Functional and Structural Impact of Target Uridine Substitutions on the H/ACA Ribonucleoprotein Particle Pseudouridine Synthase

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

Zhou, Jing; Liang, Bo; Li, Hong

2010-09-17

Box H/ACA ribonucleoprotein protein particles catalyze the majority of pseudouridylation in functional RNA. Different from stand alone pseudouridine synthases, the RNP pseudouridine synthase comprises multiple protein subunits and an RNA subunit. Previous studies showed that each subunit, regardless its location, is sensitive to the step of subunit placement at the catalytic center and potentially to the reaction status of the substrate. Here we describe the impact of chemical substitutions of target uridine on enzyme activity and structure. We found that 3-methyluridine in place of uridine inhibited its isomerization while 2{prime}-deoxyuridine or 4-thiouridine did not. Significantly, crystal structures of an archaealmore » box H/ACA RNP bound with the nonreactive and the two postreactive substrate analogues showed only subtle structural changes throughout the assembly except for a conserved tyrosine and a substrate anchoring loop of Cbf5. Our results suggest a potential role of these elements and the subunit that contacts them in substrate binding and product release.« less

Structure of H/ACA RNP protein Nhp2p reveals cis/trans isomerization of a conserved proline at the RNA and Nop10 binding interface

PubMed Central

Koo, Bon-Kyung; Park, Chin-Ju; Fernandez, Cesar F.; Chim, Nicholas; Ding, Yi; Chanfreau, Guillaume; Feigon, Juli

2011-01-01

H/ACA small nucleolar and Cajal body ribonucleoproteins (RNPs) function in site-specific pseudouridylation of eukaryotic rRNA and snRNA, rRNA processing, and vertebrate telomerase biogenesis. Nhp2, one of four essential protein components of eukaryotic H/ACA RNPs, forms a core trimer with the pseudouridylase Cbf5 and Nop10 that specifically binds to H/ACA RNAs. Crystal structures of archaeal H/ACA RNPs have revealed how the protein components interact with each other and with the H/ACA RNA. However, in place of Nhp2p, archaeal H/ACA RNPs contain L7Ae, which binds specifically to an RNA K-loop motif absent in eukaryotic H/ACA RNPs, while Nhp2 binds a broader range of RNA structures. We report solution NMR studies of S. cerevisiae Nhp2 (Nhp2p), which reveal that Nhp2p exhibits two major conformations in solution due to cis/trans isomerization of the evolutionarily conserved Pro83. The equivalent proline is in the cis conformation in all reported structures of L7Ae and other homologous proteins. Nhp2p has the expected α-β-α fold, but the solution structures of the major conformation of Nhp2p with trans Pro83 and of Nhp2p-S82W with cis Pro83 reveal that Pro83 cis/trans isomerization affects the positions of numerous residues at the Nop10- and RNA-binding interface. An S82W substitution, which stabilizes the cis conformation, also stabilizes the association of Nhp2p with H/ACA snoRNPs in vivo. We propose that Pro83 plays a key role in the assembly of the eukaryotic H/ACA RNP, with the cis conformation locking in a stable Cbf5-Nop10-Nhp2 ternary complex and positioning the protein backbone to interact with the H/ACA RNA. PMID:21708174

Stroke Location and Brain Function in an Embolic Rabbit Stroke Model

PubMed Central

Brown, Aliza T.; Skinner, Robert D.; Flores, Rene; Hennings, Leah; Borrelli, Michael J.; Lowery, John; Culp, William C.

2010-01-01

Purpose Current rabbit stroke models often depend on symptoms as endpoints for embolization and produce wide variation in location, size, and severity of strokes. To further refine our angiographic embolic stroke model we correlated localized infarctions to neurological deficits. Our goal is a rabbit model for long term studies of therapies after stroke. Materials and Methods New Zealand White rabbits (4–5 kg) (n=71) had selective internal carotid artery (ICA) angiography and a single clot was injected. At 24 hours neurological assessment scores (NAS) were measured on a 0=normal to 10=dead scale. Brains were removed and stained to identify stroke areas. All animals with single strokes, N=31, were analyzed by specific brain structure involvement and NAS values were correlated. Results Stroke incidence differed by location with cortex, subcortical, and basal ganglia regions highest. Distributions of middle cerebral artery (MCA) at 52% and anterior cerebral artery (ACA) at 29% were most commonly involved with largest stroke volumes in the ACA distribution. Brain stem and cerebellum strokes had disproportionately severe neurological deficits, scoring 2.25±1.0 vs. cortex (0.5±0.2), subcortical (1.3±0.4) and basal ganglia (0.5±0.3) all in the frontal or parietal regions on NAS (P≤0.02). Conclusions MCA and ACA distributions included 81% of strokes. These sites were relatively silent (potentially allowing longer term survival studies) while others in the posterior circulation produced disproportionately severe symptoms. Symptoms were not reliable indicators of stroke occurrence and other endpoints such as imaging may be required. These are important steps towards refinement of the rabbit stroke model. PMID:20417119

Changes in stimulus and response AC/A ratio with vision therapy in Convergence Insufficiency.

PubMed

Singh, Neeraj Kumar; Mani, Revathy; Hussaindeen, Jameel Rizwana

To evaluate the changes in the stimulus and response Accommodative Convergence to Accommodation (AC/A) ratio following vision therapy (VT) in Convergence Insufficiency (CI). Stimulus and response AC/A ratio were measured on twenty five CI participants, pre and post 10 sessions of VT. Stimulus AC/A ratio was measured using the gradient method and response AC/A ratio was calculated using modified Thorington technique with accommodative responses measured using WAM-5500 open-field autorefractor. The gradient stimulus and response AC/A cross-link ratios were compared with thirty age matched controls. Mean age of the CI and control participants were 23.3±5.2 years and 22.7±4.2 years, respectively. The mean stimulus and response AC/A ratio for CI pre therapy was 2.2±0.72 and 6.3±2.0 PD/D that changed to 4.2±0.9 and 8.28±3.31 PD/D respectively post vision therapy and these changes were statistically significant (paired t-test; p<0.001). The mean stimulus and response AC/A ratio for controls was 3.1±0.81 and 8.95±2.5 PD/D respectively. Stimulus and response AC/A ratio increased following VT, accompanied by clinically significant changes in vergence and accommodation parameters in subjects with convergence insufficiency. This represents the plasticity of the AC/A crosslink ratios that could be achieved with vision therapy in CI. Copyright © 2016 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.

Seasonally Transported Aerosol Layers Over Southeast Atlantic are Closer to Underlying Clouds than Previously Reported

NASA Technical Reports Server (NTRS)

Rajapakshe, Chamara; Zhang, Zhibo; Yorks, John E.; Yu, Hongbin; Tan, Qian; Meyer, Kerry; Platnick, Steven; Winker, David M.

2017-01-01

From June to October, low-level clouds in the southeast (SE) Atlantic often underlie seasonal aerosol layers transported from African continent. Previously, the Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observation (CALIPSO) 532 nm lidar observations have been used to estimate the relative vertical location of the above-cloud aerosols (ACA) to the underlying clouds. Here we show new observations from NASA's Cloud-Aerosol Transport System (CATS) lidar. Two seasons of CATS 1064 nm observations reveal that the bottom of the ACA layer is much lower than previously estimated based on CALIPSO 532 nm observations. For about 60% of CATS nighttime ACA scenes, the aerosol layer base is within 360 m distance to the top of the underlying cloud. Our results are important for future studies of the microphysical indirect and semidirect effects of ACA in the SE Atlantic region.

Flow Diverter Stents for the Treatment of Anterior Cerebral Artery Aneurysms: Safety and Effectiveness.

PubMed

Clarençon, F; Di Maria, F; Gabrieli, J; Shotar, E; Zeghal, C; Nouet, A; Chiras, J; Sourour, N-A

2017-03-01

Flow diverter stents (FDSs) are increasingly used for the treatment of intracranial aneurysms. Initially developed for the management of giant and large aneurysms, their indications have progressively expanded. The purpose of our study was to evaluate the safety and effectiveness of FDSs for the treatment of anterior cerebral artery (ACA) aneurysms. Among the 94 consecutive patients treated for 100 intracranial aneurysms by means of FDSs in our institution from October 2010 to January 2015, eight aneurysms (8 %) in seven patients were located on the ACA. Three aneurysms were located on the A1 segment, three aneurysms on the anterior communicating artery (ACom) and two on the A2-A3 junction. In three cases, FDS was used for angiographic recurrence after coiling. Five patients were treated with a Pipeline embolization device, one with a NeuroEndograft and the last one with a Silk FDS. Treatment was feasible in all cases. No technical difficulty was reported. No acute or delayed clinical complication was recorded. Modified Rankin Scale was 0 for six patients and one for one patient. Mean angiographic follow-up was 9.7 ± 3.9 months (range 6-15). Total exclusion was observed in five aneurysms (71.4 %) and neck remnant in two (28.6 %) cases. One patient refused the control DSA. Our series shows the safety and effectiveness of FDSs for the treatment of ACA aneurysms.

Microneurosurgical management of aneurysms at A4 and A5 segments and distal cortical branches of anterior cerebral artery.

PubMed

Lehecka, Martin; Dashti, Reza; Hernesniemi, Juha; Niemelä, Mika; Koivisto, Timo; Ronkainen, Antti; Rinne, Jaakko; Jääskeläinen, Juha

2008-10-01

Aneurysms originating distal to the A3 segment of the ACA, located on the A4 and the A5 segments or the distal cortical branches of the ACA (AdistAs) are rare, forming about 0.5% of all IAs. There are only few reports on management of AdistAs. In this article, we review the practical anatomy, preoperative planning, and avoidance of complications in the microsurgical dissection and clipping of AdistAs. This review, and the whole series on IAs, is mainly based on the personal microneurosurgical experience of the senior author (J. H.) in 2 Finnish centers (Helsinki and Kuopio), which serve without patient selection the catchment area in Southern and Eastern Finland. These 2 centers have treated more than 10000 patients with IAs since 1951. In the Kuopio Cerebral Aneurysm Database of 3005 patients and 4253 IAs, there were 26 patients carrying 26 AdistAs, forming 0.9% of all patients with IAs, 0.6% of all IAs, and 2% of all ACA aneurysms. A total of 10 (38%) patients presented with ruptured AdistAs, with ICH in 4 (40%) and IVH in 2 (20%); 16 patients (62%) had multiple aneurysms. AdistAs are small, even when ruptured, with relatively wide base, and they are frequently associated with ICHs. Our data suggest that AdistAs rupture at smaller size than IAs in general. The challenge is to locate the aneurysm inside the interhemispheric fissure and to clip the neck adequately without obstructing branching arteries at the base. Unruptured AdistAs also need microneurosurgical clipping even when they are small.

Anatomical Assessment of the Temporopolar Artery for Revascularization of Deep Recipients.

PubMed

Tayebi Meybodi, Ali; Benet, Arnau; Griswold, Dylan; Dones, Flavia; Preul, Mark C; Lawton, Michael T

2018-05-30

Intracranial-intracranial and extracranial-intracranial bypass options for revascularization of deep cerebral recipients are limited and technically demanding. To assess the anatomical feasibility of using the temporopolar artery (TPA) for revascularization of the anterior cerebral artery (ACA), posterior cerebral artery (PCA), and superior cerebellar arteries (SCA). Orbitozygomatic craniotomy was performed bilaterally on 8 cadaveric heads. The cisternal segment of the TPA was dissected. The TPA was cut at M3-M4 junction with its proximal and distal calibers and the length of the cisternal segment measured. Feasibility of the TPA-A1-ACA, TPA-A2-ACA, TPA-SCA, and TPA-PCA bypasses were assessed. A total of 17 TPAs were identified in 16 specimens. The average distal TPA caliber was 1.0 ± 0.2 mm, and the average cisternal length was 37.5 ± 9.4 mm. TPA caliber was ≥ 1.0 mm in 12 specimens (70%). The TPA-A1-ACA bypass was feasible in all specimens, whereas the TPA reached the A2-ACA, SCA, and PCA in 94% of specimens (16/17). At the point of anastomosis, the average recipient caliber was 2.5 ± 0.5 mm for A1-ACA, and 2.3 ± 0.7 mm for A2-ACA. The calibers of the SCA and PCA at the anastomosis points were 2.0 ± 0.6 mm, and 2.7 ± 0.8 mm, respectively. The TPA-ACA, TPA-PCA, and TPA-SCA bypasses are anatomically feasible and may be used when the distal caliber of the TPA stump is optimal to provide adequate blood flow. This study lays foundations for clinical use of the TPA for ACA revascularization in well-selected cases.

Effects of intravenous aminocaproic acid on exercise-induced pulmonary haemorrhage (EIPH).

PubMed

Buchholz, B M; Murdock, A; Bayly, W M; Sides, R H

2010-11-01

The antifibrinolytic, 6-aminohexanoic acid, also named aminocaproic acid (ACA), has been used empirically as a treatment for exercise-induced pulmonary haemorrhage (EIPH) on the unsubstantiated basis that transient coagulation dysfunction may contribute to its development. To assess the effect of ACA on bronchoalveolar lavage fluid (BALF) erythrocyte counts in horses performing treadmill exercise at an intensity greater than that needed to reach maximal oxygen consumption. Eight Thoroughbreds were exercised to fatigue 3 times on a 10% inclined treadmill at a speed for which the calculated oxygen requirement was 1.15 times VO2max. Horses were treated with a saline placebo, 2 and 7 g ACA i.v. 4 h before exercise, with a crossover design being used to determine the order of the injections. Exercise-induced pulmonary haemorrhage severity was quantified via the erythrocyte count in BALF. Bronchoalveolar lavage fluid was collected 4 h before and 30-60 min post exercise. Results were expressed as mean ± s.e.m. and analysed by one way repeated measures ANOVA (P < 0.05). Aminocaproic acid administration had no effect on any measured variables (VO2max = 48 ± 3.0 [C]; 148 ± 3.0 [2 g ACA]; 145 ± 3.0 [7 g ACA] ml/kg bwt/min, respectively; run time = 77 ± 3 [C]; 75 ± 2 [2 g ACA]; 79 ± 3 [7 g ACA] seconds, respectively). All horses developed EIPH: 1691 ± 690 vs. 9637 ± 3923 (C); 2149 ± 935 vs. 3378 ± 893 (2 g ACA); 1058 ± 340 vs. 4533 ± 791 (7 g ACA) erythrocytes/µl pre- vs. post exercise recovered in BALF, respectively. Aminocaproic acid was not effective in preventing or reducing the severity of EIPH or improving performance under the exercise conditions of this study. © 2010 EVJ Ltd.

[Analysis of AC/A ratio after myopic excimer laser in situ keratomileusis].

PubMed

Wu, Xiao-ying; Liu, Shuang-zhen

2003-03-01

To study the changes of AC/A ratio of myopia after excimer laser in situ keratomileusis (LASIK). 135 myopia patients were treated by LASIK, their AC/A ratios were measured with synoptohore before surgery and 3 months after surgery. The average AC/A ratios of naked eyes or eyes wearing glasses before surgery and the naked after surgery were (0.724 +/- 0.587) (Delta)/D, (2.754 +/- 1.565) (Delta)/D, (1.618 +/- 1.027) (Delta)/D in turn. There were significant difference among those groups (P < 0.001). That also appeared in different degree of myopia naked before surgery (P < 0.01). We found no significant difference between the groups wearing glasses before surgery and naked after surgery (P > 0.05). A positive correlation was built up between postoperative AC/A ratio and AC/A ratio of wearing glasses or refractive diopter before surgery (r = 0.550, P < 0.001; r = 0.185, P < 0.005). And the postoperative AC/A ratios had a negative correlation to age or length of ocular axis (r = -0.340, P < 0.001; r = -0.192, P < 0.002). The regression equation for postoperative AC/A ratios was figured out as Y((Delta)/D) = 4.080 0 - 0.031 8X(1) - 0.097 1X(2) + 0.325 0X(3) (P < 0.001). X(1) = age (year), X(2) = length of ocular axis (mm), X(3) = preoperative AC/A ratio with weaning glasses ((Delta)/D). The naked AC/A ratios are higher than the preoperative's after LASIK, but lower than the wearing glasses's before surgery. It is influenced by the factors, such as: the preoperative AC/A ratio of wearing glasses, the length of ocular axis and the age.

76 FR 17157 - Notice of an Open Meeting of the Advisory Committee on Apprenticeship (ACA)

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-28

...: Announcement of meeting. SUMMARY: Pursuant to section 10 of the Federal Advisory Committee Act (Pub. L. 92-463... the provisions of the Federal Advisory Committee Act (FACA), as amended 5 U.S.C., App. 2, and it's... location is the U.S. Department of Labor, Frances Perkins Building, 200 Constitution Avenue, NW...

Arabidopsis ACA7, encoding a putative auto-regulated Ca(2+)-ATPase, is required for normal pollen development.

PubMed

Lucca, Noel; León, Gabriel

2012-04-01

Microgametogenesis is a complex process that involves numerous well-coordinated cell activities, ending with the production of pollen grains. Pollen development has been studied at the cytological level in Arabidopsis and other plant species, where its temporal time course has been defined. However, the molecular mechanism underlying this process is still unclear, since a relative small number of genes and/or processes have been identified as essential for pollen development. We have designed a methodology to select candidate genes for functional analysis, based on transcriptomic data obtained from different stages of pollen development. From our analyses, we selected At2g22950 as a candidate gene; this gene encodes a protein belonging to the auto-regulated Ca(2+)-ATPase family, ACA7. Microarray data indicate that ACA7 is expressed exclusively in developing pollen grains, with the highest level of mRNA at the time of the second pollen mitosis. Our RT-PCR experiments showed that ACA7 mRNA is detected exclusively in developing flowers. Confocal microscopy experiments showed a plasma membrane localization for the recombinant GFP:ACA7 protein. We identified two different insertional mutant lines, aca7-1 and aca7-2; plants from both mutant lines displayed a normal vegetative development but showed large amounts of dead pollen grains in mature flowers assayed by Alexander's staining. Histological analysis indicated that abnormalities are detected after the first pollen mitosis and we found a strong correlation between ACA7 mRNA accumulation and the severity of the phenotype. Our results indicate that ACA7 is a plasma membrane protein that has an important role during pollen development, possibly through regulation of Ca(2+) homeostasis. © Springer-Verlag 2011

Metal (Fe, Co, Ni) supported on different aluminas as Fischer-Tropsch catalyst

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

Dahlan; Marsih, I. Nyoman, E-mail: nyoman@chem.itb.ac.id; Ismunandar

2015-09-30

This research aimed to compare the physico-chemical properties of the same metal M (M = iron, cobalt, nickel) supported on aluminas with different morphology and pore size as Fischer-Tropsch catalyst. The aluminas applied as support were alumina synthesized through hydrothermal process, alumina formed by pretreatment of catapal and commercial alumina which named as Ahy, Aca, and Aco respectively. Ahy has uniform morphology of nanotubes while Aca and Aco showed non-uniform morphology of particle lumps. The particle lumps of Aca were larger than those of Aco. Ahy, Aca, and Aco respectively has average pore diameter of 2.75, 2.86 and 2.9 nm. Metalsmore » were deposited on the supports by incipient-wetness impregnation method. The catalysts were characterized by XRD, H{sub 2}-TPR, and H{sub 2} chemisorption. Catalyst acitivity test for Fischer-Tropsch reaction was carried out in a micro reactor at 200 °C and 1 atm, and molar ratio of H{sub 2}/CO = 2:1. The metal oxide particle size increased in the order M/Aco < M/Aca < M/Ahy. The catalysts reducibility also increased according to the order M/Aco < M/Aca < M/Ahy suggesting that the larger metal oxide particles are more reducible. The number of active site was not proportional to the reducibility because during the reduction, larger metal oxide particles were converted into larger metal particles. On the other hand, the number of active sites was inversely proportional to the particle sizes. The number of active site increased in the order M/Ahy < M/Aco < M/Aca. The catalytic activity also increased in the following order M/Ahy < M/Aco < M/Aca. The activity per active site increased according to the order M/Aca < M/Aco < M/Ahy meaning that for M/Ahy, a little increase in active site will lead to a significance increase in catalytic activity. It showed that Ahy has potential for the better support.« less

Human intron-encoded Alu RNAs are processed and packaged into Wdr79-associated nucleoplasmic box H/ACA RNPs

PubMed Central

Jády, Beáta E.; Ketele, Amandine; Kiss, Tamás

2012-01-01

Alu repetitive sequences are the most abundant short interspersed DNA elements in the human genome. Full-length Alu elements are composed of two tandem sequence monomers, the left and right Alu arms, both derived from the 7SL signal recognition particle RNA. Since Alu elements are common in protein-coding genes, they are frequently transcribed into pre-mRNAs. Here, we demonstrate that the right arms of nascent Alu transcripts synthesized within pre-mRNA introns are processed into metabolically stable small RNAs. The intron-encoded Alu RNAs, termed AluACA RNAs, are structurally highly reminiscent of box H/ACA small Cajal body (CB) RNAs (scaRNAs). They are composed of two hairpin units followed by the essential H (AnAnnA) and ACA box motifs. The mature AluACA RNAs associate with the four H/ACA core proteins: dyskerin, Nop10, Nhp2, and Gar1. Moreover, the 3′ hairpin of AluACA RNAs carries two closely spaced CB localization motifs, CAB boxes (UGAG), which bind Wdr79 in a cumulative fashion. In contrast to canonical H/ACA scaRNPs, which concentrate in CBs, the AluACA RNPs accumulate in the nucleoplasm. Identification of 348 human AluACA RNAs demonstrates that intron-encoded AluACA RNAs represent a novel, large subgroup of H/ACA RNAs, which are apparently confined to human or primate cells. PMID:22892240

The Effect of Medicaid Expansion on Utilization in Maryland Emergency Departments.

PubMed

Klein, Eili Y; Levin, Scott; Toerper, Matthew F; Makowsky, Michael D; Xu, Tim; Cole, Gai; Kelen, Gabor D

2017-11-01

A proposed benefit of expanding Medicaid eligibility under the Patient Protection and Affordable Care Act (ACA) was a reduction in emergency department (ED) utilization for primary care needs. Pre-ACA studies found that new Medicaid enrollees increased their ED utilization rates, but the effect on system-level ED visits was less clear. Our objective was to estimate the effect of Medicaid expansion on aggregate and individual-based ED utilization patterns within Maryland. We performed a retrospective cross-sectional study of ED utilization patterns across Maryland, using data from Maryland's Health Services Cost Review Commission. We also analyzed utilization differences between pre-ACA (July 2012 to December 2013) uninsured patients who returned post-ACA (July 2014 to December 2015). The total number of ED visits in Maryland decreased by 36,531 (-1.2%) between the 6 quarters pre-ACA and the 6 quarters post-ACA. Medicaid-covered ED visits increased from 23.3% to 28.9% (159,004 additional visits), whereas uninsured patient visits decreased from 16.3% to 10.4% (181,607 fewer visits). Coverage by other insurance types remained largely stable between periods. We found no significant relationship between Medicaid expansion and changes in ED volume by hospital. For patients uninsured pre-ACA who returned post-ACA, the adjusted visits per person during 6 quarters was 2.38 (95% confidence interval 2.35 to 2.40) for those newly enrolled in Medicaid post-ACA compared with 1.66 (95% confidence interval 1.64 to 1.68) for those remaining uninsured. There was a substantial increase in patients covered by Medicaid in the post-ACA period, but this did not significantly affect total ED volume. Returning patients newly enrolled in Medicaid visited the ED more than their uninsured counterparts; however, this cohort accounted for only a small percentage of total ED visits in Maryland. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Cytogenetics-based risk prediction of blastic transformation of chronic myeloid leukemia in the era of TKI therapy

PubMed Central

Gong, Zimu; Medeiros, L. Jeffrey; Cortes, Jorge E.; Chen, Zi; Zheng, Lan; Li, Yan; Bai, Shi; Lin, Pei; Miranda, Roberto N.; Jorgensen, Jeffrey L.; McDonnell, Timothy J.; Wang, Wei; Kantarjian, Hagop M.

2017-01-01

The high fatality of patients with blast phase (BP) chronic myeloid leukemia (CML) necessitates identification of high-risk (HR) patients to prevent onset of BP. Here, we investigated the risk of BP based on additional chromosomal abnormality (ACA) profiles in a cohort of 2326 CML patients treated with tyrosine kinase inhibitors (TKIs). We examined the time intervals from initial diagnosis to ACA emergence (interval 1), from ACA emergence to onset of BP (interval 2), and survival after onset of BP (interval 3). Based on BP risk associated with each ACA, patients were stratified into intermediate-1, intermediate-2, and HR groups, with a median duration of interval 2 of unreached, 19.2 months, and 1.9 months, respectively. There was no difference in durations of intervals 1 or 3 among 3 groups. Including patients without ACAs who formed the standard-risk group, the overall 5-year cumulative probability of BP was 9.8%, 28.0%, 41.7%, and 67.4% for these 4 groups, respectively. The pre-BP disease course in those who developed BP was similar regardless of cytogenetic alterations, and 84.4% of BP patients developed BP within the first 5 years of diagnosis. In summary, interval 2 is the predominant determinant of BP risk and patient outcome. By prolonging the duration of interval 2, TKI therapy mitigates BP risk associated with low-risk ACAs or no ACAs but does not alter the natural course of CML with HR ACAs. Thus, we have identified a group of patients who have HR of BP and may benefit from timely alternative treatment to prevent onset of BP. PMID:29296906

Exploring Massachusetts Health Care Reform Impact on Fee-for-Service-Funded Substance Use Disorder Treatment Providers.

PubMed

Fields, Dail; Pruett, Jana; Roman, Paul M

2015-01-01

The Affordable Care Act (ACA) is forecast to increase the demand for and utilization of substance use disorder (SUD) treatment. Massachusetts implemented health reforms similar to the ACA in 2006-2007 that included expanding coverage for SUD treatment. This study explored the impact of Massachusetts health reforms from 2007 to 2010 on SUD treatment providers in Massachusetts, who relied on fee-for-service billings for more than 50% of their revenue. The changes across treatment facilities located in Massachusetts were compared to changes in other similar fee-for-service-funded SUD treatment providers in Northeast states bordering Massachusetts and in all other states across the US. From 2007-2010, the percentage changes for Massachusetts based providers were significantly different from the changes among providers located in the rest of the US for admissions, outpatient census, average weeks of outpatient treatment, residential/in-patient census, detoxification census, length of average inpatient and outpatient stays, and provision of medication-assisted treatment. Contrary to previous studies of publicly funded treatment providers, the results of this exploratory study of providers dependent on fee-for-service revenues were consistent with some predictions for the overall effects of the ACA.

A Pollen Coat–Inducible Autoinhibited Ca2+-ATPase Expressed in Stigmatic Papilla Cells Is Required for Compatible Pollination in the Brassicaceae[W

PubMed Central

Iwano, Megumi; Igarashi, Motoko; Tarutani, Yoshiaki; Kaothien-Nakayama, Pulla; Nakayama, Hideki; Moriyama, Hideki; Yakabe, Ryo; Entani, Tetsuyuki; Shimosato-Asano, Hiroko; Ueki, Masao; Tamiya, Gen; Takayama, Seiji

2014-01-01

In the Brassicaceae, intraspecific non-self pollen (compatible pollen) can germinate and grow into stigmatic papilla cells, while self-pollen or interspecific pollen is rejected at this stage. However, the mechanisms underlying this selective acceptance of compatible pollen remain unclear. Here, using a cell-impermeant calcium indicator, we showed that the compatible pollen coat contains signaling molecules that stimulate Ca2+ export from the papilla cells. Transcriptome analyses of stigmas suggested that autoinhibited Ca2+-ATPase13 (ACA13) was induced after both compatible pollination and compatible pollen coat treatment. A complementation test using a yeast Saccharomyces cerevisiae strain lacking major Ca2+ transport systems suggested that ACA13 indeed functions as an autoinhibited Ca2+ transporter. ACA13 transcription increased in papilla cells and in transmitting tracts after pollination. ACA13 protein localized to the plasma membrane and to vesicles near the Golgi body and accumulated at the pollen tube penetration site after pollination. The stigma of a T-DNA insertion line of ACA13 exhibited reduced Ca2+ export, as well as defects in compatible pollen germination and seed production. These findings suggest that stigmatic ACA13 functions in the export of Ca2+ to the compatible pollen tube, which promotes successful fertilization. PMID:24569769

Novel Therapeutic Strategy for the Prevention of Bone Fractures

DTIC Science & Technology

2014-08-01

GAC CTT CAA CAC CCC GTG GCC ATC TCC TGC TCG AAG TC Meredith et al 2011* Mstn ACT GGA CCT CTC GAT AGA ACA CTC ACT TAG TGC TGT GTG TGT GGA GAT...NM_010834.2 IGF-1 CAG ACA GGA GCC CAG GAA AG AAG TGC CGT ATC CCA GAG GA NM_184052 MHC ACA GTC AGA GGT GTG ACTC AGC CG CCG ACT TGC GGA GGA AAG GTG C...AGC AGA GA TGA GTG CCT GCG GTA CAG AT NM_007553.2 RUNX-2 GGA AAG GCA CTG ACT GAC CTA ACA AAT TCT AAG CTT GGG AGG A NM_009820 Osx ACT ACC CAC CCT TCC

76 FR 3879 - Procurement List Proposed Additions and Deletions

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-21

... W6BB ACA White Sands Missile Range, NM. Service Type/Location: Laundry & Dry Cleaning Service, F.E... Activity: GSA/FAS Southwest Supply Center (QSDAC), Fort Worth, TX. Service Service Type/Location: Laundry... proposing to add services to the Procurement List that will be provided by nonprofit agencies employing...

OsACA6, a P-type 2B Ca(2+) ATPase functions in cadmium stress tolerance in tobacco by reducing the oxidative stress load.

PubMed

Shukla, Devesh; Huda, Kazi Md Kamrul; Banu, Mst Sufara Akhter; Gill, Sarvajeet Singh; Gill, Sarvjeet Singh; Tuteja, Renu; Tuteja, Narendra

2014-10-01

The present study demonstrates the first direct evidence of the novel role of OsACA6 in providing Cd (2+) stress tolerance in transgenic tobacco by maintaining cellular ion homeostasis and modulating ROS-scavenging pathway. Cadmium, a non-essential toxic heavy metal, interferes with the plant growth and development. It reaches the leaves through xylem and may become part of the food chain, thus causing detrimental effects to human health. Therefore, there is an urgent need to develop strategies for engineering plants for Cd(2+) tolerance and less accumulation. The members of P-type ATPases family transport metal ions including Cd(2+), and thus play important role an ion homeostasis. The present study elucidates the role of P-type 2B Ca(2+) ATPase (OsACA6) in Cd(2+) stress tolerance. The transcript levels of OsACA6 were up-regulated upon Cd(2+), Zn(2+) and Mn(2+) exposure. Transgenic tobacco expressing OsACA6 showed tolerance towards Cd(2+) stress as demonstrated by several physiological indices including root length, biomass, chlorophyll, malondialdehyde and hydrogen peroxide content. The roots of the transgenic lines accumulated more Cd(2+) as compared to shoot. Further, confocal laser scanning microscopy showed that Cd(2+) exposure altered Ca(2+) uptake in OsACA6 transgenic plants. OsACA6 expression in tobacco also protected the transgenic plants from oxidative stress by enhancing the activity of enzymatic (SOD, CAT, APX, GR) and non-enzymatic (GSH and AsA) antioxidant machinery. Transgenic lines also tolerated Zn(2+) and Mn(2+) stress; however, tolerance for these ions was not as significant as observed for Cd(2+) exposure. Thus, overexpression of OsACA6 confers Cd(2+) stress tolerance in transgenic lines by maintaining cellular ion homeostasis and modulating reactive oxygen species (ROS)-scavenging pathway. The results of the present study will help to develop strategies for engineering Cd(2+) stress tolerance in economically important crop plants.

Effects of the Affordable Care Act on Young Women With Gynecologic Cancers.

