nominal cost such as laser pointer, lenses, glass plates, razor blades, coins, ball bearing etc. Experiments which come under wave optics (interference and diffraction) and ray optics (reflection and refraction) are explained using this kit.

  2. Optics learning through affordable kit

    NASA Astrophysics Data System (ADS)

    P, Anusha N.; Shaji, Chitra; Sharan, Alok

    2014-10-01

    An affordable kit which helps to understand some of the optical phenomena qualitatively and quantitatively is presented in this paper. It supplements optics taught in classes. The kit consists of equipments which are available in the market at nominal cost such as laser pointer, lenses, glass plates, razor blades, coins, ball bearing etc. Experiments which come under wave optics (interference and diffraction) and ray optics (reflection and refraction) are explained using this kit.

  3. 29 CFR 1977.12 - Exercise of any right afforded by the Act.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 9 2013-07-01 2013-07-01 false Exercise of any right afforded by the Act. 1977.12 Section... OCCUPATIONAL SAFETY AND HEALTH ACT OF 1970 Specific Protections § 1977.12 Exercise of any right afforded by the... because of the exercise “of any right afforded by this Act.” Certain rights are explicitly provided in...

  4. 29 CFR 1977.12 - Exercise of any right afforded by the Act.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 9 2010-07-01 2010-07-01 false Exercise of any right afforded by the Act. 1977.12 Section... OCCUPATIONAL SAFETY AND HEALTH ACT OF 1970 Specific Protections § 1977.12 Exercise of any right afforded by the... because of the exercise “of any right afforded by this Act.” Certain rights are explicitly provided in...

  5. 29 CFR 1977.12 - Exercise of any right afforded by the Act.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 29 Labor 9 2014-07-01 2014-07-01 false Exercise of any right afforded by the Act. 1977.12 Section... OCCUPATIONAL SAFETY AND HEALTH ACT OF 1970 Specific Protections § 1977.12 Exercise of any right afforded by the... because of the exercise “of any right afforded by this Act.” Certain rights are explicitly provided in...

  6. 29 CFR 1977.12 - Exercise of any right afforded by the Act.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 9 2011-07-01 2011-07-01 false Exercise of any right afforded by the Act. 1977.12 Section... OCCUPATIONAL SAFETY AND HEALTH ACT OF 1970 Specific Protections § 1977.12 Exercise of any right afforded by the... because of the exercise “of any right afforded by this Act.” Certain rights are explicitly provided in...

  7. 29 CFR 1977.12 - Exercise of any right afforded by the Act.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 29 Labor 9 2012-07-01 2012-07-01 false Exercise of any right afforded by the Act. 1977.12 Section... OCCUPATIONAL SAFETY AND HEALTH ACT OF 1970 Specific Protections § 1977.12 Exercise of any right afforded by the... because of the exercise “of any right afforded by this Act.” Certain rights are explicitly provided in...

  8. Synthesis of substantially monodispersed colloids

    NASA Technical Reports Server (NTRS)

    Klabunde, Kenneth J. (Inventor); Stoeva, Savka (Inventor); Sorensen, Christopher (Inventor)

    2003-01-01

    A method of forming ligated nanoparticles of the formula Y(Z).sub.x where Y is a nanoparticle selected from the group consisting of elemental metals having atomic numbers ranging from 21-34, 39-52, 57-83 and 89-102, all inclusive, the halides, oxides and sulfides of such metals, and the alkali metal and alkaline earth metal halides, and Z represents ligand moieties such as the alkyl thiols. In the method, a first colloidal dispersion is formed made up of nanoparticles solvated in a molar excess of a first solvent (preferably a ketone such as acetone), a second solvent different than the first solvent (preferably an organic aryl solvent such as toluene) and a quantity of ligand moieties; the first solvent is then removed under vacuum and the ligand moieties ligate to the nanoparticles to give a second colloidal dispersion of the ligated nanoparticles solvated in the second solvent. If substantially monodispersed nanoparticles are desired, the second dispersion is subjected to a digestive ripening process. Upon drying, the ligated nanoparticles may form a three-dimensional superlattice structure.

  9. Smoking Bans in Affordable Housing Benefit All

    MedlinePlus

    ... 160501.html Smoking Bans in Affordable Housing Benefit All: Study Secondhand exposure lowered, and smokers more likely ... residents of eight affordable housing properties in Minnesota. All the properties prohibited smoking indoors and three also ...

  10. Can China afford rapid aging?

    PubMed

    Jiang, Quanbao; Yang, Shucai; Sánchez-Barricarte, Jesús J

    2016-01-01

    China's rapid aging has caused widespread concern, but it seems that the situations and consequences of rapid aging are not adequately acknowledged. This study analyzed the problem of ageing in China from the aspects of elderly people's health status, income source, daily care, suicide, the weak social security system in terms of pension, health expenses, and long-term care costs as well as incoming accelerating ageing process in China. All these factors indicate that it is difficult for China to afford the issue of a rapidly aging population. PMID:27478724

  11. Perceiving Affordances for Fitting through Apertures

    ERIC Educational Resources Information Center

    Ishak, Shaziela; Adolph, Karen E.; Lin, Grace C.

    2008-01-01

    Affordances--possibilities for action--are constrained by the match between actors and their environments. For motor decisions to be adaptive, affordances must be detected accurately. Three experiments examined the correspondence between motor decisions and affordances as participants reached through apertures of varying size. A psychophysical…

  12. The Affordable Care Act: The Value of Systemic Disruption

    PubMed Central

    2013-01-01

    It is important to recognize the political and policy accomplishments of the Patient Protection and Affordable Care Act (ACA), anticipate its limitations, and use the levers it provides strategically to address the problems it does not resolve. Passage of the ACA broke the political logjam that long stymied national progress toward equitable, quality, universal, affordable health care. It extends coverage for the uninsured who are disproportionately low income and people of color, curbs health insurance abuses, and initiates improvements in the quality of care. However, challenges to affordability and cost control persist. Public health advocates should mobilize for coverage for abortion care and for immigrants, encourage public-sector involvement in negotiating health care prices, and counter disinformation by opponents on the right. PMID:23409911

  13. Energy efficient affordable housing. Final report

    SciTech Connect

    1995-07-01

    In 1994, the Southface Energy Institute, working with support from US DOE, initiated a program to provide technical assistance to nonprofit organizations developing affordable housing in the Olympic target communities of Atlanta. The specific project goals were: Identify the barriers that nonprofit affordable housing providers face in increasing the energy and resource efficiency of affordable housing; Assist them in developing the resources to overcome these barriers; Develop specific technical materials and program models that will enable these affordable housing groups to continue to improve the energy efficiency of their programs; and, To transfer the program materials to other affordable housing providers. This report summarizes the progress made in each of these areas.

  14. Affordable In-Space Transportation

    NASA Technical Reports Server (NTRS)

    Curtis, L. A.; VanDyke, M. K.; Lajoie, R. M.; Woodcock, G. R.

    1996-01-01

    Current and proposed launch systems will provide access to low-Earth orbit (LEO), and destinations beyond LEO, but the cost of delivering payloads will preclude the use of these services by many users. To develop and encourage revolutionary commercial utilization of geosynchronous orbit (GEO) and to provide an affordable means to continue NASA space science and exploration missions, the transportation costs to in-space destinations must be reduced. The principal objective of this study was to conceptually define three to four promising approaches to in-space transportation for delivery of satellites and other payloads, 3,000- to 10,000-lb class, to GEO destinations. This study established a methodology for evaluating in-space transportation systems based on life-cycle cost. The reusable concepts seemed to fare better in the evaluation than expendable, since a major driver in the life-cycle cost was the stage production cost.

  15. Income Dynamics and the Affordable Care Act

    PubMed Central

    Shore-Sheppard, Lara D

    2014-01-01

    Objective To examine the sources of family income dynamics leading to movement into and out of Medicaid expansion and subsidy eligibility under the Affordable Care Act. Data Source Survey of Income and Program Participation (SIPP): 1996, 2001, 2004, 2008 panels. Study Design Considering four broad subsidy eligibility categories for monthly Modified Adjusted Gross Income (MAGI) (<138 percent of the Federal Poverty Level [FPL], 138–250 percent FPL, 250–400 percent FPL, and >400 percent FPL), I use duration analysis to examine determinants of movements between categories over the course of a year. Data Collection/Extraction Using detailed monthly data, I determine the members of tax-filing units and calculate an approximation of MAGI at the monthly level. The analysis sample is adults ages 22–64 years. Principal Findings Incomes are highly variable within a year, particularly at the lower end of the income distribution. Employment transitions, including transitions not involving a period of nonemployment, and family structure changes strongly predict sufficient income volatility to trigger a change in subsidy category. Conclusions Income volatility arising from employment and family structure changes is likely to trigger changes in subsidy eligibility within the year, but the sources and effects of the volatility differ substantially depending on the individual's position in the income distribution. PMID:25327987

  16. 29 CFR 1990.145 - Consideration of substantial new issues or substantial new evidence.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... substance any substantial new issues upon which the Secretary did not reach a conclusion in the rulemaking... 29 Labor 9 2010-07-01 2010-07-01 false Consideration of substantial new issues or substantial new... of substantial new issues or substantial new evidence. (a) Substantial new issues....

  17. 29 CFR 1990.145 - Consideration of substantial new issues or substantial new evidence.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... substance any substantial new issues upon which the Secretary did not reach a conclusion in the rulemaking... 29 Labor 9 2011-07-01 2011-07-01 false Consideration of substantial new issues or substantial new... of substantial new issues or substantial new evidence. (a) Substantial new issues....

  18. Can consumers make affordable care affordable? The value of choice architecture.

    PubMed

    Johnson, Eric J; Hassin, Ran; Baker, Tom; Bajger, Allison T; Treuer, Galen

    2013-01-01

    Tens of millions of people are currently choosing health coverage on a state or federal health insurance exchange as part of the Patient Protection and Affordable Care Act. We examine how well people make these choices, how well they think they do, and what can be done to improve these choices. We conducted 6 experiments asking people to choose the most cost-effective policy using websites modeled on current exchanges. Our results suggest there is significant room for improvement. Without interventions, respondents perform at near chance levels and show a significant bias, overweighting out-of-pocket expenses and deductibles. Financial incentives do not improve performance, and decision-makers do not realize that they are performing poorly. However, performance can be improved quite markedly by providing calculation aids, and by choosing a "smart" default. Implementing these psychologically based principles could save purchasers of policies and taxpayers approximately 10 billion dollars every year. PMID:24367484

  19. Can Consumers Make Affordable Care Affordable? The Value of Choice Architecture

    PubMed Central

    Johnson, Eric J.; Hassin, Ran; Baker, Tom; Bajger, Allison T.; Treuer, Galen

    2013-01-01

    Tens of millions of people are currently choosing health coverage on a state or federal health insurance exchange as part of the Patient Protection and Affordable Care Act. We examine how well people make these choices, how well they think they do, and what can be done to improve these choices. We conducted 6 experiments asking people to choose the most cost-effective policy using websites modeled on current exchanges. Our results suggest there is significant room for improvement. Without interventions, respondents perform at near chance levels and show a significant bias, overweighting out-of-pocket expenses and deductibles. Financial incentives do not improve performance, and decision-makers do not realize that they are performing poorly. However, performance can be improved quite markedly by providing calculation aids, and by choosing a “smart” default. Implementing these psychologically based principles could save purchasers of policies and taxpayers approximately 10 billion dollars every year. PMID:24367484

  20. 26 CFR 7.105-2 - Substantial gainful activity.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 26 Internal Revenue 14 2012-04-01 2012-04-01 false Substantial gainful activity. 7.105-2 Section 7.105-2 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX... because of a physical or mental impairment accepts sheltered employment in a protected environment...

  1. 26 CFR 7.105-2 - Substantial gainful activity.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 14 2010-04-01 2010-04-01 false Substantial gainful activity. 7.105-2 Section 7.105-2 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX... because of a physical or mental impairment accepts sheltered employment in a protected environment...

  2. 24 CFR 572.120 - Affordability standards.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 3 2014-04-01 2013-04-01 true Affordability standards. 572.120...) Homeownership Program Requirements-Implementation Grants § 572.120 Affordability standards. (a) Initial... annual incomes of eligible families using reasonable standards and procedures consistently applied.)...

  3. College Affordability: Implications for College Opportunity

    ERIC Educational Resources Information Center

    Perna, Laura W.; Li, Chunyan

    2006-01-01

    By examining trends in college affordability, this article explores the extent to which the public perception that college is not affordable is justified. First, the article describes trends in national indicators that contribute to ability to pay, including income growth, health care costs, debt burden, and personal savings rates. Trends in…

  4. Affordability Funding Models for Early Childhood Services

    ERIC Educational Resources Information Center

    Purcal, Christiane; Fisher, Karen

    2006-01-01

    This paper presents a model of the approaches open to government to ensure that early childhood services are affordable to families. We derived the model from a comparative literature review of affordability approaches taken by government, both in Australia and internationally. The model adds significantly to the literature by proposing a means to…

  5. Section 8: Affordable Housing for Exceptional Families

    ERIC Educational Resources Information Center

    Wright, Wesley E.

    2009-01-01

    Shelter is a basic human need. Unfortunately, affordable housing is a need that low income families who are caring for children and adults with disabilities can rarely afford without assistance. Because participating families generally pay rent of no more than 30 percent of their adjusted monthly income, the Section 8 program can provide…

  6. Affordability Approaches for Human Space Exploration

    NASA Technical Reports Server (NTRS)

    Holladay, Jon; Smith, David Alan

    2012-01-01

    The design and development of historical NASA Programs (Apollo, Shuttle and International Space Station), have been based on pre-agreed missions which included specific pre-defined destinations (e.g., the Moon and low Earth orbit). Due to more constrained budget profiles, and the desire to have a more flexible architecture for Mission capture as it is affordable, NASA is working toward a set of Programs that are capability based, rather than mission and/or destination specific. This means designing for a performance capability that can be applied to a specific human exploration mission/destination later (sometime years later). This approach does support developing systems to flatter budgets over time, however, it also poses the challenge of how to accomplish this effectively while maintaining a trained workforce, extensive manufacturing, test and launch facilities, and ensuring mission success ranging from Low Earth Orbit to asteroid destinations. NASA Marshall Space Flight Center (MSFC) in support of Exploration Systems Directorate (ESD) in Washington, DC has been developing approaches to track affordability across multiple Programs. The first step is to ensure a common definition of affordability: the discipline to bear cost in meeting a budget with margin over the life of the program. The second step is to infuse responsibility and accountability for affordability into all levels of the implementing organization since affordability is no single person s job; it is everyone s job. The third step is to use existing data to identify common affordability elements organized by configuration (vehicle/facility), cost, schedule, and risk. The fourth step is to analyze and trend this affordability data using an affordability dashboard to provide status, measures, and trends for ESD and Program level of affordability tracking. This paper will provide examples of how regular application of this approach supports affordable and therefore sustainable human space exploration

  7. 46 CFR 28.501 - Substantial alterations.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 1 2014-10-01 2014-10-01 false Substantial alterations. 28.501 Section 28.501 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY UNINSPECTED VESSELS REQUIREMENTS FOR COMMERCIAL FISHING INDUSTRY VESSELS Stability § 28.501 Substantial alterations. (a) Except as provided in paragraph (b) of this section, a vessel that is...

  8. 40 CFR 725.94 - Substantiation requirements.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... CONTROL ACT REPORTING REQUIREMENTS AND REVIEW PROCESSES FOR MICROORGANISMS Confidentiality and Public... Inventory, the claim must be reasserted and substantiated at the time the Notice of Commencement (NOC) is... Inventory. (2) The submitter must substantiate the claim for confidentiality of the microorganism...

  9. 77 FR 39452 - Substantial Business Activities; Correction

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-03

    ..., June 12, 2012 (77 FR 34887) regarding whether a foreign corporation has substantial business activities...- 107889-12), which was the subject of FR. Doc. 2012-14238, is corrected as follows: On page 34887, column... Internal Revenue Service 26 CFR Part 1 RIN 1545-BK85 Substantial Business Activities; Correction...

  10. MISSE-X: Affordable Space Environment Testing

    NASA Video Gallery

    MISSE–X is a robotically serviceable ISS external facility providing government, industry and academia experimenters with affordable access to space for materials durability testing of potential ...

  11. Body-scaled affordances in sensory substitution.

    PubMed

    Travieso, David; Gómez-Jordana, Luis; Díaz, Alex; Lobo, Lorena; Jacobs, David M

    2015-12-15

    The research field on sensory substitution devices has strong implications for theoretical work on perceptual consciousness. One of these implications concerns the extent to which the devices allow distal attribution. The present study applies a classic empirical approach on the perception of affordances to the field of sensory substitution. The reported experiment considers the perception of the stair-climbing affordance. Participants judged the climbability of steps apprehended through a vibrotactile sensory substitution device. If measured with standard metric units, climbability judgments of tall and short participants differed, but if measured in units of leg length, judgments did not differ. These results are similar to paradigmatic results in regular visual perception. We conclude that our sensory substitution device allows the perception of affordances. More generally, we argue that the theory of affordances may enrich theoretical debates concerning sensory substitution to a larger extent than has hitherto been the case. PMID:26587958

  12. Modulation of visual attention by object affordance.

    PubMed

    Garrido-Vásquez, Patricia; Schubö, Anna

    2014-01-01

    Some objects in our environment are strongly tied to motor actions, a phenomenon called object affordance. A cup, for example, affords us to reach out to it and grasp it by its handle. Studies indicate that merely viewing an affording object triggers motor activations in the brain. The present study investigated whether object affordance would also result in an attention bias, that is, whether observers would rather attend to graspable objects within reach compared to non-graspable but reachable objects or to graspable objects out of reach. To this end, we conducted a combined reaction time and motion tracking study with a table in a virtual three-dimensional space. Two objects were positioned on the table, one near, the other one far from the observer. In each trial, two graspable objects, two non-graspable objects, or a combination of both was presented. Participants were instructed to detect a probe appearing on one of the objects as quickly as possible. Detection times served as indirect measure of attention allocation. The motor association with the graspable object was additionally enhanced by having participants grasp a real object in some of the trials. We hypothesized that visual attention would be preferentially allocated to the near graspable object, which should be reflected in reduced reaction times in this condition. Our results confirm this assumption: probe detection was fastest at the graspable object at the near position compared to the far position or to a non-graspable object. A follow-up experiment revealed that in addition to object affordance per se, immediate graspability of an affording object may also influence this near-space advantage. Our results suggest that visuospatial attention is preferentially allocated to affording objects which are immediately graspable, and thus establish a strong link between an object' s motor affordance and visual attention. PMID:24567725

  13. To repeal the Patient Protection and Affordable Care Act.

    THOMAS, 111th Congress

    Rep. King, Steve [R-IA-5

    2010-03-25

    06/16/2010 Motion to Discharge Committee filed by Mr. King (IA). Petition No: 111-11. (Discharge petition text with signatures.) (All Actions) Notes: On 6/16/2010, a motion was filed to discharge the Committees on Energy and Commerce, Ways and Means, Education and Labor, the Judiciary, Natural Resources, Rules, House Administration, and Appropriations from consideration of H.R.4972. A discharge petition requires 218 signatures for... Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

  14. Implications for multiple sclerosis in the era of the Affordable Care Act: the shifting managed care landscape.

    PubMed

    Mathis, A Scott; Owens, Gary M

    2014-12-01

    Multiple sclerosis (MS) is a disorder of the central nervous system that is associated with disability, reduced quality of life, extensive medical and nonmedical costs, and lost productivity. Specialty medications that are crucial to effective disease management, helping to prevent debilitating episodes of relapse, account for a substantial portion of the medical expenditures associated with MS. Although these therapies are not considered cost-effective by conventional definitions, they are comparable to one another in cost-effectiveness estimates, leaving the complex task of designing cost-efficient formulary management strategies to managed care professionals. Current epidemiologic data suggest that most patients with MS are covered by some form of healthcare insurance, but plan designs and formulary restrictions may still create access barriers for some patients. The Affordable Care Act (ACA) is recent federal legislation that seeks to provide new consumer protections, improve healthcare quality and accessibility while mitigating expenditures, and increase accountability of healthcare insurance companies. The impact of the ACA on specialty pharmaceuticals is unclear at this time, but it does appear to have already begun improving healthcare coverage across the population. Managed care professionals must work within the confines of the ACA to provide better and more affordable care that targets overall cost reductions rather than just pharmacy expenses. PMID:25734889

  15. Affordable care 2014: a tale of two boards.

    PubMed

    Hirsch, Joshua A; Barr, Robert M; McGinty, Geraldine; Nicola, Gregory N; Schaefer, Pamela W; Silva, Ezequiel; Manchikanti, Laxmaiah

    2014-11-01

    The Patient Protection and Affordable Care Act (ACA) became law on 23 March 2010. As part of the law, two independent boards were established. The Patient-Centered Outcomes Research Institute embodies national aspirations for employing comparative effectiveness research in healthcare decision-making, and the Independent Payment Advisory Board is focused on the need for a group of impartial experts to establish anticipatable growth rates for Medicare. Approximately 4 years after the bill was passed into law, these independent boards are at very different points in their life cycles. This article provides a status update. PMID:24962452

  16. Affordability of the Health Expenditures of Insured Americans Before the Affordable Care Act.

    PubMed

    Nyman, John A; Trenz, Helen M

    2016-02-01

    Central to the Affordable Care Act is the notion of affordability and the role of health insurance in making otherwise unaffordable health care affordable. We used data from the 1996 to 2008 versions of the Medical Expenditure Panel Survey to estimate the portion of overall health care expenditures by insured respondents that would otherwise have been beyond their disposable incomes and assets. We found that about one third of insured expenditures would have been unaffordable, with a much higher percentage among publicly insured individuals. This result suggests that one of the main functions of insurance is to cover expenses that insured individuals would not otherwise be able to afford. PMID:26691116

  17. Affordable housing: Reducing the energy cost burden

    SciTech Connect

    Lee, A.D.; Chin, R.I.; Marden, C.L.

    1995-01-01

    Residential energy expenditures are a key determinant of housing affordability, particularly for lower Income households. For years, federal, state and local governments and agencies have sought to defray energy expenses and Increase residential energy efficiency for low Income households through legislative and regulatory actions and programs. Nevertheless, household energy costs continue to place a major burden on lower Income families. This issue paper was written to help formulate national energy policy by providing the United States Department of Energy`s (DOE`s) Office of Energy Efficiency and Renewable Energy (EE) with Information to help define the affordable housing issue; Identify major drivers, key factors, and primary stakeholders shaping the affordable housing issue; and review how responding to this Issue may impact EE`s goals and objectives and Influence the strategic direction of the office. Typically, housing affordability is an Issue associated with lower income households. This issue paper adopts this perspective, but it is important to note that reducing energy utility costs can make {open_quotes}better{close_quote} housing affordable to any household regardless of income. As energy efficiency is improved throughout all sectors of the economy, special consideration must be given to low income households. Of all households, low income households are burdened the most by residential energy costs; their residences often are the least energy-efficient and have the greatest potential for efficiency improvements, but the occupants have the fewest resources to dedicate to conservation measures. This paper begins with a definition of {open_quotes}affordability{close_quotes} as it pertains to total housing costs and summarizes several key statistics related to housing affordability and energy use by lower income households.

  18. Achieving Sustainable Construction in Affordable Housing

    SciTech Connect

    Barcik, M.K.; Creech, D.B.; Ternes, M.P.

    1998-12-07

    An energy-efficient design and construction checklist and information sheets on energy-efficient design and construction are two products being developed. These products will help affordable housing providers take the first steps toward a whole-house approach to the design and implementation of energy-efficient construction practices. The checklist presents simple and clear guidance on energy improvements that can be readily addressed now by most affordable housing providers. The information sheets complement the checklist by providing installation instructions and material specifications that are accompanied by detailed graphics. The information sheets also identify benefits of recommended energy-efficiency measures and procedures including cost savings and impacts on health and comfort. This paper presents details on the checklist and information sheets and discusses their use in two affordable housing projects.

  19. Affordances and the musically extended mind.

    PubMed

    Krueger, Joel

    2014-01-01

    I defend a model of the musically extended mind. I consider how acts of "musicking" grant access to novel emotional experiences otherwise inaccessible. First, I discuss the idea of "musical affordances" and specify both what musical affordances are and how they invite different forms of entrainment. Next, I argue that musical affordances - via soliciting different forms of entrainment - enhance the functionality of various endogenous, emotion-granting regulative processes, drawing novel experiences out of us with an expanded complexity and phenomenal character. I argue that music therefore ought to be thought of as part of the vehicle needed to realize these emotional experiences. I appeal to different sources of empirical work to develop this idea. PMID:24432008

  20. The Transformation of Ergonomic Affordances into Cultural Affordances: The Case of the Alnuset System

    ERIC Educational Resources Information Center

    Chiappini, Giampaolo

    2012-01-01

    Is it possible to study the ergonomic affordances offered by a system designed for educational aims and their transformation into cultural affordances? To this purpose, what references can we adopt? This work describes the theoretical framework used to realise this study referring to AlNuSet, a system realised within the EC ReMath project to…

  1. The Affordable Care Act and orthopaedic trauma.

    PubMed

    Issar, Neil M; Jahangir, A Alex

    2014-10-01

    The Affordable Care Act has resulted in a dramatic governmental restructuring of the healthcare insurance market and delivery system. Orthopaedic traumatologists must be aware of the law's impact on their clinical practice, finances, and overall business model. This includes the effect of accountable care organizations, the Independent Payment Advisory Board, and the Physician Value-Based Payment Modifier program, as well as the impact of the Affordable Care Act's grace period provision, medical device excise tax, and cuts to funding for the Disproportionate Share Hospital program. PMID:25229683

  2. Affordance Templates for Shared Robot Control

    NASA Technical Reports Server (NTRS)

    Hart, Stephen; Dinh, Paul; Hambuchen, Kim

    2014-01-01

    This paper introduces the Affordance Template framework used to supervise task behaviors on the NASA-JSC Valkyrie robot at the 2013 DARPA Robotics Challenge (DRC) Trials. This framework provides graphical interfaces to human supervisors that are adjustable based on the run-time environmental context (e.g., size, location, and shape of objects that the robot must interact with, etc.). Additional improvements, described below, inject degrees of autonomy into instantiations of affordance templates at run-time in order to enable efficient human supervision of the robot for accomplishing tasks.

  3. 40 CFR 725.94 - Substantiation requirements.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... microorganism identity confidential in the MCAN and wants the identity to be listed on the confidential... submitted under § 725.190. Otherwise, EPA will list the specific microorganism identity on the public Inventory. (2) The submitter must substantiate the claim for confidentiality of the microorganism...

  4. 40 CFR 725.94 - Substantiation requirements.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... microorganism identity confidential in the MCAN and wants the identity to be listed on the confidential... submitted under § 725.190. Otherwise, EPA will list the specific microorganism identity on the public Inventory. (2) The submitter must substantiate the claim for confidentiality of the microorganism...

  5. 24 CFR 902.79 - Substantial default.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...) Notification of substantial default and response. If information from an annual assessment or audit, or any... substantively accurate; and (v) Notification to the PHA that, absent a satisfactory response in accordance with... determined to be an emergency, or in any case where the events or conditions precipitating the...

  6. Substantially oxygen-free contact tube

    NASA Technical Reports Server (NTRS)

    Pike, James F. (Inventor)

    1993-01-01

    A device for arc welding is provided in which a continuously-fed electrode wire is in electrical contact with a contact tube. The contact tube is improved by using a substantially oxygen-free conductive alloy in order to reduce the amount of electrical erosion.

  7. 21 CFR 514.4 - Substantial evidence.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... adequate and well-controlled studies, such as a study in a target species, study in laboratory animals... Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) ANIMAL DRUGS, FEEDS, AND RELATED PRODUCTS NEW ANIMAL DRUG APPLICATIONS General Provisions § 514.4 Substantial...

  8. 21 CFR 514.4 - Substantial evidence.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... effectiveness of the new animal drug involved that the new animal drug will have the effect it purports or is... have its intended effect. (b) Characteristics of substantial evidence—(1) Qualifications of experts... for use other than in animal feed or drinking water. (iii) Antibacterial with respect to a...

  9. 21 CFR 514.4 - Substantial evidence.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... effectiveness of the new animal drug involved that the new animal drug will have the effect it purports or is... have its intended effect. (b) Characteristics of substantial evidence—(1) Qualifications of experts... for use other than in animal feed or drinking water. (iii) Antibacterial with respect to a...

