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

... least two multi-State plans (MSPs) on each of the Affordable Insurance Exchanges (Exchanges). Under the... issuers to offer at least two multi-State plans (MSPs) on each of the Exchanges in the 50 States and the... Patient Protection and Affordable Care Act; Establishment of the Multi- State Plan Program for the...

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.

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).

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.

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.

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

...This final rule implements provisions related to fair health insurance premiums, guaranteed availability, guaranteed renewability, single risk pools, and catastrophic plans, consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The final rule clarifies the approach used to enforce the applicable requirements of the Affordable Care Act with respect to health insurance issuers and group health plans that are non-federal governmental plans. This final rule also amends the standards for health insurance issuers and states regarding reporting, utilization, and collection of data under the federal rate review program, and revises the timeline for states to propose state- specific thresholds for review and approval by the Centers for Medicare & Medicaid Services (CMS).

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

... renewability protections, by prohibiting the use of factors such as health status, medical history, gender, and... comply with the provisions of the final rule, including administrative and marketing costs.... SUMMARY: This proposed rule would implement the Affordable Care Act's policies related to fair health...

Patient Protection and Affordable Care Act; standards related to reinsurance, risk corridors, and risk adjustment. Final rule.

PubMed

2012-03-23

This final rule implements standards for States related to reinsurance and risk adjustment, and for health insurance issuers related to reinsurance, risk corridors, and risk adjustment consistent with title I of the Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. These programs will mitigate the impact of potential adverse selection and stabilize premiums in the individual and small group markets as insurance reforms and the Affordable Insurance Exchanges ("Exchanges") are implemented, starting in 2014. The transitional State-based reinsurance program serves to reduce uncertainty by sharing risk in the individual market through making payments for high claims costs for enrollees. The temporary Federally administered risk corridors program serves to protect against uncertainty in rate setting by qualified health plans sharing risk in losses and gains with the Federal government. The permanent State-based risk adjustment program provides payments to health insurance issuers that disproportionately attract high-risk populations (such as individuals with chronic conditions).

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

... Protection and Affordable Care Act; Exchange Functions: Standards for Navigators and Non-Navigator Assistance..., training and certification, and meaningful access standards applicable to Navigators and non-Navigator assistance personnel in Federally- facilitated Exchanges, including State Partnership Exchanges, and to non...

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…

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…

Integrating community health workers within Patient Protection and Affordable Care Act implementation.

PubMed

Islam, Nadia; Nadkarni, Smiti Kapadia; Zahn, Deborah; Skillman, Megan; Kwon, Simona C; Trinh-Shevrin, Chau

2015-01-01

The Patient Protection and Affordable Care Act's (PPACA) emphasis on community-based initiatives affords a unique opportunity to disseminate and scale up evidence-based community health worker (CHW) models that integrate CHWs within health care delivery teams and programs. Community health workers have unique access and local knowledge that can inform program development and evaluation, improve service delivery and care coordination, and expand health care access. As a member of the PPACA-defined health care workforce, CHWs have the potential to positively impact numerous programs and reduce costs. This article discusses different strategies for integrating CHW models within PPACA implementation through facilitated enrollment strategies, patient-centered medical homes, coordination and expansion of health information technology (HIT) efforts, and also discusses payment options for such integration. Title V of the PPACA outlines a plan to improve access to and delivery of health care services for all individuals, particularly low-income, underserved, uninsured, minority, health disparity, and rural populations. Community health workers' role as trusted community leaders can facilitate accurate data collection, program enrollment, and provision of culturally and linguistically appropriate, patient- and family-centered care. Because CHWs already support disease management and care coordination services, they will be critical to delivering and expanding patient-centered medical homes and Health Home services, especially for communities that suffer disproportionately from multiple chronic diseases. Community health workers' unique expertise in conducting outreach make them well positioned to help enroll people in Medicaid or insurance offered by Health Benefit Exchanges. New payment models provide opportunities to fund and sustain CHWs. Community health workers can support the effective implementation of PPACA if the capacity and potential of CHWs to serve as cultural

Integrating Community Health Workers Within Patient Protection and Affordable Care Act Implementation

PubMed Central

Islam, Nadia; Nadkarni, Smiti Kapadia; Zahn, Deborah; Skillman, Megan; Kwon, Simona C.; Trinh-Shevrin, Chau

2015-01-01

Context The Patient Protection and Affordable Care Act’s (PPACA) emphasis on community-based initiatives affords a unique opportunity to disseminate and scale up evidence-based community health worker (CHW) models that integrate CHWs within health care delivery teams and programs. Community health workers have unique access and local knowledge that can inform program development and evaluation, improve service delivery and care coordination, and expand health care access. As a member of the PPACA-defined health care workforce, CHWs have the potential to positively impact numerous programs and reduce costs. Objective This article discusses different strategies for integrating CHW models within PPACA implementation through facilitated enrollment strategies, patient-centered medical homes, coordination and expansion of health information technology (HIT) efforts, and also discusses payment options for such integration. Results Title V of the PPACA outlines a plan to improve access to and delivery of health care services for all individuals, particularly low-income, underserved, uninsured, minority, health disparity, and rural populations. Community health workers’ role as trusted community leaders can facilitate accurate data collection, program enrollment, and provision of culturally and linguistically appropriate, patient- and family-centered care. Because CHWs already support disease management and care coordination services, they will be critical to delivering and expanding patient-centered medical homes and Health Home services, especially for communities that suffer disproportionately from multiple chronic diseases. Community health workers’ unique expertise in conducting outreach make them well positioned to help enroll people in Medicaid or insurance offered by Health Benefit Exchanges. New payment models provide opportunities to fund and sustain CHWs. Conclusion Community health workers can support the effective implementation of PPACA if the capacity

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

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…

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.

Health insurance issuers implementing medical loss ratio (MLR) requirements under the Patient Protection and Affordable Care Act. Interim final rule with request for comments.

PubMed

2010-12-01

This document contains the interim final regulation implementing medical loss ratio (MLR) requirements for health insurance issuers under the Public Health Service Act, as added by the Patient Protection and Affordable Care Act (Affordable Care Act).

The Patient Protection and Affordable Care Act: implications for pediatric pharmacy practice.

PubMed

Vallejos, Ximena; Benavides, Sandra

2013-01-01

The impact of the Patient Protection and Affordable Care Act on the pediatric health care landscape includes expanded health insurance coverage and health care delivery improvements by increasing implementation of patient-centered medical homes and accountable care organizations. These offer opportunities for pharmacists to assume responsibility for the medication-related needs of pediatric patients through pharmacotherapy selection, medication therapy management performance, and medication reconciliation at each transition of care. Medically complex children with at least 2 chronic disease states may be the target population. Studies demonstrating the positive outcomes and cost-effectiveness of pharmacists in pediatric ambulatory care settings are needed.

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.

Patient Protection and Affordable Care Act Medicaid expansion and gains in health insurance coverage and access among cancer survivors.

PubMed

Nikpay, Sayeh S; Tebbs, Margaret G; Castellanos, Emily H

2018-04-17

The Patient Protection and Affordable Care Act extends Medicaid coverage to millions of low-income adults, including many survivors of cancer who were unable to purchase affordable health insurance coverage in the individual health insurance market. Using data from the 2011 to 2015 Behavioral Risk Factor Surveillance System, the authors compared changes in coverage and health care access measures for low-income cancer survivors in states that did and did not expand Medicaid. The study population of 17,381 individuals included adults aged 18 to 64 years, and was predominantly female, white, and unmarried. The authors found a relative reduction in the uninsured rate of 11.7 percentage points and a relative increase in the probability of having a personal physician of 5.8 percentage points. Stratifying by whether states expanded Medicaid by 2015, the authors found that relative gains in coverage and access were larger among those individuals residing in states with expanded Medicaid compared with those residing in nonexpansion states. The results of the current study suggest that the Patient Protection and Affordable Care Act Medicaid expansion has improved coverage and access for cancer survivors. Cancer 2018. © 2018 American Cancer Society. © 2018 American Cancer Society.

Patient Protection and Affordable Care Act; standards related to essential health benefits, actuarial value and accreditation. Final rule.

PubMed

2013-02-25

This final rule sets forth standards for health insurance issuers consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. Specifically, this final rule outlines Exchange and issuer standards related to coverage of essential health benefits and actuarial value. This rule also finalizes a timeline for qualified health plans to be accredited in Federally-facilitated Exchanges and amends regulations providing an application process for the recognition of additional accrediting entities for purposes of certification of qualified health plans.

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

PubMed

2013-06-04

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.

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:

Public health law: the constitutionality of the Patient Protection and Affordable Care Act.

PubMed

De Ville, Kenneth

2011-01-01

Congress of the Patient Protection and Affordable Care Act (PPACA) was immediately challenged by lawsuits attacking the constitutionality of the legislation. The lawsuits, joined by over 2 dozen state's attorney generals, contend that PPACA is an unconstitutional exercise of federal power. Specifically, the suits argue that the individual insurance mandate portion of the law is justified by neither the "Commerce Power" nor Congress' authority to "tax" and provide for "the general welfare." This essay outlines and analyzes the constitutional arguments for, and against, PPACA forecasting the likely resolution of the debate if the suits reach the US Supreme Court.

We all want it, but we don't know what it is: toward a standard of affordability for health insurance premiums.

PubMed

Muennig, Peter; Sampat, Bhaven; Tilipman, Nicholas; Brown, Lawrence D; Glied, Sherry A

2011-10-01

The 2010 Patient Protection and Affordable Care Act (P.L. 111-148), or ACA, requires that U.S. citizens either purchase health insurance or pay a fine. To offset the financial burden for lower-income households, it also provides subsidies to ensure that health insurance premiums are affordable. However, relatively little work has been done on how such affordability standards should be set. The existing literature on affordability is not grounded in social norms and has methodological and theoretical flaws. To address these issues, we developed a series of hypothetical vignettes in which individual and household sociodemographic characteristics were varied. We then convened a panel of eighteen experts with extensive experience in affordability standards to evaluate the extent to which each vignette character could afford to pay for one of two health insurance plans. The panel varied with respect to political ideology and discipline. We find that there was considerable disagreement about how affordability is defined. There was also disagreement about what might be included in an affordability standard, with substantive debate surrounding whether savings, debt, education, or single parenthood is relevant. There was also substantial variation in experts' assessed affordability scores. Nevertheless, median expert affordability assessments were not far from those of ACA.

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.

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

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

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-30

... Collection Request Submitted for Public 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...

Mulberry Fruit Extract Affords Protection against Ethyl Carbamate-Induced Cytotoxicity and Oxidative Stress.

PubMed

Chen, Wei; Li, Yuting; Bao, Tao; Gowd, Vemana

2017-01-01

Ethyl carbamate (EC) is a food and environmental toxicant and is a cause of concern for human exposure. Several studies indicated that EC-induced toxicity was associated with oxidative stress. Mulberry fruits are reported to have a wide range of bioactive compounds and pharmacological activities. The present study was therefore aimed to investigate the protective property of mulberry fruit extract (MFE) on EC-induced cytotoxicity and oxidative stress. Chemical composition analysis showed that total phenolic content and total flavonoid content in MFE were 502.43 ± 5.10 and 219.12 ± 4.45 mg QE/100 g FW. Cyanidin -3-O- glucoside and cyanidin -3-O- rutinoside were the major anthocyanins in MFE. In vitro antioxidant studies (DPPH, ABTS, and FRAP assays) jointly exhibited the potent antioxidant capacity of MFE. Further study indicated that MFE protected human liver HepG2 cells from EC-induced cytotoxicity by scavenging overproduced cellular ROS. EC treatment promoted intracellular glutathione (GSH) depletion and caused mitochondrial membrane potential (MMP) collapse, as well as mitochondrial membrane lipid peroxidation, whereas MFE pretreatment significantly inhibited GSH depletion and restored the mitochondrial membrane function. Overall, our study suggested that polyphenolic-rich MFE could afford a potent protection against EC-induced cytotoxicity and oxidative stress.

Mulberry Fruit Extract Affords Protection against Ethyl Carbamate-Induced Cytotoxicity and Oxidative Stress

PubMed Central

Li, Yuting; Bao, Tao; Gowd, Vemana

2017-01-01

Ethyl carbamate (EC) is a food and environmental toxicant and is a cause of concern for human exposure. Several studies indicated that EC-induced toxicity was associated with oxidative stress. Mulberry fruits are reported to have a wide range of bioactive compounds and pharmacological activities. The present study was therefore aimed to investigate the protective property of mulberry fruit extract (MFE) on EC-induced cytotoxicity and oxidative stress. Chemical composition analysis showed that total phenolic content and total flavonoid content in MFE were 502.43 ± 5.10 and 219.12 ± 4.45 mg QE/100 g FW. Cyanidin-3-O-glucoside and cyanidin-3-O-rutinoside were the major anthocyanins in MFE. In vitro antioxidant studies (DPPH, ABTS, and FRAP assays) jointly exhibited the potent antioxidant capacity of MFE. Further study indicated that MFE protected human liver HepG2 cells from EC-induced cytotoxicity by scavenging overproduced cellular ROS. EC treatment promoted intracellular glutathione (GSH) depletion and caused mitochondrial membrane potential (MMP) collapse, as well as mitochondrial membrane lipid peroxidation, whereas MFE pretreatment significantly inhibited GSH depletion and restored the mitochondrial membrane function. Overall, our study suggested that polyphenolic-rich MFE could afford a potent protection against EC-induced cytotoxicity and oxidative stress. PMID:28819542

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.

Behind the scenes of the Patient Protection and Affordable Care Act: the making of a health care co-op.

PubMed

Giaimo, Susan

2013-06-01

A primary goal of the Patient Protection and Affordable Care Act (PPACA) is to reduce the number of uninsured by making health insurance more affordable for small businesses and individuals. Toward that end, the PPACA encourages the creation of nonprofit, member-owned health insurance cooperatives to operate inside each state exchange. Co-ops face significant challenges in entering mature insurance markets, but they also possess unique characteristics that may help them survive and thrive. Using Common Ground Healthcare Cooperative in Wisconsin as a case study, this article traces the origins of co-ops in health care reform at national and state levels and analyzes the political and technical challenges and opportunities facing these organizations.

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.

Impact of the Affordable Care Act on stem cell transplantation.

PubMed

Farnia, Stephanie; Gedan, Alicia; Boo, Michael

2014-03-01

The Patient Protection and Affordable Care Act, signed into law in 2010, will have a wide-reaching impact on the health care system in the United States when it is fully implemented in 2014. Patients will see increased access to care coupled with new insurance coverage protections as well as a minimum set of benefits mandated in each state known as essential health benefits. Providers are likely to see new forms of payment reform, particularly in the Medicare program, and narrower commercial provider networks. In addition, the composition of the health insurance market will broaden with the introduction of health insurance exchanges and expanded Medicaid populations in many states. Furthermore, the Patient Protection and Affordable Care Act calls for quality initiatives such as comparative effectiveness research to increase effective, appropriate and high-value care. This paper will review the main provisions of the Patient Protection and Affordable Care Act with specific attention to their impact on the field of Stem Cell Transplantation.

Patient Protection and Affordable Care Act of 2010 and children and youth with special health care needs.

PubMed

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

2015-04-01

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.

Substantial vertebral body osteophytes protect against severe vertebral fractures in compression

PubMed Central

Aubin, Carl-Éric; Chaumoître, Kathia; Mac-Thiong, Jean-Marc; Ménard, Anne-Laure; Petit, Yvan; Garo, Anaïs; Arnoux, Pierre-Jean

2017-01-01

Recent findings suggest that vertebral osteophytes increase the resistance of the spine to compression. However, the role of vertebral osteophytes on the biomechanical response of the spine under fast dynamic compression, up to failure, is unclear. Seventeen human spine specimens composed of three vertebrae (from T5-T7 to T11-L1) and their surrounding soft tissues were harvested from nine cadavers, aged 77 to 92 years. Specimens were imaged using quantitative computer tomography (QCT) for medical observation, classification of the intervertebral disc degeneration (Thomson grade) and measurement of the vertebral trabecular density (VTD), height and cross-sectional area. Specimens were divided into two groups (with (n = 9) or without (n = 8) substantial vertebral body osteophytes) and compressed axially at a dynamic displacement rate of 1 m/s, up to failure. Normalized force-displacement curves, videos and QCT images allowed characterizing failure parameters (force, displacement and energy at failure) and fracture patterns. Results were analyzed using chi-squared tests for sampling distributions and linear regression for correlations between VTD and failure parameters. Specimens with substantial vertebral body osteophytes present higher stiffness (2.7 times on average) and force at failure (1.8 times on average) than other segments. The presence of osteophytes significantly influences the location, pattern and type of fracture. VTD was a good predictor of the dynamic force and energy at failure for specimens without substantial osteophytes. This study also showed that vertebral body osteophytes provide a protective mechanism to the underlying vertebra against severe compression fractures. PMID:29065144

Post-acute care and vertical integration after the Patient Protection and Affordable Care Act.

PubMed

Shay, Patrick D; Mick, Stephen S

2013-01-01

The anticipated changes resulting from the passage of the Patient Protection and Affordable Care Act-including the proposed adoption of bundled payment systems and the promotion of accountable care organizations-have generated considerable controversy as U.S. healthcare industry observers debate whether such changes will motivate vertical integration activity. Using examples of accountable care organizations and bundled payment systems in the American post-acute healthcare sector, this article applies economic and sociological perspectives from organization theory to predict that as acute care organizations vary in the degree to which they experience environmental uncertainty, asset specificity, and network embeddedness, their motivation to integrate post-acute care services will also vary, resulting in a spectrum of integrative behavior.

Health insurance, patient protection and Affordable Care Act, and young adults.

PubMed

Dodich, Colleen; Patel, Dilip

2013-12-01

In summary, the ACA aims to correct some of the shortcomings of our current health insurance systems. It aims to make health insurance more affordable and more accessible and the health insurance systems easier to navigate. For the young adult population, it aims to protect more individuals by allowing them to stay on their parent's insurance longer and by making it easier to choose an insurance plan that is right for them. Those with preexisting medical conditions do not have to worry about being excluded from a health plan because of their medical history. The law is also making health insurance mandatory, which may help prevent young adults who fall ill from incurring large medical bills. Initial outcomes from the implementation of the ACA have shown both positive and negative responses. All in all, it is giving young adults more options when it comes to obtaining health insurance. As part of discussion with adolescents and young adults, physicians may take into consideration key points summarized in Table 4.

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

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-28

... for OMB Review; Comment Request; Affordable Care Act Patient Protection Notice ACTION: Notice. SUMMARY... Security Administration (EBSA) sponsored information collection request (ICR) titled, ``Affordable Care Act Patient Protection Notice,'' to the Office of Management and Budget (OMB) for review and approval for...

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

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 address certain related issues concerning derivatives clearing organizations (``DCOs'') and chief compliance officers (``CCOs''). The final rules will afford greater assurances to market participants that: Customer segregated funds, secured amount funds, and cleared swaps funds are protected; customers are provided with appropriate notice of the risks of futures trading and of the FCMs with which they may choose to do business; FCMs are monitoring and managing risks in a robust manner; the capital and liquidity of FCMs are strengthened to safeguard their continued operations; and the auditing and examination programs of the Commission and the self- regulatory organizations (``SROs'') are monitoring the activities of FCMs in a prudent and thorough manner.

Key Provisions of the Patient Protection and Affordable Care Act (ACA): A Systematic Review and Presentation of Early Research Findings.

PubMed

French, Michael T; Homer, Jenny; Gumus, Gulcin; Hickling, Lucas

2016-10-01

To conduct a systematic literature review of selected major provisions of the Affordable Care Act (ACA) pertaining to expanded health insurance coverage. We present and synthesize research findings from the last 5 years regarding both the immediate and long-term effects of the ACA. We conclude with a summary and offer a research agenda for future studies. We identified relevant articles from peer-reviewed scholarly journals by performing a comprehensive search of major electronic databases. We also identified reports in the "gray literature" disseminated by government agencies and other organizations. Overall, research shows that the ACA has substantially decreased the number of uninsured individuals through the dependent coverage provision, Medicaid expansion, health insurance exchanges, availability of subsidies, and other policy changes. Affordability of health insurance continues to be a concern for many people and disparities persist by geography, race/ethnicity, and income. Early evidence also indicates improvements in access to and affordability of health care. All of these changes are certain to ultimately impact state and federal budgets. The ACA will either directly or indirectly affect almost all Americans. As new and comprehensive data become available, more rigorous evaluations will provide further insights as to whether the ACA has been successful in achieving its goals. © Health Research and Educational Trust.

Group health plans and health insurance issuers relating to coverage of preventive services under the Patient Protection and Affordable Care Act. Final rules.

PubMed

2012-02-15

These regulations finalize, without change, interim final regulations authorizing the exemption of group health plans and group health insurance coverage sponsored by certain religious employers from having to cover certain preventive health services under provisions of the Patient Protection and Affordable Care Act.

A Healthy New World: Emergent Opportunities for Clinical Psychologists in the Patient Protection and Affordable Care Act

PubMed Central

Beidas, Rinad S.; Manderscheid, Ronald W.

2014-01-01

The Patient Protection and Affordable Care Act (ACA) is radically transforming the health and mental health care landscape. Emergent opportunities exist for clinical psychologists to redefine their role in healthcare. We reflect on the Chor and colleagues article (this issue) elucidating key issues for psychologists, and present additional recommendations for consideration. Specifically, we highlight three points: (1) moving beyond just training and hoping; (2) recovery, not just symptom reduction; and (3) it’s a healthy new world. Under each of these points, we suggest tactics for how to achieve these goals. PMID:24954983

Patient Protection and Affordable Care Act; program integrity: exchange, premium stabilization programs, and market standards; amendments to the HHS notice of benefit and payment parameters for 2014. Final rule.

PubMed

2013-10-30

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 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 establishes additional standards for special enrollment periods, survey vendors that may conduct enrollee satisfaction surveys on behalf of QHP issuers, and issuer participation in an FFE, and makes certain amendments to definitions and standards related to the market reform rules. These standards, which include financial integrity provisions and protections against fraud and abuse, are consistent with Title I of the Affordable Care Act. This final rule also amends and adopts as final interim provisions set forth in the Amendments to the HHS Notice of Benefit and Payment Parameters for 2014 interim final rule, published in the Federal Register on March 11, 2013, related to risk corridors and cost-sharing reduction reconciliation.

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 the...

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 the...

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 the...

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 the...

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.

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. Project HOPE—The People-to-People Health Foundation, Inc.

The Patient Protection and Affordable Care Act, public health, and the elusive target of human rights.

PubMed

Gable, Lance

2011-01-01

The Patient Protection and Affordable Care Act (ACA) sets in motion a wide range of programs that substantially affected the health system in the United States and signify a moderate but important regulatory shift in the role of the federal government in public health. This article briefly addresses two interesting policy paradoxes about the ACA. First, while the legislation primarily addresses health care financing and insurance and establishes only a few initiatives directly targeting public health, the ACA nevertheless has the potential to produce extensive public health benefits across the United States population by improving access to health care and services and reducing cost. Essentially, the ACA does not take the explicit form of a public health law but instead strives to advance public health indirectly through its effects. Second, while the ACA does not establish a right to health - or even a right to health insurance - in the United States, it does set in motion a number of significant structural and normative changes to United States law that comport with the attainment of the right to health. Most significantly, key provisions of the bill are designed to improve availability, accessibility, acceptability, and quality of conditions necessary for health, and to prompt the government to respect, protect, and fulfill these conditions. These developments mean that, to a degree, the United States essentially has undertaken the same types of legal and policy steps that a country would be required to take to uphold the right to health without actually recognizing the right to health in any formal or legally binding way. Despite these dual paradoxes and the upside potential for public health improvements resulting from the ACA, the public health impact of the law remains uncertain and will be decided by numerous subsequent regulatory and implementation decisions. The ACA authorizes multiple federal agencies to engage in rulemaking, a process that will largely

Pharmacists' perspectives on the Patient Protection and Affordable Care Act.

PubMed

Khanna, Rahul; Mahabaleshwarkar, Rohan; Holmes, Erin R; Jariwala, Krutika

2015-01-01

Passed in 2010, the Patient Protection and Affordable Care Act (PPACA) resulted in significant changes to the health care system in the United States (US). Though general population surveys reveal the fractious political debate surrounding the law, insights on pharmacists' perspectives on the PPACA are lacking in the literature. The objectives of this study were to determine pharmacists' perspectives on the PPACA and determine whether pharmacists' demographic and practice-related characteristics and political beliefs influence their perspectives on the PPACA. This study was conducted using a descriptive, cross-sectional design. Study data were collected with a self-administered online questionnaire distributed to 21,769 registered pharmacists in five states. A total of 1127 completed surveys were received (5.6% response rate). Roughly 37% of pharmacists reported that they understood the major provisions of the PPACA although most (89%) respondents agreed that understanding such policies is important for practicing pharmacy. Just over half (50.6%) of respondents did not support the PPACA while 47.7% supported the legislation. Political orientation, age, gender, and race were found to be significantly related to pharmacists' perspectives on the PPACA. Respondent pharmacists' perceptions of the PPACA appear to be related to political orientation and demographic characteristics. Given that pharmacists will be impacted by the implementation of the PPACA and are so accessible to the public, additional information on health care policy and PPACA should be provided to pharmacists. Copyright © 2015 Elsevier Inc. All rights reserved.

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.

Alternatives to the ACA's Affordability Firewall.

PubMed

Nowak, Sarah A; Saltzman, Evan; Cordova, Amado

2016-05-09

The Affordable Care Act (ACA) was designed to increase health insurance coverage while limiting the disruption to individuals with existing sources of insurance coverage, particularly those with employer-sponsored insurance (ESI). To limit disruption to those with coverage, the ACA implements the employer mandate, which requires firms with more than 50 employees to offer health insurance or face penalties, and the individual "affordability firewall," which limits subsidies to individuals lacking access to alternative sources of coverage that are "affordable." This article examines the policy impacts of the affordability firewall and investigates two potential modifications. Option 1, which is the "entire family" scenario, involves allowing an exception to the firewall for anyone in a family where the family ESI premium contribution exceeds 9.5 percent of the worker's household income. In Option 2, the "dependents only" scenario, only dependents (and not the worker) become eligible for Marketplace subsidies when the ESI premium contribution exceeds 9.5 percent of the worker's household income. Relative to the ACA, RAND researchers estimate that nongroup enrollment will increase by 4.1 million for Option 1 and by 1.4 million for Option 2. However, the number without insurance only declines by 1.5 million in Option 1 and 0.7 million in Option 2. The difference between the increase in nongroup enrollment and the decrease in uninsurance is primarily due to ESI crowd-out, which is more pronounced for Option 1. Researchers also estimated that about 1.3 million families who have ESI and unsubsidized nongroup coverage under current ACA policy would receive Marketplace subsidies under the alternative affordability firewall scenarios. For these families, health insurance coverage would become substantially more affordable; these families' risk of spending at least 20 percent of income on health care would drop by more than two thirds. We additionally estimated that federal

Why the affordable care act needs a better name: 'Americare'.

PubMed

Sage, William M

2010-08-01

The culmination of a century's effort to enact universal coverage in the United States is a law with an uninspiring title, the Patient Protection and Affordable Care Act, and an even more awkward acronym, PPACA. The Obama administration has decided to call the legislation the Affordable Care Act, but the expansion of health coverage that the law sets in motion has no name, and therefore no identity. It badly needs one.

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. © 2014 by the American Anthropological Association.

The Patient Protection and Affordable Care Act: the impact on urologic cancer care.

PubMed

Keegan, Kirk A; Penson, David F

2013-10-01

In March 2010, the Patient Protection and Affordable Care Act as well as its amendments were signed into law. This sweeping legislation was aimed at controlling spiraling healthcare costs and redressing significant disparities in healthcare access and quality. Cancer diagnoses and their treatments constitute a large component of rising healthcare expenditures and, not surprisingly, the legislation will have a significant influence on cancer care in the USA. Because genitourinary malignancies represent an impressive 25% of all cancer diagnoses per year, this legislation could have a profound impact on urologic oncology. To this end, we will present key components of this landmark legislation, including the proposed expansion to Medicaid coverage, the projected role of Accountable Care Organizations, the expected creation of quality reporting systems, the formation of an independent Patient-Centered Outcomes Research Institute, and enhanced regulation on physician-owned practices. We will specifically address the anticipated effect of these changes on urologic cancer care. Briefly, the legal ramifications and current barriers to the statutes will be examined. Published by Elsevier Inc.

The Patient Protection and Affordable Care Act: The Impact on Urologic Cancer Care

PubMed Central

Keegan, Kirk A.; Penson, David F.

2012-01-01

In March 2010, the Patient Protection and Affordable Care Act as well as its amendments were signed into law. This sweeping legislation was aimed at controlling spiraling healthcare costs and redressing significant disparities in healthcare access and quality. Cancer diagnoses and their treatments constitute a large component of rising healthcare expenditures and, not surprisingly, the legislation will have a significant influence on cancer care in the United States. Because genitourinary malignancies represent an impressive 25% of all cancer diagnoses per year, this legislation could have a profound impact on urologic oncology. To this end, we will present key components of this landmark legislation, including the proposed expansion to Medicaid coverage, the projected role of Accountable Care Organizations, the expected creation of quality reporting systems, the formation of an independent Patient-Centered Outcomes Research Institute, and enhanced regulation on physician-owned practices. We will specifically address the anticipated effect of these changes on urological cancer care. Briefly, the legal ramifications and current barriers to the statutes will be examined. PMID:22819697

Patient protection and Affordable Care Act; data collection to support standards related to essential health benefits; recognition of entities for the accreditation of qualified health plans. Final rule.

PubMed

2012-07-20

This final rule establishes data collection standards necessary to implement aspects of section 1302 of the Patient Protection and Affordable Care Act (Affordable Care Act), which directs the Secretary of Health and Human Services to define essential health benefits. This final rule outlines the data on applicable plans to be collected from certain issuers to support the definition of essential health benefits. This final rule also establishes a process for the recognition of accrediting entities for purposes of certification of qualified health plans.

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

Health insurance exchanges under the Patient Protection and Affordable Care Act: regulatory and design challenges.

PubMed

Hoffmann, Stephanie M

2012-12-01

Under the Patient Protection and Affordable Care Act, all states are required to establish health insurance exchanges, marketplaces where individuals and small businesses can purchase health care coverage. In establishing these exchanges, states must address a range of regulatory and design issues to ensure that their exchanges are sustainable and meet the needs of their populations. The issues include the degree of federal involvement in the management of the exchanges, the overall structure and governance of the exchanges, the requirements for insurance plans to be offered on the exchanges, and the design of the exchanges themselves. Each of these issues will play a crucial role in determining the quality of coverage offered to consumers and how effectively they can access that coverage. Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.

The impact of patient protection and Affordable Care Act on trauma care: A step in the right direction.

PubMed

Joseph, Bellal; Haider, Ansab A; Azim, Asad; Kulvatunyou, Narong; Tang, Andrew; OʼKeeffe, Terence; Latifi, Rifat; Green, Donald J; Friese, Randall S; Rhee, Peter

2016-09-01

The Patient Protection and Affordable Care Act (ACA) was implemented to guarantee financial coverage for health care for all Americans. The implementation of ACA is likely to influence the insurance status of Americans and reimbursement rates of trauma centers. The aim of this study was to assess the impact of ACA on the patient insurance status, hospital reimbursements, and clinical outcomes at a Level I trauma center. We hypothesized that there would be a significant decrease in the proportion of uninsured trauma patients visiting our Level I trauma center following the ACA, and this is associated with improved reimbursement. We performed a retrospective analysis of the trauma registry and financial database at our Level I trauma center for a 27-month (July 2012 to September 2014) period by quarters. Our outcome measures were change in insurance status, hospital reimbursement rates (total payments/expected payments), and clinical outcomes before and after ACA (March 31, 2014). Trend analysis was performed to assess trends in outcomes over each quarter (3 months). A total of 9,892 patients were included in the study. The overall uninsured rate during the study period was 20.3%. Post-ACA period was associated with significantly lower uninsured rate (p < 0.001). During the same time, there was as a significant increase in the Medicaid patients (p = 0.009). This was associated with significantly improved hospital reimbursements (p < 0.001).On assessing clinical outcomes, there was no change in hospitalization (p = 0.07), operating room procedures (p = 0.99), mortality (p = 0.88), or complications (p = 0.20). Post-ACA period was also not associated with any change in the hospital (p = 0.28) or length of stay at intensive care unit (p = 0.66). The implementation of ACA has led to a decrease in the number of uninsured trauma patients. There was a significant increase in Medicaid trauma patients. This was associated with an increase in hospital reimbursements that

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

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

77 FR 73117 - Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2014

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-07

...This proposed rule provides further detail and parameters related to: the risk adjustment, reinsurance, and risk corridors programs; cost-sharing reductions; user fees for a Federally- facilitated Exchange; advance payments of the premium tax credit; a Federally-facilitated Small Business Health Option Program; and the medical loss ratio program. The cost-sharing reductions and advanced payments of the premium tax credit, combined with new insurance market reforms, will significantly increase the number of individuals with health insurance coverage, particularly in the individual market. The premium stabilization programs--risk adjustment, reinsurance, and risk corridors--will protect against adverse selection in the newly enrolled population. These programs, in combination with the medical loss ratio program and market reforms extending guaranteed availability (also known as guaranteed issue) protections and prohibiting the use of factors such as health status, medical history, gender, and industry of employment to set premium rates, will help to ensure that every American has access to high-quality, affordable health insurance.

"Affordable" Private Schools in South Africa. Affordable for Whom?

ERIC Educational Resources Information Center

Languille, Sonia

2016-01-01

The paper sets out to challenge the notions of "affordable" private schools in the context of South Africa. It is guided by one main question: "affordable private schools for whom?" It argues that, contrary to claims by its public and private proponents, affordable private schools in South Africa do not cater for poor children.…

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.

78 FR 13575 - Coverage of Certain Preventive Services Under the Affordable Care Act; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-28

... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 54 [REG-120391-10] RIN 1545-BJ60 Coverage of Certain Preventive Services Under the Affordable Care Act; Correction AGENCY: Internal Revenue... Protection and Affordable Care Act, as amended, and incorporated into the Employee Retirement Income Security...

Patient Protection and Affordable Care Act: Potential Effects on Physical Medicine and Rehabilitation

PubMed Central

Boninger, Joseph W.; Gans, Bruce M.; Chan, Leighton

2012-01-01

The objective was to review pertinent areas of the Patient Protection and Affordable Care Act (PPACA) to determine the PPACA’s impact on physical medicine and rehabilitation (PM&R). The law, and related newspaper and magazine articles, was reviewed. The ways in which provisions in the PPACA are being implemented by the Centers for Medicare and Medicaid Services and other government organizations were investigated. Additionally, recent court rulings on the PPACA were analyzed to assess the law’s chances of successful implementation. The PPACA contains a variety of reforms that, if implemented, will significantly impact the field of PM&R. Many PPACA reforms change how rehabilitative care is delivered by integrating different levels of care and creating uniform quality metrics to assess quality and efficiency. These quality metrics will ultimately be tied to new, performance-based payment systems. While the law contains ambitious initiatives that may, if unsuccessful or incorrectly implemented, negatively impact PM&R, it also has the potential to greatly improve the quality and efficiency of rehabilitative care. A proactive approach to the changes the PPACA will bring about is essential for the health of the field. PMID:22459177

Support for Government Provision of Health Care and the Patient Protection and Affordable Care Act

PubMed Central

Corman, Juliane; Levin, David

2016-01-01

Since the 1930s, US politicians have argued about whether healthcare should be the responsibility of the federal government. Both major political parties have cited public opinion concerning Americans’ support for or rejection of government provision of healthcare to support their position. With the passage of the Patient Protection and Affordable Care Act (ACA) in 2010, however, the political debate has changed. Where it had been about the government provision of healthcare as an abstract principle, it became a debate imbued with evaluations of the implementation of the ACA itself. This spawned a new line of research examining the consequences of the ACA’s implementation on public attitudes toward government provision of healthcare. The change in support for government provision of healthcare and the new post-ACA research highlight a need for a long-term examination of trends in support over the past two decades that will provide context for the new studies. This study provides that examination. PMID:27257309

Small businesses and the Affordable Care Act of 2010.

PubMed

Collins, Sara R; Davis, Karen; Nicholson, Jennifer L; Stremikis, Kristof

2010-09-01

The Patient Protection and Affordable Care Act (ACA) includes several short- and long-term provisions designed to help small businesses pay for and maintain health insurance for their workers, and to allow workers without employer coverage to gain access to affordable, comprehensive health insurance. Provisions include a small business tax credit to offset premium costs for firms that offer coverage starting this taxable year, establishment of state-based insurance exchanges that promise to lower administrative costs and pool risk more broadly, and creation of new market rules and an essential benefit standard to protect small firms and their workers. Analysis shows that up to 16.6 million workers are in firms that would be eligible for the tax credit in 2010 to 2013. Over the next 10 years, small businesses and organizations could receive an estimated $40 billion in federal support through the premium credit program.

Insurance Enrollment at a Student-Run Free Clinic After the Patient Protection and Affordable Care Act.

PubMed

McGeehan, Megan; DeMaria, Rebecca; Charney, Pamela; Batavia, Ashita S

2017-08-01

The Patient Protection and Affordable Care Act (ACA) aims to increase insurance coverage through government subsidies. Medical student-run free clinics (SRFC) are an important entry point into the healthcare system for the uninsured. SRFCs do not have a standardized approach for navigating the complexities of enrollment. The Weill Cornell Community Clinic (WCCC) developed a unique enrollment model that may inform other SRFCs. Our objective is to describe enrollment processes at SRFCs throughout New York City, and to evaluate enrollment outcomes and persistent barriers to coverage at WCCC. We surveyed SRFC leadership throughout NYC to understand enrollment processes. We evaluated enrollment outcomes at WCCC through chart review and structured phone interviews. Subjects included WCCC patients seen in clinic between October 1, 2013 and September 30, 2015 (N = 140). Demographic information, method of insurance enrollment, and qualitative description of enrollment barriers were collected. SRFCs in New York City have diverse enrollment processes. 48% (N = 42) of WCCC patients obtained health insurance. Immigration status was a barrier to coverage in 21% of patients. Failure to gain coverage was predicted by larger household size (p = 0.02). Gender and employment status were not associated with remaining uninsured. The main barriers to enrollment were inability to afford premiums and lack of interest. Insurance enrollment processes at SRFCs in New York City are mostly ad hoc and outcomes are rarely tracked. Following implementation of the ACA, WCCC stands out for its structured approach, with approximately half of eligible WCCC patients gaining coverage during the study period.

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. Copyright © 2013 Elsevier Inc. All rights reserved.

Pathways in Learning to Teach Elementary Science: Navigating Contexts, Roles, Affordances and Constraints

NASA Astrophysics Data System (ADS)

Smith, Deborah C.; Jang, Shinho

2011-12-01

This case study of a fifth-year elementary intern's pathway in learning to teach science focused on her science methods course, placement science teaching, and reflections as a first-year teacher. We studied the sociocultural contexts within which the intern learned, their affordances and constraints, and participants' perspectives on their roles and responsibilities, and her learning. Semi-structured interviews were conducted with all participants. Audiotapes of the science methods class, videotapes of her science teaching, and field notes were collected. Data were transcribed and searched for affordances or constraints within contexts, perspectives on roles and responsibilities, and how views of her progress changed. Findings show the intern's substantial progress, the ways in which affordances sometimes became constraints, and participants' sometimes contradictory perspectives.

Evidence that the adenosine A3 receptor may mediate the protection afforded by preconditioning in the isolated rabbit heart.