PubMed

Smith, Anna Jo Bodurtha; Fader, Amanda N

2018-06-01

To evaluate the effects of the dependent coverage mandate of the 2010 Affordable Care Act (ACA) on insurance status, stage at diagnosis, and receipt of fertility-sparing treatment among young women with gynecologic cancer. We used a difference-in-differences design to assess insurance status, stage at diagnosis (stage I-II vs III-IV), and receipt of fertility-spearing treatment before and after the 2010 ACA among young women aged 21-26 years vs women aged 27-35 years. We used the National Cancer Database with the 2004-2009 surveys as the pre-ACA years and the 2011-2014 surveys as the post-ACA years. Women with uterine, cervical, ovarian, vulvar, or vaginal cancer were included. We analyzed outcomes for women overall and by cancer and insurance type, adjusting for race, nonrural area, and area-level household income and education level. A total of 1,912 gynecologic cancer cases pre-ACA and 2,059 post-ACA were identified for women aged 21-26 years vs 9,782 cases pre-ACA and 10,456 post-ACA for women aged 27-35 years. The ACA was associated with increased insurance (difference in differences 2.2%, 95% CI -4.0 to 0.1, P=.04) for young women aged 21-26 years vs women aged 27-35 years and with a significant improvement in early stage at cancer diagnosis (difference in differences 3.6%, 95% CI 0.4-6.9, P=.03) for women aged 21-26 years. Receipt of fertility-sparing treatment increased for women in both age groups post-ACA (P for trend=.004 for women aged 21-26 years and .001 for women aged 27-35 years); there was no significant difference in differences between age groups. Privately insured women were more likely to be diagnosed at an early stage and receive fertility-sparing treatment than publicly insured or uninsured women throughout the study period (P<.001). Under the ACA's dependent coverage mandate, young women with gynecologic cancer were more likely to be insured and diagnosed at an early stage of disease.

Adenylyl cyclase A mRNA localized at the back of cells is actively translated in live chemotaxing Dictyostelium.

PubMed

Wang, Weiye; Chen, Song; Das, Satarupa; Losert, Wolfgang; Parent, Carole A

2018-05-04

Dictyostelium discoideum cells transport adenylyl cyclase A (ACA)-containing vesicles to the back of polarized cells to relay exogenous cAMP signals during chemotaxis. Fluorescence in situ hybridization (FISH) experiments showed that ACA mRNA is also asymmetrically distributed at the back of polarized cells. By using the MS2 bacteriophage system, we now visualize the distribution of ACA mRNA in live chemotaxing cells. We found that the ACA mRNA localization is not dependent on the translation of the protein product and requires multiple cis-acting elements within the ACA-coding sequence. We show that ACA mRNA is associated with actively translating ribosomes and is transported along microtubules towards the back of cells. By monitoring the recovery of ACA-YFP after photobleaching, we observed that local translation of ACA-YFP occurs at the back of cells. These data represent a novel functional role for localized translation in the relay of chemotactic signals during chemotaxis. © 2018. Published by The Company of Biologists Ltd.

Targeting PRMT5 as a Novel Radiosensitization Approach for Primary and Recurrent Prostate Cancer Treatment

DTIC Science & Technology

2013-08-01

CCT G-30; KLK2 F: 50- TGG CTG TGT ACA GTC ATG GA-30; KLK2 R: 50- CCT GTG TCT TCA GGC TCA AA-30; TMPRSS2 F: 50-AGG TGC ATC CGG CTC AGT A-30; TMPRSS2 R...50-GGG TCA AGG TGA TGC ACA GT-30; PCDH11 F: 50-GCG TTT CTG ACT GTG GCT ATC-30; PCDH11 R: 50-GGA AGG GGA ATG GAA TTT TG-30; UGT2B15 F: 50-TCA AATc-Jun...GAPDH F: 50-CTG ACT TCA ACA GCG ACA CC-30; GAPDH R: 50-CCC TGT TGC TGT AGC CAA AT-30; AR F: 50- GTG GAA GCT GCA AGG TCT TC-30; AR R 50-CGA AGA CGA

Cytogenetic landscape and impact in blast phase of chronic myeloid leukemia in the era of tyrosine kinase inhibitor therapy.

PubMed

Chen, Z; Shao, C; Wang, W; Zuo, Z; Mou, X; Hu, S J; DiGiuseppe, J A; Zu, Y; Medeiros, L J; Hu, S

2017-03-01

The landscape of additional chromosomal alterations (ACAs) and their impact in chronic myeloid leukemia, blast phase (CML-BP) treated with tyrosine kinase inhibitors (TKIs) have not been well studied. Here, we investigated a cohort of 354 CML-BP patients treated with TKIs. We identified +8, an extra Philadelphia chromosome (Ph), 3q26.2 rearrangement, -7 and isochromosome 17q (i(17q)) as the major-route changes with a frequency of over 10%. In addition, +21 and +19 had a frequency of over 5%. These ACAs demonstrated lineage specificity: +8, 3q26.2 rearrangement, i(17q) and +19 were significantly more common in myeloid BP, and -7 more common in lymphoid BP; +Ph and +21 were equally distributed between two groups. Pearson correlation analysis revealed clustering of common ACAs into two groups: 3q26.2 rearrangement, -7 and i(17q) formed one group, and other ACAs formed another group. The grouping correlated with risk stratification of ACAs in CML, chronic phase. Despite the overall negative prognostic impact of ACAs, stratification of ACAs into major vs minor-route changes provided no prognostic relevance in CML-BP. The emergence of 3q26.2 rearrangement as a major-route change in the TKI era correlated with a high frequency of ABL1 mutations, supporting a role for TKI resistance in the changing cytogenetic landscape in CML-BP.

High energy, widely tunable Si-prism-array coupled terahertz-wave parametric oscillator with a deformed pump and optimal crystal location for angle tuning.

PubMed

Zhang, Ruiliang; Qu, Yanchen; Zhao, Weijiang; Chen, Zhenlei

2017-03-20

A high energy, widely tunable Si-prism-array coupled terahertz-wave parametric oscillator (TPO) has been demonstrated by using a deformed pump. The deformed pump is cut from a beam spot of 2 mm in diameter by a 1-mm-wide slit. In comparison with a small pump spot (1-mm diameter), the THz-wave coupling area for the deformed pump is increased without limitation to the low-frequency end of the tuning range. Besides, the crystal location is specially designed to eliminate the alteration of the output position of the pump during angle tuning, so the initially adjusted nearest pumped region to the THz-wave exit surface is maintained throughout the tuning range. The tuning range is 0.58-2.5 THz for the deformed pump, while its low frequency end is limited at approximately 1.2 THz for the undeformed pump with 2 mm diameter. The highest THz-wave output of 2 μJ, which is 2.25 times as large as that from the pump of 1 mm in diameter, is obtained at 1.15 THz under 38 mJ (300  MW/cm²) pumping. The energy conversion efficiency is 5.3×10^-5.

PKSOI Bulletin. Volume 2, Issue 3. April 2010

DTIC Science & Technology

2010-04-01

and understand "transitions" as a crucial process during recovery from crisis and conflict. It is an opportunity for aca - demics, civil society...education is conducted at the level that can be sustained. Often, medical devices that are utilized for training (i.e. de- fibrillators) are not...location where they can utilize their improved skill set for a better monetary reward. Metrics for success: Oversight of engagements is vital; and

NOX2 amplifies acetaldehyde-mediated cardiomyocyte mitochondrial dysfunction in alcoholic cardiomyopathy

PubMed Central

Brandt, Moritz; Garlapati, Venkata; Oelze, Matthias; Sotiriou, Efthymios; Knorr, Maike; Kröller-Schön, Swenja; Kossmann, Sabine; Schönfelder, Tanja; Morawietz, Henning; Schulz, Eberhard; Schultheiss, Heinz-Peter; Daiber, Andreas; Münzel, Thomas; Wenzel, Philip

2016-01-01

Alcoholic cardiomyopathy (ACM) resulting from excess alcohol consumption is an important cause of heart failure (HF). Although it is assumed that the cardiotoxicity of the ethanol (EtOH)-metabolite acetaldehyde (ACA) is central for its development and progression, the exact mechanisms remain obscure. Murine cardiomyocytes (CMs) exposed to ACA or EtOH showed increased superoxide (O2•−) levels and decreased mitochondrial polarization, both being normalized by NADPH oxidase (NOX) inhibition. C57BL/6 mice and mice deficient for the ACA-degrading enzyme mitochondrial aldehyde dehydrogenase (ALDH-2−/−) were fed a 2% EtOH diet for 5 weeks creating an ACA-overload. 2% EtOH-fed ALDH-2−/− mice exhibited a decreased cardiac function, increased heart-to-body and lung-to-body weight ratios, increased cardiac levels of the lipid peroxidation product malondialdehyde (MDA) as well as increased NOX activity and NOX2/glycoprotein 91phox (NOX2/gp91phox) subunit expression compared to 2% EtOH-fed C57BL/6 mice. Echocardiography revealed that ALDH-2−/−/gp91phox−/− mice were protected from ACA-overload-induced HF after 5 weeks of 2% EtOH-diet, demonstrating that NOX2-derived O2•− contributes to the development of ACM. Translated to human pathophysiology, we found increased gp91phox expression in endomyocardial biopsies of ACM patients. In conclusion, ACM is promoted by ACA-driven mitochondrial dysfunction and can be improved by ablation of NOX2/gp91phox. NOX2/gp91phox therefore might be a potential pharmacological target to treat ACM. PMID:27624556

Lipase-catalyzed preparation of optically active 1'-acetoxychavicol acetates and their structure-activity relationships in apoptotic activity against human leukemia HL-60 cells.

PubMed

Azuma, Hideki; Miyasaka, Keita; Yokotani, Tsuyoshi; Tachibana, Taro; Kojima-Yuasa, Akiko; Matsui-Yuasa, Isao; Ogino, Kenji

2006-03-15

Structure-activity relationships of 1'-acetoxychavicol acetate (ACA) for apoptotic activity against human leukemia HL-60 cells were investigated using optically active ACA and various racemic ACA analogues. Natural-type (or with different acyl group) ACA showed a high apoptotic activity, but the ortho or meta isomers, 4-deacetoxy analogue, and the 2'-3' dehydrogenated derivative had no effect, or a weak activity. Optically active (R)- and (S)-ACA were prepared by a lipase-catalyzed esterification. Using a mixture of vinyl acetate-tetrahydrofuran (1:1 v/v) as a solvent at refluxing temperature, optically pure (R)- and (S)-ACA were obtained (99.7% ee and 99.1% ee, respectively). The apoptosis-inducing effects of both enantiomers were compared by means of an MTT assay and the detection of typical apoptotic phenomena (DNA fragmentation, caspase-3 activation, and PARP cleavage) and these two activities were almost equal. These results indicate that the essential moieties of ACA for apoptotic activity against HL-60 cells are both the presence of a 4-acetoxyl group and an unsaturated double bond between C-2' and C-3', and that the configuration at the 1'-position is unrelated to activity.

Bone bonding ability of a chemically and thermally treated low elastic modulus Ti alloy: gum metal.

PubMed

Tanaka, Masashi; Takemoto, Mitsuru; Fujibayashi, Shunsuke; Kawai, Toshiyuki; Yamaguchi, Seiji; Kizuki, Takashi; Matsushita, Tomiharu; Kokubo, Tadashi; Nakamura, Takashi; Matsuda, Shuichi

2014-03-01

The gum metal with composition Ti-36Nb-2Ta-3Zr-0.3O, is free from cytotoxic elements and exhibits a low elastic modulus as well as high mechanical strength. We have previously demonstrated that this gum metal, once subjected to a series of surface treatments--immersion in 1 M NaOH (alkali treatment) and then 100 mM CaCl2, before heating at 700 °C (sample: ACaH-GM), with an optional final hot water immersion (sample: ACaHW-GM)--has apatite-forming ability in simulated body fluid. To confirm the in vivo bioactivity of these treated alloys, failure loads between implants and bone at 4, 8, 16, and 26 weeks after implantation in rabbits' tibiae were measured for untreated gum metal (UT-GM), ACaH-GM and ACaHW-GM, as well as pure titanium plates after alkali and heat treatment (AH-Ti). The ACaH-GM and UT-GM plates showed almost no bonding, whereas ACaHW-GM and AH-Ti plates showed successful bonding by 4 weeks, and their failure loads subsequently increased with time. The histological findings showed a large amount of new bone in contact with the surface of ACaHW-GM and AH-Ti plates, suggesting that the ACaHW treatment could impart bone-bonding bioactivity to a gum metal in vivo. Thus, with this improved bioactive treatment, these advantageous gum metals become useful candidates for orthopedic and dental devices.

Evaluation of anterior chamber angle under dark and light conditions in angle closure glaucoma: An anterior segment OCT study.

PubMed

Masoodi, Habibeh; Jafarzadehpur, Ebrahim; Esmaeili, Alireza; Abolbashari, Fereshteh; Ahmadi Hosseini, Seyed Mahdi

2014-08-01

To evaluate changes of nasal and temporal anterior chamber angle (ACA) in subjects with angle closure glaucoma using Spectralis AS-OCT (SAS-OCT) under dark and light conditions. Based on dark-room gonioscopy, 24 subjects with open angles and 86 with narrow angles participated in this study. The nasal and temporal angle opening distance at 500 μm anterior to the scleral spur (AOD500), nasal and temporal ACA were measured using SAS-OCT in light and dark conditions. In 2 groups, ACA and AOD500 in nasal and temporal quadrants were significantly greater in light compared to dark (all with p=0.000). The AOD500 and ACA were significantly higher in nasal than temporal in measured conditions for 2 groups except the ACA and AOD500 of normal group measured in light. The difference between nasal and temporal in dark (29.07 ± 65.71 μm for AOD500 and 5.7 ± 4.07° for ACA) was greater than light (24.86 ± 79.85 μm for AOD500 and 2.09 ± 7.21° for ACA) condition. But the difference was only significant for ACA (p=0.000). The correlation analysis showed a negative correlation between AOD500 and pupil diameter in temporal and nasal quadrants (both with p=0.000). While temporal AOD500 difference correlated with spherical equivalent, temporal and asal gonioscopy, nasal AOD correlated with IOP, temporal and nasal gonioscopy. Clinically important changes in ACA structure could be detected with SAS-OCT in nasal and temporal quadrants under different illumination intensity. The results could help in improvement of examination condition for better and more accurate assessment of individuals with angle closure glaucoma. Copyright © 2014 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Characterization of onion lectin (Allium cepa agglutinin) as an immunomodulatory protein inducing Th1-type immune response in vitro.

PubMed

Prasanna, Vaddi K; Venkatesh, Yeldur P

2015-06-01

Onion (Allium cepa), a bulb crop of economic importance, is known to have many health benefits. The major objective of the present study is to address the immunomodulatory properties of onion lectin (A. cepa agglutinin; ACA). ACA was purified from onion extract by D-mannose-agarose chromatography (yield: ~1 mg/kg). ACA is non-glycosylated and showed a molecular mass of ~12 kDa under reducing/non-reducing SDS-PAGE; glutaraldehyde cross-linking indicated that ACA is a non-covalent tetramer of ~12 kDa subunits. Its N-terminal sequence (RNVLLNNEGL; UniProt KB Accn. C0HJM8) showed 70-90% homology to mannose-specific Allium agglutinins. ACA showed specific hemagglutination activity of 8200 units/mg and is stable in the pH range 6-10 and up to 45° C. The immunomodulatory activity of ACA was assessed using the macrophage cell line, RAW264.7 and rat peritoneal macrophages; at 0.1 μg/well, it showed a significant increase (6-8-fold vs. control) in the production of nitric oxide at 24h, and significantly stimulated (2-4-fold vs. control) the production of pro-inflammatory cytokines (TNF-α and IL-12) at 24h. ACA (0.1 μg/well) enhanced the proliferation of murine thymocytes by ~4 fold (vs. control) at 24h; however, ACA does not proliferate B cell-enriched rat splenocytes. Further, it significantly elevated the expression levels of cytokines (IFN-γ and IL-2) over the control in murine thymocytes. Taken together, purified ACA induces a Th1-type immune response in vitro. Though present in low amounts, ACA may contribute to the immune-boosting potential of the popular spice onion since considerable amounts are consumed on a daily basis universally. Copyright © 2015 Elsevier B.V. All rights reserved.

Are Press Depictions of Affordable Care Act Beneficiaries Favorable to Policy Durability?

PubMed

Chattopadhyay, Jacqueline

2015-01-01

If successfully implemented and enduring, the Affordable Care Act (ACA) stands to expand health insurance access in absolute terms, reduce inter-group disparities in that access, and reduce exposure to the financial vulnerabilities illness entails. Its durability--meaning both avoidance of outright retrenchment and fidelity to its policy aims--is thus of scholarly interest. Past literature suggests that social constructions of a policy's beneficiaries may impact durability. This paper first describes media portrayals of ACA beneficiaries with an eye toward answering three descriptive questions: (1) Do portrayals depict beneficiaries as economically heterogeneous? (2) Do portrayals focus attention on groups that have acquired new political relevance due to the ACA, such as young adults? (3) What themes that have served as messages about beneficiary "deservingness" in past social policy are most frequent in ACA beneficiary portrayals? The paper then assesses how the portrayal patterns that these questions uncover may work both for and against the ACA's durability, finding reasons for confidence as well as caution. Using manual and automated methods, this paper analyzes newspaper text from August 2013 through January 2014 to trace portrayals of two ACA "target populations" before and during the new law's first open-enrollment period: those newly eligible for Medicaid, and those eligible for subsidies to assist in the purchase of private health insurance under the ACA. This paper also studies newspaper text portrayals of two groups informally crafted by the ACA in this timeframe: those gaining health insurance and those losing it. The text data uncover the following answers to the three descriptive questions for the timeframe studied: (1) Portrayals may underplay beneficiaries' economic heterogeneity. (2) Portrayals pay little attention to young adults. (3) Portrayals emphasize themes of workforce participation, economic self-sufficiency, and insider status. Health status, age, gender, and race/ethnicity appear to receive little attention. Existing literature suggests that these portrayal patterns may both support and limit ACA durability. In favor of durability is that ACA beneficiaries are depicted in terms that have been associated with deservingness in past American social policy--particularly being cast as workers and insiders. Yet, the results also give three reasons for caution. First, ACA insurance-losers are also portrayed as deserving. Second, it is unclear how the portrayal patterns found may impact the durability of the ACA's efforts to cut insurance disparities by age, health status, and especially race/ethnicity. Third, portrayals' strong casting of beneficiaries as workers, and limited attention to beneficiaries' economic heterogeneity and to young adults, may do little to help cultivate beneficiary political engagement around the ACA.

Minocycline neuroprotection in a rat model of asphyxial cardiac arrest is limited.

PubMed

Keilhoff, Gerburg; Schweizer, Hannes; John, Robin; Langnaese, Kristina; Ebmeyer, Uwe

2011-03-01

The study investigated a possible neuroprotective potency of minocycline in an experimental asphyxial cardiac arrest (ACA) rat model. Clinically important survival times were evaluated thus broadening common experimental approaches. Adult rats were subjected to 5 min of ACA followed by resuscitation. There were two main treatment groups: ACA and sham operated. Relating to minocycline treatment each group consisted of three sub-groups: pre-, post-, and sans-mino, with three different survival times: 4, 7, and 21 days. Neurodegeneration and microgliosis were monitored by immunohistochemistry. Alterations of microglia-associated gene expression were analyzed by quantitative RT-PCR. ACA induced massive nerve cell loss and activation of microglia/macrophages in hippocampal CA1 cell layer intensifying with survival time. After 7 days, minocycline significantly decreased both, neuronal degeneration and microglia response in dependence on the application pattern; application post ACA was most effective. After 21 days, neuroprotective effects of minocycline were lost. ACA significantly induced expression of the microglia-associated factors Ccl2, CD45, Mac-1, F4-80, and Tnfa. Independent on survival time, minocycline affected these parameters not significantly. Expression of iNOS was unaffected by both, ACA and minocycline. In adult rat hippocampus microglia was significantly activated by ACA. Minocycline positive affected neuronal survival and microglial response temporary, even when applied up to 18 h after ACA, thus defining a therapeutically-relevant time window. As ACA-induced neuronal cell death involves acute and delayed events, longer minocycline intervention targeting also secondary injury cascades should manifest neuroprotective potency, a question to be answered by further experiments. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Health Care Sharing Ministries and Their Exemption From the Individual Mandate of the Affordable Care Act.

PubMed

Galarneau, Charlene

2015-06-01

The U.S. 2010 Patient Protection and Affordable Care Act (ACA) exempts members of health care sharing ministries (HCSMs) from the individual mandate to have minimum essential insurance coverage. Little is generally known about these religious organizations and even less critical attention has been brought to bear on them and their ACA exemption. Both deserve close scrutiny due to the exemption's less than clear legislative justification, their potential influence on the ACA's policy and ethical success, and their salience to current religious liberty debates surrounding the expansion of religious exemptions from ACA responsibilities for both individuals and corporations. Analyzing documents of the United States' three largest health care sharing ministries and related material, I examine these organizations and their ACA exemption with particular consideration of their ethical dimensions. Here a thick description of the nature and workings of health care sharing ministries precedes a similar account of the ACA exemption. From these empirical analyses, five ethical and policy concerns emerge: (1) the charity versus insurance status of these ministries; (2) the conflation of two ACA religious exemptions; (3) the tension between the values of religious liberty and of justice; (4) the potential undermining of ACA policy goals; and (5) the questionable compliance of health care sharing ministries with ACA exemption requirements.  An accurate and informed understanding of HCSMs is required for policymakers and others to justify the ACA exemption of health care sharing ministry members. A sufficient justification would address at least the five ethical and policy concerns raised here.

Influence of accommodative lag upon the far-gradient measurement of accommodative convergence to accommodation ratio in strabismic patients.

PubMed

Miyata, Manabu; Hasebe, Satoshi; Ohtsuki, Hiroshi

2006-01-01

To determine the influence of the lag of accommodation (LOA) on the accommodative convergence to accommodation (AC/A) ratio measured by the far-gradient method in strabismic patients. The AC/A ratio was measured with a distance target viewed with and without -3.00 diopter (D) addition lenses in 63 patients with different types of strabismus (age range, 7-34 years; range of strabismic angle, -60 to +40 prism diopters; refractive error range, -7.33 to +6.63 D). The LOA for the same lens was measured with an open-view-type autorefractometer. The stimulus AC/A ratio and the AC/A ratio adjusted by the individually measured LOA (adjusted AC/A ratio) were compared. The mean +/- SD of the LOA to the -3.00 D lenses was 1.06 +/- 0.43 D. The mean adjusted AC/A ratio was 41% greater than the stimulus AC/A ratio. The LOA differed widely among patients (0.13 to 2.14 D), and a large LOA tended to appear in myopic or young patients. The AC/A ratio obtained using the conventional far-gradient method is significantly biased by the LOA, and thus does not always represent the actual relationship between accommodation and vergence control systems. Copyright Japanese Ophthalmological Society 2006.

Perceived Impacts of the Affordable Care Act: Perspectives of Buprenorphine Prescribers

PubMed Central

Knudsen, Hannah K.; Studts, Jamie L.

2017-01-01

The Affordable Care Act (ACA) has been heralded as a major policy change that is expected to transform the delivery of substance use disorder (SUD) treatment. Few studies have reported on the perceived impacts of ACA from the perspectives of SUD treatment providers, such as physicians who prescribe buprenorphine to patients with opioid use disorder. The present study describes buprenorphine prescribers’ perceptions regarding impacts of the ACA on the delivery of buprenorphine and examines whether state-level approaches to implementing ACA are associated with its perceived impacts. Data are drawn from a national sample of current buprenorphine prescribers (n=1,174) who were surveyed by mail. On average, buprenorphine prescribers reported ambivalence regarding the impacts of the ACA, as indicated by a mean of 2.75 (SD=0.69) on a scale that ranged from 1 (“strongly disagree”) to 5 (“strongly agree”). A multi-level mixed effects regression model indicated that physicians practicing in states that were supportive of ACA, as indicated by adopting both the Medicaid expansion and implementing a state-based health insurance exchange, had more positive perceptions of the ACA than physicians in states that had declined both of these policies. This study suggests that state approaches to ACA may be associated with varied impacts. PMID:28296579

RNomics: an experimental approach that identifies 201 candidates for novel, small, non-messenger RNAs in mouse

PubMed Central

Hüttenhofer, Alexander; Kiefmann, Martin; Meier-Ewert, Sebastian; O’Brien, John; Lehrach, Hans; Bachellerie, Jean-Pierre; Brosius, Jürgen

2001-01-01

In mouse brain cDNA libraries generated from small RNA molecules we have identified a total of 201 different expressed RNA sequences potentially encoding novel small non-messenger RNA species (snmRNAs). Based on sequence and structural motifs, 113 of these RNAs can be assigned to the C/D box or H/ACA box subclass of small nucleolar RNAs (snoRNAs), known as guide RNAs for rRNA. While 30 RNAs represent mouse homologues of previously identified human C/D or H/ACA snoRNAs, 83 correspond to entirely novel snoRNAs. Among these, for the first time, we identified four C/D box snoRNAs and four H/ACA box snoRNAs predicted to direct modifications within U2, U4 or U6 small nuclear RNAs (snRNAs). Furthermore, 25 snoRNAs from either class lacked antisense elements for rRNAs or snRNAs. Therefore, additional snoRNA targets have to be considered. Surprisingly, six C/D box snoRNAs and one H/ACA box snoRNA were expressed exclusively in brain. Of the 88 RNAs not belonging to either snoRNA subclass, at least 26 are probably derived from truncated heterogeneous nuclear RNAs (hnRNAs) or mRNAs. Short interspersed repetitive elements (SINEs) are located on five RNA sequences and may represent rare examples of transcribed SINEs. The remaining RNA species could not as yet be assigned either to any snmRNA class or to a part of a larger hnRNA/mRNA. It is likely that at least some of the latter will represent novel, unclassified snmRNAs. PMID:11387227

Hyaluronan-Based Therapy for Metastatic Prostate Cancer

DTIC Science & Technology

2016-09-01

forward 5′-TGT GAC TTT GGT TGT TCC GTT GC-3′ and reverse 5′-ACC TGA GCC GAT GCA ACA ACA G-3′; DR5, forward 5′- AAG ACC CTT GTG CTC GTT GT-3′ and...reverse 5′-AGG TGG ACA CAA TCC CTC TG-3′; actin, forward 5′- TCC CTG GAG AAG AGC TAC GA-3′ and reverse 5′-AGC ACT GTG TTG GCG TAC AG-3′. 2.2.5. Death

A cross-jurisdictional evaluation of insurance coverage among HIV care patients following the Affordable Care Act.

PubMed

Hood, Julia E; Buskin, Susan E; Anderson, Bridget J; Gagner, Alexandra; Kienzle, Jennifer; Maggio, David; Markey, Katie; Reuer, Jennifer; Benbow, Nanette; Wortley, Pascale

2017-04-01

The impact of the Affordable Care Act (ACA) on HIV care patients, aged 18-64, was evaluated in three jurisdictions with Medicaid expansion (Chicago, New York State, and Washington) and three jurisdictions without Medicaid expansion (Georgia, Texas, and Virginia) using data from the Medical Monitoring Project. Multivariate regression models were used to evaluate insurance status that was reported pre- and post-ACA; self-reported impact of ACA on HIV care was explored with descriptive statistics. The likelihood of having insurance was significantly greater post-ACA compared to pre-ACA in Chicago (aRR = 1.33, 95%CI = 1.20, 1.47), Washington (aRR = 1.15, 95%CI = 1.08, 1.22), and Virginia (aRR = 1.14, 95%CI = 1.00, 1.29). In Washington and Chicago, the likelihood of being Medicaid-insured was greater post-ACA compared to pre-ACA implementation (Chicago: aRR = 1.25, 95%CI = 1.03,1.53; Washington: aRR = 1.66 95% CI = 1.30, 2.13). No other significant differences were observed. Only a subset of HIV care patients (range: 15-35%) reported a change in insurance that would have coincided with the implementation of ACA; and within this subset, a change in medical care costs was the most commonly noted issue. In conclusion, the influence of ACA on insurance coverage and other factors affecting HIV care likely varies by jurisdiction.

Anterior segment biometry using ultrasound biomicroscopy and the Artemis-2 very high frequency ultrasound scanner

PubMed Central

Al-Farhan, Haya M; AlMutairi, Reem N

2013-01-01

Purpose To compare the precision of anterior chamber angle (ACA) and anterior chamber depth (ACD) measurements taken with ultrasound biomicroscopy (UBM) and the Artemis-2 Very High Frequency Ultrasound Scanner (VHFUS) in normal subjects. Design Prospective study. Methods We randomly selected one eye from each of 59 normal subjects in this study. Two subjects dropped out of the study; the associated data were excluded from analysis. ACA and ACD measurements were obtained using the VHFUS and the UBM. The results were compared statistically using repeated-measures analysis of variance for the intraobserver repeatability, unpaired t-test, and limits of agreement. Results The average ACA values for the UBM and the VHFUS (±standard deviation) were 41.83° ± 5.03° and 33.36° ± 6.03°, respectively. The average ACD values were 2.96 ± 0.34 mm and 2.87 ± 0.31 mm. The intraobserver repeatability analysis of variance P-values for ACA and ACD measurements using UBM were 0.10 and 0.68, respectively; for the Artemis-2 VHFUS, the respective values were 0.68 and 0.09. The difference in ACA measurements was statistically significant (t = 8.41; P < 0.0001), while the difference in ACD values was not (t = 1.51; P < 0.13). The mean ACA difference was 8.50° ± 2.50°, and the limits of agreement were +13.30° to −3.60°. The mean ACD difference was 0.09 ± 0.27 mm, and the limits of agreement ranged from 0.61 mm to −0.43 mm. The mean difference percentage of ACD was 3.1% for both instruments. Conclusion In case of the ACD, both instruments can be used interchangeably; however, with the ACA instruments, they cannot be used interchangeably. PMID:23345968

TU-EF-304-12: Proton Radiation Therapy for Left-Sided Breast Cancer: LET and RBE Considerations for Cardiac Toxicity

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

Giantsoudi, D; Jee, K; MacDonald, S

Purpose: Increased risk of coronary artery disease has been documented for patients treated with radiation for left-sided breast cancer. Proton therapy (PRT) has been shown to significantly decrease cardiac irradiation, however variations in relative biological effectiveness (RBE) have been ignored so far. In this study we evaluate the impact of accounting for RBE variations on sensitive structures located within high linear energy transfer (LET) areas (distal end) of the proton treatment fields, for this treatment site. Methods: Three patients treated in our institution with PRT for left-sided breast cancer were selected. All patients underwent reconstructive surgery after mastectomy and treatedmore » to a total dose of 50.4Gy with beam(s) vertical to the chest wall. Dose and LET distributions were calculated using Monte Carlo (MC-TOPAS - TOol for PArticle Simulation). The LET-based, variable-RBE-weighted dose was compared to the analytical calculation algorithm (ACA) and MC dose distributions for a constant RBE of 1.1, based on volume histograms and mean values for the target, heart and left anterior descending coronary artery (LAD). Results: Assuming a constant RBE and compared to the ACA dose, MC predicted lower mean target and heart doses by 0.5% to 2.7% of the prescription dose. For variable RBE, plan evaluation showed increased mean target dose by up to 5%. Mean variable-RBE-weighted doses for the LAD ranged from 2.7 to 5.9Gy(RBE) among patients increased by 41%–64.2% compared to constant RBE ACA calculation (absolute dose: 1.7–3.9Gy(RBE)). Smaller increase in mean heart doses was noticed. Conclusion: ACA overestimates the target mean dose by up to 2.7%. However, disregarding variations in RBE may lead to significant underestimation of the dose to sensitive structures at the distal end of the proton treatment field and could thus impact outcome modeling for cardiac toxicities after proton therapy. These results are subject to RBE model and parameter uncertainties.« less

Cancer preventive services, socioeconomic status, and the Affordable Care Act.