  10. Substantially Oxygen-Free Contact Tube

    NASA Technical Reports Server (NTRS)

    Pike, James F. (Inventor)

    1991-01-01

    A device for arc welding is provided in which a continuously-fed electrode wire is in electrical contact with a contact tube. The contact tube is improved by using a substantially oxygen-free conductive alloy in order to reduce the amount of electrical erosion.

  11. The Affordable Care Act, remedy, and litigation reform.

    PubMed

    Maher, Brendan S

    2014-01-01

    The Patient Protection and Affordable Care Act of 2010 (ACA) rewrote the law of private health insurance. How the ACA rewrote the law of civil remedies, however, is a question largely unexamined by scholars. Courts everywhere, including the U.S. Supreme Court, will soon confront this important issue. This Article offers a foundational treatment of the ACA on remedy. It predicts a series of flashpoints over which litigation reform battles will be fought. It identifies several themes that will animate those conflicts and trigger others. It explains how judicial construction of the statute's functional predecessor, the Employee Retirement Income Security Act of 1974 (ERISA), converted a protective statute into a uniquely effective piece of federal litigation reform. Ultimately, it considers whether the ACA--which incorporates, modifies, and rejects ERISA in several notable ways--will experience a similar fate. PMID:25335202

  12. No Role for Motor Affordances in Visual Working Memory

    ERIC Educational Resources Information Center

    Pecher, Diane

    2013-01-01

    Motor affordances have been shown to play a role in visual object identification and categorization. The present study explored whether working memory is likewise supported by motor affordances. Use of motor affordances should be disrupted by motor interference, and this effect should be larger for objects that have motor affordances than for…

  13. Are Selective Private and Public Colleges Affordable?

    ERIC Educational Resources Information Center

    Karikari, John A.; Dezhbakhsh, Hashem

    2013-01-01

    We examine college affordability under the existing pricing and financial aid system that awards both non need-based and need-based aid. Using data of freshmen attending a large number of selective private and public colleges in the USA, we find that the prices students actually pay for college have increased over time. Need-based grant aid has…

  14. Options for Affordable Fission Surface Power Systems

    NASA Technical Reports Server (NTRS)

    Houts, Mike; Gaddis, Steve; Porter, Ron; VanDyke, Melissa; Martin Jim; Godfroy, Tom; Bragg-Sitton, Shannon; Garber, Anne; Pearson, Boise

    2006-01-01

    Fission surface power systems could provide abundant power anywhere on free surface of the moon or Mars. Locations could include permanently shaded regions on the moon and high latitudes on Mars. To be fully utilized; however, fission surface power systems must be safe, have adequate performance, and be affordable. This paper discusses options for the design and development of such systems.

  15. Can the US afford a lunar base

    SciTech Connect

    Keaton, P.W.

    1986-01-01

    Establishing a lunar base will require steady funding for a decade or two. The question addressed here is whether such a large space project is affordable at this time. The relevant facts and methodology are presented so that the reader may formulate independent answers. It is shown that a permanent lunar base can be financed without increasing NASA's historical budgetary trends.

  16. 9 Tips for Affordable Student Trips

    ERIC Educational Resources Information Center

    Adams, Jonathan

    2013-01-01

    The trick to having a successful and affordable trip is planning ahead and planning thoroughly. Keep the spirits high and the costs low by following a well-traveled ensemble director's suggestions as presented in this article. These tips include finding local attractions that are unique to the city that the group will be visiting, looking at…

  17. Actions and Affordances in Syntactic Ambiguity Resolution

    ERIC Educational Resources Information Center

    Chambers, Craig G.; Tanenhaus, Michael K.; Magnuson, James S.

    2004-01-01

    In 2 experiments, eye movements were monitored as participants followed instructions containing temporary syntactic ambiguities (e.g., "Pour the egg in the bowl over the flour"). The authors varied the affordances of task-relevant objects with respect to the action required by the instruction (e.g., whether 1 or both eggs in the visual workspace…

  18. Diabetes and the Affordable Care Act

    PubMed Central

    Schade, David S.

    2014-01-01

    Abstract The Affordable Care Act—“Obamacare”—is the most important federal medical legislation to be enacted since Medicare. Although the goal of the Affordable Care Act is to improve healthcare coverage, access, and quality for all Americans, people with diabetes are especially poised to benefit from the comprehensive reforms included in the act. Signed into law in 2010, this massive legislation will slowly be enacted over the next 10 years. In the making for at least a decade, it will affect every person in the United States, either directly or indirectly. In this review, we discuss the major changes in healthcare that will take place in the next several years, including (1) who needs to purchase insurance on the Web-based exchange, (2) the cost to individuals and the rebates that they may expect, (3) the rules and regulations for purchasing insurance, (4) the characteristics of the different “metallic” insurance plans that are available, and (5) the states that have agreed to participate. With both tables and figures, we have tried to make the Affordable Care Act both understandable and appreciated. The goal of this comprehensive review is to highlight aspects of the Affordable Care Act that are of importance to practitioners who care for people with diabetes by discussing both the positive and the potentially negative aspects of the program as they relate to diabetes care. PMID:24927108

  19. Affordances of Instrumentation in General Chemistry Laboratories

    ERIC Educational Resources Information Center

    Sherman, Kristin Mary Daniels

    2010-01-01

    The purpose of this study is to find out what students in the first chemistry course at the undergraduate level (general chemistry for science majors) know about the affordances of instrumentation used in the general chemistry laboratory and how their knowledge develops over time. Overall, students see the PASCO(TM) system as a useful and accurate…

  20. Substantiation of International Nanomaterials Security Group Creation

    NASA Astrophysics Data System (ADS)

    Sosnov, A.; Sadovnikov, S.; Panfilov, S.; Magarshak, Yu.

    Nanotechnology has achieved the status as one of the critical R&D area. Scientists use the unique properties of atomic and molecular assemblages built at the nanometer scale. The ability to manipulate the physical, chemical, and biological properties of molecules and particles affords to design agents with set up properties. But the technology allows creating not only useful agents. Possible accidental or deliberate creation of new nanoparticles (NPs) with dangerous properties is highly probable minor product of progress in the new area. The article briefly describes some pathways in development and implementation of NPs for medicinal and the similar purposes. Some of NPs can effective facilitate and mask transport of various agents in various environments. Possible creation of new dangerous NPs (e.g. conjugates based on combination of extensively use NPs and chemical, biological and radioactive agents) as well as creation of brand new NPs and nanodevices with unique properties needs creation of international multidiscipline community for security evaluation of nanomaterials and technologies. The community will forecast possible dangerous unexpectedness in the field of nanoscale materials and devices and suggests rational pathways for prevention of the threats.

  1. 76 FR 51147 - Medicaid Program; Eligibility Changes Under the Affordable Care Act of 2010

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-17

    ... Register (76 FR 41866) (``Patient Protection and Affordable Care Act; Establishment of Exchanges and... August 3, 2010 Federal Register (75 FR 45584). Second, Initial Guidance to States on Exchanges was... process for waivers for State innovation was published in the March 14, 2011 Federal Register (76 FR...

  2. Does Pluto have a substantial atmosphere

    SciTech Connect

    Trafton, L.

    1980-01-01

    The presence of CH4 ice on Pluto implies that Pluto may have a substantial atmosphere consisting of heavy gases. Without such an atmosphere, sublimation of the CH4 ice would be so rapid on a cosmogonic time scale that either such an atmosphere would soon develop through the exposure of gases trapped in the CH4 ice or else the surface CH4 ice would soon be all sublimated away as other, more stable, ices became exposed. If such stable ices were present from the beginning, the existence of CH4 frosts would also imply that Pluto's present atmosphere contains a remnant of its primordial atmosphere.

  3. An Affordable Open-Source Turbidimeter

    PubMed Central

    Kelley, Christopher D.; Krolick, Alexander; Brunner, Logan; Burklund, Alison; Kahn, Daniel; Ball, William P.; Weber-Shirk, Monroe

    2014-01-01

    Turbidity is an internationally recognized criterion for assessing drinking water quality, because the colloidal particles in turbid water may harbor pathogens, chemically reduce oxidizing disinfectants, and hinder attempts to disinfect water with ultraviolet radiation. A turbidimeter is an electronic/optical instrument that assesses turbidity by measuring the scattering of light passing through a water sample containing such colloidal particles. Commercial turbidimeters cost hundreds or thousands of dollars, putting them beyond the reach of low-resource communities around the world. An affordable open-source turbidimeter based on a single light-to-frequency sensor was designed and constructed, and evaluated against a portable commercial turbidimeter. The final product, which builds on extensive published research, is intended to catalyze further developments in affordable water and sanitation monitoring. PMID:24759114

  4. System Concepts for Affordable Fission Surface Power

    NASA Technical Reports Server (NTRS)

    Mason, Lee; Poston, David; Qualls, Louis

    2008-01-01

    This paper presents an overview of an affordable Fission Surface Power (FSP) system that could be used for NASA applications on the Moon and Mars. The proposed FSP system uses a low temperature, uranium dioxide-fueled, liquid metal-cooled fission reactor coupled to free-piston Stirling converters. The concept was determined by a 12 month NASA/DOE study that examined design options and development strategies based on affordability and risk. The system is considered a low development risk based on the use of terrestrial-derived reactor technology, high efficiency power conversion, and conventional materials. The low-risk approach was selected over other options that could offer higher performance and/or lower mass.

  5. Affordances and the musically extended mind

    PubMed Central

    Krueger, Joel

    2014-01-01

    I defend a model of the musically extended mind. I consider how acts of “musicking” grant access to novel emotional experiences otherwise inaccessible. First, I discuss the idea of “musical affordances” and specify both what musical affordances are and how they invite different forms of entrainment. Next, I argue that musical affordances – via soliciting different forms of entrainment – enhance the functionality of various endogenous, emotion-granting regulative processes, drawing novel experiences out of us with an expanded complexity and phenomenal character. I argue that music therefore ought to be thought of as part of the vehicle needed to realize these emotional experiences. I appeal to different sources of empirical work to develop this idea. PMID:24432008

  6. An affordable open-source turbidimeter.

    PubMed

    Kelley, Christopher D; Krolick, Alexander; Brunner, Logan; Burklund, Alison; Kahn, Daniel; Ball, William P; Weber-Shirk, Monroe

    2014-01-01

    Turbidity is an internationally recognized criterion for assessing drinking water quality, because the colloidal particles in turbid water may harbor pathogens, chemically reduce oxidizing disinfectants, and hinder attempts to disinfect water with ultraviolet radiation. A turbidimeter is an electronic/optical instrument that assesses turbidity by measuring the scattering of light passing through a water sample containing such colloidal particles. Commercial turbidimeters cost hundreds or thousands of dollars, putting them beyond the reach of low-resource communities around the world. An affordable open-source turbidimeter based on a single light-to-frequency sensor was designed and constructed, and evaluated against a portable commercial turbidimeter. The final product, which builds on extensive published research, is intended to catalyze further developments in affordable water and sanitation monitoring. PMID:24759114

  7. Affordable Heavy Lift Capability: 2000-2004

    NASA Technical Reports Server (NTRS)

    2004-01-01

    This custom bibliography from the NASA Scientific and Technical Information Program lists a sampling of records found in the NASA Aeronautics and Space Database. The scope of this topic includes technologies to allow robust, affordable access of cargo, particularly to low-Earth orbit. This area of focus is one of the enabling technologies as defined by NASA s Report of the President s Commission on Implementation of United States Space Exploration Policy, published in June 2004.

  8. The Affordable Care Act and emergency care.

    PubMed

    McClelland, Mark; Asplin, Brent; Epstein, Stephen K; Kocher, Keith Eric; Pilgrim, Randy; Pines, Jesse; Rabin, Elaine Judith; Rathlev, Niels Kumar

    2014-10-01

    The Affordable Care Act (ACA) will have far-reaching effects on the way health care is designed and delivered. Several elements of the ACA will directly affect both demand for ED care and expectations for its role in providing coordinated care. Hospitals will need to employ strategies to reduce ED crowding as the ACA expands insurance coverage. Discussions between EDs and primary care physicians about their respective roles providing acute unscheduled care would promote the goals of the ACA. PMID:25121814

  9. America's Affordable Health Choices Act of 2009

    THOMAS, 111th Congress

    Rep. Dingell, John D. [D-MI-15

    2009-07-14

    10/14/2009 Placed on the Union Calendar, Calendar No. 168. (All Actions) Notes: For further action, see H.R.3590, which became Public Law 111-148 on 3/23/2010. H.R.3590, often referred to as the Affordable Care Act, is the bill that became the health care reform law. Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

  10. Effects of broken affordance on visual extinction

    PubMed Central

    Wulff, Melanie; Humphreys, Glyn W.

    2015-01-01

    Previous studies have shown that visual extinction can be reduced if two objects are positioned to “afford” an action. Here we tested if this affordance effect was disrupted by “breaking” the affordance, i.e., if one of the objects actively used in the action had a broken handle. We assessed the effects of broken affordance on recovery from extinction in eight patients with right hemisphere lesions and left-sided extinction. Patients viewed object pairs that were or were not commonly used together and that were positioned for left- or right-hand actions. In the unrelated pair conditions, either two tools or two objects were presented. In line with previous research (e.g., Riddoch et al., 2006), extinction was reduced when action-related object pairs and when unrelated tool pairs were presented compared to unrelated object pairs. There was no significant difference in recovery rate between action-related (object-tool) and unrelated tool pairs. In addition, performance with action-related objects decreased when the tool appeared on the ipsilesional side compared to when it was on the contralesional side, but only when the tool handle was intact. There were minimal effects of breaking the handle of an object rather than a tool, and there was no effect of breaking the handle on either tools or objects on single item trials. The data suggest that breaking the handle of a tool lessens the degree to which it captures attention, with this attentional capture being strongest when the tool appears on the ipsilesional side. The capture of attention by the ipsilesional item then reduces the chance of detecting the contralesional stimulus. This attentional capture effect is mediated by the affordance to the intact tool. PMID:26441612

  11. Behavioral health parity and the Affordable Care Act.

    PubMed

    Frank, Richard G; Beronio, Kirsten; Glied, Sherry A

    2014-01-01

    Prior to the passage of the Mental Health Parity and Addiction Equity Act (MHPAEA) and the Patient Protection and Affordable Care Act (ACA), about 49 million Americans were uninsured. Among those with employer-sponsored health insurance, 2% had coverage that entirely excluded mental health benefits and 7% had coverage that entirely excluded substance use treatment benefits. The rates of noncoverage for mental and substance use disorder care in the individual health insurance markets are considerably higher. Private health insurance generally limits the extent of these benefits. The combination of MHPEA and ACA extended overall health insurance coverage to more people and expanded the scope of coverage to include mental health and substance abuse benefits. PMID:24483783

  12. 78 FR 13222 - Procedures for the Handling of Retaliation Complaints Under Section 1558 of the Affordable Care Act

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-27

    ...This document provides the interim final regulations governing the employee protection (whistleblower) provision of section 1558 of the Affordable Care Act, which added section 18C of the Fair Labor Standards Act, to provide protections to employees of health insurance issuers or other employers who may have been subject to retaliation for reporting potential violations of the law's consumer......

  13. Global cancer surgery: delivering safe, affordable, and timely cancer surgery.

    PubMed

    Sullivan, Richard; Alatise, Olusegun Isaac; Anderson, Benjamin O; Audisio, Riccardo; Autier, Philippe; Aggarwal, Ajay; Balch, Charles; Brennan, Murray F; Dare, Anna; D'Cruz, Anil; Eggermont, Alexander M M; Fleming, Kenneth; Gueye, Serigne Magueye; Hagander, Lars; Herrera, Cristian A; Holmer, Hampus; Ilbawi, André M; Jarnheimer, Anton; Ji, Jia-Fu; Kingham, T Peter; Liberman, Jonathan; Leather, Andrew J M; Meara, John G; Mukhopadhyay, Swagoto; Murthy, Shilpa S; Omar, Sherif; Parham, Groesbeck P; Pramesh, C S; Riviello, Robert; Rodin, Danielle; Santini, Luiz; Shrikhande, Shailesh V; Shrime, Mark; Thomas, Robert; Tsunoda, Audrey T; van de Velde, Cornelis; Veronesi, Umberto; Vijaykumar, Dehannathparambil Kottarathil; Watters, David; Wang, Shan; Wu, Yi-Long; Zeiton, Moez; Purushotham, Arnie

    2015-09-01

    Surgery is essential for global cancer care in all resource settings. Of the 15.2 million new cases of cancer in 2015, over 80% of cases will need surgery, some several times. By 2030, we estimate that annually 45 million surgical procedures will be needed worldwide. Yet, less than 25% of patients with cancer worldwide actually get safe, affordable, or timely surgery. This Commission on global cancer surgery, building on Global Surgery 2030, has examined the state of global cancer surgery through an analysis of the burden of surgical disease and breadth of cancer surgery, economics and financing, factors for strengthening surgical systems for cancer with multiple-country studies, the research agenda, and the political factors that frame policy making in this area. We found wide equity and economic gaps in global cancer surgery. Many patients throughout the world do not have access to cancer surgery, and the failure to train more cancer surgeons and strengthen systems could result in as much as US $6.2 trillion in lost cumulative gross domestic product by 2030. Many of the key adjunct treatment modalities for cancer surgery--e.g., pathology and imaging--are also inadequate. Our analysis identified substantial issues, but also highlights solutions and innovations. Issues of access, a paucity of investment in public surgical systems, low investment in research, and training and education gaps are remarkably widespread. Solutions include better regulated public systems, international partnerships, super-centralisation of surgical services, novel surgical clinical trials, and new approaches to improve quality and scale up cancer surgical systems through education and training. Our key messages are directed at many global stakeholders, but the central message is that to deliver safe, affordable, and timely cancer surgery to all, surgery must be at the heart of global and national cancer control planning. PMID:26427363

  14. Price, availability and affordability of medicines

    PubMed Central

    Mhlanga, Brenda S.

    2014-01-01

    Abstract Background Medicines play an important role in healthcare, but prices can be a barrier to patient care. Few studies have looked at the prices of essential medicines in low- and middle-income countries in terms of patient affordability. Aim To determine the prices, availability and affordability of medicines along the supply chain in Swaziland. Setting Private- and public-sector facilities in Manzini, Swaziland. Methods The standardised methodology designed by the World Health Organization and Health Action International was used to survey 16 chronic disease medicines. Data were collected in one administrative area in 10 private retail pharmacies and 10 public health facilities. Originator brand (OB) and lowest-priced generic equivalent (LPG) medicines were monitored and these prices were then compared with international reference prices (IRPs). Affordability was calculated in terms of the daily wage of the lowest-paid unskilled government worker. Results Mean availability was 68% in the public sector. Private sector OB medicines were priced 32.4 times higher than IRPs, whilst LPGs were 7.32 times higher. OBs cost 473% more than LPGs. The total cumulative mark-ups for individual medicines range from 190.99% – 440.27%. The largest contributor to add-on cost was the retail mark-up (31% – 53%). Standard treatment with originator brands cost more than a day's wage. Conclusion Various policy measures such as introducing price capping at all levels of the medicine supply chain, may increase the availability, whilst at the same time reducing the prices of essential medicines for the low income population. PMID:26245401

  15. Perceiving Affordances for Different Motor Skills

    PubMed Central

    Cole, Whitney G.; Chan, Gladys L. Y.; Vereijken, Beatrix; Adolph, Karen E.

    2013-01-01

    We examined several factors that affect people’s ability to perceive possibilities for action. In Experiment 1, 24 participants crossed expanses of various sizes in three conditions: leaping, a familiar, launching action system; arm-swinging on monkey bars, an unpracticed skill that uses the arms rather than the legs; and crawling on hands and knees, a disused skill that involves all four limbs. Before and after performing each action, participants gave verbal judgments about the largest gap they could cross. Participants scaled initial judgments to their actual abilities in all three conditions. But they considerably underestimated their abilities for leaping, a launching action, and for arm-swinging when it was performed as a launching action; judgments about crawling, a non-launching action, and arm-swinging when it was performed as a non-launching action were more accurate. Thus, launching actions appear to produce a deficit in perceiving affordances that is not ameliorated by familiarity with the action. However, after performing the actions, participants partially corrected for the deficiency and more accurately judged their abilities for launching actions—suggesting that even brief action experience facilitates the perception of affordances. In Experiment 2, we confirmed that the deficit was due to the launching nature of the leaping and arm-swinging actions in Experiment 1. We asked an additional 12 participants to cross expanses using two non-launching actions using the legs (stepping across an expanse) and the arms (reaching across an expanse). Participants were highly accurate when judging affordances for these actions, supporting launching as the cause of the underestimation reported in Experiment 1. PMID:23411672

  16. Situated language understanding as filtering perceived affordances.

    PubMed

    Gorniak, Peter; Roy, Deb

    2007-03-01

    We introduce a computational theory of situated language understanding in which the meaning of words and utterances depends on the physical environment and the goals and plans of communication partners. According to the theory, concepts that ground linguistic meaning are neither internal nor external to language users, but instead span the objective-subjective boundary. To model the possible interactions between subject and object, the theory relies on the notion of perceived affordances: structured units of interaction that can be used for prediction at multiple levels of abstraction. Language understanding is treated as a process of filtering perceived affordances. The theory accounts for many aspects of the situated nature of human language use and provides a unified solution to a number of demands on any theory of language understanding including conceptual combination, prototypicality effects, and the generative nature of lexical items. To support the theory, we describe an implemented system that understands verbal commands situated in a virtual gaming environment. The implementation uses probabilistic hierarchical plan recognition to generate perceived affordances. The system has been evaluated on its ability to correctly interpret free-form spontaneous verbal commands recorded from unrehearsed game play between human players. The system is able to "step into the shoes" of human players and correctly respond to a broad range of verbal commands in which linguistic meaning depends on social and physical context. We quantitatively compare the system's predictions in response to direct player commands with the actions taken by human players and show generalization to unseen data across a range of situations and verbal constructions. PMID:21635295

  17. Dignity for all: affordable assisted living.

    PubMed

    Janeski, James F; Pruchnicki, Alec

    2006-01-01

    In 2026, the first of the baby boomers, including Presidents Clinton and Bush, will reach the age of 80, the average age of residents currently in assisted living facilities. In her book The Denial of Aging: Perpetual Youth, Eternal Life, and Other Dangerous Fantasies, Muriel Gillick proposes that the baby boomers will seek assisted living as an alternative to nursing home care. But what about that portion of the population not able to afford the high cost of private assisted living? What option will be available to the low-asset/low-income population in lieu of nursing home care? PMID:17214248

  18. Substantial bulk photovoltaic effect enhancement via nanolayering.

    PubMed

    Wang, Fenggong; Young, Steve M; Zheng, Fan; Grinberg, Ilya; Rappe, Andrew M

    2016-01-01

    Spontaneous polarization and inversion symmetry breaking in ferroelectric materials lead to their use as photovoltaic devices. However, further advancement of their applications are hindered by the paucity of ways of reducing bandgaps and enhancing photocurrent. By unravelling the correlation between ferroelectric materials' responses to solar irradiation and their local structure and electric polarization landscapes, here we show from first principles that substantial bulk photovoltaic effect enhancement can be achieved by nanolayering PbTiO3 with nickel ions and oxygen vacancies ((PbNiO2)x(PbTiO3)(1-x)). The enhancement of the total photocurrent for different spacings between the Ni-containing layers can be as high as 43 times due to a smaller bandgap and photocurrent direction alignment for all absorption energies. This is due to the electrostatic effect that arises from nanolayering. This opens up the possibility for control of the bulk photovoltaic effect in ferroelectric materials by nanoscale engineering of their structure and composition. PMID:26791545

  19. Substantial bulk photovoltaic effect enhancement via nanolayering

    PubMed Central

    Wang, Fenggong; Young, Steve M.; Zheng, Fan; Grinberg, Ilya; Rappe, Andrew M.

    2016-01-01

    Spontaneous polarization and inversion symmetry breaking in ferroelectric materials lead to their use as photovoltaic devices. However, further advancement of their applications are hindered by the paucity of ways of reducing bandgaps and enhancing photocurrent. By unravelling the correlation between ferroelectric materials' responses to solar irradiation and their local structure and electric polarization landscapes, here we show from first principles that substantial bulk photovoltaic effect enhancement can be achieved by nanolayering PbTiO3 with nickel ions and oxygen vacancies ((PbNiO2)x(PbTiO3)1−x). The enhancement of the total photocurrent for different spacings between the Ni-containing layers can be as high as 43 times due to a smaller bandgap and photocurrent direction alignment for all absorption energies. This is due to the electrostatic effect that arises from nanolayering. This opens up the possibility for control of the bulk photovoltaic effect in ferroelectric materials by nanoscale engineering of their structure and composition. PMID:26791545

  20. Substantial nitrogen pollution embedded in international trade

    NASA Astrophysics Data System (ADS)

    Oita, Azusa; Malik, Arunima; Kanemoto, Keiichiro; Geschke, Arne; Nishijima, Shota; Lenzen, Manfred

    2016-02-01

    Anthropogenic emissions of reactive nitrogen to the atmosphere and water bodies can damage human health and ecosystems. As a measure of a nation’s contribution to this potential damage, a country’s nitrogen footprint has been defined as the quantity of reactive nitrogen emitted during the production, consumption and transportation of commodities consumed within that country, whether those commodities are produced domestically or internationally. Here we use global emissions databases, a global nitrogen cycle model, and a global input-output database of domestic and international trade to calculate the nitrogen footprints for 188 countries as the sum of emissions of ammonia, nitrogen oxides and nitrous oxide to the atmosphere, and of nitrogen potentially exportable to water bodies. Per-capita footprints range from under 7 kg N yr-1 in some developing countries to over 100 kg N yr-1 in some wealthy nations. Consumption in China, India, the United States and Brazil is responsible for 46% of global emissions. Roughly a quarter of the global nitrogen footprint is from commodities that were traded across country borders. The main net exporters have significant agricultural, food and textile exports, and are often developing countries, whereas important net importers are almost exclusively developed economies. We conclude that substantial local nitrogen pollution is driven by demand from consumers in other countries.

  1. EARLY CHILDHOOD INVESTMENTS SUBSTANTIALLY BOOST ADULT HEALTH

    PubMed Central

    Campbell, Frances; Conti, Gabriella; Heckman, James J.; Moon, Seong Hyeok; Pinto, Rodrigo; Pungello, Elizabeth; Pan, Yi

    2014-01-01

    High-quality early childhood programs have been shown to have substantial benefits in reducing crime, raising earnings, and promoting education. Much less is known about their benefits for adult health. We report the long-term health impacts of one of the oldest and most heavily cited early childhood interventions with long-term follow-up evaluated by the method of randomization: the Carolina Abecedarian Project (ABC). Using recently collected biomedical data, we find that disadvantaged children randomly assigned to treatment have significantly lower prevalence of risk factors for cardiovascular and metabolic diseases in their mid-30s. The evidence is especially strong for males. The mean systolic blood pressure among the control males is 143, while only 126 among the treated. One in four males in the control group is affected by metabolic syndrome, while none in the treatment group is. To reach these conclusions, we address several statistical challenges. We use exact permutation tests to account for small sample sizes and conduct a parallel bootstrap confidence interval analysis to confirm the permutation analysis. We adjust inference to account for the multiple hypotheses tested and for nonrandom attrition. Our evidence shows the potential of early life interventions for preventing disease and promoting health. PMID:24675955

  2. Substantial bulk photovoltaic effect enhancement via nanolayering

    DOE PAGESBeta

    Wang, Fenggong; Young, Steve M.; Zheng, Fan; Grinberg, Ilya; Rappe, Andrew M.

    2016-01-21

    Spontaneous polarization and inversion symmetry breaking in ferroelectric materials lead to their use as photovoltaic devices. However, further advancement of their applications are hindered by the paucity of ways of reducing bandgaps and enhancing photocurrent. By unravelling the correlation between ferroelectric materials’ responses to solar irradiation and their local structure and electric polarization landscapes, here we show from first principles that substantial bulk photovoltaic effect enhancement can be achieved by nanolayering PbTiO3 with nickel ions and oxygen vacancies ((PbNiO2)x(PbTiO3)1–x). The enhancement of the total photocurrent for different spacings between the Ni-containing layers can be as high as 43 times duemore » to a smaller bandgap and photocurrent direction alignment for all absorption energies. This is due to the electrostatic effect that arises from nanolayering. Lastly, this opens up the possibility for control of the bulk photovoltaic effect in ferroelectric materials by nanoscale engineering of their structure and composition.« less

  3. Gasdynamic substantiation of physical theory of meteors

    NASA Astrophysics Data System (ADS)

    Egorova, Lidia A.; Tirskiy, Grigoriy A.