PubMed

Liu, G S; Richards, S C; Olsson, R A; Mullane, K; Walsh, R S; Downey, J M

1994-07-01

Agonists selective for the A1 adenosine receptor mimic the protective effect of ischaemic preconditioning against infarction in the rabbit heart. Unselective adenosine antagonists block this protection but, paradoxically, the A1 adenosine receptor selective antagonist 8-cyclopentyl- 1,3-dipropylxanthine (DPCPX) does not. The aim of this study was to test the hypothesis that the newly described A3 adenosine receptor, which has an agonist profile similar to the A1 receptor but is insensitive to DPCPX, might mediate preconditioning. Isolated rabbit hearts perfused with Krebs buffer experienced 30 min of regional ischaemia followed by 120 min of reperfusion. Infarct size was measured by tetrazolium staining. In control hearts infarction was 32.2(SEM 1.5)% of the risk zone. Preconditioning by 5 min ischaemia and 10 min reperfusion reduced infarct size to 8.8(2.3)%. Replacing the regional ischaemia with 5 min perfusion with 10 microM adenosine or 65 nM N6-[2-(4-aminophenyl)ethyl]adenosine (APNEA), an adenosine A3 receptor agonist, was equally protective. The unselective antagonist 8-p-sulphophenyl theophylline at 100 microM abolished protection by preconditioning, adenosine, and APNEA, but 200 nM DPCPX did not block protection by any of the interventions. Likewise the potent but unselective A3 receptor antagonist 8-(4-carboxyethenylphenyl)-1,3-dipropylxanthine (BW A1433) completely blocked protection from ischaemic preconditioning. Because protection against infarction afforded by ischaemic preconditioning, adenosine, or the A3 receptor agonist APNEA could not be blocked by DPCPX and because the potent A3 receptor antagonist BW A1433 blocked protection from ischaemic preconditioning, these data indicate that the protection of preconditioning is not exclusively mediated by the adenosine A1 receptor in rabbit heart and could involve the A3 receptor.

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…

G-protection mechanisms afforded by the anti-G suit abdominal bladder with and without pressure breathing.

PubMed

Eiken, Ola; Bergsten, Eddie; Grönkvist, Mikael

2011-10-01

G protection afforded by the abdominal bladder of a pneumatic anti-G suit is usually attributed to counteraction of G-induced caudad displacement of the heart and pooling of blood in the abdominal veins. The study examined whether the abdominal bladder might provide G protection also via other mechanisms. Each subject was exposed to +Gz loads while sitting relaxed, wearing a full-coverage anti-G suit modified to permit separate pressurization of the abdominal and leg bladders. In two experimental series (N = 8, N = 14), subjects were breathing at positive airway pressure (PPB); in a third series, five subjects were breathing at atmospheric airway pressure. Intrathoracic pressures were estimated by use of esophageal catheters. During PPB at high G loads, intrathoracic pressure was higher with than without the pressurized abdominal bladder. In 7 of the 14 subjects, basilar intrathoracic pressure exceeded airway pressure during PPB when the abdominal bladder was pressurized. The mean arterial pressure response at high G loads was higher in this subset of subjects (55 +/- 23 mmHg) than in the subjects in whom airway pressure exceeded intrathoracic pressure (41 +/- 27 mmHg). Without PPB at increased G load, the intrathoracic pressure gradient was higher with than without the pressurized abdominal bladder. During PPB, the abdominal bladder acts as an airway counterpressure, thereby facilitating pressure transmission from the airways to the thorax and hence improving G protection. It also appears that in several individuals, pressure may be transmitted from the abdominal bladder to the thorax and heart.

Physician knowledge of and attitudes toward the Patient Protection and Affordable Care Act.

PubMed

Rocke, Daniel J; Thomas, Steven; Puscas, Liana; Lee, Walter T

2014-02-01

To assess otolaryngology physician knowledge of and attitudes toward the Patient Protection and Affordable Care Act (PPACA) and compare the association of bias toward the PPACA with knowledge of the provisions of the PPACA. Cross-sectional survey. Nationwide assessment. Members of the American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngology physicians answered 10 true/false questions about major provisions of the PPACA. They also indicated their level of agreement with 9 statements about health care and the PPACA. Basic demographic information was collected. Email solicitation was sent to 9972 otolaryngologists and 647 responses were obtained (6.5% response rate). Overall correct response rate was 74%. Fewer than 60% of physicians correctly answered questions on whether small businesses receive tax credits for providing health insurance, the effect of the PPACA on Medicare benefits, and whether a government-run health insurance plan was created. Academic center practice setting, bias toward the PPACA, and Democratic Party affiliation were associated with significantly more correct responses. Overall physician knowledge of the PPACA is assessed as fair, although better than the general public in 2010. There are several areas where knowledge of physicians regarding the PPACA is poor, and this knowledge deficit is more pronounced within certain subgroups. These knowledge issues should be addressed by individual physicians and medical societies.

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

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

PubMed

Abdus, Salam; Mistry, Kamila B; Selden, Thomas M

2015-11-01

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). 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. 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. 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.

Quality Health Care for Children and the Affordable Care Act: A Voltage Drop Checklist

PubMed Central

Wise, Paul H.; Halfon, Neal

2014-01-01

The Affordable Care Act (ACA) introduces enormous policy changes to the health care system with several anticipated benefits and a growing number of unanticipated challenges for child and adolescent health. Because the ACA gives each state and their payers substantial autonomy and discretion on implementation, understanding potential effects will require state-by-state monitoring of policies and their impact on children. The “voltage drop” framework is a useful interpretive guide for assessing the impact of insurance market change on the quality of care received. Using this framework we suggest a state-level checklist to examine ACA statewide implementation, assess its impact on health care delivery, and frame policy correctives to improve child health system performance. Although children’s health care is a small part of US health care spending, child health provides the foundation for adult health and must be protected in ACA implementation. PMID:25225140

Environmental Protection: Can We Afford It

DTIC Science & Technology

1993-04-01

economic stability is weakening as businesses close down, cut back, or relocate. This paper looks at how much the U.S. is spending on environmental protection and considers the benefits derived from the dollars invested, discusses some of the impacts resulting from strict environmental regulation, and offers some options to alleviate the negative consequences of current U.S. environmental

The patient protection and affordable care act: what does it mean for mental health services for older adults?

PubMed

Sorrell, Jeanne M

2012-11-01

The U.S. Supreme Court recently upheld the constitutionality of the Patient Protection and Affordable Care Act (PPACA). It is important to think about how this act will affect mental health services for older adults. The act has the potential to improve health outcomes across all income and age groups. There are specific provisions that are expected to improve care for individuals with mental illness, but there is little information about how these provisions will affect older adults with mental illness. As we move toward implementation of the PPACA, psychiatric nurses need to be aware of myths surrounding the act and to think about changes in the health care system, such as collaborative models of care, that may help identify and overcome barriers to treatment of older adults with mental illness. Copyright 2012, SLACK Incorporated.

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

PubMed Central

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

2015-01-01

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

Impact of Patient Protection and Affordable Care Act on academic radiology departments' clinical, research, and education missions.

PubMed

Mansoori, Bahar; Vidal, Lorenna L; Applegate, Kimberly; Rawson, James V; Novak, Ronald D; Ros, Pablo R

2013-10-01

The Patient Protection and Affordable Care Act (ACA) generated significant media attention since its inception. When the law was approved in 2010, the U.S. health care system began facing multiple changes to adapt and to incorporate measures to meet the new requirements. These mandatory changes will be challenging for academic radiology departments (ARDs) since they will need to promote a shift from a volume-focused to a value-focused practice. This will affect all components of the mission of ARDs, including clinical practice, education, and research. A unique key element to success in this transition is to focus on both quality and safety, thus improving the value of radiology in the post-ACA era. Given the changes ARDs will face during the implementation of ACA, suggestions are provided on how to adapt ARDs to this new environment. Copyright © 2013. Published by Elsevier Inc.

The Patient Protection and Affordable Care Act's provisions regarding medical loss ratios and quality: evidence from Texas.

PubMed

Quast, Troy

2013-01-01

The Patient Protection and Affordable Care Act (PPACA) includes a provision that penalizes insurance companies if their Medical Loss Ratio (MLR) falls below a specified threshold. The MLR is roughly measured as the ratio of health care expenses to premiums paid by enrollees. I investigate whether there is a relationship between MLRs and the quality of care provided by insurance companies. I employ a ten-year sample of market-level financial data and quality variables for Texas insurers, as well as relevant control variables, in regression analyses that utilize insurer and market fixed effects. Of the 15 quality measures, only one has a statistically significant relationship with the MLR. For this measure, the relationship is negative. Although the MLR provision may provide incentives for insurance companies to lower premiums, this sample does not suggest that there is likely to be a beneficial effect on quality.

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.

Alcohol affordability and alcohol demand: cross-country trends and panel data estimates, 1975 to 2008.

PubMed

Nelson, Jon P

2014-04-01

Relatively little is known about cross-country differences in alcohol affordability or factors that determine differences in affordability over time. This information is potentially important for alcohol policy, especially policies that focus on higher taxes or prices to reduce total alcohol consumption. This study estimates cross-country alcohol consumption relationships using economic models incorporating income and prices and alternative models based on alcohol affordability. The data and analysis are restricted to higher income countries. Data for alcohol consumption per capita (ages 15+) are analyzed for 2 samples: first, 17 countries in the Organisation for Economic Co-operation and Development for the period 1975 to 2000; second, 22 countries in the European Union for the period from 2000 to 2008. Panel data models are utilized, with country and time fixed-effects to control for confounding influences. In economic demand models, covariates are real per capita income and real alcohol price indices. In affordability models, income is divided by prices to yield an index of alcohol affordability. Analysis of data trends reveals that much of the increase in affordability is due to rising real incomes, and not falling real prices. Economic models of demand perform slightly better statistically, but differences are not substantial as income and affordability are highly correlated. For both samples, exogenous rates of growth of alcohol consumption are negative. Price and income elasticities, on average, are within the range of prior estimates. Affordability elasticities are between 0.21 and 0.25. Although alcohol affordability is a valid concept statistically, its use in policy discussions tends to hide underlying causes of changes in affordability. A better approach is a comparison and analysis of trends and cross-country differences in real incomes and real alcohol prices together with the affordability index. Country-level analysis of income and price

Enhanced protection against Ebola virus mediated by an improved adenovirus-based vaccine.

PubMed

Richardson, Jason S; Yao, Michel K; Tran, Kaylie N; Croyle, Maria A; Strong, James E; Feldmann, Heinz; Kobinger, Gary P

2009-01-01

The Ebola virus is transmitted by direct contact with bodily fluids of infected individuals, eliciting death rates as high as 90% among infected humans. Currently, replication defective adenovirus-based Ebola vaccine is being studied in a phase I clinical trial. Another Ebola vaccine, based on an attenuated vesicular stomatitis virus has shown efficacy in post-exposure treatment of nonhuman primates to Ebola infection. In this report, we modified the common recombinant adenovirus serotype 5-based Ebola vaccine expressing the wild-type ZEBOV glycoprotein sequence from a CMV promoter (Ad-CMVZGP). The immune response elicited by this improved expression cassette vector (Ad-CAGoptZGP) and its ability to afford protection against lethal ZEBOV challenge in mice was compared to the standard Ad-CMVZGP vector. Ad-CMVZGP was previously shown to protect mice, guinea pigs and nonhuman primates from an otherwise lethal challenge of Zaire ebolavirus. The antigenic expression cassette of this vector was improved through codon optimization, inclusion of a consensus Kozak sequence and reconfiguration of a CAG promoter (Ad-CAGoptZGP). Expression of GP from Ad-CAGoptZGP was substantially higher than from Ad-CMVZGP. Ad-CAGoptZGP significantly improved T and B cell responses at doses 10 to 100-fold lower than that needed with Ad-CMVZGP. Additionally, Ad-CAGoptZGP afforded full protections in mice against lethal challenge at a dose 100 times lower than the dose required for Ad-CMVZGP. Finally, Ad-CAGoptZGP induced full protection to mice when given 30 minutes post-challenge. We describe an improved adenovirus-based Ebola vaccine capable of affording post-exposure protection against lethal challenge in mice. The molecular modifications of the new improved vaccine also translated in the induction of significantly enhanced immune responses and complete protection at a dose 100 times lower than with the previous generation adenovirus-based Ebola vaccine. Understanding and improving the

Community health workers and the Patient Protection and Affordable Care Act: an opportunity for a research, advocacy, and policy agenda.

PubMed

Shah, Megha K; Heisler, Michele; Davis, Matthew M

2014-02-01

Community health workers (CHWs), who have been shown to be effective in multiple roles in the provision of culturally appropriate health care in a variety of settings, have the potential to be important members of an interdisciplinary health care team. Recent efforts have started to explore how best to integrate CHWs into the health system. However, to date, there has been limited policy guidance, support, or evidence on how best to achieve this on a larger scale. The Patient Protection and Affordable Care Act (ACA), through several provisions, provides a unique opportunity to create a unified framework for workforce integration and wider utilization of CHWs. This review identifies four major opportunities to further the research, advocacy, and policy agenda for CHWs.

Trends in Total Hip Arthroplasty Under the Patient Protection and Affordable Care Act: A National Database Analysis Between 2008 and 2015.

PubMed

Etcheson, Jennifer I; George, Nicole E; Gwam, Chukwuweike U; Nace, James; Caughran, Alexander T; Thomas, Melbin; Virani, Sana; Delanois, Ronald E

2018-05-16

The Patient Protection and Affordable Care Act expanded health coverage for low-earning individuals and families. With more Americans having access to care, the use of elective procedures, such as total hip arthroplasty (THA), was expected to increase. Therefore, the aim of this study was to evaluate trends in THA before and after the initiation of the Patient Protection and Affordable Care Act regarding race, age, body mass index, and sex between 2008 and 2015. The National Surgical Quality Improvement Program database was queried for all individuals who had undergone primary THA between 2008 and 2015. This yielded a total of 104,209 patients. Descriptive statistics were used to analyze patient-level data. A Cochran-Armitage test assessed trends in categorical data points over time. Analysis indicated an increased percentage of blacks or African Americans undergoing THA (7.8% vs 9.2%, P<.001), followed by Native Americans or Pacific Islanders (0.0% vs 0.4%, P<.001), American Indians or Alaskan Natives (0.3% vs 0.5%, P=.016), and Asians (1.4% vs 1.5%, P=.002). An increased percentage of patients 55 to 80 years old received THAs (68.6% vs 74.1%, P<.001). The percentage of patients with a body mass index of 25.0 to 29.9 kg/m 2 , 30.0 to 34.9 kg/m 2 , and 35.0 to 39.9 kg/m 2 increased (32.9% vs 33.1%, 24.2% vs 25.6%, 12.6% vs 13.3%, respectively, P<.001 for all). These findings may provide insight on the changing patient characteristics for orthopedic surgeons performing THA. Furthermore, these findings may inform health policy makers interested in increasing access to procedures underutilized by specific patient populations and the creation of strategies to meet increased demand. [Orthopedics. 201x; xx(x):xx-xx.]. Copyright 2018, SLACK Incorporated.

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

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

Procedures for the Handling of Retaliation Complaints Under Section 1558 of the Affordable Care Act. Final rule.

PubMed

2016-10-13

This document provides the final text of regulations governing employee protection (retaliation or whistleblower) claims under section 1558 of the Affordable Care Act, which added section 18C to the Fair Labor Standards Act to provide protections to employees who may have been subject to retaliation for seeking assistance under certain affordability assistance provisions (for example, health insurance premium tax credits) or for reporting potential violations of the Affordable Care Act's consumer protections (for example, the prohibition on rescissions). An interim final rule (IFR) governing these provisions and request for comments was published in the Federal Register on February 27, 2013. Thirteen comments were received; eleven were responsive to the IFR. This rule responds to those comments and establishes the final procedures and time frames for the handling of retaliation complaints under section 18C, including procedures and time frames for employee complaints to the Occupational Safety and Health Administration (OSHA), investigations by OSHA, appeals of OSHA determinations to an administrative law judge (ALJ) for a hearing de novo, hearings by ALJs, review of ALJ decisions by the Administrative Review Board (ARB) (acting on behalf of the Secretary of Labor), and judicial review of the Secretary of Labor's (Secretary's) final decision. It also sets forth the Secretary's interpretations of the Affordable Care Act whistleblower provision on certain matters.

Proposed regulations could limit access to affordable health coverage for workers' children and family members.

PubMed

Jacobs, Ken; Graham-Squire, Dave; Roby, Dylan H; Kominski, Gerald F; Kinane, Christina M; Needleman, Jack; Watson, Greg; Gans, Daphna

2011-12-01

Key Findings. The Patient Protection and Affordable Care Act (ACA) is designed to offer premium subsidies to help eligible individuals and their families purchase insurance coverage when affordable job-based coverage is not available. However, the law is unclear on how this affordability protection is applied in those instances where self-only coverage offered by an employer is affordable but family coverage is not. Regulations recently proposed by the Department of the Treasury would make family members ineligible for subsidized coverage in the exchange if an employee is offered affordable self-only coverage by an employer, even if family coverage is unaffordable. This could have significant financial consequences for low- and moderate-income families that fall in this gap. Using an alternative interpretation of the law could allow the entire family to enter the exchange when family coverage is unaffordable, which would broaden access to coverage. However, this option has been cited as cost prohibitive. In this brief we consider a middle ground alternative that would base eligibility for the individual worker on the cost of self-only coverage, but would use the additional cost to the employee for family coverage as the basis for determining affordability and eligibility for subsidies for the remaining family members. We find that: Under the middle ground alternative scenario an additional 144,000 Californians would qualify for and use premium subsidies in the California Health Benefit Exchange, half of whom are children. Less than 1 percent of those with employer-based coverage would move to subsidized coverage in the California Health Benefit Exchange as a result of having unaffordable coverage on the job.

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.

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. © 2015 Society for Public Health Education.

High medicine prices and poor affordability.

PubMed

Suh, Guk-Hee

2011-07-01

In developing countries, most people who need medicines have to pay for them out of their own pockets. This review focuses on publications to explore the affordability gap of medicines and ways to close it. Cardiovascular medicines were unaffordable in low-income to middle-income countries, whereas dementia medicines were only affordable in regions of wealth. In urban Mozambique, local mark-ups are up to two-thirds of final price in private pharmacies, whereas some governments consistently paid higher prices above the international reference prices to procure a number of medicines. Generics competition from India made an originator brand manufacturer of a AIDS drug willing to supply the drug at a cheaper rate to poorer countries, whereas a Brazilian national program to produce nonprofit generics against protected patent of originator brand products to provide free AIDS drugs had cut the number of people dying by half and hospitalization by 80%, which saved about half a billion US dollars, making the program almost fund itself. Although lowering the manufacturer's price has a greater effect on the cost, policies to eliminate duties and taxes on medicines and regulate mark-ups are practical strategies to avoid excessive add-on costs.

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

...This final rule provides detail and parameters related to: the risk adjustment, reinsurance, and risk corridors programs; cost-sharing reductions; user fees for Federally-facilitated Exchanges; advance payments of the premium tax credit; the Federally-facilitated Small Business Health Option Program; and the medical loss ratio program. Cost-sharing reductions and advance payments of the premium tax credit, combined with new insurance market reforms, are expected to significantly increase the number of individuals with health insurance coverage, particularly in the individual market. In addition, we expect the premium stabilization programs--risk adjustment, reinsurance, and risk corridors--to protect against the effects of adverse selection. These programs, in combination with the medical loss ratio program and market reforms extending guaranteed availability (also known as guaranteed issue) and prohibiting the use of factors such as health status, medical history, gender, and industry of employment to set premium rates, will help to ensure that every American has access to high-quality, affordable health insurance.

Melanin distribution in human epidermis affords localized protection against DNA photodamage and concurs with skin cancer incidence difference in extreme phototypes.

PubMed

Fajuyigbe, Damilola; Lwin, Su M; Diffey, Brian L; Baker, Richard; Tobin, Desmond J; Sarkany, Robert P E; Young, Antony R

2018-02-02

Epidermal DNA damage, especially to the basal layer, is an established cause of keratinocyte cancers (KCs). Large differences in KC incidence (20- to 60-fold) between white and black populations are largely attributable to epidermal melanin photoprotection in the latter. The cyclobutane pyrimidine dimer (CPD) is the most mutagenic DNA photolesion; however, most studies suggest that melanin photoprotection against CPD is modest and cannot explain the considerable skin color-based differences in KC incidence. Along with melanin quantity, solar-simulated radiation-induced CPD assessed immediately postexposure in the overall epidermis and within 3 epidermal zones was compared in black West Africans and fair Europeans. Melanin in black skin protected against CPD by 8.0-fold in the overall epidermis and by 59.0-, 16.5-, and 5.0-fold in the basal, middle, and upper epidermis, respectively. Protection was related to the distribution of melanin, which was most concentrated in the basal layer of black skin. These results may explain, at least in part, the considerable skin color differences in KC incidence. These data suggest that a DNA protection factor of at least 60 is necessary in sunscreens to reduce white skin KC incidence to a level that is comparable with that of black skin.-Fajuyigbe, D., Lwin, S. M., Diffey, B. L., Baker, R., Tobin, D. J., Sarkany, R. P. E., Young, A. R. Melanin distribution in human epidermis affords localized protection against DNA photodamage and concurs with skin cancer incidence difference in extreme phototypes.

The patient protection and Affordable Care Act: a primer for hand surgeons.

PubMed

Adkinson, Joshua M; Chung, Kevin C

2014-08-01

The Affordable Care Act is the largest and most comprehensive overhaul of the United States health care 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. Copyright © 2014 Elsevier Inc. All rights reserved.

Uninsured veterans who will need to obtain insurance coverage under the patient protection and affordable care act.

PubMed

Tsai, Jack; Rosenheck, Robert

2014-03-01

We examined the number and clinical needs of uninsured veterans, including those who will be eligible for the Medicaid expansion and health insurance exchanges in 2014. We analyzed weighted data for 8710 veterans from the 2010 National Survey of Veterans, classifying it by veterans' age, income, household size, and insurance status. Of 22 million veterans, about 7%, or more than 1.5 million, were uninsured and will need to obtain coverage by enrolling in US Department of Veterans Affairs (VA) care or the Medicaid expansion or by participating in the health insurance exchanges. Of those uninsured, 55%, or more than 800 000, are likely eligible for the Medicaid expansion if states implement it. Compared with veterans with any health coverage, those who were uninsured were younger and more likely to be single, Black, and low income and to have been deployed to Iraq and Afghanistan. The Patient Protection and Affordable Care Act is likely to have a considerable impact on uninsured veterans, which may have implications for the VA, the Medicaid expansion, and the health insurance exchanges.

Anticipating the effect of the Patient Protection and Affordable Care Act for patients with urologic cancer.

PubMed

Ellimoottil, Chandy; Miller, David C

2014-02-01

The Affordable Care Act seeks to overhaul the US health care system by providing insurance for more Americans, improving the quality of health care delivery, and reducing health care expenditures. Although the law's intent is clear, its implementation and effect on patient care remains largely undefined. Herein, we discuss major components of the Affordable Care Act, including the proposed insurance expansion, payment and delivery system reforms (e.g., bundled payments and Accountable Care Organizations), and other reforms relevant to the field of urologic oncology. We also discuss how these proposed reforms may affect patients with urologic cancers.

Low-dose recombinant properdin provides substantial protection against Streptococcus pneumoniae and Neisseria meningitidis infection.

PubMed

Ali, Youssif Mohammed; Hayat, Azam; Saeed, Bayad Mawlood; Haleem, Kashif S; Alshamrani, Saleh; Kenawy, Hany I; Ferreira, Viviana P; Saggu, Gurpanna; Buchberger, Anna; Lachmann, Peter J; Sim, Robert B; Goundis, Dimitrios; Andrew, Peter W; Lynch, Nicholas J; Schwaeble, Wilhelm J

2014-04-08

Modern medicine has established three central antimicrobial therapeutic concepts: vaccination, antibiotics, and, recently, the use of active immunotherapy to enhance the immune response toward specific pathogens. The efficacy of vaccination and antibiotics is limited by the emergence of new pathogen strains and the increased incidence of antibiotic resistance. To date, immunotherapy development has focused mainly on cytokines. Here we report the successful therapeutic application of a complement component, a recombinant form of properdin (Pn), with significantly higher activity than native properdin, which promotes complement activation via the alternative pathway, affording protection against N. menigitidis and S. pneumoniae. In a mouse model of infection, we challenged C57BL/6 WT mice with N. menigitidis B-MC58 6 h after i.p. administration of Pn (100 µg/mouse) or buffer alone. Twelve hours later, all control mice showed clear symptoms of infectious disease while the Pn treated group looked healthy. After 16 hours, all control mice developed sepsis and had to be culled, while only 10% of Pn treated mice presented with sepsis and recoverable levels of live Meningococci. In a parallel experiment, mice were challenged intranasally with a lethal dose of S. pneumoniae D39. Mice that received a single i.p. dose of Pn at the time of infection showed no signs of bacteremia at 12 h postinfection and had prolonged survival times compared with the saline-treated control group (P < 0.0001). Our findings show a significant therapeutic benefit of Pn administration and suggest that its antimicrobial activity could open new avenues for fighting infections caused by multidrug-resistant neisserial or streptococcal strains.

Low-dose recombinant properdin provides substantial protection against Streptococcus pneumoniae and Neisseria meningitidis infection

PubMed Central

Ali, Youssif Mohammed; Hayat, Azam; Saeed, Bayad Mawlood; Haleem, Kashif S.; Alshamrani, Saleh; Kenawy, Hany I.; Ferreira, Viviana P.; Saggu, Gurpanna; Buchberger, Anna; Lachmann, Peter J.; Sim, Robert B.; Goundis, Dimitrios; Andrew, Peter W.; Lynch, Nicholas J.; Schwaeble, Wilhelm J.

2014-01-01

Modern medicine has established three central antimicrobial therapeutic concepts: vaccination, antibiotics, and, recently, the use of active immunotherapy to enhance the immune response toward specific pathogens. The efficacy of vaccination and antibiotics is limited by the emergence of new pathogen strains and the increased incidence of antibiotic resistance. To date, immunotherapy development has focused mainly on cytokines. Here we report the successful therapeutic application of a complement component, a recombinant form of properdin (Pn), with significantly higher activity than native properdin, which promotes complement activation via the alternative pathway, affording protection against N. menigitidis and S. pneumoniae. In a mouse model of infection, we challenged C57BL/6 WT mice with N. menigitidis B-MC58 6 h after i.p. administration of Pn (100 µg/mouse) or buffer alone. Twelve hours later, all control mice showed clear symptoms of infectious disease while the Pn treated group looked healthy. After 16 hours, all control mice developed sepsis and had to be culled, while only 10% of Pn treated mice presented with sepsis and recoverable levels of live Meningococci. In a parallel experiment, mice were challenged intranasally with a lethal dose of S. pneumoniae D39. Mice that received a single i.p. dose of Pn at the time of infection showed no signs of bacteremia at 12 h postinfection and had prolonged survival times compared with the saline-treated control group (P < 0.0001). Our findings show a significant therapeutic benefit of Pn administration and suggest that its antimicrobial activity could open new avenues for fighting infections caused by multidrug-resistant neisserial or streptococcal strains. PMID:24706855

Emerging Affordances in Telecollaborative Multimodal Interactions

ERIC Educational Resources Information Center

Dey-Plissonneau, Aparajita; Blin, Françoise

2016-01-01

Drawing on Gibson's (1977) theory of affordances, Computer-Assisted Language Learning (CALL) affordances are a combination of technological, social, educational, and linguistic affordances (Blin, 2016). This paper reports on a preliminary study that sought to identify the emergence of affordances during an online video conferencing session between…

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

Limited impact on health and access to care for 19- to 25-year-olds following the Patient Protection and Affordable Care Act.

PubMed

Kotagal, Meera; Carle, Adam C; Kessler, Larry G; Flum, David R

2014-11-01

The Patient Protection and Affordable Care Act (PPACA) allowed young adults to remain on their parents' insurance until 26 years of age. Reports indicate that this has expanded health coverage. To evaluate coverage, access to care, and health care use among 19- to 25-year-olds compared with 26- to 34-year-olds following PPACA implementation. Data from the Behavior Risk Factor Surveillance System and the National Health Interview Survey, which provide nationally representative measures of coverage, access to care, and health care use, were used to conduct the study among participants aged 19 to 25 years (young adults) and 26 to 34 years (adults) in 2009 and 2012. Self-reported health insurance coverage. Health status, presence of a usual source of care, and ability to afford medications, dental care, or physician visits. Health coverage increased between 2009 and 2012 for 19- to 25-year-olds (68.3% to 71.7%). Using a difference-in-differences (DID) approach, after adjustment, the likelihood of having a usual source of care decreased in both groups but more significantly for 26- to 34-year-olds (DID, 2.8%; 95% CI, 0.45 to 5.15). There was no significant change in health status for 19- to 25-year-olds compared with 26- to 34-year-olds (DID, -0.5%; 95% CI, -1.87 to 0.87). There was no significant change for 19- to 25-year-olds compared with 26- to 34-year-olds in the percentage who reported receiving a routine checkup in the past year (DID, 0.3%; 95% CI, -2.25 to 2.85) or in the ability to afford prescription medications (DID, -0.4%; 95% CI, -2.93 to 1.93), dental care (DID, -2.6%; 95% CI, -5.61 to 0.61), or physician visits (DID, -1.7%; 95% CI, -3.66 to 0.26). There was also no change in the percentage who reported receiving a flu shot (DID, 1.9; 95% CI, -1.93 to 4.93). Insured individuals were more likely to report having a usual source of care and a recent routine checkup and were more likely to be able to afford health care than uninsured individuals

Roles of phospho-GSK-3β in myocardial protection afforded by activation of the mitochondrial K ATP channel.

PubMed

Terashima, Yoshiaki; Sato, Tatsuya; Yano, Toshiyuki; Maas, Ole; Itoh, Takahito; Miki, Takayuki; Tanno, Masaya; Kuno, Atsushi; Shimamoto, Kazuaki; Miura, Tetsuji

2010-11-01

The aim of this study was to determine the roles of glycogen synthase kinase-3β (GSK-3β) in cardioprotection by activation of the mitochondrial ATP-sensitive K(+) channel (mK(ATP) channel). In isolated rat hearts, an mK(ATP) activator, diazoxide, and a GSK-3β inhibitor, SB216763, similarly limited infarct size and the combination of these agents did not afford further protection. The protection by pre-ischemic treatment with diazoxide was abolished by inhibition of protein kinase C-ε (PKC-ε) or phosphatidylinositol-3-kinase (PI3K) upon reperfusion. Infusion of a GSK-3β inhibitor (LiCl), but not diazoxide, during reperfusion limited infarct size. Inhibition of PKC-ε or PI3K did not affect the protection by LiCl. Diazoxide infusion alone did not induce GSK-3β phosphorylation. However, diazoxide infusion before ischemia increased mitochondrial phospho-GSK-3β level and reduced cyclophilin-D (CypD) binding to adenine nucleotide translocase (ANT) at 10 min after reperfusion. This diazoxide-induced GSK-3β phosphorylation was inhibited by blockade of the mK(ATP) channel before ischemia and by blockade of PKC-ε, PI3K or the adenosine A2b receptor at the time of reperfusion. Inhibition of GSK-3β by LiCl during reperfusion increased phospho-GSK-3β but had no significant effect on CypD-ANT binding. These results suggest that GSK-3β phosphorylation at the time of reperfusion by a PKC-ε, PI3K- and A2b receptor-dependent mechanism contributes to prevention of myocardial necrosis by pre-ischemic activation of the mK(ATP) channel. Inhibition of CypD-ANT interaction may contribute to mK(ATP)-induced myocardial protection, though it is not the sole mechanism of phospho-GSK-3β-mediated cytoprotection. Copyright © 2010 Elsevier Ltd. All rights reserved.

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.

Economical impact of plasma fractionation project in Iran on affordability of plasma-derived medicines.

PubMed

Cheraghali, A M; Aboofazeli, R

2009-12-01

In Iran all transfusion services are concentrated under authority of one public and centralized transfusion organization which has created the opportunity of using plasma produced in its blood centers for fractionation. In 2008 voluntary and non remunerated Iranian donors donated 1.8 million units of blood. This indicates a 25/1000 donation index. After responding to the needs for fresh plasma and cryoprecipitate each year about 150000 L of recovered plasma are reserved for fractionation. In an attempt to improve both blood safety profile and availability and affordability of plasma derived medicines, Iran's national transfusion service has entered into a contract fractionation agreement for surplus of plasma produced from donated blood by voluntary non remunerated donors. In order to ensure safety of product produced, Iran has chosen to collaborate with international fractionators based in highly regulated countries. The main objective of this study was to evaluate the impact of contract plasma fractionation on the affordability of the plasma derived medicines in Iran. During 2006-2008, Iran's contract fractionation project was able to produce 46%, 18% and 6% of IVIG, Albumin and FVIII consumed in Iran's market, respectively. In contrary to IVIG and Albumin, due to fairly high consumption of FVIII in Iran, the role of fractionation project in meeting the needs to FVIII was not substantial. However, Iran's experience has shown that contract plasma fractionation, through direct and indirect effects on price of plasma derived medicines, could substantially improve availability and affordability of such products in national health care system.

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.

Characterization of leptospiral proteins that afford partial protection in hamsters against lethal challenge with Leptospira interrogans.

PubMed

Atzingen, Marina V; Gonçales, Amane P; de Morais, Zenaide M; Araújo, Eduardo R; De Brito, Thales; Vasconcellos, Silvio A; Nascimento, Ana L T O

2010-09-01

Leptospirosis is a worldwide zoonosis caused by pathogenic Leptospira. The whole-genome sequence of Leptospira interrogans serovar Copenhageni together with bioinformatic tools allow us to search for novel antigen candidates suitable for improved vaccines against leptospirosis. This study focused on three genes encoding conserved hypothetical proteins predicted to be exported to the outer membrane. The genes were amplified by PCR from six predominant pathogenic serovars in Brazil. The genes were cloned and expressed in Escherichia coli strain BL21-SI using the expression vector pDEST17. The recombinant proteins tagged with N-terminal 6xHis were purified by metal-charged chromatography. The proteins were recognized by antibodies present in sera from hamsters that were experimentally infected. Immunization of hamsters followed by challenge with a lethal dose of a virulent strain of Leptospira showed that the recombinant protein rLIC12730 afforded statistically significant protection to animals (44 %), followed by rLIC10494 (40 %) and rLIC12922 (30 %). Immunization with these proteins produced an increase in antibody titres during subsequent boosters, suggesting the involvement of a T-helper 2 response. Although more studies are needed, these data suggest that rLIC12730 and rLIC10494 are promising candidates for a multivalent vaccine for the prevention of leptospirosis.

Uninsured Veterans Who Will Need to Obtain Insurance Coverage Under the Patient Protection and Affordable Care Act

PubMed Central

Rosenheck, Robert

2014-01-01

Objectives. We examined the number and clinical needs of uninsured veterans, including those who will be eligible for the Medicaid expansion and health insurance exchanges in 2014. Methods. We analyzed weighted data for 8710 veterans from the 2010 National Survey of Veterans, classifying it by veterans’ age, income, household size, and insurance status. Results. Of 22 million veterans, about 7%, or more than 1.5 million, were uninsured and will need to obtain coverage by enrolling in US Department of Veterans Affairs (VA) care or the Medicaid expansion or by participating in the health insurance exchanges. Of those uninsured, 55%, or more than 800 000, are likely eligible for the Medicaid expansion if states implement it. Compared with veterans with any health coverage, those who were uninsured were younger and more likely to be single, Black, and low income and to have been deployed to Iraq and Afghanistan. Conclusions. The Patient Protection and Affordable Care Act is likely to have a considerable impact on uninsured veterans, which may have implications for the VA, the Medicaid expansion, and the health insurance exchanges. PMID:24432934

45 CFR 155.320 - Verification process related to eligibility for insurance affordability programs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... information regarding eligibility for and enrollment in a health plan, which may be considered protected health information, as that term is defined in § 160.103 of this subchapter, is expressly authorized, for... insurance affordability programs. 155.320 Section 155.320 Public Welfare Department of Health and Human...

Limited Impact on Health and Access to Care for 19- to 25-Year-Olds Following the Patient Protection and Affordable Care Act

PubMed Central

Kotagal, Meera; Carle, Adam C.; Kessler, Larry G.; Flum, David R.

2014-01-01

IMPORTANCE The Patient Protection and Affordable Care Act (PPACA) allowed young adults to remain on their parents’ insurance until 26 years of age. Reports indicate that this has expanded health coverage. OBJECTIVE To evaluate coverage, access to care, and health care use among 19- to 25-year-olds compared with 26- to 34-year-olds following PPACA implementation. DESIGN, SETTING, AND PARTICIPANTS Data from the Behavior Risk Factor Surveillance System and the National Health Interview Survey, which provide nationally representative measures of coverage, access to care, and health care use, were used to conduct the study among participants aged 19 to 25 years (young adults) and 26 to 34 years (adults) in 2009 and 2012. EXPOSURE Self-reported health insurance coverage. MAIN OUTCOMES AND MEASURES Health status, presence of a usual source of care, and ability to afford medications, dental care, or physician visits. RESULTS Health coverage increased between 2009 and 2012 for 19- to 25-year-olds (68.3% to 71.7%). Using a difference-in-differences (DID) approach, after adjustment, the likelihood of having a usual source of care decreased in both groups but more significantly for 26- to 34-year-olds (DID, 2.8%; 95% CI, 0.45 to 5.15). There was no significant change in health status for 19- to 25-year-olds compared with 26- to 34-year-olds (DID, −0.5%; 95% CI, −1.87 to 0.87). There was no significant change for 19- to 25-year-olds compared with 26- to 34-year-olds in the percentage who reported receiving a routine checkup in the past year (DID, 0.3%; 95% CI, −2.25 to 2.85) or in the ability to afford prescription medications (DID, −0.4%; 95% CI, −2.93 to 1.93), dental care (DID, −2.6%; 95% CI, −5.61 to 0.61), or physician visits (DID, −1.7%; 95% CI, −3.66 to 0.26). There was also no change in the percentage who reported receiving a flu shot (DID, 1.9; 95% CI, −1.93 to 4.93). Insured individuals were more likely to report having a usual source of care and

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

Protection afforded by respirators when performing endotracheal intubation using a direct laryngoscope, GlideScope®, and i-gel® device: A randomized trial

PubMed Central

Lim, Tae Ho; Oh, Jaehoon; Lee, Juncheol; Shin, Hyungoo

2018-01-01

Emergency physicians are at risk of infection during invasive procedures, and wearing a respirator can reduce this risk. The aim of this study was to determine whether the protection afforded by a respirator during intubation is affected by the type of airway device used. In this randomized crossover study, 26 emergency physicians underwent quantitative fit tests for a N95 respirator (cup-type or fold-type) before and during intubation with a direct laryngoscope, GlideScope®, or i-gel® airway device. The primary outcome was the fit factor value of the respirator and the secondary outcome was the level of acceptable protection provided (percentage of fit factor scores above 100). Compared with the GlideScope and i-gel device, the fit factor values and level of acceptable protection provided were lower when physicians wore the cup-type respirator while intubating using the direct laryngoscope (200 fit factor [152–200] and 200 fit factor [121.25–200] versus 166 fit factor [70–200], 100% and 100% versus 75%, respectively; all P < 0.001). There were no significant differences in the fit factor value or level of acceptable protection provided when the physicians wore the fold-type respirator while intubating using any of the three airway devices (all P > 0.05). The type of airway device used for endotracheal intubation may influence the protective performance of some types of respirators. Emergency physicians should consider the effects of airway device types on fit factor of N95 respirators, when they perform intubation at risk of infection. PMID:29672533

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…

Childhood cancer survivors' familiarity with and opinions of the Patient Protection and Affordable Care Act.

PubMed

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

2013-09-01

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. 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. 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. 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.

Achieving public health goals through Medicaid expansion: opportunities in criminal justice, homelessness, and behavioral health with the Patient Protection and Affordable Care Act.

PubMed

DiPietro, Barbara; Klingenmaier, Lisa

2013-12-01

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.

The Patient Protection and Affordable Care Act: impact on mental health services demand and provider availability.