PubMed

Cooper, Gregory S; Kou, Tzuyung Doug; Dor, Avi; Koroukian, Siran M; Schluchter, Mark D

2017-05-01

Out-of-pocket expenditures are thought to be an important barrier to the receipt of cancer preventive services, especially for those of a lower socioeconomic status (SES). The Affordable Care Act (ACA) eliminated out-of-pocket expenditures for recommended services, including mammography and colonoscopy. The objective of this study was to determine changes in the uptake of mammography and colonoscopy among fee-for-service Medicare beneficiaries before and after ACA implementation. Using Medicare claims data, this study identified women who were 70 years old or older and had not undergone mammography in the previous 2 years and men and women who were 70 years old or older, were at increased risk for colorectal cancer, and had not undergone colonoscopy in the past 5 years. The receipt of procedures in the 2-year period before the ACA's implementation (2009-2010) and after its implementation (2011 to September 2012) was also identified. Multivariate generalized estimating equation models were used to determine the independent association and county-level quartile of median income and education with the receipt of testing. For mammography, a lower SES quartile was associated with less uptake, but the post-ACA disparities were smaller than those in the pre-ACA period. In addition, mammography rates increased from the pre-ACA period to the post-ACA period in all SES quartiles. For colonoscopy, in both the pre- and post-ACA periods, there was an association between uptake and educational level and, to some extent, income. However, there were no appreciable changes in colonoscopy and SES after implementation of the ACA. The removal of out-of-pocket expenditures may overcome a barrier to the receipt of recommended preventive services, but for colonoscopy, other procedural factors may remain as deterrents. Cancer 2017;123:1585-1589. © 2017 American Cancer Society. © 2017 American Cancer Society.

Human H/ACA Small Nucleolar RNPs and Telomerase Share Evolutionarily Conserved Proteins NHP2 and NOP10

PubMed Central

Pogacic, Vanda; Dragon, François; Filipowicz, Witold

2000-01-01

The H/ACA small nucleolar RNAs (snoRNAs) are involved in pseudouridylation of pre-rRNAs. In the yeast Saccharomyces cerevisiae, four common proteins are associated with H/ACA snoRNAs: Gar1p, Cbf5p, Nhp2p, and Nop10p. In vitro reconstitution studies showed that four proteins also specifically interact with H/ACA snoRNAs in mammalian cell extracts. Two mammalian proteins, NAP57/dyskerin (the ortholog of Cbf5p) and hGAR1, have been characterized. In this work we describe properties of hNOP10 and hNHP2, human orthologs of yeast Nop10p and Nhp2p, respectively, and further characterize hGAR1. hNOP10 and hNHP2 complement yeast cells depleted of Nhp2p and Nop10p, respectively. Immunoprecipitation experiments with extracts from transfected HeLa cells indicated that epitope-tagged hNOP10 and hNHP2 specifically associate with hGAR1 and H/ACA RNAs; they also interact with the RNA subunit of telomerase, which contains an H/ACA-like domain in its 3′ moiety. Immunofluorescence microscopy experiments showed that hGAR1, hNOP10, and hNHP2 are localized in the dense fibrillar component of the nucleolus and in Cajal (coiled) bodies. Deletion analysis of hGAR1 indicated that its evolutionarily conserved core domain contains all the signals required for localization, but progressive deletions from either the N or the C terminus of the core domain abolish localization in the nucleolus and/or the Cajal bodies. PMID:11074001

Up-to-Date on Preventive Care Services Under Affordable Care Act: A Trend Analysis From MEPS 2007-2014.

PubMed

Hong, Young-Rock; Jo, Ara; Mainous, Arch G

2017-08-01

The utilization of preventive care services has been less than optimal. As part of an effort to address this, the Affordable Care Act (ACA) mandated that private health insurance plans cover evidence-based preventive services. To evaluate whether the provisions of ACA have increased being up-to-date on recommended preventive care services among privately insured individuals aged 18-64. Multivariate linear regression models were used to examine trends in prevalence of being up-to-date on selected preventive services, diagnosis of health conditions, and health expenditures between pre-ACA (2007-2010) and post-ACA (2011-2014). Adjusted difference-in-difference analyses were used to estimate changes in those outcomes in the privately insured that differed from changes in the uninsured (control group). After the passage of ACA, up-to-date rates of routine checkup (2.7%; 95% confidence interval, 0.8%-4.7%; P=0.007) and flu vaccination (5.9%; 95% confidence interval, 4.2%-7.6%; P<0.001) increased among those with private insurance, as compared with the control group. Changes in blood pressure check, cholesterol check and cancer screening (pap smear test, mammography, and colorectal cancer screening) were not associated with the ACA. Prevalence in diagnosis of health conditions remained constant. Slower uptrends in adjusted total health care expenditures and downtrends in adjusted out-of-pocket costs were observed during the study period. The provisions of the ACA have resulted in trivial increases in being up-to-date on selected preventive care services. Additional efforts may be required to take full advantage of the elimination of cost-sharing under the ACA.

Barriers to Homeless Persons Acquiring Health Insurance Through the Affordable Care Act.

PubMed

Fryling, Lauren R; Mazanec, Peter; Rodriguez, Robert M

2015-11-01

Medicaid expansion under the Affordable Care Act (ACA) is intended to provide a framework for increasing health care access for vulnerable populations, including the 1.2 million who experience homelessness each year in the United States. We sought to characterize homeless persons' knowledge of the ACA, identify barriers to their ACA enrollment, and determine access to various forms of communication that could be used to facilitate enrollment. At an urban county Level I trauma center, we interviewed all noncritically ill adults who presented to the emergency department (ED) during daytime hours and were able to provide consent. We assessed access to communication, awareness of the ACA, insurance status, and barriers preventing subjects from enrolling in health insurance and compared homeless persons' responses with concomitantly enrolled housed individuals. Of the 650 enrolled subjects, 134 (20.2%) were homeless. Homeless subjects were more likely to have never heard of the ACA (26% vs. 10%). "Not being aware if they qualify for Medicaid" was the most common (70%) and most significant (30%) barrier to enrollment reported by uninsured homeless persons. Of homeless subjects who were unsure if they qualified for Medicaid, 91% reported an income < 138% of the federal poverty level, likely qualifying them for enrollment. Although 99% of housed subjects reported access to either phone or internet, only 74% of homeless subjects reported access. Homeless persons report having less knowledge of the ACA than their housed counterparts, poor understanding of ACA qualification criteria, and limited access to phone and internet. ED-based outreach and education regarding ACA eligibility may increase their enrollment. Copyright © 2015 Elsevier Inc. All rights reserved.

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

Shortwave direct radiative effects of above cloud aerosols over global oceans derived from eight years of CALIOP and MODIS observations

NASA Astrophysics Data System (ADS)

Zhang, Z.; Meyer, K.; Yu, H.; Platnick, S.; Colarco, P.; Liu, Z.; Oreopoulos, L.

2015-09-01

In this paper, we studied the frequency of occurrence and shortwave direct radiative effects (DRE) of above-cloud aerosols (ACAs) over global oceans using eight years of collocated CALIOP and MODIS observations. Similar to previous work, we found high ACA occurrence in four regions: Southeast (SE) Atlantic region where ACAs are mostly light-absorbing aerosols, i.e., smoke and polluted dust according to CALIOP classification, originating from biomass burning over African Savanna; Tropical Northeast Atlantic and Arabian Sea where ACAs are predominantly windblown dust from the Sahara and Arabian desert, respectively; and Northwest Pacific where ACAs are mostly transported smoke and polluted dusts from Asian. From radiative transfer simulations based on CALIOP-MODIS observations and a set of the preselected aerosol optical models, we found the DREs of ACAs at the top of atmosphere (TOA) to be positive (i.e., warming) in the SE Atlantic and NW Pacific regions, but negative (i.e., cooling) in TNE Atlantic and Arabian Sea. The cancellation of positive and negative regional DREs results in a global ocean annual mean diurnally averaged cloudy-sky DRE of 0.015 W m-2 (range of -0.03 to 0.06 W m-2) at TOA. The DREs at surface and within atmosphere are -0.15 W m-2 (range of -0.09 to -0.21 W m-2), and 0.17 W m-2 (range of 0.11 to 0.24 W m-2), respectively. The regional and seasonal mean DREs are much stronger. For example, in the SE Atlantic region the JJA (July ~ August) seasonal mean cloudy-sky DRE is about 0.7 W m-2 (range of 0.2 to 1.2 W m-2) at TOA. The uncertainty in our DRE computations is mainly cause by the uncertainties in the aerosol optical properties, in particular aerosol absorption, and uncertainties in the CALIOP operational aerosol optical thickness retrieval. In situ and remotely sensed measurements of ACA from future field campaigns and satellite missions, and improved lidar retrieval algorithm, in particular vertical feature masking, would help reduce the uncertainty.

Sudden Death in Heart Failure With Preserved Ejection Fraction: A Competing Risks Analysis From the TOPCAT Trial.

PubMed

Vaduganathan, Muthiah; Claggett, Brian L; Chatterjee, Neal A; Anand, Inder S; Sweitzer, Nancy K; Fang, James C; O'Meara, Eileen; Shah, Sanjiv J; Hegde, Sheila M; Desai, Akshay S; Lewis, Eldrin F; Rouleau, Jean; Pitt, Bertram; Pfeffer, Marc A; Solomon, Scott D

2018-03-04

This study investigated the rates and predictors of SD or aborted cardiac arrest (ACA) in HFpEF. Sudden death (SD) may be an important mode of death in heart failure with preserved ejection fraction (HFpEF). We studied 1,767 patients with HFpEF (EF ≥45%) enrolled in the Americas region of the TOPCAT (Aldosterone Antagonist Therapy for Adults With Heart Failure and Preserved Systolic Function) trial. We identified independent predictors of composite SD/ACA with stepwise backward selection using competing risks regression analysis that accounted for nonsudden causes of death. During a median 3.0-year (25 th to 75 th percentile: 1.9 to 4.4 years) follow-up, 77 patients experienced SD/ACA, and 312 experienced non-SD/ACA. Corresponding incidence rates were 1.4 events/100 patient-years (25 th to 75 th percentile: 1.1 to 1.8 events/100 patient-years) and 5.8 events/100 patient-years (25 th to 75 th percentile: 5.1 to 6.4 events/100 patient-years). SD/ACA was numerically lower but not statistically reduced in those randomized to spironolactone: 1.2 events/100 patient-years (25 th to 75 th percentile: 0.9 to 1.7 events/100 patient-years) versus 1.6 events/100 patient-years (25 th to 75 th percentile: 1.2 to 2.2 events/100 patient-years); the subdistributional hazard ratio was 0.74 (95% confidence interval: 0.47 to 1.16; p = 0.19). After accounting for competing risks of non-SD/ACA, male sex and insulin-treated diabetes mellitus were independently predictive of composite SD/ACA (C-statistic = 0.65). Covariates, including eligibility criteria, age, ejection fraction, coronary artery disease, left bundle branch block, and baseline therapies, were not independently associated with SD/ACA. Sex and diabetes mellitus status remained independent predictors in sensitivity analyses, excluding patients with implantable cardioverter-defibrillators and when predicting SD alone. SD accounted for ∼20% of deaths in HFpEF. Male sex and insulin-treated diabetes mellitus identified patients at higher risk for SD/ACA with modest discrimination. These data might guide future SD preventative efforts in HFpEF. (Aldosterone Antagonist Therapy for Adults With Heart Failure and Preserved Systolic Function [TOPCAT]); NCT00094302. Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Effect of heterophoria measurement technique on the clinical accommodative convergence to accommodation ratio.

PubMed

Escalante, Jaime Bernal; Rosenfield, Mark

2006-05-01

Measurement of the stimulus accommodative convergence to accommodation (AC/A) ratio is a standard procedure in clinical optometric practice. Typically, heterophoria is assessed at several accommodative stimulus levels, and the gradient of the vergence to accommodation function computed. A number of procedures are available for the subjective measurement of heterophoria, but it is unclear whether the use of different vergence measurement techniques will alter the obtained AC/A value. Accordingly, the current study compared AC/A ratios measured using 3 clinical subjective heterophoria tests, namely the von Graefe (VG), Maddox Rod (MR), and Modified Thorington (MT) procedures. The AC/A ratio was measured in 60 visually normal subjects between 20 and 25 years of age using each of the 3 procedures listed above. The accommodative stimulus was varied by the introduction of +/-1.00 diopter (D) spherical lenses over the distance refractive correction while subjects viewed a target at a viewing distance of 40 cm. To examine the repeatability of each procedure, the AC/A ratio was measured on 2 separate occasions for each measurement technique, with the 2 sessions being separated by at least 24 hours. Mean values of stimulus AC/A ratio measured using the VG, MR, and MT procedures were 3.47, 2.99, and 2.46Delta/D, respectively. These differences were significant (p=0.0001). In addition, the coefficient of repeatability for the 3 techniques was 2.22, 1.99, and 1.20 Delta/D, respectively. Ratios obtained using the Modified Thorington technique with +/-1.00 D lenses showed the best repeatability, whereas the poorest repeatability was found with the von Graefe technique when only +1.00 D lenses were used to vary the accommodative stimulus. Accordingly, we recommend that that Modified Thorington procedure with +/-1.00 D lenses be used to quantify heterophoria during clinical measurement of the stimulus AC/A ratio.

Early Pleistocene Climate in Western Arid Central Asia Inferred from Loess-Palaeosol Sequences in North Iran

NASA Astrophysics Data System (ADS)

Wang, X.; Wei, H.; Khormali, F.; Taheri, M.; Danukalova, G.; Chen, F.

2016-12-01

Arid central Asia (ACA) is one of the most arid regions in the mid-latitudes and one of the main potential dust sources for the northern hemisphere. The relatively weak study of Pleistocene loess/dust records from in situ ACA hinders our comprehensive understanding of the spatio-temporal record of aeolian loess accumulation and long term climatic changes in Asia as a whole. The northern Iran is located in the westernmost part of ACA. The precipitation here is mainly influenced by the zonal Westerlies, while the dust is mainly transported by regional westerly and northwest-northeasterly winds. Previous loess study in northern Iran demonstrate that most of the loess deposits in this region accumulated during the middle to late Pleistocene, and that the palaeosol and loess layers formed during interglacial and glacial periods, respectively. However, the Early Pleistocene loess and paleoclimate history in this key region remains porely constraints. In this work we focus on the chronology, sedimentology, and paleoclimatic records of the early Pleistocene loess-paleosol sequence in north Iran. Multi-sedimentological evidence suggests the widely distributed red-coloured silt-dominated sediments, unconformably underlying the upper Pleistocene loess successions, in north Iran are aeolian in origin. The dominance of the coarse dust component in the loess samples suggests the main body of the Iranian loess was transported predominantly by the local low-level winds from proximal source regions. Magnetostratigraphy with biostratigraphic age constraints indiciate the red-colored loess accumulated between 2.4 and 1.81 Ma, an equivalent of the Wucheng formation on the Chinese Loess Plateau. Paleoclimatic proxy incies and micromorphological evidence reveals that the climate during the early Pleistocene in the western ACA was semi-arid, but wetter, warmer, and less windy than during the late Pleistocene and present interglacial. Comparison of loess records between north Iran and the Chinese loess Plateau suggest that the orbital-scale palaeoclimatic changes in ACA are in-phase with those of monsoonal Asia, a relationship which was probably related to the growth and decay of northern hemisphere ice sheets.

Unmanned Aircraft Systems (UAS) Integration in the National Airspace System (NAS) Project: Advanced Collision Avoidance System for UAS (ACAS Xu) Interoperability White Paper Presentation

NASA Technical Reports Server (NTRS)

Fern, Lisa

2017-01-01

The Phase 1 DAA Minimum Operational Performance Standards (MOPS) provided requirements for two classes of DAA equipment: equipment Class 1 contains the basic DAA equipment required to assist a pilot in remaining well clear, while equipment Class 2 integrates the Traffic Alert and Collision Avoidance (TCAS) II system. Thus, the Class 1 system provides RWC functionality only, while the Class 2 system is intended to provide both RWC and Collision Avoidance (CA) functionality, in compliance with the Minimum Aviation System Performance (MASPS) for the Interoperability of Airborne Collision Avoidance Systems. The FAAs TCAS Program Office is currently developing Airborne Collision Avoidance System X (ACAS X) to support the objectives of the Federal Aviation Administrations (FAA) Next Generation Air Transportation System Program (NextGen). ACAS X has a suite of variants with a common underlying design that are intended to be optimized for their intended airframes and operations. ACAS Xu being is designed for UAS and allows for new surveillance technologies and tailored logic for platforms with different performance characteristics. In addition to Collision Avoidance (CA) alerting and guidance, ACAS Xu is being tuned to provide RWC alerting and guidance in compliance with the SC 228 DAA MOPS. With a single logic performing both RWC and CA functions, ACAS Xu will provide industry with an integrated DAA solution that addresses many of the interoperability shortcomings of Phase I systems. While the MOPS for ACAS Xu will specify an integrated DAA system, it will need to show compliance with the RWC alerting thresholds and alerting requirements defined in the DAA Phase 2 MOPS. Further, some functional components of the ACAS Xu system such as the remote pilots displayed guidance might be mostly references to the corresponding requirements in the DAA MOPS. To provide a seamless, integrated, RWC-CA system to assist the pilot in remaining well clear and avoiding collisions, several issues need to be addressed within the Phase 2 SC-228 DAA efforts. Interoperability of the RWC and CA alerting and guidance, and ensuring pilot comprehension, compliance and performance, will be a primary research area.

Thermoelectric Mechanism and Interface Characteristics of Cyanide-Free Nanogold-Coated Silver Wire

NASA Astrophysics Data System (ADS)

Tseng, Yi-Wei; Hung, Fei-Yi; Lui, Truan-Sheng

2016-01-01

Traditional bath-plated gold contains a cyanide complex, which is an environmental hazard. In response, our study used a green plating process to produce cyanide-free gold-coated silver (cyanide-free ACA) bonding wire that has been proven to be a feasible alternative to gold bonding wire in semiconductor packaging. In this work, ACA wire annealed at 550°C was found to have stable microstructure and superior mechanical properties. Intermetallic compounds Ag2Al and AuAl2 grew from Ag-Au balls and Al pads after aging at 175°C for 500 h. After current testing, ACA wire was found to have improved electrical properties due to equiaxed grain growth. The gold nanolayer on the Ag surface increased the oxidation resistance. These results provide insights regarding the reliability of ACA wire in advanced bonding processes.

Polyaniline-Coated Activated Carbon Aerogel/Sulfur Composite for High-performance Lithium-Sulfur Battery

NASA Astrophysics Data System (ADS)

Tang, Zhiwei; Jiang, Jinglin; Liu, Shaohong; Chen, Luyi; Liu, Ruliang; Zheng, Bingna; Fu, Ruowen; Wu, Dingcai

2017-12-01

An activated carbon aerogel (ACA-500) with high surface area (1765 m2 g-1), pore volume (2.04 cm3 g-1), and hierarchical porous nanonetwork structure is prepared through direct activation of organic aerogel (RC-500) with a low potassium hydroxide ratio (1:1). Based on this substrate, a polyaniline (PANi)-coated activated carbon aerogel/sulfur (ACA-500-S@PANi) composite is prepared via a simple two-step procedure, including melt-infiltration of sublimed sulfur into ACA-500, followed by an in situ polymerization of aniline on the surface of ACA-500-S composite. The obtained ACA-500-S@PANi composite delivers a high reversible capacity up to 1208 mAh g-1 at 0.2C and maintains 542 mAh g-1 even at a high rate (3C). Furthermore, this composite exhibits a discharge capacity of 926 mAh g-1 at the initial cycle and 615 mAh g-1 after 700 cycles at 1C rate, revealing an extremely low capacity decay rate (0.48‰ per cycle). The excellent electrochemical performance of ACA-500-S@PANi can be attributed to the synergistic effect of hierarchical porous nanonetwork structure and PANi coating. Activated carbon aerogels with high surface area and unique three-dimensional (3D) interconnected hierarchical porous structure offer an efficient conductive network for sulfur, and a highly conductive PANi-coating layer further enhances conductivity of the electrode and prevents the dissolution of polysulfide species.

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.

Early Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non-Expansion States.

PubMed

Courtemanche, Charles; Marton, James; Ukert, Benjamin; Yelowitz, Aaron; Zapata, Daniela

2017-01-01

The Affordable Care Act (ACA) aimed to achieve nearly universal health insurance coverage in the United States through a combination of insurance market reforms, mandates, subsidies, health insurance exchanges, and Medicaid expansions, most of which took effect in 2014. This paper estimates the causal effects of the ACA on health insurance coverage in 2014 using data from the American Community Survey. We utilize difference-in-difference-in-differences models that exploit cross-sectional variation in the intensity of treatment arising from state participation in the Medicaid expansion and local area pre-ACA uninsured rates. This strategy allows us to identify the effects of the ACA in both Medicaid expansion and non-expansion states. Our preferred specification suggests that, at the average pre-treatment uninsured rate, the full ACA increased the proportion of residents with insurance by 5.9 percentage points compared to 2.8 percentage points in states that did not expand Medicaid. Private insurance expansions from the ACA were due to increases in both employer-provided and non-group coverage. The coverage gains from the full ACA were largest for those without a college degree, non-whites, young adults, unmarried individuals, and those without children in the home. We find no evidence that the Medicaid expansion crowded out private coverage.

46 CFR 108.421 - Location of fire pumps and associated equipment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Location of fire pumps and associated equipment. 108.421... pumps and associated equipment. Each fire pump required by § 108.415, and the source of power, controls, sea connections for the fire pump, and booster pumps, if installed, must be installed in locations...

Cerebral blood flow regulation during cognitive tasks

PubMed Central

Sorond, Farzaneh A.; Schnyer, D.M.; Serrador, J.M.; Milberg, W.P.; Lipsitz, L.A.

2008-01-01

Aging is associated with frontal subcortical microangiopathy and executive cognitive dysfunction, suggesting that elderly individuals may have impaired metabolic activation of cerebral blood flow to the frontal lobes. We used transcranial Doppler (TCD) ultrasound to examine the cerebral blood flow response to executive control and visual tasks in the anterior and posterior cerebral circulations and to determine the effects of healthy aging on cerebral blood flow regulation during cognitive tasks. Continuous simultaneous anterior cerebral artery (ACA) and posterior cerebral artery (PCA) blood flow velocities (BFVs) and mean arterial pressure (MAP) were measured in response to word stem completion (WSC) and a visual search (VS) task in 29 healthy subjects (14 young, 30 ± 1.5 years; 15 old, 74 ± 1.4 years). We found that: (1) ACA and PCA blood flow velocities are both significantly increased during WSC and VS cognitive tasks, (2) ACA and PCA activations were task specific in our young volunteers, with ACA > PCA BFV during the WSC task and PCA > ACA BFV during the VS task, (3) while healthy elderly subjects also had PCA > ACA BFV during the VS task, they did not have ACA > PCA activation during the WSC task, and (4) healthy elderly subjects tend to have overall greater increases in BFV during both cognitive tasks. We conclude that TCD can be used to monitor cerebrovascular hemodynamics during the performance of cognitive tasks. Our data suggest that there is differential blood flow increase in the ACA and PCA in young versus elderly subjects during cognitive tasks. PMID:18387547

Cancer Preventive Services, Socioeconomic Status and the Affordable Care Act

PubMed Central

Cooper, Gregory S; Kou, Tzuyung Doug; Dor, Avi; Koroukian, Siran M; Schluchter, Mark D

2016-01-01

Background Out of pocket expenditures are thought to be an important barrier to receipt of cancer preventive services, especially among lower socioeconomic status (SES). The Affordable Care Act (ACA) eliminated out-of-pocket expenditures for recommended services, including mammography and colonoscopy. Our objective was to determine changes in uptake of mammography and colonoscopy among fee-for-service Medicare beneficiaries before and after ACA implementation. Methods Using Medicare claims data, we identified women ≥ 70 without mammography in the previous 2 years, and men and women ≥ 70 at increased risk for colorectal cancer without colonoscopy in the past 5 years. We identified procedure receipt in the two-year period prior to ACA implementation (2009-2010) and after implementation (2011-September 2012). Multivariable generalized estimating equation models determine the independent association of and county-level quartile of median income and education with receipt of testing. Results For mammography, lower SES quartile was associated with less uptake but the post-ACA disparities were smaller compared to the pre-ACA period. In addition, mammography rates increased from pre- to post-ACA in all SES quartiles. For colonoscopy, in both the pre- and post-ACA periods, there was an association between uptake and educational level and to some extent, income. However, there were no appreciable changes with colonoscopy and SES following the ACA. Conclusions Removal of out-of-pocket expenditures may overcome a barrier to receipt of recommended preventive services but for colonoscopy, other procedural factors may remain as deterrents. PMID:28067955

Combining native MS approaches to decipher archaeal box H/ACA ribonucleoprotein particle structure and activity.

PubMed

Saliou, Jean-Michel; Manival, Xavier; Tillault, Anne-Sophie; Atmanene, Cédric; Bobo, Claude; Branlant, Christiane; Van Dorsselaer, Alain; Charpentier, Bruno; Cianférani, Sarah

2015-08-01

Site-specific isomerization of uridines into pseudouridines in RNAs is catalyzed either by stand-alone enzymes or by box H/ACA ribonucleoprotein particles (sno/sRNPs). The archaeal box H/ACA sRNPs are five-component complexes that consist of a guide RNA and the aCBF5, aNOP10, L7Ae, and aGAR1 proteins. In this study, we performed pairwise incubations of individual constituents of archaeal box H/ACA sRNPs and analyzed their interactions by native MS to build a 2D-connectivity map of direct binders. We describe the use of native MS in combination with ion mobility-MS to monitor the in vitro assembly of the active H/ACA sRNP particle. Real-time native MS was used to monitor how box H/ACA particle functions in multiple-turnover conditions. Native MS also unambiguously revealed that a substrate RNA containing 5-fluorouridine (f(5) U) was hydrolyzed into 5-fluoro-6-hydroxy-pseudouridine (f(5) ho(6) Ψ). In terms of enzymatic mechanism, box H/ACA sRNP was shown to catalyze the pseudouridylation of a first RNA substrate, then to release the RNA product (S22 f(5) ho(6) ψ) from the RNP enzyme and reload a new substrate RNA molecule. Altogether, our native MS-based approaches provide relevant new information about the potential assembly process and catalytic mechanism of box H/ACA RNPs. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Peri-operative blood-loss after total hip arthroplasty can be significantly reduced with topical application of epsilon-aminocaproic acid.

PubMed

Sucher, Mark G; Giordani, Mauro; Figoni, Andrew; Nedopil, Alexander J

2016-10-01

To evaluate the peri-operative blood loss with the use of epsilon-aminocaproic acid (ε-ACA) in total hip arthroplasty (THA). One hundred sixty patients treated with THA were followed; 5 g ε-ACA diluted in 100 ml normal saline was applied intra-operatively. Eighty patients not receiving ε-ACA (non ε-ACA group) and eighty patients receiving ε-ACA (ε-ACA group) were compared regarding blood loss, need of transfusion, and thrombo-embolic complications. Blood loss (mean ± SD) for the non ε-ACA group was 1678 ± 515 ml and for the ε-ACA group 1403 ± 417 ml (p < 0.05). In the non ε-ACA group 23 patients needed blood transfusions compared to ten patients in the ε-ACA group (p < 0.05). Cost savings were $284.39 per patient. No patient in either group developed a thrombo-embolic complication. This study demonstrates a significant reduction in peri-operative blood loss after THA with topically applied ε-ACA. The application of ε-ACA reduced costs by lowering transfusion rates and did not increase thrombo-embolic events. ε-ACA is safe and effective in reducing blood loss and cost-efficient in THA.

Suppression of microRNA-629 enhances sensitivity of cervical cancer cells to 1'S-1'-acetoxychavicol acetate via regulating RSU1.

PubMed

Phuah, Neoh Hun; Azmi, Mohamad Nurul; Awang, Khalijah; Nagoor, Noor Hasima

2017-01-01

Cervical cancer is the fourth most frequent malignancy affecting women worldwide, but drug resistance and toxicities remain a major challenge in chemotherapy. The use of natural compounds is promising because they are less toxic and able to target multiple signaling pathways. The 1'S-1'-acetoxychavicol acetate (ACA), a natural compound isolated from wild ginger Alpinia conchigera , induced cytotoxicity on various cancer cells including cervical cancer. MicroRNAs (miRNAs) are short noncoding RNAs that regulate numerous biological processes, such as apoptosis and chemosensitivity. Past studies reported that miR-629 is upregulated in many cancers, and its expression was altered in ACA-treated cervical cancer cells. However, the role of miR-629 in regulating sensitivity toward ACA or other anticancer agents has not been reported. Hence, this study aims to investigate the role of miR-629 in regulating response toward ACA on cervical cancer cells. The miR-629 expression following transfection with miR-629 hairpin inhibitor and hairpin inhibitor negative control was measured using quantitative real-time polymerase chain reaction (RT-qPCR). The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was used to investigate sensitivity toward ACA. Apoptosis was detected using Annexin V/propidium iodide and Caspase 3/7 assays. The gene target for miR-629 was identified using miRNA target prediction programs, luciferase reporter assay and Western blots. Gene overexpression studies were performed to evaluate its role in regulating response toward ACA. Transfection with miR-629 hairpin inhibitor downregulated its expression in both cervical cancer cell lines. Suppression of miR-629 increased sensitivity toward ACA by reducing cell proliferation and inducing apoptosis. Luciferase reporter assay confirmed RSU1 as a direct target of miR-629. Overexpression of miR-629 decreased RSU1 protein expression, while inhibition of miR-629 increased RSU1 protein expression. Overexpression of RSU1 augmented antiproliferative and apoptosis-inducing effects of ACA. Our findings showed that combination of ACA with miR-629 and RSU1 may provide a potential strategy in treating cervical cancer.

Antihypertensive and vasorelaxant effects of aqueous extract of Artemisia campestris L. from Eastern Morocco.