    2014-12-01

    Physical theory of meteors developing since 30s of the last century, based on two ordinary differential equations: the equation of motion for the center of mass of meteoroid and equation of meteoroid ablation. These equations contain drag and heat transfer coefficients, which are share of momentum and energy transferred from gas to meteoroid and effective enthalpy of mass loss. Accounting for different values of these coefficients substantially changes meteoroid ballistics compared with the results of simple physical theory of meteors. For the drag coefficient a simple interpolation formula is valid for all flow regimes and depends on the Reynolds number. The heat transfer coefficient represented in the form of the approximation depending on density and meteoroid radius. Based on the law of conservation of mass and energy at the front of meteoroid melting and evaporation the explicit expression for the effective enthalpy of mass loss Q was obtained, depending on the speed of the meteoroid and heterogeneous reactions on the surface. Classical solution gives a significant deviation from the exact one obtained in present study for small bodies (1 mm) at high altitudes and high speeds.

  4. 12 CFR 1807.400 - Affordable housing-general.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 9 2013-01-01 2013-01-01 false Affordable housing-general. 1807.400 Section 1807.400 Banks and Banking COMMUNITY DEVELOPMENT FINANCIAL INSTITUTIONS FUND, DEPARTMENT OF THE TREASURY CAPITAL MAGNET FUND Qualification as Affordable Housing § 1807.400 Affordable...

  5. 12 CFR 1807.402 - Affordable housing-homeownership.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Affordable housing-homeownership. 1807.402 Section 1807.402 Banks and Banking COMMUNITY DEVELOPMENT FINANCIAL INSTITUTIONS FUND, DEPARTMENT OF THE TREASURY CAPITAL MAGNET FUND Qualification as Affordable Housing § 1807.402 Affordable...

  6. 12 CFR 1807.400 - Affordable housing-general.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Affordable housing-general. 1807.400 Section 1807.400 Banks and Banking COMMUNITY DEVELOPMENT FINANCIAL INSTITUTIONS FUND, DEPARTMENT OF THE TREASURY CAPITAL MAGNET FUND Qualification as Affordable Housing § 1807.400 Affordable...

  7. 12 CFR 1807.400 - Affordable housing-general.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 9 2012-01-01 2012-01-01 false Affordable housing-general. 1807.400 Section 1807.400 Banks and Banking COMMUNITY DEVELOPMENT FINANCIAL INSTITUTIONS FUND, DEPARTMENT OF THE TREASURY CAPITAL MAGNET FUND Qualification as Affordable Housing § 1807.400 Affordable...

  8. 12 CFR 1807.400 - Affordable housing-general.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 10 2014-01-01 2014-01-01 false Affordable housing-general. 1807.400 Section 1807.400 Banks and Banking COMMUNITY DEVELOPMENT FINANCIAL INSTITUTIONS FUND, DEPARTMENT OF THE TREASURY CAPITAL MAGNET FUND Qualification as Affordable Housing § 1807.400 Affordable...

  9. 12 CFR 1807.402 - Affordable housing-homeownership.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 9 2012-01-01 2012-01-01 false Affordable housing-homeownership. 1807.402 Section 1807.402 Banks and Banking COMMUNITY DEVELOPMENT FINANCIAL INSTITUTIONS FUND, DEPARTMENT OF THE TREASURY CAPITAL MAGNET FUND Qualification as Affordable Housing § 1807.402 Affordable...

  10. 12 CFR 1807.402 - Affordable housing-homeownership.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 10 2014-01-01 2014-01-01 false Affordable housing-homeownership. 1807.402 Section 1807.402 Banks and Banking COMMUNITY DEVELOPMENT FINANCIAL INSTITUTIONS FUND, DEPARTMENT OF THE TREASURY CAPITAL MAGNET FUND Qualification as Affordable Housing § 1807.402 Affordable...

  11. 12 CFR 1807.402 - Affordable housing-homeownership.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 9 2013-01-01 2013-01-01 false Affordable housing-homeownership. 1807.402 Section 1807.402 Banks and Banking COMMUNITY DEVELOPMENT FINANCIAL INSTITUTIONS FUND, DEPARTMENT OF THE TREASURY CAPITAL MAGNET FUND Qualification as Affordable Housing § 1807.402 Affordable...

  12. 12 CFR 1291.12 - Affordable Housing Reserve Fund.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Affordable Housing Reserve Fund. 1291.12 Section 1291.12 Banks and Banking FEDERAL HOUSING FINANCE AGENCY HOUSING GOALS AND MISSION FEDERAL HOME LOAN BANKS' AFFORDABLE HOUSING PROGRAM § 1291.12 Affordable Housing Reserve Fund. (a) Deposits. If...

  13. 12 CFR 1291.12 - Affordable Housing Reserve Fund.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 9 2013-01-01 2013-01-01 false Affordable Housing Reserve Fund. 1291.12 Section 1291.12 Banks and Banking FEDERAL HOUSING FINANCE AGENCY HOUSING GOALS AND MISSION FEDERAL HOME LOAN BANKS' AFFORDABLE HOUSING PROGRAM § 1291.12 Affordable Housing Reserve Fund. (a) Deposits. If...

  14. 12 CFR 1291.12 - Affordable Housing Reserve Fund.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 10 2014-01-01 2014-01-01 false Affordable Housing Reserve Fund. 1291.12 Section 1291.12 Banks and Banking FEDERAL HOUSING FINANCE AGENCY HOUSING GOALS AND MISSION FEDERAL HOME LOAN BANKS' AFFORDABLE HOUSING PROGRAM § 1291.12 Affordable Housing Reserve Fund. (a) Deposits. If...

  15. 12 CFR 1291.12 - Affordable Housing Reserve Fund.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 9 2012-01-01 2012-01-01 false Affordable Housing Reserve Fund. 1291.12 Section 1291.12 Banks and Banking FEDERAL HOUSING FINANCE AGENCY HOUSING GOALS AND MISSION FEDERAL HOME LOAN BANKS' AFFORDABLE HOUSING PROGRAM § 1291.12 Affordable Housing Reserve Fund. (a) Deposits. If...

  16. 12 CFR 1291.12 - Affordable Housing Reserve Fund.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Affordable Housing Reserve Fund. 1291.12 Section 1291.12 Banks and Banking FEDERAL HOUSING FINANCE AGENCY HOUSING GOALS AND MISSION FEDERAL HOME LOAN BANKS' AFFORDABLE HOUSING PROGRAM § 1291.12 Affordable Housing Reserve Fund. (a) Deposits. If...

  17. Affordable access to care for the undocumented.

    PubMed

    Rosen, Dennis

    2014-09-01

    How do you tell a sick kid that nobody cares if he gets better? That's an exaggeration, of course, but it is the fundamental message our society sends when we tell him that, because he and his family are undocumented immigrants, we are unwilling to extend them access to affordable and reliable health insurance. One major shortcoming of the Affordable Care Act is its specific exclusion of the almost twelve million undocumented immigrants-including millions of children-in this country from access to the state and federal insurance exchanges where coverage can be purchased. It is true that providing undocumented immigrants access to the exchanges and subsidies mandated by the ACA would require additional funding. However, a recent analysis in California has found that the costs of expanding state-supported care to include undocumented immigrants would largely be offset by the increased state sales tax revenue paid by managed care organizations and by reduced spending at the county level on emergency-room and hospital care of the uninsured. PMID:25231664

  18. States in the Driver's Seat: Leveraging State Aid to Align Policies and Promote Access, Success, and Affordability

    ERIC Educational Resources Information Center

    Prescott, Brian T.; Longanecker, David A.

    2014-01-01

    With increasingly widespread calls to raise educational attainment levels without substantially growing public investment in higher education, policymakers and others have devoted growing attention to the role of financial aid programs in providing access to, promoting affordability for, and incentivizing success in college. Given relative levels…

  19. Piecing Together the College Affordability Puzzle: Student Characteristics and Patterns of (Un)Affordability

    ERIC Educational Resources Information Center

    Welbeck, Rashida; Diamond, John; Mayer, Alexander; Richburg-Hayes, Lashawn

    2014-01-01

    The cost of attending college has risen sharply over the last 40 years. Although more credit and grant aid have been made available to students, there are still major gaps between aid and the cost of attendance for many students in the United States, all of whom are left to figure out whether they can afford the remaining costs associated with…

  20. NASA's Space Launch System: Affordability for Sustainability

    NASA Technical Reports Server (NTRS)

    May, Todd A.; Creech, Stephen D.

    2012-01-01

    The National Aeronautics and Space Administration's (NASA) Space Launch System (SLS) Program, managed at the Marshall Space Flight Center, is charged with delivering a new capability for human exploration beyond Earth orbit in an austere economic climate. But the SLS value is clear and codified in United States (U.S.) budget law. The SLS Program knows that affordability is the key to sustainability and will provide an overview of initiatives designed to fit within the funding guidelines by using existing engine assets and hardware now in testing to meet a first launch by 2017 within the projected budget. It also has a long-range plan to keep the budget flat, yet evolve the 70-tonne (t) initial lift capability to 130-t lift capability after the first two flights. To achieve the evolved configuration, advanced technologies must offer appropriate return on investment to be selected through the competitive process. For context, the SLS will be larger than the Saturn V that took 12 men on 6 trips for a total of 11 days on the lunar surface some 40 years ago. Astronauts train for long-duration voyages on platforms such as the International Space Station, but have not had transportation to go beyond Earth orbit in modern times, until now. To arrive at the launch vehicle concept, the SLS Program conducted internal engineering and business studies that have been externally validated by industry and reviewed by independent assessment panels. In parallel with SLS concept studies, NASA is now refining its mission manifest, guided by U.S. space policy and the Global Exploration Roadmap, which reflects the mutual goals of a dozen member nations. This mission planning will converge with a flexible heavy-lift rocket that can carry international crews and the air, water, food, and equipment they need for extended trips to asteroids and Mars. In addition, the SLS capability will accommodate very large science instruments and other payloads, using a series of modular fairings and

  1. Lightning Protection

    NASA Technical Reports Server (NTRS)

    1994-01-01

    Kit-built airplanes are more affordable because they are assembled by the owner and do not require Federal Aviation Administration (FAA) certification. The Glasair III, is an advanced technology homebuilt, constructed of a fiberglass and graphite fiber composite material, and equipped with digital instruments. Both technologies make the airplane more susceptible to lightning effects. When Glasair manufacturer, Stoddard-Hamilton, decided that lightning protection would enable more extensive instrument flight and make the plane more marketable, they proposed a joint development program to NASA Langley Research Center (LAR). Under a Small Business Innovation Research (SBIR) contract, Langley contractors designed and tested a lightning protection system, and the Glasair III-LP became the first kit-built composite aircraft to be lightning tested and protection-verified under FAA guidelines for general aviation aircraft.

  2. 20 CFR 220.141 - Substantial gainful activity, defined.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... activities like taking care of one's self, household tasks, hobbies, therapy, school attendance, club...) Substantial work activity. Substantial work activity is work activity that involves doing significant...

  3. 20 CFR 220.141 - Substantial gainful activity, defined.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... activities like taking care of one's self, household tasks, hobbies, therapy, school attendance, club...) Substantial work activity. Substantial work activity is work activity that involves doing significant...

  4. 20 CFR 220.141 - Substantial gainful activity, defined.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... activities like taking care of one's self, household tasks, hobbies, therapy, school attendance, club...) Substantial work activity. Substantial work activity is work activity that involves doing significant...

  5. 20 CFR 220.141 - Substantial gainful activity, defined.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... activities like taking care of one's self, household tasks, hobbies, therapy, school attendance, club...) Substantial work activity. Substantial work activity is work activity that involves doing significant...

  6. 20 CFR 220.141 - Substantial gainful activity, defined.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... activities like taking care of one's self, household tasks, hobbies, therapy, school attendance, club...) Substantial work activity. Substantial work activity is work activity that involves doing significant...

  7. Affordable Laser Communication in the Classroom

    NASA Astrophysics Data System (ADS)

    Walker, Constance E.; Sparks, R.; Pompea, S.

    2006-12-01

    Several companies sell systems that illustrate laser communication such as Arbor Scientific1. These systems can be too expensive for classroom use. We will demonstrate a technique to modulate a standard diode laser using a microphone or other sound source that is capable of transmitting voice and music. This affordable system can transmit over 350 feet using simple, inexpensive parts readily available at your local electronics store. We will provide a list of parts necessary for assembly, detailed assembly instructions, as well as some suggested investigations using the laser communication system. This system can be used in the classroom either as a demonstration or hands-on activity to explore the physics and technology involved, citing more sophisticated laser communication systems on board spacecraft such as the Mercury Messenger Mission and the Mars Telecommunications Orbiter. 1http://www.arborsci.com

  8. Why epidemiologists cannot afford to ignore poverty.

    PubMed

    Krieger, Nancy

    2007-11-01

    Epidemiologists cannot afford to ignore poverty. To do so would, first, wrongly obscure the devastating impact of poverty on population health, and, second, undercut our commitment to scientific rigor. At issue is doing correct science, not "politically correct" science. Blot poverty and inequity from view, and not only will we contribute to making suffering invisible but our understanding of disease etiology and distribution will be marred. To make this case, I address current debates about the causal relationships between poverty and health, and provide examples of how failing to consider the impact of socioeconomic position has biased epidemiologic knowledge and harmed the public's health. By definition, the people we study are simultaneously social beings and biologic organisms-and we cannot study the latter without taking into account the former. It is the responsibility of all epidemiologists, and not only social epidemiologists, to keep in mind the connections between poverty and health. PMID:18049180

  9. Affordable Care Act and Diabetes Mellitus.

    PubMed

    Shi, Qian; Nellans, Frank P; Shi, Lizheng

    2015-12-01

    The Affordable Care Act (ACA) has the potential for great impact on U.S. health care, especially for chronic disease patients requiring long-term care and management. The act was designed to improve insurance coverage, health care access, and quality of care for all Americans, which will assist patients with diabetes mellitus in acquiring routine monitoring and diabetes-related complication screening for better health management and outcomes. There is great potential for patients with diabetes to benefit from the new policy mandating health insurance coverage and plan improvement, Medicaid expansion, minimum coverage guarantees, and free preventative care. However, policy variability among states and ACA implementation present challenges to people with diabetes in understanding and optimizing ACA impact. This paper aims to select the most influential components of the ACA as relates to people with diabetes and discuss how the ACA may improve health care for this vulnerable population. PMID:26458377

  10. The Affordable Care Act: implications for cardiothoracic surgery.

    PubMed

    Ferguson, T Bruce; Babb, Joseph A

    2013-01-01

    The Affordable Care Act legislation that was passed by the US Congress and signed into law by President Obama on March 23, 2010 is having a substantial effect throughout all of health care in the United States. Cardiothoracic surgeons, as hospital-based procedural specialists, bring unique assets and certain important liabilities into this massive restructuring of our health care delivery system. This article highlights how each of the 10 titles in the Obamacare legislation might affect our specialty; its collaborative relationship with our cardiovascular, medical specialty, and primary care colleagues; and our clinical practice roles and responsibilities in accountable care organizations and primary care medical homes. This article also addresses the unique assets in clinical data in medicine and quality improvement demonstrated by our specialty that have been used to help shape the current and future landscape. Finally, key resources are identified to allow the cardiothoracic community to monitor the ongoing progress of Obamacare as implementation begins. Keeping abreast of these rapidly changing developments will be an important role for our specialty societies and for practitioners alike going forward. PMID:24673956

  11. 20 CFR 404.1675 - Finding of substantial failure.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Finding of substantial failure. 404.1675... DISABILITY INSURANCE (1950- ) Determinations of Disability Substantial Failure § 404.1675 Finding of substantial failure. A finding of substantial failure with respect to a State may not be made unless and...

  12. 20 CFR 416.1075 - Finding of substantial failure.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Finding of substantial failure. 416.1075... AGED, BLIND, AND DISABLED Determinations of Disability Substantial Failure § 416.1075 Finding of substantial failure. A finding of substantial failure with respect to a State may not be made unless and...

  13. 20 CFR 404.1675 - Finding of substantial failure.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Finding of substantial failure. 404.1675... DISABILITY INSURANCE (1950- ) Determinations of Disability Substantial Failure § 404.1675 Finding of substantial failure. A finding of substantial failure with respect to a State may not be made unless and...

  14. 20 CFR 416.1075 - Finding of substantial failure.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Finding of substantial failure. 416.1075... AGED, BLIND, AND DISABLED Determinations of Disability Substantial Failure § 416.1075 Finding of substantial failure. A finding of substantial failure with respect to a State may not be made unless and...

  15. 20 CFR 404.1675 - Finding of substantial failure.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Finding of substantial failure. 404.1675... DISABILITY INSURANCE (1950- ) Determinations of Disability Substantial Failure § 404.1675 Finding of substantial failure. A finding of substantial failure with respect to a State may not be made unless and...

  16. 20 CFR 416.1075 - Finding of substantial failure.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Finding of substantial failure. 416.1075... AGED, BLIND, AND DISABLED Determinations of Disability Substantial Failure § 416.1075 Finding of substantial failure. A finding of substantial failure with respect to a State may not be made unless and...

  17. 20 CFR 404.1675 - Finding of substantial failure.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Finding of substantial failure. 404.1675... DISABILITY INSURANCE (1950- ) Determinations of Disability Substantial Failure § 404.1675 Finding of substantial failure. A finding of substantial failure with respect to a State may not be made unless and...

  18. 20 CFR 416.1075 - Finding of substantial failure.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Finding of substantial failure. 416.1075... AGED, BLIND, AND DISABLED Determinations of Disability Substantial Failure § 416.1075 Finding of substantial failure. A finding of substantial failure with respect to a State may not be made unless and...

  19. 20 CFR 404.1675 - Finding of substantial failure.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Finding of substantial failure. 404.1675... DISABILITY INSURANCE (1950- ) Determinations of Disability Substantial Failure § 404.1675 Finding of substantial failure. A finding of substantial failure with respect to a State may not be made unless and...

  20. Racial and Ethnic Health Disparities and the Affordable Care Act: a Status Update.

    PubMed

    Sealy-Jefferson, Shawnita; Vickers, Jasmine; Elam, Angela; Wilson, M Roy

    2015-12-01

    Persistent racial and ethnic health disparities exist in the USA, despite decades of research and public health initiatives. Several factors contribute to health disparities, including (but not limited to) implicit provider bias, access to health care, social determinants, and biological factors. Disparities in health by race/ethnicity are unacceptable and correctable. The Patient Protection and Affordable Care Act is a comprehensive legislation that is focused on improving health care access, quality, and cost control. This health care reform includes specific provisions which focus on preventive care, the standardized collection of data on race, ethnicity, primary language and disability status, and health information technology. Although some provisions of the Patient Protection and Affordable Care Act have not been implemented, such as funding for the U.S. Public Health Sciences track, which would have addressed the shortage of medical professionals in the USA who are trained to use patient-centered, interdisciplinary, and care coordination approaches, this legislation is still poised to make great strides toward eliminating health disparities. The purpose of this manuscript is to highlight the unprecedented opportunities that exist for the Patient Protection and Affordable Care Act to reduce racial and ethnic disparities in health in the USA. PMID:26668787

  1. Partnerships for affordable and equitable disaster insurance

    NASA Astrophysics Data System (ADS)

    Mysiak, J.; Pérez-Blanco, C. D.

    2015-08-01

    Extreme events are becoming more frequent and intense, inflating the economic damages and social hardship set-off by natural catastrophes. Amidst budgetary cuts, there is a growing concern on societies' ability to design solvent disaster recovery strategies, while addressing equity and affordability concerns. The participation of private sector along with public one through Public-Private Partnerships (PPPs) has gained on importance as a means to address these seemingly conflicting objectives through the provision of (catastrophic) natural hazard insurance. This is the case of many OECD countries, notably some EU Member States such as the United Kingdom and Spain. The EU legislator has adapted to this new scenario and recently produced major reforms in the legislation and regulation that govern the framework in which PPPs for (catastrophic) natural hazard insurance develop. This paper has a dual objective: (1) review the complex legal background that rules the provision of insurance against natural catastrophes in the EU after these major reforms, (2) assess the implications of the reforms and offer concise Policy Guiding Principles.

  2. Affordable underwater wireless optical communication using LEDs

    NASA Astrophysics Data System (ADS)

    Pilipenko, Vladimir; Arnon, Shlomi

    2013-09-01

    In recent years the need for high data rate underwater wireless communication (WC) has increased. Nowadays, the conventional technology for underwater communication is acoustic. However, the maximum data rate that acoustic technology can provide is a few kilobits per second. On the other hand, emerging applications such as underwater imaging, networks of sensors and swarms of underwater vehicles require much faster data rates. As a result, underwater optical WC, which can provide much higher data rates, has been proposed as an alternative means of communication. In addition to high data rates, affordable communication systems become an important feature in the development requirements. The outcome of these requirements is a new system design based on off-the-shelf components such as blue and green light emitting diodes (LEDs). This is due to the fact that LEDs offer solutions characterized by low cost, high efficiency, reliability and compactness. However, there are some challenges to be met when incorporating LEDs as part of the optical transmitter, such as low modulation rates and non linearity. In this paper, we review the main challenges facing the incorporation of LEDs as an integral part of underwater WC systems and propose some techniques to mitigate the LED limitations in order to achieve high data rate communication

  3. Affordable, Robust Ceramic Joining Technology (ARCJoint) Developed

    NASA Technical Reports Server (NTRS)

    Steele, Gynelle C.

    2001-01-01

    Affordable, Robust Ceramic Joining Technology (ARCJoint) is a method for joining high temperature- resistant ceramic pieces together, establishing joints that are strong, and allowing joining to be done in the field. This new way of joining allows complex shapes to be formed by joining together geometrically simple shapes. The joining technology at NASA is one of the enabling technologies for the application of silicon-carbide-based ceramic and composite components in demanding and high-temperature applications. The technology is being developed and tested for high-temperature propulsion parts for aerospace use. Commercially, it can be used for joining ceramic pieces used for high temperature applications in the power-generating and chemical industries, as well as in the microelectronics industry. This innovation could yield big payoffs for not only the power-generating industry but also the Silicon Valley chipmakers. This technology, which was developed at the NASA Glenn Research Center by Dr. Mrityunjay Singh, is a two-step process involving first using a paste to join together ceramic pieces and bonding them by heating the joint to 110 to 120 C for between 10 and 20 min. This makes the joint strong enough to be handled for the final joining. Then, a silicon-based substance is applied to the joint and heated to 1400 C for 10 to 15 min. The resulting joint is as strong as the original ceramic material and can withstand the same high temperatures.

  4. Control your mind, make affordance available.

    PubMed

    Jin, Zheng; Lee, Yang; Zhu, Jin

    2015-01-01

    Evaluating the affordance-control interpretation of the relationship between performance and object estimation has been proposed by psychophysical and psychonomic studies. This study examined the weight estimation-performance relationship. Individuals with visual impairment or blindness put shots that varied in weight among five scales. In Experiment 1, only the perceived weight was a significant performance constraint. In Experiment 2, the weight was perceived as heavier when the participants' actions were manipulated through cognitive interpretation. The increase in perceived weight appeared to be related to performance and intrinsically scaled to the action, even when the action was only mental rather than physical. The study's findings suggest that bodily experience and action are the basis for physical judgments and likely underlie other basic cognitive interpretations of sensory stimuli. This suggestion goes hand in hand with the biofunctional approaches which assume direct experience of the integrated wholeness of one's body is fundamental for developing other kinds of awareness. Different perspectives from oriental philosophy and psychology are also discussed. PMID:25741298

  5. Empathy and the responsiveness to social affordances.

    PubMed

    Kiverstein, Julian

    2015-11-01

    The direct perception theory of empathy claims that we can immediately experience a person's state of mind. I can see for instance that my neighbour is angry with me in his bodily countenance. I develop a version of the direct perception theory of empathy which takes this perceptual capacity to depend upon recognising in what way the other person is responsive to the affordances the environment provides. By recognising which possibilities for action are relevant to a person, I can thereby understand something about the meaning they give to the world. I come to share something of their perspective on the world, and this allows me to grasp based on my perception of them something about their current state of mind. I argue that shared affect plays a central role in this perceptual capacity. Shared affect allows me to orient my attention to possibilities for action that matter to the other person. I end by briefly discuss the implications of this view of empathy for the disturbances in so-called "cognitive empathy" that are found in people diagnosed with autism spectrum disorder. PMID:26021190

  6. 40 CFR 300.322 - Response to substantial threats to public health or welfare of the United States.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 28 2011-07-01 2011-07-01 false Response to substantial threats to public health or welfare of the United States. 300.322 Section 300.322 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS NATIONAL OIL AND HAZARDOUS...

  7. Ground Processing Affordability for Space Vehicles

    NASA Technical Reports Server (NTRS)

    Ingalls, John; Scott, Russell

    2011-01-01

    Launch vehicles and most of their payloads spend the majority of their time on the ground. The cost of ground operations is very high. So, why so often is so little attention given to ground processing during development? The current global space industry and economic environment are driving more need for efficiencies to save time and money. Affordability and sustainability are more important now than ever. We can not continue to treat space vehicles as mere science projects. More RLV's (Reusable Launch Vehicles) are being developed for the gains of reusability which are not available for ELV's (Expendable Launch Vehicles). More human-rated vehicles are being developed, with the retirement of the Space Shuttles, and for a new global space race, yet these cost more than the many unmanned vehicles of today. We can learn many lessons on affordability from RLV's. DFO (Design for Operations) considers ground operations during design, development, and manufacturing-before the first flight. This is often minimized for space vehicles, but is very important. Vehicles are designed for launch and mission operations. You will not be able to do it again if it is too slow or costly to get there. Many times, technology changes faster than space products such that what is launched includes outdated features, thus reducing competitiveness. Ground operations must be considered for the full product Lifecycle, from concept to retirement. Once manufactured, launch vehicles along with their payloads and launch systems require a long path of processing before launch. Initial assembly and testing always discover problems to address. A solid integration program is essential to minimize these impacts, as was seen in the Constellation Ares I-X test rocket. For RLV's, landing/recovery and post-flight turnaround activities are performed. Multi-use vehicles require reconfiguration. MRO (Maintenance, Repair, and Overhaul) must be well-planned--- even for the unplanned problems. Defect limits and

  8. Commercial Platforms Allow Affordable Space Research

    NASA Technical Reports Server (NTRS)

    2013-01-01

    At an altitude of about 240 miles, its orbital path carries it over 90 percent of the Earth s population. It circles the Earth in continuous free fall; its crew of six and one Robonaut pass the days, experiencing 16 sunrises and 16 sunsets every 24 hours, in microgravity, an environment in which everything from bodily functions to the physical behavior of materials changes drastically from what is common on the ground. Outside its shielded confines, temperatures cycle from one extreme to the other, radiation is rampant, and atomic oxygen corrodes everything it touches. A unique feat of engineering, the International Space Station (ISS) also represents the most remarkable platform for scientific research ever devised. In 2005, anticipating the space station s potential for NASA and non-NASA scientists alike, the NASA Authorization Act designated the US segment of the ISS as a national laboratory, instructing the Agency to "increase the utilization of the ISS by other Federal entities and the private sector." With the ISS set to maintain operations through at least 2020, the station offers an unprecedented long-term access to space conditions, enabling research not previously possible. "There will be new drug discoveries, new pharmaceuticals, a better understanding of how we affect the planet and how we can maintain it," says Marybeth Edeen, the ISS National Laboratory manager, based at Johnson Space Center. The ISS, she says, represents a major example of the government s role in making such advancements possible. "The government is key in that researchers cannot afford to build the kind of infrastructure that the government can provide. But we then have to make that infrastructure available at a reasonable cost." Enter Jeff Manber, who saw in the ISS National Lab an extraordinary opportunity to advance science, education, and business in ways never before seen.

  9. Affordable WDM components: the polymer solution

    NASA Astrophysics Data System (ADS)

    Eldada, Louay A.; Yin, Shing; Norwood, Robert A.; Yardley, James T.

    1998-02-01

    An advanced polymeric waveguide technology was developed for affordable WDM components that address the needs of both the Telecom and the Datacom industries. We engineered high- performance organic polymers that can be readily made into both multimode and single-mode optical waveguide structures of controlled numerical aperture and geometry. These materials are formed from highly-crosslinked acrylate monomers with specific linkages that determine properties such as flexibility, toughness, loss, and environmental stability. These monomers are intermiscible, providing for precise adjustment of the refractive index from 1.3 to 1.6. In polymer form, they exhibit state-of-the-art loss values, high thermal stability, high humidity resistance, low dispersion and low birefringence. Waveguides are formed photolithographically, with the liquid monomer mixture polymerizing upon illumination in the UV via either mask exposure or laser direct writing. A wide range of rigid and flexible substrates can be used, including glass, quartz, oxidized silicon, glass-filled epoxy printed circuit board substrate, and flexible polyimide film. Waveguiding structures measuring tens of inches in length can be produced on computer boards, and guides that are meters long can be printed on rolls of plastic. We describe the fabrication of both Bragg gratings and waveguide grating routes in our polymers for filtering and demultiplexing applications in Telecom WDM systems. In Datacom, we describe polymeric components that we produced for aerospace WDM sensor systems. The importance of CAD tools in designing WDM devices is emphasized in this work. We further discuss the low-cost manufacturing of WDM components in an industrial environment.