PubMed

Pearlman, Shoshannah A

2013-01-01

The Patient Protection and Affordable Care Act (ACA) will greatly increase the demand for mental health (MH) services, as 62.5 million Americans from relatively high-need populations will be newly eligible for MH benefits. Consequently, the supply of MH care provider services is expected to proportionately decrease by 18% to 21% in 2014. ACA funding does not demonstrate the ability to increase turnout of psychiatrists sufficiently to meet the need. Available data indicate that the numbers of advanced practice psychiatric nurses (APPNs) continue to increase at a much greater rate, but information from either a clinical perspective or a market perspective is complicated by the weak distinctions that are made between nurse practitioners (NPs) and other nonphysician care professionals. The following recommendations are made: (a) some of the ACA funding for research into efficient and effective care delivery systems should be allocated to acquiring data on APPNs in leadership roles or clinical settings in which they are ultimately responsible for management of MH care, as differentiated from settings in which they provide support for psychiatrists; and (b) since the available data indicate nurse practitioners achieve good outcomes and are more economically viable than psychiatrists, placement of psychiatric-mental health nurse practitioners in community settings should be recognized as a realistic solution to the shortfall of MH services.

Children and the Patient Protection and Affordable Care Act: opportunities and challenges in an evolving system.

PubMed

Keller, David; Chamberlain, Lisa J

2014-01-01

The Patient Protection and Affordable Care Act (ACA), passed in 2010, focused primarily on the problems of adults, but the changes in payment for and delivery of care it fosters will likely impact the health care of children. The evolving epidemiology of pediatric illness in the United States has resulted in a relatively small population of medically fragile children dispersed through the country and a large population of children with developmental and behavioral health issues who experience wide degrees of health disparities. Review of previous efforts to change the health care system reveals specific innovations in child health delivery that have been designed to address issues of child health. The ACA is complex and contains some language that improves access to care, quality of care, and the particular needs of the pediatric workforce. Most of the payment models and delivery systems proposed in the ACA, however, were not designed with the needs of children in mind and will need to be adapted to address their needs. To assure that the needs of children are met as systems evolve, child health professionals within and outside academe will need to focus their efforts in clinical care, research, education, and advocacy to incorporate child health programs into changing systems and to prevent unintended harm to systems designed to care for children. Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Polarized stakeholders and institutional vulnerabilities: the enduring politics of the Patient Protection and Affordable Care Act.

PubMed

Béland, Daniel; Rocco, Philip; Waddan, Alex

2015-04-01

We conducted a comparative study of how state-level political stakeholders affected the implementation of 3 major reforms within the Patient Protection and Affordable Care Act (ACA). Our goal was to analyze the effects of policy legacy, institutional fragmentation, and public sentiments on state obstruction of the reform. We gathered quantitative and qualitative evidence to generate cross-case comparisons of state implementation of 3 reform streams within the ACA: health insurance exchanges, Medicaid expansion, and regulatory reform. Our sources included secondary literature, analysis of official decisions, and background interviews with experts and public officials. We found that state-level opponents of the ACA were most likely to be successful in challenging reforms with few preexisting policy legacies, high institutional fragmentation, and negative public sentiments. Reforms that built on existing state legislation, avoided state veto points or offered lucrative fiscal incentives, and elicited less negative public reaction were less likely to be contested. Our findings point to the importance of institutional design for the role of political stakeholders in implementing reforms to improve the cost, quality, and availability of medical treatments. Although other research has found that political polarization has shaped early ACA outcomes, comparative analysis suggests political stakeholders have had the highest effect on reforms that were particularly vulnerable. Copyright © 2015 Elsevier HS Journals, Inc. All rights reserved.

Social affordances and the possibility of ecological linguistics.

PubMed

Kono, Tetsuya

2009-12-01

This paper includes an effort to extend the notion of affordance from a philosophical point of view the importance of ecological approach for social psychology, ethics, and linguistics. Affordances are not always merely physical but also interpersonal and social. I will conceptualize affordance in general and social affordance in particular, and will elucidate the relation between intentional action and affordances, and that between affordances and free will. I will also focus on the relation between social institution and affordance. An extended theory of affordances can provide a way to analyze in concrete ways how social institution works as an implicit background of interpersonal interactions. Ecological approach considers social institution as the producer and maintainer of affordances. Social institutions construct the niches for human beings. Finally, I will argue the possibility of the ecological linguistics. Language is a social institution. The system of signs is the way to articulate and differentiate interpersonal affordances. Language acquires its meaning, i.e. communicative power in the interpersonal interactions, and interpersonal interactions, in turn, develop and are elaborated through the usage of signs. Communication is seen as never aimed to transmit inner ideas to others, but to guide and adjust the behaviors of others thorough articulating the affordance of responsible-ness.

Affordance Equivalences in Robotics: A Formalism

PubMed Central

Andries, Mihai; Chavez-Garcia, Ricardo Omar; Chatila, Raja; Giusti, Alessandro; Gambardella, Luca Maria

2018-01-01

Automatic knowledge grounding is still an open problem in cognitive robotics. Recent research in developmental robotics suggests that a robot's interaction with its environment is a valuable source for collecting such knowledge about the effects of robot's actions. A useful concept for this process is that of an affordance, defined as a relationship between an actor, an action performed by this actor, an object on which the action is performed, and the resulting effect. This paper proposes a formalism for defining and identifying affordance equivalence. By comparing the elements of two affordances, we can identify equivalences between affordances, and thus acquire grounded knowledge for the robot. This is useful when changes occur in the set of actions or objects available to the robot, allowing to find alternative paths to reach goals. In the experimental validation phase we verify if the recorded interaction data is coherent with the identified affordance equivalences. This is done by querying a Bayesian Network that serves as container for the collected interaction data, and verifying that both affordances considered equivalent yield the same effect with a high probability. PMID:29937724

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

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

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

Health gains and financial risk protection afforded by public financing of selected interventions in Ethiopia: an extended cost-effectiveness analysis.

PubMed

Verguet, Stéphane; Olson, Zachary D; Babigumira, Joseph B; Desalegn, Dawit; Johansson, Kjell Arne; Kruk, Margaret E; Levin, Carol E; Nugent, Rachel A; Pecenka, Clint; Shrime, Mark G; Memirie, Solomon Tessema; Watkins, David A; Jamison, Dean T

2015-05-01

The way in which a government chooses to finance a health intervention can affect the uptake of health interventions and consequently the extent of health gains. In addition to health gains, some policies such as public finance can insure against catastrophic health expenditures. We aimed to evaluate the health and financial risk protection benefits of selected interventions that could be publicly financed by the government of Ethiopia. We used extended cost-effectiveness analysis to assess the health gains (deaths averted) and financial risk protection afforded (cases of poverty averted) by a bundle of nine (among many other) interventions that the Government of Ethiopia aims to make universally available. These nine interventions were measles vaccination, rotavirus vaccination, pneumococcal conjugate vaccination, diarrhoea treatment, malaria treatment, pneumonia treatment, caesarean section surgery, hypertension treatment, and tuberculosis treatment. Our analysis shows that, per dollar spent by the Ethiopian Government, the interventions that avert the most deaths are measles vaccination (367 deaths averted per $100,000 spent), pneumococcal conjugate vaccination (170 deaths averted per $100,000 spent), and caesarean section surgery (141 deaths averted per $100,000 spent). The interventions that avert the most cases of poverty are caesarean section surgery (98 cases averted per $100,000 spent), tuberculosis treatment (96 cases averted per $100,000 spent), and hypertension treatment (84 cases averted per $100,000 spent). Our approach incorporates financial risk protection into the economic evaluation of health interventions and therefore provides information about the efficiency of attainment of both major objectives of a health system: improved health and financial risk protection. One intervention might rank higher on one or both metrics than another, which shows how intervention choice-the selection of a pathway to universal health coverage-might involve

Muscarinic Receptor Activation Protects Cells from Apoptotic Effects of DNA Damage, Oxidative Stress, and Mitochondrial Inhibition*

PubMed Central

De Sarno, Patrizia; Shestopal, Svetlana A.; King, Taj D.; Zmijewska, Anna; Song, Ling; Jope, Richard S.

2006-01-01

The impact of muscarinic receptor stimulation was examined on apoptotic signaling induced by DNA damage, oxidative stress, and mitochondrial impairment. Exposure of human neuroblastoma SH-SY5Y cells to the DNA-damaging agent camptothecin increased p53 levels, activated caspase-3, and caused cell death. Pretreatment with oxotremorine-M, a selective agonist of muscarinic receptors that are expressed endogenously in these cells, did not affect the accumulation of p53 but greatly attenuated caspase-3 activation and protected from cell death to nearly the same extent as treatment with a general caspase inhibitor. Treatment with 50–200 μm H2O2 caused the activation of caspase-3 beginning after 2–3 h, followed by eventual cell death. Oxotremorine-M pretreatment protected cells from H2O2-inducedcaspase-3 activation and death, and this was equivalent to protection afforded by a caspase inhibitor. Muscarinic receptor stimulation also protected cells from caspase-3 activation induced by exposure to rotenone, a mitochondrial complex 1 inhibitor, but no protection was evident from staurosporine-induced caspase-3 activation. The mechanism of protection afforded by muscarinic receptor activation from camptothecin-induced apoptotic signaling involved blockade of mitochondrial cytochrome c release associated with a bolstering of mitochondrial bcl-2 levels and blockade of the translocation of Bax to mitochondria. Likely the most proximal of these events to muscarinic receptor activation, mitochondrial Bax accumulation, also was attenuated by oxotremorine-M treatment after treatment with H2O2 or rotenone. These results demonstrate that stimulation of muscarinic receptors provides substantial protection from DNA damage, oxidative stress, and mitochondrial impairment, insults that may be encountered by neurons in development, aging, or neurodegenerative diseases. These findings suggest that neurotransmitter-induced signaling bolsters survival mechanisms, and inadequate

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…

[Scientific substantiation of sizes of sanitary protection zones of anthrax burial sites based on the comprehensive evaluation of risk factors].

PubMed

Kartavaya, S A; Simonova, E G; Loktionova, M N; Kolganova, O A; Ladny, V I; Raichich, S R

In the Russian Federation anthrax epizootics are still being registered among animals as well as epidemic foci of the population. This situation is linked to natural reservoirs of the pathogen - numerous anthrax burial sites which belong to class I of dangerous objects. In this connection, a one-kilometer sanitary protective zone is required according to current Russian Federation legislation. As a result, a significant land of the country is unsuitable for any agricultural use. Meanwhile, epizootologo-epidemiological observations indicate to that different anthrax burial sites differ in their characteristics and represent varying degrees of the risk. In connection with the development of the agricultural sector, intensive construction and the development of new and abandoned areas there is a need of creating unified approaches to assess the risk of anthrax burial sites, as well as to determine the size of sanitary protection zones based on the risk assessment. This article represents an original methodology to assess the actual danger of anthrax burial sites. It is based on a comprehensive multi-factor quantity-related risk assessment, described by a model that accounting the importance of each study for natural, social and biological factors. Undertaking this methodology allowed to reveal a degree of danger of anthrax burial sites located in different territories of the Russian Federation, and helped to substantiate the dimensions of their sanitary protection zones.

75 FR 27504 - Substantial Product Hazard List: Hand-Held Hair Dryers

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-17

...The Consumer Product Safety Improvement Act of 2008 (``CPSIA''), authorizes the United States Consumer Product Safety Commission (``Commission'') to specify, by rule, for any consumer product or class of consumer products, characteristics whose existence or absence shall be deemed a substantial product hazard under certain circumstances. In this document, the Commission is proposing a rule to determine that any hand-held hair dryer without integral immersion protection presents a substantial product hazard.

Affordable housing and health: a health impact assessment on physical inspection frequency.

PubMed

Klein, Elizabeth G; Keller, Brittney; Hood, Nancy; Holtzen, Holly

2015-01-01

To characterize the prevalence of health-related housing quality exposure for the vulnerable populations that live in affordable housing. Retrospective cross-sectional study. Affordable housing properties in Ohio inspected between 2007 and 2011. Stratified random sample of physical inspection reports (n = 370), including a case study of properties receiving multiple inspections (n = 35). Health-related housing factors, including mold, fire hazard, and others. The majority of affordable housing property inspections (85.1%) included at least 1 health-related housing quality issue. The prevalence of specific health-related violations was varied, with appliance and plumbing issues being the most common, followed by fire, mold, and pest violations. Across funding agencies, the actual implementation of inspection protocols differed. The majority of physical inspections identified housing quality issues that have the potential to impact human health. If the frequency of physical inspections is reduced as a result of inspection alignment, the most health protective inspection protocol should be selected for funding agency inspections; a standardized physical inspection tool is recommended to improve the consistency of inspection findings between mandatory physical inspections in order to promote optimum tenant health.

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

PubMed

Lemaire, Robin H; Bailey, Linda; Leischow, Scott J

2015-11-01

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). 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. 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. 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.

The Perceived Impact of the Patient Protection and Affordable Care Act on North Carolina's Free Clinics.

PubMed

Swan, Greg A; Foley, Kristie L

2016-01-01

The Patient Protection and Affordable Care Act of 2010 (ACA) may dramatically affect the demographics of the uninsured population and the funding prospects for free health clinics. We conducted a cross-sectional survey of 64 of 80 free clinics (80.0% response rate) in North Carolina to assess free clinic directors' knowledge of the ACA and their perceptions of how the ACA would affect clinic operations. Free clinic directors were knowledgeable about well publicized aspects of the ACA (eg, lack of Medicaid expansion in North Carolina), but they were less knowledgeable about provisions such as the Federal Tort Claims Act and high-risk pools, which may have direct and indirect effects on free clinics. Directors expressed concern over the unintended consequences of the ACA, such as reduced funding and reduced volunteerism. Anticipated clinic changes as a result of the ACA include initiation of electronic medical records and, to a lesser extent, a move to become "hybrid" clinics (federally qualified health center look-alikes). This study is focused on North Carolina free clinics that are members of the North Carolina Association of Free Clinics (NCAFC). Findings cannot be generalized to non-NCAFC free clinics or to free clinic networks outside the state. Despite its effort to expand health insurance coverage, the ACA may have unintended consequences to low-cost free clinics that serve uninsured populations. ©2016 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

Cumulative stress and substantiated maltreatment: the importance of caregiver vulnerability and adult partner violence.

PubMed

Wekerle, Christine; Wall, Anne-Marie; Leung, Eman; Trocmé, Nico

2007-04-01

Our goal is to assess the effect of caregiver vulnerabilities, singly and in combination, on the substantiation of child abuse (physical, sexual) and neglect, while controlling for relevant background variables. We test the moderator role of adult partner violence in qualifying the relationship between caregiver vulnerabilities and maltreatment substantiation. Secondary analyses of the 1998 Canadian Incidence Study of Reported Child Maltreatment (CIS) are used to predict child protective service investigation substantiation versus non-substantiation from a range of caregiver vulnerability factors. Involvement in partner violence was examined as a moderator in the relation between caregiver vulnerabilities and maltreatment substantiation. The CIS is an epidemiological survey of first-reported cases to child protective services, using a random sample of child welfare agencies across Canada. Child welfare workers completed a research form on the child, primary caregiver, family, perpetrator, severity and type of maltreatment, as well as services and court outcomes. All maltreatment classifications were assigned according to the Canadian legal definition of child abuse and neglect. Hierarchical logistic regression analyses were used, with stepped entry of: (1) demographic factors, socioeconomic disadvantage, and caregiver's own history of maltreatment; (2) caregiver vulnerability factors; (3) involvement in partner violence; (4) the interaction between caregiver vulnerability and partner violence. Caregiver substance abuse was found to be the single most potent kind of caregiver vulnerability in predicting maltreatment substantiation. When the total number of vulnerabilities was used as the predictor, prediction across all types of maltreatment increased, especially for substantiated neglect. Analyses also showed that the presence of partner violence in the home exacerbated the effect of caregiver vulnerability on substantiation. The total number of caregiver

Refusal to enrol in Ghana's National Health Insurance Scheme: is affordability the problem?

PubMed

Kusi, Anthony; Enemark, Ulrika; Hansen, Kristian S; Asante, Felix A

2015-01-17

Access to health insurance is expected to have positive effect in improving access to healthcare and offer financial risk protection to households. Ghana began the implementation of a National Health Insurance Scheme (NHIS) in 2004 as a way to ensure equitable access to basic healthcare for all residents. After a decade of its implementation, national coverage is just about 34% of the national population. Affordability of the NHIS contribution is often cited by households as a major barrier to enrolment in the NHIS without any rigorous analysis of this claim. In light of the global interest in achieving universal health insurance coverage, this study seeks to examine the extent to which affordability of the NHIS contribution is a barrier to full insurance for households and a burden on their resources. The study uses data from a cross-sectional household survey involving 2,430 households from three districts in Ghana conducted between January-April, 2011. Affordability of the NHIS contribution is analysed using the household budget-based approach based on the normative definition of affordability. The burden of the NHIS contributions to households is assessed by relating the expected annual NHIS contribution to household non-food expenditure and total consumption expenditure. Households which cannot afford full insurance were identified. Results show that 66% of uninsured households and 70% of partially insured households could afford full insurance for their members. Enroling all household members in the NHIS would account for 5.9% of household non-food expenditure or 2.0% of total expenditure but higher for households in the first (11.4%) and second (7.0%) socio-economic quintiles. All the households (29%) identified as unable to afford full insurance were in the two lower socio-economic quintiles and had large household sizes. Non-financial factors relating to attributes of the insurer and health system problems also affect enrolment in the NHIS. Affordability

Patterns in Health Care Access and Affordability Among Cancer Survivors During Implementation of the Affordable Care Act.

PubMed

Nipp, Ryan D; Shui, Amy M; Perez, Giselle K; Kirchhoff, Anne C; Peppercorn, Jeffrey M; Moy, Beverly; Kuhlthau, Karen; Park, Elyse R

2018-06-01

Cancer survivors face ongoing health issues and need access to affordable health care, yet studies examining health care access and affordability in this population are lacking. To evaluate health care access and affordability in a national sample of cancer survivors compared with adults without cancer and to evaluate temporal trends during implementation of the Affordable Care Act. We used data from the National Health Interview Survey from 2010 through 2016 to conduct a population-based study of 30 364 participants aged 18 years or older. We grouped participants as cancer survivors (n = 15 182) and those with no reported history of cancer, whom we refer to as control respondents (n = 15 182), matched on age. We excluded individuals reporting a cancer diagnosis prior to age 18 years and those with nonmelanoma skin cancers. We compared issues with health care access (eg, delayed or forgone care) and affordability (eg, unable to afford medications or health care services) between cancer survivors and control respondents. We also explored trends over time in the proportion of cancer survivors reporting these difficulties. Of the 30 364 participants, 18 356 (57.4%) were women. The mean (SD) age was 63.5 (23.5) years. Cancer survivors were more likely to be insured (14 412 [94.8%] vs 13 978 [92.2%], P < .001) and to have government-sponsored insurance (7266 [44.3%] vs 6513 [38.8%], P < .001) compared with control respondents. In multivariable models, cancer survivors were more likely than control respondents to report delayed care (odds ratio [OR], 1.38; 95% CI, 1.16-1.63), forgone medical care (OR, 1.76; 95% CI, 1.45-2.12), and/or inability to afford medications (OR, 1.77; 95% CI, 1.46-2.14) and health care services (OR, 1.46; 95% CI, 1.27-1.68) (P < .001 for all). From 2010 to 2016, the proportion of survivors reporting delayed medical care decreased each year (B = 0.47; P = .047), and the proportion of those needing and not

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... not be denied on the basis that the applicant is or has been a victim of domestic violence, dating...

Perceptions of Occupational Therapists on the Patient Protection and Affordable Care Act: Five Years After Its Enactment.

PubMed

Yuen, Hon K; Spicher, Hillary S; Semon, Madelyn R; Winwood, Leah M; Dudgeon, Brian J

2017-01-01

This study explored the perceptions of occupational therapists regarding the impact and implications of the Patient Protection and Affordable Care Act (PPACA or ACA) on occupational therapy practice. Fifteen occupational therapists participated in an interview to answer open-ended questions related to their thoughts and perceptions regarding the impact and implications of the ACA on their practice. The participants were practicing in eight different states and worked in five different settings with clinical experience ranging from 3 to 38 years; their positions ranged from staff therapist to owner of a free-standing outpatient clinic. Qualitative content analysis was used to synthesize the interview transcripts. Results showed that therapists did not have sufficient knowledge on the various mandates and provisions of the ACA, or were uncertain about what implications the ACA would have on practice, with the ACA affecting some settings more than others. Data revealed the perceived impacts of the ACA on occupational therapy practice include greater attention on documenting outcome-focused care, external accountability pressures on productivity, conscientiousness about clients' insurance coverage, uncertainty about collaborative care delivery, and survival of small businesses. Findings suggest training regarding knowledge about and implications of different elements of the ACA is needed as well as practices needing to promote the services that occupational therapists can provide to improve cost-effectiveness and outcomes in collaborative care environments.

Affording Sustainability: Adopting a Theory of Affordances as a Guiding Heuristic for Environmental Policy.

PubMed

Kaaronen, Roope O

2017-01-01

Human behavior is an underlying cause for many of the ecological crises faced in the 21st century, and there is no escaping from the fact that widespread behavior change is necessary for socio-ecological systems to take a sustainable turn. Whilst making people and communities behave sustainably is a fundamental objective for environmental policy, behavior change interventions and policies are often implemented from a very limited non-systemic perspective. Environmental policy-makers and psychologists alike often reduce cognition 'to the brain,' focusing only to a minor extent on how everyday environments systemically afford pro-environmental behavior. Symptomatic of this are the widely prevalent attitude-action, value-action or knowledge-action gaps, understood in this paper as the gulfs lying between sustainable thinking and behavior due to lack of affordances. I suggest that by adopting a theory of affordances as a guiding heuristic, environmental policy-makers are better equipped to promote policies that translate sustainable thinking into sustainable behavior, often self-reinforcingly, and have better conceptual tools to nudge our socio-ecological system toward a sustainable turn. Affordance theory, which studies the relations between abilities to perceive and act and environmental features, is shown to provide a systemic framework for analyzing environmental policies and the ecology of human behavior. This facilitates the location and activation of leverage points for systemic policy interventions, which can help socio-ecological systems to learn to adapt to more sustainable habits. Affordance theory is presented to be applicable and pertinent to technically all nested levels of socio-ecological systems from the studies of sustainable objects and households to sustainable urban environments, making it an immensely versatile conceptual policy tool. Finally, affordance theory is also discussed from a participatory perspective. Increasing the fit between local

Affording Sustainability: Adopting a Theory of Affordances as a Guiding Heuristic for Environmental Policy

PubMed Central

Kaaronen, Roope O.

2017-01-01

Human behavior is an underlying cause for many of the ecological crises faced in the 21st century, and there is no escaping from the fact that widespread behavior change is necessary for socio-ecological systems to take a sustainable turn. Whilst making people and communities behave sustainably is a fundamental objective for environmental policy, behavior change interventions and policies are often implemented from a very limited non-systemic perspective. Environmental policy-makers and psychologists alike often reduce cognition ‘to the brain,’ focusing only to a minor extent on how everyday environments systemically afford pro-environmental behavior. Symptomatic of this are the widely prevalent attitude–action, value–action or knowledge–action gaps, understood in this paper as the gulfs lying between sustainable thinking and behavior due to lack of affordances. I suggest that by adopting a theory of affordances as a guiding heuristic, environmental policy-makers are better equipped to promote policies that translate sustainable thinking into sustainable behavior, often self-reinforcingly, and have better conceptual tools to nudge our socio–ecological system toward a sustainable turn. Affordance theory, which studies the relations between abilities to perceive and act and environmental features, is shown to provide a systemic framework for analyzing environmental policies and the ecology of human behavior. This facilitates the location and activation of leverage points for systemic policy interventions, which can help socio–ecological systems to learn to adapt to more sustainable habits. Affordance theory is presented to be applicable and pertinent to technically all nested levels of socio–ecological systems from the studies of sustainable objects and households to sustainable urban environments, making it an immensely versatile conceptual policy tool. Finally, affordance theory is also discussed from a participatory perspective. Increasing the fit

Areas of Potential Impact of the Patient Protection and Affordable Care Act on EMS: A Synthesis of the Literature.

PubMed

Ostermayer, Daniel G; Brown, Charles A; Fernandez, William G; Couvillon, Emily

2017-04-01

This comprehensive review synthesizes the existing literature on the Patient Protection and Affordable Care Act (ACA) as it relates to emergency medical services (EMS) in order to provide guidance for navigating current and future healthcare changes. We conducted a comprehensive review to identify all existing literature related to the ACA and EMS and all sections within the federal law pertaining to EMS. Many changes enacted by the ACA directly affect emergency care with potential indirect effects on EMS systems. New Medicaid enrollees and changes to existing coverage plans may alter EMS transport volumes. Reimbursement changes such as adjustments to the ambulance inflation factor (AIF) alter the yearly increases in EMS reimbursement by incorporating the multifactor productivity value into yearly reimbursement adjustments. New initiatives, funded by the Center for Medicare & Medicaid Innovation are exploring novel and cost-effective prehospital care delivery opportunities while EMS agencies individually explore partnerships with healthcare systems. EMS systems should be aware of the direct and indirect impact of ACA on prehospital care due to the potential for changes in financial reimbursement, acuity and volume changes, and ongoing new care delivery initiatives.

Areas of Potential Impact of the Patient Protection and Affordable Care Act on EMS: A Synthesis of the Literature

PubMed Central

Ostermayer, Daniel G.; Brown, Charles A.; Fernandez, William G.; Couvillon, Emily

2017-01-01

Introduction This comprehensive review synthesizes the existing literature on the Patient Protection and Affordable Care Act (ACA) as it relates to emergency medical services (EMS) in order to provide guidance for navigating current and future healthcare changes. Methods We conducted a comprehensive review to identify all existing literature related to the ACA and EMS and all sections within the federal law pertaining to EMS. Results Many changes enacted by the ACA directly affect emergency care with potential indirect effects on EMS systems. New Medicaid enrollees and changes to existing coverage plans may alter EMS transport volumes. Reimbursement changes such as adjustments to the ambulance inflation factor (AIF) alter the yearly increases in EMS reimbursement by incorporating the multifactor productivity value into yearly reimbursement adjustments. New initiatives, funded by the Center for Medicare & Medicaid Innovation are exploring novel and cost-effective prehospital care delivery opportunities while EMS agencies individually explore partnerships with healthcare systems. Conclusion EMS systems should be aware of the direct and indirect impact of ACA on prehospital care due to the potential for changes in financial reimbursement, acuity and volume changes, and ongoing new care delivery initiatives. PMID:28435495

77 FR 16501 - Certain Preventive Services Under the Affordable Care Act

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-21

...This advance notice of proposed rulemaking announces the intention of the Departments of Health and Human Services, Labor, and the Treasury to propose amendments to regulations regarding certain preventive health services under provisions of the Patient Protection and Affordable Care Act (Affordable Care Act). The proposed amendments would establish alternative ways to fulfill the requirements of section 2713 of the Public Health Service Act and companion provisions under the Employee Retirement Income Security Act and the Internal Revenue Code when health coverage is sponsored or arranged by a religious organization that objects to the coverage of contraceptive services for religious reasons and that is not exempt under the final regulations published February 15, 2012. This document serves as a request for comments in advance of proposed rulemaking on the potential means of accommodating such organizations while ensuring contraceptive coverage for plan participants and beneficiaries covered under their plans (or, in the case of student health insurance plans, student enrollees and their dependents) without cost sharing.

Early impact of the Affordable Care Act on health insurance coverage of young adults.

PubMed

Cantor, Joel C; Monheit, Alan C; DeLia, Derek; Lloyd, Kristen

2012-10-01

To evaluate one of the first implemented provisions of the Patient Protection and Affordable Care Act (ACA), which permits young adults up to age 26 to enroll as dependents on a parent's private health plan. Nearly one-in-three young adults lacked coverage before the ACA. STUDY DESIGN, METHODS, AND DATA: Data from the Current Population Survey 2005-2011 are used to estimate linear probability models within a difference-in-differences framework to estimate how the ACA affected coverage of eligible young adults compared to slightly older adults. Multivariate models control for individual characteristics, economic trends, and prior state-dependent coverage laws. This ACA provision led to a rapid and substantial increase in the share of young adults with dependent coverage and a reduction in their uninsured rate in the early months of implementation. Models accounting for prior state dependent expansions suggest greater policy impact in 2010 among young adults who were also eligible under a state law. ACA-dependent coverage expansion represents a rare public policy success in the effort to cover the uninsured. Still, this policy may have later unintended consequences for premiums for alternative forms of coverage and employer-offered rates for young adult workers. © Health Research and Educational Trust.

Early Impact of the Affordable Care Act on Health Insurance Coverage of Young Adults

PubMed Central

Cantor, Joel C; Monheit, Alan C; DeLia, Derek; Lloyd, Kristen

2012-01-01

Research Objective To evaluate one of the first implemented provisions of the Patient Protection and Affordable Care Act (ACA), which permits young adults up to age 26 to enroll as dependents on a parent's private health plan. Nearly one-in-three young adults lacked coverage before the ACA. Study Design, Methods, and Data Data from the Current Population Survey 2005–2011 are used to estimate linear probability models within a difference-in-differences framework to estimate how the ACA affected coverage of eligible young adults compared to slightly older adults. Multivariate models control for individual characteristics, economic trends, and prior state-dependent coverage laws. Principal Findings This ACA provision led to a rapid and substantial increase in the share of young adults with dependent coverage and a reduction in their uninsured rate in the early months of implementation. Models accounting for prior state dependent expansions suggest greater policy impact in 2010 among young adults who were also eligible under a state law. Conclusions and Implications ACA-dependent coverage expansion represents a rare public policy success in the effort to cover the uninsured. Still, this policy may have later unintended consequences for premiums for alternative forms of coverage and employer-offered rates for young adult workers. PMID:22924684

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 counselor program. It creates conflict-of-interest, training and certification, and meaningful access standards; clarifies that any licensing, certification, or other standards prescribed by a state or Exchange must not prevent application of the provisions of title I of the Affordable Care Act; adds entities with relationships to issuers of stop loss insurance to the list of entities that are ineligible to become Navigators; and clarifies that the same ineligibility criteria that apply to Navigators apply to certain non-Navigator assistance personnel. The final rule also directs that each Exchange designate organizations which will then certify their staff members and volunteers to be application counselors that assist consumers and facilitate enrollment in qualified health plans and insurance affordability programs, and provides standards for that designation.

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. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

The corrosion protection of aluminum by various anodizing treatments

NASA Technical Reports Server (NTRS)

Danford, Merlin D.

1989-01-01

Corrosion protection to 6061-T6 aluminum, afforded by both teflon-impregnated anodized coats (Polylube and Tufram) and hard-anodized coats (water sealed and dichromate sealed), was studied at both pH 5.5 and pH 9.5, with an exposure period of 28 days in 3.5 percent NaCl solution (25 C) for each specimen. In general, corrosion protection for all specimens was better at pH 9.5 than at pH 5.5. Protection by a Tufram coat proved superior to that afforded by Polylube at each pH, with corrosion protection by the hard-anodized, water-sealed coat at pH 9.5 providing the best protection. Electrochemical work in each case was corroborated by microscopic examination of the coats after exposure. Corrosion protection by Tufram at pH 9.5 was most comparable to that of the hard-anodized samples, although pitting and some cracking of the coat did occur.

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

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…

Are You Covered? Associations Between Patient Protection and Affordable Care Act Knowledge and Preventive Reproductive Service Use.

PubMed

Sawyer, Ashlee N; Kwitowski, Melissa A; Benotsch, Eric G

2018-05-01

Sexual and reproductive health conditions (eg, infections, cancers) represent public health concerns for American women. The present study examined how knowledge of the Patient Protection and Affordable Care Act (PPACA) relates to receipt of preventive reproductive health services among women. Cross-sectional online survey. Online questionnaires were completed via Amazon Mechanical Turk, a crowdsourcing website where individuals complete web-based tasks for compensation. Cisgendered women aged 18 to 44 years (N = 1083) from across the United States. Participants completed online questionnaires assessing demographics, insurance status, preventive service use, and knowledge of PPACA provisions. Chi-squares showed that receipt of well-woman, pelvic, and breast examinations, as well as pap smears, was related to insurance coverage, with those not having coverage at all during the previous year having significantly lower rates of use. Hierarchical logistic regressions determined the independent relationship between PPACA knowledge and use of health services after controlling for demographic factors and insurance status. Knowledge of PPACA provisions was associated with receiving well-woman, pelvic, and breast examinations, human papillomavirus vaccination, and sexually transmitted infections testing, after controlling for these factors. Results indicate that expanding knowledge about health-care legislation may be beneficial in increasing preventive reproductive health service use among women. Current findings provide support for increasing resources for outreach and education of the general population about the provisions and benefits of health-care legislation, as well as personal health coverage plans.

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.

Expansion of Coverage under the Patient Protection and Affordable Care Act and Primary Care Utilization

PubMed Central

Hofer, Adam N; Abraham, Jean Marie; Moscovice, Ira

2011-01-01

Context: Provisions of the Patient Protection and Affordable Care Act of 2010 (PPACA) expand Medicaid to all individuals in families earning less than 133 percent of the federal poverty level (FPL) and make available subsidies to uninsured lower-income Americans (133 to 400 percent of FPL) without access to employer-based coverage to purchase insurance in new exchanges. Since primary care physicians typically serve as the point of entry into the health care delivery system, an adequate supply of them is critical to meeting the anticipated increase in demand for medical care resulting from the expansion of coverage. This article provides state-level estimates of the anticipated increases in primary care utilization given the PPACA's provisions for expanded coverage. Methods: Using the Medical Expenditure Panel Survey, this article estimates a multivariate regression model of annual primary care utilization. Using the model estimates and state-level information regarding the number of uninsured, it predicts, by state, the change in primary care visits expected from the expanded coverage. Finally, the article predicts the number of primary care physicians needed to accommodate this change in utilization. Findings: This expanded coverage is predicted to increase by 2019 the number of annual primary care visits between 15.07 million and 24.26 million. Assuming stable levels of physicians’ productivity, between 4,307 and 6,940 additional primary care physicians would be needed to accommodate this increase. Conclusions: The PPACA's health insurance expansion parameters are expected to significantly increase the use of primary care. Two strategies that policymakers may consider are creating stronger financial incentives to attract medical school students to primary care and changing the delivery of care in ways that lead to operational improvements, higher throughput, and better quality of care. PMID:21418313

A review of the literature: differences in outcomes for uninsured versus insured critically ill patients: opportunities and challenges for critical care nurses as the Patient Protection and Affordable Care Act begins open enrollment for all Americans.

PubMed

Dillman, Jedd; Mancas, Bianca; Jacoby, Mandi; Ruth-Sahd, Lisa

2014-01-01

The US health care system stands alone in its uniqueness compared with other industrialized nations. Unlike other developed nations, the United States does not provide universal health care coverage to its citizens. America relies primarily on private health insurance, allowing for protection against the high cost of illness. Because of the economic recession, many Americans cannot afford to pay for private health insurance. Contemporary nursing research is reviewing the question "Is there is a difference in patient outcomes for the critically ill depending upon whether or not they have private health insurance?" By using the Johns Hopkins Nursing Evidence-Based Practice Model (Johns Hopkins Nursing Evidenced-Based Practice Model and Guidelines. 2nd ed. Indianapolis, IN: Sigma Theta Tau International; 2012), 6 articles (level III and IV) were reviewed and summarized. After reviewing all the evidence, it is apparent that there are poorer patient outcomes, more specifically death in the critically ill patient population, if the patient does not have private health insurance. Current recommendations from these studies support the Patient Protection and Affordable Care Act (http://www.ehealthinsurance.com), which will take effect in 2014 and will enable uninsured individuals to have access to medical insurance. This provision can also improve preventative care and overall patient outcomes. This article has implications for the critical care nurse in the following ways: First, it will help the nurse to interpret the implications of the Patient Protection and Affordable Care Act and how it will impact critical care practice; second, it validates the challenges that uninsured patients present to acute health care facilities as they come with more complications and consequently are at greater risk for complications; third, it magnifies that the critical care nurse may see millions of new patients; and fourth, it demonstrates for the critical care nurse how to use the Johns

12 CFR 1807.400 - Affordable housing-general.

Code of Federal Regulations, 2011 CFR

2011-01-01

... percent of Eligible Project Costs are attributable to housing units that meet the affordability... Project Costs must be attributable to housing units that meet the affordability qualifications set forth...

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 a...

Procedures for the handling of retaliation complaints under section 1558 of the Affordable Care Act. Interim final rule; request for comments.

PubMed

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 protections (e.g., the prohibition on denials of insurance due to pre-existing conditions) or affordability assistance provisions (e.g., access to health insurance premium tax credits). This interim rule establishes procedures and time frames for the handling of retaliation complaints under section 18C, including procedures and time frames for employee complaints to the Occupational Safety and Health Administration (OSHA), investigations by OSHA, appeals of OSHA determinations to an administrative law judge (ALJ) for a hearing de novo, hearings by ALJs, review of ALJ decisions by the Administrative Review Board (ARB) (acting on behalf of the Secretary of Labor), and judicial review of the Secretary's final decision.

Tobacco industry efforts to keep cigarettes affordable: a case study from Hungary.

PubMed

Szilágyi, T; Chapman, S

2003-12-01

To review strategies of multinational tobacco companies aimed at keeping tobacco products affordable to smokers in Hungary and to provide background information on the Hungarian request for the delayed introduction of minimum European Union tobacco excise duty levels. Review of internal tobacco industry documents available on the World Wide Web, downloaded between 26 July 2001 and 31 October 2002. Appropriate pricing strategies and lobbying for low tobacco tax policies were used by the tobacco industry in Hungary to keep cigarettes affordable to the public. During the 1990s and in the early 2000s transnational tobacco companies (TTCs) were still able to prevent substantial cigarette price rises, which would have been desirable for more effective control of Hungarian tobacco use. Strategies used by TTCs included the creation of new partnerships, use of supportive MPs, communication around tobacco tax issues and also the successful management of the differences in approaches used by individual companies regarding taxation of tobacco products. These resulted in the adoption of governmental policy aimed at delaying the introduction of the EU directive on the minimum tax levels of retail prices of cigarettes.

What is an affordance? 40 years later.

PubMed

Osiurak, François; Rossetti, Yves; Badets, Arnaud

2017-06-01

About 40 years ago, James J. Gibson coined the term "affordance" to describe the action possibilities offered to an animal by the environment with reference to the animal's action capabilities. Since then, this notion has acquired a multitude of meanings, generating confusion in the literature. Here, we offer a clear operationalization of the concept of affordances and related concepts in the field of tool use. Our operationalization is organized around the distinction between the physical (what is objectively observable) and neurocognitive (what is subjectively experienced) levels. This leads us to propose that motor control (dorso-dorsal system), mechanical knowledge (ventro-dorsal system) and function knowledge (ventral system) could be neurocognitive systems respectively involved in the perception of affordances, the understanding of mechanical actions and the storage of contextual relationships (three action-system model; 3AS). We end by turning to two key issues that can be addressed within 3AS. These issues concern the link between affordances and tool incorporation, and the constraints posed by affordances for tool use. Copyright © 2017 Elsevier Ltd. All rights reserved.

Affordable health benefits for workers without employer coverage.

PubMed

Etheredge, L; Jones, S B

1998-02-01

With 42 million individuals lacking health insurance in 1996, an increase of 1.1 million uninsured from the previous year, new initiatives to deal with health insurance problems merit a high priority among domestic policy initiatives. This paper examines the opportunities for assisting full-time workers (and their families) who do not receive employer-paid health insurance-a group that now includes 49 million individuals-by using three policy tools that Congress and President Clinton have already agreed to use in recent healthcare legislation: (a) equitable tax assistance; (b) market reforms; and (c) competition among health plans that offer economical benefits. Estimates for a model plan illustrate that such strategies could make decent private health insurance more affordable and more accessible for workers and their families who want to purchase it; family insurance protection, with guaranteed issue of insurance and large-group-rated premiums, could be offered at potential savings of 42% (or more). Premiums for worker's coverage, after tax assistance, would be below $1,200 per year, i.e., less than 60 cents per hour. These market-oriented reforms can be accomplished with a limited government role, and, after start-up costs, ongoing federal expenses would be modest, predictable, and controllable. When combined with the new $24 billion child health initiative to assist low-income families, the proposed plan would provide considerable progress toward universal access to affordable insurance coverage.