PubMed

Dib, Ikram; Tits, Monique; Angenot, Luc; Wauters, Jean Noel; Assaidi, Asmae; Mekhfi, Hassane; Aziz, Mohammed; Bnouham, Mohammed; Legssyer, Abdelkhaleq; Frederich, Michel; Ziyyat, Abderrahim

2017-07-12

Artemisia campestris L. (Asteraceae) has many traditional uses, among which treatment of diabetes and hypertension. This study was conducted in order to confirm the antihypertensive and hypotensive effects of A. campestris L. aqueous extract (AcAE) and to explore the underlying mechanism of action of its vasorelaxant effect, besides the acute toxicity. Also, the chemical composition of AcAE was investigated. the chemical content of AcAE was determined by using HPLC and NMR techniques. The antihypertensive effect was assessed indirectly by tail-cuff method on L-NAME induced hypertensive rats, while the hypotensive action was monitored intravenously by invasive method on normotensive rats. The vasorelaxant effect and vascular mechanism of action were studied in the presence of antagonists and blockers on aorta isolated from normotensive rats. On the other side, the acute toxicity was studied by oral feeding of extract to the mice. The global phytochemical profile of AcAE reveals the presence of several polyphenols as main components. A. campestris L. infusion was characterized by mono- and di-cinnamoyl compounds, with 3,5-dicaffeoylquinic (isochlorogenic A) acid being the main compound, followed by 5-caffeoylquinic (chlorogenic) acid. Vicenin-2 (apigenin 6,8-di-C-glucoside) appeared to be the most abundant compound among flavonoids. The daily treatment with AcAE at 150mg/kg/day prevented the installation of hypertension on L-NAME hypertensive rats, and reduced SBP from 172mmHg up to 144mmHg. At the dose 40mg/kg, AcAE provoked reduction of systolic (SBP), diastolic (DBP) and mean arterial pressure (MAP), without affecting the heart rate. Also, AcAE (10 -2 -2mg/ml) relaxed the precontracted aorta by 95.8±1.3%. The denudation and preincubation of aorta with atropine, calmidazolium, L-NAME, hydroxycobalamin, ODQ, 8-RP-Br-PET-cGMP, thapsigargin and verapamil attenuated the vasorelaxant response, while the pre-treatment with 4-AP, TEA, glibenclamide and BaCl 2 did not alter this effect. The oral administration of AcAE (0-6g/kg) reveals no mortality or toxicity. our study proved that AcAE possess an important antihypertensive, hypotensive and vasorelaxant effect, which is mediated via calmodulin-NO-cGC-PKG pathway, and via inhibition of calcium influx through voltage-operated calcium channels and activation of intracellular calcium mobilization into sarcoplasmic reticulum. Therefore, our findings give first evidence about the traditional use of A. campestris L. as antihypertensive plant. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Shortwave direct radiative effects of above-cloud aerosols over global oceans derived from 8 years of CALIOP and MODIS observations

NASA Astrophysics Data System (ADS)

Zhang, Zhibo; Meyer, Kerry; Yu, Hongbin; Platnick, Steven; Colarco, Peter; Liu, Zhaoyan; Oreopoulos, Lazaros

2016-03-01

In this paper, we studied the frequency of occurrence and shortwave direct radiative effects (DREs) of above-cloud aerosols (ACAs) over global oceans using 8 years (2007-2014) of collocated CALIOP and MODIS observations. Similar to previous work, we found high ACA occurrence in four regions: southeastern (SE) Atlantic region, where ACAs are mostly light-absorbing aerosols, i.e., smoke and polluted dust according to CALIOP classification, originating from biomass burning over the African Savanna; tropical northeastern (TNE) Atlantic and the Arabian Sea, where ACAs are predominantly windblown dust from the Sahara and Arabian deserts, respectively; and the northwestern (NW) Pacific, where ACAs are mostly transported smoke and polluted dusts from Asian. From radiative transfer simulations based on CALIOP-MODIS observations and a set of the preselected aerosol optical models, we found the DREs of ACAs at the top of atmosphere (TOA) to be positive (i.e., warming) in the SE Atlantic and NW Pacific regions, but negative (i.e., cooling) in the TNE Atlantic Ocean and the Arabian Sea. The cancellation of positive and negative regional DREs results in a global ocean annual mean diurnally averaged cloudy-sky DRE of 0.015 W m-2 (range of -0.03 to 0.06 W m-2) at TOA. The DREs at surface and within the atmosphere are -0.15 W m-2 (range of -0.09 to -0.21 W m-2), and 0.17 W m-2 (range of 0.11 to 0.24 W m-2), respectively. The regional and seasonal mean DREs are much stronger. For example, in the SE Atlantic region, the JJA (July-August) seasonal mean cloudy-sky DRE is about 0.7 W m-2 (range of 0.2 to 1.2 W m-2) at TOA. All our DRE computations are publicly available1. The uncertainty in our DRE computations is mainly caused by the uncertainties in the aerosol optical properties, in particular aerosol absorption, the uncertainties in the CALIOP operational aerosol optical thickness retrieval, and the ignorance of cloud and potential aerosol diurnal cycle. In situ and remotely sensed measurements of ACA from future field campaigns and satellite missions and improved lidar retrieval algorithm, in particular vertical feature masking, would help reduce the uncertainty.

Shortwave Direct Radiative Effects of Above-Cloud Aerosols Over Global Oceans Derived From 8 Years of CALIOP and MODIS Observations

NASA Technical Reports Server (NTRS)

Zhang, Zhibo; Meyer, Kerry; Yu, Hongbin; Platnick, Steven; Colarco, Peter; Liu, Zhaoyan; Oraiopoulos, Lazaros

2016-01-01

In this paper, we studied the frequency of occurrence and shortwave direct radiative effects (DREs) of above-cloud aerosols (ACAs) over global oceans using 8 years (2007-2014) of collocated CALIOP and MODIS observations. Similar to previous work, we found high ACA occurrence in four regions: southeastern (SE) Atlantic region, where ACAs are mostly light-absorbing aerosols, i.e., smoke and polluted dust according to CALIOP classification, originating from biomass burning over the African Savanna; tropical northeastern (TNE) Atlantic and the Arabian Sea, where ACAs are predominantly windblown dust from the Sahara and Arabian deserts, respectively; and the northwestern (NW) Pacific, where ACAs are mostly transported smoke and polluted dusts from Asia. From radiative transfer simulations based on CALIOP-MODIS observations and a set of the preselected aerosol optical models, we found the DREs of ACAs at the top of atmosphere (TOA) to be positive (i.e., warming) in the SE Atlantic and NW Pacific regions, but negative (i.e., cooling) in the TNE Atlantic Ocean and the Arabian Sea. The cancellation of positive and negative regional DREs results in a global ocean annual mean diurnally averaged cloudy-sky DRE of 0.015 W m(exp. -2) [range of -0.03 to 0.06 W m (exp. -2)] at TOA. The DREs at surface and within the atmosphere are -0.015 W m(exp. -2) [range of -0.09 to -0.21 W m(exp. -2)], and 0.17 W m(exp. -2) [range of 0.11 to 0.24 W m(exp. -2)], respectively. The regional and seasonal mean DREs are much stronger. For example, in the SE Atlantic region, the JJA (July-August) seasonal mean cloudy-sky DRE is about 0.7 W m(exp. -2) [range of 0.2 to 1.2 W m(exp. -2)] at TOA. All our DRE computations are publicly available. The uncertainty in our DRE computations is mainly caused by the uncertainties in the aerosol optical properties, in particular aerosol absorption, the uncertainties in the CALIOP operational aerosol optical thickness retrieval, and the ignorance of cloud and potential aerosol diurnal cycle. In situ and remotely sensed measurements of ACA from future field campaigns and satellite missions and improved lidar retrieval algorithm, in particular vertical feature masking, would help reduce the uncertainty.

Dysregulation of H/ACA ribonucleoprotein components in chronic lymphocytic leukemia.

PubMed

Dos Santos, Patricia Carolina; Panero, Julieta; Stanganelli, Carmen; Palau Nagore, Virginia; Stella, Flavia; Bezares, Raimundo; Slavutsky, Irma

2017-01-01

Telomeres are protective repeats of TTAGGG sequences located at the end of human chromosomes. They are essential to maintain chromosomal integrity and genome stability. Telomerase is a ribonucleoprotein complex containing an internal RNA template (hTR) and a catalytic subunit (hTERT). The human hTR gene consists of three major domains; among them the H/ACA domain is essential for telomere biogenesis. H/ACA ribonucleoprotein (RNP) complex is composed of four evolutionary conserved proteins, including dyskerin (encoded by DKC1 gene), NOP10, NHP2 and GAR1. In this study, we have evaluated the expression profile of the H/ACA RNP complex genes: DKC1, NOP10, NHP2 and GAR1, as well as hTERT and hTR mRNA levels, in patients with chronic lymphocytic leukemia (CLL). Results were correlated with the number and type of genetic alteration detected by conventional cytogenetics and FISH (fluorescence in situ hybridization), IGHV (immunoglobulin heavy chain variable region) mutational status, telomere length (TL) and clinico-pathological characteristics of patients. Our results showed significant decreased expression of GAR1, NOP10, DKC1 and hTR, as well as increased mRNA levels of hTERT in patients compared to controls (p≤0.04). A positive correlation between the expression of GAR1-NHP2, GAR1-NOP10, and NOP10-NHP2 (p<0.0001), were observed. The analysis taking into account prognostic factors showed a significant increased expression of hTERT gene in unmutated-IGHV cases compared to mutated-CLL patients (p = 0.0185). The comparisons among FISH groups exhibited increased expression of DKC1 in cases with two or more alterations with respect to no abnormalities, trisomy 12 and del13q14, and of NHP2 and NOP10 compared to those with del13q14 (p = 0.03). The analysis according to TL showed a significant increased expression of hTERT (p = 0.0074) and DKC1 (p = 0.0036) in patients with short telomeres compared to those with long TL. No association between gene expression and clinical parameters was found. Our results suggest a role for these telomere associated genes in genomic instability and telomere dysfunction in CLL.

Comparative effectiveness of epsilon-aminocaproic acid and tranexamic acid on postoperative bleeding following cardiac surgery during a national medication shortage.

PubMed

Blaine, Kevin P; Press, Christopher; Lau, Ken; Sliwa, Jan; Rao, Vidya K; Hill, Charles

2016-12-01

The aim of this study was to compare the effectiveness of epsilon-aminocaproic acid (εACA) and tranexamic acid (TXA) in contemporary clinical practice during a national medication shortage. A retrospective cohort study. The study was performed in all consecutive cardiac surgery patients (n=128) admitted to the cardiac-surgical intensive care unit after surgery at a single academic center immediately before and during a national medication shortage. Demographic, clinical, and outcomes data were compared by descriptive statistics using χ 2 and t test. Surgical drainage and transfusions were compared by multivariate linear regression for patients receiving εACA before the shortage and TXA during the shortage. In multivariate analysis, no statistical difference was found for surgical drain output (OR 1.10, CI 0.97-1.26, P=.460) or red blood cell transfusion requirement (OR 1.79, CI 0.79-2.73, P=.176). Patients receiving εACA were more likely to receive rescue hemostatic medications (OR 1.62, CI 1.02-2.55, P=.041). Substitution of εACA with TXA during a national medication shortage produced equivalent postoperative bleeding and red cell transfusions, although patients receiving εACA were more likely to require supplemental hemostatic agents. Published by Elsevier Inc.

Effect of Nano-SiO2 on the Early Hydration of Alite-Sulphoaluminate Cement

PubMed Central

Sun, Jinfeng; Xu, Zhiqiang; Li, Weifeng; Shen, Xiaodong

2017-01-01

The impact of nano-SiO2 on the early hydration properties of alite-sulphoaluminate (AC$A) cement was investigated with a fixed water to solid ratio (w/s) of one. Nano-SiO2 was used in partial substitution of AC$A cement at zero, one and three wt %. Calorimetry, X-ray diffraction (XRD), thermogravimetric/derivative thermogravimetric (TG/DTG), mercury intrusion porosimetry (MIP) and scanning electron microscopy (SEM) analyses were used to characterize the hydration and hydrates of the blended cement. The hydration of the AC$A cement was significantly promoted, resulting in an increase of the heat released with the addition of nano-SiO2. Phase development composition analysis showed that nano-SiO2 had no effect on the type of crystalline hydration products of the AC$A cement. Moreover, nano-SiO2 showed significant positive effects on pore refinement where the total porosity decreased by 54.09% at three days with the inclusion of 3% nano-SiO2. Finally, from the SEM observations, nano-SiO2 was conducive to producing a denser microstructure than that of the control sample. PMID:28467348

Revascularization of the anterior cerebral artery by Y-shaped superficial temporal artery interposition graft for the treatment of a de novo aneurysm arising at the site of A3-A3 bypass: technical case report.

PubMed

Endo, Hidenori; Sugiyama, Shin-Ichiro; Endo, Toshiki; Fujimura, Miki; Shimizu, Hiroaki; Tominaga, Teiji

2017-12-22

The most frequently used option to reconstruct the anterior cerebral artery (ACA) is an ACA-ACA side-to-side anastomosis. The long-term outcome and complications of this technique are unclear. The authors report a case of a de novo aneurysm arising at the site of A 3 -A 3 anastomosis. A 53-year-old woman underwent A 3 -A 3 side-to-side anastomosis for the treatment of a ruptured right A 2 dissecting aneurysm. At 44 months after surgery, a de novo aneurysm developed at the site of anastomosis. The aneurysm developed in the front wall of the anastomosis site, and projected to the anterosuperior direction. A computational fluid dynamics (CFD) study showed the localized region with high wall shear stress coincident with the pulsation in the front wall of the anastomosis site, where the aneurysm developed. A Y-shaped superficial temporal artery (STA) interposition graft was used successfully to reconstruct both ACAs, and then the aneurysm was trapped. To the authors' knowledge, this is the first case of a de novo aneurysm that developed at the site of an ACA-ACA side-to-side anastomosis. A CFD study showed that hemodynamic stress might be an underlying cause of the aneurysm formation. A Y-shaped STA interposition graft is a useful option to treat this aneurysm. Long-term follow-up is necessary to detect this rare complication after ACA-ACA anastomosis.

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

Antioxidant, antibacterial, anti-inflammatory and wound healing effects of Artemisia campestris aqueous extract in rat.

PubMed

Ghlissi, Zohra; Sayari, Nadhim; Kallel, Rim; Bougatef, Ali; Sahnoun, Zouheir

2016-12-01

This study investigated some biological properties of Artemisia campestris aqueous extract (ACAE) as well its global chemical compositions. Twenty four rats were excised on the posterior neck skin area and divided into 4 groups, treated respectively with: sterile saline, glycerol, CICAFLORA and ACAE. The wound closure rate, histopathology evolution and the superoxide dismutase (SOD), catalase (CAT) and malondialdehyde (MDA) level in skin tissue were evaluated. Anti-inflammatory activity was studied by carrageenan-induced rat paw edema. Animals were divided into 3 groups pre-treated respectively with sterile saline, acetylsalicylic acid (AA) and ACAE. The antibacterial activity was tested against six bacteria and the antioxidant activity was estimated by the 1,1-diphenyl-2-picrylhydrazyl (DPPH), reducing power and β-carotene activities. Our results demonstrated a significant improvement in wound healing progression and in oxidative stress damage in the wounds tissues of ACAE-treated rats, compared to control. ACAE-treated rats revealed also a significant inhibition of carrageenan-induced hind paws edema as confirmed by the histological analysis. In addition to the antioxidant activity, ACAE showed considerable antibacterial activities. ACAE exhibited important wound healing effect probably due to the anti-inflammatory, antibacterial and antioxidant activities of its phytochemical contents. Therefore, this study confirms its popular use and highlights its promise in the development of new drugs. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

76 FR 46325 - Notice of Lodging of Stipulated Order Under the Clean Water Act

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-02

... located on St. Croix, and (b) implement repairs at the Figtree Pump Station, the Barren Spot Pump Station... emergency backup pump available at the Figtree, Barren Spot, LBJ, and Lagoon Street pump stations located on... the Barren Spot, Lagoon Street, Figtree and LBJ pump stations located on St. Thomas and to the Cancryn...

OGLE-IV Transient Search report 31 December 2016, part 2

NASA Astrophysics Data System (ADS)

Wyrzykowski, L.; Hamanowicz, A.; Kostrzewa-Rutkowska, Z.; Klencki, J.; Sitek, M.; Udalski, A.; Kozlowski, S.; Ulaczyk, K.; Soszynski, I.; Mroz, P.; Szymanski, M. K.; Poleski, R.; Pietrukowicz, P.; Pawlak, M.; Skowron, J.

2016-12-01

The OGLE-IV Transient Detection System (Wyrzykowski et al. 2014, AcA,64,197; Kozlowski et al. 2013; Klencki et al. 2016, AcA, 66,15) announces discovery of 46 transients discovered in last three months.

Overview of the Affordable Care Act's impact on military and veteran mental health services: nine implications for significant improvements in care.

PubMed

Russell, Mark C; Figley, Charles R

2014-01-01

On March 23, 2010, President Barack Obama signed the Affordable Care Act (ACA) into law. Implications of the ACA on mental health care for 9.7 million military active-duty, reserve, and family members and 22.2 million veterans, as well as 1.3 uninsured veterans, is reviewed in light of a major crisis. The authors trace historical roots of the ACA to the World War II generation and efforts to transform the mental health care system by implementing hard-won war trauma lessons. The authors posit 9 principles reflected in the ACA that represent unfulfilled generational war trauma lessons and potential transformation of the military and national mental health care systems.

Revisiting the structure/function relationships of H/ACA(-like) RNAs: a unified model for Euryarchaea and Crenarchaea

PubMed Central

Toffano-Nioche, Claire; Gautheret, Daniel; Leclerc, Fabrice

2015-01-01

A structural and functional classification of H/ACA and H/ACA-like motifs is obtained from the analysis of the H/ACA guide RNAs which have been identified previously in the genomes of Euryarchaea (Pyrococcus) and Crenarchaea (Pyrobaculum). A unified structure/function model is proposed based on the common structural determinants shared by H/ACA and H/ACA-like motifs in both Euryarchaea and Crenarchaea. Using a computational approach, structural and energetic rules for the guide:target RNA-RNA interactions are derived from structural and functional data on the H/ACA RNP particles. H/ACA(-like) motifs found in Pyrococcus are evaluated through the classification and their biological relevance is discussed. Extra-ribosomal targets found in both Pyrococcus and Pyrobaculum might support the hypothesis of a gene regulation mediated by H/ACA(-like) guide RNAs in archaea. PMID:26240384

77 FR 65006 - Air Cargo Advance Screening (ACAS) Pilot Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-24

... later than the time of departure of the aircraft for the United States (from specified locations) or... earliest point practicable prior to loading of the cargo onto the aircraft destined to or transiting... electronic cargo information by way of a CBP-approved electronic data interchange (EDI) system before the...

1′-Acetoxychavicol Acetate Isolated from Alpinia galanga Ameliorates Ovalbumin-Induced Asthma in Mice

PubMed Central

Park, Sang-Joon; Lee, Eun-Ji; Lee, Jong-Hwa; Han, Sang-Seop; Pyo, Byeong Sik; Park, Dae-Hun; Kim, Bong-Hee

2013-01-01

The World Health Organization reports that 235 million people are currently affected by asthma. This disease is associated with an imbalance of Th1 and Th2 cells, which results in the upregulation of cytokines that promote chronic inflammation of the respiratory system. The inflammatory response causes airway obstruction and can ultimately result in death. In this study we evaluated the effect of 1′-acetoxychavicol acetate (ACA) isolated from Alpinia galanga rhizomes in a mouse model of ovalbumin (OVA)-induced asthma. To generate the mouse model, BALB/c mice were sensitized by intraperitoneal injection of OVA and then challenged with OVA inhalation for 5 days. Mice in the vehicle control group were sensitized with OVA but not challenged with OVA. Treatment groups received dexamethasone, 25 mg/kg/day ACA, or 50 mg/kg/day ACA for 5 days. Asthma-related inflammation was assessed by bronchoalveolar lavage fluid cell counts and histopathological and immunohistochemical analysis of lung tissues. Our results showed that ACA reduced the infiltration of white blood cells (especially eosinophils) and the level of IgE in the lungs of mice challenged with OVA and suppressed histopathological changes such as airway remodeling, goblet-cell hyperplasia, eosinophil infiltration, and glycoprotein secretion. In addition, ACA inhibited expression of the Th2 cytokines interleukin (IL)-4 and IL-13, and Th1 cytokines IL-12α and interferon-γ. Because asthmatic reactions are mediated by diverse immune and inflammatory pathways, ACA shows promise as an antiasthmatic drug candidate. PMID:23451048

Validating Above-cloud Aerosol Optical Depth Retrieved from MODIS using NASA Ames Airborne Sun-Tracking Photometric and Spectrometric (AATS and 4STAR) Measurements

NASA Astrophysics Data System (ADS)

Jethva, H. T.; Torres, O.; Remer, L. A.; Redemann, J.; Dunagan, S. E.; Livingston, J. M.; Shinozuka, Y.; Kacenelenbogen, M. S.; Segal-Rosenhaimer, M.

2014-12-01

Absorbing aerosols produced from biomass burning and dust outbreaks are often found to overlay the lower level cloud decks as evident in the satellite images. In contrast to the cloud-free atmosphere, in which aerosols generally tend to cool the atmosphere, the presence of absorbing aerosols above cloud poses greater potential of exerting positive radiative effects (warming) whose magnitude directly depends on the aerosol loading above cloud, optical properties of clouds and aerosols, and cloud fraction. In recent years, development of algorithms that exploit satellite-based passive measurements of ultraviolet (UV), visible, and polarized light as well as lidar-based active measurements constitute a major breakthrough in the field of remote sensing of aerosols. While the unprecedented quantitative information on aerosol loading above cloud is now available from NASA's A-train sensors, a greater question remains ahead: How to validate the satellite retrievals of above-cloud aerosols (ACA)? Direct measurements of ACA such as carried out by the NASA Ames Airborne Tracking Sunphotometer (AATS) and Spectrometer for Sky-Scanning, Sun-Tracking Atmospheric Research (4STAR) can be of immense help in validating ACA retrievals. In this study, we validate the ACA optical depth retrieved using the 'color ratio' (CR) method applied to the MODIS cloudy-sky reflectance by using the airborne AATS and 4STAR measurements. A thorough search of the historic AATS-4STAR database collected during different field campaigns revealed five events where biomass burning, dust, and wildfire-emitted aerosols were found to overlay lower level cloud decks observed during SAFARI-2000, ACE-ASIA 2001, and SEAC4RS-2013, respectively. The co-located satellite-airborne measurements revealed a good agreement (root-mean-square-error<0.1 for Aerosol Optical Depth (AOD) at 500 nm) with most matchups falling within the estimated uncertainties in the MODIS retrievals (-10% to +50%). An extensive validation of satellite-based ACA retrievals requires equivalent field measurements particularly over the regions where ACA are often observed from satellites, i.e., south-eastern Atlantic Ocean, tropical Atlantic Ocean, northern Arabian Sea, South-East and North-East Asia.

Differences in the Stimulus Accommodative Convergence/Accommodation Ratio using Various Techniques and Accommodative Stimuli.

PubMed

Satou, Tsukasa; Ito, Misae; Shinomiya, Yuma; Takahashi, Yoshiaki; Hara, Naoto; Niida, Takahiro

2018-04-04

To investigate differences in the stimulus accommodative convergence/accommodation (AC/A) ratio using various techniques and accommodative stimuli, and to describe a method for determining the stimulus AC/A ratio. A total of 81 subjects with a mean age of 21 years (range, 20-23 years) were enrolled. The relationship between ocular deviation and accommodation was assessed using two methods. Ocular deviation was measured by varying the accommodative requirement using spherical plus/minus lenses to create an accommodative stimulus of 10.00 diopters (D) (in 1.00 D steps). Ocular deviation was assessed using the alternate prism cover test in method 1 at distance (5 m) and near (1/3 m), and the major amblyoscope in method 2. The stimulus AC/A ratios obtained using methods 1 and 2 were calculated and defined as the stimulus AC/A ratios with low and high accommodation, respectively, using the following analysis method. The former was calculated as the difference between the convergence response to an accommodative stimulus of 3 D and 0 D, divided by 3. The latter was calculated as the difference between the convergence response to a maximum (max) accommodative stimulus with distinct vision of the subject and an accommodative stimulus of max minus 3.00 D, divided by 3. The median stimulus AC/A ratio with low accommodation (1.0 Δ/D for method 1 at distance, 2.0 Δ/D for method 1 at near, and 2.7 Δ/D for method 2) differed significantly among the measurement methods (P < 0.01). Differences in the median stimulus AC/A ratio with high accommodation (4.0 Δ/D for method 1 at distance, 3.7 Δ/D for method 1 at near, and 4.7 Δ/D for method 2) between method 1 at distance and method 2 were statistically significant (P < 0.05), while method 1 at near was not significantly different compared with other methods. Differences in the stimulus AC/A ratio value were significant according to measurement technique and accommodative stimuli. However, differences caused by measurement technique may be reduced by using a high accommodative stimulus during measurements.

Anticardiolipin antibodies in rheumatoid arthritis.

PubMed

Keane, A; Woods, R; Dowding, V; Roden, D; Barry, C

1987-10-01

Anticardiolipin antibody (ACA) was present in the sera of 49% of 90 consecutive patients with rheumatoid arthritis (RA). The ACA was absent in 30 control patients with osteoarthritis. C-reactive protein levels equal to or exceeding 7 mg/dl were found in 10 patients all of whom were ACA positive. ACA was present in a larger proportion of rheumatoid factor (RF) positive than of RF negative patients. Male sex and extra-articular manifestations of RA were both more common in ACA positive than ACA negative patients. In the ACA positive group the lupus anticoagulant and VDRL tests were negative. However, a small number of patients had evidence of vascular events.

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 incorporating into the osteopathic medical curriculum knowledge of the dynamics of health care policy and reform and for creating opportunities for students to follow health policy developments as they evolve in real time. © 2015 The American Osteopathic Association.

Three Dimensional Imaging of Helicon Wave Fields Via Magnetic Induction Probes

DTIC Science & Technology

2009-07-13

Elastomer Flange 50 The chamber is pumped by a Varian TV-300 HT turbomolecular vacuum pump with a pumping speed of 250 l/s backed by a dry scroll ... vacuum diffusion chamber with pump locations .................................................. 49 Figure 3.2. RF power delivery system...steel, 0.5 meter diameter by 1.0 meter long vacuum chamber. It has 24 access ports / flanges of varying diameter for diagnostic feed-throughs, pumping

Frequency of distracting tasks people do while driving : an analysis of the ACAS FOT data.

DOT National Transportation Integrated Search

2007-06-01

This report describes further analysis of data from the advanced collision avoidance system (ACAS) field operational test, a naturalistic driving study. To determine how distracted and nondistracted driving differ, a stratified sample of 2,914 video ...

OGLE-IV Transient Search report 25 September 2017 part 2

NASA Astrophysics Data System (ADS)

Wyrzykowski, L.; Gromadzki, M.; Hamanowicz, A.; Rybicki, K.; Klencki, J.; Kozlowski, S.; Udalski, A.; Poleski, R.; Szymanski, M. K.; Skowron, J.; Ulaczyk, K.; Pawlak, M.; Mroz, P.; Soszynski, I.; Pietrukowicz, P.; Sitek, M.; Ihanec, N.

2017-09-01

The OGLE-IV Transient Detection System (Wyrzykowski et al. 2014, AcA,64,197; Kozlowski et al. 2013; Klencki et al. 2016, AcA, 66,15) announces discovery of 49 new on-going and recently finished transients discovered since Jan 2017.

Changes in Self-reported Insurance Coverage, Access to Care, and Health Under the Affordable Care Act.

PubMed

Sommers, Benjamin D; Gunja, Munira Z; Finegold, Kenneth; Musco, Thomas

2015-07-28

The Affordable Care Act (ACA) completed its second open enrollment period in February 2015. Assessing the law's effects has major policy implications. To estimate national changes in self-reported coverage, access to care, and health during the ACA's first 2 open enrollment periods and to assess differences between low-income adults in states that expanded Medicaid and in states that did not expand Medicaid. Analysis of the 2012-2015 Gallup-Healthways Well-Being Index, a daily national telephone survey. Using multivariable regression to adjust for pre-ACA trends and sociodemographics, we examined changes in outcomes for the nonelderly US adult population aged 18 through 64 years (n = 507,055) since the first open enrollment period began in October 2013. Linear regressions were used to model each outcome as a function of a linear monthly time trend and quarterly indicators. Then, pre-ACA (January 2012-September 2013) and post-ACA (January 2014-March 2015) changes for adults with incomes below 138% of the poverty level in Medicaid expansion states (n = 48,905 among 28 states and Washington, DC) vs nonexpansion states (n = 37,283 among 22 states) were compared using a differences-in-differences approach. Beginning of the ACA's first open enrollment period (October 2013). Self-reported rates of being uninsured, lacking a personal physician, lacking easy access to medicine, inability to afford needed care, overall health status, and health-related activity limitations. Among the 507,055 adults in this survey, pre-ACA trends were significantly worsening for all outcomes. Compared with the pre-ACA trends, by the first quarter of 2015, the adjusted proportions who were uninsured decreased by 7.9 percentage points (95% CI, -9.1 to -6.7); who lacked a personal physician, -3.5 percentage points (95% CI, -4.8 to -2.2); who lacked easy access to medicine, -2.4 percentage points (95% CI, -3.3 to -1.5); who were unable to afford care, -5.5 percentage points (95% CI, -6.7 to -4.2); who reported fair/poor health, -3.4 percentage points (95% CI, -4.6 to -2.2); and the percentage of days with activities limited by health, -1.7 percentage points (95% CI, -2.4 to -0.9). Coverage changes were largest among minorities; for example, the decrease in the uninsured rate was larger among Latino adults (-11.9 percentage points [95% CI, -15.3 to -8.5]) than white adults (-6.1 percentage points [95% CI, -7.3 to -4.8]). Medicaid expansion was associated with significant reductions among low-income adults in the uninsured rate (differences-in-differences estimate, -5.2 percentage points [95% CI, -7.9 to -2.6]), lacking a personal physician (-1.8 percentage points [95% CI, -3.4 to -0.3]), and difficulty accessing medicine (-2.2 percentage points [95% CI, -3.8 to -0.7]). The ACA's first 2 open enrollment periods were associated with significantly improved trends in self-reported coverage, access to primary care and medications, affordability, and health. Low-income adults in states that expanded Medicaid reported significant gains in insurance coverage and access compared with adults in states that did not expand Medicaid.

Genome-wide analysis of wheat calcium ATPases and potential role of selected ACAs and ECAs in calcium stress.

PubMed

Aslam, Roohi; Williams, Lorraine E; Bhatti, Muhammad Faraz; Virk, Nasar

2017-10-27

P 2 - type calcium ATPases (ACAs-auto inhibited calcium ATPases and ECAs-endoplasmic reticulum calcium ATPases) belong to the P- type ATPase family of active membrane transporters and are significantly involved in maintaining accurate levels of Ca 2+ , Mn 2+ and Zn 2+ in the cytosol as well as playing a very important role in stress signaling, stomatal opening and closing and pollen tube growth. Here we report the identification and possible role of some of these ATPases from wheat. In this study, ACA and ECA sequences of six species (belonging to Poaceae) were retrieved from different databases and a phylogenetic tree was constructed. A high degree of evolutionary relatedness was observed among P 2 sequences characterized in this study. Members of the respective groups from different plant species were observed to fall under the same clade. This pattern highlights the common ancestry of P 2- type calcium ATPases. Furthermore, qRT-PCR was used to analyse the expression of selected ACAs and ECAs from Triticum aestivum (wheat) under calcium toxicity and calcium deficiency. The data indicated that expression of ECAs is enhanced under calcium stress, suggesting possible roles of these ATPases in calcium homeostasis in wheat. Similarly, the expression of ACAs was significantly different in plants grown under calcium stress as compared to plants grown under control conditions. This gives clues to the role of ACAs in signal transduction during calcium stress in wheat. Here we concluded that wheat genome consists of nine P 2B and three P 2A -type calcium ATPases. Moreover, gene loss events in wheat ancestors lead to the loss of a particular homoeolog of a gene in wheat. To elaborate the role of these wheat ATPases, qRT-PCR was performed. The results indicated that when plants are exposed to calcium stress, both P 2A and P 2B gene expression get enhanced. This further gives clues about the possible role of these ATPases in wheat in calcium management. These findings can be useful in future for genetic manipulations as well as in wheat genome annotation process.

Clinical outcomes of Ahmed glaucoma valve in anterior chamber versus ciliary sulcus.

PubMed

Bayer, A; Önol, M

2017-04-01

PurposeTo evaluate the outcomes of Ahmed glaucoma valve (AGV) tube insertion through the anterior chamber angle (ACA) or through the ciliary sulcus (CS).Patients and methodsIn this case-control study, we retrospectively reviewed the charts of consecutive glaucoma patients who had undergone AGV implantation either through the ACA or the CS between March 2009 and December 2014. The main outcome measures were intraocular pressure (IOP), number of glaucoma medications prescribed, best corrected visual acuity (BCVA), glaucoma type, success rate, complications, and survival ratios. Statistical analysis was carried out using SPSS.ResultsThere were 68 eyes in the ACA group and 35 eyes in the CS group. There were no significant differences between the groups for age, sex, laterality, IOP, preoperative glaucoma medication number, BCVA or glaucoma type (P>0.05). The postoperative follow-up period was 27.2±16.5 months and 30.2±17.7 months for the ACA and the CS groups (P=0.28); IOP values were significantly reduced at the last visit to 16.4±7.2 mm Hg and 14.4±6.8 mm Hg. The difference in the last-visit IOP between the groups was not significant (P=0.06), but the IOP reduction ratio was higher in the CS group (P=0.03). There was no significant difference in the number of postoperative medications (P=0.18). Postoperative complications were similar, but the incidence of flat anterior chamber was higher in the ACA group (P=0.05).ConclusionsThe use of an AGV can control IOP in the majority of cases whether placed in the ACA or the CS. The IOP reduction ratio seemed to be higher in the CS group.