  10. Affordable Space Tourism: SpaceStationSim

    NASA Technical Reports Server (NTRS)

    2006-01-01

    For over 5 years, people have been living and working in space on the International Space Station (ISS), a state-of-the-art laboratory complex orbiting high above the Earth. Offering a large, sustained microgravity environment that cannot be duplicated on Earth, the ISS furthers humankind s knowledge of science and how the body functions for extended periods of time in space all of which will prove vital on long-duration missions to Mars. On-orbit construction of the station began in November 1998, with the launch of the Russian Zarya Control Module, which provided battery power and fuel storage. This module was followed by additional components and supplies over the course of several months. In November 2000, the first ISS Expedition crew moved in. Since then, the ISS has continued to change and evolve. The space station is currently 240 feet wide, measured across the solar arrays, and 171 feet long, from the NASA Destiny Laboratory to the Russian Zvezda Habitation Module. It is 90 feet tall, and it weighs approximately 404,000 pounds. Crews inhabit a living space of about 15,000 cubic feet. To date, 90 scientific investigations have been conducted on the space station. New results from space station research, from basic science to exploration research, are being published each month, and more breakthroughs are likely to come. It is not all work on the space station, though. The orbiting home affords many of the comforts one finds on Earth. There is a weightless "weight room" and even a musical keyboard alongside research facilities. Holidays are observed, and with them, traditional foods such as turkey and cobbler are eaten, with lemonade to wash them down

  11. Affordance Analysis--Matching Learning Tasks with Learning Technologies

    ERIC Educational Resources Information Center

    Bower, Matt

    2008-01-01

    This article presents a design methodology for matching learning tasks with learning technologies. First a working definition of "affordances" is provided based on the need to describe the action potentials of the technologies (utility). Categories of affordances are then proposed to provide a framework for analysis. Following this, a methodology…

  12. The Influence of Affordability in Strategic Enrollment Management

    ERIC Educational Resources Information Center

    Pugh, Susan L.; Thompson, Roger J.

    2008-01-01

    In state houses around the country, one of the common higher education themes is affordability. As tuition costs have increased at rates exceeding that of inflation, students and families have pressed their legislative representatives to examine these increases. Affordability is a term used by various constituent groups, and its definition varies…

  13. 24 CFR 1006.20 - Grants for affordable housing activities.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... URBAN DEVELOPMENT NATIVE HAWAIIAN HOUSING BLOCK GRANT PROGRAM General § 1006.20 Grants for affordable housing activities. (a) Annual grant. Each fiscal year, HUD will make a grant (to the extent that amounts... 24 Housing and Urban Development 4 2013-04-01 2013-04-01 false Grants for affordable...

  14. 24 CFR 1006.20 - Grants for affordable housing activities.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... URBAN DEVELOPMENT NATIVE HAWAIIAN HOUSING BLOCK GRANT PROGRAM General § 1006.20 Grants for affordable housing activities. (a) Annual grant. Each fiscal year, HUD will make a grant (to the extent that amounts... 24 Housing and Urban Development 4 2012-04-01 2012-04-01 false Grants for affordable...

  15. 24 CFR 1006.20 - Grants for affordable housing activities.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... URBAN DEVELOPMENT NATIVE HAWAIIAN HOUSING BLOCK GRANT PROGRAM General § 1006.20 Grants for affordable housing activities. (a) Annual grant. Each fiscal year, HUD will make a grant (to the extent that amounts... 24 Housing and Urban Development 4 2014-04-01 2014-04-01 false Grants for affordable...

  16. 24 CFR 1006.20 - Grants for affordable housing activities.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... URBAN DEVELOPMENT NATIVE HAWAIIAN HOUSING BLOCK GRANT PROGRAM General § 1006.20 Grants for affordable housing activities. (a) Annual grant. Each fiscal year, HUD will make a grant (to the extent that amounts... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Grants for affordable...

  17. One Hand, Two Objects: Emergence of Affordance in Contexts

    ERIC Educational Resources Information Center

    Borghi, Anna M.; Flumini, Andrea; Natraj, Nikhilesh; Wheaton, Lewis A.

    2012-01-01

    Studies on affordances typically focus on single objects. We investigated whether affordances are modulated by the context, defined by the relation between two objects and a hand. Participants were presented with pictures displaying two manipulable objects linked by a functional (knife-butter), a spatial (knife-coffee mug), or by no relation. They…

  18. Providing Affordable Housing: Small Communities Benefit from Upgrading Dilapidated Homes.

    ERIC Educational Resources Information Center

    Hestekin, Kay

    1991-01-01

    Describes the Affordable Housing Opportunities Program (AHOP) created by the Eau Claire County Housing Authority in Wisconsin. The AHOP buys, renovates, and sells homes for prices below fair market value. This provides safe, sanitary housing for families who could not otherwise afford it. Describes the purchase, renovation, and sale of four…

  19. What's the Issue about Affordability of Public Higher Education?

    ERIC Educational Resources Information Center

    Goff, Donald Gary

    This study compared and contrasted data reports of two national policy centers on the affordability of public higher education. The study examined cost findings of the National Center for Educational Statistics (NCES) and the major affordability findings of the National Center for Public Policy and Higher Education (NCPPHE). Both policy centers…

  20. 24 CFR 92.254 - Qualification as affordable housing: Homeownership.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 1 2013-04-01 2013-04-01 false Qualification as affordable housing: Homeownership. 92.254 Section 92.254 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development HOME INVESTMENT PARTNERSHIPS PROGRAM Project Requirements § 92.254 Qualification as affordable...

  1. 24 CFR 92.254 - Qualification as affordable housing: Homeownership.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... application under 24 CFR part 597 has incorporated the type of market data described above, that submission... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 false Qualification as affordable housing... Qualification as affordable housing: Homeownership. (a) Acquisition with or without rehabilitation. Housing...

  2. Nurturing Opportunities for Educational Leadership: How Affordance and Leadership Interconnect

    ERIC Educational Resources Information Center

    Margolin, Ilana

    2013-01-01

    This qualitative ethnographic study focused on the affordances that facilitated the emergence of leadership, capturing a range of perspectives on leadership and leadership development of four groups: district superintendents; teacher-educators; mentor-teachers and graduates. The term "affordances" implies a reciprocal relationship…

  3. The Nature and Substantiation of Official Sexual Abuse Reports.

    ERIC Educational Resources Information Center

    Eckenrode, John; And Others

    1988-01-01

    A sample of 796 New York sexual abuse reports was studied to explore factors associated with substantiation of the reports following an investigation. Substantiation rates increased with the child's age, and reports were more likely to be substantiated when they involved female children or came from a mandated source. (Author/JDD)

  4. 24 CFR 907.3 - Bases for substantial default.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 4 2011-04-01 2011-04-01 false Bases for substantial default. 907.3 Section 907.3 Housing and Urban Development REGULATIONS RELATING TO HOUSING AND URBAN DEVELOPMENT... DEVELOPMENT SUBSTANTIAL DEFAULT BY A PUBLIC HOUSING AGENCY § 907.3 Bases for substantial default....

  5. 19 CFR 10.7 - Substantial containers or holders.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 19 Customs Duties 1 2010-04-01 2010-04-01 false Substantial containers or holders. 10.7 Section 10... Exported and Returned § 10.7 Substantial containers or holders. (a) Substantial containers or holders... domestic products exported and returned. When such containers or holders are imported not containing...

  6. 29 CFR 825.218 - Substantial and grievous economic injury.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 29 Labor 3 2012-07-01 2012-07-01 false Substantial and grievous economic injury. 825.218 Section... Medical Leave Act § 825.218 Substantial and grievous economic injury. (a) In order to deny restoration to... cause “substantial and grievous economic injury” to the operations of the employer, not whether...

  7. 29 CFR 825.218 - Substantial and grievous economic injury.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 3 2011-07-01 2011-07-01 false Substantial and grievous economic injury. 825.218 Section... Medical Leave Act § 825.218 Substantial and grievous economic injury. (a) In order to deny restoration to... cause “substantial and grievous economic injury” to the operations of the employer, not whether...

  8. 29 CFR 825.218 - Substantial and grievous economic injury.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Substantial and grievous economic injury. 825.218 Section... Medical Leave Act § 825.218 Substantial and grievous economic injury. (a) In order to deny restoration to... cause “substantial and grievous economic injury” to the operations of the employer, not whether...

  9. 29 CFR 825.218 - Substantial and grievous economic injury.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 3 2013-07-01 2013-07-01 false Substantial and grievous economic injury. 825.218 Section... Medical Leave Act § 825.218 Substantial and grievous economic injury. (a) In order to deny restoration to... cause substantial and grievous economic injury to the operations of the employer, not whether...

  10. 29 CFR 825.218 - Substantial and grievous economic injury.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 29 Labor 3 2014-07-01 2014-07-01 false Substantial and grievous economic injury. 825.218 Section... Medical Leave Act § 825.218 Substantial and grievous economic injury. (a) In order to deny restoration to... cause substantial and grievous economic injury to the operations of the employer, not whether...

  11. An Affordability Comparison Tool (ACT) for Space Transportation

    NASA Technical Reports Server (NTRS)

    McCleskey, C. M.; Bollo, T. R.; Garcia, J. L.

    2012-01-01

    NASA bas recently emphasized the importance of affordability for Commercial Crew Development Program (CCDP), Space Launch Systems (SLS) and Multi-Purpose Crew Vehicle (MPCV). System architects and designers are challenged to come up with architectures and designs that do not bust the budget. This paper describes the Affordability Comparison Tool (ACT) analyzes different systems or architecture configurations for affordability that allows for a comparison of: total life cycle cost; annual recurring costs, affordability figures-of-merit, such as cost per pound, cost per seat, and cost per flight, as well as productivity measures, such as payload throughput. Although ACT is not a deterministic model, the paper develops algorithms and parametric factors that use characteristics of the architectures or systems being compared to produce important system outcomes (figures-of-merit). Example applications of outcome figures-of-merit are also documented to provide the designer with information on the relative affordability and productivity of different space transportation applications.

  12. To Copy-Protect or Not to Copy-Protect?

    ERIC Educational Resources Information Center

    Sacks, Jonathan

    1985-01-01

    Discusses the issues of software piracy, why people illegally copy software, protection afforded software developers by copyright laws, and current and future methods of disk-based protection built into software by developers and the problems these methods have created. (MBR)

  13. 76 FR 21906 - Notice of Intent To Award Affordable Care Act Funding to Approved Applications Formerly Received...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-19

    ...This notice provides public announcement of CDC's intent to fund Approved cooperative agreement applications previously received and competed in response to CDC Funding Opportunity, CDC-RFA-IP11-010, ``Enhanced Surveillance for New Vaccine Preventable Disease.'' It is the intent of CDC to fund the applications with Patient Protection Affordable Care Act (ACA), Section 4002, appropriations.......

  14. On Medicaid and the Affordable Care Act in Connecticut

    PubMed Central

    Manthous, Constantine A.; Sofair, Andre N.

    2014-01-01

    Background: Medicaid is the federal program, administered by states, for health care for the poor. The Affordable Care Act (ACA) has added a large number of new recipients to this program. Hypothesis: Medicaid programs in some, if not many, states do not provide patients uniform access to subspecialty care guaranteed by the federal statutes. Insofar as the ACA does not address this pre-existing “sub-specialty gap” and more patients are now covered by Medicaid under the ACA, the gap is likely to increase and may contribute to disparities of health care access and outcomes. Methods: A brief description of previous studies demonstrating or suggesting a subspecialty gap in Medicaid services is accompanied by perspectives of the authors, using published literature — most notably the Denver, Colorado health care system — to propose various solutions that may be deployed to address gaps in subspecialty coverage. Results: All published studies describing the Medicaid subspecialty gap are qualitative, survey designs. There are no authoritative objective data regarding the exact prevalence of gaps for each subspecialty in each state. However, surveys of caregivers suggest that gaps were prevalent in the United States prior to initiation of the ACA. Even fewer papers have addressed solutions (in light of the paucity of data describing the magnitude of the problem), and proposed solutions remain speculative and not grounded in objective data. Conclusions: There is reason to believe that a substantial proportion of U.S. citizens — those who are guaranteed a full complement of health services through Medicaid — have difficult or no access to some subspecialty services, many of which other citizens take for granted. This problem deserves greater attention to verify its existence, quantify its magnitude, and develop solutions. PMID:25506291

  15. Preparedness of Americans for the Affordable Care Act

    PubMed Central

    Barcellos, Silvia Helena; Wuppermann, Amelie C.; Carman, Katherine Grace; Bauhoff, Sebastian; McFadden, Daniel L.; Kapteyn, Arie; Winter, Joachim K.; Goldman, Dana

    2014-01-01

    This paper investigates whether individuals are sufficiently informed to make reasonable choices in the health insurance exchanges established by the Affordable Care Act (ACA). We document knowledge of health reform, health insurance literacy, and expected changes in healthcare using a nationally representative survey of the US population in the 5 wk before the introduction of the exchanges, with special attention to subgroups most likely to be affected by the ACA. Results suggest that a substantial share of the population is unprepared to navigate the new exchanges. One-half of the respondents did not know about the exchanges, and 42% could not correctly describe a deductible. Those earning 100–250% of federal poverty level (FPL) correctly answered, on average, 4 out of 11 questions about health reform and 4.6 out of 7 questions about health insurance. This compares with 6.1 and 5.9 correct answers, respectively, for those in the top income category (400% of FPL or more). Even after controlling for potential confounders, a low-income person is 31% less likely to score above the median on ACA knowledge questions, and 54% less likely to score above the median on health insurance knowledge than a person in the top income category. Uninsured respondents scored lower on health insurance knowledge, but their knowledge of ACA is similar to the overall population. We propose that simplified options, decision aids, and health insurance product design to address the limited understanding of health insurance contracts will be crucial for ACA’s success. PMID:24706843

  16. An Exploratory Study of Drug-Exposed Infants: Case Substantiation and Subsequent Child Maltreatment

    ERIC Educational Resources Information Center

    Sun, An-Pyng; Freese, Margaret P.; Fitzgerald, Mark

    2007-01-01

    This study explores factors related to drug-exposed infants' case substantiation and subsequent child maltreatment. Child protective services computerized administrative data (from January 1998 to October 2001) were obtained from an urban Nevada county. The data included 457 drug-exposed infant cases. Chi-square, t-test, one-way ANOVA, and…

  17. The Affording Mars Workshop: Background and Recommendations

    NASA Technical Reports Server (NTRS)

    Thronson, Harley A.; Carberry, Christopher

    2014-01-01

    . The workshop was organized around three topical breakout sessions: 1. The ISS and the path to Mars: The critical coming decade 2. Affordability and sustainability: what does it mean and what are its implications within guidelines established at the start of the workshop? 3. Notional sequence(s) of cost-achievable missions for the 2020s to 2030s, including capability objectives at each stage and opportunities for coordinated robotic partnerships.

  18. Balancing adequacy and affordability?: Essential Health Benefits under the Affordable Care Act.

    PubMed

    Haeder, Simon F

    2014-12-01

    The Essential Health Benefits provisions under the Affordable Care Act require that eligible plans provide coverage for certain broadly defined service categories, limit consumer cost-sharing, and meet certain actuarial value requirements. Although the Department of Health and Human Services (HHS) was tasked with the regulatory development of these EHB under the ACA, the department quickly devolved this task to the states. Not surprisingly, states fully exploited the leeway provided by HHS, and state decision processes and outcomes differed widely. However, none of the states took advantage of the opportunity to restructure fundamentally their health insurance markets, and only a very limited number of states actually included sophisticated policy expertise in their decisionmaking processes. As a result, and despite a major expansion of coverage, the status quo ex ante in state insurance markets was largely perpetuated. Decisionmaking for the 2016 revisions should be transparent, included a wide variety of stakeholders and policy experts, and focus on balancing adequacy and affordability. However, the 2016 revisions provide an opportunity to address these previous shortcomings. PMID:25316210

  19. Are Americans finding affordable coverage in the health insurance marketplaces? Results from the Commonwealth Fund Affordable Care Act Tracking Survey.

    PubMed

    Rasmussen, Petra W; Collins, Sara R; Doty, Michelle M; Beutel, Sophie

    2014-09-01

    By the end of the first open enrollment period for coverage offered through the Affordable Care Act's marketplaces, increasing numbers of people said they found it easy to find a plan they could afford, according to The Commonwealth Fund's Affordable Care Act Tracking Survey, April-June 2014. Adults with low or moderate incomes were more likely to say it was easy to find an affordable plan than were adults with higher incomes. Adults with low or moderate incomes who purchased a plan through the marketplaces this year have similar premium costs and deductibles as adults in the same income ranges with employer-provided coverage. A majority of adults with marketplace coverage gave high ratings to their insurance and were confident in their ability to afford the care they need when sick. PMID:25265646

  20. A Murine Genital-Challenge Model Is a Sensitive Measure of Protective Antibodies against Human Papillomavirus Infection ▿

    PubMed Central

    Longet, Stéphanie; Schiller, John T.; Bobst, Martine; Jichlinski, Patrice; Nardelli-Haefliger, Denise

    2011-01-01

    The available virus-like particle (VLP)-based prophylactic vaccines against specific human papillomavirus (HPV) types afford close to 100% protection against the type-associated lesions and disease. Based on papillomavirus animal models, it is likely that protection against genital lesions in humans is mediated by HPV type-restricted neutralizing antibodies that transudate or exudate at the sites of genital infection. However, a correlate of protection was not established in the clinical trials because few disease cases occurred, and true incident infection could not be reliably distinguished from the emergence or reactivation of prevalent infection. In addition, the current assays for measuring vaccine-induced antibodies, even the gold standard HPV pseudovirion (PsV) in vitro neutralization assay, may not be sensitive enough to measure the minimum level of antibodies needed for protection. Here, we characterize the recently developed model of genital challenge with HPV PsV and determine the minimal amounts of VLP-induced neutralizing antibodies that can afford protection from genital infection in vivo after transfer into recipient mice. Our data show that serum antibody levels >100-fold lower than those detectable by in vitro PsV neutralization assays are sufficient to confer protection against an HPV PsV genital infection in this model. The results clearly demonstrate that, remarkably, the in vivo assay is substantially more sensitive than in vitro PsV neutralization and thus may be better suited for studies to establish correlates of protection. PMID:21976653

  1. The Affordable Care Act: the ethical call to transform the organizational culture.

    PubMed

    Piper, Llewellyn E

    2014-01-01

    The Patient Protection and Affordable Care Act will require health care leaders and managers to develop strategies and implement organizational tactics for their organization to survive and thrive under the federal mandates of this new health care law. Successful health care organizations and health care systems will be defined by their adaptability in the new value-based marketplace created by the Affordable Care Act. The most critical underlining challenge for this success will be the effective transformation of the organizational culture. Transformational value-based leadership is now needed to answer the ethical call for transforming the organizational culture. This article provides a model and recommendations to influence change in the most difficult leadership duty-transforming the organizational culture. PMID:25068882

  2. The Affordable Care Act: the ethical call for value-based leadership to transform quality.

    PubMed

    Piper, Llewellyn E

    2013-01-01

    Hospitals in America face a daunting and historical challenge starting in 2013 as leadership navigates their organizations toward a new port of call-the Patient Protection and Affordable Care Act. Known as the Affordable Care Act (ACA) was signed into law in March 2010 and held in abeyance waiting on 2 pivotal points-the Supreme Court's June 2012 ruling upholding the constitutionality of the ACA and the 2012 presidential election of Barack Obama bringing to reality to health care organizations that leadership now must implement the mandates of health care delivery under the ACA. This article addresses the need for value-based leadership to transform the culture of health care organizations in order to be successful in navigating uncharted waters under the unprecedented challenges for change in the delivery of quality health care. PMID:23903938

  3. What Health Care Reform Means for Immigrants: Comparing the Affordable Care Act and Massachusetts Health Reforms.

    PubMed

    Joseph, Tiffany D

    2016-02-01

    The 2010 Patient Protection and Affordable Care Act (ACA) was passed to provide more affordable health coverage to Americans beginning in 2014. Modeled after the 2006 Massachusetts health care reform, the ACA includes an individual mandate, Medicaid expansion, and health exchanges through which middle-income individuals can purchase coverage from private insurance companies. However, while the ACA provisions exclude all undocumented and some documented immigrants, Massachusetts uses state and hospital funds to extend coverage to these groups. This article examines the ACA reform using the Massachusetts reform as a comparative case study to outline how citizenship status influences individuals' coverage options under both policies. The article then briefly discusses other states that provide coverage to ACA-ineligible immigrants and the implications of uneven ACA implementation for immigrants and citizens nationwide. PMID:26567382

  4. How Has the Affordable Care Act Affected Health Insurers' Financial Performance?

    PubMed

    Hall, Mark A; McCue, Michael J

    2016-07-01

    Starting in 2014, the Affordable Care Act transformed the market for individual health insurance by changing how insurance is sold and by subsidizing coverage for millions of new purchasers. Insurers, who had no previous experience under these market conditions, competed actively but faced uncertainty in how to price their products. This issue brief uses newly available data to understand how health insurers fared financially during the ACA's first year of full reforms. Overall, health insurers' financial performance began to show some strain in 2014, but the ACA's reinsurance program substantially buffered the negative effects for most insurers. Although a quarter of insurers did substantially worse than others, experience under the new market rules could improve the accuracy of pricing decisions in subsequent years. PMID:27459740

  5. Setting a standard of affordability for health insurance coverage.

    PubMed

    Blumberg, Linda J; Holahan, John; Hadley, Jack; Nordahl, Katharine

    2007-01-01

    Recently, Massachusetts passed landmark legislation designed to expand health insurance coverage. This legislation includes a requirement that all adults enroll in a health insurance plan. This mandate takes effect only if an "affordable" plan is available. The definition of affordability for individuals and families of different incomes or circumstances is a critical decision in implementation and is relevant to any state or federal reform requiring individual premium or cost-sharing contributions, or both. This analysis was done to assist the policy design process in Massachusetts and delineates an empirically based approach to setting affordability standards. PMID:17548341

  6. Ninety-day waiting period limitation and technical amendments to certain health coverage requirements under the Affordable Care Act. Final rule.

    PubMed

    2014-02-24

    These final regulations implement the 90-day waiting period limitation under section 2708 of the Public Health Service Act, as added by the Patient Protection and Affordable Care Act (Affordable Care Act), as amended, and incorporated into the Employee Retirement Income Security Act of 1974 and the Internal Revenue Code. These regulations also finalize amendments to existing regulations to conform to Affordable Care Act provisions. Specifically, these rules amend regulations implementing existing provisions such as some of the portability provisions added by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) because those provisions of the HIPAA regulations have become superseded or require amendment as a result of the market reform protections added by the Affordable Care Act. PMID:24611209

  7. 49 CFR 384.301 - Substantial compliance-general requirements.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 CFR 383.123 not later than September 30, 2006. (c) A State must come into substantial compliance... statutes, regulations, administrative procedures and practices, organizational structures, internal...

  8. 49 CFR 384.301 - Substantial compliance-general requirements.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., organizational structures, internal control mechanisms, resource assignments (facilities, equipment, and... come into substantial compliance with 49 CFR 383.123 not later than September 30, 2006. (c) A...

  9. 49 CFR 384.301 - Substantial compliance-general requirements.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ..., organizational structures, internal control mechanisms, resource assignments (facilities, equipment, and... come into substantial compliance with 49 CFR 383.123 not later than September 30, 2006. (c) A...

  10. 49 CFR 384.301 - Substantial compliance-general requirements.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., organizational structures, internal control mechanisms, resource assignments (facilities, equipment, and... come into substantial compliance with 49 CFR 383.123 not later than September 30, 2006. (c) A...

  11. 49 CFR 384.301 - Substantial compliance-general requirements.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., organizational structures, internal control mechanisms, resource assignments (facilities, equipment, and... come into substantial compliance with 49 CFR 383.123 not later than September 30, 2006. (c) A...

  12. The Constitution of the Human Embryo as Substantial Change.

    PubMed

    Alvargonzález, David

    2016-04-01

    This paper analyzes the transformation from the human zygote to the implanted embryo under the prism of substantial change. After a brief introduction, it vindicates the Aristotelian ideas of substance and accident, and those of substantial and accidental change. It then claims that the transformation from the multicelled zygote to the implanted embryo amounts to a substantial change. Pushing further, it contends that this substantial change cannot be explained following patterns of genetic reductionism, emergence, and self-organization, and proposes Gustavo Bueno's idea of anamorphosis as a means to encapsulate criticism against such positions. PMID:26850033

  13. Object Affordances Potentiate Responses but Do Not Guide Attentional Prioritization

    PubMed Central

    Yamani, Yusuke; Ariga, Atsunori; Yamada, Yuki

    2016-01-01

    Handled objects automatically activate afforded responses. The current experiment examined whether objects that afford a response are also prioritized for attentional processing in visual search. Targets were pictures of coffee cups with handles oriented either to the right or the left. Subjects searched for a target, a right-handled vs. left-handled coffee cup, among a varying number of distractor cups oriented in the opposite direction. Responses were faster when the direction of target handle and the key press were spatially matched than mismatched (stimulus-response compatibility (SRC) effect), but object affordance did not moderate slopes of the search functions, indicating the absence of attentional prioritization effect. These findings imply that handled objects prime afforded responses without influencing attentional prioritization. PMID:26793077

  14. Development of Basic Housing Systems for Maximum Affordability

    SciTech Connect

    Aglan, H.; Gibbons, A.; McQueen, T.M.; Morris, C.; Raines, J.; Wendt, R.L.

    1999-04-19

    The ability to provide safe, habitable, comfortable housing for very low income residents within the target budget of $10,000 presents unique design and construction challenges. However, a number of preliminary conclusions have been inferred as being important concepts relative to the study of affordable housing. The term affordable housing can have many meanings and research is needed to define this explicitly. As it is most often used, affordable housing refers to an economic relationship between the price of housing, household income and current interest rates available from a lending institution. There is no direct relationship between architectural style, construction technology or user needs and the concept of affordability. For any home to be affordable, the home owner must balance the combination of housing needs and desires within the limits of an actual budget. There are many misconceptions that affordable housing must be defined as housing for those who cannot afford the free-market price. The concept of affordable housing must also include a component that recognizes the quality of the housing as an important element of the design and construction. In addition, responses to local climate impacts are necessary and are always part of a regional expression of architectural design. By using careful planning and design it may be possible to construct a limited dwelling unit today for a sum of approximately $10,000. Since the organization of the construction process must involve the owner/occupants as well as other volunteers, the project must not only be well conceived, but well developed and coordinated.

  15. Affordable Exploration of Mars: Recommendations from a Community Workshop

    NASA Technical Reports Server (NTRS)

    Thronson, Harley A.; Carberry, Chris; Cassady, R. Joseph; Cooke, Doug; Kirkpatrick, Jim; Perino, Maria Antonietta; Raftery, Michael; Westenberg, Artemis; Zucker, Richard

    2014-01-01

    There is a growing opinion that within two decades initial human missions to Mars are affordable under plausible budget scenarios, with sustained international participation, and --- especially --- without requiring those first missions to achieve a burdensome number of goals. In response to this view, a group of experts from the Mars exploration stakeholder communities attended the "Affording Mars" workshop at George Washington University in December 2013. Participants reviewed scenarios for proposed affordable and sustainable human and robotic exploration of Mars, the role of the International Space Station as the essential early step toward humans to Mars, possible "bridge" or "transition" missions in the 2020s, key capabilities required for affordable initial missions, international partnerships, and usable definitions of affordability and sustainability. We report here the findings, observations, and recommendations that were agreed to at that workshop. In the context of affordable early missions to Mars, we also discuss the recent report of the National Research Council on human space flight and a pair of recent scenarios that appear to promise reduced costs.