Childhood Cancer Survivor Study participants' perceptions and understanding of the Affordable Care Act.

PubMed

Park, Elyse R; Kirchhoff, Anne C; Perez, Giselle K; Leisenring, Wendy; Weissman, Joel S; Donelan, Karen; Mertens, Ann C; Reschovsky, James D; Armstrong, Gregory T; Robison, Leslie L; Franklin, Mariel; Hyland, Kelly A; Diller, Lisa R; Recklitis, Christopher J; Kuhlthau, Karen A

2015-03-01

The Patient Protection and Affordable Care Act (ACA) established provisions intended to increase access to affordable health insurance and thus increase access to medical care and long-term surveillance for populations with pre-existing conditions. However, childhood cancer survivors' coverage priorities and familiarity with the ACA are unknown. Between May 2011 and April 2012, we surveyed a randomly selected, age-stratified sample of 698 survivors and 210 siblings from the Childhood Cancer Survivor Study. Overall, 89.8% of survivors and 92.1% of siblings were insured. Many features of insurance coverage that survivors considered "very important" are addressed by the ACA, including increased availability of primary care (94.6%), no waiting period before coverage initiation (79.0%), and affordable premiums (88.1%). Survivors were more likely than siblings to deem primary care physician coverage and choice, protections from costs due to pre-existing conditions, and no start-up period as "very important" (P < .05 for all). Only 27.3% of survivors and 26.2% of siblings reported familiarity with the ACA (12.1% of uninsured v 29.0% of insured survivors; odds ratio, 2.86; 95% CI, 1.28 to 6.36). Only 21.3% of survivors and 18.9% of siblings believed the ACA would make it more likely that they would get quality coverage. Survivors' and siblings' concerns about the ACA included increased costs, decreased access to and quality of care, and negative impact on employers and employees. Although survivors' coverage preferences match many ACA provisions, survivors, particularly uninsured survivors, were not familiar with the ACA. Education and assistance, perhaps through cancer survivor navigation, are critically needed to ensure that survivors access coverage and benefits. © 2015 by American Society of Clinical Oncology.

Childhood Cancer Survivor Study Participants' Perceptions and Understanding of the Affordable Care Act

PubMed Central

Park, Elyse R.; Kirchhoff, Anne C.; Perez, Giselle K.; Leisenring, Wendy; Weissman, Joel S.; Donelan, Karen; Mertens, Ann C.; Reschovsky, James D.; Armstrong, Gregory T.; Robison, Leslie L.; Franklin, Mariel; Hyland, Kelly A.; Diller, Lisa R.; Recklitis, Christopher J.; Kuhlthau, Karen A.

2015-01-01

Purpose The Patient Protection and Affordable Care Act (ACA) established provisions intended to increase access to affordable health insurance and thus increase access to medical care and long-term surveillance for populations with pre-existing conditions. However, childhood cancer survivors' coverage priorities and familiarity with the ACA are unknown. Methods Between May 2011 and April 2012, we surveyed a randomly selected, age-stratified sample of 698 survivors and 210 siblings from the Childhood Cancer Survivor Study. Results Overall, 89.8% of survivors and 92.1% of siblings were insured. Many features of insurance coverage that survivors considered “very important” are addressed by the ACA, including increased availability of primary care (94.6%), no waiting period before coverage initiation (79.0%), and affordable premiums (88.1%). Survivors were more likely than siblings to deem primary care physician coverage and choice, protections from costs due to pre-existing conditions, and no start-up period as “very important” (P < .05 for all). Only 27.3% of survivors and 26.2% of siblings reported familiarity with the ACA (12.1% of uninsured v 29.0% of insured survivors; odds ratio, 2.86; 95% CI, 1.28 to 6.36). Only 21.3% of survivors and 18.9% of siblings believed the ACA would make it more likely that they would get quality coverage. Survivors' and siblings' concerns about the ACA included increased costs, decreased access to and quality of care, and negative impact on employers and employees. Conclusion Although survivors' coverage preferences match many ACA provisions, survivors, particularly uninsured survivors, were not familiar with the ACA. Education and assistance, perhaps through cancer survivor navigation, are critically needed to ensure that survivors access coverage and benefits. PMID:25646189

To be an affordable healthy house, case study Medan

NASA Astrophysics Data System (ADS)

Silitonga, Shanty

2018-03-01

House has a paramount meaning in human life. Provision of adequate housing will be able to improve the quality of life. Provision of an affordable house is a major step to fulfilling the needs of houses in the big city. Medan has built a lot of affordable houses, and mostly it takes place in the suburbs. Although the affordable house is for low-income people, it must be worthy of its physical condition, affordable in the budget and healthy for its users. House often saw only as physical alone, the provision of a house only to achieve solely in quantity regardless its quality. This study aims to examine the condition of affordable houses in the suburbs of Medan. The research method used qualitative descriptive, using indicator according to affordable healthy house standard according to the regulation in Indonesia and other related theories. This study took place in Medan by taking three areas in the suburbs of Medan. The results show that most affordable houses in the suburbs of Medan are unhealthy. There are several design recommendations for the houses to meet the affordable healthy house category; the most important is the addition of ventilation and window holes.

Calculating the affordability of antiretrovirals in St Lucia.

PubMed

Reddock, J R; Grignon, M

2013-01-01

The cost of antiretrovirals is borne by donors in many low- and middle-income countries, including St Lucia. Although donor involvement has facilitated access to antiretrovirals, donor engagement in HIV/AIDS has changed over the years. This paper assesses the affordability of antiretrovirals at the individual level if donors were no longer available to fund the cost of first and second-line antiretrovirals and a prospective third-line regimen. Various conceptions of affordability are reviewed using different assumptions of what is required to maintain a standard of living that would avoid individuals descending into poverty as a result of antiretroviral purchases. These concepts of affordability are operationalized using data from the Household Budgeting Survey conducted in St Lucia in 2005/2006. While there is a range of results for the affordability of first and second-line antiretrovirals depending on which standard of affordability is used, third-line antiretrovirals are unaffordable to more than 80% of the population across the four standards of affordability used - the national poverty line, 50% of median annual consumption, 10% of annual consumption and a proposed reasonable minimum standard.

Oral administration of a Salmonella enterica-based vaccine expressing Bacillus anthracis protective antigen confers protection against aerosolized B. anthracis.

PubMed

Stokes, Margaret G M; Titball, Richard W; Neeson, Brendan N; Galen, James E; Walker, Nicola J; Stagg, Anthony J; Jenner, Dominic C; Thwaite, Joanne E; Nataro, James P; Baillie, Leslie W J; Atkins, Helen S

2007-04-01

Bacillus anthracis is the causative agent of anthrax, a disease that affects wildlife, livestock, and humans. Protection against anthrax is primarily afforded by immunity to the B. anthracis protective antigen (PA), particularly PA domains 4 and 1. To further the development of an orally delivered human vaccine for mass vaccination against anthrax, we produced Salmonella enterica serovar Typhimurium expressing full-length PA, PA domains 1 and 4, or PA domain 4 using codon-optimized PA DNA fused to the S. enterica serovar Typhi ClyA and under the control of the ompC promoter. Oral immunization of A/J mice with Salmonella expressing full-length PA protected five of six mice against a challenge with 10(5) CFU of aerosolized B. anthracis STI spores, whereas Salmonella expressing PA domains 1 and 4 provided only 25% protection (two of eight mice), and Salmonella expressing PA domain 4 or a Salmonella-only control afforded no measurable protection. However, a purified recombinant fusion protein of domains 1 and 4 provided 100% protection, and purified recombinant 4 provided protection in three of eight immunized mice. Thus, we demonstrate for the first time the efficacy of an oral S. enterica-based vaccine against aerosolized B. anthracis spores.

Affordances and the musically extended mind.

PubMed

Krueger, Joel

2014-01-06

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.

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 of Health and Human Services, in coordination with the Secretary of the Treasury, to designate other health benefits coverage as minimum essential coverage by providing that certain coverage be designated as minimum essential coverage. It also outlines substantive and procedural requirements that other types of individual coverage must fulfill in order to be certified as minimum essential coverage.

41 CFR 109-27.5104-2 - Physical protection and storage.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 41 Public Contracts and Property Management 3 2013-07-01 2013-07-01 false Physical protection and... PROCUREMENT 27-INVENTORY MANAGEMENT 27.51-Management of Precious Metals § 109-27.5104-2 Physical protection and storage. Precious metals shall be afforded exceptional physical protection from time of receipt...

41 CFR 109-27.5104-2 - Physical protection and storage.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 41 Public Contracts and Property Management 3 2011-01-01 2011-01-01 false Physical protection and... PROCUREMENT 27-INVENTORY MANAGEMENT 27.51-Management of Precious Metals § 109-27.5104-2 Physical protection and storage. Precious metals shall be afforded exceptional physical protection from time of receipt...

41 CFR 109-27.5104-2 - Physical protection and storage.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 41 Public Contracts and Property Management 3 2014-01-01 2014-01-01 false Physical protection and... PROCUREMENT 27-INVENTORY MANAGEMENT 27.51-Management of Precious Metals § 109-27.5104-2 Physical protection and storage. Precious metals shall be afforded exceptional physical protection from time of receipt...

41 CFR 109-27.5104-2 - Physical protection and storage.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Physical protection and... PROCUREMENT 27-INVENTORY MANAGEMENT 27.51-Management of Precious Metals § 109-27.5104-2 Physical protection and storage. Precious metals shall be afforded exceptional physical protection from time of receipt...

41 CFR 109-27.5104-2 - Physical protection and storage.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 41 Public Contracts and Property Management 3 2012-01-01 2012-01-01 false Physical protection and... PROCUREMENT 27-INVENTORY MANAGEMENT 27.51-Management of Precious Metals § 109-27.5104-2 Physical protection and storage. Precious metals shall be afforded exceptional physical protection from time of receipt...

Salmonella Enteritidis with double deletion in phoP fliC and a competitive exclusion culture elicit substantial additive protective effects against Salmonella exposure in newly hatched chicks.

PubMed

Methner, U; Berndt, A; Locke, M

2017-10-27

A live Salmonella Enteritidis vaccine (SE147N ΔphoP fliC), able to express both a homologous intestinal colonisation-inhibition effect and a systemic invasion-inhibition effect, was tested for its potential to generate a postulated additive protective effect in case of combined application with a competitive exclusion (CE) culture against Salmonella exposure in very young chicks. Both, SE147N ΔphoP fliC and the CE culture alone were highly protective against systemic and intestinal colonisation of the challenge strain in case of moderate Salmonella exposure, consequently, additive protective effects in combined use could not be detected. However, in case of high Salmonella Enteritidis challenge with 10 6 cfu/bird at day 3 of life the combination of the ΔphoP fliC vaccine and the CE culture resulted in a protective effect much more pronounced than either of the single preparations and most substantial compared to untreated control birds. The term additive protective effects reflects the recognition that exclusion effects by gut flora cultures and inhibition effects by Salmonella vaccines are caused by different mechanisms. Copyright © 2017 Elsevier Ltd. All rights reserved.

Effects of low speed wind on the recognition/identification and pass-through communication tasks of auditory situation awareness afforded by military hearing protection/enhancement devices and tactical communication and protective systems.

PubMed

Lee, Kichol; Casali, John G

2016-01-01

To investigate the effect of controlled low-speed wind-noise on the auditory situation awareness performance afforded by military hearing protection/enhancement devices (HPED) and tactical communication and protective systems (TCAPS). Recognition/identification and pass-through communications tasks were separately conducted under three wind conditions (0, 5, and 10 mph). Subjects wore two in-ear-type TCAPS, one earmuff-type TCAPS, a Combat Arms Earplug in its 'open' or pass-through setting, and an EB-15LE electronic earplug. Devices with electronic gain systems were tested under two gain settings: 'unity' and 'max'. Testing without any device (open ear) was conducted as a control. Ten subjects were recruited from the student population at Virginia Tech. Audiometric requirements were 25 dBHL or better at 500, 1000, 2000, 4000, and 8000 Hz in both ears. Performance on the interaction of communication task-by-device was significantly different only in 0 mph wind speed. The between-device performance differences varied with azimuthal speaker locations. It is evident from this study that stable (non-gusting) wind speeds up to 10 mph did not significantly degrade recognition/identification task performance and pass-through communication performance of the group of HPEDs and TCAPS tested. However, the various devices performed differently as the test sound signal speaker location was varied and it appears that physical as well as electronic features may have contributed to this directional result.

Amendment to the interim final rules for group health plans and health insurance coverage relating to status as a grandfathered health plan under the Patient Protection and Affordable Care Act. Amendment to interim final rules with request for comments.

PubMed

2010-11-17

This document contains an amendment to interim final regulations implementing the rules for group health plans and health insurance coverage in the group and individual markets under provisions of the Patient Protection and Affordable Care Act regarding status as a grandfathered health plan; the amendment permits certain changes in policies, certificates, or contracts of insurance without loss of grandfathered status.

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.

What Does Electronic Conferencing Afford Distance Education?

ERIC Educational Resources Information Center

Barnes, Sally

2000-01-01

Discusses the use of technology for distance learning in higher education and examines the similarities and differences between face-to-face seminars and online discussions. Considers the concept of affordance in relation to information and communication technologies and distance education; and examines affordances of electronic conferencing and…

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. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Affordable Care Act's plan for consumer assistance with insurance moves states forward but remains a work in progress.

PubMed

Grob, Rachel; Schlesinger, Mark; Davis, Sarah; Cohen, Deborah; Lapps, Joshua

2013-02-01

The Affordable Care Act provides support for state-run consumer assistance programs to help privately insured consumers who experience problems with their coverage. Its provisions signify the first national commitment to such assistance and to using cases aggregated by these state programs to inform policy. We interviewed state-level administrators and analyzed program documents to assess whether federal support for state-run consumer assistance programs achieved certain goals. We found that some federally supported programs made substantial progress in supporting and empowering patients by reorienting state agencies to become active advocates for their citizens. Yet progress across the country was inconsistent, and there was little evidence that programs addressed systemic problems experienced by consumers. On balance, the consumer assistance provisions of health care reform do not yet ensure protection for all privately insured Americans because of uneven implementation-a problem likely to be of further concern as coverage is expanded and health insurance exchanges come on line in 2014. At the same time, the demonstrated impact of consumer assistance programs in the most innovative states is arguably a useful "proof of concept" for this young federal program.

Dissociating Simon and affordance compatibility effects: silhouettes and photographs.

PubMed

Pappas, Zissis

2014-12-01

When a graspable object's handle is oriented to the same side as the response hand, responses are quicker and more accurate than when it is oriented to the opposite side. This effect has been attributed to the affordance of the object's handle (Tucker & Ellis, 1998). Recent findings suggest this effect results instead from an abstract spatial response code (i.e., Simon effect; Cho & Proctor, 2010). However, the stimuli used in these previous studies differ in the amount of object and environmental depth information they contain, which may be critical to conveying an affordance. This information could explain these disparate findings as well as dissociate Simon and affordance compatibility effects. Four experiments demonstrate that the Simon effect results from the absence of this information, as in a silhouette, and the affordance effect results from its presence, as in a photograph. A fifth experiment confirmed that modifying information associated with the affordance, rather than the modification itself, produced the effects observed in the previous experiments. These findings support the following: (a) the internal details of an object and environmental depth can dissociate Simon and affordance compatibility effects, (b) this information is necessary to convey the object's graspable affordance, and (c) the outer shape of the object is not sufficient to elicit an affordance effect. These findings are discussed in relation to the theory of embodied cognition. Copyright © 2014 Elsevier B.V. All rights reserved.

Manufacturing Affordability

DTIC Science & Technology

2011-10-01

Effective planning early in and throughout program develop - ment is critical to enabling manufacturing affordability. There is no silver bullet and no...unexpected lessons. “Gee, this stove is hot” may be an unexpected lesson for the toddler but should not be so for the adult. All production programs...in program design efforts from day 1 of Engineer- ing and Manufacturing Development , you should be seriously worried. A program that includes the

Report of the Committee To Study Affordability.

ERIC Educational Resources Information Center

Illinois State Board of Higher Education, Springfield.

This report addresses college affordability in Illinois from the student's perspective and makes specific recommendations to improve affordability at public institutions of higher education. The report also seeks to make students and their families more aware of the close connection between academic preparation, progress, and college costs. It…

Biometrics can help protect and safeguard.

PubMed

Oakes, Shaun

2017-06-01

Shaun Oakes, managing director at ievo, a north-east England-based manufacturer of biometric fingerprint readers, argues that growing use of biometrics technology can improve security and afford better protection to premises, valuable items, and people, across an ever-busier NHS.

78 FR 72321 - Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2015

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-02

... post all comments received before the close of the comment period on the following Web site as soon as... market Medicaid expansion plans, and seeks comment on how to adjust the geographic cost factor in the... Affordable Care Act, establishes permissible rating factors that may be used to vary the premium rate charged...

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.

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…

The affordable care ACT on loyalty programs for federal beneficiaries.

PubMed

Piacentino, Justin J; Williams, Karl G

2014-02-01

To discuss changes in the law that allow community pharmacy loyalty programs to include and offer incentives to Medicare and Medicaid beneficiaries. The retailer rewards exception of the Patient Protection and Affordable Care Act of 2010 and its change to the definition of remuneration in the civil monetary penalties of the Anti-Kickback Statute now allow incentives to be earned on federal benefit tied prescription out-of-pocket costs. The criteria required to design a compliant loyalty program are discussed. Community pharmacies can now include Medicare and Medicaid beneficiaries in compliant customer loyalty programs, where allowed by state law. There is a need for research directly on the influence of loyalty programs and nominal incentives on adherence.

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.

Housing Affordability And Children's Cognitive Achievement.

PubMed

Newman, Sandra; Holupka, C Scott

2016-11-01

Housing cost burden-the fraction of income spent on housing-is the most prevalent housing problem affecting the healthy development of millions of low- and moderate-income children. By affecting disposable income, a high burden affects parents' expenditures on both necessities for and enrichment of their children, as well as investments in their children. Reducing those expenditures and investments, in turn, can affect children's development, including their cognitive skills and physical, social, and emotional health. This article summarizes the first empirical evidence of the effects of housing affordability on children's cognitive achievement and on one factor that appears to contribute to these effects: the larger expenditures on child enrichment by families in affordable housing. We found that housing cost burden has the same relationship to both children's cognitive achievement and enrichment spending on children, exhibiting an inverted U shape in both cases. The maximum benefit occurs when housing cost burden is near 30 percent of income-the long-standing rule-of-thumb definition of affordable housing. The effect of the burden is stronger on children's math ability than on their reading comprehension and is more pronounced with burdens above the 30 percent standard. For enrichment spending, the curve is "shallower" (meaning the effect of optimal affordability is less pronounced) but still significant. Project HOPE—The People-to-People Health Foundation, Inc.

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

Anticipating the Impact of the Patient Protection and Affordable Care Act for Patients with Urological Cancer

PubMed Central

Ellimoottil, Chandy; Miller, David C.

2014-01-01

The Affordable Care Act seeks to overhaul the US healthcare system by providing insurance for more Americans, improving the quality of healthcare delivery, and reducing healthcare expenditures. While the law’s intent is clear, its implementation and effect on patient care remains largely undefined. Herein, we discuss major components of the ACA, including the proposed insurance expansion, payment and delivery system reforms (e.g. bundled payments and Accountable Care Organizations) and other reforms relevant to the field of urologic oncology. We also discuss how these proposed reforms may impact patients with urological cancers. PMID:24588021

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

Code of Federal Regulations, 2013 CFR

2013-07-01

... public health or welfare of the United States. 300.322 Section 300.322 Protection of Environment... Removal § 300.322 Response to substantial threats to public health or welfare of the United States. (a) As... in a substantial threat to public health or welfare of the United States (including, but not limited...

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

Code of Federal Regulations, 2012 CFR

2012-07-01

... public health or welfare of the United States. 300.322 Section 300.322 Protection of Environment... Removal § 300.322 Response to substantial threats to public health or welfare of the United States. (a) As... in a substantial threat to public health or welfare of the United States (including, but not limited...

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

Code of Federal Regulations, 2014 CFR

2014-07-01

... public health or welfare of the United States. 300.322 Section 300.322 Protection of Environment... Removal § 300.322 Response to substantial threats to public health or welfare of the United States. (a) As... in a substantial threat to public health or welfare of the United States (including, but not limited...

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

Code of Federal Regulations, 2010 CFR

2010-07-01

... public health or welfare of the United States. 300.322 Section 300.322 Protection of Environment... Removal § 300.322 Response to substantial threats to public health or welfare of the United States. (a) As... in a substantial threat to public health or welfare of the United States (including, but not limited...

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

... public health or welfare of the United States. 300.322 Section 300.322 Protection of Environment... Removal § 300.322 Response to substantial threats to public health or welfare of the United States. (a) As... in a substantial threat to public health or welfare of the United States (including, but not limited...

Critical Care Implications of the Affordable Care Act

PubMed Central

Dogra, Anjali P.; Dorman, Todd

2015-01-01

Objectives To provide an overview of key elements of the Affordable Care Act (ACA). To evaluate ways in which the ACA will likely impact the practice of critical care medicine. To describe strategies that may help health systems and providers effectively adapt to changes brought about by the ACA. Data Sources and Synthesis Data sources for this concise review include search results from the PubMed and Embase databases, as well as sources relevant to public policy such as the text of the Patient Protection and Affordable Care Act and reports of the Congressional Budget Office (CBO). As all of the ACA's provisions will not be fully implemented until 2019, we also drew upon cost, population and utilization projections as well as the experience of existing state-based healthcare reforms. Conclusion The ACA represents the furthest reaching regulatory changes in the US healthcare system since the 1965 Medicare and Medicaid provisions of the Social Security Act. The ACA aims to expand health insurance coverage to millions of Americans and place an emphasis on quality and cost-effectiveness of care. From models which link pay and performance to those which center on episodic care, the ACA outlines sweeping changes to health systems, reimbursement structures, and the delivery of critical care. Staffing models that include daily rounding by an intensivist, palliative care integration, and expansion of the role of telemedicine in areas where intensivists are inaccessible are potential strategies that may improve quality and profitability of ICU care in the post-ACA era. PMID:26565630

Urging Affordable Access to High-Value Cancer Drugs

Cancer.gov

This infographic highlights some of the main messages from the President’s Cancer Panel report Promoting Value, Affordability, and Innovation in Cancer Drug Treatment. The graphic includes the panel’s recommendations to maximize the value and affordability of cancer drug treatment.

24 CFR 1000.102 - What are eligible affordable housing activities?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false What are eligible affordable housing activities? 1000.102 Section 1000.102 Housing and Urban Development Regulations Relating to... § 1000.102 What are eligible affordable housing activities? Eligible affordable housing activities are...

Anti-inflammatory protection afforded by cyanidin-3-glucoside and resveratrol in human intestinal cells via Nrf2 and PPAR-γ: Comparison with 5-aminosalicylic acid.

PubMed

Serra, Diana; Almeida, Leonor M; Dinis, Teresa C P

2016-12-25

This study investigated the involvement of nuclear factor erythroid 2 (Nrf2) and peroxisome proliferator-activated receptor-gamma (PPAR-γ) pathways in the protection afforded by two polyphenols abundant in diet, cyanidin-3-glucoside and resveratrol, against cytokine-induced inflammation and oxidative insult in HT-29 intestinal cells, in comparison with the drug 5-aminosalicylic acid (5-ASA). Our data show for the first time that in cytokine-challenged cells, cyanidin-3-glucoside and resveratrol induced Nrf2 activation, increased hemoxygenase-1 and glutamate cysteine ligase mRNA expression, enhanced reduced glutathione to oxidized glutathione ratio and inhibited reactive species production, at much lower concentrations than 5-ASA. Unlike cyanidin-3-glucoside, resveratrol and 5-ASA also increased nuclear levels of PPAR-γ in cytokine-stimulated cells. In conclusion, both polyphenols might be interesting as nutraceuticals, giving complementary benefits to conventional drugs against intestinal inflammation, typically present in patients with inflammatory bowel disease. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Young children's tool innovation across culture: Affordance visibility matters.

PubMed

Neldner, Karri; Mushin, Ilana; Nielsen, Mark

2017-11-01

Young children typically demonstrate low rates of tool innovation. However, previous studies have limited children's performance by presenting tools with opaque affordances. In an attempt to scaffold children's understanding of what constitutes an appropriate tool within an innovation task we compared tools in which the focal affordance was visible to those in which it was opaque. To evaluate possible cultural specificity, data collection was undertaken in a Western urban population and a remote Indigenous community. As expected affordance visibility altered innovation rates: young children were more likely to innovate on a tool that had visible affordances than one with concealed affordances. Furthermore, innovation rates were higher than those reported in previous innovation studies. Cultural background did not affect children's rates of tool innovation. It is suggested that new methods for testing tool innovation in children must be developed in order to broaden our knowledge of young children's tool innovation capabilities. Copyright © 2017 Elsevier B.V. All rights reserved.

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…

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

Consequences of BBPs Affordability Initiative

DTIC Science & Technology

2016-04-30

qÜáêíÉÉåíÜ=^ååì~ä= ^Åèìáëáíáçå=oÉëÉ~êÅÜ= póãéçëáìã= tÉÇåÉëÇ~ó=pÉëëáçåë= sçäìãÉ=f= = Consequences of BBP’s Affordability Initiative Gregory Davis , Research...Initiative Gregory Davis , Research Staff Member, Institute for Defense Analyses Lawrence Goeller, Defense Acquisition Analyst, Institute for Defense...Consequences of BBP’s Affordability Initiative Gregory Davis —has been at the Institute for Defense Analyses (IDA) since 2006, conducting research on as

The Automaticity of Affordance of Dangerous Object.

PubMed

Zhao, Liang

2016-11-03

Objects observation automatically elicits the activation of a reach-to-grasp response specifically directed to interact with the object, which is termed affordance. Murphy, van Velzen, and de Fockert (2012) found that only when an irrelevant object receives sufficient attention, it can potentiate an action. However, it remains unclear whether the dangerous object would afford an action when it receives insufficient attention. In this study, we manipulated the perceptual load in a letter identification task. Participants were required to identify a target letter with the right or left hand while ignoring a neutral or dangerous graspable object. The target letter was presented either on its own (low perceptual load), alongside five non-target letters (high load), or alongside eight non-target letters (super high load). Under the low perceptual load, for both neutral and dangerous object, responses were faster when the action afforded by the ignored object was congruent (vs. incongruent) with the current target response (t(27) = 4.44, p < .001; t(27) = 7.99, p < .001, respectively). However, during the high perceptual load, for dangerous object, responses were slower when the action afforded by the ignored object was congruent (vs. incongruent) with the current target response (t(27) = 4.97, p < .001). There was not any effect for both neutral object and dangerous object under super high perceptual load. These results suggest the affordance of dangerous object is also sensitive to the perceptual load. An irrelevant dangerous object can't potentiate an action if it receives insufficient attention.

Conflict in object affordance revealed by grip force

PubMed Central

McBride, Jennifer; Sumner, Petroc; Husain, Masud

2011-01-01

Viewing objects can result in automatic, partial activation of motor plans associated with them—“object affordance”. Here, we recorded grip force simultaneously from both hands in an object affordance task to investigate the effects of conflict between coactivated responses. Participants classified pictures of objects by squeezing force transducers with their left or right hand. Responses were faster on trials where the object afforded an action with the same hand that was required to make the response (congruent trials) compared to the opposite hand (incongruent trials). In addition, conflict between coactivated responses was reduced if it was experienced on the preceding trial, just like Gratton adaptation effects reported in “conflict” tasks (e.g., Eriksen flanker). This finding suggests that object affordance demonstrates conflict effects similar to those shown in other stimulus–response mapping tasks and thus could be integrated into the wider conceptual framework on overlearnt stimulus–response associations. Corrected erroneous responses occurred more frequently when there was conflict between the afforded response and the response required by the task, providing direct evidence that viewing an object activates motor plans appropriate for interacting with that object. Recording continuous grip force, as here, provides a sensitive way to measure coactivated responses in affordance tasks. PMID:21824035

Federal Restrictions on Educational Research: Privacy Protection Study Commission Hearings

ERIC Educational Resources Information Center

Michael, John; Weinberg, JoAnn

1977-01-01

The Privacy Protection Study Commission (PPSC) held public hearings on personal data record-keeping policies and practices in educational institutions in Los Angeles in October and in Washington, D.C. in November, 1976. Under consideration were the protections afforded parents and students by the Family Educational Rights and Privacy Act.…

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

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... URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Affordable Housing Activities § 1000.101 What is...

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.

Improving perceptions of healthy food affordability: results from a pilot intervention.

PubMed

Williams, Lauren K; Abbott, Gavin; Thornton, Lukar E; Worsley, Anthony; Ball, Kylie; Crawford, David

2014-03-10

Despite strong empirical support for the association between perceived food affordability and dietary intake amongst families with a lower socioeconomic position (SEP), there is limited evidence of the most effective strategies for promoting more positive perceptions of healthy food affordability among this group. This paper reports findings from a pilot intervention that aimed to improve perceptions of healthy food affordability amongst mothers. Participants were 66 mothers who were the parents of children recruited from primary schools located in socioeconomically disadvantaged suburbs. Intervention group participants viewed a slideshow focussed on healthy snack food affordability that illustrated cheaper healthier alternatives to common snack foods as well as food budgeting tips and price comparison education. A mixed between-within ANCOVA was conducted to examine group differences in perceived affordability of healthy food across three time points. Results revealed no difference in perceived affordability of healthy food between the two groups at baseline whereas at post-intervention and follow-up, mothers in the intervention group perceived healthy food as more affordable than the control group. Focussing on education-based interventions to improve perceptions of healthy food affordability may be a promising approach that complements existing nutrition promotion strategies.

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

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…

Protection from extinction.

PubMed

Rescorla, Robert A

2003-05-01

The effect of the presence of a conditioned inhibitor on extinction of excitatory conditioning was studied in one magazine approach and three autoshaping experiments using rats and pigeons. In each case, the presence of an inhibitor reduced responding to an exciter during extinction but allowed substantial recovery of responding to that exciter when subsequently tested separately. Control stimuli with a history of being irrelevant to reinforcement or being nonreinforced had less of a protective effect. This constitutes a clear demonstration of protection from extinction, a phenomenon of substantial theoretical and applied importance.

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.

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Redman, R.S.; Rodriguez, R.J.; Clifton, D.R.

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 andmore » 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.« less

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.

77 FR 58072 - Finding of Substantial Inadequacy of Implementation Plan; Call for California State...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-19

... Substantial Inadequacy of Implementation Plan; Call for California State Implementation Plan Revision; South Coast AGENCY: Environmental Protection Agency (EPA). ACTION: Proposed rule. SUMMARY: In response to a... that the California State Implementation Plan (SIP) for the Los Angeles-South Coast Air Basin (South...

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…

Neighborhood-Level Social Processes and Substantiated Cases of Child Maltreatment

PubMed Central

Molnar, Beth E.; Goerge, Robert M.; Gilsanz, Paola; Hill, Andrea; Subramanian, SV; Holton, John K.; Duncan, Dustin T.; Beatriz, Elizabeth D.; Beardslee, William R.

2015-01-01

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

Defining and Measuring the Affordability of New Medicines: A Systematic Review.

PubMed

Antoñanzas, Fernando; Terkola, Robert; Overton, Paul M; Shalet, Natalie; Postma, Maarten

2017-08-01

In many healthcare systems, affordability concerns can lead to restrictions on the use of expensive efficacious therapies. However, there does not appear to be any consensus as to the terminology used to describe affordability, or the thresholds used to determine whether new drugs are affordable. The aim of this systematic review was to investigate how affordability is defined and measured in healthcare. MEDLINE, EMBASE and EconLit databases (2005-July 2016) were searched using terms covering affordability and budget impact, combined with definitions, thresholds and restrictions, to identify articles describing a definition of affordability with respect to new medicines. Additional definitions were identified through citation searching, and through manual searches of European health technology assessment body websites. In total, 27 definitions were included in the review. Of these, five definitions described affordability in terms of the value of a product; seven considered affordability within the context of healthcare system budgets; and 15 addressed whether products are affordable in a given country based on economic factors. However, there was little in the literature to indicate that the price of medicines is considered alongside both their value to individual patients and their budget impact at a population level. Current methods of assessing affordability in healthcare may be limited by their focus on budget impact. A more effective approach may involve a broader perspective than is currently described in the literature, to consider the long-term benefits of a therapy and cost savings elsewhere in the healthcare system, as well as cooperation between healthcare payers and the pharmaceutical industry to develop financing models that support sustainability as well as innovation.

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. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The ACA’s Cost-Sharing Reduction Plans: A Key to Affordable Health Coverage for Millions of U.S. Workers.

PubMed

Gabel, Jon; Whitmore, Heidi; Green, Matthew; Call, Adrienne; Stromberg, Sam; Oran, Rebecca

2016-10-01

Issue: Without the cost-sharing reductions (CSRs) made available by the Affordable Care Act, health plans sold in the marketplaces may be unaffordable for many low-income people. CSRs are available to households earning between 100 percent and 250 percent of the federal poverty level that choose a silver-level marketplace plan. In 2016, about 7 million people received cost-sharing reductions that substantially lowered their deductibles, copayments, coinsurance, and out-of-pocket limits. Goal: To examine variations in consumer cost-sharing reductions between silver-level plans with CSRs to traditional marketplace plans and to employer-based insurance. Methods: Data analysis of 1,209 CSR-eligible plans sold in individual marketplaces in all 50 states and Washington, D.C. Key findings and conclusions: Cost-sharing amounts in silver plans with CSRs are much less than those in non-CSR base silver plans; silver plans with CSRs generally offer far better financial protection than those without. General annual deductibles range from $246 for CSR silver plans with a platinum-level actuarial value (94%) to as much as $3,063 for non-CSR silver plans. Out-of-pocket limits vary from $6,223 in base silver plans to $1,102 in silver plans with CSRs and a platinum-level actuarial level.

Burnout Stress Syndrome in Child Protection.

ERIC Educational Resources Information Center

Verstraete, Patricia A.

1994-01-01

Burnout stress syndrome is a complex concept reflecting a failure in both the individual's defense mechanism and in the work environment. Since child protection agencies cannot afford the costs of staff burnout, time and money spent by the organization to reduce employee stress is an investment in better service delivery. (TJQ)

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.

G protection: interaction of straining maneuvers and positive pressure breathing.

PubMed

Eiken, Ola; Kölegärd, Roger; Bergsten, Eddie; Grönkvist, Mikael

2007-04-01

G protection in the 39 Gripen aircraft is provided by a full coverage anti-G suit, a pressure-breathing system, and anti-G straining maneuvers (AGSM). The purpose was to study (1) the interaction of pressure breathing and AGSM while wearing an anti-G suit; and (2) the G-protective properties of the anti-G suit alone and in combination with the pressure-breathing system. During rapid onset rate G-time profiles (< or =9 G), 10 subjects were investigated in 5 conditions: (I) sitting relaxed, without any G-protective garment; (II) sitting relaxed and wearing an anti-G suit; (III) sitting relaxed, wearing an anti-G suit, and pressure breathing; IV) wearing an anti-G suit and performing AGSM; and V) wearing an anti-G suit, pressure breathing, and performing AGSM. In supplementary experiments (n=9), the share of the anti-G suit protection afforded by the abdominal bladder was investigated. G tolerance was 3.4 Gz (range: 2.8-4.3) in condition I, > or = 6.5 Gz (4.5-9.0) in II, > or = 8.0 Gz (6.5-9.0) in III, > or = 8.9 Gz (8.5-9.0) in IV and > or = 9.0 Gz (8.5-9.0) in V. In the supplementary experiments, the anti-G suit afforded a 2.8-G protection, a third of which was contributed by the abdominal bladder. In the relaxed state, pressure applied to the airways was transmitted undistorted to the intrathoracic space. During AGSM, intrathoracic pressure rose to 10-14 kPa, regardless of whether AGSM was performed with or without pressure breathing. The anti-G suit and the pressure breathing system provide G protection of > or = 4.6 G, of which the anti-G suit contributes about 3.0 G. The C-protective properties of the anti-G suit and those of pressure breathing appears to be additive, whereas the G protection afforded by pressure breathing does not add to that provided by AGSM.

Emotion regulation choice: the role of environmental affordances.

PubMed

Suri, Gaurav; Sheppes, Gal; Young, Gerald; Abraham, Damon; McRae, Kateri; Gross, James J

2017-09-01

Which emotion regulation strategy one uses in a given context can have profound affective, cognitive, and social consequences. It is therefore important to understand the determinants of emotion regulation choice. Many prior studies have examined person-specific, internal determinants of emotion regulation choice. Recently, it has become clear that external variables that are properties of the stimulus can also influence emotion regulation choice. In the present research, we consider whether reappraisal affordances, defined as the opportunities for re-interpretation of a stimulus that are inherent in that stimulus, can shape individuals' emotion regulation choices. We show that reappraisal affordances have stability across people and across time (Study 1), and are confounded with emotional intensity for a standardised set of picture stimuli (Study 2). Since emotional intensity has been shown to drive emotion regulation choice, we construct a context in which emotional intensity is separable from reappraisal affordances (Study 3) and use this context to show that reappraisal affordances powerfully influence emotion regulation choice even when emotional intensity and discrete emotions are taken into account (Study 4).

10 CFR 140.84 - Criterion I-Substantial discharge of radioactive material or substantial radiation levels offsite.

Code of Federal Regulations, 2013 CFR

2013-01-01

... or substantial radiation levels offsite. 140.84 Section 140.84 Energy NUCLEAR REGULATORY COMMISSION... § 140.84 Criterion I—Substantial discharge of radioactive material or substantial radiation levels... radioactive material offsite, or that there have been substantial levels of radiation offsite, when, as a...

10 CFR 140.84 - Criterion I-Substantial discharge of radioactive material or substantial radiation levels offsite.

Code of Federal Regulations, 2014 CFR

2014-01-01

... or substantial radiation levels offsite. 140.84 Section 140.84 Energy NUCLEAR REGULATORY COMMISSION... § 140.84 Criterion I—Substantial discharge of radioactive material or substantial radiation levels... radioactive material offsite, or that there have been substantial levels of radiation offsite, when, as a...

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

... TRADE SECRET DISCLOSURES TO HEALTH PROFESSIONALS Trade Secrecy Claims § 350.27 Substantiation form to... Secret Substantiation Form General Information EPA requires that the information requested in a trade secret substantiation be completed using this substantiation form in order to ensure that all facility...

40 CFR 350.27 - Substantiation form to accompany claims of trade secrecy, instructions to substantiation form.

Code of Federal Regulations, 2014 CFR

2014-07-01

... TRADE SECRET DISCLOSURES TO HEALTH PROFESSIONALS Trade Secrecy Claims § 350.27 Substantiation form to... Secret Substantiation Form General Information EPA requires that the information requested in a trade secret substantiation be completed using this substantiation form in order to ensure that all facility...

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

... TRADE SECRET DISCLOSURES TO HEALTH PROFESSIONALS Trade Secrecy Claims § 350.27 Substantiation form to... Secret Substantiation Form General Information EPA requires that the information requested in a trade secret substantiation be completed using this substantiation form in order to ensure that all facility...

40 CFR 350.27 - Substantiation form to accompany claims of trade secrecy, instructions to substantiation form.

Code of Federal Regulations, 2012 CFR

2012-07-01

... TRADE SECRET DISCLOSURES TO HEALTH PROFESSIONALS Trade Secrecy Claims § 350.27 Substantiation form to... Secret Substantiation Form General Information EPA requires that the information requested in a trade secret substantiation be completed using this substantiation form in order to ensure that all facility...