Clinical outcomes of Ahmed glaucoma valve in anterior chamber versus ciliary sulcus

PubMed Central

Bayer, A; Önol, M

2017-01-01

Purpose To evaluate the outcomes of Ahmed glaucoma valve (AGV) tube insertion through the anterior chamber angle (ACA) or through the ciliary sulcus (CS). Patients and methods In this case-control study, we retrospectively reviewed the charts of consecutive glaucoma patients who had undergone AGV implantation either through the ACA or the CS between March 2009 and December 2014. The main outcome measures were intraocular pressure (IOP), number of glaucoma medications prescribed, best corrected visual acuity (BCVA), glaucoma type, success rate, complications, and survival ratios. Statistical analysis was carried out using SPSS. Results There were 68 eyes in the ACA group and 35 eyes in the CS group. There were no significant differences between the groups for age, sex, laterality, IOP, preoperative glaucoma medication number, BCVA or glaucoma type (P>0.05). The postoperative follow-up period was 27.2±16.5 months and 30.2±17.7 months for the ACA and the CS groups (P=0.28); IOP values were significantly reduced at the last visit to 16.4±7.2 mm Hg and 14.4±6.8 mm Hg. The difference in the last-visit IOP between the groups was not significant (P=0.06), but the IOP reduction ratio was higher in the CS group (P=0.03). There was no significant difference in the number of postoperative medications (P=0.18). Postoperative complications were similar, but the incidence of flat anterior chamber was higher in the ACA group (P=0.05). Conclusions The use of an AGV can control IOP in the majority of cases whether placed in the ACA or the CS. The IOP reduction ratio seemed to be higher in the CS group. PMID:27983734

The effect of pharmacologic pupillary dilatation on anterior segment parameters in patients with exfoliation syndrome.

PubMed

Mocan, Mehmet Cem; Ustunel, Saim; Dikmetas, Ozlem; Bozkurt, Banu; Irkec, Murat

2014-01-01

The purpose of this study was to evaluate the effect of pharmacologic pupillary dilatation on anterior chamber depth (ACD) and anterior chamber angle (ACA) in eyes with exfoliation syndrome (XFS). Thirty-six eyes of 36 patients with XFS were evaluated with slit-lamp examination, Goldmann applanation tonometry and ultrasound biomicroscopy (UBM) under standard light conditions. Primary outcome parameters were defined as the change in ACD and ACA measured before and 40 min after instillation of a single drop of either 1% cyclopentolate (Group I; n=12), 2.5% phenylephrine (Group II; n=12) or 1% tropicamide (Group III; n=12). Change in intraocular pressure (IOP) during the same time interval was included as a secondary outcome measure. The average predilatation ACD, ACA and IOP values in the study subjects were 2.54±0.40 mm, 27.9±6.3° and 14.9±3.1 mmHg, respectively. There were no significant differences in the mean age (p=0.461), the female/male ratio (p=0.232), baseline ACD (p=0.841), ACA (p=0.761) or IOP (p=0.070) within the three groups. Differences in dilation induced changes in ACD (p=0.108), ACA (p=0.636) and IOP (p=0.160) between the three groups were not statistically significant. Pupillary dilatation with a single drop of 1.0% cyclopentolate, 2.5% phenylephrine or 1% tropicamide is not associated with shallowing of the anterior chamber or narrowing of the ACA in patients with XFS who present with open angles. Copyright © 2013 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.

HIV positivity but not HPV/p16 status is associated with higher recurrence rate in anal cancer.

PubMed

Meyer, Joshua E; Panico, Vinicius J A; Marconato, Heloisa M F; Sherr, David L; Christos, Paul; Pirog, Edyta C

2013-12-01

Human papillomavirus (HPV) is a pathogenic factor of squamous cell carcinoma in various mucosal locations, including anal carcinoma (ACA). It is also known that patients positive for HIV are at high risk of ACA. The goal of this study was to examine clinical outcome in ACA in relation to HPV/p16 positivity, histologic tumor differentiation, and HIV status. Patients with oropharyngeal cancers that are positive for HPV and show overexpression of p16 as well as having non-keratinizing/basaloid histology have been reported to have better outcomes following chemoradiation (CRT). However, such relationships in ACA remain unknown. Forty-two patients with SCC of the anus treated with CRT between 1997 and 2009 were identified. The tumors were subclassified as either non-keratinizing (including basaloid) or keratinizing categories. HPV testing was performed using SPF10-PCR, and all cases were immunostained for p16. There were 23 men and 19 women; 43% of men and 11% of women were HIV-positive (p = 0.04). Fifty-five percent of patients had local disease (stages I and II) and 41% were stages III and IV, with 4% stage unknown. All tumors were positive for high-oncogenic risk HPVs, and all were positive with p16 immunostain. Sixty-four percent of tumors were non-keratinizing/basaloid and 36 % were keratinizing. The keratinizing tumors were more common in HIV-positive patients (67%), whereas non-keratinizing/basaloid tumors were more common in HIV-negative patients (77%) (p = 0.008). Thirty-one percent of patients had recurrence of disease, including 50% HIV-positive patients and 23% HIV-negative patients (p = 0.09). There was no difference in the recurrence rate between non-keratinizing and keratinizing tumor subtypes (p = 0.80). The 24-month recurrence-free survival for the cohort was 66% (95% CI = 46%, 81%), with HIV-positive patients having worse recurrence-free survival compared to HIV-negative patients (HR = 2.85, 95% CI = 0.95, 8.53; p = 0.06). The regional and distant failure rate was not related to HPV/p16 positivity or histologic differentiation of ACA; however, HIV positivity appeared to be associated with a higher recurrence rate and worse recurrence-free survival.

Environmental DNA sampling protocol - filtering water to capture DNA from aquatic organisms

USGS Publications Warehouse

Laramie, Matthew B.; Pilliod, David S.; Goldberg, Caren S.; Strickler, Katherine M.

2015-09-29

Environmental DNA (eDNA) analysis is an effective method of determining the presence of aquatic organisms such as fish, amphibians, and other taxa. This publication is meant to guide researchers and managers in the collection, concentration, and preservation of eDNA samples from lentic and lotic systems. A sampling workflow diagram and three sampling protocols are included as well as a list of suggested supplies. Protocols include filter and pump assembly using: (1) a hand-driven vacuum pump, ideal for sample collection in remote sampling locations where no electricity is available and when equipment weight is a primary concern; (2) a peristaltic pump powered by a rechargeable battery-operated driver/drill, suitable for remote sampling locations when weight consideration is less of a concern; (3) a 120-volt alternating current (AC) powered peristaltic pump suitable for any location where 120-volt AC power is accessible, or for roadside sampling locations. Images and detailed descriptions are provided for each step in the sampling and preservation process.

Social, Reproductive, and Attitudinal Factors Associated with U.S. Women's Disagreement with the Passage of the Affordable Care Act.

PubMed

Hall, Kelli Stidham; Nadella, Samantha Paturu; Zochowski, Melissa K; Patel, Divya; Dalton, Vanessa K

2015-09-01

Notably absent from research and public and policy dialogue on the Affordable Care Act (ACA) and reproductive health care are women's perspectives and a broader understanding of factors that shape ACA attitudes. We investigated social, reproductive, and attitudinal factors associated with women's disagreement with the passage of the ACA. Data were drawn from the Women's Health Care Experiences and Preferences Study, our population-based internet survey of 1,078 randomly sampled United States women ages 18-55 years conducted in September 2013. Items measured ACA attitudes, including disagreement with the ACA's passage. We examined relationships between ACA disagreement, sociodemographic and reproductive characteristics, health service experiences, and reproductive health care and policy attitudes with logistic regression. Among women who had heard of the ACA (n=888), 35% disagreed with it and 38% did not know how they felt. Black women (adjusted odds ratio [aOR] 0.12, 95% confidence interval [CI] 0.03-0.55) and women with incomes of >$75k (aOR 0.38, CI 0.17-0.88), Medicare/Medicaid insurance (aOR 0.24, CI 0.10-0.61), and infrequent religious service attendance (aOR 0.57, CI 0.35-0.93) were less likely to disagree with the ACA's passage, compared with their counterparts. Republican party affiliation was the strongest predictor of ACA disagreement (aOR 17.10, CI 9.12-32.09). Negative beliefs about the ACA's ability to improve access to preferred care and regarding employers' and the government's roles in reproductive health care were positively associated with ACA disagreement. Many women who could benefit from the ACA disagree with or do not know how they feel about its passage, which may influence participation in ACA benefits and services.

A bio-injectable algin-aminocaproic acid thixogel with tri-stimuli responsiveness.

PubMed

Chejara, Dharmesh R; Mabrouk, Mostafa; Badhe, Ravindra V; Mulla, Jameel A S; Kumar, Pradeep; Choonara, Yahya E; du Toit, Lisa C; Pillay, Viness

2016-01-01

In this article a novel bio-injectable algin-aminocaproic acid (Alg-ACA) tri-stimuli responsive thixogel system is reported. The designed soft thixotrophic hydrogel (thixogel) was characterized using various analytical techniques such as FT-IR, NMR, SEM, AFM and DSC. The soft thixogel system was further investigated for stress responsiveness using different rheological studies which confirmed the thixotropic nature of the gel [Thixotropic area (Ar) of Alg-ACA (1:0.5), Alg-ACA (1:1) and Alg-ACA (1:2), were 23.5%, 43.1%, and 27.59%, respectively, which were higher than that of Na-Alg (2.08%)]. The thixogel also demonstrated temperature and ultrasonication responsiveness. This tri-stimuli responsive soft thixogel system was rendered flowable (fluid) on applying the described physical stimuli and recovered its "rigid" gel structure upon removal of the applied stimuli. This approach of synthesizing a thixogels may be applicable to a broad variety of other natural polymers and has the potential for use in biomedical applications. Copyright © 2015 Elsevier Ltd. All rights reserved.

Tissue-specific root ion profiling reveals essential roles of the CAX and ACA calcium transport systems in response to hypoxia in Arabidopsis

PubMed Central

Wang, Feifei; Chen, Zhong-Hua; Liu, Xiaohui; Colmer, Timothy David; Zhou, Meixue; Shabala, Sergey

2016-01-01

Waterlogging is a major abiotic stress that limits the growth of plants. The crucial role of Ca2+ as a second messenger in response to abiotic and biotic stimuli has been widely recognized in plants. However, the physiological and molecular mechanisms of Ca2+ distribution within specific cell types in different root zones under hypoxia is poorly understood. In this work, whole-plant physiological and tissue-specific Ca2+ changes were studied using several ACA (Ca2+-ATPase) and CAX (Ca2+/proton exchanger) knock-out Arabidopsis mutants subjected to waterlogging treatment. In the wild-type (WT) plants, several days of hypoxia decreased the expression of ACA8, CAX4, and CAX11 by 33% and 50% compared with the control. The hypoxic treatment also resulted in an up to 11-fold tissue-dependent increase in Ca2+ accumulation in root tissues as revealed by confocal microscopy. The increase was much higher in stelar cells in the mature zone of Arabidopsis mutants with loss of function for ACA8, ACA11, CAX4, and CAX11. In addition, a significantly increased Ca2+ concentration was found in the cytosol of stelar cells in the mature zone after hypoxic treatment. Three weeks of waterlogging resulted in dramatic loss of shoot biomass in cax11 plants (67% loss in shoot dry weight), while in the WT and other transport mutants this decline was only 14–22%. These results were also consistent with a decline in leaf chlorophyll fluorescence (F v/F m). It is suggested that CAX11 plays a key role in maintaining cytosolic Ca2+ homeostasis and/or signalling in root cells under hypoxic conditions. PMID:26889007

Food labeling; nutrition labeling of standard menu items in restaurants and similar retail food establishments. Final rule.

PubMed

2014-12-01

To implement the nutrition labeling provisions of the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act or ACA), the Food and Drug Administration (FDA or we) is requiring disclosure of certain nutrition information for standard menu items in certain restaurants and retail food establishments. The ACA, in part, amended the Federal Food, Drug, and Cosmetic Act (the FD&C Act), among other things, to require restaurants and similar retail food establishments that are part of a chain with 20 or more locations doing business under the same name and offering for sale substantially the same menu items to provide calorie and other nutrition information for standard menu items, including food on display and self-service food. Under provisions of the ACA, restaurants and similar retail food establishments not otherwise covered by the law may elect to become subject to these Federal requirements by registering every other year with FDA. Providing accurate, clear, and consistent nutrition information, including the calorie content of foods, in restaurants and similar retail food establishments will make such nutrition information available to consumers in a direct and accessible manner to enable consumers to make informed and healthful dietary choices.

Photocopy of drawing located at National Archives, San Bruno, California ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Photocopy of drawing located at National Archives, San Bruno, California (Navy # 110-A-1 1 of 5. Scofiled Construction Company Mafre Island Office, Mare Island Cal. Details of skylight for pump house stone and concrete dry-dock for US Navy Yard Mare Island Cal, contract no. 257; September 2, 1908. - Mare Island Naval Shipyard, Pump House, California Avenue, east side between Dry Dock 1 & Dry Dock 2, near Ninth Street, Vallejo, Solano County, CA

Human Papillomavirus Vaccination Uptake before and after the Affordable Care Act: Variation According to Insurance Status, Race, and Education (NHANES 2006-2014).

PubMed

Corriero, Rosemary; Gay, Jennifer L; Robb, Sara Wagner; Stowe, Ellen W

2018-02-01

The purpose of the study was to compare human papillomavirus (HPV) vaccination rates before and after Affordable Care Act (ACA) implementation among women, and examine differences according to insurance status and other sociodemographic variables. This was a cross-sectional analysis of the National Health and Nutrition Examination Survey questionnaire data. Participants (n = 4599) were from a random sample of the United States population. HPV vaccination status and number of doses received according to age, income, education, race, and insurance coverage. Over time, the proportion of women reporting HPV vaccination increased from 16.4% to 27.6%, and reporting vaccination completion (3 doses) increased from 56.8% to 67.2%. After ACA implementation, respondents were 3.3 times more likely to be vaccinated compared with before ACA implementation (95% confidence interval [CI], 2.0-5.5) adjusting for age, race, and insurance coverage. Similarly, respondents were more likely to have received 2 (odds ratio, 2.8; 95% CI, 1.5-5.3) or 3 doses (odds ratio, 5.8; 95% CI, 2.5-13.6). Vaccination uptake increased in a comparison of waves of data from before and after ACA implementation. This increase in vaccination coverage could be related to the increased preventative service coverage, which includes vaccines, required by the ACA. Future studies might focus on the role insurance has on vaccination uptake, and meeting Healthy People 2020 objectives for vaccination coverage. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Histopathology and immunophenotype of acrodermatitis chronica atrophicans correlated with ospA and ospC genotypes of Borrelia species.

PubMed

Brandt, Friederike C; Ertas, Beyhan; Falk, Thomas M; Metze, Dieter; Böer-Auer, Almut

2015-10-01

Chronic cutaneous borreliosis (acrodermatitis chronica atrophicans, ACA) is a relatively rare manifestation of borreliosis attributed mainly to Borrelia afzelii. Chronic borreliosis has been associated with ospA and ospC genotypes. Literature on molecular investigations of Borrelia in lesions of ACA is scant. Histopathological and immmunohistochemical features in 22 biopsies of ACA (16 patients) were examined. Paraffin-embedded biopsies were analyzed with polymerase chain reaction (PCR) assays targeting ospA and ospC genes, sequencing and phylogenetic analysis. Genotyping of ospA identified B. afzelii, serotype 2, in 12 of 16 patients. ospC-PCR was positive in seven patients revealing genotypes Af5 (n = 4), Af2 (n = 2) and Af6 (n = 1). Histopathologically, interstitial granulomatous infiltrates (CD68 positive) were common, combined with thickened collagen bundles and band-like infiltrates of CD4 positive T lymphocytes. Plasma cells were sparse/absent in 9 of 22 specimens even on staining with CD138. On CD34-staining, interstitial fibroblasts were often reduced akin to the situation in morphea. With assays targeting ospA and ospC genes we confirmed from paraffin-embedded biopsies that B. afzelii, serotype 2, osp C groups Af5, Af2 and Af6 is the main cause of ACA. Specimens commonly showed a combination of band-like T-cell-rich infiltrates with interstitial granulomatous features, a pattern previously under-recognized in ACA. This finding was particularly typical for lesions infected with ospC genotype Af5. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Direct and indirect organogenesis of Alpinia galanga and the phytochemical analysis.

PubMed

Rao, Kiranmayee; Chodisetti, Bhuvaneswari; Gandi, Suryakala; Mangamoori, Lakshmi Narasu; Giri, Archana

2011-11-01

Alpinia galanga is a rhizomatous herb rich in essential oils and various other significant phytoconstituents. Rapid direct regeneration was obtained from the rhizome explants (15.66 ± 0.57 shoots) on MS media supplemented with zeatin at a concentration of 2 mg/l. The callus cultures of A. galanga were initiated from the rhizome explants on MS media supplemented with 2 mg/l each of BAP, 2,4-D, and NAA. The callus was analyzed for the presence of a vital phytoconstituent--acetoxychavicol acetate (ACA) associated with various biological properties. ACA was detected in the young friable callus as well as the stationary phase callus. Moreover, the induction of morphogenetic response in callus resulted in higher accumulation of ACA. The phytohormone withdrawal from the propagation media and the subsequent transfer of callus to BAP (2 mg/l) containing MS media has resulted in multiple shoot induction. The regenerated (indirect) plants have shown 1.6-fold higher ACA content (1.253%) when compared to the control plant (0.783%). Micropropagation of such conventionally propagated plants is very essential to meet the commercial demand as well as to ensure easy storage and transportation of disease free stocks.

STA-ACA bypass using the ipsilateral free STA graft as an interposition graft and A3-A3 anastomosis for treatment of bilateral ACA steno-occlusive ischemia.

PubMed

Horiuchi, Tetsuyoshi; Ichinose, Shunsuke; Agata, Masahiro; Ito, Kiyoshi; Hongo, Kazuhiro

2018-04-01

Anterior cerebral artery (ACA)-related ischemia is a rare entity in patients with atherosclerosis. Some surgical treatments are reported to date. We present the modification of intracranial-intracranial and intracranial-extracranial bypasses for symptomatic bilateral ACA steno-occlusive disease. The A3-A3 bypass followed by the superficial temporal artery-ACA bypass using the ipsilateral free superficial temporal artery graft is useful without harvesting of the radial artery. Bilateral ACA steno-occlusive induced ischemia can be treated with tailored bypass procedures.

[Comparison study on subjective and objective measurements of the accommodative convergence to accommodation ratio].

PubMed

Xu, Jing-jing; Xu, Dan; Huang, Tao; Jiang, Jian; Lü, Fan

2012-05-01

To detect the accommodative convergence to accommodation (AC/A) ratios measured respectively by objective and subjective methods. The differences and its relative factors were explored. Forty young volunteers were measured by eye tracker to get the amount of convergence when fixating at the target at 100 cm, 50 cm, 33 cm and 25 cm and were measured by infrared auto-refractor to get corresponding accommodative responses. AC/A ratio based on these two measurements were compared with the calculated and the gradient AC/A ratio from Von Graefe tests. Mean value of stimulated AC/A ratio measured by eye tracker was higher than the calculated and gradient AC/A ratio by Von Graefe method (P = 0.003, 0.001). There are statistic correlation (r = 0.871, P = 0.000) and difference (P = 0.000) between stimulated AC/A ratio and response AC/A ratios both measured by eye tracker, and the difference trends to be greater with the higher AC/A ratio. The objective AC/A ratio is usually higher than the clinical subjective measurement because of more proximal effect. The response AC/A ratio measured objectively may reveal realistically the mutual effect and relationship between accommodation and convergence and it seems to be more credible to be the monitor parameter on progression of myopia in clinics.

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 spending will increase by $8.9 billion and $3.9 billion for Options 1 and 2, respectively, relative to the ACA.

20. ENGINE/PUMP HOUSE EXTENSION, PUMP NO. 4, HOUSING FOR ECCENTRICS ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

20. ENGINE/PUMP HOUSE EXTENSION, PUMP NO. 4, HOUSING FOR ECCENTRICS THAT CONTROL THE STEAM FOR EAST PISTON LOCATED BELOW THE PISTON CRANKSHAFT HUB AND ABOVE THE THRUST BEARING; CONTROL RODS FOR PISTON NO. 3 LOCATED AT RIGHT. - Deer Island Pumping Station, Boston, Suffolk County, MA

Prevalence, significance and predictive value of antiphospholipid antibodies in Crohn’s disease

PubMed Central

Sipeki, Nora; Davida, Laszlo; Palyu, Eszter; Altorjay, Istvan; Harsfalvi, Jolan; Antal Szalmas, Peter; Szabo, Zoltan; Veres, Gabor; Shums, Zakera; Norman, Gary L; Lakatos, Peter L; Papp, Maria

2015-01-01

AIM: To assess the prevalence and stability of different antiphospholipid antibodies (APLAs) and their association with disease phenotype and progression in inflammatory bowel diseases (IBD) patients. METHODS: About 458 consecutive patients [Crohn’s disease (CD): 271 and ulcerative colitis (UC): 187] were enrolled into a follow-up cohort study in a tertiary IBD referral center in Hungary. Detailed clinical phenotypes were determined at enrollment by reviewing the patients’ medical charts. Disease activity, medical treatment and data about evolvement of complications or surgical interventions were determined prospectively during the follow-up. Disease course (development f complicated disease phenotype and need for surgery), occurrence of thrombotic events, actual state of disease activity according to clinical, laboratory and endoscopic scores and accurate treatment regime were recorded during the follow-up, (median, 57.4 and 61.6 mo for CD and UC). Sera of IBD patients and 103 healthy controls (HC) were tested on individual anti-β2-Glycoprotein-I (anti-β2-GPI IgA/M/G), anti-cardiolipin (ACA IgA/M/G) and anti-phosphatidylserine/prothrombin (anti-PS/PT IgA/M/G) antibodies and also anti-Saccharomyces cerevisiae antibodies (ASCA IgA/G) by enzyme-linked immunosorbent assay (ELISA). In a subgroup of CD (n = 198) and UC patients (n = 103), obtaining consecutive samples over various arbitrary time-points during the disease course, we evaluated the intraindividual stability of the APLA status. Additionally, we provide an overview of studies, performed so far, in which significance of APLAs in IBD were assessed. RESULTS: Patients with CD had significantly higher prevalence of both ACA (23.4%) and anti-PS/PT (20.4%) antibodies than UC (4.8%, P < 0.0001 and 10.2%, P = 0.004) and HC (2.9%, P < 0.0001 and 15.5%, P = NS). No difference was found for the prevalence of anti-β2-GPI between different groups (7.2%-9.7%). In CD, no association was found between APLA and ASCA status of the patients. Occurrence of anti-β2-GPI, ACA and anti-PS/PT was not different between the group of patients with active vs inactive disease state according to appropriate clinical, laboratory and endoscopic scores in CD as well as in UC patients. All subtypes of anti-β2-GPI and ACA IgM status were found to be very stable over time, in contrast ACA IgG and even more ACA IgA status showed significant intraindividual changes. Changes in antibody status were more remarkable in CD than UC (ACA IgA: 49.9% vs 23.3% and ACA IgG: 21.2% vs 5.8%). Interestingly, 59.1% and 30.1% of CD patients who received anti-TNF therapy showed significant negative to positive changes in ACA IgA and IgG antibody status respectively. APLA status was not associated with the clinical phenotype at diagnosis or during follow-up, medical therapy, or thrombotic events and it was not associated with the probability of developing complicated disease phenotype or surgery in a Kaplan-Meier analysis. CONCLUSION: The present study demonstrated enhanced formation of APLAs in CD patients. However, presence of different APLAs were not associated with the clinical phenotype or disease course. PMID:26078573

Social, Reproductive, and Attitudinal Factors Associated with U.S. Women's Disagreement with the Passage of the Affordable Care Act

PubMed Central

Nadella, Samantha Paturu; Zochowski, Melissa K.; Patel, Divya; Dalton, Vanessa K.

2015-01-01

Abstract Background: Notably absent from research and public and policy dialogue on the Affordable Care Act (ACA) and reproductive health care are women's perspectives and a broader understanding of factors that shape ACA attitudes. We investigated social, reproductive, and attitudinal factors associated with women's disagreement with the passage of the ACA. Methods: Data were drawn from the Women's Health Care Experiences and Preferences Study, our population-based internet survey of 1,078 randomly sampled United States women ages 18–55 years conducted in September 2013. Items measured ACA attitudes, including disagreement with the ACA's passage. We examined relationships between ACA disagreement, sociodemographic and reproductive characteristics, health service experiences, and reproductive health care and policy attitudes with logistic regression. Results: Among women who had heard of the ACA (n=888), 35% disagreed with it and 38% did not know how they felt. Black women (adjusted odds ratio [aOR] 0.12, 95% confidence interval [CI] 0.03–0.55) and women with incomes of >$75k (aOR 0.38, CI 0.17–0.88), Medicare/Medicaid insurance (aOR 0.24, CI 0.10–0.61), and infrequent religious service attendance (aOR 0.57, CI 0.35–0.93) were less likely to disagree with the ACA's passage, compared with their counterparts. Republican party affiliation was the strongest predictor of ACA disagreement (aOR 17.10, CI 9.12–32.09). Negative beliefs about the ACA's ability to improve access to preferred care and regarding employers' and the government's roles in reproductive health care were positively associated with ACA disagreement. Conclusions: Many women who could benefit from the ACA disagree with or do not know how they feel about its passage, which may influence participation in ACA benefits and services. PMID:26125483

Function and Evolution of a MicroRNA That Regulates a Ca2+-ATPase and Triggers the Formation of Phased Small Interfering RNAs in Tomato Reproductive Growth[W][OA

PubMed Central

Wang, Ying; Itaya, Asuka; Zhong, Xuehua; Wu, Yang; Zhang, Jianfeng; van der Knaap, Esther; Olmstead, Richard; Qi, Yijun; Ding, Biao

2011-01-01

MicroRNAs (miRNAs) regulate a wide variety of biological processes in most eukaryotes. We investigated the function and evolution of miR4376 in the family Solanaceae. We report that the 22-nucleotide miR4376 regulates the expression of an autoinhibited Ca2+-ATPase, tomato (Solanum lycopersicum) ACA10, which plays a critical role in tomato reproductive growth. Deep phylogenetic mapping suggested (1) an evolution course of MIR4376 loci and posttranscriptional processing of pre-miR4376 as a likely limiting step for the evolution of miR4376, (2) an independent phylogenetic origin of the miR4376 target site in ACA10 homologs, and (3) alternative splicing as a possible mechanism of eliminating such a target in some ACA10 homologs. Furthermore, miR4376 triggers the formation of phased small interfering RNAs (siRNAs) from Sl ACA10 and its Solanum tuberosum homolog. Together, our data provide experimental evidence of miRNA-regulated expression of universally important Ca2+-ATPases. The miR4376-regulated expression of ACA10 itself, and possibly also the associated formation of phased siRNAs, may function as a novel layer of molecular mechanisms underlying tomato reproductive growth. Finally, our data suggest that the stochastic emergence of a miRNA-target gene combination involves multiple molecular events at the genomic, transcriptional, and posttranscriptional levels that may vary drastically in even closely related species. PMID:21917547

The Affordable Care Act, Accountable Care Organizations, and Mental Health Care for Older Adults: Implications and Opportunities.

PubMed

Bartels, Stephen J; Gill, Lydia; Naslund, John A

2015-01-01

The Patient Protection and Affordable Care Act (ACA) represents the most significant legislative change in the United States health care system in nearly half a century. Key elements of the ACA include reforms aimed at addressing high-cost, complex, vulnerable patient populations. Older adults with mental health disorders are a rapidly growing segment of the population and are among the most challenging subgroups within health care, and they account for a disproportionate amount of costs. What does the ACA mean for geriatric mental health? We address this question by highlighting opportunities for reaching older adults with mental health disorders by leveraging the diverse elements of the ACA. We describe nine relevant initiatives: (1) accountable care organizations, (2) patient-centered medical homes, (3) Medicaid-financed specialty health homes, (4) hospital readmission and health care transitions initiatives, (5) Medicare annual wellness visit, (6) quality standards and associated incentives, (7) support for health information technology and telehealth, (8) Independence at Home and 1915(i) State Plan Home and Community-Based Services program, and (9) Medicare-Medicaid Coordination Office, Center for Medicare and Medicaid Innovation, and the Patient-Centered Outcomes Research Institute. We also consider potential challenges to full implementation of the ACA and discuss novel solutions for advancing geriatric mental health in the context of projected workforce shortages and the opportunities afforded by the ACA.

The Affordable Care Act, Accountable Care Organizations, and Mental Health Care for Older Adults: Implications and Opportunities

PubMed Central

Bartels, Stephen J.; Gill, Lydia; Naslund, John A.

2015-01-01

Abstract The Patient Protection and Affordable Care Act (ACA) represents the most significant legislative change in the United States health care system in nearly half a century. Key elements of the ACA include reforms aimed at addressing high-cost, complex, vulnerable patient populations. Older adults with mental health disorders are a rapidly growing segment of the population and are among the most challenging subgroups within health care, and they account for a disproportionate amount of costs. What does the ACA mean for geriatric mental health? We address this question by highlighting opportunities for reaching older adults with mental health disorders by leveraging the diverse elements of the ACA. We describe nine relevant initiatives: (1) accountable care organizations, (2) patient-centered medical homes, (3) Medicaid-financed specialty health homes, (4) hospital readmission and health care transitions initiatives, (5) Medicare annual wellness visit, (6) quality standards and associated incentives, (7) support for health information technology and telehealth, (8) Independence at Home and 1915(i) State Plan Home and Community-Based Services program, and (9) Medicare-Medicaid Coordination Office, Center for Medicare and Medicaid Innovation, and the Patient-Centered Outcomes Research Institute. We also consider potential challenges to full implementation of the ACA and discuss novel solutions for advancing geriatric mental health in the context of projected workforce shortages and the opportunities afforded by the ACA. PMID:25811340

Ca2+ Induces Spontaneous Dephosphorylation of a Novel P5A-type ATPase

PubMed Central

Sørensen, Danny Mollerup; Møller, Annette B.; Jakobsen, Mia K.; Jensen, Michael K.; Vangheluwe, Peter; Buch-Pedersen, Morten J.; Palmgren, Michael G.

2012-01-01

P5 ATPases constitute the least studied group of P-type ATPases, an essential family of ion pumps in all kingdoms of life. Although P5 ATPases are present in every eukaryotic genome analyzed so far, they have remained orphan pumps, and their biochemical function is obscure. We show that a P5A ATPase from barley, HvP5A1, locates to the endoplasmic reticulum and is able to rescue knock-out mutants of P5A genes in both Arabidopsis thaliana and Saccharomyces cerevisiae. HvP5A1 spontaneously forms a phosphorylated reaction cycle intermediate at the catalytic residue Asp-488, whereas, among all plant nutrients tested, only Ca2+ triggers dephosphorylation. Remarkably, Ca2+-induced dephosphorylation occurs at high apparent [Ca2+] (Ki = 0.25 mm) and is independent of the phosphatase motif of the pump and the putative binding site for transported ligands located in M4. Taken together, our results rule out that Ca2+ is a transported substrate but indicate the presence of a cytosolic low affinity Ca2+-binding site, which is conserved among P-type pumps and could be involved in pump regulation. Our work constitutes the first characterization of a P5 ATPase phosphoenzyme and points to Ca2+ as a modifier of its function. PMID:22730321

1'-Acetoxychavicol acetate inhibits growth of human oral carcinoma xenograft in mice and potentiates cisplatin effect via proinflammatory microenvironment alterations.