  16. Affordability of alcohol and alcohol-related mortality in Belarus.

    PubMed

    Razvodovsky, Yury E

    2013-01-01

    Alcohol abuse has numerous adverse health and social consequences. The consumer response to changes in alcohol affordability is an important issue on alcohol policy debates. Studies from many countries have shown an inverse relationship between alcohol prices and alcohol consumption in the population. There are, however, suggestions that increasing the price of alcohol by rising taxes may have limited effect on alcohol-related problems, associated with long-term heavy drinking. The aim of the present study was to evaluate the relationship between alcohol affordability and alcohol-related mortality rates in post-Soviet Belarus. For this purpose trends in alcohol-related mortality rates (mortality from liver cirrhosis, pancreatitis, alcoholism and alcohol psychoses) and affordability of vodka between 1990 and 2010 were compared. The time series analysis revealed that 1% increase in vodka affordability is associated with an increase in liver cirrhosis mortality of 0,77%, an increase in pancreatitis mortality of 0.53%, an increase in mortality from alcoholism and alcohol psychoses of 0,70%. The major conclusion emerging from this study is that affordability of alcohol is one of the most important predictor of alcohol-related problems in a population. These findings provide additional evidence that decreasing in affordability of alcohol is an effective strategy for reducing alcohol consumption and alcohol-related harm. PMID:23748944

  17. Stable and variable affordances are both automatic and flexible

    PubMed Central

    Borghi, Anna M.; Riggio, Lucia

    2015-01-01

    The mere observation of pictures or words referring to manipulable objects is sufficient to evoke their affordances since objects and their nouns elicit components of appropriate motor programs associated with object interaction. While nobody doubts that objects actually evoke motor information, the degree of automaticity of this activation has been recently disputed. Recent evidence has indeed revealed that affordances activation is flexibly modulated by the task and by the physical and social context. It is therefore crucial to understand whether these results challenge previous evidence showing that motor information is activated independently from the task. The context and the task can indeed act as an early or late filter. We will review recent data consistent with the notion that objects automatically elicit multiple affordances and that top-down processes select among them probably inhibiting motor information that is not consistent with behavior goals. We will therefore argue that automaticity and flexibility of affordances are not in conflict. We will also discuss how language can incorporate affordances showing similarities, but also differences, between the motor information elicited by vision and language. Finally we will show how the distinction between stable and variable affordances can accommodate all these effects. PMID:26150778

  18. 19 CFR 134.35 - Articles substantially changed by manufacture.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 19 Customs Duties 1 2012-04-01 2012-04-01 false Articles substantially changed by manufacture. 134...; DEPARTMENT OF THE TREASURY COUNTRY OF ORIGIN MARKING Exceptions to Marking Requirements § 134.35 Articles substantially changed by manufacture. (a) Articles other than goods of a NAFTA country. An article used in...

  19. 26 CFR 1.528-4 - Substantiality test.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 7 2014-04-01 2013-04-01 true Substantiality test. 1.528-4 Section 1.528-4 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Homeowners Associations § 1.528-4 Substantiality test. (a) In general. In...

  20. 19 CFR 134.35 - Articles substantially changed by manufacture.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 19 Customs Duties 1 2010-04-01 2010-04-01 false Articles substantially changed by manufacture. 134...; DEPARTMENT OF THE TREASURY COUNTRY OF ORIGIN MARKING Exceptions to Marking Requirements § 134.35 Articles substantially changed by manufacture. (a) Articles other than goods of a NAFTA country. An article used in...

  1. 19 CFR 134.35 - Articles substantially changed by manufacture.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 19 Customs Duties 1 2011-04-01 2011-04-01 false Articles substantially changed by manufacture. 134... substantially changed by manufacture. (a) Articles other than goods of a NAFTA country. An article used in the United States in manufacture which results in an article having a name, character, or use differing...

  2. 19 CFR 134.35 - Articles substantially changed by manufacture.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 19 Customs Duties 1 2014-04-01 2014-04-01 false Articles substantially changed by manufacture. 134... substantially changed by manufacture. (a) Articles other than goods of a NAFTA country. An article used in the United States in manufacture which results in an article having a name, character, or use differing...

  3. 19 CFR 134.35 - Articles substantially changed by manufacture.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 19 Customs Duties 1 2013-04-01 2013-04-01 false Articles substantially changed by manufacture. 134... substantially changed by manufacture. (a) Articles other than goods of a NAFTA country. An article used in the United States in manufacture which results in an article having a name, character, or use differing...

  4. 20 CFR 627.477 - Governor's determination of substantial violation.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Governor's determination of substantial... Standards § 627.477 Governor's determination of substantial violation. (a) Except as provided at paragraph (d) of this section, if, as a result of financial and compliance audits or otherwise, the...

  5. Differentiating between substantiated, suspected, and unsubstantiated maltreatment in Canada.

    PubMed

    Trocmé, Nico; Knoke, Della; Fallon, Barbara; MacLaurin, Bruce

    2009-02-01

    The decision to substantiate is a key factor in determining eligibility for services and decisions to press criminal charges or to remove a child, and it is frequently the basis for selecting samples of maltreated children or to measure recidivism or intervention effectiveness. Although there is a growing body of research on case substantiation in the United States, few studies have examined this decision in other jurisdictions. Using data from the 2003 Canadian Incidence Study of Reported Child Abuse and Neglect, this study examines the profiles of a national sample of 10,010 investigations. Multivariate analyses reveal that substantiation decisions are generally made in a fashion that is relatively consistent with the clinical characteristics of cases. Along with severity of harm, parent risk factors, and housing risk factors, police referrals are among the most important predictors of case substantiation. Cases involving multiple forms of maltreatment are also more likely to be substantiated. PMID:18710956

  6. Elected Officials Travel in Parallel Universes Regarding the Affordable Care Act.

    PubMed

    Elwood, Thomas W

    2015-01-01

    This authoritative appraisal of the much debated U.S. Patient Protection and Affordable Care Act, often referred to as Obamacare, describes the controversy, support, and opposition from federal and state governments during the first 5.5 years since the law was passed. Its history, the impact on individual and community health status, the limitations of health reform, its accomplishments and deficiencies, and the impact of societal determinants on program implementation are presented in a refreshing, candid, objective, and knowledgeable manner. PMID:26543040

  7. Nondestructive Evaluation (NDE) Results on Sikorsky Aircraft Survivable Affordable Reparable Airframe Program (SARAP) Samples

    NASA Technical Reports Server (NTRS)

    Zalameda, Joseph N.; Anastasi, Robert F.; Madaras, Eric I.

    2004-01-01

    The Survivable, Affordable, Reparable Airframe Program (SARAP) will develop/produce new structural design concepts with lower structural weight, reduced manufacturing complexity and development time, increased readiness, and improved threat protection. These new structural concepts will require advanced field capable inspection technologies to help meet the SARAP structural objectives. In the area of repair, damage assessment using nondestructive inspection (NDI) is critical to identify repair location and size. The purpose of this work is to conduct an assessment of new and emerging NDI methods that can potentially satisfy the SARAP program goals.

  8. Why employers will continue to provide health insurance: the impact of the Affordable Care Act.

    PubMed

    Blumberg, Linda J; Buettgens, Matthew; Feder, Judith; Holahan, John

    2012-01-01

    The Congressional Budget Office, the Rand Corporation, and the Urban Institute have estimated that the Patient Protection and Affordable Care Act (ACA) will leave employer-sponsored coverage largely intact; in contrast, some economists and benefit consultants argue that the ACA encourages employers to drop coverage, thereby making both their workers and their firms better off (a "win-win" situation). This analysis shows that no such "win-win" situation exists and that employer-sponsored insurance will remain the primary source of coverage for most workers. Analysis of three issues-the terms of the ACA, worker characteristics, and the fundamental economics of competitive markets-supports this conclusion. PMID:22931019

  9. The Affordable Care Act, health care reform, prescription drug formularies and utilization management tools.

    PubMed

    Ung, Brian L; Mullins, C Daniel

    2015-01-01

    The U.S. Patient Protection and Affordable Care Act (hence, Affordable Care Act, or ACA) was signed into law on March 23, 2010. Goals of the ACA include decreasing the number of uninsured people, controlling cost and spending on health care, increasing the quality of care provided, and increasing insurance coverage benefits. This manuscript focuses on how the ACA affects pharmacy benefit managers and consumers when they have prescriptions dispensed. PBMs use formularies and utilization control tools to steer drug usage toward cost-effective and efficacious agents. A logic model was developed to explain the effects of the new legislation. The model draws from peer-reviewed and gray literature commentary about current and future U.S. healthcare reform. Outcomes were identified as desired and undesired effects, and expected unintended consequences. The ACA extends health insurance benefits to almost 32 million people and provides financial assistance to those up to 400% of the poverty level. Increased access to care leads to a similar increase in overall health care demand and usage. This short-term increase is projected to decrease downstream spending on disease treatment and stunt the continued growth of health care costs, but may unintentionally exacerbate the current primary care physician shortage. The ACA eliminates limitations on insurance and increases the scope of benefits. Online health care insurance exchanges give patients a central location with multiple insurance options. Problems with prescription drug affordability and control utilization tools used by PBMs were not addressed by the ACA. Improving communication within the U.S. healthcare system either by innovative health care delivery models or increased usage of health information technology will help alleviate problems of health care spending and affordability. PMID:25217142

  10. Affordability Engineering: Bridging the Gap Between Design and Cost

    NASA Technical Reports Server (NTRS)

    Reeves, J. D.; DePasquale, Dominic; Lim, Evan

    2010-01-01

    Affordability is a commonly used term that takes on numerous meanings depending on the context used. Within conceptual design of complex systems, the term generally implies comparisons between expected costs and expected resources. This characterization is largely correct, but does not convey the many nuances and considerations that are frequently misunderstood and underappreciated. In the most fundamental sense, affordability and cost directly relate to engineering and programmatic decisions made throughout development programs. Systems engineering texts point out that there is a temporal aspect to this relationship, for decisions made earlier in a program dictate design implications much more so than those made during latter phases. This paper explores affordability engineering and its many sub-disciplines by discussing how it can be considered an additional engineering discipline to be balanced throughout the systems engineering and systems analysis processes. Example methods of multidisciplinary design analysis with affordability as a key driver will be discussed, as will example methods of data visualization, probabilistic analysis, and other ways of relating design decisions to affordability results.

  11. The Affordance Template ROS Package for Robot Task Programming

    NASA Technical Reports Server (NTRS)

    Hart, Stephen; Dinh, Paul; Hambuchen, Kimberly

    2015-01-01

    This paper introduces the Affordance Template ROS package for quickly programming, adjusting, and executing robot applications in the ROS RViz environment. This package extends the capabilities of RViz interactive markers by allowing an operator to specify multiple end-effector waypoint locations and grasp poses in object-centric coordinate frames and to adjust these waypoints in order to meet the run-time demands of the task (specifically, object scale and location). The Affordance Template package stores task specifications in a robot-agnostic XML description format such that it is trivial to apply a template to a new robot. As such, the Affordance Template package provides a robot-generic ROS tool appropriate for building semi-autonomous, manipulation-based applications. Affordance Templates were developed by the NASA-JSC DARPA Robotics Challenge (DRC) team and have since successfully been deployed on multiple platforms including the NASA Valkyrie and Robonaut 2 humanoids, the University of Texas Dreamer robot and the Willow Garage PR2. In this paper, the specification and implementation of the affordance template package is introduced and demonstrated through examples for wheel (valve) turning, pick-and-place, and drill grasping, evincing its utility and flexibility for a wide variety of robot applications.

  12. 26 CFR 1.507-6 - Substantial contributor defined.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... taxable years. Status as a substantial contributor, however, will date from the time when the donor first... October 9, 1969, H (W's spouse at the time of the 1941 gift) is considered to have made such...

  13. 26 CFR 1.274-5 - Substantiation requirements.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 3 2011-04-01 2011-04-01 false Substantiation requirements. 1.274-5 Section 1.274-5 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Items Not Deductible § 1.274-5 Substantiation requirements. (a)-(b) . For further guidance, see § 1.274-5T(a) and...

  14. Why do so many Americans oppose the Affordable Care Act?

    PubMed

    Dalen, James E; Waterbrook, Keith; Alpert, Joseph S

    2015-08-01

    The Patient Protection and Affordable Care Act (ACA) was passed by a Democratic Congress and signed into law by a Democratic president in 2010. Republican congressmen, governors, and Republican candidates have consistently opposed the ACA and have vowed to repeal it. Polls have consistently shown that it is supported by <50% of Americans. The most important goal of the ACA is to improve the health of Americans by increasing the number covered by health insurance. In the first year of its implementation, more than 10 million citizens gained health insurance. The percentage of Americans without health insurance decreased from 18% in July 2013 to 13.4% in June 2014. In addition, the ACA has eliminated many of the negative features of private insurance such as the denial of coverage for those with "prior conditions." The benefits of Medicare have been enhanced to decrease the cost of prescription drugs and to eliminate co-pays for preventive services. Despite these positive changes, a near majority of Americans still oppose the ACA, even though they approve of most of its features. They oppose the mandate that all Americans must have health insurance (the individual mandate), and they oppose a government role in health care. Yet Medicare, a mandatory insurance for seniors administered by the federal government since 1965, is overwhelmingly approved by the American public. The opposition to a government role in health care is based on the fact that that the vast majority of our citizens do not trust their government. Republicans are much less trusting of the federal government and much less supportive of a government role in health care than Democrats. The overwhelmingly negative TV ads against the ACA by the Republican candidates in the elections of 2012 and 2014 have had a major impact on Americans' views of the ACA. More than 60% of Americans have stated that most of what they know about the ACA came from watching TV. Opposition to a government role in health care

  15. Conflict in the kitchen: Contextual modulation of responsiveness to affordances.

    PubMed

    Wokke, Martijn E; Knot, Sarah L; Fouad, Aisha; Richard Ridderinkhof, K

    2016-02-01

    Recently, human behavior has been considered the product of continuous interactions between perception, cognition and action in which "affordances" (action possibilities the environment has to offer) play an important role. Converging evidence suggests that multiple action possibilities simultaneously compete for further processing, while external and internal factors (e.g., incoming sensory information, predictions) bias this competition. In the present study we used a stop-task to investigate whether context is able to modulate the strength of the responsiveness to affordances. We therefore placed participants in an actual kitchen and workshop during electroencephalographic recordings. A faster response to context congruent objects demonstrated that the direct surrounding is able to affect responsiveness to affordances. In addition, when responses needed to be withheld, context congruent objects evoked greater response conflict as indicated by an enhanced N2 Event Related Potential (ERP) component. PMID:26821243

  16. The Value of Full Correction: Achieving Excellent and Affordable Results.

    PubMed

    Kaplan, Julie Bass

    2016-01-01

    Patients often come to medical aesthetic offices with hopes to fully correct lost facial volume and achieve a natural appearance. Unfortunately, the cost per syringe of dermal filler can be a barrier to desired outcomes. Many aesthetic practitioners do the best they can with the amount of product the patient can afford, often falling short of the "wow" effect for the patient. This article describes what one office implemented to solve the conundrum of affordability while still allowing offices to cover its own financial realities. This tool can help patients achieve beautiful, natural, and affordable outcomes while helping offices advance in manufacturer's tiers, improve word-of-mouth advertising, and increase job satisfaction. PMID:27606585

  17. Conflict between object structural and functional affordances in peripersonal space.

    PubMed

    Kalénine, Solène; Wamain, Yannick; Decroix, Jérémy; Coello, Yann

    2016-10-01

    Recent studies indicate that competition between conflicting action representations slows down planning of object-directed actions. The present study aims to assess whether similar conflict effects exist during manipulable object perception. Twenty-six young adults performed reach-to-grasp and semantic judgements on conflictual objects (with competing structural and functional gestures) and non-conflictual objects (with similar structural and functional gestures) presented at difference distances in a 3D virtual environment. Results highlight a space-dependent conflict between structural and functional affordances. Perceptual judgments on conflictual objects were slower that perceptual judgments on non-conflictual objects, but only when objects were presented within reach. Findings demonstrate that competition between structural and functional affordances during object perception induces a processing cost, and further show that object position in space can bias affordance competition. PMID:27327864

  18. The Challenge to States: Preserving College Access and Affordability in a Time of Crisis

    ERIC Educational Resources Information Center

    National Center for Public Policy and Higher Education, 2009

    2009-01-01

    The American Recovery and Reinvestment Act of 2009 represents both an opportunity and a challenge for states to set priorities. A substantial portion of these one-time federal funds can be used to reposition higher education strategically to protect access and quality and to stimulate the increased cost effectiveness and degree productivity…

  19. Predictors of Smoke-Free Policies in Affordable Multiunit Housing, North Carolina, 2013

    PubMed Central

    Suttie, Janet; Baker, Laura; Agans, Robert; Xue, Wei; Bowling, J. Michael

    2015-01-01

    Introduction Smoke-free policies can effectively protect nonsmokers from secondhand smoke (SHS) exposure in multiunit housing. We surveyed all affordable multiunit housing properties in North Carolina to determine the statewide prevalence of smoke-free policies and to identify predictors of smoke-free policies. Methods Representatives of affordable housing properties in North Carolina completed a mailed or online survey during June through October 2013. The primary outcome measure was presence of a smoke-free policy, defined as prohibiting smoking in all residential units. We used χ2 analysis and multivariate logistic regression to identify correlates of smoke-free policies. Results Of 1,865 eligible properties, responses were received for 1,063 (57%). A total of 16.5% of properties had policies that prohibited smoking in all residential units, while 69.6% prohibited smoking in indoor common areas. In multivariate analysis, an increase in the number of children per unit was associated with a decrease in the odds of having a smoke-free policy at most properties. Newer properties across all company sizes were more likely to have smoke-free policies. Accessing units from interior hallways predicted smoke-free policies among medium-sized companies. Conclusion More smoke-free policies in affordable multiunit housing are needed to protect vulnerable populations, particularly children, from SHS exposure. Public health professionals should continue to educate housing operators about SHS and the benefits of smoke-free policies at all properties, including older ones and ones where units are accessed from outside rather than from an interior hallway. PMID:25974143

  20. Can Low-Income Americans Afford a Healthy Diet?

    PubMed Central

    Drewnowski, Adam; Eichelsdoerfer, Petra

    2010-01-01

    Many nutritional professionals believe that all Americans, regardless of income, have access to a nutritious diet of whole grains, lean meats, and fresh vegetables and fruit. In reality, food prices pose a significant barrier for many consumers who are trying to balance good nutrition with affordability. The Thrifty Food Plan (TFP), commonly cited as a model of a healthy low-cost diet, achieves cost goals by relaxing some nutrition constraints and by disregarding the usual eating habits of the American population. Diet optimization techniques, when sensitive to cost and social norms, can help identify affordable, good tasting, nutrient-rich foods that are part of the mainstream American diet. PMID:20368762

  1. Approach to an Affordable and Sustainable Space Transportation System

    NASA Technical Reports Server (NTRS)

    McCleskey, Caey M.; Rhodes, R. E.; Robinson, J. W.; Henderson, E. M.

    2012-01-01

    This paper describes an approach and a general procedure for creating space transportation architectural concepts that are at once affordable and sustainable. Previous papers by the authors and other members of the Space Propulsion Synergy Team (SPST) focused on a functional system breakdown structure for an architecture and definition of high-payoff design techniques with a technology integration strategy. This paper follows up by using a structured process that derives architectural solutions focused on achieving life cycle affordability and sustainability. Further, the paper includes an example concept that integrates key design techniques discussed in previous papers. !

  2. Measuring Substantial Reduction in Functioning in Patients with CFS

    PubMed Central

    Jason, Leonard A.; Brown, Molly; Evans, Meredyth; Anderson, Valerie; Lerch, Athena; Brown, Abigail; Hunnell, Jessica; Porter, Nicole

    2011-01-01

    Purpose All of the major current case definitions for chronic fatigue syndrome (CFS) specify substantial reductions in previous levels of occupational, educational, social, or personal activities to meet criteria. Difficulties have been encountered in operationalizing “substantial reductions.” For example, the Medical Outcomes Study Short Form-36 Health Survey (SF-36) has been used to determine whether individuals met the CFS disability criterion. However, previous methods of using the SF-36 have been prone to including people without substantial reductions in key areas of physical functioning when diagnosing CFS. This study sought to empirically identify the most appropriate SF-36 subscales for measuring substantial reductions in patients with CFS. Method The SF-36 was administered to two samples of patients with CFS: one recruited from tertiary care and the other a community-based sample; as well as a non-fatigued control group. Receiver operating characteristics were used to determine optimal cutoff scores for identifying patients with CFS. Results The SF-36 Role-Emotional subscale had the worst sensitivity and specificity, whereas the Vitality, Role-Physical, and Social Functioning subscales had the best sensitivity and specificity. Conclusion Based on evidence from this study, potential criteria for defining substantial reductions in functioning and diagnosing CFS is provided. PMID:20617920

  3. The Affordable Care Act and hospital chaplaincy: re-visioning spiritual care, re-valuing institutional wholeness.

    PubMed

    Frierdich, Matthew D

    2015-01-01

    This article focuses on the institutional dimensions of spiritual care within hospital settings in the context of the Patient Protection and Affordable Care Act of 2010 (ACA), applying policy information and systems theory to re-imagine the value and function of chaplaincy to hospital communities. This article argues that chaplaincy research and practice must look beyond only individual interventions and embrace chaplain competencies of presence, ritual, and communication as foundational tools for institutional spiritual care. PMID:26207905

  4. 76 FR 20354 - Notice of Intent To Award Supplemental Affordable Care Act Funding

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-12

    ... Affordable Care Act Funding Notice of Intent to award supplemental Affordable Care Act funding to support...: Notice. SUMMARY: This notice provides public announcement of CDC's intent to use Affordable Care Act (ACA....'' Funding is appropriated under the Affordable Care Act (Pub. L. 111-148), Title IV, Section...

  5. Method of sealing an ultracapacitor substantially free of water

    DOEpatents

    Chapman-Irwin, Patricia; Feist, Thomas Paul

    2002-04-02

    A method of sealing an ultracapacitor substantially free of water is disclosed. The method includes providing a multilayer cell comprising two solid, non porous current collectors, separated by two porous electrodes with a separator between the two electrodes, sealing the cell with a reclosable hermetic closure. Water inside the closure is dissociated by an applied voltage to the cell and escapes in the form of hydrogen and oxygen when the closure is unmated, the closure is then mated to hermetically seal the cell which is substantially free of water.

  6. Learning Affordances of Language and Communication National Curricula

    ERIC Educational Resources Information Center

    Scott, David

    2016-01-01

    This article focuses on the learning affordances of different language and communication curricula in the world. For reasons of space, only two national education systems (Finland and Singapore) and their language and communication curricula are referred to. The accounts of national education systems consist of the identification of mechanisms…

  7. Affordances of Learning Technologies in Higher Education Multicultural Environments

    ERIC Educational Resources Information Center

    Arenas, Edilson

    2015-01-01

    A cluster of research has been conducted in higher education to investigate the affordances (action possibilities) and the influence information and communication technologies (ICT) may have on students' learning experiences and outcomes. Such studies have given rise to the implementation of a wide range of educational frameworks with a great deal…

  8. Voters and the Affordable Care Act in the 2014 election.

    PubMed

    Blendon, Robert J; Benson, John M

    2014-11-13

    In this analysis of data from 27 public opinion polls, the authors examine the role of the Affordable Care Act in the 2014 congressional elections. The outcome of the elections is likely to influence implementation of the ACA and future U.S. health care policy. PMID:25353968

  9. 12 CFR 1282.14 - Special Affordable Housing Goal.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Insurance Fund; and (C) Subject to, and have received at least a satisfactory performance evaluation rating... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Special Affordable Housing Goal. 1282.14 Section 1282.14 Banks and Banking FEDERAL HOUSING FINANCE AGENCY HOUSING GOALS AND MISSION...

  10. Inside the Virtual Classroom: Student Perspectives on Affordances and Limitations

    ERIC Educational Resources Information Center

    Falloon, Garry

    2012-01-01

    Research indicates learners studying at a distance can experience perceptions of isolation and lack of "belonging" and support, which can adversely affect their learning experience and performance. Recently, the advent of affordable, accessible and reliable high-speed broadband has meant that a whole new array of digital tools to support…

  11. Music Composition Lessons: The Multimodal Affordances of Technology

    ERIC Educational Resources Information Center

    Gall, Marina; Breeze, Nick

    2005-01-01

    This article investigates the multimodal affordances presented by music software and how it can provide new opportunities for students to engage with composition work in the classroom. It seeks to broaden the scope of current research into classroom composition using technology, through a study of students' environments and compositional processes…

  12. 7 CFR 3565.352 - Preservation of affordable housing.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 15 2013-01-01 2013-01-01 false Preservation of affordable housing. 3565.352 Section 3565.352 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, DEPARTMENT OF AGRICULTURE GUARANTEED RURAL RENTAL HOUSING PROGRAM Project Management § 3565.352...

  13. 7 CFR 3565.352 - Preservation of affordable housing.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 15 2014-01-01 2014-01-01 false Preservation of affordable housing. 3565.352 Section 3565.352 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, DEPARTMENT OF AGRICULTURE GUARANTEED RURAL RENTAL HOUSING PROGRAM Project Management § 3565.352...

  14. 7 CFR 3565.352 - Preservation of affordable housing.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 15 2011-01-01 2011-01-01 false Preservation of affordable housing. 3565.352 Section 3565.352 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, DEPARTMENT OF AGRICULTURE GUARANTEED RURAL RENTAL HOUSING PROGRAM Project Management § 3565.352...

  15. 7 CFR 3565.352 - Preservation of affordable housing.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 15 2012-01-01 2012-01-01 false Preservation of affordable housing. 3565.352 Section 3565.352 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, DEPARTMENT OF AGRICULTURE GUARANTEED RURAL RENTAL HOUSING PROGRAM Project Management § 3565.352...

  16. 7 CFR 3565.352 - Preservation of affordable housing.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Preservation of affordable housing. 3565.352 Section 3565.352 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, DEPARTMENT OF AGRICULTURE GUARANTEED RURAL RENTAL HOUSING PROGRAM Project Management § 3565.352...

  17. 24 CFR 1006.201 - Eligible affordable housing activities.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... URBAN DEVELOPMENT NATIVE HAWAIIAN HOUSING BLOCK GRANT PROGRAM Eligible Activities § 1006.201 Eligible... 24 Housing and Urban Development 4 2014-04-01 2014-04-01 false Eligible affordable housing activities. 1006.201 Section 1006.201 Housing and Urban Development REGULATIONS RELATING TO HOUSING AND...

  18. 24 CFR 1006.201 - Eligible affordable housing activities.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... URBAN DEVELOPMENT NATIVE HAWAIIAN HOUSING BLOCK GRANT PROGRAM Eligible Activities § 1006.201 Eligible... 24 Housing and Urban Development 4 2012-04-01 2012-04-01 false Eligible affordable housing activities. 1006.201 Section 1006.201 Housing and Urban Development REGULATIONS RELATING TO HOUSING AND...

  19. 24 CFR 1006.201 - Eligible affordable housing activities.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... URBAN DEVELOPMENT NATIVE HAWAIIAN HOUSING BLOCK GRANT PROGRAM Eligible Activities § 1006.201 Eligible... 24 Housing and Urban Development 4 2013-04-01 2013-04-01 false Eligible affordable housing activities. 1006.201 Section 1006.201 Housing and Urban Development REGULATIONS RELATING TO HOUSING AND...

  20. 24 CFR 92.254 - Qualification as affordable housing: Homeownership.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... Zone or Enterprise Community application under 24 CFR part 597 has incorporated the type of market data... 24 Housing and Urban Development 1 2014-04-01 2014-04-01 false Qualification as affordable housing: Homeownership. 92.254 Section 92.254 Housing and Urban Development Office of the Secretary, Department...

  1. 24 CFR 1006.201 - Eligible affordable housing activities.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... URBAN DEVELOPMENT NATIVE HAWAIIAN HOUSING BLOCK GRANT PROGRAM Eligible Activities § 1006.201 Eligible... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Eligible affordable housing activities. 1006.201 Section 1006.201 Housing and Urban Development Regulations Relating to Housing and...

  2. 24 CFR 1006.201 - Eligible affordable housing activities.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 4 2011-04-01 2011-04-01 false Eligible affordable housing activities. 1006.201 Section 1006.201 Housing and Urban Development REGULATIONS RELATING TO HOUSING AND URBAN DEVELOPMENT (CONTINUED) OFFICE OF ASSISTANT SECRETARY FOR PUBLIC AND INDIAN HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE...

  3. 24 CFR 1006.20 - Grants for affordable housing activities.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 4 2011-04-01 2011-04-01 false Grants for affordable housing activities. 1006.20 Section 1006.20 Housing and Urban Development REGULATIONS RELATING TO HOUSING AND URBAN DEVELOPMENT (CONTINUED) OFFICE OF ASSISTANT SECRETARY FOR PUBLIC AND INDIAN HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE...