40 CFR 350.27 - Substantiation form to accompany claims of trade secrecy, instructions to substantiation form.

Code of Federal Regulations, 2013 CFR

2013-07-01

... TRADE SECRET DISCLOSURES TO HEALTH PROFESSIONALS Trade Secrecy Claims § 350.27 Substantiation form to... Secret Substantiation Form General Information EPA requires that the information requested in a trade secret substantiation be completed using this substantiation form in order to ensure that all facility...

Schizophrenia: An Impairment in the Capacity to Perceive Affordances

PubMed Central

Kim, Nam-Gyoon; Kim, Hakboon

2017-01-01

Phenomenological psychopathologists conceptualize schizophrenia as a self-disorder involving profound distortions of selfhood. For James Gibson, “to perceive the world is to coperceive oneself.” If the sense of self is disturbed in individuals with schizophrenia, this could also lead to disturbances in these individuals’ ability to perceive affordances, environmental properties taken with reference to the perceiver’s action capabilities (e.g., a rigid surface affording ‘walk-on-able,’ chairs ‘sit-on-able,’ and so on). To test this hypothesis, three experiments investigated schizophrenia patients’ affordance perception. Participants were presented with a photo of a common object on the computer and then asked to judge its secondary affordance (a non-designed function) in a two-choice reaction time task in Experiment 1 and in a yes/no task in Experiment 2. Schizophrenia participants performed less accurately and more slowly than controls. To rule out visual impairment as a contributing factor, in Experiment 3, participants identified physical properties (color, shape, material composition) of the objects. Schizophrenia participants were as accurate as controls and responded faster than in the previous experiments. Results suggest that the capacity to perceive affordances is likely impaired in people with schizophrenia, although the capacity to detect the object’s physical properties is kept intact. Inability to perceive affordances, those functionally significant properties of the surrounding environment, may help explain why schizophrenia patients may appear as somewhat detached from the world. PMID:28701973

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.

Domestic violence, parental substance misuse and the decision to substantiate child maltreatment.

PubMed

Victor, Bryan G; Grogan-Kaylor, Andrew; Ryan, Joseph P; Perron, Brian E; Gilbert, Terri Ticknor

2018-05-01

Families that experience domestic violence and parental substance misuse are disproportionately involved with the child welfare system. Prior research suggests that child protective services (CPS) caseworkers are more likely to substantiate maltreatment allegations when domestic violence and parental substance misuse are identified during the investigation, pointing to one possible mechanism for this disproportionate involvement. While previous studies have relied on nationally representative data sets, the current study used administrative records from a large Midwestern child welfare agency that accounts for state-level variation in child welfare policy and practice. A total of 501,060 substantiation decisions made between 2009 and 2013 were examined to assess the influence of caseworker-perceived domestic violence and parental substance misuse on the decision to substantiate reported maltreatment. Results from multilevel modeling suggest that the identification of domestic violence and parental substance misuse during an investigation significantly increased the probability that an allegation would be substantiated. The implication of these findings for child welfare practice are considered in light of the fact that many child welfare agencies do not consider exposure to domestic violence and parental substance misuse in and of themselves to constitute child maltreatment. Copyright © 2018 Elsevier Ltd. All rights reserved.

Income dynamics and the Affordable Care Act.

PubMed

Shore-Sheppard, Lara D

2014-12-01

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. Survey of Income and Program Participation (SIPP): 1996, 2001, 2004, 2008 panels. 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. 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. 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. 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. © Health Research and Educational Trust.

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

American surgery and the Affordable Care Act.

PubMed

Stain, Steven C; Hoyt, David B; Hunter, John G; Joyce, Geoffrey; Hiatt, Jonathan R

2014-09-01

The Affordable Care Act (ACA) attempts to change the way we finance and deliver health care by coordinating the delivery of primary, specialty, and hospital services in accountable care organizations. The ways in which accountable care organizations will develop and evolve is unclear; however, the effects on surgeons and their patients will be substantial. High-value care in the ACA emphasizes quality, safety, resource use and appropriateness, and the patient's experience of care. Payment will be linked to these principles. Department chairs overseeing a clinical enterprise in academic medical centers now must add financial and quality measures to the traditional missions of education, research, and clinical service. At a time when surgical training is in dramatic evolution, with work hour limitations for residents and an emphasis on quality, productivity, and increasing oversight of trainees for faculty, residency programs will need to meet the increasing demands of an aging population and newly insured patients under the ACA. The American College of Surgeons, with its century-long commitment to quality improvement, research-based standards, and performance measurement and verification, has begun its Inspiring Quality Campaign, is developing new educational tools, and is preparing proposals for payment reform based on surgeons' participation in quality programs.

Program Affordability Tradeoffs

DTIC Science & Technology

2016-04-30

engineering, trade -studies, and risk assessment and management for a variety of civilian and DoD sponsors. She holds a master’s degree in mathematics...mph in as little as 2.8 seconds. Prius Model 2 fuel economy (MPG): 54 - 58 city | 50 - 53 highway Trade -Off Analysis Costs: $80,000...affordability trades  What is the impact to goals/missions/objectives of pursuing a lower cost, lower performing alternative? Is this impact

Article having an improved platinum-aluminum-hafnium protective coating

NASA Technical Reports Server (NTRS)

Nagaraj, Bangalore Aswatha (Inventor); Williams, Jeffrey Lawrence (Inventor)

2005-01-01

An article protected by a protective coating has a substrate and a protective coating having an outer layer deposited upon the substrate surface and a diffusion zone formed by interdiffusion of the outer layer and the substrate. The protective coating includes platinum, aluminum, no more than about 2 weight percent hafnium, and substantially no silicon. The outer layer is substantially a single phase.

Oral immunisation with live aroA attenuated Salmonella enterica serovar Typhimurium expressing the Yersinia pestis V antigen protects mice against plague.

PubMed

Garmory, Helen S; Griffin, Kate F; Brown, Katherine A; Titball, Richard W

2003-06-20

Bubonic and pneumonic plague are caused by the bacterium Yersinia pestis. The V antigen of Y. pestis is a protective antigen against plague. In this study, an aroA attenuated strain of Salmonella enterica serovar Typhimurium (SL3261) has been used to deliver the Y. pestis V antigen as a candidate oral plague vaccine. SL3261 was transformed with the expression plasmid pTrc-LcrV, containing the lcrV gene encoding V antigen. Immunoblot analysis showed V antigen expression in SL3261 in vitro and intragastric immunisation of mice with the recombinant Salmonella resulted in the induction of V antigen-specific serum antibody responses and afforded protection against Y. pestis challenge. However, the antibody responses induced by the recombinant Salmonella did not correlate with the protection afforded, indicating that immune responses other than antibody may play a role in the protection afforded against plague by this candidate vaccine.

Quantifying the Impoverishing Effects of Purchasing Medicines: A Cross-Country Comparison of the Affordability of Medicines in the Developing World

PubMed Central

Niëns, Laurens M.; Cameron, Alexandra; Van de Poel, Ellen; Ewen, Margaret; Brouwer, Werner B. F.; Laing, Richard

2010-01-01

Background Increasing attention is being paid to the affordability of medicines in low- and middle-income countries (LICs and MICs) where medicines are often highly priced in relation to income levels. The impoverishing effect of medicine purchases can be estimated by determining pre- and postpayment incomes, which are then compared to a poverty line. Here we estimate the impoverishing effects of four medicines in 16 LICs and MICs using the impoverishment method as a metric of affordability. Methods and Findings Affordability was assessed in terms of the proportion of the population being pushed below US$1.25 or US$2 per day poverty levels because of the purchase of medicines. The prices of salbutamol 100 mcg/dose inhaler, glibenclamide 5 mg cap/tab, atenolol 50 mg cap/tab, and amoxicillin 250 mg cap/tab were obtained from facility-based surveys undertaken using a standard measurement methodology. The World Bank's World Development Indicators provided household expenditure data and information on income distributions. In the countries studied, purchasing these medicines would impoverish large portions of the population (up to 86%). Originator brand products were less affordable than the lowest-priced generic equivalents. In the Philippines, for example, originator brand atenolol would push an additional 22% of the population below US$1.25 per day, whereas for the lowest priced generic equivalent this demographic shift is 7%. Given related prevalence figures, substantial numbers of people are affected by the unaffordability of medicines. Conclusions Comparing medicine prices to available income in LICs and MICs shows that medicine purchases by individuals in those countries could lead to the impoverishment of large numbers of people. Action is needed to improve medicine affordability, such as promoting the use of quality assured, low-priced generics, and establishing health insurance systems. Please see later in the article for the Editors' Summary PMID:20824175

Designing Smart Objects to Support Affording Situations: Exploiting Affordance Through an Understanding of Forms of Engagement

PubMed Central

Baber, Chris

2018-01-01

In this paper I consider how the concept of “affordance” has been adapted from the original writings of Gibson and applied to interaction design. I argue that a clear understanding of affordance shifts the goal of interaction design from one of solely focusing on either the physical object or the capabilities of the person, toward an understanding of interactivity. To do this, I develop the concept of Forms of Engagement, originally proposed to account for tool use. Finally, I extend this concept to interacting with modified tangible user interfaces, or “animate objects.” These animate objects not only sense how they are being used, but also communicate with each other to develop a shared intent, and provide prompts and cues to encourage specific actions. In this way, the human-object-environment system creates affording situations in pursuit of shared intentions and goals. In order to determine when to provide prompts and cues, the objects need to have a model of how they ought to be used and what intention they are being used to achieve. Consequently, affordances become not only the means by which actions are encouraged but also the manner in which intentions are identified and agreed. PMID:29593601

Affordances: Ten Years On

ERIC Educational Resources Information Center

Brown, Jill P.; Stillman, Gloria

2014-01-01

Ten years ago the construct, affordance, was rising in prominence in scholarly literature. A proliferation of different uses and meanings was evident. Beginning with its origin in the work of Gibson, we traced its development and use in various scholarly fields. This paper revisits our original question with respect to its utility in mathematics…

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. Copyright © 2016 by Duke University Press.

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. Copyright © 2015 Elsevier Ltd. All rights reserved.

The Problem with Affordance

ERIC Educational Resources Information Center

Oliver, Martin

2005-01-01

This article reviews the concept of "affordance", a term widely used in the literature on learning and technology to try and explain the properties technologies have. It is argued that the concept has drifted so far from its origins that it is now too ambiguous to be analytically valuable. In addition, it is suggested that its origins in…

Duet for menstrual protection: a feasibility study in Zimbabwe.

PubMed

Averbach, Sarah; Sahin-Hodoglugil, Nuriye; Musara, Petina; Chipato, Tsungai; van der Straten, Ariane

2009-06-01

Managing menses is a challenge for women in developing countries. Duet is a cervical barrier being developed for contraception and STI prevention. We explored the hypothetical acceptability of using Duet as a menstrual cup, among Zimbabwean women. A survey and focus group discussions (FGD) were conducted with 43 women aged 18-45 years to gain information about their menstrual practices and attitudes regarding the use of Duet for menstrual protection. All 43 women reported that if Duet were available, they would "definitely" try it, and that it was "very important" that Duet is low cost and easy to clean; 86% reported that using it would make a difference in their lives. FGD findings highlighted unhygienic practices due to the lack of affordable options for menstrual management and a genuine interest in Duet, including its potential use for multiple purposes (contraception, disease prevention and menstrual protection). Accessing affordable and hygienic menstrual protection was a problem for these Zimbabwean women. Duet appeared acceptable and it would be feasible to conduct a user-acceptability study of Duet as a menstrual cup in Zimbabwe.

Affordability Tradeoffs Under Uncertainty Using Epoch-Era Analysis

DTIC Science & Technology

2013-09-30

Procedia Computer Science , Retrieved from: http://www.elsevier.com Bobinis, J., Haimowitz, J., Tuttle, P., & Garrison, C. (2012, October). Affordability...commercial products. Dr. Rhodes received her PhD in Systems Science from the T.J. Watson School of Engineering at Binghamton University. She serves on...components, evaluate feedback, and be adaptive to evolving system behaviors . As affordability is a concept evaluated over time, such a method can

Challenges of Integrating Affordable and Sustainable Housing in Malaysia

NASA Astrophysics Data System (ADS)

Syed Jamaludin, S. Z. H.; Mahayuddin, S. A.; Hamid, S. H. A.

2018-04-01

Developing countries including Malaysia have begun to comprehend the needs for affordable and sustainable housing development. The majority of the population is still aspiring for a comfortable, safe and reasonably priced house. Households in the low-middle income range face difficulties to find housing that can satisfy their needs and budget. Unfortunately, most of the housing development programs are considering affordability rather than sustainable aspects. Furthermore, developers are more interested in profit and neglect sustainability issues. Thus, the aim of this paper is to review the challenges in integrating affordable housing and sustainable practices in Malaysia. This paper is produced based on an extensive literature review as a basis to develop strategies of integrated affordable and sustainable housing in Malaysia. The challenges are divided into four sections, namely market challenges, professional challenges, societal challenges and technological challenges. The outcomes of this paper will assist in the decision making involving housing development and in enhancing quality of life for sustainable communities.

Are essential medicines in Malaysia accessible, affordable and available?

PubMed

Saleh, Kamaruzaman; Ibrahim, Mohamed I M

2005-12-01

To assess the pharmaceutical sector to know whether people have access to essential medicines. The study was conducted in 20 public health clinics, five public district drug stores and 20 private retail pharmacies selected randomly in five different areas randomly selected (four states and a federal territory). The methodology used was adopted from the World Health Organization study protocol. The degree of attainment of the strategic pharmaceutical objectives of improved access is measured by a list of tested indicators. Access is measured in terms of the availability and affordability of essential medicines, especially to the poor and in the public sector. The first survey in the public health clinics and public district drug stores gathered information about current availability of essential medicines, prevalence of stock-outs and affordability of treatment (except drug stores). The second survey assessed affordability of treatment in public health clinics and private retail pharmacies. Availability, stock-out duration, percent of medicines dispensed, accessibility and affordability of key medicines. The average availability of key medicines in the public health clinics for the country was 95.4%. The average stock-out duration of key medicines was 6.5 days. However, average availability of key medicines in the public district drug stores was 89.2%; with an average stock-out duration of 32.4 days. Medicines prescribed were 100% dispensed to the patients. Average affordability for public health clinics was 1.5 weeks salary and for the private pharmacies, 3.7 weeks salary. The present pharmaceutical situation in the context of essential medicines list implementation reflected that the majority of the population in Malaysia had access to affordable essential medicines. If medicines need to be obtained from the private sector, they are hardly affordable. Although the average availability of essential medicines in Malaysia was high being more than 95.0%, in certain

The Fidelity of ’Feel’: Emotional Affordance in Virtual Environments

DTIC Science & Technology

2005-07-01

The Fidelity of “Feel”: Emotional Affordance in Virtual Environments Jacquelyn Ford Morie, Josh Williams, Aimee Dozois, Donat-Pierre Luigi... environment but also the participant. We do this with the focus on what emotional affordances this manipulation will provide. Our first evaluation scenario...emotionally affective VEs. Keywords: Immersive Environments , Virtual Environments , VEs, Virtual Reality, emotion , affordance, fidelity, presence

Plastic surgery practice models and research aims under the Patient Protection and Affordable Care Act.

PubMed

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

2015-02-01

As the health care landscape in the United States changes under the Affordable Care Act, 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 health care 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 to dictate adequate compensation in the future. In this article, the authors discuss bundle payments and accountable care organizations, and how plastic surgeons might best engage in these new system designs. In addition, the authors 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.

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

Does Task Affordance Moderate Age-related Deficits in Strategy Production?

PubMed Central

Bottiroli, Sara; Dunlosky, John; Guerini, Kate; Cavallini, Elena; Hertzog, Christopher

2011-01-01

According to the task-affordance hypothesis, people will be more likely to use a specific strategy as tasks more readily afford its use. To evaluate this hypothesis, we examined the degree to which older and younger adults used a self-testing strategy to learn items, because previous studies suggest that age-related differences in the use of this powerful strategy vary across tasks. These tasks (words affixed to a board vs. pairs on flashcards) differentially afford the use of the self-testing strategy and may moderate the age-related effects on strategy use. Participants performed a recall-readiness task in which they continued to study items until they were ready for the criterion test. As predicted, self testing was used less often on tasks that least afforded its use. Namely, participants used self testing less when they studied single words affixed to a board than when they studied pairs on flashcards. Most important, age-related deficits in strategy use were greater for the former task and nonexistent for the latter one, suggesting that task affordance moderates age differences in strategy use. PMID:20552461

Does task affordance moderate age-related deficits in strategy production?

PubMed

Bottiroli, Sara; Dunlosky, John; Guerini, Kate; Cavallini, Elena; Hertzog, Christopher

2010-09-01

According to the task-affordance hypothesis, people will be more likely to use a specific strategy as tasks more readily afford its use. To evaluate this hypothesis, we examined the degree to which older and younger adults used a self-testing strategy to learn items, because previous studies suggest that age-related differences in the use of this powerful strategy vary across tasks. These tasks (words affixed to a board vs. pairs on flashcards) differentially afford the use of the self-testing strategy and may moderate the age-related effects on strategy use. Participants performed a recall-readiness task in which they continued to study items until they were ready for the criterion test. As predicted, self testing was used less often on tasks that least afforded its use. Namely, participants used self testing less when they studied single words affixed to a board than when they studied pairs on flashcards. Most important, age-related deficits in strategy use were greater for the former task and nonexistent for the latter one, suggesting that task affordance moderates age differences in strategy use.

Emerging Affordances in Videoconferencing for Language Learning and Teaching

ERIC Educational Resources Information Center

Dey-Plissonneau, Aparajita

2017-01-01

The theory of affordances (Gibson, 1977) came into focus in humancomputer interactions and ecological interactive design to explore design strategies to support the actor in direct perception of action possibilities in the operation of things. However, few studies have analysed the basis of affordances in the cultural-historical development of…

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…

Making Sense of Biodiversity: The Affordances of Systems Ecology.

PubMed

Andersson, Erik; McPhearson, Timon

2018-01-01

We see two related, but not well-linked fields that together could help us better understand biodiversity and how it, over time, provides benefits to people. The affordances approach in environmental psychology offers a way to understand our perceptual appraisal of landscapes and biodiversity and, to some extent, intentional choice or behavior, i.e., a way of relating the individual to the system s/he/it lives in. In the field of ecology, organism-specific functional traits are similarly understood as the physiological and behavioral characteristics of an organism that informs the way it interacts with its surroundings. Here, we review the often overlooked role of traits in the provisioning of ecosystem services as a potential bridge between affordance theory and applied systems ecology. We propose that many traits can be understood as the basis for the affordances offered by biodiversity, and that they offer a more fruitful way to discuss human-biodiversity relations than do the taxonomic information most often used. Moreover, as emerging transdisciplinary studies indicate, connecting affordances to functional traits allows us to ask questions about the temporal and two-way nature of affordances and perhaps most importantly, can serve as a starting point for more fully bridging the fields of ecology and environmental psychology with respect to how we understand human-biodiversity relationships.

Foregrounding Sociomaterial Practice in Our Understanding of Affordances: The Skilled Intentionality Framework.

PubMed

van Dijk, Ludger; Rietveld, Erik

2016-01-01

Social coordination and affordance perception always take part in concrete situations in real life. Nonetheless, the different fields of ecological psychology studying these phenomena do not seem to make this situated nature an object of study. To integrate both fields and extend the reach of the ecological approach, we introduce the Skilled Intentionality Framework that situates both social coordination and affordance perception within the human form of life and its rich landscape of affordances. We argue that in the human form of life the social and the material are intertwined and best understood as sociomateriality. Taking the form of life as our starting point foregrounds sociomateriality in each perspective we take on engaging with affordances. Using ethnographical examples we show how sociomateriality shows up from three different perspectives we take on affordances in a real-life situation. One perspective shows us a landscape of affordances that the sociomaterial environment offers. Zooming in on this landscape to the perspective of a local observer, we can focus on an individual coordinating with affordances offered by things and other people situated in this landscape. Finally, viewed from within this unfolding activity, we arrive at the person's lived perspective: a field of relevant affordances solicits activity. The Skilled Intentionality Framework offers a way of integrating social coordination and affordance theory by drawing attention to these complementary perspectives. We end by showing a real-life example from the practice of architecture that suggests how this situated view that foregrounds sociomateriality can extend the scope of ecological psychology to forms of so-called "higher" cognition.

Foregrounding Sociomaterial Practice in Our Understanding of Affordances: The Skilled Intentionality Framework

PubMed Central

van Dijk, Ludger; Rietveld, Erik

2017-01-01

Social coordination and affordance perception always take part in concrete situations in real life. Nonetheless, the different fields of ecological psychology studying these phenomena do not seem to make this situated nature an object of study. To integrate both fields and extend the reach of the ecological approach, we introduce the Skilled Intentionality Framework that situates both social coordination and affordance perception within the human form of life and its rich landscape of affordances. We argue that in the human form of life the social and the material are intertwined and best understood as sociomateriality. Taking the form of life as our starting point foregrounds sociomateriality in each perspective we take on engaging with affordances. Using ethnographical examples we show how sociomateriality shows up from three different perspectives we take on affordances in a real-life situation. One perspective shows us a landscape of affordances that the sociomaterial environment offers. Zooming in on this landscape to the perspective of a local observer, we can focus on an individual coordinating with affordances offered by things and other people situated in this landscape. Finally, viewed from within this unfolding activity, we arrive at the person’s lived perspective: a field of relevant affordances solicits activity. The Skilled Intentionality Framework offers a way of integrating social coordination and affordance theory by drawing attention to these complementary perspectives. We end by showing a real-life example from the practice of architecture that suggests how this situated view that foregrounds sociomateriality can extend the scope of ecological psychology to forms of so-called “higher” cognition. PMID:28119638

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…

24 CFR 572.120 - Affordability standards.

Code of Federal Regulations, 2010 CFR

2010-04-01

... (Continued) OFFICE OF ASSISTANT SECRETARY FOR COMMUNITY PLANNING AND DEVELOPMENT, DEPARTMENT OF HOUSING AND... affordability. (1) The monthly expenditure for principal, interest, taxes, and insurance by an eligible family...

Evaporation-Cooled Protective Suits for Firefighters

NASA Technical Reports Server (NTRS)

Weinstein, Leonard Murray

2007-01-01

Suits cooled by evaporation of water have been proposed as improved means of temporary protection against high temperatures near fires. When air temperature exceeds 600 F (316 C) or in the presence of radiative heating from nearby sources at temperatures of 1,200 F (649 C) or more, outer suits now used by firefighters afford protection for only a few seconds. The proposed suits would exploit the high latent heat of vaporization of water to satisfy a need to protect against higher air temperatures and against radiant heating for significantly longer times. These suits would be fabricated and operated in conjunction with breathing and cooling systems like those with which firefighting suits are now equipped

10 CFR 840.4 - Criterion I-Substantial discharge of radioactive material or substantial radiation levels offsite.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 4 2012-01-01 2012-01-01 false Criterion I-Substantial discharge of radioactive material or substantial radiation levels offsite. 840.4 Section 840.4 Energy DEPARTMENT OF ENERGY EXTRAORDINARY NUCLEAR OCCURRENCES § 840.4 Criterion I—Substantial discharge of radioactive material or...

10 CFR 840.4 - Criterion I-Substantial discharge of radioactive material or substantial radiation levels offsite.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 4 2013-01-01 2013-01-01 false Criterion I-Substantial discharge of radioactive material or substantial radiation levels offsite. 840.4 Section 840.4 Energy DEPARTMENT OF ENERGY EXTRAORDINARY NUCLEAR OCCURRENCES § 840.4 Criterion I—Substantial discharge of radioactive material or...

10 CFR 840.4 - Criterion I-Substantial discharge of radioactive material or substantial radiation levels offsite.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Criterion I-Substantial discharge of radioactive material or substantial radiation levels offsite. 840.4 Section 840.4 Energy DEPARTMENT OF ENERGY EXTRAORDINARY NUCLEAR OCCURRENCES § 840.4 Criterion I—Substantial discharge of radioactive material or...

10 CFR 840.4 - Criterion I-Substantial discharge of radioactive material or substantial radiation levels offsite.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Criterion I-Substantial discharge of radioactive material or substantial radiation levels offsite. 840.4 Section 840.4 Energy DEPARTMENT OF ENERGY EXTRAORDINARY NUCLEAR OCCURRENCES § 840.4 Criterion I—Substantial discharge of radioactive material or...

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…

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. Copyright © 2015 Elsevier Ltd. All rights reserved.

Availability, accessibility, and affordability of neurodiagnostic tests in 37 countries.

PubMed

McLane, Hannah C; Berkowitz, Aaron L; Patenaude, Bryan N; McKenzie, Erica D; Wolper, Emma; Wahlster, Sarah; Fink, Günther; Mateen, Farrah J

2015-11-03

To determine the availability, accessibility, and affordability of EEG, EMG, CSF analysis, head CT, and brain MRI for neurologic disorders across countries. An online, 60-question survey was distributed to neurology practitioners in 2014 to assess the presence, wait time, and cost of each test in private and public health sectors. Data were stratified by World Bank country income group. Affordability was calculated with reference to the World Health Organization's definition of catastrophic health expenditure as health-related out-of-pocket expenditure of >40% of disposable household income, and assessment of providers' perceptions of affordability to the patient. Availability of EEG and EMG is correlated with higher World Bank income group (correlation coefficient 0.38, test for trend p = 0.046; 0.376, p = 0.043); CSF, CT, and MRI did not show statistically significant associations with income groups. Patients in public systems wait longer for neurodiagnostic tests, especially MRI, EEG, and urgent CT (p < 0.0001). The mean cost per test, across all tests, was lower in the public vs private sector (US $55.25 vs $214.62, p < 0.001). Each drop in World Bank income group is associated with a 29% decrease in the estimated share of the population who can afford a given test (95% confidence interval -33.4, 25.2; p < 0.001). In most low-income countries surveyed, only the top 10% or 20% of the population was able to afford tests below catastrophic levels. In surveyed lower-middle-income countries, >40% of the population, on average, could not afford neurodiagnostic tests. Neurodiagnostic tests are least affordable in the lowest income settings. Closing this "diagnostic gap" for countries with the lowest incomes is essential. © 2015 American Academy of Neurology.

The Affordable Care Act’s Impacts on Access to Insurance and Health Care for Low-Income Populations

PubMed Central

Kominski, Gerald F.; Nonzee, Narissa J.; Sorensen, Andrea

2018-01-01

The Patient Protection and Affordable Care Act (ACA) expands access to health insurance in the United States, and, to date, an estimated 20 million previously uninsured individuals have gained coverage. Understanding the law’s impact on coverage, access, utilization, and health outcomes, especially among low-income populations, is critical to informing ongoing debates about its effectiveness and implementation. Early findings indicate that there have been significant reductions in the rate of uninsurance among the poor and among those who live in Medicaid expansion states. In addition, the law has been associated with increased health care access, affordability, and use of preventive and outpatient services among low-income populations, though impacts on inpatient utilization and health outcomes have been less conclusive. Although these early findings are generally consistent with past coverage expansions, continued monitoring of these domains is essential to understand the long-term impact of the law for underserved populations. PMID:27992730

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

Affordance Analysis of Google+ Features: Advancing Teaching and Learning in Higher Education

ERIC Educational Resources Information Center

Zawawi, Boshra F.; Al Abri, Maimoona H.; Dabbagh, Nada

2017-01-01

This paper aims to analyze the affordances of the digital technology (DT) Google+. The analysis process was informed by the theory of affordances. Accordingly, this paper highlighted the different types of affordances of Google+ features, i.e., functional, cognitive, physical, sensory, emotional, and social. In addition, the authors reviewed…

Erythropoietin affords additional cardioprotection to preconditioned hearts by enhanced phosphorylation of glycogen synthase kinase-3 beta.

PubMed

Nishihara, Masahiro; Miura, Tetsuji; Miki, Takayuki; Sakamoto, Jun; Tanno, Masaya; Kobayashi, Hironori; Ikeda, Yoshihiro; Ohori, Katsuhiko; Takahashi, Akari; Shimamoto, Kazuaki

2006-08-01

The aim of this study was to determine whether erythropoietin (EPO) affords additional cardioprotection to the preconditioned myocardium by enhanced phosphorylation of Akt, STAT3, or glycogen synthase kinase-3beta (GSK-3 beta). Preconditioning (PC) with 5-min ischemia/5-min reperfusion and EPO (5,000 U/kg iv) reduced infarct size (as % of area at risk, %IS/AR) after 20-min ischemia in rat hearts in situ from 56.5 +/- 1.8% to 25.2 +/- 2.1% and to 36.2 +/- 2.8%, respectively. PC-induced protection was significantly inhibited by a protein kinase C inhibitor, chelerythrine (5 mg/kg), and slightly blunted by a phosphatidylinositol-3-kinase inhibitor, wortmannin (15 microg/kg). The opposite pattern of inhibition was observed for EPO-induced protection. The combination of PC and EPO further reduced %IS/AR to 8.9 +/- 1.9%, and this protection was inhibited by chelerythrine and wortmannin. The additive effects of PC and EPO on infarct size were mirrored by their effects on the level of phosphorylated GSK-3 beta at 5 min after reperfusion but not their effects on the level of phospho-Akt or phospho-STAT3. To mimic phosphorylation-induced inhibition of GSK-3 beta activity, SB-216763 (SB), a GSK-3 beta inhibitor, was administered before ischemia or 5 min before reperfusion. Infarct size was significantly reduced by preischemic injection (%IS/AR = 40.4 +/- 2.2% by 0.6 mg/kg SB and 34.0 +/- 1.8% by 1.2 mg/kg SB) and also by prereperfusion injection (%IS/AR = 32.0 +/- 2.0% by 1.2 mg/kg SB). These results suggest that EPO and PC afford additive infarct size-limiting effects by additive phosphorylation of GSK-3beta at the time of reperfusion by Akt-dependent and -independent mechanisms.

Investigating cigarette affordability in 60 cities using the cigarette price‐daily income ratio

PubMed Central

Kan, Ming‐yue

2007-01-01

Objective To investigate cigarette affordability in 60 cities. Methods Affordability of cigarettes is defined as the ratio of the price of one pack of cigarettes to daily income (cigarette price‐daily income ratio: CPDIR). Daily income data were calculated using the mean of the seven occupations with the lowest daily wage, as listed in the 2006 Union Bank of Switzerland survey; cigarette prices in 2006 were sourced from the Economist Intelligence Unit. Results Cigarette affordability in most of the surveyed cities remains high. There is a tendency for cities with high income economies to have a high level of cigarette affordability. Most of the cities in Western Europe and South and North America have high cigarette affordability, whereas 66.7% of their counterparts in Eastern Europe have medium cigarette affordability. In Asia, all cities with high cigarette affordability belong to the group of upper middle to high income economies, except for the Philippines. In Africa, Johannesburg and Nairobi have high and medium levels of cigarette affordability, respectively. Conclusion Cigarette affordability for most of the sampled cities, especially those in high income economies, is high. There is room for increasing cigarette prices via tax increases. There is a risk that the increase in cigarette prices in newly emerging economies lags behind the high speed of economic growth being experiencing. Tax increases should be given high priority. PMID:18048622

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…

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.

Affordances and Landscapes: Overcoming the Nature-Culture Dichotomy through Niche Construction Theory.

PubMed

Heras-Escribano, Manuel; De Pinedo-García, Manuel

2017-01-01

In this paper we reject the nature-culture dichotomy by means of the idea of affordance or possibility for action, which has important implications for landscape theory. Our hypothesis is that, just as the idea of affordance can serve to overcome the subjective-objective dichotomy, the ideas of landscape and ecological niche, properly defined, would allow us to also transcend the nature-culture dichotomy. First, we introduce an overview of landscape theory, emphasizing processual landscape theory as the most suitable approach for satisfying both cultural and naturalist approaches. After that, we introduce the idea of affordance and we analyze a tension between sociocultural and transcultural affordances (affordances that depend on cultural conventions and affordances that depend on lawful information and bodily aspects of agents). This tension has various implications for landscape theory and ecological niches. Our proposal is that sociocultural and transcultural aspects of affordances could be systematically accommodated if we apply niche construction theory (the theory that explains the process by which organisms modify their selective environments) as a methodological framework for explaining the emergence of ecological niches. This approach will lead us to an integrative account of landscapes as the products of the interaction between human and environmental elements, making it a clear example of a concept that transcends the nature-culture dichotomy.

Contribution of antibody production against neuraminidase to the protection afforded by influenza vaccines

PubMed Central

Marcelin, Glendie; Sandbulte, Matthew R.; Webby, Richard J.

2012-01-01

SUMMARY Vaccines are instrumental in controlling the burden of influenza virus infection in humans and animals. Antibodies raised against both major viral surface glycoproteins, hemagglutinin (HA) and neuraminidase (NA), can contribute to protective immunity. Vaccine-induced HA antibodies have been characterized extensively, and they generally confer protection by blocking the attachment and fusion of a homologous virus onto host cells. Though not as well characterized, some functions of NA antibodies in influenza vaccine-mediated immunity have been recognized for many years. In this review we summarize the case for NA antibodies in influenza vaccine-mediated immunity. In the absence of well-matched HA antibodies, NA antibodies can provide varying degrees of protection against disease. NA proteins of seasonal influenza vaccines have been shown in some instances to elicit serum antibodies with cross-reactivity to avian- and swine-origin influenza strains, in addition to HA drift variants. NA-mediated immunity has been linked to [i] conserved NA epitopes amongst otherwise antigenically distinct strains, partly attributable to the segmented influenza viral genome; [ii] inhibition of NA enzymatic activity; and [iii] the NA content in vaccine formulations. There is potential to enhance the effectiveness of existing and future influenza vaccines by focusing greater attention on the antigenic characteristics and potency of the NA protein. PMID:22438243

77 FR 34887 - Substantial Business Activities

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-12

... Substantial Business Activities AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice of proposed... regarding whether a foreign corporation has substantial business activities in a foreign country. These... provide guidance regarding whether a foreign corporation has substantial business activities in a foreign...

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

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

Affordance Realization in Climbing: Learning and Transfer.

PubMed

Seifert, Ludovic; Orth, Dominic; Mantel, Bruno; Boulanger, Jérémie; Hérault, Romain; Dicks, Matt

2018-01-01

The aim of this study was to investigate how the affordances of an indoor climbing wall changed for intermediate climbers following a period of practice during which hold orientation was manipulated within a learning and transfer protocol. The learning protocol consisted of four sessions, in which eight climbers randomly ascended three different routes of fixed absolute difficulty (5c on the French scale), as fluently as possible. All three routes were 10.3 m in height and composed of 20 hand-holds at the same locations on an artificial climbing wall; only hold orientations were altered: (i) a horizontal-edge route (H) was designed to afford horizontal hold grasping, (ii) a vertical-edge route (V) afforded vertical hold grasping, and (iii), a double-edge route (D) was designed to afford both horizontal and vertical hold grasping. Five inertial measurement units (IMU) (3D accelerometer, 3D gyroscope, 3D magnetometer) were attached to the hip, feet and forearms to analyze the vertical acceleration and direction (3D unitary vector) of each limb and hip in ambient space during the entire ascent. Segmentation and classification processes supported detection of movement and stationary phases for each IMU. Depending on whether limbs and/or hip were moving, a decision tree distinguished four states of behavior: stationary (absence of limb and hip motion), hold exploration (absence of hip motion but at least one limb in motion), hip movement (hip in motion but absence of limb motion) and global motion (hip in motion and at least one limb in motion). Results showed that with practice, the learners decreased the relative duration of hold exploration, suggesting that they improved affordance perception of hold grasp-ability. The number of performatory movements also decreased as performance increased during learning sessions, confirming that participants' climbing efficacy improved as a function of practice. Last, the results were more marked for the H route, while the D route

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.

Comparison of the immunogenicity and protection against bovine tuberculosis following immunization by BCG-priming and boosting with adenovirus or protein based vaccines.

PubMed

Dean, G; Whelan, A; Clifford, D; Salguero, F J; Xing, Z; Gilbert, S; McShane, H; Hewinson, R G; Vordermeier, M; Villarreal-Ramos, B

2014-03-05

There is a requirement for vaccines or vaccination strategies that confer better protection against TB than the current live attenuated Mycobacterium bovis Bacillus Calmette-Guerin (BCG) vaccine for use in cattle. Boosting with recombinant viral vectors expressing mycobacterial proteins, such as Ag85A, has shown a degree of promise as a strategy for improving on the protection afforded by BCG. Experiments in small animal models have indicated that broadening the immune response to include mycobacterial antigens other than Ag85A, such as Rv0288, induced by boosting with Ad5 constructs has a direct effect on the protection afforded against TB. Here, we compared the immunogenicity and protection against challenge with M. bovis afforded by boosting BCG-vaccinated cattle with a human type 5 (Ad5)-based vaccine expressing the mycobacterial antigens Ag85A (Ad5-85A); or Ag85A, Rv0251, Rv0287 and Rv0288 (Ad5-TBF); or with protein TBF emulsified in adjuvant (Adj-TBF). Boosting with TBF broaden the immune response. The kinetics of Ad5-TBF and Adj-TBF were shown to be different, with effector T cell responses from the latter developing more slowly but being more durable than those induced by Ad5-TBF. No increase in protection compared to BCG alone was afforded by Ad5-TBF or Adj-TBF by gross pathology or bacteriology. Using histopathology, as a novel parameter of protection, we show that boosting BCG vaccinated cattle with Ad5-85A induced significantly better protection than BCG alone. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

Electrostatic protection of the solar power satellite and rectenna. Part 2: Lightning protection of the rectenna

NASA Technical Reports Server (NTRS)

1980-01-01

Computer simulations and laboratory tests were used to evaluate the hazard posed by lightning flashes to ground on the Solar Power Satellite rectenna and to make recommendations on a lightning protection system for the rectenna. The distribution of lightning over the lower 48 of the continental United States was determined, as were the interactions of lightning with the rectenna and the modes in which those interactions could damage the rectenna. Lightning protection was both required and feasible. Several systems of lightning protection were considered and evaluated. These included two systems that employed lightning rods of different lengths and placed on top of the rectenna's billboards and a third, distribution companies; it consists of short lightning rods all along the length of each billboard that are connected by a horizontal wire above the billboard. The distributed lightning protection system afforded greater protection than the other systems considered and was easier to integrate into the rectenna's structural design.

77 FR 36272 - SunShot Prize: America's Most Affordable Rooftop

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-18

... Most Affordable Rooftop Solar for public comment. Interested persons are encouraged to learn about the SunShot Prize: America's Most Affordable Rooftop rules at eere.energy.gov/solar/sunshot/prize.html.... Department of Energy, Office of Solar, 1000 Independence Avenue SW., Washington, DC 20585 FOR FURTHER...

The corrosion protection of several aluminum alloys by chromic acid and sulfuric acid anodizing

NASA Technical Reports Server (NTRS)

Danford, M. D.

1994-01-01

The corrosion protection afforded 7075-T6, 7075-T3, 6061-T6, and 2024-T3 aluminum alloys by chromic acid and sulfuric acid anodizing was examined using electrochemical techniques. From these studies, it is concluded that sulfuric acid anodizing provides superior corrosion protection compared to chromic acid anodizing.

Affordances and Landscapes: Overcoming the Nature–Culture Dichotomy through Niche Construction Theory

PubMed Central

Heras-Escribano, Manuel; De Pinedo-García, Manuel

2018-01-01

In this paper we reject the nature–culture dichotomy by means of the idea of affordance or possibility for action, which has important implications for landscape theory. Our hypothesis is that, just as the idea of affordance can serve to overcome the subjective–objective dichotomy, the ideas of landscape and ecological niche, properly defined, would allow us to also transcend the nature–culture dichotomy. First, we introduce an overview of landscape theory, emphasizing processual landscape theory as the most suitable approach for satisfying both cultural and naturalist approaches. After that, we introduce the idea of affordance and we analyze a tension between sociocultural and transcultural affordances (affordances that depend on cultural conventions and affordances that depend on lawful information and bodily aspects of agents). This tension has various implications for landscape theory and ecological niches. Our proposal is that sociocultural and transcultural aspects of affordances could be systematically accommodated if we apply niche construction theory (the theory that explains the process by which organisms modify their selective environments) as a methodological framework for explaining the emergence of ecological niches. This approach will lead us to an integrative account of landscapes as the products of the interaction between human and environmental elements, making it a clear example of a concept that transcends the nature–culture dichotomy. PMID:29375426

The Affordable Care Act Appears to Have Narrowed Racial and Ethnic Disparities in Insurance Coverage and Access to Care Among Young Adults.