PubMed

In, Lionel L A; Arshad, Norhafiza M; Ibrahim, Halijah; Azmi, Mohamad Nurul; Awang, Khalijah; Nagoor, Noor Hasima

2012-10-09

Oral cancers although preventable, possess a low five-year survival rate which has remained unchanged over the past three decades. In an attempt to find a more safe, affordable and effective treatment option, we describe here the use of 1'S-1'-acetoxychavicol acetate (ACA), a component of Malaysian ginger traditionally used for various medicinal purposes. Whether ACA can inhibit the growth of oral squamous cell carcinoma (SCC) cells alone or in combination with cisplatin (CDDP), was explored both in vitro using MTT assays and in vivo using Nu/Nu mice. Occurrence of apoptosis was assessed using PARP and DNA fragmentation assays, while the mode of action were elucidated through global expression profiling followed by Western blotting and IHC assays. We found that ACA alone inhibited the growth of oral SCC cells, induced apoptosis and suppressed its migration rate, while minimally affecting HMEC normal cells. ACA further enhanced the cytotoxic effects of CDDP in a synergistic manner as suggested by combination index studies. We also found that ACA inhibited the constitutive activation of NF-κB through suppression of IKKα/β activation. Human oral tumor xenografts studies in mice revealed that ACA alone was as effective as CDDP in reducing tumor volume, and further potentiated CDDP effects when used in combination with minimal body weight loss. The effects of ACA also correlated with a down-regulation of NF-κB regulated gene (FasL and Bim), including proinflammatory (NF-κB and COX-2) and proliferative (cyclin D1) biomarkers in tumor tissue. Overall, our results suggest that ACA inhibits the growth of oral SCC and further potentiates the effect of standard CDDP treatment by modulation of proinflammatory microenvironment. The current preclinical data could form the basis for further clinical trials to improve the current standards for oral cancer care using this active component from the Malaysian ginger.

1’-Acetoxychavicol acetate inhibits growth of human oral carcinoma xenograft in mice and potentiates cisplatin effect via proinflammatory microenvironment alterations

PubMed Central

2012-01-01

Background Oral cancers although preventable, possess a low five-year survival rate which has remained unchanged over the past three decades. In an attempt to find a more safe, affordable and effective treatment option, we describe here the use of 1’S-1’-acetoxychavicol acetate (ACA), a component of Malaysian ginger traditionally used for various medicinal purposes. Methods Whether ACA can inhibit the growth of oral squamous cell carcinoma (SCC) cells alone or in combination with cisplatin (CDDP), was explored both in vitro using MTT assays and in vivo using Nu/Nu mice. Occurrence of apoptosis was assessed using PARP and DNA fragmentation assays, while the mode of action were elucidated through global expression profiling followed by Western blotting and IHC assays. Results We found that ACA alone inhibited the growth of oral SCC cells, induced apoptosis and suppressed its migration rate, while minimally affecting HMEC normal cells. ACA further enhanced the cytotoxic effects of CDDP in a synergistic manner as suggested by combination index studies. We also found that ACA inhibited the constitutive activation of NF-κB through suppression of IKKα/β activation. Human oral tumor xenografts studies in mice revealed that ACA alone was as effective as CDDP in reducing tumor volume, and further potentiated CDDP effects when used in combination with minimal body weight loss. The effects of ACA also correlated with a down-regulation of NF-κB regulated gene (FasL and Bim), including proinflammatory (NF-κB and COX-2) and proliferative (cyclin D1) biomarkers in tumor tissue. Conclusion Overall, our results suggest that ACA inhibits the growth of oral SCC and further potentiates the effect of standard CDDP treatment by modulation of proinflammatory microenvironment. The current preclinical data could form the basis for further clinical trials to improve the current standards for oral cancer care using this active component from the Malaysian ginger. PMID:23043547

Alleviation of cyclophosphamide-induced immunosuppression in Wistar rats by onion lectin (Allium cepa agglutinin).

PubMed

Kumar, Vaddi P; Venkatesh, Yeldur P

2016-06-20

In various traditional medicines, onion has been classified as an immune-boosting food. Recent studies have claimed this property due to the presence of bioactive organosulfur compounds, prebiotic fructo-oligosaccharides and an immunomodulatory protein, lectin (Allium cepa agglutinin; ACA) (Prasanna and Venkatesh, 2015. Characterization of onion lectin (Allium cepa agglutinin) as an immunomodulatory protein inducing Th1-type immune response in vitro. Int. Immunopharmacol. vol. 26, pp. 304-313). The aim of this study was to evaluate the immunoprotective properties of ACA in normal and cyclophosphamide (CP; 100μg/kg)-induced immunosuppressed Wistar rats. Wistar rats were administrated different doses of ACA (1, 10, and 100μg) to respective groups in normal as well as immunosuppressed animals. The effect of ACA on the status of immune organs was assessed by examining the splenic and thymic indices, and histopathological changes. The biomarkers for humoral immunity (serum IgG and IgA levels) and serum pro-inflammatory markers (COX-2, TNF-α and IL-10) were measured by ELISA. ACA showed immunoprotective properties by significantly promoting the restoration of lymphoid cell count by ~6 fold vs. model control (immunosuppressed animals) and promotes the immune response significantly (~1.5-fold) in CP-induced immunosuppressed animals compared to model control; production of pro-inflammatory molecules (COX-2 and nitric oxide) and expression levels of immune regulatory molecule (TNF-α) were elevated in a dose-dependent manner. The observed in vivo results suggest that ACA has the potential to be used as a nutritional therapeutic to boost the immune status of immunosuppressed subjects brought about by CP administration. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The Affordable Care Act and Diabetes Diagnosis and Care: Exploring the Potential Impacts

PubMed Central

Laiteerapong, Neda

2016-01-01

This article reviews available data on the implications of the Affordable Care Act (ACA) for the diagnosis and care of type 2 diabetes. We provide a general overview of the major issues for diabetes diagnosis and care, and describe the policies in the ACA that affect diabetes diagnosis and care. We also estimate that approximately 2.3 million of the 4.6 million people in the USA with undiagnosed diabetes aged 18–64 in 2009–2010 may have gained access to free preventive care under the ACA, which could increase diabetes detection. In addition, we note two factors that may limit the success of the ACA for improving access to diabetes care. First, many states with the highest diabetes prevalence have not expanded Medicaid eligibility, and second, primary care providers may not adequately meet the increase in Medicaid patients because federal funding to increase provider reimbursement for Medicaid visits recently expired. We close by discussing current gaps in the literature and future directions for research on the ACA’s impact on diabetes diagnosis, care, and health outcomes. PMID:26892908

46 CFR 108.421 - Location of fire pumps and associated equipment.

Code of Federal Regulations, 2011 CFR

2011-10-01

... pumps and associated equipment. Each fire pump required by § 108.415, and the source of power, controls... installed to protect at least one of the fire pumps, its source of power, and controls. ... 46 Shipping 4 2011-10-01 2011-10-01 false Location of fire pumps and associated equipment. 108.421...

46 CFR 108.421 - Location of fire pumps and associated equipment.

Code of Federal Regulations, 2014 CFR

2014-10-01

... pumps and associated equipment. Each fire pump required by § 108.415, and the source of power, controls... installed to protect at least one of the fire pumps, its source of power, and controls. ... 46 Shipping 4 2014-10-01 2014-10-01 false Location of fire pumps and associated equipment. 108.421...

46 CFR 108.421 - Location of fire pumps and associated equipment.

Code of Federal Regulations, 2012 CFR

2012-10-01

... pumps and associated equipment. Each fire pump required by § 108.415, and the source of power, controls... installed to protect at least one of the fire pumps, its source of power, and controls. ... 46 Shipping 4 2012-10-01 2012-10-01 false Location of fire pumps and associated equipment. 108.421...

46 CFR 108.421 - Location of fire pumps and associated equipment.

Code of Federal Regulations, 2013 CFR

2013-10-01

... pumps and associated equipment. Each fire pump required by § 108.415, and the source of power, controls... installed to protect at least one of the fire pumps, its source of power, and controls. ... 46 Shipping 4 2013-10-01 2013-10-01 false Location of fire pumps and associated equipment. 108.421...

Detection and quantification of RNA 2′-O-methylation and pseudouridylation

PubMed Central

Karijolich, John

2016-01-01

RNA-guided RNA modification is a naturally occurring process that introduces 2′-O-methylation and pseudouridylation into rRNA, spliceosomal snRNA and several other types of RNA. The Box C/D ribonucleoproteins (RNP) and Box H/ACA RNP, each containing one unique guide RNA (Box C/D RNA or Box H/ACA RNA) and a set of core proteins, are responsible for 2′-O-methylation and pseudouridylation respectively. Box C/D RNA and Box H/ACA RNA provide the modification specificity through base pairing with their RNA substrate. These post-transcriptional modifications could profoundly alter the properties and functions of substrate RNAs. Thus it is desirable to establish reliable and standardized modification methods to study biological functions of modified nucleotides in RNAs. Here, we present several sensitive and efficient methods and protocols for detecting and quantifying post-transcriptional 2′-O-methylation and pseudouridylation. PMID:26853326

Fluid sampling system for a nuclear reactor

DOEpatents

Lau, Louis K.; Alper, Naum I.

1994-01-01

A system of extracting fluid samples, either liquid or gas, from the interior of a nuclear reactor containment utilizes a jet pump. To extract the sample fluid, a nonradioactive motive fluid is forced through the inlet and discharge ports of a jet pump located outside the containment, creating a suction that draws the sample fluid from the containment through a sample conduit connected to the pump suction port. The mixture of motive fluid and sample fluid is discharged through a return conduit to the interior of the containment. The jet pump and means for removing a portion of the sample fluid from the sample conduit can be located in a shielded sample grab station located next to the containment. A non-nuclear grade active pump can be located outside the grab sampling station and the containment to pump the nonradioactive motive fluid through the jet pump.

Fluid sampling system for a nuclear reactor

DOEpatents

Lau, L.K.; Alper, N.I.

1994-11-22

A system of extracting fluid samples, either liquid or gas, from the interior of a nuclear reactor containment utilizes a jet pump. To extract the sample fluid, a nonradioactive motive fluid is forced through the inlet and discharge ports of a jet pump located outside the containment, creating a suction that draws the sample fluid from the containment through a sample conduit connected to the pump suction port. The mixture of motive fluid and sample fluid is discharged through a return conduit to the interior of the containment. The jet pump and means for removing a portion of the sample fluid from the sample conduit can be located in a shielded sample grab station located next to the containment. A non-nuclear grade active pump can be located outside the grab sampling station and the containment to pump the nonradioactive motive fluid through the jet pump. 1 fig.

Non-linearity of the response accommodative convergence to accommodation ratio.

PubMed

Johnston, Miriam S; Firth, Alison Y

2013-09-01

Previous studies have reported variation in stimulus accommodative convergence to accommodation (AC/A) ratio across differing accommodative stimuli. Response AC/A ratio was assessed across 4 accommodative demands to determine if these differences could be due to accommodative inaccuracies to stimuli. Twenty-three student participants aged 18 to 26 years (mean age 20.3 ± 1.7 years) successfully completed all testing conditions. The modified Thorington technique was used at 4 m to measure heterophoria. The Shin Nippon SRW 5000 infrared autorefractor was used to determine accommodative change to -1.50, -3.00, -4.50, and -6.00D lens stimuli. Significant differences were found in response AC/A ratio between different minus lens stimulated accommodative demands (p < 0.001). Mean AC/A ratio values were 3.11 ± 1.29 with the -1.50D lens stimulus; 4.03 ± 2.11 with -3.00D; 4.14 ± 1.40 with -4.50D; and 4.48 ± 1.56 with -6.00D. No differences in linearity were noted between myopes and non-myopic participants, but myopes tended to have higher response AC/A ratios than non-myopes, mean 4.88 ± 1.89 for myopes vs 3.61 ± 1.47 for non-myopes (p = 0.045). Response AC/A ratio did not display linearity across 4 minus lens accommodative stimuli, but tended to increase with accommodative demand. Significant variability in response AC/A ratio was found, both within individuals to different accommodative demands, and between individuals across the data set.

Characteristics of Posterior Corneal Astigmatism in Different Stages of Keratoconus.

PubMed

Aslani, Fereshteh; Khorrami-Nejad, Masoud; Aghazadeh Amiri, Mohammad; Hashemian, Hesam; Askarizadeh, Farshad; Khosravi, Bahram

2018-01-01

To evaluate the magnitudes and axis orientation of anterior corneal astigmatism (ACA) and posterior corneal astigmatism (PCA), the ratio of ACA to PCA, and the correlation between ACA and PCA in the different stages of keratoconus (KCN). This retrospective case series comprised 161 eyes of 161 patients with KCN (104 men, 57 women; mean age, 22.35 ± 6.10 years). The participants were divided into four subgroups according to the Amsler-Krumeich classification. A Scheimpflug imaging system was used to measure the magnitude and axis orientation of ACA and PCA. The posterior-anterior corneal astigmatism ratio was also calculated. The results were compared among different subgroups. The average amounts of anterior, posterior, and total corneal astigmatism were 4.08 ± 2.21 diopters (D), 0.86 ± 0.46 D, and 3.50 ± 1.94 D, respectively. With-the-rule, against-the-rule, and oblique astigmatisms of the posterior surface of the cornea were found in 61 eyes (37.9%), 67 eyes (41.6%), and 33 eyes (20.5%), respectively; corresponding figures in the anterior corneal surface were 55 eyes (32.4%), 56 eyes (34.8%), and 50 eyes (31.1%), respectively. A strong correlation ( P ≤ 0.001, r = 0.839) was found between ACA and PCA in the different stages of KCN; the correlation was weaker in eyes with grade 3 ( P ≤ 0.001, r = 0.711) and grade 4 ( P ≤ 0.001, r = 0.717) KCN. The maximum posterior-anterior corneal astigmatism ratio (PCA/ACA, 0.246) was found in patients with stage 1 KCN. Corneal astigmatism in anterior surface was more affected than posterior surface by increasing in the KCN severity, although PCA was more affected than ACA in an early stage of KCN.

Impacts of the Affordable Care Act's Medicaid Expansion on Women of Reproductive Age: Differences by Parental Status and State Policies.

PubMed

Johnston, Emily M; Strahan, Andrea E; Joski, Peter; Dunlop, Anne L; Adams, E Kathleen

We use data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2012 to 2015 to estimate the effects of the Affordable Care Act's (ACA) Medicaid expansions on insurance coverage and access to care for low-income women of reproductive age (19-44). We use two-way fixed effects difference-in-differences models to estimate the effects of Medicaid expansions on low-income (<100% of the Federal Poverty Level) women of reproductive age. Additional models are stratified to estimate effects based on women's parental status, pre-ACA state Medicaid eligibility levels, and the presence of a state Medicaid family planning waiver. ACA Medicaid expansions decreased uninsurance among low-income women of reproductive age by 13.2 percentage points. This decrease was driven by a decrease of 27.4 percentage points for women without dependent children, who also experienced a decrease in the likelihood of not having a personal doctor (13.3 percentage points). We find a 3.8-percentage point reduction in the likelihood of experiencing a cost barrier to care among all women, but no significant effects for other access measures or subgroups. When stratified by state policies, decreases in uninsurance were greater in states expanding from pre-ACA eligibility levels of less than 50% of Federal Poverty Level (19.4 percentage points) and in states without a Medicaid family planning waiver (17.6 percentage points). The ACA Medicaid expansion increased insurance coverage for low-income women of reproductive age, with the greatest effects for women without dependent children and women residing in states with relatively lower pre-ACA Medicaid eligibility levels or with no family planning waiver before the ACA. Copyright © 2017 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Changes in premiums of cancelled nongroup plans under the Affordable Care Act.

PubMed

Maeda, Jared Lane L K; Chen, Jersey; Plemons, Brent R

2016-07-01

To examine the effect of the Affordable Care Act (ACA) on changes in premiums for subscribers of nongrandfathered, nongroup insurance plans that were "cancelled." Retrospective multivariate analyses. Changes in annual premiums post ACA were evaluated across subgroups of subscriber and health plan characteristics. Data was derived from databases containing information on premiums, plan benefit, and demographics for subscribers aged 18 to 64 years within Kaiser Permanente of the Mid-Atlantic States. A linear regression model was used to examine the independent association between subscriber and health plan characteristics on the relative change in premiums. In 2013, 4169 nongroup subscribers were enrolled in plans that were cancelled as a result of the ACA. The median pre-ACA premium was $3240 (range = $780-$39,492), which increased by a median of 21.3% (range = -77.4% to 193.6%), or $685 (range = -$27,464 to $8676), post ACA in 2014. Premiums increased more for high-deductible plans (median = 63.7%) than standard-deductible plans (median = 8.4%). Due to shifts in the age curve, premiums decreased for more than half of women aged 18 to 44 years, but increased by 35.2% for women aged 55 to 64 years. Premiums fell by 15.5% for subscribers who did not pass standard medical underwriting due to preexisting conditions. Changes in premiums in the nongroup market post ACA, varied substantially across subgroups, primarily due to differences in the amount of coverage, changes in rating criteria, shifts in the age curve, and anticipated differences in risk selection and composition of the risk pool. Given the extent of this variation, it would be incorrect to conclude the ACA as being uniformly beneficial or detrimental to subscribers of these cancelled plans.

An anti-steroidogenic inhibitory primer pheromone in male sea lamprey (Petromyzon marinus)

USGS Publications Warehouse

Chung-Davidson, Yu-Wen; Wang, Huiyong; Bryan, Mara B.; Wu, Hong; Johnson, Nicholas S.; Li, Weiming

2013-01-01

Reproductive functions can be modulated by both stimulatory and inhibitory primer pheromones released by conspecifics. Many stimulatory primer pheromones have been documented, but relatively few inhibitory primer pheromones have been reported in vertebrates. The sea lamprey male sex pheromone system presents an advantageous model to explore the stimulatory and inhibitory primer pheromone functions in vertebrates since several pheromone components have been identified. We hypothesized that a candidate sex pheromone component, 7α, 12α-dihydroxy-5α-cholan-3-one-24-oic acid (3 keto-allocholic acid or 3kACA), exerts priming effects through the hypothalamic-pituitary-gonadal (HPG) axis. To test this hypothesis, we measured the peptide concentrations and gene expressions of lamprey gonadotropin releasing hormones (lGnRH) and the HPG output in immature male sea lamprey exposed to waterborne 3kACA. Exposure to waterborne 3kACA altered neuronal activation markers such as jun and jun N-terminal kinase (JNK), and lGnRH mRNA levels in the brain. Waterborne 3kACA also increased lGnRH-III, but not lGnRH-I or -II, in the forebrain. In the plasma, 3kACA exposure decreased all three lGnRH peptide concentrations after 1 h exposure. After 2 h exposure, 3kACA increased lGnRHI and -III, but decreased lGnRH-II peptide concentrations in the plasma. Plasma lGnRH peptide concentrations showed differential phasic patterns. Group housing condition appeared to increase the averaged plasma lGnRH levels in male sea lamprey compared to isolated males. Interestingly, 15α-hydroxyprogesterone (15α-P) concentrations decreased after prolonged 3kACA exposure (at least 24 h). To our knowledge, this is the only known synthetic vertebrate pheromone component that inhibits steroidogenesis in males.

Thermal transpiration in zeolites: A mechanism for motionless gas pumps

NASA Astrophysics Data System (ADS)

Gupta, Naveen K.; Gianchandani, Yogesh B.

2008-11-01

We explore the use of a naturally occurring zeolite, clinoptilolite, for a chip-scale, thermal transpiration-based gas pump. The nanopores in clinoptilolite enable the required free-molecular flow, even at atmospheric pressure. The pump utilizes a foil heater located between zeolite disks in a plastic package. A 2.3mm thick zeolite disk generates a typical gas flow rate of 6.6×10-3 cc/min-cm2 with an input power of <300mW/cm2. The performance is constrained by imperfections in clinoptilolite, which provide estimated leakage apertures of 10.2-13.5μm/cm2 of flow cross section. The transient response of the pump is studied to quantify nonidealities.

Asymmetric conjugate addition of Grignard reagents to pyranones.

PubMed

Mao, Bin; Fañanás-Mastral, Martín; Feringa, Ben L

2013-01-18

An efficient enantioselective synthesis of lactones was developed based on the catalytic asymmetric conjugate addition (ACA) of alkyl Grignard reagents to pyranones. The use of 2H-pyran-2-one for the first time in the ACA with Grignard reagents allows for a variety of further transformations to access highly versatile building blocks such as β-alkyl substituted aldehydes or β-bromo-γ-alkyl substituted alcohols with excellent regio- and stereoselectivity.

Inpatient Trauma Mortality after Implementation of the Affordable Care Act in Illinois

PubMed Central

Dresden, Scott M.; Powell, Emilie S.; Feinglass, Joe

2018-01-01

Introduction Illinois hospitals have experienced a marked decrease in the number of uninsured patients after implementation of the Affordable Care Act (ACA). However, the full impact of health insurance expansion on trauma mortality is still unknown. The objective of this study was to determine the impact of ACA insurance expansion on trauma patients hospitalized in Illinois. Methods We performed a retrospective cohort study of 87,001 trauma inpatients from third quarter 2010 through second quarter 2015, which spans the implementation of the ACA in Illinois. We examined the effects of insurance expansion on trauma mortality using multivariable Poisson regression. Results There was no significant difference in mortality comparing the post-ACA period to the pre-ACA period incident rate ratio (IRR)=1.05 (95% confidence interval [CI] [0.93–1.17]). However, mortality was significantly higher among the uninsured in the post-ACA period when compared with the pre-ACA uninsured population IRR=1.46 (95% CI [1.14–1.88]). Conclusion While the ACA has reduced the number of uninsured trauma patients in Illinois, we found no significant decrease in inpatient trauma mortality. However, the group that remains uninsured after ACA implementation appears to be particularly vulnerable. This group should be studied in order to reduce disparate outcomes after trauma. PMID:29560058

States' implementation of the Affordable Care Act and the supply of physicians waivered to prescribe buprenorphine for opioid dependence.

PubMed

Knudsen, Hannah K; Lofwall, Michelle R; Havens, Jennifer R; Walsh, Sharon L

2015-12-01

Although the Affordable Care Act (ACA) is anticipated to affect substance use disorder (SUD) treatment, its impact on the supply of physicians waivered to treat opioid dependence with buprenorphine has not been considered. This study examined whether states more supportive of ACA, meaning those that had opted to expand Medicaid and establish a state-based health insurance exchange, experienced greater growth in physician supply than less supportive states. Buprenorphine physician supply, including total physician supply, supply of 30-patient physicians, and supply of 100-patient physicians per 100,000 state residents, was measured from June 2013 to May 2015. State characteristics were drawn from multiple secondary sources, with states categorized as ACA-supportive, ACA-hybrid (where states either expanded Medicaid or established a state-based exchange), or ACA-resistant (where states took neither action). Mixed effects regression was used to estimate state-level growth curves to test whether rates of growth varied by states' approaches to implementing ACA. The supply of waivered physicians grew significantly over the two-year period. Rates of growth were significantly lower in ACA-hybrid and ACA-resistant states relative to growth in ACA-supportive states. Average buprenorphine physician supply at baseline varied by region, the percentage of residents covered by Medicaid, and the supply of specialty SUD treatment programs. This study found a positive impact of the ACA on growth in the supply of buprenorphine-waivered physicians in US states. Future research should address whether the ACA affects the number of patients receiving buprenorphine, Medicaid spending, and the quality of treatment services delivered. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

States' implementation of the Affordable Care Act and the supply of physicians waivered to prescribe buprenorphine for opioid dependence

PubMed Central

Knudsen, Hannah K.; Lofwall, Michelle R.; Havens, Jennifer R.; Walsh, Sharon L.

2015-01-01

Background Although the Affordable Care Act (ACA) is anticipated to affect substance use disorder (SUD) treatment, its impact on the supply of physicians waivered to treat opioid dependence with buprenorphine has not been considered. This study examined whether states more supportive of ACA, meaning those that had opted to expand Medicaid and establish a state-based health insurance exchange, experienced greater growth in physician supply than less supportive states. Methods Buprenorphine physician supply, including total physician supply, supply of 30-patient physicians, and supply of 100-patient physicians per 100,000 state residents, was measured from June 2013 to May 2015. State characteristics were drawn from multiple secondary sources, with states categorized as ACA-supportive, ACA-hybrid (where states either expanded Medicaid or established a state-based exchange), or ACA-resistant (where states took neither action). Mixed effects regression was used to estimate state-level growth curves to test whether rates of growth varied by states' approaches to implementing ACA. Results The supply of waivered physicians grew significantly over the two-year period. Rates of growth were significantly lower in ACA-hybrid and ACA-resistant states relative to growth in ACA-supportive states. Average buprenorphine physician supply at baseline varied by region, the percentage of residents covered by Medicaid, and the supply of specialty SUD treatment programs. Conclusions This study found a positive impact of the ACA on growth in the supply of buprenorphine-waivered physicians in US states. Future research should address whether the ACA affects the number of patients receiving buprenorphine, Medicaid spending, and the quality of treatment services delivered. PMID:26483356

Topically Applied Epsilon-Aminocaproic Acid Reduces Blood Loss and Length of Hospital Stay After Total Knee Arthroplasty.

PubMed

Harper, Robert A; Sucher, Mark G; Giordani, Mauro; Nedopil, Alexander J

2017-11-01

Perioperative blood loss after total knee arthroplasty (TKA) affects postoperative recovery. Tranexamic acid is safe and efficient in reducing blood loss without increasing thromboembolic events. Epsilon-aminocaproic acid (ε-ACA) is less expensive than and as safe as tranexamic acid. Its efficiency when locally applied in TKA is unknown. The authors retrospectively followed 240 consecutive patients treated by 1 surgeon with TKA from January 2012 to August 2016. From January 2013 to May 2015, the authors topically applied 5 g of ε-ACA to the open wound after tourniquet release and before closure (ε-ACA-after-tourniquet-release group). From August 2015 to August 2016, the authors topically applied 5 g of ε-ACA intraoperatively to the open wound 3 minutes before tourniquet release (ε-ACA-before-tourniquet-release group). The last 80 patients not receiving ε-ACA (control group), the 80 patients in the ε-ACA-after-tourniquet-release group, and the 80 patients in the ε-ACA-before-tourniquet-release group were compared regarding blood loss, treatment costs, and thromboembolic complications. The mean±SD calculated blood loss was 1478.8±367.1 mL for the control group, 1424.0±249.3 mL for the ε-ACA-after-tourniquet-release group, and 1052.3±419.1 mL for the ε-ACA-before-tourniquet-release group (P<.05). Using ε-ACA before tourniquet release reduced the length of hospital stay by 0.7 days (P<.05) compared with not using ε-ACA, leading to cost savings of $1547.37 per patient. One patient in the ε-ACA-before-tourniquet-release group and 1 patient in the control group developed a venous thromboembolism in the postoperative period. Epsilon-aminocaproic acid significantly reduces blood loss after TKA when topically applied before tourniquet release. Its application reduced costs by decreasing the length of hospital stay and did not increase thromboembolic events. [Orthopedics. 2017; 40(6):e1044-e1049.]. Copyright 2017, SLACK Incorporated.

Novel Therapeutic Strategy for the Prevention of Bone Fractures

DTIC Science & Technology

2013-06-01

AGA GAG GGA GAT GCT CAG TGT TGG M32599 18S AGT GCG GGT CAT AAG CTT GC GGG CCT CAC TAA AC CAT CCA V00851 β-actin GTT TGA GAC CTT CAA CAC CCC GTG ...GCC ATC TCC TGC TCG AAG TC Meredith et al 2011* Mstn ACT GGA CCT CTC GAT AGA ACA CTC ACT TAG TGC TGT GTG TGT GGA GAT NM_010834.2 IGF-1 CAG...ACA GGA GCC CAG GAA AG AAG TGC CGT ATC CCA GAG GA NM_184052 MHC ACA GTC AGA GGT GTG ACTC AGC CG CCG ACT TGC GGA GGA AAG GTG C NM_001099635 Murf1

The Apical Localization of Na+, K+-ATPase in Cultured Human Retinal Pigment Epithelial Cells Depends on Expression of the β2 Subunit

PubMed Central

Lobato-Álvarez, Jorge A.; Roldán, María L.; López-Murillo, Teresa del Carmen; González-Ramírez, Ricardo; Bonilla-Delgado, José; Shoshani, Liora

2016-01-01

Na+, K+-ATPase, or the Na+ pump, is a key component in the maintenance of the epithelial phenotype. In most epithelia, the pump is located in the basolateral domain. Studies from our laboratory have shown that the β1 subunit of Na+, K+-ATPase plays an important role in this mechanism because homotypic β1-β1 interactions between neighboring cells stabilize the pump in the lateral membrane. However, in the retinal pigment epithelium (RPE), the Na+ pump is located in the apical domain. The mechanism of polarization in this epithelium is unclear. We hypothesized that the apical polarization of the pump in RPE cells depends on the expression of its β2 subunit. ARPE-19 cells cultured for up to 8 weeks on inserts did not polarize, and Na+, K+-ATPase was expressed in the basolateral membrane. In the presence of insulin, transferrin and selenic acid (ITS), ARPE-19 cells cultured for 4 weeks acquired an RPE phenotype, and the Na+ pump was visible in the apical domain. Under these conditions, Western blot analysis was employed to detect the β2 isoform and immunofluorescence analysis revealed an apparent apical distribution of the β2 subunit. qPCR results showed a time-dependent increase in the level of β2 isoform mRNA, suggesting regulation at the transcriptional level. Moreover, silencing the expression of the β2 isoform in ARPE-19 cells resulted in a decrease in the apical localization of the pump, as assessed by the mislocalization of the α2 subunit in that domain. Our results demonstrate that the apical polarization of Na+, K+-ATPase in RPE cells depends on the expression of the β2 subunit. PMID:27774068

The Apical Localization of Na+, K+-ATPase in Cultured Human Retinal Pigment Epithelial Cells Depends on Expression of the β2 Subunit.

PubMed

Lobato-Álvarez, Jorge A; Roldán, María L; López-Murillo, Teresa Del Carmen; González-Ramírez, Ricardo; Bonilla-Delgado, José; Shoshani, Liora

2016-01-01

Na + , K + -ATPase, or the Na + pump, is a key component in the maintenance of the epithelial phenotype. In most epithelia, the pump is located in the basolateral domain. Studies from our laboratory have shown that the β 1 subunit of Na + , K + -ATPase plays an important role in this mechanism because homotypic β 1 -β 1 interactions between neighboring cells stabilize the pump in the lateral membrane. However, in the retinal pigment epithelium (RPE), the Na + pump is located in the apical domain. The mechanism of polarization in this epithelium is unclear. We hypothesized that the apical polarization of the pump in RPE cells depends on the expression of its β 2 subunit. ARPE-19 cells cultured for up to 8 weeks on inserts did not polarize, and Na + , K + -ATPase was expressed in the basolateral membrane. In the presence of insulin, transferrin and selenic acid (ITS), ARPE-19 cells cultured for 4 weeks acquired an RPE phenotype, and the Na + pump was visible in the apical domain. Under these conditions, Western blot analysis was employed to detect the β 2 isoform and immunofluorescence analysis revealed an apparent apical distribution of the β 2 subunit. qPCR results showed a time-dependent increase in the level of β 2 isoform mRNA, suggesting regulation at the transcriptional level. Moreover, silencing the expression of the β 2 isoform in ARPE-19 cells resulted in a decrease in the apical localization of the pump, as assessed by the mislocalization of the α 2 subunit in that domain. Our results demonstrate that the apical polarization of Na + , K + -ATPase in RPE cells depends on the expression of the β 2 subunit.

Intraoperative trans-fontanellar cerebral ultrasonography in infants during cardiac surgery under cardiopulmonary bypass: an observational study.

PubMed

Park, Yong-Hee; Song, In-Kyung; Lee, Ji-Hyun; Kim, Hee-Soo; Kim, Chong-Sung; Kim, Jin-Tae

2017-02-01

This study was performed to evaluate the feasibility of intraoperative point-of-care trans-fontanellar cerebral ultrasonography (TFCU) to obtain blood flow velocity (BFV) reference values at the internal carotid arteries (ICAs) and peri-callosal part of the anterior cerebral artery (pACA) during pediatric cardiac surgery under cardiopulmonary bypass (CPB). TFCU was performed at three time points (after induction of anesthesia, during CPB, after CPB) in 35 infants. BFV was measured at both ICAs and pACA through the anterior fontanelle with an ultrasound sector probe. We divided patients into Group S (<5 kg, n = 16) and Group L (≥5 kg, n = 19) for comparisons according to weight. We also analyzed BFV in low cerebral regional oxygen saturation (rSO 2 ) data. All measurements of the BFV at both the ICAs and the pACA were possible. BFVs at the ICAs were lower in Group S than in Group L at all three time points. BFVs at the pACA were similar in both groups except higher value in Group L after CPB. When the rSO 2 was <50, most BFVs (14 of 15 measurements) were lower than the median BFV value during CPB. However, a low rSO 2 did not always reflect low BFV before and after CPB. Point-of-care TFCU can determine BFV at the ICAs and pACA during pediatric cardiac surgery. BFV differs according to the patient's size and CPB application. TFCU can be a practical cerebral blood flow monitoring method when rSO 2 changes without any specific reason in infants.ClinicalTrials.gov NCT01996020.