  4. Pedagogical Affordances of Multiple External Representations in Scientific Processes

    NASA Astrophysics Data System (ADS)

    Wu, Hsin-Kai; Puntambekar, Sadhana

    2012-12-01

    Multiple external representations (MERs) have been widely used in science teaching and learning. Theories such as dual coding theory and cognitive flexibility theory have been developed to explain why the use of MERs is beneficial to learning, but they do not provide much information on pedagogical issues such as how and in what conditions MERs could be introduced and used to support students' engagement in scientific processes and develop competent scientific practices (e.g., asking questions, planning investigations, and analyzing data). Additionally, little is understood about complex interactions among scientific processes and affordances of MERs. Therefore, this article focuses on pedagogical affordances of MERs in learning environments that engage students in various scientific processes. By reviewing literature in science education and cognitive psychology and integrating multiple perspectives, this article aims at exploring (1) how MERs can be integrated with science processes due to their different affordances, and (2) how student learning with MERs can be scaffolded, especially in a classroom situation. We argue that pairing representations and scientific processes in a principled way based on the affordances of the representations and the goals of the activities is a powerful way to use MERs in science education. Finally, we outline types of scaffolding that could help effective use of MERs including dynamic linking, model progression, support in instructional materials, teacher support, and active engagement.

  5. 24 CFR 401.408 - Affordability and use restrictions required.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Development (Continued) OFFICE OF HOUSING AND OFFICE OF MULTIFAMILY HOUSING ASSISTANCE RESTRUCTURING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT MULTIFAMILY HOUSING MORTGAGE AND HOUSING ASSISTANCE RESTRUCTURING PROGRAM (MARK-TO-MARKET) Restructuring Plan § 401.408 Affordability and use restrictions required....

  6. Learning at Work: Organisational Affordances and Individual Engagement

    ERIC Educational Resources Information Center

    Bryson, Jane; Pajo, Karl; Ward, Robyn; Mallon, Mary

    2006-01-01

    Purpose: The purpose of this research is to explore the interaction between organisational affordances for the development of individuals' capability, and the engagement of workers at various levels with those opportunities. Design/methodology/approach: A case study of a large New Zealand wine company, using in-depth interviews. Interviews were…

  7. Can the United States afford a lunar base

    NASA Technical Reports Server (NTRS)

    Keaton, Paul W.

    1988-01-01

    Establishing a lunar base will require steady funding for a decade or two. The question addressed is whether such a large space project is affordable at this time. The relevant facts and methodology are presented so that the reader may formulate independent answers. It is shown that a permanent lunar base can be financed without increasing NASA's historical budgetary trend.

  8. 24 CFR 1000.101 - What is affordable housing?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false What is affordable housing? 1000.101 Section 1000.101 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued) OFFICE OF ASSISTANT SECRETARY FOR PUBLIC AND INDIAN HOUSING, DEPARTMENT OF HOUSING...

  9. Can Canadian Seniors on Public Pensions Afford a Nutritious Diet?

    ERIC Educational Resources Information Center

    Green, Rebecca J.; Williams, Patricia L.; Johnson, C. Shanthi; Blum, Ilya

    2008-01-01

    This study examined whether Canada's public pensions (Old Age Security and Canada Pension Plan) provided adequate income for seniors living in Nova Scotia in 2005 to afford a basic nutritious diet. Monthly incomes were compared to essential monthly expenses for four household scenarios: (a) married couple, 80 years and 78 years, in urban Nova…

  10. The Affordability Challenge in California Higher Education: Options for Change

    ERIC Educational Resources Information Center

    California Postsecondary Education Commission, 2007

    2007-01-01

    California's Master Plan for Higher Education represented a promise, of an affordable college education, to every person who could benefit. For decades, California's lawmakers honored that promise. Rapidly increasing college fees, coupled with higher costs for room and board, books, transportation, and healthcare are pricing students out of higher…

  11. Lean, Mean and Green: An Affordable Net Zero School

    ERIC Educational Resources Information Center

    Stanfield, Kenneth

    2010-01-01

    From its conception, Richardsville Elementary was designed to be an affordable net zero facility. The design team explored numerous energy saving strategies to dramatically reduce energy consumption. By reducing energy use to 19.31 kBtus annually, the net zero goal could be realized through the implementation of a solar array capable of producing…

  12. Material Affordances: The Potential of Scrapbooks in the Composition Classroom

    ERIC Educational Resources Information Center

    Alexander, Kara Poe

    2013-01-01

    A multiliteracies pedagogy has renewed our interest in materiality, or how the physical text interacts with the author's choices and the context to contribute to the message, yet little attention has been paid to materiality in analog texts, such as the scrapbook, even though this medium contains affordances (capabilities and limitations) that…

  13. 24 CFR 81.14 - Special Affordable Housing Goal.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... MAE) AND THE FEDERAL HOME LOAN MORTGAGE CORPORATION (FREDDIE MAC) Housing Goals § 81.14 Special..., as a Special Affordable Housing Home Purchase Subgoal, 17 percent of the total number of home purchase mortgages in metropolitan areas financed by each GSE's mortgage purchases shall be home...

  14. 24 CFR 81.14 - Special Affordable Housing Goal.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... MAE) AND THE FEDERAL HOME LOAN MORTGAGE CORPORATION (FREDDIE MAC) Housing Goals § 81.14 Special..., as a Special Affordable Housing Home Purchase Subgoal, 17 percent of the total number of home purchase mortgages in metropolitan areas financed by each GSE's mortgage purchases shall be home...

  15. Affordances for Second Language Learning in "World of Warcraft"

    ERIC Educational Resources Information Center

    Rama, Paul S.; Black, Rebecca W.; van Es, Elizabeth; Warschauer, Mark

    2012-01-01

    What are the affordances of online gaming environments for second language learning and socialization? To answer this question, this qualitative study examines two college-age Spanish learners' experiences participating in the Spanish language version of the massively multi-player online game "World of Warcraft." Using data culled from participant…

  16. Monitoring the price and affordability of foods and diets globally.

    PubMed

    Lee, A; Mhurchu, C N; Sacks, G; Swinburn, B; Snowdon, W; Vandevijvere, S; Hawkes, C; L'abbé, M; Rayner, M; Sanders, D; Barquera, S; Friel, S; Kelly, B; Kumanyika, S; Lobstein, T; Ma, J; Macmullan, J; Mohan, S; Monteiro, C; Neal, B; Walker, C

    2013-10-01

    Food prices and food affordability are important determinants of food choices, obesity and non-communicable diseases. As governments around the world consider policies to promote the consumption of healthier foods, data on the relative price and affordability of foods, with a particular focus on the difference between 'less healthy' and 'healthy' foods and diets, are urgently needed. This paper briefly reviews past and current approaches to monitoring food prices, and identifies key issues affecting the development of practical tools and methods for food price data collection, analysis and reporting. A step-wise monitoring framework, including measurement indicators, is proposed. 'Minimal' data collection will assess the differential price of 'healthy' and 'less healthy' foods; 'expanded' monitoring will assess the differential price of 'healthy' and 'less healthy' diets; and the 'optimal' approach will also monitor food affordability, by taking into account household income. The monitoring of the price and affordability of 'healthy' and 'less healthy' foods and diets globally will provide robust data and benchmarks to inform economic and fiscal policy responses. Given the range of methodological, cultural and logistical challenges in this area, it is imperative that all aspects of the proposed monitoring framework are tested rigorously before implementation. PMID:24074213

  17. Affordable comfort 95 - investing in our energy future

    SciTech Connect

    1995-12-31

    This report describes the topics from the conference on Affordable Comfort, held March 26-31, 1995. Topics are concerned with energy efficiency in homes, retrofitting, weatherization, and monitoring of appliances, heating, and air conditioning systems for performance, as well as topics on electric utilities.

  18. Toward Affordability: Policy Recommendations for Virginia Higher Education

    ERIC Educational Resources Information Center

    State Council of Higher Education for Virginia, 2009

    2009-01-01

    In its 2007-13 strategic plan, Advancing Virginia: Access, Alignment, Investment, the State Council highlighted 12 strategic higher education initiatives that it believed were necessary to ensure Virginia's future. Key among these goals was improvement of the affordability of a college education in the Commonwealth. Recent events have reinforced…

  19. Learning to Identify and Actualize Affordances in a New Tool

    ERIC Educational Resources Information Center

    Haines, Karen J.

    2015-01-01

    Keeping abreast of new technologies and the opportunities they offer is a challenge for inservice teachers (Blake, 2008; Egbert, Akasha, Huff, & Lee, 2011; Hanson-Smith, 2006; Hubbard, 2007; Robb, 2006). An important aspect of teacher learning about the use of technology is the ability to identify the affordances of new tools and how they can…

  20. The ICCE Framework: Framing Learning Experiences Afforded by Games

    ERIC Educational Resources Information Center

    Foster, Aroutis; Shah, Mamta

    2015-01-01

    There is a need for game-based learning frameworks that provide a lens for understanding learning experiences afforded in digital games. These frameworks should aim to facilitate game analyses, identification of learning opportunities, and support for learner experiences. This article uses the inquiry, communication, construction, and expression…

  1. 24 CFR 81.14 - Special Affordable Housing Goal.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 1 2012-04-01 2012-04-01 false Special Affordable Housing Goal. 81.14 Section 81.14 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development THE SECRETARY OF HUD'S REGULATION OF THE FEDERAL NATIONAL MORTGAGE ASSOCIATION...

  2. 24 CFR 81.14 - Special Affordable Housing Goal.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 1 2013-04-01 2013-04-01 false Special Affordable Housing Goal. 81.14 Section 81.14 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development THE SECRETARY OF HUD'S REGULATION OF THE FEDERAL NATIONAL MORTGAGE ASSOCIATION...

  3. 24 CFR 81.14 - Special Affordable Housing Goal.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 1 2014-04-01 2014-04-01 false Special Affordable Housing Goal. 81.14 Section 81.14 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development THE SECRETARY OF HUD'S REGULATION OF THE FEDERAL NATIONAL MORTGAGE ASSOCIATION...

  4. The Weight of Time: Affordances for an Integrated Magnitude System

    ERIC Educational Resources Information Center

    Lu, Aitao; Mo, Lei; Hodges, Bert H.

    2011-01-01

    In five experiments we explored the effects of weight on time in different action contexts to test the hypothesis that an integrated magnitude system is tuned to affordances. Larger magnitudes generally seem longer; however, Lu and colleagues (2009) found that if numbers were presented as weights in a range heavy enough to affect lifting, the…

  5. Affordance, Learning Opportunities, and the Lesson Plan Pro Forma

    ERIC Educational Resources Information Center

    Anderson, Jason

    2015-01-01

    This article argues that the most commonly used lesson plan pro formas in language teacher education are inappropriately premised on an outcomes-based approach to teaching, one that is in conflict with what we know about how languages are learnt and how experienced teachers teach. It proposes an alternative, affordance-based approach to lesson…

  6. Implementing the Affordable Care Act: The Promise and Limits of Health Care Reform.

    PubMed

    Oberlander, Jonathan

    2016-08-01

    The Obama administration has confronted a formidable array of obstacles in implementing the Affordable Care Act (ACA). The ACA has overcome those obstacles to substantially expand access to health insurance, though significant problems with its approach have emerged. What does the ACA's performance to date tell us about the possibilities and limits of health care reform in the United States? I identify key challenges in ACA implementation-the inherently disruptive nature of reform, partisan polarization, the limits of "near universal" coverage, complexity, and divided public opinion-and analyze how these issues have shaped its evolution. The article concludes by exploring the political and policy challenges that lie ahead for the ACA. PMID:27127261

  7. Limb apraxia and the “affordance competition hypothesis”

    PubMed Central

    Rounis, Elisabeth; Humphreys, Glyn

    2015-01-01

    Limb apraxia, a disorder of higher order motor control, has long been a challenge for clinical assessment and understanding (Leiguarda and Marsden, 2000). The deficits originally described in limb apraxia (Liepmann, 1920) have been classified by the nature of the errors made by the patients leading to, namely, ideational and ideomotor apraxia. The dual stream hypothesis (Goodale and Milner, 1992) has been used to explain these categories: ideational apraxia is thought to relate to a deficit in the concept of a movement (coded in the ventral stream). Patients have difficulty using objects, sequencing actions to interact with them or pantomiming their use. Ideomotor apraxia, on the other hand, is thought to arise from problems in the accurate implementation of movements within the dorsal stream. One of the limitations on understanding apraxia is the failure by the clinical literature to draw on knowledge of the factors determining actions in the environment. Here we emphasize the role of affordance. There is much recent work indicating that our responses to stimuli are strongly influenced by the actions that the objects “afford”, based on their physical properties and the intentions of the actor (e.g., Tucker and Ellis, 1998). The concept of affordance, originally suggested by Gibson (1979) has been incorporated in a recent model of interactive behavior that draws from findings in non-human primates, namely the “affordance competition hypothesis” (Cisek, 2007). This postulates that interactive behavior arises by a process of competition between possible actions elicited by the environment. In this paper we argue that “affordance competition” may play a role in apraxia. We review evidence that at least some aspects of apraxia may reflect an abnormal sensitivity to competition when multiple affordances are present (Riddoch et al., 1998) and/or a poor ability to exert cognitive control over this competition when it occurs. This framework suggests a new way

  8. 76 FR 38961 - Tobacco Products, Exemptions From Substantial Equivalence Requirements

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-05

    ... / Tuesday, July 5, 2011 / Rules and Regulations#0;#0; ] DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and... Substantial Equivalence Requirements AGENCY: Food and Drug Administration, HHS. ACTION: Final rule. SUMMARY: The Food and Drug Administration (FDA) is issuing this final rule to establish procedures...

  9. 29 CFR 4043.27 - Distribution to a substantial owner.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... TERMINATIONS REPORTABLE EVENTS AND CERTAIN OTHER NOTIFICATION REQUIREMENTS Post-Event Notice of Reportable Events § 4043.27 Distribution to a substantial owner. (a) Reportable event. A reportable event occurs for... does not exceed the limitation (as of the date the reportable event occurs) under section...

  10. 29 CFR 4043.27 - Distribution to a substantial owner.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 29 Labor 9 2014-07-01 2014-07-01 false Distribution to a substantial owner. 4043.27 Section 4043.27 Labor Regulations Relating to Labor (Continued) PENSION BENEFIT GUARANTY CORPORATION PLAN TERMINATIONS REPORTABLE EVENTS AND CERTAIN OTHER NOTIFICATION REQUIREMENTS Post-Event Notice of Reportable Events § 4043.27 Distribution to a...

  11. 29 CFR 4043.27 - Distribution to a substantial owner.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... TERMINATIONS REPORTABLE EVENTS AND CERTAIN OTHER NOTIFICATION REQUIREMENTS Post-Event Notice of Reportable Events § 4043.27 Distribution to a substantial owner. (a) Reportable event. A reportable event occurs for... does not exceed the limitation (as of the date the reportable event occurs) under section...

  12. 29 CFR 4043.27 - Distribution to a substantial owner.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 9 2010-07-01 2010-07-01 false Distribution to a substantial owner. 4043.27 Section 4043.27 Labor Regulations Relating to Labor (Continued) PENSION BENEFIT GUARANTY CORPORATION PLAN TERMINATIONS REPORTABLE EVENTS AND CERTAIN OTHER NOTIFICATION REQUIREMENTS Post-Event Notice of Reportable Events § 4043.27 Distribution to a...

  13. 29 CFR 4043.27 - Distribution to a substantial owner.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... TERMINATIONS REPORTABLE EVENTS AND CERTAIN OTHER NOTIFICATION REQUIREMENTS Post-Event Notice of Reportable Events § 4043.27 Distribution to a substantial owner. (a) Reportable event. A reportable event occurs for... does not exceed the limitation (as of the date the reportable event occurs) under section...

  14. 77 FR 35245 - Substantially Underserved Trust Areas (SUTA)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-13

    ... entitled ``Department Programs and Activities Excluded from Executive Order 12372,'' (50 FR 47034). However... October 14, 2011, (76 FR 63846), the agency requested comments regarding implementing the Substantially... Guarantees. The Catalog is available on the Internet at http://www.cfda.gov . Executive Order 12372...

  15. 20 CFR 404.1510 - Meaning of substantial gainful activity.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Meaning of substantial gainful activity. 404.1510 Section 404.1510 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Determining Disability and Blindness Definition of Disability §...

  16. 20 CFR 404.1510 - Meaning of substantial gainful activity.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Meaning of substantial gainful activity. 404.1510 Section 404.1510 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Determining Disability and Blindness Definition of Disability §...

  17. 20 CFR 404.1510 - Meaning of substantial gainful activity.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Meaning of substantial gainful activity. 404.1510 Section 404.1510 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Determining Disability and Blindness Definition of Disability §...

  18. 20 CFR 404.1510 - Meaning of substantial gainful activity.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Meaning of substantial gainful activity. 404.1510 Section 404.1510 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Determining Disability and Blindness Definition of Disability §...

  19. 20 CFR 404.1510 - Meaning of substantial gainful activity.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Meaning of substantial gainful activity. 404.1510 Section 404.1510 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Determining Disability and Blindness Definition of Disability §...

  20. 15 CFR 970.209 - Substantial compliance with application requirements.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 15 Commerce and Foreign Trade 3 2014-01-01 2014-01-01 false Substantial compliance with application requirements. 970.209 Section 970.209 Commerce and Foreign Trade Regulations Relating to Commerce and Foreign Trade (Continued) NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE GENERAL REGULATIONS OF THE ENVIRONMENTAL...

  1. 76 FR 737 - Tobacco Products, Exemptions From Substantial Equivalence Requirements

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-06

    ...The Food and Drug Administration (FDA) is issuing this proposed rule to establish procedures for requesting an exemption from the substantial equivalence requirements of the Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act). The proposed rule would describe the process and statutory criteria for requesting an exemption and explain how FDA would review requests for......

  2. 15 CFR 970.209 - Substantial compliance with application requirements.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 15 Commerce and Foreign Trade 3 2011-01-01 2011-01-01 false Substantial compliance with application requirements. 970.209 Section 970.209 Commerce and Foreign Trade Regulations Relating to Commerce and Foreign Trade (Continued) NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE GENERAL REGULATIONS OF THE ENVIRONMENTAL...

  3. 15 CFR 970.209 - Substantial compliance with application requirements.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 15 Commerce and Foreign Trade 3 2013-01-01 2013-01-01 false Substantial compliance with application requirements. 970.209 Section 970.209 Commerce and Foreign Trade Regulations Relating to Commerce and Foreign Trade (Continued) NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE GENERAL REGULATIONS OF THE ENVIRONMENTAL...

  4. Mistreatment in Assisted Living Facilities: Complaints, Substantiations, and Risk Factors

    ERIC Educational Resources Information Center

    Phillips, Linda R.; Guo, Guifang

    2011-01-01

    Purpose of the Study: Use archived public data from Arizona to explore relationships among selected institutional and resident risk and situation-specific factors and complaints and substantiated allegations of various types of mistreatment in assisted living facilities (ALFs). Design and Methods: An exploratory/descriptive 2-group design was…

  5. 29 CFR 4.12 - Substantial interest proceedings.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... procedures set forth at 29 CFR part 6. (f) Referral to the Administrative Review Board. When the person or... accordance with the procedures set forth at 29 CFR part 8. ... 29 Labor 1 2010-07-01 2010-07-01 true Substantial interest proceedings. 4.12 Section 4.12...

  6. 20 CFR 416.910 - Meaning of substantial gainful activity.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Meaning of substantial gainful activity. 416.910 Section 416.910 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Determining Disability and Blindness Definition of Disability §...

  7. 20 CFR 416.910 - Meaning of substantial gainful activity.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Meaning of substantial gainful activity. 416.910 Section 416.910 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Determining Disability and Blindness Definition of Disability §...

  8. 20 CFR 416.910 - Meaning of substantial gainful activity.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Meaning of substantial gainful activity. 416.910 Section 416.910 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Determining Disability and Blindness Definition of Disability §...

  9. 20 CFR 416.910 - Meaning of substantial gainful activity.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Meaning of substantial gainful activity. 416.910 Section 416.910 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Determining Disability and Blindness Definition of Disability §...

  10. 20 CFR 416.910 - Meaning of substantial gainful activity.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Meaning of substantial gainful activity. 416.910 Section 416.910 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Determining Disability and Blindness Definition of Disability §...

  11. 15 CFR 970.209 - Substantial compliance with application requirements.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 15 Commerce and Foreign Trade 3 2010-01-01 2010-01-01 false Substantial compliance with application requirements. 970.209 Section 970.209 Commerce and Foreign Trade Regulations Relating to Commerce and Foreign Trade (Continued) NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE GENERAL REGULATIONS OF THE ENVIRONMENTAL...

  12. Marine protected areas and resilience to sedimentation in the Solomon Islands

    NASA Astrophysics Data System (ADS)

    Halpern, B. S.; Selkoe, K. A.; White, C.; Albert, S.; Aswani, S.; Lauer, M.

    2013-03-01

    The ability of marine protected areas (MPAs) to provide protection from indirect stressors, via increased resilience afforded by decreased impact from direct stressors, remains an important and unresolved question about the role MPAs can play in broader conservation and resource management goals. Over a five-year period, we evaluated coral and fish community responses inside and outside three MPAs within the Roviana Lagoon system in Solomon Islands, where sedimentation pressure from upland logging is substantial. We found little evidence that MPAs decrease impact or improve conditions and instead found some potential declines in fish abundance. We also documented modest to high levels of poaching during this period. Where compliance with management is poor, and indirect stressors play a dominant role in determining ecosystem condition, as appears to be the case in Roviana Lagoon, MPAs may provide little management benefit.

  13. The present and future role of coastal wetland vegetation in protecting shorelines: Answering recent challenges to the paradigm

    USGS Publications Warehouse

    Gedan, Keryn B.; Kirwan, Matthew L.; Wolanski, Eric; Barbier, Edward B.; Silliman, Brian R.

    2011-01-01

    For more than a century, coastal wetlands have been recognized for their ability to stabilize shorelines and protect coastal communities. However, this paradigm has recently been called into question by small-scale experimental evidence. Here, we conduct a literature review and a small meta-analysis of wave attenuation data, and we find overwhelming evidence in support of established theory. Our review suggests that mangrove and salt marsh vegetation afford context-dependent protection from erosion, storm surge, and potentially small tsunami waves. In biophysical models, field tests, and natural experiments, the presence of wetlands reduces wave heights, property damage, and human deaths. Meta-analysis of wave attenuation by vegetated and unvegetated wetland sites highlights the critical role of vegetation in attenuating waves. Although we find coastal wetland vegetation to be an effective shoreline buffer, wetlands cannot protect shorelines in all locations or scenarios; indeed large-scale regional erosion, river meandering, and large tsunami waves and storm surges can overwhelm the attenuation effect of vegetation. However, due to a nonlinear relationship between wave attenuation and wetland size, even small wetlands afford substantial protection from waves. Combining man-made structures with wetlands in ways that mimic nature is likely to increase coastal protection. Oyster domes, for example, can be used in combination with natural wetlands to protect shorelines and restore critical fishery habitat. Finally, coastal wetland vegetation modifies shorelines in ways (e.g. peat accretion) that increase shoreline integrity over long timescales and thus provides a lasting coastal adaptation measure that can protect shorelines against accelerated sea level rise and more frequent storm inundation. We conclude that the shoreline protection paradigm still stands, but that gaps remain in our knowledge about the mechanistic and context-dependent aspects of shoreline

  14. University Tuition, Consumer Choice and College Affordability: Strategies for Addressing a Higher Education Affordability Challenge. A NASULGC Discussion Paper

    ERIC Educational Resources Information Center

    McPherson, Peter; Shulenburger, David

    2008-01-01

    With passage of the Higher Education Opportunity Act of 2008, the Higher Education Act (HEA) is now reauthorized. What effect will it have on U.S. higher education? Students receiving Pell grants will find that college is more affordable while those who feared that the government would exert control over learning outcomes have breathed a…

  15. 24 CFR 5.2005 - VAWA protections.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... GENERAL HUD PROGRAM REQUIREMENTS; WAIVERS Protection for Victims of Domestic Violence, Dating Violence, or... applicable, must include a description of specific protections afforded to the victims of domestic violence, dating violence, or stalking, as provided in this subpart. (b) Applicants. Admission to the program...

  16. 24 CFR 5.2005 - VAWA protections.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... GENERAL HUD PROGRAM REQUIREMENTS; WAIVERS Protection for Victims of Domestic Violence, Dating Violence, or... applicable, must include a description of specific protections afforded to the victims of domestic violence, dating violence, or stalking, as provided in this subpart. (b) Applicants. Admission to the program...

  17. 24 CFR 5.2005 - VAWA protections.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... GENERAL HUD PROGRAM REQUIREMENTS; WAIVERS Protection for Victims of Domestic Violence, Dating Violence, or... applicable, must include a description of specific protections afforded to the victims of domestic violence, dating violence, or stalking, as provided in this subpart. (b) Applicants. Admission to the program...

  18. 24 CFR 5.2005 - VAWA protections.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... GENERAL HUD PROGRAM REQUIREMENTS; WAIVERS Protection for Victims of Domestic Violence, Dating Violence, or... applicable, must include a description of specific protections afforded to the victims of domestic violence, dating violence, or stalking, as provided in this subpart. (b) Applicants. Admission to the program...

  19. DIVA defense: Broad protection for salmonella suppression

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A live, attenuated Salmonella enterica serovar Typhimurium vaccine was developed to confer broad protection against multiple Salmonella serovars to prevent disease and reduce pathogen colonization and shedding. Two vaccine trials were performed in swine to determine the protection afforded by the va...

  20. Substantial Life Extension and the Fair Distribution of Healthspans.

    PubMed

    Wareham, Christopher S

    2016-10-01

    One of the strongest objections to the development and use of substantially life-extending interventions is that they would exacerbate existing unjust disparities of healthy lifespans between rich and poor members of society. In both popular opinion and ethical theory, this consequence is sometimes thought to justify a ban on life-prolonging technologies. However, the practical and ethical drawbacks of banning receive little attention, and the viability of alternative policies is seldom considered. Moreover, where ethicists do propose alternatives, there is scant effort to consider their merits in light of developing world priorities. In response to these shortcomings, I distinguish four policy options and, on the basis of a plausible intuition about fairness, evaluate their implications for a fair distribution of healthy lifespans. I claim that even in developing nations it would be fairest to favor policies that promote equal access to at least one promising category of substantially life-extending intervention: calorie restriction mimetics. PMID:27465775

  1. Broad Hepatitis C Treatment Scenarios Return Substantial Health Gains, But Capacity Is A Concern.

    PubMed

    Van Nuys, Karen; Brookmeyer, Ronald; Chou, Jacquelyn W; Dreyfus, David; Dieterich, Douglas; Goldman, Dana P

    2015-10-01

    Treatment of hepatitis C virus, the most common chronic viral infection in the United States, has historically suffered from challenges including serious side effects, low efficacy, and ongoing transmission and reinfection. Recent innovations have produced breakthrough therapies that are effective in more than 90 percent of patients. These treatments could dramatically reduce the virus's prevalence but are costly. To quantify the benefit of these treatments to society, including the value of reduced transmission, we estimated the effects of several hepatitis C treatment strategies on cost and population health. Treating patients at all disease stages could generate $610-$1,221 billion in additional quality-adjusted life-years, plus an additional $139 billion in saved medical expenditures over fifty years, and minimize the disease burden, but up-front treatment costs would exceed $150 billion. An intermediate scenario--treating 5 percent of the infected population annually, regardless of patients' disease stages--would also return substantial benefits and would be much more affordable under current financing schemes. PMID:26438742

  2. Patients' substantialization of disease, the hybrid symptom and metaphysical care.

    PubMed

    Pârvan, Alexandra

    2015-06-01

    In the context of current scholarship concerned with facilitating integration between the biomedical and the patient-centred models of care, the article suggests that disease brings about an ontological disruption in patients, which is not directly addressed in either model, and may interfere with treatment and therapy outcomes if not met with a type of care termed here as 'metaphysical'. The receipt of diagnosis and medical care can give patients the sense that they are ontologically diminished, or less of a human, and along with physicians' approaches to and discourses about disease, may prompt them to seek ontological restoration or security in the same way as psychologically traumatized patients sometimes do: by treating the disease and/or the experience of harm associated with it as a thing that exists per se. I call this 'substantialization' of disease (or harm) and draw on Augustine's theory of non-substantial deficiencies (physiological and moral) and on Plato's and Plotinus's different takes on such defects in order to discuss what substantialization can do for patients. Based on literature that examines patients' ways of talking about and living with their disease, I speculate that substantialization can generate a 'hybrid symptom', consisting in patterns of exercising agency which may predispose to non-adherence. Ways in which physicians could provide metaphysical care are proposed, along with an understanding of chronic patients as hybrid ontological and agentic units, which draws on theories of enactive cognition. I opine that metaphysical care may facilitate integration between the depersonalized and personalized models of care. PMID:25312387

  3. Automatic Filtering and Substantiation of Drug Safety Signals

    PubMed Central

    Bauer-Mehren, Anna; van Mullingen, Erik M.; Avillach, Paul; Carrascosa, María del Carmen; Garcia-Serna, Ricard; Piñero, Janet; Singh, Bharat; Lopes, Pedro; Oliveira, José L.; Diallo, Gayo; Ahlberg Helgee, Ernst; Boyer, Scott; Mestres, Jordi; Sanz, Ferran; Kors, Jan A.; Furlong, Laura I.