PubMed

Lipton, Brandy J; Decker, Sandra L; Sommers, Benjamin D

2017-04-01

Prior to the Affordable Care Act, one in three young adults aged 19 to 25 years were uninsured, with substantial racial/ethnic disparities in coverage. We analyzed the separate and cumulative changes in racial/ethnic disparities in coverage and access to care among young adults after implementation of the Affordable Care Act's 2010 dependent coverage provision and 2014 Medicaid and Marketplace expansions. We find that the dependent coverage provision was associated with similar gains across racial/ethnic groups, but the 2014 expansion was associated with larger gains in coverage among Hispanics and Blacks relative to Whites. After the 2014 expansion, coverage increased by 11.0 and 10.1 percentage points among Hispanics and Blacks, respectively, compared with a 5.6 percentage point increase among Whites. The percentage with a usual source of care and a recent doctor's visit also increased more for Blacks relative to Whites. Increases in coverage were larger in Medicaid expansion compared with nonexpansion states for most racial/ethnic groups.

The Patient Protection and Affordable Care Act dependent coverage expansion: Disparities in impact among young adult oncology patients.

PubMed

Alvarez, Elysia M; Keegan, Theresa H; Johnston, Emily E; Haile, Robert; Sanders, Lee; Wise, Paul H; Saynina, Olga; Chamberlain, Lisa J

2018-01-01

Private health insurance is associated with improved outcomes in patients with cancer. However, to the authors' knowledge, little is known regarding the impact of the Patient Protection and Affordable Care Act Dependent Coverage Expansion (ACA-DCE), which extended private insurance to young adults (to age 26 years) beginning in 2010, on the insurance status of young adults with cancer. The current study was a retrospective, population-based analysis of hospitalized young adult oncology patients (aged 22-30 years) in California during 2006 through 2014 (11,062 patients). Multivariable regression analyses examined factors associated with having private insurance. Results were presented as adjusted odds ratios and 95% confidence intervals. A difference-in-difference analysis examined the influence of the ACA-DCE on insurance coverage by race/ethnicity and federal poverty level. Multivariable regression demonstrated that patients of black and Hispanic race/ethnicity were less likely to have private insurance before and after the ACA-DCE, compared with white patients. Younger age (22-25 years) was associated with having private insurance after implementation of the ACA-DCE (odds ratio, 1.20; 95% confidence interval, 1.06-1.35). In the difference-in-difference analysis, private insurance increased among white patients aged 22 to 25 years who were living in medium-income (2006-2009: 64.6% vs 2011-2014: 69.1%; P = .003) and high-income (80.4% vs 82%; P = .043) zip codes and among Asians aged 22 to 25 years living in high-income zip codes (73.2 vs 85.7%; P = .022). Private insurance decreased for all Hispanic patients aged 22 to 25 years between the 2 time periods. The ACA-DCE provision increased insurance coverage, but not among all patients. Private insurance increased for white and Asian patients in higher income neighborhoods, potentially widening social disparities in private insurance coverage among young adults with cancer. Cancer 2018;124:110-7. © 2017 American

75 FR 70160 - Affordable Care Act; Federal External Review Process; Request for Information

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-17

...-9986-NC] DEPARTMENT OF LABOR Employee Benefits Security Administration 29 CFR Part 2590 Affordable Care... Affordable Care Act, and its implementing regulations. DATES: Submit written or electronic comments by... processes under the Affordable Care Act; those comments are being collected and evaluated on a separate...

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…

Affordability of medicines in the European Union.

PubMed

Zaprutko, Tomasz; Kopciuch, Dorota; Kus, Krzysztof; Merks, Piotr; Nowicka, Monika; Augustyniak, Izabela; Nowakowska, Elżbieta

2017-01-01

Medications and their prices are key issues for healthcare. Although access to medicines at affordable prices had been specified as a key objective of the European Health Policy, it seems that these goals have not been achieved. Therefore, we attempted an evaluation of affordability of selected medicines at full prices. The analysis concerned 2012 and was conducted between 2013 and 2015 in all the European Union (EU) countries divided into 3 groups depending on the date of their accession to the EU. Finally, we considered 9 originators used in the treatment of schizophrenia and multiple sclerosis. Information on drug prices were collected from pharmacies. Participation in the study was voluntary and anonymous in order to avoid accusations of advertising. To evaluate affordability, several factors were used (e.g. minimum earnings and Gini coefficient). Due to unavailability in some countries, the exact number of analyzed medicines varies. Drug prices vary significantly between EU Member States. Almost eleven fold difference was observed between Germany (EUR 1451.17) and Croatia (EUR 132.77) in relation to Interferone beta-1a 22 μg. Generally, prices were the highest in Germany. The cheapest drugs were found in various countries but never in the poorest ones like Bulgaria or Romania. Discrepancies in wages were observed too (the smallest minimum wage was EUR 138.00 in Bulgaria and the highest EUR 1801.00 in Luxembourg). Full price of olanzapine 5mg, however, was higher in Bulgaria (EUR 64.53) than, for instance, in Belgium (EUR 37.26). Analyzed medications are still unaffordable for many citizens of the EU. Besides, access to medicines is also impaired e.g. due to parallel trade. Unaffordability of medications may lead to the patients' non-compliance and therefore to increased direct and indirect costs of treatment. Common European solutions are needed to achieve a real affordability and accessibility of medications.

Increased Emergency Department Use in Illinois After Implementation of the Patient Protection and Affordable Care Act.

PubMed

Dresden, Scott M; Powell, Emilie S; Kang, Raymond; McHugh, Megan; Cooper, Andrew J; Feinglass, Joe

2017-02-01

We examine emergency department (ED) use and hospitalizations through the ED after Patient Protection and Affordable Care Act (ACA) health insurance expansion in Illinois, a Medicaid expansion state. Using statewide hospital administrative data from 2011 through 2015 from 201 nonfederal Illinois hospitals for patients aged 18 to 64 years, mean monthly ED visits were compared before and after ACA implementation by disposition from the ED and primary payer. Visit data were combined with 2010 to 2014 census insurance estimates to compute payer-specific ED visit rates. Interrupted time-series analyses tested changes in ED visit rates and ED hospitalization rates by insurance type after ACA implementation. Average monthly ED visit volume increased by 14,080 visits (95% confidence interval [CI] 4,670 to 23,489), a 5.7% increase, after ACA implementation. Changes by payer were as follows: uninsured decreased by 24,158 (95% CI -27,037 to -21,279), Medicaid increased by 28,746 (95% CI 23,945 to 33,546), and private insurance increased by 9,966 (95% 6,241 to 13,690). The total monthly ED visit rate increased by 1.8 visits per 1,000 residents (95% CI 0.6 to 3.0). The monthly ED visit rate decreased by 8.7 visit per 1,000 uninsured residents (95% CI -11.1 to -6.3) and increased by 10.2 visit per 1,000 Medicaid beneficiaries (95% CI 4.4 to 16.1) and 1.3 visits per 1,000 privately insured residents (95% CI 0.6 to 1.9). After adjusting for baseline trends and season, these changes remained statistically significant. The total number of hospitalizations through the ED was unchanged. ED visits by adults aged 18 to 64 years in Illinois increased after ACA health insurance expansion. The increase in total ED visits was driven by an increase in visits resulting in discharge from the ED. A large post-ACA increase in Medicaid visits and a modest increase in privately insured visits outpaced a large reduction in ED visits by uninsured patients. These changes are larger than can be

Modeling the protection afforded by burrows, cavities, and roosts during wildland surface fires

Treesearch

Anthony Bova; Matthew Dickinson

2009-01-01

Wildland surface fires produce many toxic and irritating compounds, such as formaldehyde and acrolein, and harmful gases such as carbon monoxide. Several factors influence the degree of protection offered by animal shelters against combustion products and heat.

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.

The affordability for patients of a new universal MDR-TB coverage model in China.

PubMed

Ruan, Y-Z; Li, R-Z; Wang, X-X; Wang, L-X; Sun, Q; Chen, C; Xu, C-H; Su, W; Zhao, J; Pang, Y; Cheng, J; Wang, Q; Fu, Y-T; Huan, S-T; Chen, M-T; Scano, F; Floyd, K; Chin, D P; Fitzpatrick, C

2016-05-01

China has piloted a new model of universal coverage for multidrug-resistant tuberculosis (MDR-TB), designed to rationalize hospital use of drugs and tests and move away from fee-for-service payment towards a standard package with financial protection against catastrophic health costs. To evaluate the affordability to patients of this new model. This was an observational study of 243 MDR-TB cases eligible for enrolment on treatment under the project. We assessed the affordability of the project from the perspective of households, with a focus on catastrophic costs. Of the 243 eligible cases, 172 (71%) were enrolled on treatment; of the 71 cases not enrolled, 26 (37%) cited economic reasons. The 73 surveyed cases paid an average of RMB 5977 (US$920) out-of-pocket in search costs incurred outside the pilot model. Within the pilot, they paid another RMB 2094 (US$322) in medical fees and RMB 5230 (US$805) in direct non-medical costs. Despite 90% reimbursement of medical fees, 78% of households experienced catastrophic costs, including indirect costs. The objectives of the pilot model are aligned with health reform in China and universal health coverage globally. Enrollment would almost certainly be higher with 100% reimbursement of medical fees, but patient enablers will be required to truly eliminate catastrophic costs.

Five Affordances of Computational Thinking to Support Elementary Mathematics Education

ERIC Educational Resources Information Center

Gadanidis, George

2017-01-01

With the increased focus on computational thinking (CT) in education, it is important to investigate the affordances that CT may offer to support teaching and learning. This paper outlines five affordances of CT that may support elementary mathematics education, whose conceptualization was refined in a year-long study involving eight Grades 3-4…

24 CFR 954.306 - Rental housing: qualification as affordable housing and income targeting.

Code of Federal Regulations, 2011 CFR

2011-04-01

... affordable housing and income targeting. 954.306 Section 954.306 Housing and Urban Development REGULATIONS... Affordability § 954.306 Rental housing: qualification as affordable housing and income targeting. (a) Rent... tenant; or (ii) A rent that does not exceed 30 percent of the adjusted income of a family whose gross...

Factors influencing success of marine protected areas in the Visayas, Philippines as related to increasing protected area coverage.

PubMed

Pollnac, Richard; Seara, Tarsila

2011-04-01

Throughout the world there is a general consensus among environmentalists that there should be an increase in the amount of marine area that should be reserved in marine protected areas (MPAs). In fact, the 1998 Philippines Fishery Code indicates a need for designation of at least 15% of municipal waters for fish refuges or sanctuaries. Such an increase in area would take productive fishing areas away from fishing communities that can ill-afford the loss. The larger the protected area, there will be a greater number of people impacted. This article examines the relationship between factors that influence the success of Community Based MPA (CBMPA) performance in the Visayas, Philippines and their significance in efforts to increase the size of protected areas.

In-Space Propulsion Assessment Processes and Criteria for Affordable Systems

NASA Technical Reports Server (NTRS)

Zapata, Edgar; Rhodes, Russel

1999-01-01

In a world of high launch costs to Low Earth Orbit (LEO), and of costs nearly twice as high to Geosynchronous Earth Orbit (GEO), it is clear that processes and criteria are required which will surface the path to greater affordability. Further, with propulsion systems making up a major part of the systems placed into multiple orbits, or beyond, it is clear that addressing propulsion systems for in-space propulsion (ISP) is a key part to breaking the barriers to affordable systems. While multitudes of Earth to Orbit transportation system efforts focus on reduced costs, the often neglected costs and related interactions of the in-space system equally require improvements that will enable broad end-to end customer affordability.

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.

Corrosion protection of aluminum alloys in contact with other metals

NASA Technical Reports Server (NTRS)

Kuster, C. A.

1969-01-01

Study establishes the quality of chemical and galvanized protection afforded by anodized and aldozided coatings applied to test panels of various aluminum alloys. The test panels, placed in firm contact with panels of titanium alloys, were subjected to salt spray tests and visually examined for corrosion effect.

Analytical Tools for Affordability Analysis

DTIC Science & Technology

2015-05-01

function (Womer)  Unit cost as a function of learning and rate  Learning with forgetting (Benkard)  Learning depreciates over time  Discretionary...Analytical Tools for Affordability Analysis David Tate Cost Analysis and Research Division Institute for Defense Analyses Report Documentation...ES) Institute for Defense Analyses, Cost Analysis and Research Division,4850 Mark Center Drive,Alexandria,VA,22311-1882 8. PERFORMING ORGANIZATION

Relative Affordability of Health Insurance Premiums under CHIP Expansion Programs and the ACA.

PubMed

Gresenz, Carole Roan; Laugesen, Miriam J; Yesus, Ambeshie; Escarce, José J

2011-10-01

Affordability is integral to the success of health care reforms aimed at ensuring universal access to health insurance coverage, and affordability determinations have major policy and practical consequences. This article describes factors that influenced the determination of affordability benchmarks and premium-contribution requirements for Children's Health Insurance Program (CHIP) expansions in three states that sought to universalize access to coverage for youth. It also compares subsidy levels developed in these states to the premium subsidy schedule under the Affordable Care Act (ACA) for health insurance plans purchased through an exchange. We find sizeable variability in premium-contribution requirements for children's coverage as a percentage of family income across the three states and in the progressivity and regressivity of the premium-contribution schedules developed. These findings underscore the ambiguity and subjectivity of affordability standards. Further, our analyses suggest that while the ACA increases the affordability of family coverage for families with incomes below 400 percent of the federal poverty level, the evolution of CHIP over the next five to ten years will continue to have significant implications for low-income families.

Coding of navigational affordances in the human visual system

PubMed Central

Epstein, Russell A.

2017-01-01

A central component of spatial navigation is determining where one can and cannot go in the immediate environment. We used fMRI to test the hypothesis that the human visual system solves this problem by automatically identifying the navigational affordances of the local scene. Multivoxel pattern analyses showed that a scene-selective region of dorsal occipitoparietal cortex, known as the occipital place area, represents pathways for movement in scenes in a manner that is tolerant to variability in other visual features. These effects were found in two experiments: One using tightly controlled artificial environments as stimuli, the other using a diverse set of complex, natural scenes. A reconstruction analysis demonstrated that the population codes of the occipital place area could be used to predict the affordances of novel scenes. Taken together, these results reveal a previously unknown mechanism for perceiving the affordance structure of navigable space. PMID:28416669

How can states provide affordable pharmaceuticals to the underserved?

PubMed

Zara, Jane

2006-11-01

Advocates of drug price restrictions in the U.S. argue that pharmaceutical companies operate in an unregulated market, free to charge whatever price the market will bear. The pharmaceutical industry insists that these large profits are justified for investments toward discovering new life saving medicines. As innovation wanes, marketing costs soar, and drug profits rise, public interest advocates and state leaders are challenging this justification. This article examines current problems associated with the ability to procure affordable medicines, and examines mounting tensions between the federal government and the states, particularly regarding the states' ability to negotiate lower prices with drug manufacturers in light of the recent Medicare changes. It provides a brief survey of efforts underway to secure affordable pharmaceuticals for state's residents, addressing the history and feasibility of using compulsory licensing for producing affordable life-saving drugs with respect to public health, constitutional, eminent domain, and anti-trust issues.

System engineering of complex optical systems for mission assurance and affordability

NASA Astrophysics Data System (ADS)

Ahmad, Anees

2017-08-01

Affordability and reliability are equally important as the performance and development time for many optical systems for military, space and commercial applications. These characteristics are even more important for the systems meant for space and military applications where total lifecycle costs must be affordable. Most customers are looking for high performance optical systems that are not only affordable but are designed with "no doubt" mission assurance, reliability and maintainability in mind. Both US military and commercial customers are now demanding an optimum balance between performance, reliability and affordability. Therefore, it is important to employ a disciplined systems design approach for meeting the performance, cost and schedule targets while keeping affordability and reliability in mind. The US Missile Defense Agency (MDA) now requires all of their systems to be engineered, tested and produced according to the Mission Assurance Provisions (MAP). These provisions or requirements are meant to ensure complex and expensive military systems are designed, integrated, tested and produced with the reliability and total lifecycle costs in mind. This paper describes a system design approach based on the MAP document for developing sophisticated optical systems that are not only cost-effective but also deliver superior and reliable performance during their intended missions.

Perceiving affordances in rugby union.

PubMed

Passos, Pedro; Cordovil, Rita; Fernandes, Orlando; Barreiros, João

2012-01-01

To succeed in competitive environments, players need to continuously adjust their decisions and actions to the behaviour of relevant others. Players' interactions demand ongoing decisions that are constrained by what is previously defined (e.g., coaches' prescriptions that establish 'what' to do) and by information that is available in the context and specifies not only 'what' the player should do, but also 'how', 'when' and 'where'. We describe what affordances emerge to the ball carrier as a consequence of changes in kinematic variables, such as interpersonal distances or distances to the nearest sideline. Changes in these variables determine whether and when different actions are possible. The ball carrier tended to perform a pass when the tackler was farthest from the sideline and the velocity of approach to the tackler did not seem to effect the ball carrier's decision. In the few episodes where the ball carrier moved forward instead of passing the ball, he was mainly influenced by contextual information, such as the variability of the players' distance to the nearest sideline. In sum, actors must be aware of the affordances of others that are specified by particular variables that become available just before decision-making.

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.

Protection of microelectronic devices during packaging

DOEpatents

Peterson, Kenneth A.; Conley, William R.

2002-01-01

The present invention relates to a method of protecting a microelectronic device during device packaging, including the steps of applying a water-insoluble, protective coating to a sensitive area on the device; performing at least one packaging step; and then substantially removing the protective coating, preferably by dry plasma etching. The sensitive area can include a released MEMS element. The microelectronic device can be disposed on a wafer. The protective coating can be a vacuum vapor-deposited parylene polymer, silicon nitride, metal (e.g. aluminum or tungsten), a vapor deposited organic material, cynoacrylate, a carbon film, a self-assembled monolayered material, perfluoropolyether, hexamethyldisilazane, or perfluorodecanoic carboxylic acid, silicon dioxide, silicate glass, or combinations thereof. The present invention also relates to a method of packaging a microelectronic device, including: providing a microelectronic device having a sensitive area; applying a water-insoluble, protective coating to the sensitive area; providing a package; attaching the device to the package; electrically interconnecting the device to the package; and substantially removing the protective coating from the sensitive area.

High school youth and suicide risk: exploring protection afforded through physical activity and sport participation.

PubMed

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

2008-10-01

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 hopelessness and suicidality associated with physical activity and sport participation. Data from the CDC's 2005 Youth Risk Behavior Survey were analyzed. Logistic regression modeling was used to compare the odds of hopelessness and suicidality in students who engaged in various levels of physical activity to inactive students. Similar analyses were performed comparing risks of athletes to nonathletes, and the risks of highly involved athletes to nonathletes. Findings showed that frequent, vigorous activity reduced the risk of hopelessness and suicidality among male adolescents. However, low levels of activity actually increased the risk of feeling hopeless among young females. Yet, for both males and females, sport participation protected against hopelessness and suicidality. These findings indicate that involvement in sport confers unique psychosocial benefits that protect adolescents against suicidality. Findings suggest that mechanisms other than physical activity contribute to the protective association between sport and reduced suicidality. Social support and integration may account for some of the differences found in suicidality between athletes and nonathletes.

20 CFR 220.141 - Substantial gainful activity, defined.

Code of Federal Regulations, 2011 CFR

2011-04-01

...) Substantial work activity. Substantial work activity is work activity that involves doing significant physical... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false Substantial gainful activity, defined. 220... RETIREMENT ACT DETERMINING DISABILITY Substantial Gainful Activity § 220.141 Substantial gainful activity...

20 CFR 220.141 - Substantial gainful activity, defined.

Code of Federal Regulations, 2010 CFR

2010-04-01

...) Substantial work activity. Substantial work activity is work activity that involves doing significant physical... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Substantial gainful activity, defined. 220... RETIREMENT ACT DETERMINING DISABILITY Substantial Gainful Activity § 220.141 Substantial gainful activity...

Protection of wooden airplane parts against moisture by means of varnish

NASA Technical Reports Server (NTRS)

Wolff, E B; Van Ewijk, L J G

1926-01-01

The objects of the experiments herein described were to test the protection afforded by Valspar oil varnish against the absorption of moisture by wooden airplane parts and the consequent changes in their elastic properties and to compare some of the best Dutch varnishes with Valspar.

12 CFR 1282.13 - Multifamily special affordable housing goal and subgoal.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 10 2014-01-01 2014-01-01 false Multifamily special affordable housing goal... AND MISSION ENTERPRISE HOUSING GOALS AND MISSION Housing Goals § 1282.13 Multifamily special affordable housing goal and subgoal. (a) Multifamily housing goal and subgoal. An Enterprise shall be in...

Affordances of instrumentation in general chemistry laboratories

NASA Astrophysics Data System (ADS)

Sherman, Kristin Mary Daniels

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 measuring tool for general chemistry labs. They see the probeware as easy to use, portable, and able to interact with computers. Students find that the PASCO(TM) probeware system is useful in their general chemistry labs, more advanced chemistry labs, and in other science classes, and can be used in a variety of labs done in general chemistry. Students learn the affordances of the probeware through the lab manual, the laboratory teaching assistant, by trial and error, and from each other. The use of probeware systems provides lab instructors the opportunity to focus on the concepts illustrated by experiments and the opportunity to spend time discussing the results. In order to teach effectively, the instructor must know the correct name of the components involved, how to assemble and disassemble it correctly, how to troubleshoot the software, and must be able to replace broken or missing components quickly. The use of podcasts or Web-based videos should increase student understanding of affordances of the probeware.

77 FR 26046 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Affordable...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-02

... for OMB Review; Comment Request; Affordable Care Act Internal Claims and Appeals and External Review...) titled, ``Affordable Care Act Internal Claims and Appeals and External Review Procedures for Non... provisions of the Affordable Care Act pertaining to internal claims and appeals, and the external review...

Affordability of medicines in the European Union

PubMed Central

Zaprutko, Tomasz; Kopciuch, Dorota; Kus, Krzysztof; Merks, Piotr; Nowicka, Monika; Augustyniak, Izabela; Nowakowska, Elżbieta

2017-01-01

Background Medications and their prices are key issues for healthcare. Although access to medicines at affordable prices had been specified as a key objective of the European Health Policy, it seems that these goals have not been achieved. Therefore, we attempted an evaluation of affordability of selected medicines at full prices. Methods The analysis concerned 2012 and was conducted between 2013 and 2015 in all the European Union (EU) countries divided into 3 groups depending on the date of their accession to the EU. Finally, we considered 9 originators used in the treatment of schizophrenia and multiple sclerosis. Information on drug prices were collected from pharmacies. Participation in the study was voluntary and anonymous in order to avoid accusations of advertising. To evaluate affordability, several factors were used (e.g. minimum earnings and Gini coefficient). Due to unavailability in some countries, the exact number of analyzed medicines varies. Results Drug prices vary significantly between EU Member States. Almost eleven fold difference was observed between Germany (EUR 1451.17) and Croatia (EUR 132.77) in relation to Interferone beta-1a 22 μg. Generally, prices were the highest in Germany. The cheapest drugs were found in various countries but never in the poorest ones like Bulgaria or Romania. Discrepancies in wages were observed too (the smallest minimum wage was EUR 138.00 in Bulgaria and the highest EUR 1801.00 in Luxembourg). Full price of olanzapine 5mg, however, was higher in Bulgaria (EUR 64.53) than, for instance, in Belgium (EUR 37.26). Conclusions Analyzed medications are still unaffordable for many citizens of the EU. Besides, access to medicines is also impaired e.g. due to parallel trade. Unaffordability of medications may lead to the patients’ non-compliance and therefore to increased direct and indirect costs of treatment. Common European solutions are needed to achieve a real affordability and accessibility of medications. PMID

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.

Medicine prices, availability and affordability in Sri Lanka

PubMed Central

Senarathna, S.M.D.K. Ganga; Mannapperuma, Uthpali; Fernandopulle, B.M. Rohini

2011-01-01

Background: No pricing formula has been implemented from November 2002 to date in Sri Lanka. Therefore, we initiated a study in 2003 to determine the prices, availability and affordability of medicines in the private sector of Sri Lanka in the absence of a price control. Materials and Methods: The World Health Organization/Health Action International methodology was used. The study was conducted in retail pharmacies (Rajya Osu Sala) of State Pharmaceuticals Corporation (semigovernment) and privately owned retail pharmacies (n = 15) in 2003, 2006 and 2009 in a geographical area. Essential medicines (n = 28) were studied and, for each medicine, innovator, most sold generic and cheapest generic were monitored. The medicine’s median price was compared with the international reference prices (IRP) to obtain the median price ratio. The daily wage of the lowest-paid government worker was used to calculate affordability. Results: Innovators were five to six-times the IRP at privately owned pharmacies and four to seven-times at the Rajya Osu Sala. The prices of generics were ≤1 the IRP during 6 years in privately owned and Rajya Osu Sala pharmacies. Cheapest generics were high in availability (>80%) throughout the study period. Innovators cost more than a day’s wage of the lowest-paid government worker; in contrast, generics were always less than one day’s wage. There seems to be no difference in affordability between privately owned or semigovernment pharmacies. Conclusion: In Sri Lanka, generic medicines have effective pricing and are available and affordable. No drastic changes in prices of medicine in the private sector were observed over the 6 years despite removal of price control. PMID:21455424

Developing affordable housing guidelines near rail transit in Los Angeles : final report.

DOT National Transportation Integrated Search

2016-12-01

Providing affordable housing and reducing greenhouse gases are common goals in cities worldwide. Transit-oriented development (TOD) can enable incremental progress on both fronts, by building affordable housing near transit and by providing alternati...

12 CFR 1282.13 - Multifamily special affordable housing goal and subgoal.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 9 2012-01-01 2012-01-01 false Multifamily special affordable housing goal and... MISSION ENTERPRISE HOUSING GOALS AND MISSION Housing Goals § 1282.13 Multifamily special affordable housing goal and subgoal. (a) Multifamily housing goal and subgoal. An Enterprise shall be in compliance...

12 CFR 1282.13 - Multifamily special affordable housing goal and subgoal.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Multifamily special affordable housing goal and... MISSION ENTERPRISE HOUSING GOALS AND MISSION Housing Goals § 1282.13 Multifamily special affordable housing goal and subgoal. (a) Multifamily housing goal and subgoal. An Enterprise shall be in compliance...

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…

U.S. Alcohol Affordability and Real Tax Rates, 1950–2011

PubMed Central

Kerr, William C.; Paterson, Deidre; Greenfield, Thomas K.; Jones, Alison Snow; McGeary, Kerry Anne; Terza, Joseph V.; Ruhm, Christopher J.

2013-01-01

Background The affordability of alcoholic beverages, determined by the relationship of prices to incomes, may be an important factor in relation to heavy drinking, but little is known about how affordability has changed over time. Purpose To calculate real prices and affordability measures for alcoholic beverages in the U.S. over the period from 1950 to 2011. Methods Affordability is calculated as the percentage of mean disposable income required to purchase 1 drink per day of the cheapest spirits, as well as popular brands of spirits, beer and wine. Alternative income and price measures are also considered. Analyses were conducted in 2012. Results One drink per day of the cheapest brand of spirits required 0.29% of U.S. mean per capita disposable income in 2011 as compared to 1.02% in 1980, 2.24% in 1970, 3.61% in 1960 and 4.46% in 1950. One drink per day of a popular beer required 0.96% of income in 2010 compared to 4.87% in 1950, while a low-priced wine in 2011 required 0.36% of income compared to 1.05% in 1978. Reduced real federal and state tax rates were an important source of the declines in real prices. Conclusions Alcoholic beverages sold for off-premises consumption are more affordable today than at any time in the past 60 years; dramatic increases in affordability occurred particularly in the 1960s and 1970s. Declines in real prices are a major component of this change. Increases in alcoholic beverage tax rates and/or implementing minimum prices, together with indexing these to inflation could be used to mitigate further declines in real prices. PMID:23597808

NASA Affordable Vehicle Avionics (AVA): Common Modular Avionics System for Nano-Launchers Offering Affordable Access to Space

NASA Technical Reports Server (NTRS)

Cockrell, James

2015-01-01

Small satellites are becoming ever more capable of performing valuable missions for both government and commercial customers. However, currently these satellites can only be launched affordably as secondary payloads. This makes it difficult for the small satellite mission to launch when needed, to the desired orbit, and with acceptable risk. NASA Ames Research Center has developed and tested a prototype low-cost avionics package for space launch vehicles that provides complete GNC functionality in a package smaller than a tissue box with a mass less than 0.84 kg. AVA takes advantage of commercially available, low-cost, mass-produced, miniaturized sensors, filtering their more noisy inertial data with realtime GPS data. The goal of the Advanced Vehicle Avionics project is to produce and flight-verify a common suite of avionics and software that deliver affordable, capable GNC and telemetry avionics with application to multiple nano-launch vehicles at 1 the cost of current state-of-the-art avionics.

Making care affordable.

PubMed

Solomon, S

1999-01-01

The YRG Centre for AIDS Research and Education (CARE) in Chennai, India runs an integrated care program ensuring appropriate and affordable care to everyone who needs it. The program includes both voluntary counseling/testing and hospital/home-based care. YRG CARE developed several strategies for the care program, which include 1) different fees for an HIV test, 2) free counseling service, 3) different charges for other care services, 4) a subsidized pharmacy (involving purchasing drugs directly from manufacturers and wholesalers, ordering free samples from manufacturers, and acquiring drugs through the drug component of its clinical research projects, from overseas hospitals, and from YRG CARE hospital and community-based patients who have not used them), and 5) subsidized meals.

29 CFR 1977.5 - Persons protected by section 11(c).

Code of Federal Regulations, 2011 CFR

2011-07-01

... demonstrates a clear congressional intent that the existence of an employment relationship, for purposes of... employees are afforded the full protection of section 11(c). For purposes of the Act, an employee is defined...) For purposes of section 11(c), even an applicant for employment could be considered an employee. See...

Affordable Exploration of Mars: Recommendations from a Community Workshop on Sustainable Initial Human Missions

NASA Technical Reports Server (NTRS)

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

2013-01-01

There is a growing consensus that within two decades initial human missions to Mars are affordable under plausible budget assumptions and with sustained international participation. In response to this idea, a distinguished group of experts from the Mars exploration stakeholder communities attended the "Affording Mars" workshop at George Washington University in December, 2013. Participants reviewed and discussed scenarios for affordable and sustainable human and robotic exploration of Mars, the role of the International Space Station over the coming decade as the essential early step toward humans to Mars, possible "bridge" missions in the 2020s, key capabilities required for affordable initial missions, international partnerships, and a usable definition of affordability and sustainability. We report here the findings, observations, and recommendations that were agreed to at that workshop.

The Affordable Care Act and Implications for Health Care Services for American Indian and Alaska Native Individuals

PubMed Central

Ross, Raven E.; Garfield, Lauren D.; Brown, Derek S.; Raghavan, Ramesh

2016-01-01

American Indian and Alaska Native (AI/AN) populations report poor physical and mental health outcomes while tribal health providers and the Indian Health Service (IHS) operate in a climate of significant under funding. Understanding how the Patient Protection and Affordable Care Act (ACA) affects Native American tribes and the IHS is critical to addressing the improvement of the overall access, quality, and cost of health care within AI/AN communities. This paper summarizes the ACA provisions that directly and/or indirectly affect the service delivery of health care provided by tribes and the IHS. PMID:26548665

Affordance of Braille Music as a Mediational Means: Significance and Limitations

ERIC Educational Resources Information Center

Park, Hyu-Yong; Kim, Mi-Jung

2014-01-01

Affordance refers to the properties or designs of a thing that offer the function of the thing. This paper discusses the affordance of Braille music in terms of three notions: mediational means, mastery and appropriation, and focuses on answering the following three questions: (i) How do musicians with visual impairments (MVI) perceive Braille…

Parametric analysis: SOC meteoroid and debris protection

NASA Technical Reports Server (NTRS)

Kowalski, R.

1985-01-01

The meteoroid and man made space debris environments of an Earth orbital manned space operations center are discussed. Protective shielding thickness and design configurations for providing given levels of no penetration probability were also calculated. Meteoroid/debris protection consists of a radiator/shield thickness, which is actually an outer skin, separated from the pressure wall, thickness by a distance. An ideal shield thickness, will, upon impact with a particle, cause both the particle and shield to vaporize, allowing a minimum amount of debris to impact the pressure wall itself. A shield which is too thick will crater on the outside, and release small particles of shield from the inside causing damage to the pressure wall. Inversely, if the shield is too thin, it will afford no protection, and the backup must provide all necessary protection. It was concluded that a double wall concept is most effective.

Online Case-Based Discussions: Examining Coverage of the Afforded Problem Space

ERIC Educational Resources Information Center

Ertmer, Peggy A.; Koehler, Adrie A.

2014-01-01

Case studies hold great potential for engaging students in disciplinary content. However, little is known about the extent to which students actually cover the problem space afforded by a particular case study. In this research, we compared the problem space afforded by an instructional design case study with the actual content covered by 16…

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. Copyright © 2016 Elsevier B.V. All rights reserved.

Implementing the Affordable Care Act: state approaches to premium rate reforms in the individual health insurance market.

PubMed

Giovannelli, Justin; Lucia, Kevin W; Corlette, Sabrina

2014-12-01

The Affordable Care Act protects people from being charged more for insurance based on factors like medical history or gender and establishes new limits on how insurers can adjust premiums for age, tobacco use, and geography. This brief examines how states have implemented these federal reforms in their individual health insurance markets. We identify state rating standards for the first year of full implementation of reform and explore critical considerations weighed by policymakers as they determined how to adopt the law's requirements. Most states took the opportunity to customize at least some aspect of their rating standards. Interviews with state regulators reveal that many states pursued implementation strategies intended primarily to minimize market disruption and premium shock and therefore established standards as consistent as possible with existing rules or market practice. Meanwhile, some states used the transition period to strengthen consumer protections, particularly with respect to tobacco rating.

Sprayable Phase Change Coating Thermal Protection Material

NASA Technical Reports Server (NTRS)

Richardson, Rod W.; Hayes, Paul W.; Kaul, Raj

2005-01-01

the launch and processing costs of a reusable space vehicle to an affordable level, refurbishment costs must be substantially reduced. A key component of such a cost effective approach is the use of a reusable, phase change, thermal protection coating.

Affordable Care Act Provision Lowered Out-Of-Pocket Cost And Increased Colonoscopy Rates Among Men In Medicare.

PubMed

Hamman, Mary K; Kapinos, Kandice A

2015-12-01

Colorectal cancer screening is one of the few cancer screenings with an "A" rating from the US Preventive Services Task Force, meaning that the procedure confers a substantial health benefit. However, 40 percent of people who should receive colorectal cancer screenings do not receive them. Colonoscopies are the most thorough method of screening because they allow physicians to view the entire length of the colon and remove polyps as needed. Billing methods that distinguish between screening and therapeutic procedures have kept expected colonoscopy costs high. However, the Affordable Care Act partially closed the so-called colonoscopy loophole and reduced expected out-of-pocket expenses for all Medicare beneficiaries. Using data from the Behavioral Risk Factor Surveillance System, we found that annual colonoscopy rates among men ages 66-75 increased significantly (by 4.0 percentage points) after the Affordable Care Act policy change, and we found some evidence of even larger increases among socioeconomically disadvantaged men. We found no significant increases among women, a result that may be explained by health behavior and other factors and that requires further study. Our research indicates that cost may be an important barrier to colorectal cancer screening, at least among men, and that making further policy changes to close remaining loopholes may improve screening rates. Project HOPE—The People-to-People Health Foundation, Inc.

Using task dynamics to quantify the affordances of throwing for long distance and accuracy.

PubMed

Wilson, Andrew D; Weightman, Andrew; Bingham, Geoffrey P; Zhu, Qin

2016-07-01

In 2 experiments, the current study explored how affordances structure throwing for long distance and accuracy. In Experiment 1, 10 expert throwers (from baseball, softball, and cricket) threw regulation tennis balls to hit a vertically oriented 4 ft × 4 ft target placed at each of 9 locations (3 distances × 3 heights). We measured their release parameters (angle, speed, and height) and showed that they scaled their throws in response to changes in the target's location. We then simulated the projectile motion of the ball and identified a continuous subspace of release parameters that produce hits to each target location. Each subspace describes the affordance of our target to be hit by a tennis ball moving in a projectile motion to the relevant location. The simulated affordance spaces showed how the release parameter combinations required for hits changed with changes in the target location. The experts tracked these changes in their performance and were successful in hitting the targets. We next tested unusual (horizontal) targets that generated correspondingly different affordance subspaces to determine whether the experts would track the affordance to generate successful hits. Do the experts perceive the affordance? They do. In Experiment 2, 5 cricketers threw to hit either vertically or horizontally oriented targets and successfully hit both, exhibiting release parameters located within the requisite affordance subspaces. We advocate a task dynamical approach to the study of affordances as properties of objects and events in the context of tasks as the future of research in this area. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Surgeon Reimbursements in Maxillofacial Trauma Surgery: Effect of the Affordable Care Act in Ohio.

PubMed

Khansa, Ibrahim; Khansa, Lara; Pearson, Gregory D

2016-02-01

Surgical treatment of maxillofacial injuries has historically been associated with low reimbursements, mainly because of the high proportion of uninsured patients. The Affordable Care Act, implemented in January of 2014, aimed to reduce the number of uninsured. If the Affordable Care Act achieves this goal, surgeons may benefit from improved reimbursement rates. The authors' purpose was to evaluate the effects of the Affordable Care Act on payor distribution and surgeon reimbursements for maxillofacial trauma surgery at their institution. A review of all patients undergoing surgery for maxillofacial trauma between January of 2012 and December of 2014 was conducted. Insurance status, and amounts billed and collected by the surgeon, were recorded. Patients treated before implementation of the Affordable Care Act were compared to those treated after. Five hundred twenty-three patients were analyzed. Three hundred thirty-four underwent surgery before implementation of the Affordable Care Act, and 189 patients underwent surgery after. After implementation of the Affordable Care Act, the proportion of uninsured decreased (27.2 percent to 11.1 percent; p < 0.001) and the proportion of patients on Medicaid increased (7.8 percent to 25.4 percent; p < 0.001). Overall surgeon reimbursement rate increased from 14.3 percent to 19.8 percent (p < 0.001). After implementation of the Affordable Care Act, we observed a significant reduction in the proportion of maxillofacial trauma patients who were uninsured. Surgeons' overall reimbursement rate increased. These trends should be followed over a longer term to determine the full effect of the Affordable Care Act.

Optics learning through affordable kit

DOE Office of Scientific and Technical Information (OSTI.GOV)

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

Affordable proteomics: the two-hybrid systems.

PubMed

Gillespie, Marc

2003-06-01

Numerous proteomic methodologies exist, but most require a heavy investment in expertise and technology. This puts these approaches out of reach for many laboratories and small companies, rarely allowing proteomics to be used as a pilot approach for biomarker or target identification. Two proteomic approaches, 2D gel electrophoresis and the two-hybrid systems, are currently available to most researchers. The two-hybrid systems, though accommodating to large-scale experiments, were originally designed as practical screens, that by comparison to current proteomics tools were small-scale, affordable and technically feasible. The screens rapidly generated data, identifying protein interactions that were previously uncharacterized. The foundation for a two-hybrid proteomic investigation can be purchased as separate kits from a number of companies. The true power of the technique lies not in its affordability, but rather in its portability. The two-hybrid system puts proteomics back into laboratories where the output of the screens can be evaluated by researchers with experience in the particular fields of basic research, cancer biology, toxicology or drug development.

Do Affordable Housing Projects Harm Suburban Communities? Crime, Property Values, and Taxes in Mount Laurel, NJ.