How Have Health Insurers Performed Financially Under the ACA' Market Rules?

PubMed

McCue, Michael J; Hall, Mark A

2017-10-01

The Affordable Care Act (ACA) transformed the market for individual health insurance, so it is not surprising that insurers' transition was not entirely smooth. Insurers, with no previous experience under these market conditions, were uncertain how to price their products. As a result, they incurred significant losses. Based on this experience, some insurers have decided to leave the ACA’s subsidized market, although others appear to be thriving. Examine the financial performance of health insurers selling through the ACA's marketplace exchanges in 2015--the market’s most difficult year to date. Analysis of financial data for 2015 reported by insurers from 48 states and D.C. to the Centers for Medicare and Medicaid Services. Although health insurers were profitable across all lines of business, they suffered a 10 percent loss in 2015 on their health plans sold through the ACA's exchanges. The top quarter of the ACA exchange market was comfortably profitable, while the bottom quarter did much worse than the ACA market average. This indicates that some insurers were able to adapt to the ACA's new market rules much better than others, suggesting the ACA's new market structure is sustainable, if supported properly by administrative policy.

Adenylyl cyclase A expression is tip-specific in Dictyostelium slugs and directs StatA nuclear translocation and CudA gene expression.

PubMed

Verkerke-van Wijk, I; Fukuzawa, M; Devreotes, P N; Schaap, P

2001-06-01

cAMP oscillations, generated by adenylyl cyclase A (ACA), coordinate cell aggregation in Dictyostelium and have also been implicated in organizer function during multicellular development. We used a gene fusion of the ACA promoter with a labile lacZ derivative to study the expression pattern of ACA. During aggregation, most cells expressed ACA, but thereafter expression was lost in all cells except those of the anterior tip. Before aggregation, ACA transcription was strongly upregulated by nanomolar cAMP pulses. Postaggregative transcription was sustained by nanomolar cAMP pulses, but downregulated by a continuous micromolar cAMP stimulus and by the stalk-cell-inducing factor DIF. Earlier work showed that the transcription factor StatA displays tip-specific nuclear translocation and directs tip-specific expression of the nuclear protein CudA, which is essential for culmination. Both StatA and CudA were present in nuclei throughout the entire slug in an aca null mutant that expresses ACA from the constitutive actin15 promoter. This suggests that the tip-specific expression of ACA directs tip-specific nuclear translocation of StatA and tip-specific expression of CudA. Copyright 2001 Academic Press.

The Affordable Care Act's Effects On The Formation, Expansion, And Operation Of Physician-Owned Hospitals.

PubMed

Plummer, Elizabeth; Wempe, William

2016-08-01

The Affordable Care Act (ACA) imposed new restrictions on the formation and expansion of physician-owned hospitals. These restrictions provided incentives for the hospitals and their owners to take preemptive actions before the effective dates of ACA provisions and modify their operations thereafter. We studied 106 physician-owned hospitals in Texas to determine how they responded to ACA restrictions. We found that there were significant pre-ACA increases in the formation, physician ownership, and physical capacity of physician-owned hospitals, which suggests that they reacted quickly to the policy changes. After the ACA's provisions took effect, the hospitals improved the use of their assets to generate increased amounts of services, revenue, and profits. We found no evidence that existing physician-owned hospitals stopped accepting Medicare to avoid the ACA restrictions, although some investors adopted a seemingly unsuccessful strategy of not accepting Medicare at physician-owned hospitals formed after implementation of the ACA. We conclude that the ACA restrictions effectively eliminated the formation of new physician-owned hospitals, thus accomplishing what previous legislative efforts had failed to do. Project HOPE—The People-to-People Health Foundation, Inc.

Accommodation, accommodative convergence, and response AC/A ratios before and at the onset of myopia in children.

PubMed

Gwiazda, Jane; Thorn, Frank; Held, Richard

2005-04-01

The purpose of this study was to investigate accommodation, accommodative convergence, and AC/A ratios before and at the onset of myopia in children. Refractive error, accommodation, and phorias were measured annually over a period of 3 years in 80 6- to 18-year-old children (mean age at first visit = 11.1 years), including 26 who acquired myopia of at least -0.50 D and 54 who remained emmetropic (-0.25 to + 0.75 D). Refraction was measured by noncycloplegic distance retinoscopy. Concomitant measures of accommodation and phorias were taken for letter targets at 4.0 m and 0.33 m using the Canon R-1 open field-of-view autorefractor with an attached motorized Risley prism and Maddox rod. The accommodation and phoria measurements were used to calculate response AC/A ratios. Compared with children who remained emmetropic, those who became myopic had elevated response AC/A ratios at 1 and 2 years before the onset of myopia, in addition to at onset and 1 year later (t's = -2.97 to -4.04, p < 0.01 at all times). The significantly higher AC/A ratios in the children who became myopic are a result of significantly reduced accommodation. Accommodative convergence was significantly greater in myopes only at onset. These findings suggest that the abnormal oculomotor factors found before the onset of myopia may contribute to myopigenesis by producing hyperopic retinal defocus when a child is engaged in near-viewing tasks.

VizieR Online Data Catalog: LMC OGLE-III Shallow Survey variable stars (Ulaczyk+, 2013)

NASA Astrophysics Data System (ADS)

Ulaczyk, K.; Szymanski, M. K.; Udalski, A.; Kubiak, M.; Pietrzynski, G.; Soszynski, I.; Wyrzykowski, L.; Poleski, R.; Gieren, W.; Walker, A. R.; Garcia-Varela, A.

2017-07-01

Photometric data were collected using the 1.3-m Warsaw Telescope located at Las Campanas Observatory, operated by the Carnegie Institution for Science. We used exactly the same photometric system as in the OGLE-III main survey. Detailed information about whole instrumentation can be found in Udalski (2003AcA....53..291U). (5 data files).

ACA and the Triple Aim: Musings of a Health Care Actuary.

PubMed

McCarthy, Mac

2015-01-01

In 2008, the Institute for Healthcare Improvement (IHI) promulgated the Triple Aim, which advocates simultaneous improvements in patient experiences, improved population health and lower cost per capita. In 2010, the Patient Protection and Affordable Care Act (ACA) promised quality, affordable health care for all Americans. It's fair to assume that the framers of ACA were aware of the Triple Aim, and it is likely that much of ACA was heavily influenced by IHI's positions. So it is reasonable, from time to time, to assess ACA's impact on health care against the Triple Aim principles.

Predictors of anonymous cyber aggression: the role of adolescents' beliefs about anonymity, aggression, and the permanency of digital content.

PubMed

Wright, Michelle F

2014-07-01

Little attention has been given to whether adolescents' beliefs about anonymity and their normative beliefs about cyber aggression jointly increase their perpetration of cyber aggression. To this end, the present longitudinal study examined the moderating influence of these variables on the relationships among adolescents' attitudes toward the permanency of digital content, confidence with not getting caught, and anonymous cyber aggression (ACA) assessed 1 year later (Time 2). These associations were examined among 274 7th and 8th graders and through five technologies, including social networking sites (SNS), e-mail, instant messenger (IM), mobile phones, and chatrooms. Findings indicated that increases in Time 2 ACA and attitudes toward the permanency of digital content were more strongly related when adolescents reported greater confidence with not getting caught and higher normative beliefs concerning cyber aggression through SNS and mobile phones. In addition, higher levels of attitudes toward the permanency of digital content, confidence with not getting caught, beliefs about anonymity, and normative beliefs regarding cyber aggression were related to greater Time 2 ACA through e-mail, IM, and chatrooms. All findings are discussed in the context of adolescents' positive attitudes toward ACA, and an appeal for additional research is made to understand more about anonymity in cyberspace.

Gain in Insurance Coverage and Residual Uninsurance Under the Affordable Care Act: Texas, 2013-2016.

PubMed

Pickett, Stephen; Marks, Elena; Ho, Vivian

2017-01-01

To examine the effects of the Affordable Care Act's (ACA's) Marketplace on Texas residents and determine which population subgroups benefited the most and which the least. We analyzed insurance coverage rates among nonelderly Texas adults using the Health Reform Monitoring Survey-Texas from September 2013, just before the first open enrollment period in the Marketplace, through March 2016. Texas has experienced a roughly 6-percentage-point increase in insurance coverage (from 74.7% to 80.6%; P = .012) after implementation of the major insurance provisions of the ACA. The 4 subgroups with the largest increases in adjusted insurance coverage between 2013 and 2016 were persons aged 50 to 64 years (12.1 percentage points; P = .002), Hispanics (10.9 percentage points; P = .002), persons reporting fair or poor health status (10.2 percentage points; P = .038), and those with a high school diploma as their highest educational attainment (9.2 percentage points; P = .023). Many population subgroups have benefited from the ACA's Marketplace, but approximately 3 million Texas residents still lack health coverage. Adopting the ACA's Medicaid expansion is a means to address the lack of coverage.

[Effect of Acaí (Euterpe oleracea) on biological expression characteristics of deficiency-heat and deficiency-cold rats].

PubMed

Wang, Lin-Yuan; Zhang, Jian-Jun; Wang, Chun; Zhu, Ying-Li; Wang, Zi-Chen; He, Cheng; Qu, Yan; Wang, Sha

2016-10-01

To study the effects of Acaí on biological expression characteristics in rats with deficiency-heat and deficiency-cold syndromes, SD rats were divided into blank group, deficiency-heat model group, deficiency-heat+Phellodendri Chinensis Cortex group, deficiency-heat+Acaí high dose and low dose groups, deficiency-cold model group, deficiency-cold+Cinnamomi Cortex group, deficiency-cold+Acaí high dose and low dose groups. The rats were treated with intramuscular injection of hydrocortisone (20 mg•kg⁻¹) or dexamethasone sodium phosphate (0.35 mg•kg⁻¹) for 21 days to set up deficiency-heat model and deficiency-cold models. The levels of cAMP, cGMP, T3, T4 and rT3 were detected by radioimmunoassay. The levels of TP, UA, TC, TG and ALB were detected by colorimetry. The level of cAMP, cAMP/cGMP in serum were reduced in Acaí high dose group (P<0.05, P<0.001). The levels of T3, T4 and rT3 were significantly reduced in the Acaí high dose group (P<0.01, P<0.001, P<0.05). The levels of TP, UA, TC, TG and ALB were significantly reduced in the Acaí high dose group (P<0.001, P<0.05, P<0.05, P<0.05, P<0.01). However, Acaí had no obvious effects on deficiency-cold models. Acaí showed the same effect with Phellodendri Chinensis Cortex in adjusting the levels of deficiency-heat rats; but unlike Cinnamomi Cortex, Acaí showed no obvious effects in adjusting the levels of deficiency-cold rats. Copyright© by the Chinese Pharmaceutical Association.

Plastic Surgeons’ Perceptions of the Affordable Care Act: Results of a National Survey

PubMed Central

Israel, Jacqueline S.; Chen, Jenny T.; Rao, Venkat K.

2015-01-01

Background: The Affordable Care Act (ACA) aims to expand coverage to the uninsured, improve quality, and contain costs. The goal of this study was to ascertain how plastic surgeons perceive the ACA. Methods: An electronic questionnaire was e-mailed to members of the American Society of Plastic Surgeons between May and June 2014. The survey was anonymous and voluntary and included questions to assess understanding and opinions of the ACA. Results: The survey was sent to 3070 members of the American Society of Plastic Surgeons, and the response rate was 17%. Sixty-eight percent agree or strongly agree that they understand the basic concepts of the ACA. The majority of respondents disagree (38% strongly disagree, 31% disagree) with the notion that the ACA will positively affect their practice, and 51% agree with the statement, “I do not support the ACA, and I believe it did too much.” Two thirds (66%) believe that the ACA deserves a grade of D or F. When answers were analyzed across demographics, 42% of respondents with “Academic” practice background identify with the statement, “I support the ACA but I think it needs more work,” compared to 15% of those who selected “Solo Practice” (p <0.001). Conclusions: The ACA will affect all specialties, including plastic surgery. The results of this survey suggest that many plastic surgeons believe that they have a baseline understanding of current health-care reform. The majority of surveyed surgeons do not support the Act. It is imperative that plastic surgeons possess the knowledge of the ACA; its changes, both current and impending, will likely affect patient mix, coverage of procedures, and reimbursement. PMID:25674374

Surgical flow modification of the anterior cerebral artery-anterior communicating artery complex in the management of giant aneurysms of internal carotid artery bifurcation: An alternative for a difficult clip reconstruction

PubMed Central

Pahl, Felix Hendrik; de Oliveira, Matheus Fernandes; Beer-Furlan, André Luiz; Rotta, José Marcus

2016-01-01

Background: Internal carotid artery bifurcation (ICAb) aneurysms account for about 2–15% of all intracranial aneurysms. In giant and complex cases, treatment may be difficult and dangerous, once some aneurysms have wide neck and anterior cerebral artery (ACA) and middle cerebral artery (MCA) may arise from the aneurysm itself. Clip reconstruction may be difficult in such cases. Whenever possible, the occlusion of ACA transform the bifurcation in a single artery reconstruction (ICA to MCA), much easier than a bifurcation reconstruction. Methods: In patients with giant and complex ICAb aneurysms, we propose routine preoperative angiography with anatomical evaluation of anterior communicating artery (ACoA) patency during cervical common carotid compression with concomitant contralateral carotid artery injection. This allowed visualization of the expected reversal of flow in the A1 segment–ACoA complex. When test is positive, we can perform ipsilateral ACA (A1 segment) clip occlusion and flow modification of the ACA-ACoA complex transforming a three vessel (ICA, ACA, and MCA) reconstruction into a two vessel (ICA and MCA) reconstruction. Results: Two patients were treated, with 100% of occlusion and good outcome. Conclusions: Surgical treatment of giant and complex ICAb may be achieved with acceptable morbidity. PMID:27313968

Preoperative Biometric Parameters Predict the Vault after ICL Implantation: A Retrospective Clinical Study.

PubMed

Zheng, Qian-Yin; Xu, Wen; Liang, Guan-Lu; Wu, Jing; Shi, Jun-Ting

2016-01-01

To investigate the correlation between the preoperative biometric parameters of the anterior segment and the vault after implantable Collamer lens (ICL) implantation via this retrospective study. Retrospective clinical study. A total of 78 eyes from 41 patients who underwent ICL implantation surgery were included in this study. Preoperative biometric parameters, including white-to-white (WTW) diameter, central corneal thickness, keratometer, pupil diameter, anterior chamber depth, sulcus-to-sulcus diameter, anterior chamber area (ACA) and central curvature radius of the anterior surface of the lens (Lenscur), were measured. Lenscur and ACA were measured with Rhinoceros 5.0 software on the image scanned with ultrasound biomicroscopy (UBM). The vault was assessed by UBM 3 months after surgery. Multiple stepwise regression analysis was employed to identify the variables that were correlated with the vault. The results showed that the vault was correlated with 3 variables: ACA (22.4 ± 4.25 mm2), WTW (11.36 ± 0.29 mm) and Lenscur (9.15 ± 1.21 mm). The regressive equation was: vault (mm) = 1.785 + 0.017 × ACA + 0.051 × Lenscur - 0.203 × WTW. Biometric parameters of the anterior segment (ACA, WTW and Lenscur) can predict the vault after ICL implantation using a new regression equation. © 2016 The Author(s) Published by S. Karger AG, Basel.

Retrieval, Inter-Comparison, and Validation of Above-Cloud Aerosol Optical Depth from A-train Sensors

NASA Technical Reports Server (NTRS)

Jethva, Hiren; Torres, Omar; Bhartia, Pawan K.; Remer, Lorraine; Redemann, Jens; Dunagan, Stephen E.; Livingston, John; Shinozuka, Yohei; Kacenelenbogen, Meloe; Segal-Rosenbeimer, Michal;

Degraded Operational Environment: Integration of Social Network Infrastructure Concept in a Traditional Military C2 System

DTIC Science & Technology

2013-06-01

Communication Applet) UNIGE – D.I.M.E. Using a free application as “MIT APP Inventor” Android Software Development Kit DEGRADED C2 ICCRTS 2013...operate on an Android operating system up-gradable on which will be developed a simplified ACA ( Android Communication Applet) that will call C24U...Server) IP number . . . Portable COTS Devices ACA - C24U ( Android Communication Applet) Sending/receiving SEFL (Simple Exchange

Circulating MicroRNAs as Novel Biomarkers of Stenosis Progression in Asymptomatic Carotid Stenosis.

PubMed

Dolz, Sandra; Górriz, David; Tembl, José Ignacio; Sánchez, Dolors; Fortea, Gerardo; Parkhutik, Vera; Lago, Aida

2017-01-01

Progression of asymptomatic carotid artery stenosis (ACAS) in patients with >50% luminal narrowing is considered a potential risk factor for ischemic stroke; however, subclinical molecular biomarkers of ACAS progression are lacking. Recent studies suggest a regulatory function for several microRNAs (miRNAs) on the evolution of carotid plaque, but its role in ACAS progression is mostly unknown. The aim of our study was to investigate a wide miRNA panel in peripheral blood exosomes from patients with ACAS to associate circulating miRNA expression profiles with stenosis progression. The study included 60 patients with ACAS carrying >50% luminal narrowing. First, miRNA expression profiles of circulating exosomes were determined by Affymetrix microarrays from plasma samples of 16 patients from the cohort. Second, those miRNAs among the most differentially expressed in patients with ACAS progression were quantified by real-time polymerase chain reaction in a separate replication cohort of 39 subjects within the patient sample. Our results showed that ACAS progression was associated with development of stroke. MiR-199b-3p, miR-27b-3p, miR-130a-3p, miR-221-3p, and miR-24-3p presented significant higher expression in those patients with ACAS progression. In conclusion, our study supports that specific circulating miRNA expression profiles could provide a new tool that complements the monitoring of ACAS progression, improving therapeutic approaches to prevent ischemic stroke. © 2016 American Heart Association, Inc.

Effects of Proposed Additional Ground-Water Withdrawals from the Mississippi River Valley Alluvial Aquifer on Water Levels in Lonoke County, Arkansas

USGS Publications Warehouse

Czarnecki, John B.

2006-01-01

The Grand Prairie Water Users Association, located in Lonoke County, Arkansas, plans to increase ground-water withdrawals from the Mississippi River Valley alluvial aquifer from their current (2005) rate of about 400 gallons per minute to 1,400 gallons per minute (2,016,000 gallons per day). The effect of pumping from a proposed well was simulated using a digital model of ground-water flow. The proposed additional withdrawals were added to an existing pumping cell specified in the model, with increased pumping beginning in 2005, and specified to pump at a total combined rate of 2,016,000 gallons per day for a period of 46 years. In addition, pumping from wells owned by Cabot Water Works, located about 2 miles from the proposed pumping, was added to the model beginning in 2001 and continuing through to the end of 2049. Simulated pumping causes a cone of depression to occur in the alluvial aquifer with a maximum decline in water level of about 8.5 feet in 46 years in the model cell of the proposed well compared to 1998 withdrawals. However, three new dry model cells occur south of the withdrawal well after 46 years. This total water-level decline takes into account the cumulative effect of all wells pumping in the vicinity, although the specified pumping rate from all other model cells in 2005 is less than for actual conditions in 2005. After 46 years with the additional pumping, the water-level altitude in the pumped model cell was about 177.4 feet, which is 41.7 feet higher than 135.7 feet, the altitude corresponding to half of the original saturated thickness of the alluvial aquifer (a metric used to determine if the aquifer should be designated as a Critical Ground-Water Area (Arkansas Natural Resources Commission, 2006)).

INTERIOR VIEW OF MIANUS RIVER PUMP STATION LOOKING SOUTHEAST. THE ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

INTERIOR VIEW OF MIANUS RIVER PUMP STATION LOOKING SOUTHEAST. THE CYLINDRICAL TANKS ON THE RIGHT SIDE OF THE PHOTOGRAPH ARE SAND-GRAVEL FILTERS. THE DIESEL POWERED PUMPS LOCATED IN THE CENTER LEFT FOREGOUND SUPPLIED FRESH WATER THROUGH A 16" LINE TO THE POWER PLANT BOILERS LOCATED ONE MILE SOUTH OF THE PUMP STATION - New York, New Haven & Hartford Railroad, Mianus River Pumping Station, River Road & Boston Post Road, Greenwich, Fairfield County, CT

Health Care Reform: Understanding Individuals' Attitudes and Information Sources

PubMed Central

Shue, Carolyn K.; McGeary, Kerry Anne; Reid, Ian; Fan, Maoyong

2014-01-01

Since passage of the Affordable Care Act (ACA) was signed into law by President Barrack Obama, little is known about state-level perceptions of residents on the ACA. Perceptions about the act could potentially affect implementation of the law to the fullest extent. This 3-year survey study explored attitudes about the ACA, the types of information sources that individuals rely on when creating those attitudes, and the predictors of these attitudes among state of Indiana residents. The respondents were split between favorable and unfavorable views of the ACA, yet the majority of respondents strongly supported individual components of the act. National TV news, websites, family members, and individuals' own reading of the ACA legislation were identified as the most influential information sources. After controlling for potential confounders, the respondent's political affiliation, age, sex, and obtaining ACA information from watching national television news were the most important predictors of attitudes about the ACA and its components. These results mirror national-level findings. Implications for implementing health care reform at the state-level are discussed. PMID:25045705

Three human chromosomal autoantigens are recognized by sera from patients with anti-centromere antibodies.

PubMed Central

Earnshaw, W; Bordwell, B; Marino, C; Rothfield, N

1986-01-01

We have identified 39 individuals with anti-centromere antibodies (ACA) in our patient population, all of whom have Raynaud's syndrome or disease. We have used sera from the ACA-positive patients and from 123 controls (22 normal individuals and 101 additional patients with either Raynaud's disease or Raynaud's syndrome plus an associated connective tissue disease) to screen the proteins of highly purified human (HeLa) mitotic chromosomes by sodium dodecyl sulfate polyacrylamide gel electrophoresis and immunoblotting. Three antigens were recognized by the sera from the ACA-positive patients. These were centromere protein (CENP)-B (80,000 mol wt--recognized by all ACA-positive sera), CENP-A (17,000 mol wt--recognized by 38 of 39 ACA-positive sera), and CENP-C (140,000 mol wt--recognized by 37 of 39 ACA-positive sera). None of these antigens were recognized by any of the 123 control sera, although binding was occasionally seen to other chromosomal antigens. Therefore the ACA response is highly uniform in our patient population. Antibody to CENP-B shows a 100% correlation with anti-centromere staining by indirect immunofluorescence. Images PMID:3511098

Three human chromosomal autoantigens are recognized by sera from patients with anti-centromere antibodies.

PubMed

Earnshaw, W; Bordwell, B; Marino, C; Rothfield, N

1986-02-01

We have identified 39 individuals with anti-centromere antibodies (ACA) in our patient population, all of whom have Raynaud's syndrome or disease. We have used sera from the ACA-positive patients and from 123 controls (22 normal individuals and 101 additional patients with either Raynaud's disease or Raynaud's syndrome plus an associated connective tissue disease) to screen the proteins of highly purified human (HeLa) mitotic chromosomes by sodium dodecyl sulfate polyacrylamide gel electrophoresis and immunoblotting. Three antigens were recognized by the sera from the ACA-positive patients. These were centromere protein (CENP)-B (80,000 mol wt--recognized by all ACA-positive sera), CENP-A (17,000 mol wt--recognized by 38 of 39 ACA-positive sera), and CENP-C (140,000 mol wt--recognized by 37 of 39 ACA-positive sera). None of these antigens were recognized by any of the 123 control sera, although binding was occasionally seen to other chromosomal antigens. Therefore the ACA response is highly uniform in our patient population. Antibody to CENP-B shows a 100% correlation with anti-centromere staining by indirect immunofluorescence.

Anti-mitochondrial type 5 antibodies and anti-cardiolipin antibodies in systemic lupus erythematosus and auto-immune diseases.

PubMed Central

Meyer, O; Abuaf, N; Cyna, L; Homberg, J C; Kahn, M F; Ryckewaert, A

1987-01-01

Twenty sera from patients with systemic lupus erythematosus (SLE) and high titre of IgG anti-cardiolipin antibodies (ACA) were studied in order to evaluate the prevalence of anti-mitochondrial type 5 antibodies (AMA 5). None of these sera were found to be AMA 5 positive but five of 18 were positive for VDRL. Twenty sera from patients with AMA 5 were studied in order to evaluate the prevalence of ACA: only six of 20 were positive for ACA. In contrast to this finding, 15 of the 20 sera positive for AMA 5 were also positive for VDRL (P less than 0.001). The six sera positive for ACA and AMA 5 were absorbed with cardiolipin micelles. This absorption eliminated the ACA activity but not the AMA 5 activity. Despite the clinical similarities between the two groups of patients with AMA 5 or ACA, these data suggest that patients with AMA 5 and patients with ACA belong to two different subsets of SLE or SLE-like syndromes and that AMA 5 antigen is different from cardiolipin. Images Fig. 1 PMID:3311494

Elimination of cost-sharing and receipt of screening for colorectal and breast cancer.

PubMed

Fedewa, Stacey A; Goodman, Michael; Flanders, W Dana; Han, Xuesong; Smith, Robert A; M Ward, Elizabeth; Doubeni, Chyke A; Sauer, Ann Goding; Jemal, Ahmedin

2015-09-15

The aim of the cost-sharing provision of the Patient Protection and Affordable Care Act (ACA) was to reduce financial barriers for preventive services, including screening for colorectal cancer (CRC) and breast cancer (BC) among privately and Medicare-insured individuals. Whether the provision has affected CRC and BC screening prevalence is unknown. The current study investigated whether CRC and BC screening prevalence among privately and Medicare-insured adults by socioeconomic status (SES) changed before and after the ACA. Data obtained from the National Health Interview Survey pertaining to privately and Medicare-insured adults from 2008 (before the ACA) and 2013 (after the ACA) were used. There were 15,786 adults aged 50 to 75 years in the CRC screening analysis and 14,530 women aged ≥40 years in the BC screening analysis. Changes in guideline-recommended screening between 2008 and 2013 by SES were expressed as the prevalence difference (PD) and 95% confidence interval (95% CI) adjusted for demographics, insurance, income, education, body mass index, and having a usual provider. Overall, CRC screening prevalence increased from 57.3% to 61.2% between 2008 and 2013 (P<.001). Adjusted CRC screening prevalence during the corresponding period increased in low-income (PD, 5.9; 95% CI, 1.8 to 10.2), least-educated (PD, 7.2; 95% CI, 0.9 to 13.5), and Medicare-insured (PD, 6.2; 95% CI, 1.7 to 10.7) individuals, but not in high-income, most-educated, and privately insured respondents. BC screening remained unchanged overall (70.5% in 2008 vs 70.2% in 2013) and in the low SES groups. Increases in CRC screening prevalence between 2008 and 2013 were confined to respondents with low SES. These findings may in part reflect the ACA's removal of financial barriers. © 2015 American Cancer Society.

AGOR 28: SIO Shipyard Representative Bi-Weekly Progress Report

DTIC Science & Technology

2013-07-18

ADA DBL)/ADA t/s  Lkr Md-2 (CG) 6  Sally Ride Gray Water Tank – Tank pressurized and boundaries inspected for leaks with ABS in...SPARES (VRS) LISTINGS, STATISTICS, AND LOCATIONS (DI-051 (VRS) for Pl 72428-03 Gray Water Discharge Pump)(R/ASR) 570/0 AGOR27 A051 STD Report...VENDOR RECOMMENDED SPARES (VRS) LISTINGS, STATISTICS, AND LOCATIONS ( DI-051 (VRS) for PL 72428-08 Hot Water Circ Pump)(R/ASR) 574/0 AGOR27 A055 TM

Specialty, political affiliation, and perceived social responsibility are associated with U.S. physician reactions to health care reform legislation.

PubMed

Antiel, Ryan M; James, Katherine M; Egginton, Jason S; Sheeler, Robert D; Liebow, Mark; Goold, Susan Dorr; Tilburt, Jon C

2014-02-01

Little is known about how U.S. physicians’ political affiliations, specialties, or sense of social responsibility relate to their reactions to health care reform legislation. To assess U.S. physicians’ impressions about the direction of U.S. health care under the Affordable Care Act (ACA), whether that legislation will make reimbursement more or less fair, and examine how those judgments relate to political affiliation and perceived social responsibility. A cross-sectional, mailed, self-reported survey. Simple random sample of 3,897 U.S.physicians. Views on the ACA in general, reimbursement under the ACA in particular, and perceived social responsibility. Among 2,556 physicians who responded (RR2: 65 %), approximately two out of five (41 %) believed that the ACA will turn U.S. health care in the right direction and make physician reimbursement less fair (44 %). Seventy-two percent of physicians endorsed a general professional obligation to address societal health policy issues, 65 % agreed that every physician is professionally obligated to care for the uninsured or underinsured, and half (55 %) were willing to accept limits on coverage for expensive drugs and procedures for the sake of expanding access to basic health care. In multivariable analyses, liberals and independents were both substantially more likely to endorse the ACA (OR 33.0 [95 % CI, 23.6–46.2]; OR 5.0 [95 % CI, 3.7–6.8], respectively), as were physicians reporting a salary (OR 1.7 [95 % CI, 1.2–2.5])or salary plus bonus (OR 1.4 [95 % CI, 1.1–1.9)compensation type. In the same multivariate models, those who agreed that addressing societal health policy issues are within the scope of their professional obligations (OR 1.5 [95 % CI, 1.0–2.0]), who believe physicians are professionally obligated to care for the uninsured / under-insured (OR 1.7 [95 % CI,1.3–2.4]), and who agreed with limiting coverage for expensive drugs and procedures to expand insurance coverage (OR 2.3 [95 % CI, 1.8–3.0]), were all significantly more likely to endorse the ACA. Surgeons and procedural specialists were less likely to endorse it (OR 0.5 [95 % CI, 0.4–0.7], OR 0.6 [95 %CI, 0.5–0.9], respectively). Significant subsets of U.S. physicians express concerns about the direction of U.S. health care under recent health care reform legislation. Those opinions appear intertwined with political affiliation,type of medical specialty, as well as perceived social responsibility.

[Cardiac arrest during anesthesia and recovery period].