    2012-01-01

    Drug safety issues pose serious health threats to the population and constitute a major cause of mortality worldwide. Due to the prominent implications to both public health and the pharmaceutical industry, it is of great importance to unravel the molecular mechanisms by which an adverse drug reaction can be potentially elicited. These mechanisms can be investigated by placing the pharmaco-epidemiologically detected adverse drug reaction in an information-rich context and by exploiting all currently available biomedical knowledge to substantiate it. We present a computational framework for the biological annotation of potential adverse drug reactions. First, the proposed framework investigates previous evidences on the drug-event association in the context of biomedical literature (signal filtering). Then, it seeks to provide a biological explanation (signal substantiation) by exploring mechanistic connections that might explain why a drug produces a specific adverse reaction. The mechanistic connections include the activity of the drug, related compounds and drug metabolites on protein targets, the association of protein targets to clinical events, and the annotation of proteins (both protein targets and proteins associated with clinical events) to biological pathways. Hence, the workflows for signal filtering and substantiation integrate modules for literature and database mining, in silico drug-target profiling, and analyses based on gene-disease networks and biological pathways. Application examples of these workflows carried out on selected cases of drug safety signals are discussed. The methodology and workflows presented offer a novel approach to explore the molecular mechanisms underlying adverse drug reactions. PMID:22496632

  4. Motivational Affordance and Risk-Taking Across Decision Domains.

    PubMed

    Zou, Xi; Scholer, Abigail A

    2016-03-01

    We propose a motivational affordance account to explain both stability and variability in risk-taking propensity in major decision domains. We draw on regulatory focus theory to differentiate two types of motivation (prevention, promotion) that play a key role in predicting risk-taking. Study 1 demonstrated that prevention motivation is negatively associated with risk-taking across six key decision domains, including health/safety, ethics, recreation, gambling, investment, and social. In contrast, promotion motivation is positively associated with risk-taking in the social and investment domains. Study 2 replicated the same pattern and provided direct evidence that promotion motivation is a strong predictor of risk-taking only in domains where there is true potential for gains. Study 3 manipulated promotion (vs. prevention) motivation experimentally to demonstrate that motivational affordance is a critical mechanism for understanding risk-taking behaviors. PMID:26802189

  5. Nesting in perception of affordances for stepping and leaping.

    PubMed

    Wagman, Jeffrey B; Bai, Jiuyang; Smith, Peter J K

    2016-08-01

    Perception of affordances for a given behavior typically reflects the task-specific action capabilities of the perceiver. However, many experiments have shown a discrepancy between the perceptual and behavioral boundaries for a given behavior. One possibility for such a discrepancy is that the context of many experimental tasks transformed what is typically a dynamic perception-action task into an analytical or reflective judgment. We investigated this hypothesis with respect to perception of maximum stepping and leaping distance. For both behaviors, perception of these affordances more closely reflected action capabilities when the perceptual task was nested within a superordinate task than when it was not (regardless of whether the behavior itself was performed). Additionally, verbal reports of perception of maximum leaping distance more closely reflected action capabilities when there was an explicit time limit on such reports. The results are discussed in the context of the ecological principle of nesting and in attentional focus during motor control tasks. PMID:27220935

  6. Monolithic QCL design approaches for improved reliability and affordability

    NASA Astrophysics Data System (ADS)

    Law, K. K.

    2013-12-01

    Many advances have been made recently in mid-wave infrared and long-wave infrared quantum cascade lasers (QCLs) technologies, and there is an increasing demand for these laser sources for ever expanding Naval, DoD and homeland security applications. We will discuss in this paper a portfolio of various Naval Air Warfare Weapons Division's current and future small business innovative research programs and efforts on significantly improving QCLs' performance, affordability, and reliability.

  7. The Affordable Care Act: Opportunities and Challenges for Physicians.

    PubMed

    Chen, Min

    2015-11-01

    The Affordable Care Act (ACA) will affect many aspects of health care across the nation, presenting both opportunities and challenges. Physicians who have a solid understanding of the recent industry trends and the role they will be playing in the post-ACA world will be able to better adapt to the new environment. This article analyzes the implications of the health care reform for physicians and offers recommendations on how to turn challenges into opportunities. PMID:26501969

  8. Options for Affordable Planetary Fission Surface Power Systems

    NASA Technical Reports Server (NTRS)

    Houts, Mike; Gaddis, Steve; Porter, Ron; VanDyke, Melissa; Martin, Jim; Godfroy, Tom; Bragg-Sitton, Shannon; Garber, Anne; Pearson, Boise

    2006-01-01

    Nuclear fission systems could serve as "workhorse" power plants for the Vision for Space Exploration. In this context, the "workhorse" power plant is defined as a system that could provide power anywhere on the surface of the moon or Mars, land on the moon using a Robotic Lunar Exploration Program (RLEP)-developed lander, and would be a viable, affordable option once power requirements exceed that which can be provided by existing energy systems.

  9. Clinical Preventive Services Coverage and the Affordable Care Act

    PubMed Central

    Fox, Jared B.; Shaw, Frederic E.

    2016-01-01

    The Affordable Care Act requires many health plans to provide coverage for certain recommended clinical preventive services without charging copays or deductible payments. This provision could lead to greater uptake of many services that can improve health and save lives. Although the coverage provision is broad, there are many caveats that also apply. It is important for providers and public health professionals to understand the nuances of the coverage rules to help maximize their potential to improve population health. PMID:25393173

  10. Approach to an Affordable and Productive Space Transportation System

    NASA Technical Reports Server (NTRS)

    McCleskey, Carey M.; Rhodes, Russel E.; Lepsch, Roger A.; Henderson, Edward M.; Robinson, John W.

    2012-01-01

    This paper describes an approach for creating space transportation architectures that are affordable, productive, and sustainable. The architectural scope includes both flight and ground system elements, and focuses on their compatibility to achieve a technical solution that is operationally productive, and also affordable throughout its life cycle. Previous papers by the authors and other members of the Space Propulsion Synergy Team (SPST) focused on space flight system engineering methods, along with operationally efficient propulsion system concepts and technologies. This paper follows up previous work by using a structured process to derive examples of conceptual architectures that integrate a number of advanced concepts and technologies. The examples are not intended to provide a near-term alternative architecture to displace current near-term design and development activity. Rather, the examples demonstrate an approach that promotes early investments in advanced system concept studies and trades (flight and ground), as well as in advanced technologies with the goal of enabling highly affordable, productive flight and ground space transportation systems.

  11. The Politics of Native American Health Care and the Affordable Care Act.

    PubMed

    Skinner, Daniel

    2016-02-01

    This article examines an important but largely overlooked dimension of the Patient Protection and Affordable Care Act (ACA), namely, its significance for Native American health care. The author maintains that reading the ACA against the politics of Native American health care policy shows that, depending on their regional needs and particular contexts, many Native Americans are well-placed to benefit from recent Obama-era reforms. At the same time, the kinds of options made available by the ACA constitute a departure from the service-based (as opposed to insurance-based) Indian Health Service (IHS). Accordingly, the author argues that ACA reforms--private marketplaces, Medicaid expansion, and accommodations for Native Americans--are best read as potential "supplements" to an underfunded IHS. Whether or not Native Americans opt to explore options under the ACA will depend in the long run on the quality of the IHS in the post-ACA era. Beyond understanding the ACA in relation to IHS funding, the author explores how Native American politics interacts with the key tenets of Obama-era health care reform--especially "affordability"--which is critical for understanding what is required from and appropriate to future Native American health care policy making. PMID:26567380

  12. Affordability of emergency obstetric and neonatal care at public hospitals in Madagascar.

    PubMed

    Honda, Ayako; Randaoharison, Pierana Gabriel; Matsui, Mitsuaki

    2011-05-01

    Timely access to emergency obstetric care is necessary to save the lives of women experiencing complications at delivery, and for newborn babies. Out-of-pocket costs are one of the critical factors hindering access to such services in low- and middle-income countries. This study measured out-of-pocket costs for caesarean section and neonatal care at an urban tertiary public hospital in Madagascar, assessed affordability in relation to household expenditure and investigated where families found the money to cover these costs. Data were collected for 103 women and 73 newborns at the Centre Hospitalier Universitaire de Mahajanga in the Boeny region of Madagascar between September 2007 and January 2008. Out-of-pocket costs for caesarean section were catastrophic for middle and lower socio-economic households, and treatment for neonatal complications also created a big financial burden, with geographical and other financial barriers further limiting access to hospital care. This study identified 12 possible cases where the mother required an emergency caesarean section and her newborn required emergency care, placing a double burden on the household. In an effort to make emergency obstetric and neonatal care affordable and available to all, including those living in rural areas and those of medium and lower socio-economic status, well-designed financial risk protection mechanisms and a strong commitment by the government to mobilise resources to finance the country's health system are necessary. PMID:21555082

  13. Disparities in reported and substantiated infant maltreatment by maternal Hispanic origin and nativity: a birth cohort study.

    PubMed

    Johnson-Motoyama, Michelle; Putnam-Hornstein, Emily; Dettlaff, Alan J; Zhao, Kechen; Finno-Velasquez, Megan; Needell, Barbara

    2015-05-01

    We followed Latino infants prospectively through age 1 to determine whether maternal foreign-born status conferred a protective advantage against reported and substantiated maltreatment across Hispanic-origin groups, and whether the likelihood an infant was reported or substantiated for maltreatment varied by Hispanic origin. We drew data for all Latino infants born in California between 2000 and 2006 (N = 1,909,155) from population-based birth records linked to child protective services data. We used χ(2) tests to assess distributional differences in covariates and utilized generalized linear models to estimate the adjusted relative risk of report and substantiation in models stratified by nativity. We observed significant health advantages in reported and substantiated maltreatment for infants of foreign-born mothers within every Hispanic-origin group. Risks of report and substantiation among infants of Mexican and Central/South American mothers were consistently lower than Puerto Rican and Cuban mothers despite socioeconomic disadvantage. The presence of disparities among Hispanic-origin groups in child maltreatment report and substantiation during infancy has implications for the health of Latinos across the life course. Further research is warranted to unravel the complex processes underlying observed relationships. PMID:25081241

  14. 25 CFR 63.22 - Can an employer certify an individual with a prior conviction or substantiated misconduct as...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 25 Indians 1 2014-04-01 2014-04-01 false Can an employer certify an individual with a prior conviction or substantiated misconduct as suitable for employment? 63.22 Section 63.22 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR TRIBAL GOVERNMENT INDIAN CHILD PROTECTION AND FAMILY...

  15. 25 CFR 63.22 - Can an employer certify an individual with a prior conviction or substantiated misconduct as...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 1 2011-04-01 2011-04-01 false Can an employer certify an individual with a prior conviction or substantiated misconduct as suitable for employment? 63.22 Section 63.22 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR TRIBAL GOVERNMENT INDIAN CHILD PROTECTION AND FAMILY...

  16. 25 CFR 63.22 - Can an employer certify an individual with a prior conviction or substantiated misconduct as...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Can an employer certify an individual with a prior conviction or substantiated misconduct as suitable for employment? 63.22 Section 63.22 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR TRIBAL GOVERNMENT INDIAN CHILD PROTECTION AND FAMILY...

  17. Healthy Libraries Develop Healthy Communities: Public Libraries and their Tremendous Efforts to Support the Affordable Care Act

    PubMed Central

    Collins, Lydia N.

    2015-01-01

    This article is about the dedication of public library staff and my role as the Consumer Health Coordinator for the National Network of Libraries of Medicine, Middle Atlantic Region (NN/LM MAR) to support outreach efforts for health insurance enrollment under the Patient Protection and Affordable Care Act (ACA). ACA was created in order to ensure that all Americans have access to affordable health care. What we didn’t know is that public libraries across the nation would play such an integral role in the health insurance enrollment process. The National Network of Libraries of Medicine (NN/LM) worked closely with public libraries in order to assist with this new role. As we approach the second enrollment and re-enrollment periods, public libraries are gearing up once again to assist with ACA. PMID:25798077

  18. 45 CFR 1355.34 - Criteria for determining substantial conformity.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... determines that the title IV-E agency has in place an array of services (45 CFR 1357.15(n) and section 422(b... assurances: (A) The requirements in 45 CFR 1357.15(p) regarding services designed to assure the safety and protection of children and the preservation and support of families; (B) The requirements in 45 CFR...

  19. 45 CFR 1355.34 - Criteria for determining substantial conformity.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... determines that the State has in place an array of services (45 CFR 1357.15(n) and section 422(b)(10)(B)(iii...) The requirements in 45 CFR 1357.15(p) regarding services designed to assure the safety and protection of children and the preservation and support of families; (B) The requirements in 45 CFR...

  20. 45 CFR 1355.34 - Criteria for determining substantial conformity.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... determines that the title IV-E agency has in place an array of services (45 CFR 1357.15(n) and section 422(b... assurances: (A) The requirements in 45 CFR 1357.15(p) regarding services designed to assure the safety and protection of children and the preservation and support of families; (B) The requirements in 45 CFR...

  1. 45 CFR 1355.34 - Criteria for determining substantial conformity.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... determines that the title IV-E agency has in place an array of services (45 CFR 1357.15(n) and section 422(b... assurances: (A) The requirements in 45 CFR 1357.15(p) regarding services designed to assure the safety and protection of children and the preservation and support of families; (B) The requirements in 45 CFR...

  2. 45 CFR 1355.34 - Criteria for determining substantial conformity.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... determines that the State has in place an array of services (45 CFR 1357.15(n) and section 422(b)(10)(B)(iii...) The requirements in 45 CFR 1357.15(p) regarding services designed to assure the safety and protection of children and the preservation and support of families; (B) The requirements in 45 CFR...

  3. THE AFFORDABLE CARE ACT AND MEDICAL LOSS RATIOS: NO IMPACT IN FIRST THREE YEARS.

    PubMed

    Day, Benjamin; Himmelstein, David U; Broder, Michael; Woolhandler, Steffie

    2015-01-01

    The Patient Protection and Affordable Care Act (ACA) set limits on insurers' overhead, mandating a medical loss ratio (MLR) of at least 80 percent in the individual and small-group markets and 85 percent in the large-group market starting in 2011. In implementing the law, the Obama administration introduced new rules that changed (and inflated) how insurers calculate MLRs, distorting time trends. We used insurers' filings with the U.S. Securities and Exchange Commission to calculate the largest insurers' MLRs before and after the ACA regulations took effect, using a constant definition of MLR. MLRs averaged 83.04 percent in the three years before reform and 83.05 percent in the three years after reform. We conclude that the ACA had no impact on insurance industry overhead spending. PMID:26460451

  4. Coverage of Certain Preventive Services Under the Affordable Care Act. Final rules.

    PubMed

    2015-07-14

    This document contains final regulations regarding coverage of certain preventive services under section 2713 of the Public Health Service Act (PHS Act), added by the Patient Protection and Affordable Care Act, as amended, and incorporated into the Employee Retirement Income Security Act of 1974 and the Internal Revenue Code. Section 2713 of the PHS Act requires coverage without cost sharing of certain preventive health services by non-grandfathered group health plans and health insurance coverage. These regulations finalize provisions from three rulemaking actions: Interim final regulations issued in July 2010 related to coverage of preventive services, interim final regulations issued in August 2014 related to the process an eligible organization uses to provide notice of its religious objection to the coverage of contraceptive services, and proposed regulations issued in August 2014 related to the definition of "eligible organization,'' which would expand the set of entities that may avail themselves of an accommodation with respect to the coverage of contraceptive services. PMID:26173301

  5. The Impact of the Affordable Care Act on Large Employers: A Retrospective.

    PubMed

    Abbott, Randall K

    2015-01-01

    The Patient Protection and Affordable Care Act (ACA) has created a new environment for employer health benefit plan management that is influencing costs, benefit design, delivery, administration, financing and compliance as well as the positioning of health care within the benefits portfolio and the broader total rewards strategy. This article will examine the key pragmatic effects of health reform for larger employers to date, quantifying its direct costs and discussing the new dimensions of management that reform has introduced. The discussion will focus on nongrandfathered self-funded plans and will address only major influences. It is not intended to be all-encompassing and is, of necessity, general in nature. Each employer will have somewhat differing experiences and results but should find the discussion to be helpful both in understanding what has evolved as well as what is to come. PMID:26540937

  6. The State of Diabetes Prevention Policy in the USA Following the Affordable Care Act.

    PubMed

    Konchak, Juleigh Nowinski; Moran, Margaret R; O'Brien, Matthew J; Kandula, Namratha R; Ackermann, Ronald T

    2016-06-01

    Type 2 diabetes is a major public health problem in the USA, affecting over 12 % of American adults and imposing considerable health and economic burden on individuals and society. There is a strong evidence base demonstrating that lifestyle behavioral changes and some medications can prevent or delay the onset of type 2 diabetes in high risk adults, and several policy and healthcare system changes motivated by the Patient Protection and Affordable Care Act (ACA) have the potential to accelerate diabetes prevention. In this narrative review, we (1) offer a conceptual framework for organizing how the ACA may influence diabetes prevention efforts at the level of individuals, healthcare providers, and health systems; (2) highlight ACA provisions at each of these levels that could accelerate type 2 diabetes prevention nationwide; and (3) explore possible policy gaps and opportunity areas for future research and action. PMID:27145778

  7. Achieving a deeper understanding of the implemented provisions of the Affordable Care Act.

    PubMed

    Zhang, Shuang Qin; Polite, Blase N

    2014-01-01

    The Patient Protection and Affordable Care Act (ACA) was signed into law by President Barack Obama on March 23, 2010. Since that time, numerous regulations have been promulgated, legal battles continue to be fought and the major provisions of the law are being implemented. In the following article, we outline components of the ACA that are relevant to cancer health care, review current implementation of the new health care reform law, and identify challenges that may lie ahead in the post-ACA era. Specifically, among the things we explore are Medicaid expansion, health insurance exchanges, essential health benefits and preventive services, subsidies, access to clinical trials, the Medicare Part D donut hole, and physician quality payment reform. PMID:24857142

  8. The Relevance of the Affordable Care Act for Improving Mental Health Care.

    PubMed

    Mechanic, David; Olfson, Mark

    2016-03-28

    Provisions of the Affordable Care Act provide unprecedented opportunities for expanded access to behavioral health care and for redesigning the provision of services. Key to these reforms is establishing mental and substance abuse care as essential coverage, extending Medicaid eligibility and insurance parity, and protecting insurance coverage for persons with preexisting conditions and disabilities. Many provisions, including Accountable Care Organizations, health homes, and other structures, provide incentives for integrating primary care and behavioral health services and coordinating the range of services often required by persons with severe and persistent mental health conditions. Careful research and experience are required to establish the services most appropriate for primary care and effective linkage to specialty mental health services. Research providing guidance on present evidence and uncertainties is reviewed. Success in redesign will follow progress building on collaborative care and other evidence-based practices, reshaping professional incentives and practices, and reinvigorating the behavioral health workforce. PMID:26666969

  9. Implications of the Affordable Care Act for occupational therapy practitioners providing services to Medicare recipients.

    PubMed

    Fisher, Gail; Friesema, Jennifer

    2013-01-01

    The passage of the Patient Protection and Affordable Care Act of 2010 (ACA; Pub. L. 111-148) represents the largest expansion in government funding of health care since Medicare and Medicaid were established in 1965 (Curfman, Abel, & Landers, 2012). Although the health insurance mandate and Medicaid expansion have received the most attention as a result of legal challenges and the July 2012 Supreme Court ruling on the legality of the ACA (Henry J. Kaiser Family Foundation, 2012), other ACA initiatives may have even greater implications for occupational therapy. The ACA includes sections on improving quality and health systems performance for Medicare recipients, with some sections also applying to Medicaid recipients. Insurance companies commonly follow Medicare rules; therefore, the Medicare reforms are likely to spread across all payers, health care settings, and care recipients. PMID:23968787

  10. Why we should not use the Affordable Care Act to encourage widespread whole genome sequencing.

    PubMed

    Ossorio, Pilar N; Kelleher, J Paul

    2014-02-01

    Perry Payne argues that the health care system should encourage provision of whole genome sequencing (WGS) for most people in the near future. Payne's essay contains two distinct claims. One claim is that near-universal access to WGS would be beneficial both to individuals and to populations who, without it, could be on the losing end of widening health disparities. The second claim is that the preventive services provisions of the Patient Protection and Affordable Care Act (ACA) should be invoked to establish legal entitlements to WGS, without any patient cost sharing. We believe there are strong reasons to reject both of these claims. Indeed, the reasons that count against providing wide access to WGS are the very same reasons that undermine Payne's argument for providing WGS under the preventive services provisions of the ACA. PMID:24193611

  11. Medicaid program; increased Federal Medical Assistance Percentage changes under the Affordable Care Act of 2010. Final rule with request for comments.

    PubMed

    2013-04-01

    This final rule implements the provisions of the Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act) relating to the availability of increased Federal Medical Assistance Percentage (FMAP) rates for certain adult populations under states' Medicaid programs. This final rule implements and interprets the increased FMAP rates that will be applicable beginning January 1, 2014 and sets forth conditions for states to claim these increased FMAP rates. PMID:23556184

  12. 75 FR 32480 - Funding Opportunity: Affordable Care Act Medicare Beneficiary Outreach and Assistance Program...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-08

    ... HUMAN SERVICES Administration on Aging Funding Opportunity: Affordable Care Act Medicare Beneficiary Outreach and Assistance Program Funding for Title VI Native American Programs Purpose of Notice: Availability of funding opportunity announcement. Funding Opportunity Title/Program Name: Affordable Care...

  13. Neighborhood-level social processes and substantiated cases of child maltreatment.

    PubMed

    Molnar, Beth E; Goerge, Robert M; Gilsanz, Paola; Hill, Andrea; Subramanian, S V; Holton, John K; Duncan, Dustin T; Beatriz, Elizabeth D; Beardslee, William R

    2016-01-01

    Child maltreatment is a preventable public health problem. Research has demonstrated that neighborhood structural factors (e.g. poverty, crime) can influence the proportion of a neighborhood's children who are victims of maltreatment. A newer strategy is the identification of potentially modifiable social processes at the neighborhood level that can also influence maltreatment. Toward this end, this study examines neighborhood-level data (maltreatment cases substantiated by Illinois' child protection agency, 1995-2005, social processes measured by the Project on Human Development in Chicago Neighborhoods, U.S. Census data, proportions of neighborhoods on public assistance, and crime data) that were linked across clusters of contiguous, relatively homogenous Chicago, IL census tracts with respect to racial/ethnic and socioeconomic composition. Our analysis-an ecological-level, repeated cross-sectional design utilizing random-intercept logit models-with a sensitivity analysis using spatial models to control for spatial autocorrelation-revealed consistent associations between neighborhood social processes and maltreatment. Neighborhoods higher in collective efficacy, intergenerational closure, and social networks, and lower in disorder had lower proportions of neglect, physical abuse, and sexual abuse substantiated cases, controlling for differences in structural factors. Higher collective efficacy and social network size also predicted a lower proportion of substance-exposed infants. This research indicates that strategies to mobilize neighborhood-level protective factors may decrease child maltreatment more effectively than individual and family-focused efforts alone. PMID:26684963

  14. 78 FR 54069 - Patient Protection and Affordable Care Act; Program Integrity: Exchange, SHOP, and Eligibility...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-30

    ... and Input II. Provisions of the Proposed Regulations and Analysis of and Responses to Public Comments...; Final Rule #0;#0;Federal Register / Vol. 78, No. 169 / Friday, August 30, 2013 / Rules and Regulations#0... is finalizing previously proposed policies without change. DATES: These regulations are effective...

  15. 77 FR 18309 - Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-27

    .../exchange_q_and_a.pdf.pdf . II. Provisions of the Proposed Regulation and Analysis and Responses to Public... Request for Comment (the RFC) on August 3, 2010 (75 FR 45584) inviting the public to provide input.... Response: The term ``benefit year'' is defined only for the purposes of this regulation and does not...

  16. 78 FR 42823 - Patient Protection and Affordable Care Act; Exchange Functions: Standards for Navigators and Non...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-17

    ...This final rule addresses various requirements applicable to Navigators and non-Navigator assistance personnel in Federally- facilitated Exchanges, including State Partnership Exchanges, and to non-Navigator assistance personnel in State Exchanges that are funded through federal Exchange Establishment grants. It finalizes the requirement that Exchanges must have a certified application......

  17. 76 FR 77392 - Patient Protection and Affordable Care Act; Establishment of Consumer Operated and Oriented Plan...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-13

    ... FR 5774) seeking public comment on the rules that will govern the CO-OP program. The public comments... innovation was published in the Federal Register on March 14, 2011 (76 FR 13553). On July 15, 2011, two... Federal Register on July 20, 2011 with a comment period that ended on September 16, 2011 (76 ] FR...

  18. 76 FR 43237 - Patient Protection and Affordable Care Act; Establishment of Consumer Operated and Oriented Plan...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-20

    ... State innovation was published in the Federal Register on March 14, 2011 (76 FR 13553). Fourth, on July... Comment On February 2, 2011, CMS published a Request for Comment (RFC) in the Federal Register (76 FR 5774... FR 41866). The terms ``individual market,'' ``small group market,'' ``SHOP,'' and ``Exchange''...

  19. 77 FR 29235 - Patient Protection and Affordable Care Act; Standards Related to Reinsurance, Risk Corridors, and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-17

    ... section 553(b) of the Administrative Procedure Act (APA) (5 U.S.C. 553(b)). However, we can waive this... FURTHER INFORMATION CONTACT: Jeff Wu at (301) 492-4416. Wakina Scott at (301) 492-4393. SUPPLEMENTARY INFORMATION: I. Background In Federal Register Doc. 2012-6594 of March 23, 2012 (77 FR 17220- 17252),...

  20. 76 FR 60788 - Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-30

    ... July 15, 2011 (76 FR 41866 and 76 FR 41930, respectively), is extended from 5 p.m. Eastern Standard... Register (76 FR 41866 through 41927 and 76 FR 41930 through 41956, respectively). The first rule would... (76 FR 51148, 76 FR 51202, and 76 FR 50931, respectively), about eligibility determinations by...

  1. 78 FR 33233 - Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-04

    ... Health Plans; Exchange Standards for Employers, 77 FR 18310 (March 27, 2012) (to be codified at 45 CFR... Payment Parameters for 2014, 78 FR 15410 (March 11, 2013) (to be codified at 45 CFR parts 153, 155, 156... Health Plans; Small Business Health Options Program, 77 FR 15553 (March 11, 2013) (to be codified at...

  2. 75 FR 37187 - Patient Protection and Affordable Care Act: Preexisting Condition Exclusions, Lifetime and Annual...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-28

    ... the Federal Register on April 14, 2010 (75 FR 19297 and 19335). The second phase was interim final... the Federal Register on May 13, 2010 (75 FR 27122). The third phase was interim final regulations...), published in the Federal Register on June 17, 2010 (75 FR 34538). These interim final regulations are...

  3. 76 FR 41865 - Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-15

    ... relating to Exchanges, published in the Federal Register on August 3, 2010 (75 FR 45584). Second, ] Initial... March 14, 2011 (76 FR 13553). Fourth, two proposed regulations, including this one, are published...

  4. 76 FR 76573 - Medical Loss Ratio Requirements Under the Patient Protection and Affordable Care Act

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-07

    ... section 2718 was published in the Federal Register on April 14, 2010 (75 FR 19297). On December 1, 2010, HHS published an interim final rule (75 FR 74864) with 60 day public comment period, entitled ``Health... issued on December 30, 2010 (75 FR 82277). II. Provisions of the Interim Final Rule and Responses...