PubMed

Albright, Len; Derickson, Elizabeth S; Massey, Douglas S

2013-06-01

This paper offers a mixed-method analysis of the municipal-level consequences of an affordable housing development built in suburban New Jersey. Opponents of affordable housing development often suggest that creating affordable housing will harm surrounding communities. Feared consequences include increases in crime, declining property values, and rising taxes. To evaluate these claims, the paper uses the case of Mt. Laurel, NJ - the site of a landmark affordable housing legal case and subsequent affordable housing development. Employing a multiple time series group control design, we compare crime rates, property values, and property taxes in Mt. Laurel to outcomes in similar nearby municipalities that do not contain comparable affordable housing developments. We find that the opening of the affordable housing development was not associated with trends in crime, property values, or taxes, and discuss management practices and design features that may have mitigated potential negative externalities.

Do Affordable Housing Projects Harm Suburban Communities? Crime, Property Values, and Taxes in Mount Laurel, NJ

PubMed Central

Albright, Len; Derickson, Elizabeth S.; Massey, Douglas S.

2016-01-01

This paper offers a mixed-method analysis of the municipal-level consequences of an affordable housing development built in suburban New Jersey. Opponents of affordable housing development often suggest that creating affordable housing will harm surrounding communities. Feared consequences include increases in crime, declining property values, and rising taxes. To evaluate these claims, the paper uses the case of Mt. Laurel, NJ – the site of a landmark affordable housing legal case and subsequent affordable housing development. Employing a multiple time series group control design, we compare crime rates, property values, and property taxes in Mt. Laurel to outcomes in similar nearby municipalities that do not contain comparable affordable housing developments. We find that the opening of the affordable housing development was not associated with trends in crime, property values, or taxes, and discuss management practices and design features that may have mitigated potential negative externalities. PMID:27390552

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 until...

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 until...

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 until...

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 until...

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 until...

Educational Affordances of a Ubiquitous Learning Environment in a Natural Science Course

ERIC Educational Resources Information Center

Tan, Tan-Hsu; Lin, Min-Sheng; Chu, Yu-Ling; Liu, Tsung-Yu

2012-01-01

Educational affordances are worthy of being explored because the affordances of Information and Communication Technologies (ICT) provide the pedagogical effects for promoting cognitive acceleration, increasing the self-management of students, facilitating data collection, and presentation in science learning. This study aims to explore educational…

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…

Active design in affordable housing: A public health nudge.

PubMed

Garland, Elizabeth; Garland, Victoria; Peters, Dominique; Doucette, John; Thanik, Erin; Rajupet, Sritha; Sanchez, Sadie H

2018-06-01

This pilot study investigates the impact of active design (AD) strategies on physical activity (PA) among adults living in two Leadership in Energy and Environmental Design (LEED) certified affordable housing developments in the South Bronx, New York. One building incorporates LEED Innovation in Design (ID) Credit: Design for Health through Increased Physical Activity. Tenants in an affordable housing building (AH) incorporating active design strategies completed PA self-assessments at their lease signing and one year later in 2015. Trained research assistants obtained body measurements. Residents of neighboring non-AD affordable housing (MCV) served as a comparison. Thirty four adults were recruited from AH and 29 from MCV, retention was 56% (n = 19) and 52% (n = 15) respectively at one year. The two groups' body mass index (BMI) and high-risk waist-to-hip ratio (WHR) were not statistically significantly different when analyzed as continuous variables, although BMI category had a greater decline at AH than at MCV (p = 0.054). There was a 31.5% increase in AH participants meeting MPA requirements and a statistically significant improvement in females (p = 0.031); while there was no change in the MCV participants overall or when stratified by gender. AH participants were significantly more likely to have reported increased stair use and less likely to have reported no change or decreased stair use than participants from MCV participants (p = 0.033). Housing has a role in individual health outcomes and behavior change, broad adoption of active design strategies in affordable housing is warranted to improve physical activity measures.

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 until...

20 CFR 416.1075 - 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. 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 until...

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 until...

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 until...

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 until...

Intergenerational transmission of child abuse and neglect: Do maltreatment type, perpetrator, and substantiation status matter?

PubMed

Bartlett, Jessica Dym; Kotake, Chie; Fauth, Rebecca; Easterbrooks, M Ann

2017-01-01

A maternal history of childhood maltreatment is thought to be a potent risk factor for child abuse and neglect, yet the extent of continuity across generations is unclear, with studies reporting vastly different rates of intergenerational transmission. Disparate findings may be due to lack of attention to the nature of maltreatment experiences in each generation. We sought to expand the current literature by examining the role of maltreatment type, perpetrator identity, and substantiation status of reports to child protective services (CPS) on intergenerational maltreatment among adolescent mothers (n=417) and their children. We found that when mothers had at least one report of childhood maltreatment (substantiated or not), the odds that they maltreated their children increased by 72% (OR=2.52), compared to mothers who are not maltreated, but the odds were considerably lower when we limited analysis to substantiated reports. Both a maternal history of substantiated neglect and multiple type maltreatment (neglect and physical or sexual abuse) were associated with increased risk of child maltreatment, yet the likelihood of children experiencing multiple maltreatment perpetrated with their mothers identified as perpetrators increased over 300% when mothers had a childhood history of multiple maltreatment. Copyright © 2016 Elsevier Ltd. All rights reserved.

Microbiological challenge of four protective devices for the reconstitution of cytotoxic agents.

PubMed

De Prijck, K; D'Haese, E; Vandenbroucke, J; Coucke, W; Robays, H; Nelis, H J

2008-12-01

To evaluate the susceptibility to microbial contamination that occurs during simulated handling of protective devices for the preparation of cytotoxic drug solutions. Four devices, i.e. Chemoprotect spike, Clave connector, PhaSeal and Securmix were challenged with low and high inocula of micro-organisms. The cells, transferred to the connected vials during repeated manipulations of the devices were counted by means of solid-phase cytometry. Of the four devices, PhaSeal afforded the lowest transfer of micro-organisms. Secondly, the efficiency of procedures for the disinfection of an artificially contaminated rubber stopper was compared prior to connection of the vial to the PhaSeal device. Spraying or swabbing alone was inadequate, as opposed to a combination of spraying [0.5% or 2.0% (w/v) chlorhexidine in isopropanol] and swabbing [70% (v/v) isopropanol]. Although Phaseal afforded the lowest transfer of micro-organisms, adequate disinfection of the vial prior to connection remains required. Unlike aspects of operator protection, which are well documented, the microbiological safety of protective devices for the preparation of cytotoxic drugs has not been addressed in the literature. This study estimates the susceptibility to microbial contamination during handling of four commonly used devices.

The Relevance of the Affordable Care Act for Improving Mental Health Care.

PubMed

Mechanic, David; Olfson, Mark

2016-01-01

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.

Acquisition Management for System of Systems: Affordability through Effective Portfolio Management

DTIC Science & Technology

2013-04-01

the management of strategic “ portfolios of systems” in military acquisitions; this includes application of Real Options (RO) theory and metrics such...Affordability Through Effective Portfolio Management Navindran Davendralingam and Daniel DeLaurentis Purdue University Published April 1, 2013...Systems: Affordability Through Effective Portfolio Management 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d

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. !

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.

24 CFR 1000.104 - What families are eligible for affordable housing activities?

Code of Federal Regulations, 2010 CFR

2010-04-01

... affordable housing activities? 1000.104 Section 1000.104 Housing and Urban Development Regulations Relating... Activities § 1000.104 What families are eligible for affordable housing activities? The following families... Indian area. (b) A non-low income Indian family may receive housing assistance in accordance with § 1000...

Self-organization, free energy minimization, and optimal grip on a field of affordances.

PubMed

Bruineberg, Jelle; Rietveld, Erik

2014-01-01

In this paper, we set out to develop a theoretical and conceptual framework for the new field of Radical Embodied Cognitive Neuroscience. This framework should be able to integrate insights from several relevant disciplines: theory on embodied cognition, ecological psychology, phenomenology, dynamical systems theory, and neurodynamics. We suggest that the main task of Radical Embodied Cognitive Neuroscience is to investigate the phenomenon of skilled intentionality from the perspective of the self-organization of the brain-body-environment system, while doing justice to the phenomenology of skilled action. In previous work, we have characterized skilled intentionality as the organism's tendency toward an optimal grip on multiple relevant affordances simultaneously. Affordances are possibilities for action provided by the environment. In the first part of this paper, we introduce the notion of skilled intentionality and the phenomenon of responsiveness to a field of relevant affordances. Second, we use Friston's work on neurodynamics, but embed a very minimal version of his Free Energy Principle in the ecological niche of the animal. Thus amended, this principle is helpful for understanding the embeddedness of neurodynamics within the dynamics of the system "brain-body-landscape of affordances." Next, we show how we can use this adjusted principle to understand the neurodynamics of selective openness to the environment: interacting action-readiness patterns at multiple timescales contribute to the organism's selective openness to relevant affordances. In the final part of the paper, we emphasize the important role of metastable dynamics in both the brain and the brain-body-environment system for adequate affordance-responsiveness. We exemplify our integrative approach by presenting research on the impact of Deep Brain Stimulation on affordance responsiveness of OCD patients.

Developing Countries Vaccine Manufacturers Network: doing good by making high-quality vaccines affordable for all.

PubMed

Pagliusi, Sonia; Leite, Luciana C C; Datla, Mahima; Makhoana, Morena; Gao, Yongzhong; Suhardono, Mahendra; Jadhav, Suresh; Harshavardhan, Gutla V J A; Homma, Akira

2013-04-18

The Developing Countries Vaccine Manufacturers Network (DCVMN) is a unique model of a public and private international alliance. It assembles governmental and private organizations to work toward a common goal of manufacturing and supplying high-quality vaccines at affordable prices to protect people around the world from known and emerging infectious diseases. Together, this group of manufacturers has decades of experience in manufacturing vaccines, with technologies, know-how, and capacity to produce more than 40 vaccines types. These manufacturers have already contributed more than 30 vaccines in various presentations that have been prequalified by the World Health Organization for use by global immunization programmes. Furthermore, more than 45 vaccines are in the pipeline. Recent areas of focus include vaccines to protect against rotavirus, human papillomavirus (HPV), Japanese encephalitis, meningitis, hepatitis E, poliovirus, influenza, and pertussis, as well as combined pentavalent vaccines for children. The network has a growing number of manufacturers that produce a growing number of products to supply the growing demand for vaccines in developing countries. Copyright © 2013. Published by Elsevier Ltd.

Measuring water affordability in developed economies. The added value of a needs-based approach.

PubMed

Vanhille, Josefine; Goedemé, Tim; Penne, Tess; Van Thielen, Leen; Storms, Bérénice

2018-07-01

In developed countries, water affordability problems remain up on the agenda as the increasing financial costs of water services can impede the realisation of an equal access to water. More than ever, public authorities that define water tariffs face the challenge of reconciling environmental and cost recovery objectives with equity and financial accessibility for all. Indicators of water affordability can be helpful in this regard. Conventional affordability indicators often rely on the actual amount that households spend on water use. In contrast, we propose a needs-based indicator that measures the risk of being unable to afford the amount of water necessary to fulfill essential needs, i.e. needs that should be fulfilled for adequate participation in society. In this paper we set forth the methodological choices inherent to constructing a needs-based affordability indicator. Using a micro-dataset on households in Flanders (Belgium), we compare its results with the outcomes of a more common actual expenses-indicator. The paper illustrates how the constructed needs-based indicator can complement existing affordability indicators, and its capacity to reveal important risk groups. Copyright © 2018 Elsevier Ltd. All rights reserved.

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. © 2013 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of the International Association for the Study of Obesity.

27 CFR 24.166 - Buildings or rooms.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Buildings or rooms. 24.166... OF THE TREASURY LIQUORS WINE Construction and Equipment § 24.166 Buildings or rooms. All buildings or... afford adequate protection to the revenue. Each building or room will be constructed of substantial...

Tualang honey protects keratinocytes from ultraviolet radiation-induced inflammation and DNA damage.

PubMed

Ahmad, Israr; Jimenez, Hugo; Yaacob, Nik Soriani; Yusuf, Nabiha

2012-01-01

Malaysian tualang honey possesses strong antioxidant and anti-inflammatory properties. Here, we evaluated the effect of tualang honey on early biomarkers of photocarcinogenesis employing PAM212 mouse keratinocyte cell line. Keratinocytes were treated with tualang honey (1.0%, v/v) before a single UVB (150 mJ cm(-2) ) irradiation. We found that the treatment of tualang honey inhibited UVB-induced DNA damage, and enhanced repair of UVB-mediated formation of cyclobutane pyrimidine dimers and 8-oxo-7,8-dihydro-2'-deoxyguanosine. Treatment of tualang honey inhibited UVB-induced nuclear translocation of NF-κB and degradation of IκBα in murine keratinocyte cell line. The treatment of tualang honey also inhibited UVB-induced inflammatory cytokines and inducible nitric oxide synthase protein expression. Furthermore, the treatment of tualang honey inhibited UVB-induced COX-2 expression and PGE2 production. Taken together, we provide evidence that the treatment of tualang honey to keratinocytes affords substantial protection from the adverse effects of UVB radiation via modulation in early biomarkers of photocarcinogenesis and provide suggestion for its photochemopreventive potential. © 2012 Wiley Periodicals, Inc. Photochemistry and Photobiology © 2012 The American Society of Photobiology.

Treatment for Substance Use Disorder: Opportunities and Challenges under the Affordable Care Act

PubMed Central

Tai, Betty; Volkow, Nora D.

2016-01-01

Addiction is a chronic brain disease with consequences that remain problematic years after discontinuation of use. Despite this, treatment models focus on acute interventions and are carved out from the main health care system. The Patient Protection and Affordable Care Act (2010) brings the opportunity to change the way substance use disorder (SUD) is treated in the United States. The treatment of SUD must adapt to a chronic care model offered in an integrated care system that screens for at-risk patients and includes services needed to prevent relapses. The partnering of the health care system with substance abuse treatment programs could dramatically expand the benefits of prevention and treatment of SUD. Expanding roles of health information technology and nonphysician workforces, such as social workers, are essential to the success of a chronic care model. PMID:23731411

Global Trends in the Affordability of Sugar-Sweetened Beverages, 1990-2016.

PubMed

Blecher, Evan; Liber, Alex C; Drope, Jeffrey M; Nguyen, Binh; Stoklosa, Michal

2017-05-04

The objective of this study was to quantify changes in the affordability of sugar-sweetened beverages, a product implicated as a contributor to rising rates of obesity worldwide, as a function of product price and personal income. We used international survey data in a retrospective analysis of 40 high-income and 42 low-income and middle-income countries from 1990 to 2016. Prices of sugar-sweetened beverages were from the Economist Intelligence Unit's World Cost of Living Survey. Income and inflation data were from the International Monetary Fund's World Economic Outlook Database. The measure of affordability was the average annual percentage change in the relative-income price of sugar-sweetened beverages, which is the annual rate of change in the proportion of per capita gross domestic product needed to purchase 100 L of Coca-Cola in each country in each year of the study. In 79 of 82 countries, the proportion of income needed to purchase sugar-sweetened beverages declined on average (using annual measures) during the study period. This pattern, described as an increase in the affordability of sugar-sweetened beverages, indicated that sugar-sweetened beverages became more affordable more rapidly in low-income and middle-income countries than in high-income countries, a fact largely attributable to the higher rate of income growth in those countries than to a decline in the real price of sugar-sweetened beverages. Without deliberate policy action to raise prices, sugar-sweetened beverages are likely to become more affordable and more widely consumed around the world.

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... or an Advance Notice of Proposed Rulemaking; (v) A detailed statement and analysis as to why the...

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... or an Advance Notice of Proposed Rulemaking; (v) A detailed statement and analysis as to why the...

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

Protective Effects of Parent-College Student Communication during the First Semester of College

ERIC Educational Resources Information Center

Small, Meg L.; Morgan, Nicole; Abar, Caitlin; Maggs, Jennifer L.

2011-01-01

Objective: Recent studies suggest that parents maintain influence as their adolescents transition into college. Advances in communication technology make frequent communication between parents and college students easy and affordable. This study examines the protective effect of parent-college student communication on student drinking behaviors,…

High Working Memory Load Increases Intracortical Inhibition in Primary Motor Cortex and Diminishes the Motor Affordance Effect.

PubMed

Freeman, Scott M; Itthipuripat, Sirawaj; Aron, Adam R

2016-05-18

Motor affordances occur when the visual properties of an object elicit behaviorally relevant motor representations. Typically, motor affordances only produce subtle effects on response time or on motor activity indexed by neuroimaging/neuroelectrophysiology, but sometimes they can trigger action itself. This is apparent in "utilization behavior," where individuals with frontal cortex damage inappropriately grasp affording objects. This raises the possibility that, in healthy-functioning individuals, frontal cortex helps ensure that irrelevant affordance provocations remain below the threshold for actual movement. In Experiment 1, we tested this "frontal control" hypothesis by "loading" the frontal cortex with an effortful working memory (WM) task (which ostensibly consumes frontal resources) and examined whether this increased EEG measures of motor affordances to irrelevant affording objects. Under low WM load, there were typical motor affordance signatures: an event-related desynchronization in the mu frequency and an increased P300 amplitude for affording (vs nonaffording) objects over centroparietal electrodes. Contrary to our prediction, however, these affordance measures were diminished under high WM load. In Experiment 2, we tested competing mechanisms responsible for the diminished affordance in Experiment 1. We used paired-pulse transcranial magnetic stimulation over primary motor cortex to measure long-interval cortical inhibition. We found greater long-interval cortical inhibition for high versus low load both before and after the affording object, suggesting that a tonic inhibition state in primary motor cortex could prevent the affordance from provoking the motor system. Overall, our results suggest that a high WM load "sets" the motor system into a suppressed state that mitigates motor affordances. Is an irrelevant motor affordance more likely to be triggered when you are under low or high cognitive load? We examined this using physiological measures

A Novel Adjustable Concept for Permeable Gas/Vapor Protective Clothing: Balancing Protection and Thermal Strain.

PubMed

Bogerd, Cornelis Peter; Langenberg, Johannes Pieter; DenHartog, Emiel A

2018-02-13

Armed forces typically have personal protective clothing (PPC) in place to offer protection against chemical, biological, radiological and nuclear (CBRN) agents. The regular soldier is equipped with permeable CBRN-PPC. However, depending on the operational task, these PPCs pose too much thermal strain to the wearer, which results in a higher risk of uncompensable heat stress. This study investigates the possibilities of adjustable CBRN-PPC, consisting of different layers that can be worn separately or in combination with each other. This novel concept aims to achieve optimization between protection and thermal strain during operations. Two CBRN-PPC (protective) layers were obtained from two separate manufacturers: (i) a next-to-skin (NTS) and (ii) a low-burden battle dress uniform (protective BDU). In addition to these layers, a standard (non-CBRN protective) BDU (sBDU) was also made available. The effect of combining clothing layers on the levels of protection were investigated with a Man-In-Simulant Test. Finally, a mechanistic numerical model was employed to give insight into the thermal burden of the evaluated CBRN-PPC concepts. Combining layers results in substantially higher protection that is more than the sum of the individual layers. Reducing the airflow on the protective layer closest to the skin seems to play an important role in this, since combining the NTS with the sBDU also resulted in substantially higher protection. As expected, the thermal strain posed by the different clothing layer combinations decreases as the level of protection decreases. This study has shown that the concept of adjustable protection and thermal strain through multiple layers of CBRN-PPC works. Adjustable CBRN-PPC allows for optimization of the CBRN-PPC in relation to the threat level, thermal environment, and tasks at hand in an operational setting. © The Author(s) 2017. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.

An Exploratory Study of Emotional Affordance of a Massive Open Online Course

ERIC Educational Resources Information Center

Cheng, Jeremy C. Y.

2014-01-01

This exploratory study examines emotional affordance of a massive open online course (MOOC). Postings in a discussion forum of a MOOC in computer science are analysed following a research design informed by virtual ethnography. Emotional affordance is investigated, focusing on non-achievement emotions which are not directly linked to achievement…

Long-term treatment with a Yang-invigorating Chinese herbal formula produces generalized tissue protection against oxidative damage in rats.

PubMed

Chiu, Po Yee; Leung, Hoi Yan; Siu, Ada Hoi Ling; Chen, Na; Poon, Michel K T; Ko, Kam Ming

2008-02-01

Previous work in our laboratory has shown that long-term treatment with Vigconic 28 (VI-28), a Yang-invigorating Chinese herbal formula used for the promotion of overall wellness in Chinese medicine, can enhance the mitochondrial functional ability and antioxidant capacity in various tissues of both male and female rats. To investigate whether the VI-28 treatment regimen could afford tissue protection against oxidative injury, the effects of long-term VI-28 treatment (80 or 240 mg/kg/d x 30) on oxidative stress-induced tissue damage in various organs (brain, heart, liver, and kidney) were examined in female rats. The results indicated that long-term VI-28 treatment invariably protected against oxidative tissue damage in the rat models of cerebral/myocardial ischemia-reperfusion injury, CCl4 hepatotoxicity, and gentamicin nephrotoxicity. The tissue protection was associated with increases in the levels and activities of mitochondrial antioxidant components as well as with the preservation of mitochondrial structural integrity. This was evidenced by decreases in the sensitivity of mitochondria to Ca2+-induced permeability transition, and in the levels of mitochondrial malondialdehyde production, Ca2+ loading, and cytochrome c release in the tissues examined. Interestingly, the VI-28 treatment increased red cell CuZn-superoxide dismutase (CuZn-SOD) levels, and these levels correlated positively with the degree of tissue protection afforded by long-term VI-28 treatment in rats. The generalized tissue protection afforded by long-term VI-28 treatment may have clinical implications in the prevention of age-related diseases, and VI-28 treatment may possibly delay the aging process.

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. Copyright © 2016 Elsevier Ltd. All rights reserved.

Implementing the Affordable Care Act: Promoting Competition in the Individual Marketplaces.

PubMed

Cusano, David; Lucia, Kevin

2016-02-01

A main goal of the Affordable Care Act is to provide Americans with access to affordable coverage in the individual market, achieved in part by pro­moting competition among insurers on premium price and value. One primary mechanism for meeting that goal is the establishment of new individual health insurance marketplaces where consumers can shop for, compare, and purchase plans, with subsidies if they are eligible. In this issue brief, we explore how the Affordable Care Act is influencing competition in the individual marketplaces in four states--Kansas, Nevada, Rhode Island, and Washington. Strategies include: educating consumers and providing coverage information in one place to ease decision-making; promoting competition among insurers; and ensuring a level playing field for premium rate development through the rate review process.

Self-organization, free energy minimization, and optimal grip on a field of affordances

PubMed Central

Bruineberg, Jelle; Rietveld, Erik

2014-01-01

In this paper, we set out to develop a theoretical and conceptual framework for the new field of Radical Embodied Cognitive Neuroscience. This framework should be able to integrate insights from several relevant disciplines: theory on embodied cognition, ecological psychology, phenomenology, dynamical systems theory, and neurodynamics. We suggest that the main task of Radical Embodied Cognitive Neuroscience is to investigate the phenomenon of skilled intentionality from the perspective of the self-organization of the brain-body-environment system, while doing justice to the phenomenology of skilled action. In previous work, we have characterized skilled intentionality as the organism's tendency toward an optimal grip on multiple relevant affordances simultaneously. Affordances are possibilities for action provided by the environment. In the first part of this paper, we introduce the notion of skilled intentionality and the phenomenon of responsiveness to a field of relevant affordances. Second, we use Friston's work on neurodynamics, but embed a very minimal version of his Free Energy Principle in the ecological niche of the animal. Thus amended, this principle is helpful for understanding the embeddedness of neurodynamics within the dynamics of the system “brain-body-landscape of affordances.” Next, we show how we can use this adjusted principle to understand the neurodynamics of selective openness to the environment: interacting action-readiness patterns at multiple timescales contribute to the organism's selective openness to relevant affordances. In the final part of the paper, we emphasize the important role of metastable dynamics in both the brain and the brain-body-environment system for adequate affordance-responsiveness. We exemplify our integrative approach by presenting research on the impact of Deep Brain Stimulation on affordance responsiveness of OCD patients. PMID:25161615

75 FR 43993 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel: Patient Protection...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-27

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Disease, Disability, and Injury Prevention and Control Special Emphasis Panel: Patient Protection and Affordable Care Act (PPACA), Emerging Infections Program (EIP), Enhancing Epidemiology and Laboratory Capacity...

Testing Penetration of Epoxy Resin and Diamine Hardeners through Protective Glove and Clothing Materials.

PubMed

Henriks-Eckerman, Maj-Len; Mäkelä, Erja A; Suuronen, Katri

2015-10-01

Efficient, comfortable, yet affordable personal protective equipment (PPE) is needed to decrease the high incidence of allergic contact dermatitis arising from epoxy resin systems (ERSs) in industrial countries. The aim of this study was to find affordable, user-friendly glove and clothing materials that provide adequate skin protection against splashes and during the short contact with ERS that often occurs before full cure. We studied the penetration of epoxy resin and diamine hardeners through 12 glove or clothing materials using a newly developed test method. The tests were carried out with two ERS test mixtures that had a high content of epoxy resin and frequently used diamine hardeners of different molar masses. A drop (50 µl) of test mixture was placed on the outer surface of the glove/clothing material, which had a piece of Fixomull tape or Harmony protection sheet attached to the inner surface as the collection medium. The test times were 10 and 30 min. The collecting material was removed after the test was finished and immersed into acetone. The amounts of diglycidyl ether of bisphenol A (DGEBA), isophorone diamine (IPDA), and m-xylylenediamine (XDA) in the acetone solution were determined by gas chromatography with mass spectrometric detection. The limit for acceptable penetration of XDA, IPDA, and DGEBA through glove materials was set at 2 µg cm(-2). Penetration through the glove materials was 1.4 µg cm(-2) or less. The three tested chemical protective gloves showed no detectable penetration (<0.5 µg cm(-2)). Several affordable glove and clothing materials were found to provide adequate protection during short contact with ERS, in the form of, for example, disposable gloves or clothing materials suitable for aprons and as additional protective layers on the most exposed parts of clothing, such as the front of the legs and thighs and under the forearms. Every ERS combination in use should be tested separately to find the best skin protection material

Protection against California 2002 NDV strain afforded by adenovirus vectored vaccine expressing Fusion or Hemagglutination-neuraminidase genes

USDA-ARS?s Scientific Manuscript database

Vectored vaccines expressing the combination of the hemagglutinin-neuraminidase (HN) and fusion (F) genes generally have better clinical protection against Newcastle disease virus (NDV) than when either the F and HN genes are expressed alone. Interestingly, the protection induced by F is usually bet...

[Good for your health? An analysis of the requirements for scientific substantiation in European health claims regulation].

PubMed

Todt, Oliver; Luján, José Luis

2016-06-01

To identify the various types of evidence, as well as their relative importance in European health claims regulation, in order to analyze the consequences for consumer protection of the requirements for scientific substantiation in this regulation. Qualitative analysis of various documents relevant to the regulatory process, particularly as to the implications of the standards of proof for the functional food market, as well as consumer behavior. European regulation defines a hierarchy of evidence that turns randomized controlled trials into a necessary and sufficient condition for health claim authorizations. Consumer protection can be interpreted in different manners. High standards of proof protect consumers from false information about the health outcomes of functional foods, while lower standards lead to more, albeit less accurate information about such outcomes being available to consumers.

Dark Side of Information Systems and Protection of Children Online: Examining Predatory Behavior and Victimization of Children within Social Media

ERIC Educational Resources Information Center

Albert, Connie S.

2014-01-01

Protecting children online from sexual predators has been a focus of research in psychiatry, sociology, computer science, and information systems (IS) for many years. However, the anonymity afforded by social media has made finding a solution to the problem of child protection difficult. Pedophiles manipulate conversation (discourse) with children…

Elementary Content Specialization: Models, Affordances, and Constraints

ERIC Educational Resources Information Center

Markworth, Kimberly A.; Brobst, Joseph; Ohana, Chris; Parker, Ruth

2016-01-01

Background: This study investigates the models of elementary content specialization (ECS) in elementary mathematics and science and the affordances and constraints related to ECS--both generally and in relation to specific models. Elementary content specialists are defined as full-time classroom teachers who are responsible for content instruction…

Catching up: Latino health coverage gains and challenges under the Affordable Care Act: results from the Commonwealth Fund Affordable Care Act Tracking Survey.

PubMed

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

2014-09-01

For decades, Latinos have had the highest uninsured rates of any racial or ethnic group in the United States. Less than one year after the Affordable Care Act's health insurance marketplaces opened for enrollment, the overall Latino uninsured rate dropped from 36 percent to 23 percent, according to the Commonwealth Fund Affordable Care Act Tracking Survey, conducted April 9 to June 2, 2014. However, the high uninsured rate among Latinos in states that had not expanded their Medicaid program at the time of the survey--33 percent--remained statistically unchanged. These states are home to about 20 million Latinos, the majority of whom live in Texas and Florida.

NASA Affordable Vehicle Avionics (AVA). Common Modular Avionics System for Nanolaunchers Offering Affordable Access to Space; [Space Technology: Game Changing Development

NASA Technical Reports Server (NTRS)

Aquilina, Rudy

2017-01-01

Small satellites are becoming ever more capable of performing valuable missions for both government and commercial customers. However, currently these satellites can be launched affordably only as secondary payloads. This makes it difficult for the small satellite mission to launch when needed, to the desired orbit, and with acceptable risk. What is needed is a class of low-cost launchers, so that launch costs to low-Earth orbit (LEO) are commensurate with payload costs. Several private and government-sponsored launch vehicle developers are working toward just that-the ability to affordably insert small payloads into LEO. But until now, cost of the complex avionics remained disproportionately high. AVA (Affordable Vehicle Avionics) solves this problem. Significant contributors to the cost of launching nanosatellites to orbit are the avionics and software systems that steer and control the launch vehicles, sequence stage separation, deploy payloads, and telemeter data. The high costs of these guidance, navigation and control (GNC) avionics systems are due in part to the current practice of developing unique, single-use hardware and software for each launch. High-performance, high-reliability inertial sensors components with heritage from legacy launchers also contribute to costs-but can low-cost commercial inertial sensors work just as well? NASA Ames Research Center has developed and tested a prototype low-cost avionics package for space launch vehicles that provides complete GNC functionality in a package smaller than a tissue box (100 millimeters by 120 millimeters by 69 millimeters; 4 inches by 4.7 inches by 2.7 inches), with a mass of less than 0.84 kilogram (2 pounds. AVA takes advantage of commercially available, low-cost, mass-produced, miniaturized sensors, filtering their more noisy inertial data with real-time GPS (Global Positioning Satellite) data. The goal of the AVA project is to produce and light-verify a common suite of avionics and software that

Relationship between the ability of sunscreens containing 2-ethylhexyl-4'-methoxycinnamate to protect against UVR-induced inflammation, depletion of epidermal Langerhans (Ia+) cells and suppression of alloactivating capacity of murine skin in vivo.

PubMed

Walker, S L; Morris, J; Chu, A C; Young, A R

1994-01-01

The UVB sunscreen 2-ethylhexyl-4'-methoxycinnamate was evaluated in hairless albino mouse skin for its ability to inhibit UVR-induced (i) oedema, (ii) epidermal Langerhans cell (Ia+) depletion and (iii) suppression of the alloactivating capacity of epidermal cells (mixed epidermal cell-lymphocyte reaction, MECLR). The sunscreen, prepared at 9% in ethanol or a cosmetic lotion, was applied prior to UVB/UVA irradiation. In some experiments there was a second application halfway through the irradiation. Single applications in both vehicles gave varying degrees of protection from oedema and Langerhans cell depletion but afforded no protection from suppression of MECLR. When the sunscreens were applied twice there was improved protection from oedema and Langerhans cell depletion and complete protection was afforded from suppression of MECLR. There was a clear linear relationship between Langerhans cell numbers and oedema with and without sunscreen application. The relationship between Langerhans cell numbers and MECLR was more complex. These data confirm published discrepancies between protection from oedema (a model for human erythema) and endpoints with immunological significance, but show that 2-ethylhexyl-4'-methoxycinnamate can afford complete immunoprotection, although protection is dependent on the application rate and vehicle.

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.

Understanding the adoption dynamics of medical innovations: affordances of the da Vinci robot in the Netherlands.

PubMed

Abrishami, Payam; Boer, Albert; Horstman, Klasien

2014-09-01

This study explored the rather rapid adoption of a new surgical device - the da Vinci robot - in the Netherlands despite the high costs and its controversial clinical benefits. We used the concept 'affordances' as a conceptual-analytic tool to refer to the perceived promises, symbolic meanings, and utility values of an innovation constructed in the wider social context of use. This concept helps us empirically understand robot adoption. Data from 28 in-depth interviews with diverse purposively-sampled stakeholders, and from medical literature, policy documents, Health Technology Assessment reports, congress websites and patients' weblogs/forums between April 2009 and February 2014 were systematically analysed from the perspective of affordances. We distinguished five interrelated affordances of the robot that accounted for shaping and fulfilling its rapid adoption: 'characteristics-related' affordances such as smart nomenclature and novelty, symbolising high-tech clinical excellence; 'research-related' affordances offering medical-technical scientific excellence; 'entrepreneurship-related' affordances for performing better-than-the-competition; 'policy-related' affordances indicating the robot's liberalised provision and its reduced financial risks; and 'communication-related' affordances of the robot in shaping patients' choices and the public's expectations by resonating promising discourses while pushing uncertainties into the background. These affordances make the take-up and use of the da Vinci robot sound perfectly rational and inevitable. This Dutch case study demonstrates the fruitfulness of the affordances approach to empirically capturing the contextual dynamics of technology adoption in health care: exploring in-depth actors' interaction with the technology while considering the interpretative spaces created in situations of use. This approach can best elicit real-life value of innovations, values as defined through the eyes of (potential) users

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

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-19

... Vol. 78 Wednesday, No. 118 June 19, 2013 Part III Department of Health and Human Services 45 CFR... HUMAN SERVICES 45 CFR Parts 144, 147, 153, 155, and 156 [CMS-9957-P] RIN 0938-AR82 Patient Protection... Standards AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Proposed rule. SUMMARY: This...

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

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-12

... Intent To Award Supplemental Affordable Care Act Funding Notice of Intent to award supplemental Affordable Care Act funding to support enhancement of an existing laboratory fellowship training program through funding opportunity CDC-RFA-HM10-1001, ``APHL--CDC Partnership for Quality Laboratory Practice...

Preparedness of Americans for the Affordable Care Act.

PubMed

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

2014-04-15

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.

Health Care Reform and Young Adults' Access to Sexual Health Care: An Exploration of Potential Confidentiality Implications of the Affordable Care Act

PubMed Central

Garcia, Carolyn M.; Long, Sharon K.; Lechner, Kate E.; Lust, Katherine; Eisenberg, Marla E.

2012-01-01

One provision of the 2010 Affordable Care Act is extension of dependent coverage for young adults aged up to 26 years on their parent’s private insurance plan. This change, meant to increase insurance coverage for young adults, might yield unintended consequences. Confidentiality concerns may be triggered by coverage through parental insurance, particularly regarding sexual health. The existing literature and our original research suggest that actual or perceived limits to confidentiality could influence the decisions of young adults about whether, and where, to seek care for sexual health issues. Further research is needed on the scope and outcomes of these concerns. Possible remedial actions include enhanced policies to protect confidentiality in billing and mechanisms to communicate confidentiality protections to young adults. PMID:22897544

76 FR 63846 - Substantially Underserved Trust Areas (SUTA)

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-14

... CFR Part 1700 RIN 0572-AC23 Substantially Underserved Trust Areas (SUTA) AGENCY: Rural Utilities... of infrastructure projects in Substantially Underserved Trust Areas (SUTA). The intent is to..., Washington, DC 20250-1522. Title: Substantially Underserved Trust Areas. Type of Request: Approval of a new...

Students' Affordance of Teleologic Explanations and Anthropomorphic Language in Eliciting Concepts in Physics

ERIC Educational Resources Information Center

Bautista, Romiro G.

2015-01-01

This study ascertains that the students' affordance of teleologic explanations and anthropomorphic language in eliciting concepts in Physics is influenced by their age and learning exposure and experience. Using Explicative-Reductive Method of Descriptive Research, this study focused on the determinants of students' affordance of…

24 CFR 907.7 - Remedies 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 Remedies for substantial default... URBAN DEVELOPMENT SUBSTANTIAL DEFAULT BY A PUBLIC HOUSING AGENCY § 907.7 Remedies for substantial... staff; or (3) Provide assistance deemed necessary, in the discretion of HUD, to remedy emergency...

Rhythm as an affordance for the entrainment of movement.

PubMed

Cummins, Fred

2009-01-01

A general account of rhythm in human behaviour is provided, according to which rhythm inheres in the affordance that a signal provides for the entrainment of movement on the part of a perceiver. This generic account is supported by an explication of the central concepts of affordance and entrainment. When viewed in this light, rhythm appears as the correct explanandum to account for coordinated behaviour in a wide variety of situations, including such core senses as dance and the production of music. Speech may appear to be only marginally rhythmical under such an account, but several experimental studies reveal that speech, too, has the potential to entrain movement. (c) 2009 S. Karger AG, Basel.

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.

Assessing the engineering performance of affordable net-zero energy housing

NASA Astrophysics Data System (ADS)

Wallpe, Jordan P.

The purpose of this research was to evaluate affordable technologies that are capable of providing attractive, cost-effective energy savings to the housing industry. The research did so by investigating the 2011 Solar Decathlon competition, with additional insight from the Purdue INhome. Insight from the Purdue INhome verified the importance of using a three step design process to design a net-zero energy building. In addition, energy consumption values of the INhome were used to compare and contrast different systems used in other houses. Evaluation of unbiased competition contests gave a better understanding of how a house can realistically reach net-zero. Upon comparison, off-the-shelf engineering systems such as super-efficient HVAC units, heat pump hot water heaters, and properly designed photovoltaic arrays can affordably enable a house to become net-zero. These important and applicable technologies realized from the Solar Decathlon will reduce the 22 percent of all energy consumed through the residential sector in the United States. In conclusion, affordable net-zero energy buildings can be built today with commitment from design professionals, manufacturers, and home owners.

24 CFR 907.3 - Bases for substantial default.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 4 2013-04-01 2013-04-01 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. (a...

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. (a...

24 CFR 907.3 - Bases for substantial default.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 4 2012-04-01 2012-04-01 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. (a...

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 or...

Information Dominance: Can We Afford It

DTIC Science & Technology

1997-03-01

dominate all campaign areas such as air and fire superiority. This paper focuses on information warfare (IW) and its subset, information dominance (ID...the U.S. need information dominance , especially offensively, against second and third world countries, or should it put resources into active defense...Does the U.S. need defensive and offensive modes of information dominance ; can we afford both? Are we headed for information ’overkill’ to gain

76 FR 20352 - Notice of Intent To Award Affordable Care Act (ACA) Funding

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-12

... Intent To Award Affordable Care Act (ACA) Funding Notice of Intent to award Affordable Care Act (ACA) funding to two Emerging Infections Program (EIP) grantees, the Connecticut Department of Public Health and... grantees' Fiscal Year (FY) 2011 non-competitive continuation applications under funding opportunity CI05...

Closing the Communal Gap: The Importance of Communal Affordances in Science Career Motivation

PubMed Central

Brown, Elizabeth R.; Thoman, Dustin B.; Smith, Jessi L.; Diekman, Amanda B.

2015-01-01

To remain competitive in the global economy, the United States (and other countries) is trying to broaden participation in science, technology, engineering, and mathematics (STEM) by graduating an additional 1 million people in STEM fields by 2018. Although communion (working with, helping, and caring for others) is a basic human need, STEM careers are often (mis)perceived as being uncommunal. Across three naturalistic studies we found greater support for the communal affordance hypothesis, that perceiving STEM careers as affording greater communion is associated with greater STEM career interest, than two alternative hypotheses derived from goal congruity theory. Importantly, these findings held regardless of major (Study 1), college enrollment (Study 2), and gender (Studies 1–3). For undergraduate research assistants, mid-semester beliefs that STEM affords communion predicted end of the semester STEM motivation (Study 3). Our data highlight the importance of educational and workplace motivational interventions targeting communal affordances beliefs about STEM. PMID:26806983

Closing the Communal Gap: The Importance of Communal Affordances in Science Career Motivation.