  5. Loss of the Endothelial Glucocorticoid Receptor Prevents the Therapeutic Protection Afforded by Dexamethasone after LPS

    PubMed Central

    Goodwin, Julie E.; Feng, Yan; Velazquez, Heino; Zhou, Han; Sessa, William C.

    2014-01-01

    Glucocorticoids are normally regarded as anti-inflammatory therapy for a wide variety of conditions and have been used with some success in treating sepsis and sepsis-like syndromes. We previously demonstrated that mice lacking the glucocorticoid receptor in the endothelium (GR EC KO mice) are extremely sensitive to low-dose LPS and demonstrate prolonged activation and up regulation of NF-κB. In this study we pre-treated these GR EC KO mice with dexamethasone and assessed their response to an identical dose of LPS. Surprisingly, the GR EC KO mice fared even worse than when given LPS alone demonstrating increased mortality, increased levels of the inflammatory cytokines TNF-α and IL-6 and increased nitric oxide release after the dexamethasone pre-treatment. As expected, control animals pre-treated with dexamethasone showed improvement in all parameters assayed. Mechanistically we demonstrate that GR EC KO mice show increased iNOS production and NF-κB activation despite treatment with dexamethasone. PMID:25299055

  6. 78 FR 69418 - Patient Protection and Affordable Care Act; Exchanges and Qualified Health Plans, Quality Rating...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-19

    ... Plans; Exchange Standards for Employers, 77 FR 18310 (Mar. 27, 2012) (to be codified at 45 CFR parts 155... Quality for Exchanges: http://www.gpo.gov/fdsys/pkg/FR-2012-11-27/pdf/2012-28473.pdf . Importance: the... Rule 78 FR 12834 (Feb. 25, 2013) (to be codified at 45 CFR parts 147, 155 and 156). The draft...

  7. 77 FR 70583 - Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-26

    ... final rule with comment period (76 FR 29964), to implement the annual review ] of unreasonable increases... group health plans that are non-federal governmental plans. This proposed rule would also amend the... allow some form of gender rating in practice. In the small group market, 38 states allow health...

  8. 77 FR 42658 - Patient Protection and Affordable Care Act; Data Collection To Support Standards Related to...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-20

    ... effective on August 20, 2012. FOR FURTHER INFORMATION CONTACT: Adam Block at (410) 786-1698, for matters... related to accreditation of qualified health plans. SUPPLEMENTARY INFORMATION: Executive Summary Beginning... report information on covered benefits. In addition, this rule establishes the first phase of a...

  9. 76 FR 51201 - Patient Protection and Affordable Care Act; Exchange Functions in the Individual Market...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-17

    ... on August 3, 2010 (75 FR 45584). Second, Initial Guidance to States on Exchanges was issued on... for State innovation was published in the Federal Register on March 14, 2011 (76 FR 13553). Fourth, two proposed regulations were published in the Federal Register on July 15, 2011 (76 FR 41866 and...

  10. 78 FR 79619 - Patient Protection and Affordable Care Act; Program Integrity: Exchange, Premium Stabilization...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-31

    ... INFORMATION: I. Background In FR Doc. 2013-25326 of October 30, 2013 (78 FR 65046), final rule entitled..., and Market Standards; Amendments to the HHS Notice of Benefit and Payment Parameters for 2014 (78...

  11. Clinical decision support for imaging in the era of the Patient Protection and Affordable Care Act.

    PubMed

    Zafar, Hanna M; Mills, Angela M; Khorasani, Ramin; Langlotz, Curtis P

    2012-12-01

    Imaging clinical decision support (CDS) systems provide evidence for or against imaging procedures ordered within a computerized physician order entry system at the time of the image order. Depending on the pertinent clinical history provided by the ordering clinician, CDS systems can optimize imaging by educating providers on appropriate image order entry and by alerting providers to the results of prior, potentially relevant imaging procedures, thereby reducing redundant imaging. The American Recovery and Reinvestment Act (ARRA) has expedited the adoption of computerized physician order entry and CDS systems in health care through the creation of financial incentives and penalties to promote the "meaningful use" of health IT. Meaningful use represents the latest logical next step in a long chain of legislation promoting the areas of appropriate imaging utilization, accurate reporting, and IT. It is uncertain if large-scale implementation of imaging CDS will lead to improved health care quality, as seen in smaller settings, or to improved patient outcomes. However, imaging CDS enables the correlation of existing imaging evidence with outcome measures, including morbidity, mortality, and short-term imaging-relevant management outcomes (eg, biopsy, chemotherapy). The purposes of this article are to review the legislative sequence relevant to imaging CDS and to give guidance to radiology practices focused on quality and financial performance improvement during this time of accelerating regulatory change. PMID:23206649

  12. 78 FR 4093 - Extension of Comment Period for the Rulemaking Enhancing Protections Afforded Customers and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-18

    ... Customer Funds Held by Futures Commission Merchants and Derivatives Clearing Organizations, 77 FR 67866... disclosures, and auditing and examination programs for futures commission merchants (``FCMs''). The...

  13. 78 FR 12833 - Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-25

    ..., Final Rule, 77 FR 42658-42672 (July 20, 2012) (to be codified at 45 CFR part 156). HHS also published a... CFR 156.275, as published on July 20, 2012 (77 FR 42658), which established the first phase of an... Assurance (NCQA) and URAC as published in the Federal Register notice on November 23, 2012 (77 FR...

  14. 76 FR 41929 - Patient Protection and Affordable Care Act; Standards Related to Reinsurance, Risk Corridors and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-15

    ... three-year reinsurance program should replace commercial reinsurance or internal risk mitigation... insurance issuers to control costs. However, use of a reinsurance cap, as well as the requirement for health... insurance issuers to control costs. We invite comment regarding the best method of determining payments...

  15. 40 CFR 350.27 - Substantiation form to accompany claims of trade secrecy, instructions to substantiation form.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS TRADE SECRECY CLAIMS FOR EMERGENCY PLANNING AND COMMUNITY RIGHT-TO-KNOW INFORMATION: AND....epa.gov/tri. This information can also be obtained by contacting the Emergency Planning and...

  16. 40 CFR 350.27 - Substantiation form to accompany claims of trade secrecy, instructions to substantiation form.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS TRADE SECRECY CLAIMS FOR EMERGENCY PLANNING AND COMMUNITY RIGHT-TO-KNOW INFORMATION: AND....epa.gov/tri. This information can also be obtained by contacting the Emergency Planning and...

  17. Modelling the affordability and distributional implications of future health care financing options in South Africa.

    PubMed

    McIntyre, Di; Ataguba, John E

    2012-03-01

    South Africa is considering introducing a universal health care system. A key concern for policy-makers and the general public is whether or not this reform is affordable. Modelling the resource and revenue generation requirements of alternative reform options is critical to inform decision-making. This paper considers three reform scenarios: universal coverage funded by increased allocations to health from general tax and additional dedicated taxes; an alternative reform option of extending private health insurance coverage to all formal sector workers and their dependents with the remainder using tax-funded services; and maintaining the status quo. Each scenario was modelled over a 15-year period using a spreadsheet model. Statistical analyses were also undertaken to evaluate the impact of options on the distribution of health care financing burden and benefits from using health services across socio-economic groups. Universal coverage would result in total health care spending levels equivalent to 8.6% of gross domestic product (GDP), which is comparable to current spending levels. It is lower than the status quo option (9.5% of GDP) and far lower than the option of expanding private insurance cover (over 13% of GDP). However, public funding of health services would have to increase substantially. Despite this, universal coverage would result in the most progressive financing system if the additional public funding requirements are generated through a surcharge on taxable income (but not if VAT is increased). The extended private insurance scheme option would be the least progressive and would impose a very high payment burden; total health care payments on average would be 10.7% of household consumption expenditure compared with the universal coverage (6.7%) and status quo (7.5%) options. The least pro-rich distribution of service benefits would be achieved under universal coverage. Universal coverage is affordable and would promote health system equity, but

  18. Who has housing affordability problems? Disparities in Housing Cost burden by Race, Nativity and Legal Status in Los Angeles

    PubMed Central

    McConnell, Eileen Diaz

    2013-01-01

    Housing costs are a substantial component of U.S. household expenditures. Those who allocate a large proportion of their income to housing often have to make difficult financial decisions with significant short-term and long-term implications for adults and children. This study employs cross-sectional data from the first wave of the Los Angeles Family and Neighborhood Survey (L.A.FANS) collected between 2000 and 2002 to examine the most common U.S. standard of housing affordability, the likelihood of spending thirty percent or more of income on shelter costs. Multivariate analyses of a low-income sample of U.S. born Latinos, Whites, African Americans, authorized Latino immigrants and unauthorized Latino immigrants focus on baseline and persistent differences in the likelihood of being cost burdened by race, nativity and legal status. Nearly half or more of each group of low-income respondents experience housing affordability problems. The results suggest that immigrants’ legal status is the primary source of disparities among those examined, with the multivariate analyses revealing large and persistent disparities for unauthorized Latino immigrants relative to most other groups. Moreover, the higher odds of housing cost burden observed for unauthorized immigrants compared with their authorized immigrant counterparts remains substantial, accounting for traditional indicators of immigrant assimilation. These results are consistent with emerging scholarship regarding the role of legal status in shaping immigrant outcomes in the United States. PMID:24077641

  19. Who has housing affordability problems? Disparities in Housing Cost burden by Race, Nativity and Legal Status in Los Angeles.

    PubMed

    McConnell, Eileen Diaz

    2013-09-01

    Housing costs are a substantial component of U.S. household expenditures. Those who allocate a large proportion of their income to housing often have to make difficult financial decisions with significant short-term and long-term implications for adults and children. This study employs cross-sectional data from the first wave of the Los Angeles Family and Neighborhood Survey (L.A.FANS) collected between 2000 and 2002 to examine the most common U.S. standard of housing affordability, the likelihood of spending thirty percent or more of income on shelter costs. Multivariate analyses of a low-income sample of U.S. born Latinos, Whites, African Americans, authorized Latino immigrants and unauthorized Latino immigrants focus on baseline and persistent differences in the likelihood of being cost burdened by race, nativity and legal status. Nearly half or more of each group of low-income respondents experience housing affordability problems. The results suggest that immigrants' legal status is the primary source of disparities among those examined, with the multivariate analyses revealing large and persistent disparities for unauthorized Latino immigrants relative to most other groups. Moreover, the higher odds of housing cost burden observed for unauthorized immigrants compared with their authorized immigrant counterparts remains substantial, accounting for traditional indicators of immigrant assimilation. These results are consistent with emerging scholarship regarding the role of legal status in shaping immigrant outcomes in the United States. PMID:24077641

  20. Delivering affordable cancer care in high-income countries.

    PubMed

    Sullivan, Richard; Peppercorn, Jeffrey; Sikora, Karol; Zalcberg, John; Meropol, Neal J; Amir, Eitan; Khayat, David; Boyle, Peter; Autier, Philippe; Tannock, Ian F; Fojo, Tito; Siderov, Jim; Williamson, Steve; Camporesi, Silvia; McVie, J Gordon; Purushotham, Arnie D; Naredi, Peter; Eggermont, Alexander; Brennan, Murray F; Steinberg, Michael L; De Ridder, Mark; McCloskey, Susan A; Verellen, Dirk; Roberts, Terence; Storme, Guy; Hicks, Rodney J; Ell, Peter J; Hirsch, Bradford R; Carbone, David P; Schulman, Kevin A; Catchpole, Paul; Taylor, David; Geissler, Jan; Brinker, Nancy G; Meltzer, David; Kerr, David; Aapro, Matti

    2011-09-01

    The burden of cancer is growing, and the disease is becoming a major economic expenditure for all developed countries. In 2008, the worldwide cost of cancer due to premature death and disability (not including direct medical costs) was estimated to be US$895 billion. This is not simply due to an increase in absolute numbers, but also the rate of increase of expenditure on cancer. What are the drivers and solutions to the so-called cancer-cost curve in developed countries? How are we going to afford to deliver high quality and equitable care? Here, expert opinion from health-care professionals, policy makers, and cancer survivors has been gathered to address the barriers and solutions to delivering affordable cancer care. Although many of the drivers and themes are specific to a particular field-eg, the huge development costs for cancer medicines-there is strong concordance running through each contribution. Several drivers of cost, such as over-use, rapid expansion, and shortening life cycles of cancer technologies (such as medicines and imaging modalities), and the lack of suitable clinical research and integrated health economic studies, have converged with more defensive medical practice, a less informed regulatory system, a lack of evidence-based sociopolitical debate, and a declining degree of fairness for all patients with cancer. Urgent solutions range from re-engineering of the macroeconomic basis of cancer costs (eg, value-based approaches to bend the cost curve and allow cost-saving technologies), greater education of policy makers, and an informed and transparent regulatory system. A radical shift in cancer policy is also required. Political toleration of unfairness in access to affordable cancer treatment is unacceptable. The cancer profession and industry should take responsibility and not accept a substandard evidence base and an ethos of very small benefit at whatever cost; rather, we need delivery of fair prices and real value from new technologies

  1. A Bootstrap Approach to an Affordable Exploration Program

    NASA Technical Reports Server (NTRS)

    Oeftering, Richard C.

    2011-01-01

    This paper examines the potential to build an affordable sustainable exploration program by adopting an approach that requires investing in technologies that can be used to build a space infrastructure from very modest initial capabilities. Human exploration has had a history of flight programs that have high development and operational costs. Since Apollo, human exploration has had very constrained budgets and they are expected be constrained in the future. Due to their high operations costs it becomes necessary to consider retiring established space facilities in order to move on to the next exploration challenge. This practice may save cost in the near term but it does so by sacrificing part of the program s future architecture. Human exploration also has a history of sacrificing fully functional flight hardware to achieve mission objectives. An affordable exploration program cannot be built when it involves billions of dollars of discarded space flight hardware, instead, the program must emphasize preserving its high value space assets and building a suitable permanent infrastructure. Further this infrastructure must reduce operational and logistics cost. The paper examines the importance of achieving a high level of logistics independence by minimizing resource consumption, minimizing the dependency on external logistics, and maximizing the utility of resources available. The approach involves the development and deployment of a core suite of technologies that have minimum initial needs yet are able expand upon initial capability in an incremental bootstrap fashion. The bootstrap approach incrementally creates an infrastructure that grows and becomes self sustaining and eventually begins producing the energy, products and consumable propellants that support human exploration. The bootstrap technologies involve new methods of delivering and manipulating energy and materials. These technologies will exploit the space environment, minimize dependencies, and

  2. Plastic modes of listening: affordance in constructed sound environments

    NASA Astrophysics Data System (ADS)

    Sjolin, Anders

    This thesis is concerned with how the ecological approach to perception with the inclusion of listening modes, informs the creation of sound art installation, or more specifically as referred to in this thesis as constructed sound environments. The basis for the thesis has been a practiced based research where the aim and purpose of the written part of this PhD project has been to critically investigate the area of sound art, in order to map various approaches towards participating in and listening to a constructed sound environment. The main areas has been the notion of affordance as coined by James J. Gibson (1986), listening modes as coined by Pierre Schaeffer (1966) and further developed by Michel Chion (1994), aural architects as coined by Blesser and Salter (2007) and the holistic approach towards understanding sound art developed by Brandon LaBelle (2006). The findings within the written part of the thesis, based on a qualitative analysis, have informed the practice that has resulted in artefacts in the form of seven constructed sound environments that also functions as case studies for further analysis. The aim of the practice has been to exemplify the methodology, strategy and progress behind the organisation and construction of sound environments The research concerns point towards the acknowledgment of affordance as the crucial factor in understanding a constructed sound environment. The affordance approach govern the idea that perceiving a sound environment is a top-down process where the autonomic quality of a constructed sound environment is based upon the perception of structures of the sound material and its relationship with speaker placement and surrounding space. This enables a researcher to side step the conflicting poles of musical/abstract and non-musical/realistic classification of sound elements and regard these poles as included, not separated elements in the analysis of a constructed sound environment.

  3. DOE-HUD Initiative: Making Housing Affordable Through Energy Efficiency

    SciTech Connect

    Not Available

    1991-10-01

    A new collaborative program of the U.S. Department of Energy (DOE) and the U.S. Department of Housing and Urban Development (HUD) is a significant step toward making HUD-aided housing more comfortable and affordable through greater energy efficiency. The initiative on Energy Efficiency in Housing combines DOE's technical capabilities and HUD's experience in housing assistance. Over the next decade, the energy savings potential of this initiative is estimated to be 150 trillion Btu (0.15 quad) per year, or nearly $1.5 billion in annual energy costs.

  4. Enabling Dedicated, Affordable Space Access Through Aggressive Technology Maturation

    NASA Technical Reports Server (NTRS)

    Jones, Jonathan E.; Kibbey, Timothy P.; Cobb, C. Brent; Harris, Lawanna L.

    2014-01-01

    A launch vehicle at the scale and price point which allows developers to take reasonable risks with high payoff propulsion and avionics hardware solutions does not exist today. Establishing this service provides a ride through the proverbial technology "valley of death" that lies between demonstration in laboratory and flight environments. NASA's NanoLaunch effort will provide the framework to mature both earth-to-orbit and on-orbit propulsion and avionics technologies while also providing affordable, dedicated access to low earth orbit for cubesat class payloads.

  5. The Affordable Care Act versus Medicare for All.

    PubMed

    Seidman, Laurence

    2015-08-01

    Many problems facing the Affordable Care Act would disappear if the nation were instead implementing Medicare for All - the extension of Medicare to every age group. Every American would be automatically covered for life. Premiums would be replaced with a set of Medicare taxes. There would be no patient cost sharing. Individuals would have free choice of doctors. Medicare's single-payer bargaining power would slow price increases and reduce medical cost as a percentage of gross domestic product (GDP). Taxes as a percentage of GDP would rise from below average to average for economically advanced nations. Medicare for All would be phased in by age. PMID:26124300

  6. Creating affordable Internet map server applications for regional scale applications.

    PubMed

    Lembo, Arthur J; Wagenet, Linda P; Schusler, Tania; DeGloria, Stephen D

    2007-12-01

    This paper presents an overview and process for developing an Internet Map Server (IMS) application for a local volunteer watershed group using an Internal Internet Map Server (IIMS) strategy. The paper illustrates that modern GIS architectures utilizing an internal Internet map server coupled with a spatial SQL command language allow for rapid development of IMS applications. The implication of this approach means that powerful IMS applications can be rapidly and affordably developed for volunteer organizations that lack significant funds or a full time information technology staff. PMID:17234328

  7. RF Sputtering for preparing substantially pure amorphous silicon monohydride

    DOEpatents

    Jeffrey, Frank R.; Shanks, Howard R.

    1982-10-12

    A process for controlling the dihydride and monohydride bond densities in hydrogenated amorphous silicon produced by reactive rf sputtering of an amorphous silicon target. There is provided a chamber with an amorphous silicon target and a substrate therein with the substrate and the target positioned such that when rf power is applied to the target the substrate is in contact with the sputtering plasma produced thereby. Hydrogen and argon are fed to the chamber and the pressure is reduced in the chamber to a value sufficient to maintain a sputtering plasma therein, and then rf power is applied to the silicon target to provide a power density in the range of from about 7 watts per square inch to about 22 watts per square inch to sputter an amorphous silicon hydride onto the substrate, the dihydride bond density decreasing with an increase in the rf power density. Substantially pure monohydride films may be produced.

  8. Borehole survey method and apparatus for drilling substantially horizontal boreholes

    SciTech Connect

    Trowsdale, L.S.

    1982-11-30

    A borehole survey method and apparatus are claimed for use in drilling substantially horizontal boreholes through a mineral deposit wherein a dip accelerometer, a roll accelerometer assembly and a fluxgate are disposed near the drill bit, which is mounted on a bent sub, and connected to a surface computation and display unit by a cable which extends through the drill string. The dip angle of the borehole near the drill bit, the azimuth of the borehole near the drill bit and the roll angle or orientation of the bent sub are measured and selectively displayed at the surface while the drill string is in the borehole for utilization in guiding the drill bit through the mineral deposit along a predetermined path.

  9. Clozapine-induced dysphagia with secondary substantial weight loss.

    PubMed

    Osman, Mugtaba; Devadas, Vekneswaran

    2016-01-01

    Dysphagia is listed as a 'rare' side effect following clozapine treatment. In this case report, we describe how significant clozapine-induced dysphagia has led to significant reduction of nutritional intake with subsequent substantial weight loss. An 18-year-old single man with an established diagnosis of treatment-resistant paranoid schizophrenia recovered well on a therapeutic dose of clozapine. However, he was noted to lose weight significantly (up to 20% of his original weight) as the dose was uptitrated. This was brought about by development of dysphagia, likely to be due to clozapine. Addition of nutritional supplementary liquids and initiation of a modified behavioural dietary/swallowing programme, while repeatedly mastering the Mendelsohn manoeuvre technique, alleviated the swallowing difficulties and restored his weight. PMID:27543610

  10. Resonant infrared detector with substantially unit quantum efficiency

    NASA Technical Reports Server (NTRS)

    Farhoomand, Jam (Inventor); Mcmurray, Robert E., Jr. (Inventor)

    1994-01-01

    A resonant infrared detector includes an infrared-active layer which has first and second parallel faces and which absorbs radiation of a given wavelength. The detector also includes a first tuned reflective layer, disposed opposite the first face of the infrared-active layer, which reflects a specific portion of the radiation incident thereon and allows a specific portion of the incident radiation at the given wavelength to reach the infrared-active layer. A second reflective layer, disposed opposite the second face of the infrared-active layer, reflects back into the infrared-active layer substantially all of the radiation at the given wavelength which passes through the infrared-active layer. The reflective layers have the effect of increasing the quantum efficiency of the infrared detector relative to the quantum efficiency of the infrared-active layer alone.

  11. Method and apparatus for a substantially coaxial injector element

    NASA Technical Reports Server (NTRS)

    Horn, Mark D. (Inventor); Miyata, Shinjiro (Inventor); Farhangi, Shahram (Inventor)

    2006-01-01

    A system to provide a two piece robust fluid injector. According to various embodiments, the fluid injector is a fuel injector for a combustion engine. The injector includes two coaxially formed annuluses. One annulus is formed in a face plate and the second annulus or hole is defined by a tube extending through the face plate. The tube extends through the face plate in a portion of a through bore which also is used to define the second annulus. The second annulus is formed using a throughbore through which the tube extends. This allows the second annulus to always be formed inherently and precisely substantially coaxial with the first annulus. Moreover, the second annulus can be formed with a much greater tolerance than if other independent components needed to be added.

  12. 77 FR 26046 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Affordable...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-02

    ...; Affordable Care Act Internal Claims and Appeals and External Review Procedures for Non-Grandfathered Plans... Administration (EBSA) sponsored information collection request (ICR) titled, ``Affordable Care Act Internal...: Affordable Care Act Internal Claims and Appeals and External Review Procedures for Non-grandfathered...

  13. 76 FR 11283 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Affordable...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-01

    ...; Affordable Care Act Internal Claims and Appeals and External Review Procedures for Non-Grandfathered Plans... Administration (EBSA) sponsored information collection request (ICR) titled, ``Affordable Care Act Internal... Affordable Care Act added Public Health Service Act section 2719, which provides rules relating to......

  14. 77 FR 17143 - Medicaid Program; Eligiblity Changes Under the Affordable Care Act of 2010

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-23

    ... Medicaid eligibility changes under the Affordable Care Act (listed in more detail in 76 FR 51155) and... Services 42 CFR Parts 431, 435 and 457 Medicaid Program; Eligibility Changes Under the Affordable Care Act... Parts 431, 435, and 457 RIN 0938-AQ62 Medicaid Program; Eligiblity Changes Under the Affordable Care...

  15. Learning Outcomes Afforded by Self-Assessed, Segmented Video-Print Combinations

    ERIC Educational Resources Information Center

    Koumi, Jack

    2015-01-01

    Learning affordances of video and print are examined in order to assess the learning outcomes afforded by hybrid video-print learning packages. The affordances discussed for print are: navigability, surveyability and legibility. Those discussed for video are: design for constructive reflection, provision of realistic experiences, presentational…

  16. Teacher Perceptions of Learning Affordances of Multi-User Virtual Environments

    ERIC Educational Resources Information Center

    Gamage, Vimani; Tretiakov, Alexei; Crump, Barbara

    2011-01-01

    While the affordances of multi-user virtual environments (MUVEs) for teaching and learning are a subject of numerous experience reports, there is little research on educators' perceptions of various MUVE affordances claimed in the literature. We investigate the educators' perceptions of claimed MUVE affordances for learning by conducting in-depth…

  17. 76 FR 59702 - Notice of Intent To Award Affordable Care Act (ACA) Funding

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-27

    ... HUMAN SERVICES Centers for Disease Control and Prevention Notice of Intent To Award Affordable Care Act... Services (HHS). ACTION: Notice. Overview Information Notice of Intent to Award Affordable Care Act (ACA...: This notice provides public announcement of CDC's intent to award Affordable Care Act...

  18. Demonstrating the Viability and Affordability of Nuclear Surface Power Systems

    NASA Technical Reports Server (NTRS)

    Vandyke, Melissa K.

    2006-01-01

    A set of tasks have been identified to help demonstrate the viability, performance, and affordability of surface fission systems. Completion of these tasks will move surface fission systems closer to reality by demonstrating affordability and performance potential. Tasks include fabrication and test of a 19-pin section of a Surface Power Unit Demonstrator (SPUD); design, fabrication, and utilization of thermal simulators optimized for surface fission' applications; design, fabrication, and utilization of GPHS module thermal simulators; design, fabrication, and test of a fission surface power system shield; and work related to potential fission surface power fuel/clad systems. Work on the SPUD will feed directly into joint NASA MSFC/NASA GRC fabrication and test of a surface power plant Engineering Development Unit (EDU). The goal of the EDU will be to perform highly realistic thermal, structural, and electrical testing on an integrated fission surface power system. Fission thermal simulator work will help enable high fidelity non-nuclear testing of pumped NaK surface fission power systems. Radioisotope thermal simulator work will help enable design and development of higher power radioisotope systems (power ultimately limited by Pu-238 availability). Shield work is designed to assess the potential of using a water neutron shield on the surface of the moon. Fuels work is geared toward assessing the current potential of using fuels that have already flown in space.

  19. Anticipating Human Activities Using Object Affordances for Reactive Robotic Response.

    PubMed

    Koppula, Hema S; Saxena, Ashutosh

    2016-01-01

    An important aspect of human perception is anticipation, which we use extensively in our day-to-day activities when interacting with other humans as well as with our surroundings. Anticipating which activities will a human do next (and how) can enable an assistive robot to plan ahead for reactive responses. Furthermore, anticipation can even improve the detection accuracy of past activities. The challenge, however, is two-fold: We need to capture the rich context for modeling the activities and object affordances, and we need to anticipate the distribution over a large space of future human activities. In this work, we represent each possible future using an anticipatory temporal conditional random field (ATCRF) that models the rich spatial-temporal relations through object affordances. We then consider each ATCRF as a particle and represent the distribution over the potential futures using a set of particles. In extensive evaluation on CAD-120 human activity RGB-D dataset, we first show that anticipation improves the state-of-the-art detection results. We then show that for new subjects (not seen in the training set), we obtain an activity anticipation accuracy (defined as whether one of top three predictions actually happened) of 84.1, 74.4 and 62.2 percent for an anticipation time of 1, 3 and 10 seconds respectively. Finally, we also show a robot using our algorithm for performing a few reactive responses. PMID:26656575

  20. Methadone dosing, heroin affordability, and the severity of addiction.

    PubMed Central

    Bach, P B; Lantos, J

    1999-01-01

    OBJECTIVES: This study sought to track changes in US heroin prices from 1988 to 1995 and to determine whether changes in the affordability of heroin were associated with changes in the use of heroin by users seeking methadone treatment, as indexed by methadone dose levels. METHODS: Data on the price of heroin were from the Drug Enforcement Administration; data on methadone doses were from surveys conducted in 1988, 1990, and 1995 of 100 methadone maintenance centers. Multivariable models that controlled for time and city effects were used to ascertain whether clinics in cities where heroin was less expensive had patients receiving higher doses of methadone, which would suggest that these patients had relatively higher physiological levels of opiate addiction owing to increased heroin use. RESULTS: The amount of pure heroin contained in a $100 (US) purchase has increased on average 3-fold between 1988 and 1995. The average dose of methadone in clinics was positively associated with the affordability of local heroin (P < .01). CONCLUSIONS: When heroin prices fall, heroin addicts require more methadone (a heroin substitute) to stabilize their addiction--evidence that they are consuming more heroin. PMID:10224975