PubMed

Brown, Elizabeth R; Thoman, Dustin B; Smith, Jessi L; Diekman, Amanda B

2015-12-01

To remain competitive in the global economy, the United States (and other countries) is trying to broaden participation in science, technology, engineering, and mathematics (STEM) by graduating an additional 1 million people in STEM fields by 2018. Although communion (working with, helping, and caring for others) is a basic human need, STEM careers are often (mis)perceived as being uncommunal. Across three naturalistic studies we found greater support for the communal affordance hypothesis, that perceiving STEM careers as affording greater communion is associated with greater STEM career interest, than two alternative hypotheses derived from goal congruity theory. Importantly, these findings held regardless of major (Study 1), college enrollment (Study 2), and gender (Studies 1-3). For undergraduate research assistants, mid-semester beliefs that STEM affords communion predicted end of the semester STEM motivation (Study 3). Our data highlight the importance of educational and workplace motivational interventions targeting communal affordances beliefs about STEM.

49 CFR 384.301 - Substantial compliance-general requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... personnel), and enforcement practices. (b)(1) A State must come into substantial compliance with the... come into substantial compliance with 49 CFR 383.123 not later than September 30, 2006. (c) A State must come into substantial compliance with the requirements of subpart B of this part in effect as of...

49 CFR 384.301 - Substantial compliance-general requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... personnel), and enforcement practices. (b)(1) A State must come into substantial compliance with the... come into substantial compliance with 49 CFR 383.123 not later than September 30, 2006. (c) A State must come into substantial compliance with the requirements of subpart B of this part in effect as of...

49 CFR 384.301 - Substantial compliance-general requirements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... personnel), and enforcement practices. (b)(1) A State must come into substantial compliance with the... come into substantial compliance with 49 CFR 383.123 not later than September 30, 2006. (c) A State must come into substantial compliance with the requirements of subpart B of this part in effect as of...

49 CFR 384.301 - Substantial compliance-general requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... personnel), and enforcement practices. (b)(1) A State must come into substantial compliance with the... come into substantial compliance with 49 CFR 383.123 not later than September 30, 2006. (c) A State must come into substantial compliance with the requirements of subpart B of this part in effect as of...

Affordability as a discursive accomplishment in a changing National Health Service.

PubMed

Russell, Jill; Greenhalgh, Trisha

2012-12-01

Health systems worldwide face the challenges of rationing. The English National Health Service (NHS) was founded on three core principles: universality, comprehensiveness, and free at the point of delivery. Yet patients are increasingly hearing that some treatments are unaffordable on the NHS. We considered affordability as a social accomplishment and sought to explore how those charged with allocating NHS resources achieved this in practice. We undertook a linguistic ethnography to examine the work practices of resource allocation committees in three Primary Care Trusts (PCTs) in England between 2005 and 2012, specifically deliberations over 'individual funding requests' (IFRs)--requests by patients and their doctors for the PCT to support a treatment not routinely funded. We collected and analysed a diverse dataset comprising policy documents, legal judgements, audio recordings, ethnographic field notes and emails from PCT committee meetings, interviews and a focus group with committee members. We found that the fundamental values of universality and comprehensiveness strongly influenced the culture of these NHS organisations, and that in this context, accomplishing affordability was not easy. Four discursive practices served to confer legitimacy on affordability as a guiding value of NHS health care: (1) categorising certain treatments as only eligible for NHS funding if patients could prove 'exceptional' circumstances; (2) representing resource allocation decisions as being not (primarily) about money; (3) indexical labelling of affordability as an ethical principle, and (4) recontextualising legal judgements supporting refusal of NHS treatment on affordability grounds as 'rational'. The overall effect of these discursive practices was that denying treatment to patients became reasonable and rational for an organisation even while it continued to espouse traditional NHS values. We conclude that deliberations about the funding of treatments at the margins of NHS

Paying for Cures: Perspectives on Solutions to the "Affordability Issue".

PubMed

Schaffer, Sarah Karlsberg; Messner, Donna; Mestre-Ferrandiz, Jorge; Tambor, Ellen; Towse, Adrian

2018-03-01

Curative therapies and other medicines considered "game-changing" in terms of health gain can be accompanied by high demand and high list prices that pose budget challenges to public and private payers and health systems-the so-called affordability issue. These challenges are exacerbated when longer term effectiveness, and thus value for money, is uncertain, but they can arise even when treatments are proven to be highly cost-effective at the time of launch. This commentary reviews innovative payment solutions proposed in the literature to address the affordability issue, including the use of credit markets and of staged payments linked to patient outcomes, and draws on discussions with payers in the United States and Europe on the feasibility or desirability of operationalizing any of the alternative financing and payment strategies that appear in the literature. This included a small number of semistructured interviews. We conclude that there is a mismatch between the enthusiasm in the academic literature for developing new approaches and the scepticism of payers that they can work or are necessary. For the foreseeable future, affordability pressures will continue to be handled by aggressive price bargaining, high co-pays (in systems in which this is possible), and restricting access to subgroups of patients. Of the mechanisms we explored, outcomes-based payments were of most interest to payers, but the costs associated with operating such schemes, together with implementation challenges, did not make them an attractive option for managing affordability. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Anti-islanding protection using a twin-peak band-pass filter in interconnected PV systems, and substantiating evaluations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ishida, T.; Hagihara, R.; Yugo, M.

1994-12-31

The authors have successfully developed and industrialized a new frequency-shift anti-islanding protection method using a twin-peak band-pass filter (BPF) for grid-interconnected photovoltaic (PV) systems. In this method, the power conditioner has a twin-peak BPF in a current feed back loop in place of the normal BPF. The new method works perfectly for various kinds of loads such as resistance, inductive and capacitive loads connected to the PV system. Furthermore, because there are no mis-detections, the system enables the most effective generation of electric energy from solar cells. A power conditioner equipped with this protection was officially certified as suitable formore » grid-interconnection.« less

49 CFR 384.301 - Substantial compliance-general requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... State must come into substantial compliance with the requirements of subpart B of this part in effect as..., not later than September 30, 2005. (2) Exception. A State must come into substantial compliance with 49 CFR 383.123 not later than September 30, 2006. (c) A State must come into substantial compliance...

Affordances and Constraints of a Blended Course in a Teacher Professional Development Program

ERIC Educational Resources Information Center

Bakir, Nesrin; Devers, Christopher; Hug, Barbara

2016-01-01

Using a descriptive research design approach, this study investigated the affordances and constraints of a graduate level blended course focused on science teaching and learning. Data were gathered from 24 in-service teacher interviews and surveys. Identified affordances included the structure and implementation of the course, the flexibility of…

Investigation of Effectiveness of Air-Heating a Hollow Steel Propeller for Protection Against Icing. 1: Unpartitioned Blades

NASA Technical Reports Server (NTRS)

Mulholland, Donald R.; Perkins, Porter J.

1948-01-01

An investigation to determine the effectiveness of icing protection afforded by air-heating hollow steel unpartitioned propeller blades has been conducted In the NACA Cleveland icing research tunnel. The propeller used was a production model modified with blade shank and tip openings to permit internal passage of heated air. Blade-surface and heated-air temperatures were obtained and photographic observations of Ice formations were made with variations In icing intensity and heating rate to the blades. For the conditions of Icing to which the propeller was subjected, it was found that adequate ice protection was afforded with a heating rate of 40 1 000 Btu per hour per blade. With less than 40,000 Btu per hour per blade, ice protection failed because of significant ice accretions on the leading edge. The chordwise distribution of heat was unsatisfactory with most of the available heat dissipated well back of the leading edge on both the thrust and camber face's instead of at the leading edge where it was most needed. A low utilization of available heat for icing protection is indicated by a beat-exchanger effectiveness of approximately 47 percent.

77 FR 39452 - Substantial Business Activities; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-03

... Substantial Business Activities; Correction AGENCY: Internal Revenue Service (IRS), Treasury. ACTION... whether a foreign corporation has substantial business activities in a foreign country. FOR FURTHER... the Code, the regulations have been submitted to the Chief Counsel for Advocacy of the Small Business...

Colour Polymorphism Protects Prey Individuals and Populations Against Predation.

PubMed

Karpestam, Einat; Merilaita, Sami; Forsman, Anders

2016-02-23

Colour pattern polymorphism in animals can influence and be influenced by interactions between predators and prey. However, few studies have examined whether polymorphism is adaptive, and there is no evidence that the co-occurrence of two or more natural prey colour variants can increase survival of populations. Here we show that visual predators that exploit polymorphic prey suffer from reduced performance, and further provide rare evidence in support of the hypothesis that prey colour polymorphism may afford protection against predators for both individuals and populations. This protective effect provides a probable explanation for the longstanding, evolutionary puzzle of the existence of colour polymorphisms. We also propose that this protective effect can provide an adaptive explanation for search image formation in predators rather than search image formation explaining polymorphism.

Colour Polymorphism Protects Prey Individuals and Populations Against Predation

PubMed Central

Karpestam, Einat; Merilaita, Sami; Forsman, Anders

2016-01-01

Colour pattern polymorphism in animals can influence and be influenced by interactions between predators and prey. However, few studies have examined whether polymorphism is adaptive, and there is no evidence that the co-occurrence of two or more natural prey colour variants can increase survival of populations. Here we show that visual predators that exploit polymorphic prey suffer from reduced performance, and further provide rare evidence in support of the hypothesis that prey colour polymorphism may afford protection against predators for both individuals and populations. This protective effect provides a probable explanation for the longstanding, evolutionary puzzle of the existence of colour polymorphisms. We also propose that this protective effect can provide an adaptive explanation for search image formation in predators rather than search image formation explaining polymorphism. PMID:26902799

Global Trends in the Affordability of Sugar-Sweetened Beverages, 1990–2016

PubMed Central

Blecher, Evan; Liber, Alex C.; Nguyen, Binh; Stoklosa, Michal

2017-01-01

Introduction The objective of this study was to quantify changes in the affordability of sugar-sweetened beverages, a product implicated as a contributor to rising rates of obesity worldwide, as a function of product price and personal income. Methods We used international survey data in a retrospective analysis of 40 high-income and 42 low-income and middle-income countries from 1990 to 2016. Prices of sugar-sweetened beverages were from the Economist Intelligence Unit’s World Cost of Living Survey. Income and inflation data were from the International Monetary Fund’s World Economic Outlook Database. The measure of affordability was the average annual percentage change in the relative-income price of sugar-sweetened beverages, which is the annual rate of change in the proportion of per capita gross domestic product needed to purchase 100 L of Coca-Cola in each country in each year of the study. Results In 79 of 82 countries, the proportion of income needed to purchase sugar-sweetened beverages declined on average (using annual measures) during the study period. This pattern, described as an increase in the affordability of sugar-sweetened beverages, indicated that sugar-sweetened beverages became more affordable more rapidly in low-income and middle-income countries than in high-income countries, a fact largely attributable to the higher rate of income growth in those countries than to a decline in the real price of sugar-sweetened beverages. Conclusion Without deliberate policy action to raise prices, sugar-sweetened beverages are likely to become more affordable and more widely consumed around the world. PMID:28472607

A Burgeoning Crisis? A Nationwide Assessment of the Geography of Water Affordability in the United States

PubMed Central

Mack, Elizabeth A.; Wrase, Sarah

2017-01-01

While basic access to clean water is critical, another important issue is the affordability of water access for people around the globe. Prior international work has highlighted that a large proportion of consumers could not afford water if priced at full cost recovery levels. Given growing concern about affordability issues due to rising water rates, and a comparative lack of work on affordability in the developed world, as compared to the developing world, more work is needed in developed countries to understand the extent of this issue in terms of the number of households and persons impacted. To address this need, this paper assesses potential affordability issues for households in the United States using the U.S. EPA’s 4.5% affordability criteria for combined water and wastewater services. Analytical results from this paper highlight high-risk and at-risk households for water poverty or unaffordable water services. Many of these households are clustered in pockets of water poverty within counties, which is a concern for individual utility providers servicing a large proportion of customers with a financial inability to pay for water services. Results also highlight that while water rates remain comparatively affordable for many U.S. households, this trend will not continue in the future. If water rates rise at projected amounts over the next five years, conservative projections estimate that the percentage of U.S. households who will find water bills unaffordable could triple from 11.9% to 35.6%. This is a concern due to the cascading economic impacts associated with widespread affordability issues; these issues mean that utility providers could have fewer customers over which to spread the large fixed costs of water service. Unaffordable water bills also impact customers for whom water services are affordable via higher water rates to recover the costs of services that go unpaid by lower income households. PMID:28076374

A Burgeoning Crisis? A Nationwide Assessment of the Geography of Water Affordability in the United States.

PubMed

Mack, Elizabeth A; Wrase, Sarah

2017-01-01

While basic access to clean water is critical, another important issue is the affordability of water access for people around the globe. Prior international work has highlighted that a large proportion of consumers could not afford water if priced at full cost recovery levels. Given growing concern about affordability issues due to rising water rates, and a comparative lack of work on affordability in the developed world, as compared to the developing world, more work is needed in developed countries to understand the extent of this issue in terms of the number of households and persons impacted. To address this need, this paper assesses potential affordability issues for households in the United States using the U.S. EPA's 4.5% affordability criteria for combined water and wastewater services. Analytical results from this paper highlight high-risk and at-risk households for water poverty or unaffordable water services. Many of these households are clustered in pockets of water poverty within counties, which is a concern for individual utility providers servicing a large proportion of customers with a financial inability to pay for water services. Results also highlight that while water rates remain comparatively affordable for many U.S. households, this trend will not continue in the future. If water rates rise at projected amounts over the next five years, conservative projections estimate that the percentage of U.S. households who will find water bills unaffordable could triple from 11.9% to 35.6%. This is a concern due to the cascading economic impacts associated with widespread affordability issues; these issues mean that utility providers could have fewer customers over which to spread the large fixed costs of water service. Unaffordable water bills also impact customers for whom water services are affordable via higher water rates to recover the costs of services that go unpaid by lower income households.

5 CFR 550.183 - Substantial hours requirement.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Substantial hours requirement. 550.183 Section 550.183 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Premium Pay Law Enforcement Availability Pay § 550.183 Substantial hours requirement. (a...

5 CFR 550.183 - Substantial hours requirement.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Substantial hours requirement. 550.183 Section 550.183 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Premium Pay Law Enforcement Availability Pay § 550.183 Substantial hours requirement. (a...

5 CFR 550.183 - Substantial hours requirement.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Substantial hours requirement. 550.183 Section 550.183 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Premium Pay Law Enforcement Availability Pay § 550.183 Substantial hours requirement. (a...

5 CFR 550.183 - Substantial hours requirement.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Substantial hours requirement. 550.183 Section 550.183 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Premium Pay Law Enforcement Availability Pay § 550.183 Substantial hours requirement. (a...

Relay protection features of frequency-adjustable electric drive

NASA Astrophysics Data System (ADS)

Kuprienko, V. V.

2018-03-01

The features of relay protection of high-voltage electric motors in composition of the frequency-adjustable electric drive are considered in the article. The influence of frequency converters on the stability of the operation of various types of relay protection used on electric motors is noted. Variants of circuits for connecting relay protection devices are suggested. The need to develop special relay protection devices for a frequency-adjustable electric drive is substantiated.

Affordable Housing and the Empty Nester Boom.

ERIC Educational Resources Information Center

Hare, Patrick H.

One of the best ways to produce affordable housing is to address the needs of a group that has too much housing. A baby boom generation generates an empty nester boom. An empty nester boom means dramatic underutilization of the housing stock. If a small percentage of homeowners were to install an accessory apartment, they would have a significant…

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…

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…

12 CFR 1282.19 - Affordability-Rent level definitions-tenant income is not known.

Code of Federal Regulations, 2010 CFR

2010-01-01

... very low-, low-, or moderate-income families where the income of the family in the dwelling unit is not known to the Enterprise, the affordability of the unit is determined based on unit size as follows: (a) For moderate-income, maximum affordable rents to count as housing for moderate-income families shall...

3 CFR 8782 - Proclamation 8782 of March 5, 2012. National Consumer Protection Week, 2012

Code of Federal Regulations, 2013 CFR

2013-01-01

..., mortgages, and student loans, to build the foundation for a better tomorrow. These tools help bring our aspirations within reach and empower countless individuals to earn an education, afford a home, or raise a... highlighting the ways individuals and families can protect themselves from scams, fraud, and abuse. Robust...

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 order...

Tempting foods and the affordability axiom: Food cues change beliefs about the costs of healthy eating.

PubMed

Hill, Sarah E; Baskett, Kaily; Bradshaw, Hannah K; Prokosch, Marjorie L; DelPriore, Danielle J; Rodeheffer, Christopher D

2016-12-01

Many consumers report that healthy eating is more expensive than unhealthy eating (the affordability axiom). We hypothesize that endorsement of this belief may be driven by the motivation to eat unhealthy foods. We tested this hypothesis in three studies. Study 1 revealed that the affordability axiom is associated with poorer eating habits and higher Body Mass Index (BMI). Study 2 found that the presence of a tasty food cue in the environment increased endorsement of affordability axiom. Study 3 found that these effects were moderated by one's food intake goals. Food cues led non-dieters to increase endorsement of the affordability axiom, but had the opposite effect among those seeking to restrict their calorie intake. The affordability axiom might persist as a means of validating unhealthy food choices. Copyright © 2016 Elsevier Ltd. All rights reserved.

Passive fire protection--a vital safety role.

PubMed

MacInnes, Callum; Rankin, Richard

2012-06-01

Callum Maclnnes BSc (Hons), AIFireE, an engineer at WSP UK--part of a global design engineering and management consultancy group specialising in property, transport and infrastructure, industry and environment projects--and his colleague, senior engineer, Richard Rankin CEng MEng (Hons) MIFireE, discuss the importance of passive fire protection in healthcare premises at a time when, due particularly to the difficult financial climate, many hospitals are undergoing upgrading and refurbishment, potentially affording an ideal opportunity to ensure that proper fire compartmentation measures are in place.

Temporary coatings for protection of microelectronic devices during packaging

DOEpatents

Peterson, Kenneth A.; Conley, William R.

2005-01-18

The present invention relates to a method of protecting a microelectronic device during device packaging, including the steps of applying a water-insoluble, temporary protective coating to a sensitive area on the device; performing at least one packaging step; and then substantially removing the protective coating, preferably by dry plasma etching. The sensitive area can include a released MEMS element. The microelectronic device can be disposed on a wafer. The protective coating can be a vacuum vapor-deposited parylene polymer, silicon nitride, metal (e.g. aluminum or tungsten), a vapor deposited organic material, cynoacrylate, a carbon film, a self-assembled monolayered material, perfluoropolyether, hexamethyldisilazane, or perfluorodecanoic carboxylic acid, silicon dioxide, silicate glass, or combinations thereof. The present invention also relates to a method of packaging a microelectronic device, including: providing a microelectronic device having a sensitive area; applying a water-insoluble, protective coating to the sensitive area; providing a package; attaching the device to the package; electrically interconnecting the device to the package; and substantially removing the protective coating from the sensitive area.

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 Preservation...

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 Preservation...

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 Preservation...

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 Preservation...

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 Preservation...

Children, Families, and Disparities: Pediatric Provisions in the Affordable Care Act.

PubMed

Grace, Aimee M; Horn, Ivor; Hall, Robert; Cheng, Tina L

2015-10-01

The Affordable Care Act has caused and continues to cause sweeping changes throughout the health system in the United States. Poorly explained, complex, controversial, confusing, and subject to continuous legal and regulatory definition, the law stands as a hallmark piece of legislation that will change the health sector in America forever. This article summarizes the Affordable Care Act with a focus on children, families, and disparities. Also provided is the context of the current system of health care coverage in the United States. Published by Elsevier Inc.

Educational Affordances of PDAs: A Study of a Teacher's Exploration of This Technology

ERIC Educational Resources Information Center

Churchill, Daniel; Churchill, Natalia

2008-01-01

This paper reports on a case study of a teacher from a technical education institution who explored the educational affordances of PDA technology over a period of six months. Based on this teacher's perspectives, the study was designed to inform our own understanding of educational affordances of this new and emerging technology. Understanding of…

Motorcycle helmets in Vietnam: ownership, quality, purchase price, and affordability.

PubMed

Hung, Dang Viet; Stevenson, Mark R; Ivers, Rebecca Q

2008-06-01

This study investigated motorcycle helmet ownership, quality, purchase price, and affordability in Vietnam. A random sample of motorcyclists was interviewed to investigate aspects of helmet ownership, the purchase price, and affordability of a motorcycle helmet. Multivariate modeling conducted to determine factors associated with the purchase price and affordability of motorcycle helmets. Helmet quality was assessed based on current legal requirements in Vietnam. The prevalence of helmet use in Vietnam remains low (23.3%) despite a high level of helmet ownership (94%), indicating that this is an important area for public health intervention. Overall the quality of helmets appeared to be good; however, few helmets displayed legally required information. Motorcyclists with a high income purchase more helmets for their household rather than more expensive helmets. To ensure that helmets are accessible to the community, policy-makers need to consider pricing motorcycle helmets at a price indicated by the results of this study. Prior to universal motorcycle helmet legislation, the government will also need to ensure that standard helmets are available and that enforcement is at a level to ensure that motorcycle helmets are actually used.

Extending Marketplace Tax Credits Would Make Coverage More Affordable for Middle-Income Adults.

PubMed

Liu, Jodi; Eiber, Christine

2017-07-01

ISSUE: Affordability of health coverage is a growing challenge for Americans facing rising premiums, deductibles, and copayments. The Affordable Care Act's tax credits make marketplace insurance more affordable for eligible lower-income individuals. However, individuals lose tax credits when their income exceeds 400 percent of the federal poverty level, creating a steep cliff. GOALS: To analyze the effects of extending eligibility for tax credits to individuals with incomes above 400 percent of the federal poverty level. METHODS: We used RAND's COMPARE microsimulation model to examine changes in insurance coverage and health care spending. KEY FINDINGS AND CONCLUSIONS: Extending tax-credit eligibility increases insurance enrollment by 1.2 million, at a total federal cost of $6.0 billion. Those who would benefit from the tax-credit extension are mostly middle-income adults ages 50 to 64. These new enrollees would be healthier than current enrollees their age, which would improve the risk pool and lower premiums. Eliminating the cliff at 400 percent of the federal poverty level is one policy option that may be considered to increase affordability of insurance.

Does Question Wording Predict Support for the Affordable Care Act? An Analysis of Polling During the Implementation Period, 2010-2016.

PubMed

Holl, Kristen; Niederdeppe, Jeff; Schuldt, Jonathon P

2018-07-01

The Patient Protection and Affordable Care Act (ACA) continues to be the subject of fierce political debate in the United States. Drawing on issue framing theory, together with research on wording effects in survey responding, we tested how common differences in the wording of ACA surveys relate to apparent public support for the law. We report on a content analysis of N = 376 U.S. national opinion surveys fielded during a more than six-year period, beginning 23 March 2010 (when President Obama signed the bill into law) and ending 8 November 2016 (Election Day), and use ordinary least squares (OLS) regression models to predict public support for the law as a function of variation in question wording. We coded questions gauging general sentiment toward the law for differences in issue labeling (e.g., Obamacare, Affordable Care Act), whether or not they referenced particular political entities (e.g., President Obama, Congress) or segments of the public (e.g., You, Your Family), various opinion metrics (e.g., Support, Favor), and different response options (e.g., Repeal, Expand) which we used to model aggregate levels of support. The results revealed several key differences in question wording-for example, generic references to the Healthcare Law were employed much more frequently than Obamacare or Affordable Care Act-a number of which reliably predicted aggregate levels of public support. The discussion considers possible explanations for these patterns and reiterates the value of attending to questionnaire design features when interpreting survey data about politically contentious health policy issues.

The Impact of Family Engagement and Child Welfare Services on Maltreatment Re-reports and Substantiated Re-reports.

PubMed

Fuller, Tamara; Zhang, Saijun

2017-08-01

Despite decades of debate about the most effective ways to intervene with families reported to child protective services (CPS), little evidence exists regarding the types of services or approach that reduce children's risk of additional maltreatment. The current study used data collected during a statewide experimental evaluation of CPS to examine the impact of numerous service variables, family engagement, and family characteristics on the risk of maltreatment re-reports and substantiated re-reports among families initially reported for neglect and risk of harm. The sample included 4,868 families with screened-in reports that were randomly assigned to receive either an investigation or an assessment. The results of the Cox regression analyses found that service duration, intensity, and breadth were unrelated to maltreatment re-report or substantiated re-reports, but caseworker ratings of the service-need match were associated with both. The provision of domestic violence services was related to decreased risk of maltreatment re-reports. Increased levels of family engagement were associated with lowered risk of both maltreatment re-reports and substantiated re-reports. Once the effects of services, engagement, and family characteristics were taken into account, CPS response pathway (investigation or assessment) had no relationship to maltreatment re-reports or substantiated re-reports.

Medicaid/CHIP Program; Medicaid Program and Children's Health Insurance Program (CHIP); Changes to the Medicaid Eligibility Quality Control and Payment Error Rate Measurement Programs in Response to the Affordable Care Act. Final rule.

PubMed

2017-07-05

This final rule updates the Medicaid Eligibility Quality Control (MEQC) and Payment Error Rate Measurement (PERM) programs based on the changes to Medicaid and the Children's Health Insurance Program (CHIP) eligibility under the Patient Protection and Affordable Care Act. This rule also implements various other improvements to the PERM program.

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.

Aerogel-Based Multilayer Insulation with Micrometeoroid Protection

NASA Technical Reports Server (NTRS)

Begag, Redouane; White, Shannon

2013-01-01

Ultra-low-density, highly hydrophobic, fiber-reinforced aerogel material integrated with MLI (aluminized Mylar reflectors and B4A Dacron separators) offers a highly effective insulation package by providing unsurpassed thermal performance and significant robustness, delivering substantial MMOD protection via the addition of a novel, durable, external aerogel layer. The hydrophobic nature of the aerogel is an important property for maintaining thermal performance if the material is exposed to the environment (i.e. rain, snow, etc.) during ground installations. The hybrid aerogel/MLI/MMOD solution affords an attractive alternative because it will perform thermally in the same range as MLI at all vacuum levels (including high vacuum), and offers significant protection from micrometeoroid damage. During this effort, the required low-density and resilient aerogel materials have been developed that are needed to optimize the thermal performance for space (high vacuum) cryotank applications. The proposed insulation/MMOD package is composed of two sections: a stack of interleaved aerogel layers and MLI intended for cryotank thermal insulation, and a 1.5- to 1-in. (.2.5- to 3.8- cm) thick aerogel layer (on top of the insulation portion) for MMOD protection. Learning that low-density aerogel cannot withstand the hypervelocity impact test conditions, the innovators decided during the course of the program to fabricate a high-density and strong material based on a cross-linked aerogel (X-aerogel; developed elsewhere by the innovators) for MMOD protection. This system has shown a very high compressive strength that is capable of withstanding high-impact tests if a proper configuration of the MMOD aerogel layer is used. It was learned that by stacking two X-aerogel layers [1.5-in. (.3.8-cm) thick] separated by an air gap, the system would be able to hold the threat at a speed of 5 km/s and gpass h the test. The first aerogel panel stopped the projectile from damaging the second

Places to Intervene to Make Complex Food Systems More Healthy, Green, Fair, and Affordable

PubMed Central

Malhi, Luvdeep; Karanfil, Özge; Merth, Tommy; Acheson, Molly; Palmer, Amanda; Finegood, Diane T.

2009-01-01

A Food Systems and Public Health conference was convened in April 2009 to consider research supporting food systems that are healthy, green, fair, and affordable. We used a complex systems framework to examine the contents of background material provided to conference participants. Application of our intervention-level framework (paradigm, goals, system structure, feedback and delays, structural elements) enabled comparison of the conference themes of healthy, green, fair, and affordable. At the level of system structure suggested actions to achieve these goals are fairly compatible, including broad public discussion and implementation of policies and programs that support sustainable food production and distribution. At the level of paradigm and goals, the challenge of making healthy and green food affordable becomes apparent as some actions may be in conflict. Systems thinking can provide insight into the challenges and opportunities to act to make the food supply more healthy, green, fair, and affordable. PMID:23173029

A study of social information control affordances and gender difference in Facebook self-presentation.

PubMed

Kuo, Feng-Yang; Tseng, Chih-Yi; Tseng, Fan-Chuan; Lin, Cathy S

2013-09-01

Affordances refer to how interface features of an IT artifact, perceived by its users in terms of their potentials for action, may predict the intensity of usage. This study investigates three social information affordances for expressive information control, privacy information control, and image information control in Facebook. The results show that the three affordances can significantly explain how Facebook's interface designs facilitate users' self-presentation activities. In addition, the findings reveal that males are more engaged in expressing information than females, while females are more involved in privacy control than males. A practical application of our study is to compare and contrast the level of affordances offered by various social network sites (SNS) like Facebook and Twitter, as well as differences in online self-presentations across cultures. Our approach can therefore be useful to investigate how SNS design features can be tailored to specific gender and culture needs.

Reliability and Maintainability Engineering - A Major Driver for Safety and Affordability

NASA Technical Reports Server (NTRS)

Safie, Fayssal M.

2011-01-01

The United States National Aeronautics and Space Administration (NASA) is in the midst of an effort to design and build a safe and affordable heavy lift vehicle to go to the moon and beyond. To achieve that, NASA is seeking more innovative and efficient approaches to reduce cost while maintaining an acceptable level of safety and mission success. One area that has the potential to contribute significantly to achieving NASA safety and affordability goals is Reliability and Maintainability (R&M) engineering. Inadequate reliability or failure of critical safety items may directly jeopardize the safety of the user(s) and result in a loss of life. Inadequate reliability of equipment may directly jeopardize mission success. Systems designed to be more reliable (fewer failures) and maintainable (fewer resources needed) can lower the total life cycle cost. The Department of Defense (DOD) and industry experience has shown that optimized and adequate levels of R&M are critical for achieving a high level of safety and mission success, and low sustainment cost. Also, lessons learned from the Space Shuttle program clearly demonstrated the importance of R&M engineering in designing and operating safe and affordable launch systems. The Challenger and Columbia accidents are examples of the severe impact of design unreliability and process induced failures on system safety and mission success. These accidents demonstrated the criticality of reliability engineering in understanding component failure mechanisms and integrated system failures across the system elements interfaces. Experience from the shuttle program also shows that insufficient Reliability, Maintainability, and Supportability (RMS) engineering analyses upfront in the design phase can significantly increase the sustainment cost and, thereby, the total life cycle cost. Emphasis on RMS during the design phase is critical for identifying the design features and characteristics needed for time efficient processing

Corrosion Protection by Calcite-Type Coatings

DTIC Science & Technology

1989-10-01

CORROSION PROTECTION BY CALCITE -TYPE COATINGS OCTOBER, 1989 Prepared by: OCEAN CITY RESEARCH CORPORATION Tennessee Avenue & Beach Thorofare Ocean...REPORT DATE OCT 1989 2. REPORT TYPE N/A 3. DATES COVERED - 4. TITLE AND SUBTITLE Corrosion Protection by Calcite -Type Coatings 5a. CONTRACT... calcite -type coatings to segregated seawater ballast tanks. If perfected, a calcite coating approach could substantially reduce the cost of corrosion

Osteopathic medical students' understanding of the Patient Protection and Affordable Care Act: a first step toward a policy-informed curriculum.

PubMed

Beverly, Elizabeth Ann; Skinner, Daniel; Bianco, Joseph A; Ice, Gillian H

2015-03-01

Current osteopathic medical students will play an important role in implementing, modifying, and advocating for or against the Patient Protection and Affordable Care Act (ACA) of 2010. Accordingly, medical educators will need to address curricular gaps specific to the ACA and medical practice. Research that gauges osteopathic medical students' level of understanding of the ACA is needed to inform an evidence-based curriculum. To assess first- and second-year osteopathic medical students' beliefs about the ACA. In this descriptive cross-sectional survey-based study, first- and second-year students were recruited because their responses would be indicative of what, if any, information about the ACA was being covered in the preclinical curriculum. A 30-item survey was distributed in November 2013, after the health insurance exchanges launched on October 1, 2013. A total of 239 first- and second-year osteopathic medical students completed the survey. One hundred ten students (46%) disagreed and 103 (43.1%) agreed that the ACA would provide health insurance coverage for all US citizens. The ACA was predicted to lead to lower wages and fewer jobs (73 students [30.5%]), as well as small business bankruptcy because of employees' health insurance costs (96 [40.2%]). Regarding Medicare recipients, 113 students (47.3%) did not know whether these individuals would be required to buy insurance through the health insurance exchanges. The majority of students knew that the ACA would require US citizens to pay a penalty if they did not have health insurance (198 [82.8%]) and understood that not everyone would be required to purchase health insurance through health insurance exchanges (137 [57.3%]). Although students took note of certain clinical benefits for patients offered by the ACA, they remained concerned about the ACA's impact on their professional prospects, particularly in the area of primary care. These findings build on the existing literature that emphasize the need for

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.

Parenting and the workplace: the construction of parenting protections in United States law.

PubMed

Eichner, Maxine

2008-08-04

In this paper, I discuss the shortcomings of the legal protections that exist for pregnancy, breastfeeding, and parenting for United States' workers. The two main sources of protection for pregnancy and parenting in United States employment law are the Pregnancy Discrimination Act (PDA) and the Family and Medical Leave Act (FMLA). Both, I argue, contain inadequate protections for the needs of pregnant women and breastfeeding mothers, as well as their infants. I consider what it is about the way these statutes conceptualize the needs of pregnant women, mothers, and their babies, that prevents more robust protection of their needs. I then compare the minimal protection afforded American women and families with more progressive policies in other countries to highlight the possibilities that arise when the state affirmatively supports working parents and their children.

Potential Adult Medicaid Beneficiaries Under the Patient Protection and Affordable Care Act Compared With Current Adult Medicaid Beneficiaries

PubMed Central

Chang, Tammy; Davis, Matthew

2013-01-01

PURPOSE Under health care reform, states will have the opportunity to expand Medicaid to millions of uninsured US adults. Information regarding this population is vital to physicians as they prepare for more patients with coverage. Our objective was to describe demographic and health characteristics of potentially eligible Medicaid beneficiaries. METHODS We performed a cross-sectional study using data from the National Health and Nutrition Examination Survey (2007–2010) to identify and compare adult US citizens potentially eligible for Medicaid under provisions of the Patient Protection and Affordable Care Act (ACA) with current adult Medicaid beneficiaries. We compared demographic characteristics (age, sex, race/ethnicity, education) and health measures (self-reported health status; measured body mass index, hemoglobin A1c level, systolic and diastolic blood pressure, depression screen [9-item Patient Health Questionnaire], tobacco smoking, and alcohol use). RESULTS Analyses were based on an estimated 13.8 million current adult non-elderly Medicaid beneficiaries and 13.6 million nonelderly adults potentially eligible for Medicaid. Potentially eligible individuals are expected to be more likely male (49.2% potentially eligible vs 33.3% current beneficiaries; P <.001), to be more likely white and less likely black (58.8% white, 20.0% black vs 49.9% white, 25.2% black; P = .02), and to be statistically indistinguishable in terms of educational attainment. Overall, potentially eligible adults are expected to have better health status (34.8% “excellent” or “very good,” 40.4% “good”) than current beneficiaries (33.5% “excellent” or “very good,” 31.6% “good”; P <.001). The proportions obese (34.5% vs 42.9%; P = .008) and with depression (15.5% vs 22.3%; P = .003) among potentially eligible individuals are significantly lower than those for current beneficiaries, while there are no significant differences in the expected prevalence of diabetes or

Potential adult Medicaid beneficiaries under the Patient Protection and Affordable Care Act compared with current adult Medicaid beneficiaries.

PubMed

Chang, Tammy; Davis, Matthew

2013-01-01

Under health care reform, states will have the opportunity to expand Medicaid to millions of uninsured US adults. Information regarding this population is vital to physicians as they prepare for more patients with coverage. Our objective was to describe demographic and health characteristics of potentially eligible Medicaid beneficiaries. We performed a cross-sectional study using data from the National Health and Nutrition Examination Survey (2007-2010) to identify and compare adult US citizens potentially eligible for Medicaid under provisions of the Patient Protection and Affordable Care Act (ACA) with current adult Medicaid beneficiaries. We compared demographic characteristics (age, sex, race/ethnicity, education) and health measures (self-reported health status; measured body mass index, hemoglobin A1c level, systolic and diastolic blood pressure, depression screen [9-item Patient Health Questionnaire], tobacco smoking, and alcohol use). Analyses were based on an estimated 13.8 million current adult non-elderly Medicaid beneficiaries and 13.6 million nonelderly adults potentially eligible for Medicaid. Potentially eligible individuals are expected to be more likely male (49.2% potentially eligible vs 33.3% current beneficiaries; P <.001), to be more likely white and less likely black (58.8% white, 20.0% black vs 49.9% white, 25.2% black; P = .02), and to be statistically indistinguishable in terms of educational attainment. Overall, potentially eligible adults are expected to have better health status (34.8% "excellent" or "very good," 40.4% "good") than current beneficiaries (33.5% "excellent" or "very good," 31.6% "good"; P <.001). The proportions obese (34.5% vs 42.9%; P = .008) and with depression (15.5% vs 22.3%; P = .003) among potentially eligible individuals are significantly lower than those for current beneficiaries, while there are no significant differences in the expected prevalence of diabetes or hypertension. Current tobacco smoking (49.2% vs

The Consequences for Women of the Availability and Affordability of Child Care

DTIC Science & Technology

1988-07-01

00 THE CONSEQUENCES FOR WOMEN OF THE AVAILABILITY AND AFFORDABILITY OF CHILD CARE Arleen Leibowitz Linda J. Waite July 1988 DTI -%ELECTEE NOV07 IM P...Research Council’s Committee on Child Care. It focuses on the effects for women of the availability and affordability of child care, concentrating...especially on effects on women’s employment and earnings. The paper discusses the implications of raising the wages of child care workers, of the

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. Copyright © 2014 Elsevier Ltd. All rights reserved.

Tobacco tax as a health protecting policy: a brief review of the New Zealand evidence.

PubMed

Wilson, Nick; Thomson, George

2005-04-15

To review the evidence relating to tobacco taxation as a health and equity protecting policy for New Zealand. Searches of Medline, EconLit, ECONbase, Index NZ, and library databases for literature on tobacco taxation. The New Zealand evidence indicates that increases in tobacco prices are associated with decreases in tobacco consumption in the general population over the long term. This finding comes from multiple studies relating to: tobacco supplies released from bond, supermarket tobacco sales, household tobacco expenditure data, trends in smoking prevalence data, and from data on calls to the Quitline service. For the 1988-1998 period, the overall price elasticity of demand for all smoking households was estimated to be such that a 10% price increase would lower demand by 5% to 8%. Two studies are suggestive that increased tobacco affordability is also a risk factor for higher youth smoking rates. There is evidence from two studies that tobacco price increases reduce tobacco consumption in some low-income groups and one other study indicates that tobacco taxation is likely to be providing overall health benefit to low-income New Zealanders. These findings are broadly consistent with the very large body of scientific evidence from other developed countries. There is good evidence that tobacco taxation is associated with reduced tobacco consumption in the New Zealand setting, and some limited evidence for equity benefits from taxation increases. Substantial scope exists for improving tobacco taxation policy in New Zealand to better protect public health and to improve equity.

76 FR 11283 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Affordable...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-01

... for OMB Review; Comment Request; Affordable Care Act Internal Claims and Appeals and External Review...) titled, ``Affordable Care Act Internal Claims and Appeals and External Review Procedures for Non... rules relating to internal claims and appeals and external review processes. On July 23, 2010, the EBSA...

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…

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…