PubMed

Otteni, J C; Steib, A; Pottecher, T

1990-01-01

Cardiac arrests (CA) occurring during anaesthesia and recovery can be classified into three groups: CA not related to anaesthesia (NACA), CA related to anaesthesia (ACA), whether partially (PACA) or totally (TACA). In the French survey, NACAs were three times more frequent than ACAs. Nearly 25% of ACAs occurred at induction and consisted mainly in TACAs. Another quarter of ACAs occurred during maintenance and consisted mainly in PACAs. About 50% of ACAs occurred after the end of anaesthesia and had the highest mortality rate. Cardiac arrest corresponds to the status of a heart unable to generate the minimum aortic blood flow required for functioning of vital organs. For the brain, a zero-blood flow of more than 4 seconds results in coma. Consequently CA exists when the time interval between two subsequent efficient systoles is greater than 4 seconds. Anaesthetic agents can result in CA by 1) overdose (absolute, relative), 2) anaphylactoid/anaphylactic reactions, 3) specific effects (acetylcholine-like effect, hyperkalaemia and malignant hyperthermia for succinylcholine; vagal effect of vecuronium and atracurium; cardiotoxicity of bupivacaine) and 4) drug interaction. In hypoxic CA, severe neurologic impairment often still exists at the time of onset of CA. The anaesthesia machine and controlled ventilation can induce CA by hypoxic ventilation, overdose of anaesthetic vapour, excessive CO2 reinhalation, hypoventilation, disconnection, excessive pressure in airways. Cardiac hypothermia can be a cause of CA as well as a cause of unsuccessful CPR. Massive infusion of unwarmed fluids and IPPV with unheated gases generate a temperature gradient within the heart which may result in severe arrhythmias and CA.(ABSTRACT TRUNCATED AT 250 WORDS)

Veterans' Health Insurance Coverage Under the Affordable Care Act and Implications of Repeal for the Department of Veterans Affairs

PubMed Central

Dworsky, Michael; Farmer, Carrie M.; Shen, Mimi

2018-01-01

Abstract This article describes the Affordable Care Act's (ACA's) effects on nonelderly veterans' insurance coverage and demand for Department of Veterans Affairs (VA) health care and assesses the coverage and VA utilization changes that could result from repealing the ACA. Although prior research has shown that the number of uninsured veterans fell after the ACA took effect, the implications of ACA repeal for veterans and, especially, for VA have received less attention. Besides providing a new coverage option to veterans who are not enrolled in VA, the ACA also had the potential to affect health care use among VA patients. Findings include the following: In 2013, prior to the major coverage expansions under the ACA, nearly one in ten nonelderly veterans were uninsured, lacking access to both VA coverage and non-VA health insurance. Uninsurance among nonelderly veterans fell by an adjusted 36 percent (3.3 percentage points) after implementation of the ACA, from 9.1 percent in 2013 to 5.8 percent in 2015. By increasing non-VA health insurance coverage for VA patients, the ACA likely reduced demand for VA care; the authors estimate that, if the gains in insurance coverage that occurred between 2013 and 2015 had not occurred, nonelderly veterans would have used about 1 percent more VA health care in 2015: 125,000 more office visits, 1,500 more inpatient surgeries, and 375,000 more prescriptions. Recent congressional proposals to repeal and replace the ACA would increase the number of uninsured nonelderly veterans and further increase demand for VA health care. PMID:29607249

Comparison of changes in mean flow velocity in anterior cerebral artery before and during cognitive stimulation between non-stroke and post-stroke people

NASA Astrophysics Data System (ADS)

Fitri, F. I.; Erwin, I.; Batubara, C. A.; Rambe, A. S.; Anwar, Y.

2018-03-01

Transcranial Doppler (TCD) is a tool that has been used widely to measure cerebral blood flow and changes in the cerebral autoregulatory mechanism that can be observed during cognitive stimulation task as changes in mean flow velocity (MFV). This cross-sectional study was to compare the anterior cerebral arteries (ACA) MFV changes during cognitive stimulation using TCD in post-stroke and control group in Neurology Department Adam Malik General Hospital. From August to December 2016, all subject underwent TCD examination to assess baseline characteristic both side of ACA; then the patients were stimulated using Stroop Task. During stimulation, we measured changes in MFV that were correlated with cerebral autoregulation in total 13 pairs of post-stroke and control recruited. Paired t-test was used to evaluate the difference in baseline and during stimulation for each post stroke and control group while independent t-test was used to determine the MFV changes difference between both groups. There were significant differences for MFV changes in each artery for control [R- ACA (p=0.001), L-ACA (p=0.001)] and post-stroke [R-ACA (p=0.001), L-ACA (p=0.001)]. Meanwhile, there was no significant difference for MFV elevation for arteries compared between groups [R-ACA (p=0.374) and L-ACA (0.272)].

Use of Prescription Assistance Programs After the Affordable Health Care Act.

PubMed

Khan, Ghazala; Karabon, Patrick; Lerchenfeldt, Sarah

2018-03-01

Insurance coverage in the United States seems to be in a state of unrest. The 2010 passage of the Patient Protection and Affordable Health Care Act (ACA) extended health insurance coverage to roughly 32 million people. An increase in the number of people with health insurance benefits raised the question of whether prescription assistance programs (PAPs) would still be used after ACA implementation. To evaluate the use of PAPs following the implementation of the ACA insurance mandate. Health insurance was not required by the ACA until January 2014, so we retrospectively examined the use of drug company-sponsored PAPs before and after the ACA implementation. Since each PAP had its own qualifying criteria, any person who used a PAP through the assistance of NeedyMeds and its PAPTracker between the years of 2011 and 2016 were included for analysis. Data were pulled by NeedyMeds from the PAPTracker software, which produces completed PAP applications from drug manufacturer forms for PAPs. The number of PAP orders, number of unique patient orders, and annual patient prescription savings were assessed. Between 2011 and 2013, there was an average of 4.2 annual PAP orders per patient; however, annual PAP orders decreased to 3.1 per patient between 2014 and 2016 (P < 0.001). PAP orders declined by an average of 3.0% per month between 2014 and 2016 (P < 0.001), and average prescription savings per order increased from $870.40 before the ACA to $1,086.40 after ACA implementation (P = 0.0024). Patients saved an average of over $3,000 on prescriptions annually with the use of PAPs after the ACA mandate. Although health care reform is inevitable, our study showed that PAPs remain important to help cover prescription drug costs for eligible patients, even with invariable changes to health insurance, including a health insurance requirement. While the ACA may have been an important step forward in extending health insurance coverage to millions, PAPs are still used to help U.S. patients obtain their medications at no cost or very low cost. These programs will most likely remain relevant until other approaches are taken to help alleviate the effects of increasing drug prices in the United States. No outside funding supported this research. The authors have no relevant financial or nonfinancial relationships to disclose. Study concept and design were contributed by Khan, Lerchenfeldt, and Karabon. Khan collected the data, and all authors participated in data analysis. The manuscript was primarily written by Lerchenfeldt, along with Khan and Karabon, and revised by Lerchenfeldt, along with Karabon and Khan.

Recirculating Molten Metal Supply System And Method

DOEpatents

Kinosz, Michael J.; Meyer, Thomas N.

2003-07-01

The melter furnace includes a heating chamber (16), a pump chamber (18), a degassing chamber (20), and a filter chamber (22). The pump chamber (18) is located adjacent the heating chamber (16) and houses a molten metal pump (30). The degassing chamber (20) is located adjacent and in fluid communication with the pump chamber (18), and houses a degassing mechanism (36). The filter chamber (22) is located adjacent and in fluid communication with the degassing chamber (20). The filter chamber (22) includes a molten metal filter (38). The melter furnace (12) is used to supply molten metal to an externally located holder furnace (14), which then recirculates molten metal back to the melter furnace (12).

Low-temperature thermal control for a lunar base

NASA Technical Reports Server (NTRS)

Swanson, Theodore D.; Radermacher, Reinhard; Costello, Frederick A.; Moore, James S., Jr.; Mengers, David R.

1990-01-01

The generic problem of rejecting low- to moderate-temperature heat from space facilities located in a hot thermal sink environment is studied, and the example of a lunar base located near the equator is described. The effective thermal sink temperature is often above or near nominal room temperature. A three heat pump assisted thermal bus concept appears to be the most viable as they are the least sensitive to environmental conditions. Weight estimates are also developed for each of the five thermal control concepts studied: (1) 149kg/kW for a central thermal loop with unitary heat pumps; (2) 133 kg/kW for a conventional bus connected to large, central heat pumps at the radiator; (3) 134 kg/kW for a central, dual loop heat pump concept; (4) 95 kg/kW for the selective field-of-view radiator; and (5) 126 kg/kW for the regolith concept.

Attachment method for stacked integrated circuit (IC) chips

DOEpatents

Bernhardt, Anthony F.; Malba, Vincent

1999-01-01

An attachment method for stacked integrated circuit (IC) chips. The method involves connecting stacked chips, such as DRAM memory chips, to each other and/or to a circuit board. Pads on the individual chips are rerouted to form pads on the side of the chip, after which the chips are stacked on top of each other whereby desired interconnections to other chips or a circuit board can be accomplished via the side-located pads. The pads on the side of a chip are connected to metal lines on a flexible plastic tape (flex) by anisotropically conductive adhesive (ACA). Metal lines on the flex are likewise connected to other pads on chips and/or to pads on a circuit board. In the case of a stack of DRAM chips, pads to corresponding address lines on the various chips may be connected to the same metal line on the flex to form an address bus. This method has the advantage of reducing the number of connections required to be made to the circuit board due to bussing; the flex can accommodate dimensional variation in the alignment of chips in the stack; bonding of the ACA is accomplished at low temperature and is otherwise simpler and less expensive than solder bonding; chips can be bonded to the ACA all at once if the sides of the chips are substantially coplanar, as in the case for stacks of identical chips, such as DRAM.

Growth and structural characterization of large superconducting crystals of La 2 - x Ca 1 + x Cu 2 O 6

DOE PAGES

Schneeloch, J. A.; Guguchia, Z.; Stone, M. B.; ...

2017-12-01

Lmore » arge crystals of a 2 - x Ca 1 + x Cu 2 O 6 (a-Ca-2126) with x = 0:10 and 0.15 have been grown and converted to bulk superconductors by high-pressure oxygen annealing. The superconducting transition temperature, T c, is as high as 55 K; this can be raised to 60 K by post-annealing in air. Here we present structural and magnetic characterizations of these crystals using neutron scattering and muon spin rotation techniques. While the as-grown, non-superconducting crystals are single phase, we nd that the superconducting crystals contain 3 phases forming coherent domains stacked along the c axis: the dominant a-Ca-2126 phase, very thin (1.5 unit-cell) intergrowths of a 2CuO 4, and an antiferromagnetic a 8Cu 8O 20 phase. We propose that the formation and segregation of the latter phases increases the Ca concentration of the a-Ca-2126, thus providing the hole-doping that supports superconductivity.« less

Growth and structural characterization of large superconducting crystals of La 2 - x Ca 1 + x Cu 2 O 6

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

Schneeloch, J. A.; Guguchia, Z.; Stone, M. B.

Lmore » arge crystals of a 2 - x Ca 1 + x Cu 2 O 6 (a-Ca-2126) with x = 0:10 and 0.15 have been grown and converted to bulk superconductors by high-pressure oxygen annealing. The superconducting transition temperature, T c, is as high as 55 K; this can be raised to 60 K by post-annealing in air. Here we present structural and magnetic characterizations of these crystals using neutron scattering and muon spin rotation techniques. While the as-grown, non-superconducting crystals are single phase, we nd that the superconducting crystals contain 3 phases forming coherent domains stacked along the c axis: the dominant a-Ca-2126 phase, very thin (1.5 unit-cell) intergrowths of a 2CuO 4, and an antiferromagnetic a 8Cu 8O 20 phase. We propose that the formation and segregation of the latter phases increases the Ca concentration of the a-Ca-2126, thus providing the hole-doping that supports superconductivity.« less

Quality of Artemisinin-Containing Antimalarials in Tanzania's Private Sector—Results from a Nationally Representative Outlet Survey

PubMed Central

2015-01-01

Ensuring that artemisinin-containing antimalarials (ACAs) are of good quality is a key component of effective malaria treatment. There are concerns that a high proportion of ACAs are falsified or substandard, though estimates are rarely based on representative data. During a nationally representative survey in Tanzania, ACAs were purchased from private retail drug outlets, and the active pharmaceutical ingredient (API) was measured. All 1,737 ACAs contained the labeled artemisinin derivative, with 4.1% being outside the 85–115% artemisinin API range defined as acceptable quality. World Health Organization (WHO) prequalified drugs had 0.1 times the odds of being poor quality compared with non-prequalified ACAs for the artemisinin component. When partner components of combination therapies were also considered, 12.1% were outside the acceptable API range, and WHO prequalified ACAs had 0.04 times the odds of being poor quality. Although the prevalence of poor quality ACAs was lower than reported elsewhere, the minority of samples found to be substandard is a cause for concern. Improvements in quality could be achieved by increasing the predominance of WHO prequalified products in the market. Continued monitoring of quality standards is essential. PMID:25897065

Impact of Affordable Care Act coverage expansion on women's reproductive preventive services in the United States.

PubMed

Arora, Prachi; Desai, Karishma

2016-08-01

The Affordable Care Act (ACA) expansion mandated the private health plans to cover women's preventive services starting August 2012. With limited and contradictory evidence, this study intends to assess the impact of ACA on the utilization rates and the cost burden of women's reproductive preventive service. A pre-post analysis was conducted using a nationally representative sample of females (aged 15-44years, n=4397) participating in the 2011-2013 National Survey of Family Growth. The utilization rates and cost burdens were compared for six services using bivariate and multivariable logistic regression models. After the ACA expansion, there wasn't a significant increase in the utilization rates of birth control/prescription (33.7% vs. 30.7%), birth control counseling (17.7% vs. 16.9%), sterilization counseling (3.3% vs. 3.5%), STI counsel/test/treat (15% vs. 14.6%) and HIV screening (24.1% vs. 23.1%). Respondents paying through insurance increased after ACA, but out-of-pocket spending (cost-sharing) didn't decrease for respondents. Type of insurance was an important predictor of utilization rates with publicly insured having significantly higher Odds Ratio (OR) or likelihood of receiving birth control counseling (OR:1.71), sterilization counseling (OR:2.67), STI counsel/test/treat (OR:1.54) and HIV screening (OR:1.69) compared to privately insured. The early-on impact of ACA expansion on utilization rates of women's reproductive preventive services didn't appear to be significant. Private health plans, however, might have expanded their coverage but burden of cost sharing still existed. Future research should evaluate the long term impact of ACA expansion on women's health and the economic gains. Copyright © 2016 Elsevier Inc. All rights reserved.

Program Implementation Approaches to Build and Sustain Health Care Coordination for Type 2 Diabetes.

PubMed

Fitzgerald, Tania M; Williams, Pam A; Dodge, Julia A; Quinn, Martha; Heminger, Christina L; Moultrie, Rebecca; Taylor, Olivia; Nelson, Belinda W; Lewis, Megan A

2017-03-01

As more people enter the U.S. health care system under the Affordable Care Act (ACA), it is increasingly critical to deliver coordinated, high-quality health care. The ACA supports implementation and sustainability of efficient health care models, given expected limits in available resources. This article highlights implementation strategies to build and sustain care coordination, particularly ones consistent with and reinforced by the ACA. It focuses on disease self-management programs to improve the health of patients with type 2 diabetes, exemplified by grantees of the Alliance to Reduce Disparities in Diabetes. We conducted interviews with grantee program representatives throughout their 5-year programs and conducted a qualitative framework analysis of data to identify key themes related to care coordination. The most promising care coordination strategies that grantee programs described included establishing clinic-community collaborations, embedding community health workers within care management teams, and sharing electronic data. Establishing provider buy-in was crucial for these strategies to be effective. This article adds new insights into strategies promoting effective care coordination. The strategies that grantees implemented throughout the program align with ACA requirements, underscoring their relevance to the changing U.S. health care environment and the likelihood of further support for program sustainability.

Early Impact of the Affordable Care Act on Uptake of Long-acting Reversible Contraceptive Methods.

PubMed

Pace, Lydia E; Dusetzina, Stacie B; Keating, Nancy L

2016-09-01

The Affordable Care Act (ACA) required most private insurance plans to cover contraceptive services without patient cost-sharing as of January 2013 for most plans. Whether the ACA's mandate has impacted long-acting reversible contraceptives (LARC) use is unknown. The aim of this article is to assess trends in LARC cost-sharing and uptake before and one year after implementation of the ACA's contraceptive mandate. A retrospective cohort study using Truven Health MarketScan claims data from January 2010 to December 2013. Women aged 18-45 years with continuous insurance coverage with claims for oral contraceptive pills, patches, rings, injections, or LARC during 2010-2013 (N=3,794,793). Descriptive statistics were used to assess trends in LARC cost-sharing and uptake from 2010 through 2013. Interrupted time series models were used to assess the association of time, ACA, and time after the ACA on LARC cost-sharing and initiation rates, adjusting for patient and plan characteristics. The proportion of claims with $0 cost-sharing for intrauterine devices and implants, respectively, rose from 36.6% and 9.3% in 2010 to 87.6% and 80.5% in 2013. The ACA was associated with a significant increase in these proportions and in their rate of increase (level and slope change both P<0.001). LARC uptake increased over time with no significant change in level of LARC use after ACA implementation in January 2013 (P=0.44) and a slightly slower rate of growth post-ACA than previously reported (β coefficient for trend, -0.004; P<0.001). The ACA has significantly decreased LARC cost-sharing, but during its first year had not yet increased LARC initiation rates.

Implementation and Operational Research: Affordable Care Act Implementation in a California Health Care System Leads to Growth in HIV-Positive Patient Enrollment and Changes in Patient Characteristics.

PubMed

Satre, Derek D; Altschuler, Andrea; Parthasarathy, Sujaya; Silverberg, Michael J; Volberding, Paul; Campbell, Cynthia I

2016-12-15

This study examined implementation of the Affordable Care Act (ACA) in relation to HIV-positive patient enrollment in an integrated health care system; as well as changes in new enrollee characteristics, benefit structure, and health care utilization after key ACA provisions went into effect in 2014. This mixed-methods study was set in Kaiser Permanente Northern California (KPNC). Qualitative interviews with 29 KPNC leaders explored planning for ACA implementation. Quantitative analyses compared newly enrolled HIV-positive patients in KPNC between January and December 2012 ("pre-ACA," N = 661) with newly enrolled HIV-positive patients between January and December 2014 ("post-ACA," N = 880) on demographics; medical, psychiatric, and substance use disorder diagnoses; HIV clinical indicators; and type of health care utilization. Interviews found that ACA preparation focused on enrollment growth, staffing, competition among health plans, concern about cost sharing, and HIV pre-exposure prophylaxis (PrEP) services. Quantitative analyses found that post-ACA HIV-positive patient enrollment grew. New enrollees in 2014 were more likely than 2012 enrollees to be enrolled in high-deductible plans (P < 0.01) or through Medicaid (P < 0.01), and marginally more likely to have better HIV viral control (P < 0.10). They also were more likely to be diagnosed with asthma (P < 0.01) or substance use disorders (P < 0.05) and to have used primary care health services in the 6 months postenrollment (P < 0.05) than the pre-ACA cohort. As anticipated by KPNC interviewees, ACA implementation was followed by HIV-positive patient enrollment growth and changing benefit structures and patient characteristics. Although HIV viral control improved, comorbid diagnosis findings reinforced the importance of coordinated health care.

Impacts of the Affordable Care Act on Community Health Centers: Characteristics of New Patients and Early Changes in Delivery of Care.

PubMed

Hatch, Brigit; Smith, Ning; McBurnie, Mary Ann; Quach, Thu; Mayer, Kenneth H; Dunne, Mary J; Cottrell, Erika

2018-05-15

The aim of this study was to assess the impact of the Affordable Care Act (ACA) on community health centers (CHCs). Using electronic health records from the Community Health Applied Research Network, we assessed new patient characteristics, office visit volume, and payer distribution among CHC patients before and after ACA implementation, 2011-2014 (n = 442 455). New patients post-ACA were younger, more likely to be female and have chronic health conditions, and utilized more primary care (P < .05 for each). Post-ACA, clinics delivered 19% more office visits and more visits were reimbursed by Medicaid. The support of CHCs is needed to meet increased demand post-ACA.

28. Main engine air pump located to port side of ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

28. Main engine air pump located to port side of main engine cylinder beside engine bed. Dynamo lies aft of air pump (at right), pipe at extreme left of image carries lake water to condenser valves. - Steamboat TICONDEROGA, Shelburne Museum Route 7, Shelburne, Chittenden County, VT

A Tianshan Mountains loess-paleosol sequence indicates anti-phase climatic variations in arid central Asia and in East Asia

NASA Astrophysics Data System (ADS)

Li, Guoqiang; Chen, Fahu; Xia, Dunsheng; Yang, He; Zhang, Xiaojian; Madsen, David; Oldknow, Chris; Wei, Haitao; Rao, Zhiguo; Qiang, Mingrui

2018-07-01

Paleoclimatic changes in arid central Asia (ACA), one of the largest arid regions in the world, are complex and the nature of these changes on orbital cycles remains unclear. Widely distributed loess records in ACA potentially provide records of paleoclimatic variation, but these records are difficult to interpret due to a lack of robust high resolution chronologies. K-feldspar pIRIR dating was employed to date 37 samples from a 13 m loess-paleosol sequence (section KS15) in an intermontane basin of the Tianshan Mountains, central ACA, NW China. The reliability of the pIRIR ages was determined by using internal checks of luminescence characteristics of the pIR50IR290 and pIR200IR290 signals, and by comparing pIR50IR290 and pIR200IR290 ages. A high resolution chronology for the loess-paleosol sequence, spanning 130-45 ka, was established using Bacon age/depth modeling. In combination with climate proxy indexes of magnetic susceptibility, total organic material, and δ13C of organic remains from the sequence, our results suggest: (1) the pIRIR ages utilizing pIR50IR290 and pIR200IR290 signals are consistent for loess samples <150 ka; (2) eolian loess was deposited in intermontane basins of the Tianshan Mountains by at least ∼150 ka, with a steadily increasing rate of loess deposition from the last interglacial to the last glacial period; (3) ACA had a moist climate, characterized by paleosol development, during periods at 117-109, 97-85, 77-70 and 58-50 ka, corresponding to MIS 5d, MIS 5b, MIS 5-4 and MIS 3c; (4) ACA had dry climates, characterized by loess deposition, at 131-117, 109-97, 85-76, 70-58 and 50-46 ka, corresponding to MIS 5e, MIS 5c, MIS a and MIS 3b; and (5) during sub-stages of MIS 5 the ACA climate was characterized by cold-moist to warm-dry shifts which appear to be related to ∼21 ka precession cycles, but inversely related to Northern Hemisphere summer insolation patterns. Moisture variation in ACA thus has an anti-phase relationship to that in monsoonal East Asia. Orbital forcing may be responsible for this moisture variation in ACA.

Comparative Analysis of ACAS-Xu and DAIDALUS Detect-and-Avoid Systems

NASA Technical Reports Server (NTRS)

Davies, Jason T.; Wu, Minghong G.

2018-01-01

The Detect and Avoid (DAA) capability of a recent version (Run 3) of the Airborne Collision Avoidance System-Xu (ACAS-Xu) is measured against that of the Detect and AvoID Alerting Logic for Unmanned Systems (DAIDALUS), a reference algorithm for the Phase 1 Minimum Operational Performance Standards (MOPS) for DAA. This comparative analysis of the two systems' alerting and horizontal guidance outcomes is conducted through the lens of the Detect and Avoid mission using flight data of scripted encounters from a recent flight test. Results indicate comparable timelines and outcomes between ACAS-Xu's Remain Well Clear alert and guidance and DAIDALUS's corrective alert and guidance, although ACAS-Xu's guidance appears to be more conservative. ACAS-Xu's Collision Avoidance alert and guidance occurs later than DAIDALUS's warning alert and guidance, and overlaps with DAIDALUS's timeline of maneuver to remain Well Clear. Interesting discrepancies between ACAS-Xu's directive guidance and DAIDALUS's "Regain Well Clear" guidance occur in some scenarios.

Effects of Affordable Care Act Marketplaces and Medicaid Eligibility Expansion on Access to Cancer Care.

PubMed

Graves, John A; Swartz, Katherine

The aim of this study was to inform oncologists about how repealing the Affordable Care Act (ACA) may affect their ability to provide cancer therapies for people with cancer enrolled in ACA health plans and why proposals to change Medicaid funding may make it even more difficult for Medicaid beneficiaries to access cancer treatments. We examined the regulations and provisions of the ACA related to how health insurance impacts access to diagnostic testing and treatments for people with cancer, including access to clinical trials. Similarly, we examined federal and state rules affecting Medicaid beneficiaries' access to cancer treatments. Repealing various provisions of the ACA will restrict who has access to both current and new cancer treatments. Such changes also will impact oncology research that depends on having heterogeneous people in clinical trials. Significant changes to the ACA will affect oncology treatment choices of everyone with health insurance-not only the 10 million people newly covered by ACA health plans and the 70 million people with Medicaid coverage.

Effects of Affordable Care Act Marketplaces and Medicaid Eligibility Expansion on Access to Cancer Care

PubMed Central

Graves, John A.; Swartz, Katherine

2017-01-01

Purpose To inform oncologists about how repealing the ACA may affect their ability to provide cancer therapies for people with cancer enrolled in ACA health plans, and why proposals to change Medicaid funding may make it even more difficult for Medicaid beneficiaries to access cancer treatments. Methods We examined the regulations and provisions of the ACA related to how health insurance impacts access to diagnostic testing and treatments for people with cancer, including access to clinical trials. Similarly, we examined federal and state rules affecting Medicaid beneficiaries’ access to cancer treatments. Results Repealing various provisions of the ACA will restrict who has access to both current and new cancer treatments. Such changes also will impact oncology research that depends on having heterogeneous people in clinical trials. Discussion Significant changes to the ACA will affect oncology treatment choices of everyone with health insurance – not just the 10 million people newly covered by ACA health plans and the 70 million people with Medicaid coverage. PMID:28537962

Role of Setbp1 in Myeloid Leukemia Development

DTIC Science & Technology

2014-09-05

CTC ACT GTG GAG ACG ATT C 3’ 5’ TTC TTA TCC AGC ACA CCA AGC TT 3’ Hoxa9 5’ TGT CTC CTC TCC CCC AAA CC 3’ 5’ GAG ATG AGG CCT GGG ATTTAG A 3’ Hoxa10...highlighted in yellow and noncoding exons in gray . Arrows indicate transcription start sites. The location and orientation of viral integrations are

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.

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

Multi-point laser ignition device

DOEpatents

McIntyre, Dustin L.; Woodruff, Steven D.

2017-01-17

A multi-point laser device comprising a plurality of optical pumping sources. Each optical pumping source is configured to create pumping excitation energy along a corresponding optical path directed through a high-reflectivity mirror and into substantially different locations within the laser media thereby producing atomic optical emissions at substantially different locations within the laser media and directed along a corresponding optical path of the optical pumping source. An output coupler and one or more output lenses are configured to produce a plurality of lasing events at substantially different times, locations or a combination thereof from the multiple atomic optical emissions produced at substantially different locations within the laser media. The laser media is a single continuous media, preferably grown on a single substrate.

32. PLAN OF DEER ISLAND PUMPING STATION SHOWING EXISTING PUMPING ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

32. PLAN OF DEER ISLAND PUMPING STATION SHOWING EXISTING PUMPING PLANT AND LOCATION OF PROPOSED ADDITIONS, JULY 1898 SHEET NO. 1. Aperture card 4966-1 - Deer Island Pumping Station, Boston, Suffolk County, MA

Evaluating internal and ocular residual astigmatism in Chinese myopic children.

PubMed

Liu, Yanlin; Cheng, Yong; Zhang, Yue; Zhang, Lu; Zhao, Mingwei; Wang, Kai

2017-11-01

To investigate the nature of internal astigmatism (IA) and ocular residual astigmatism (ORA) in Chinese myopic children and to identify factors that may influence IA and ORA. A total of 206 eyes of 206 myopic children (97 boys and 109 girls; 10.95 ± 2.2 years) were enrolled in this cross sectional study. Total ocular astigmatism (TOA), anterior corneal astigmatism (ACA), posterior corneal astigmatism (PCA) and total corneal astigmatism (TCA) were measured directly using either a Hartmann-Shack wavefront sensor or a Pentacam. IA and ORA were calculated by Fourier vector analyses (the definitions of IA and ORA are: IA = TOA - ACA - PCA, ORA = TOA - ACA). Spearman or Pearson correlation was adopted to detect multiple factors that may influence IA and ORA, which were then predicted by linear regressions. Modified compensation factors were applied to evaluate the inter-relationship between corneal astigmatism and ORA. While the mean values of IA and ORA were -0.52 DC × 94.8° and -0.63 DC × 93.0°, respectively, the percentage of ORA power over 1.00 D was as high as 28.64%. Full or under-compensation of ACA by ORA predominated in the enrolled subjects. The mean ORA J 0 and J 45 were -0.311 ± 0.236 and -0.032 ± 0.156 D, respectively, negatively correlated with the corresponding ACA components (J 0 : r = -0.276, J 45 : r = -0.616, p < 0.001). While age was not correlated with either IA or ORA (p > 0.1), the power of IA or ORA was correlated inversely with the axial length (IA: r = -0.193, p = 0.005; ORA: r = -0.169, p = 0.015) and positively with the spherical equivalent refraction (IA r = 0.195, p = 0.005; ORA r = 0.213, p = 0.002) and power of corneal astigmatism (IA-ACA: r = 0.302, IA-TCA: r = 0.368, ORA-ACA: r = 0.334, ORA-TCA: r = 0.293). Girls had larger IA powers than boys (0.741 ± 0.345 D vs 0.651 ± 0.340, p = 0.036). Full or under-compensation of ACA by ORA is common in Chinese myopic children, and the compensation efficiency may decrease with age. Among Chinese children with myopia, a larger ORA is more prevalent with less myopia and greater corneal astigmatism.

Quality of artemisinin-based combination formulations for malaria treatment: prevalence and risk factors for poor quality medicines in public facilities and private sector drug outlets in Enugu, Nigeria.

PubMed

Kaur, Harparkash; Allan, Elizabeth Louise; Mamadu, Ibrahim; Hall, Zoe; Ibe, Ogochukwu; El Sherbiny, Mohamed; van Wyk, Albert; Yeung, Shunmay; Swamidoss, Isabel; Green, Michael D; Dwivedi, Prabha; Culzoni, Maria Julia; Clarke, Siân; Schellenberg, David; Fernández, Facundo M; Onwujekwe, Obinna

2015-01-01

Artemisinin-based combination therapies are recommended by the World Health Organisation (WHO) as first-line treatment for Plasmodium falciparum malaria, yet medication must be of good quality for efficacious treatment. A recent meta-analysis reported 35% (796/2,296) of antimalarial drug samples from 21 Sub-Saharan African countries, purchased from outlets predominantly using convenience sampling, failed chemical content analysis. We used three sampling strategies to purchase artemisinin-containing antimalarials (ACAs) in Enugu metropolis, Nigeria, and compared the resulting quality estimates. ACAs were purchased using three sampling approaches--convenience, mystery clients and overt, within a defined area and sampling frame in Enugu metropolis. The active pharmaceutical ingredients were assessed using high-performance liquid chromatography and confirmed by mass spectrometry at three independent laboratories. Results were expressed as percentage of APIs stated on the packaging and used to categorise each sample as acceptable quality, substandard, degraded, or falsified. Content analysis of 3024 samples purchased from 421 outlets using convenience (n=200), mystery (n=1,919) and overt (n=905) approaches, showed overall 90.8% ACAs to be of acceptable quality, 6.8% substandard, 1.3% degraded and 1.2% falsified. Convenience sampling yielded a significantly higher prevalence of poor quality ACAs, but was not evident by the mystery and overt sampling strategies both of which yielded results that were comparable between each other. Artesunate (n=135; 4 falsified) and dihydroartemisinin (n=14) monotherapy tablets, not recommended by WHO, were also identified. Randomised sampling identified fewer falsified ACAs than previously reported by convenience approaches. Our findings emphasise the need for specific consideration to be given to sampling frame and sampling approach if representative information on drug quality is to be obtained.

Systemic Sclerosis Sine Scleroderma in Mexican Patients. Case Reports.

PubMed

Vera-Lastra, Olga; Sauceda-Casas, Christian Alexis; Domínguez, María Del Pilar Cruz; Alvarez, Sergio Alberto Mendoza; Sepulceda-Delgado, Jesús

2017-01-03

Systemic sclerosis sine scleroderma (ssSSc) is a form of systemic sclerosis that is characterized by Raynaud's phenomenon (RP), visceral involvement without thickening of skin and anticentromere antibodies (ACA). We studied 10 ssSsc patients with a prevalence of 2%. The clinical signs were: RP 9/10, esophageal manifestations 8/10, pulmonary arterial hypertension 4/10, interstitial lung disease 4/10, cardiac signs 3/10 and ACA 8/10. In patients with RP, esophageal dysmotility, interstitial lung disease and pulmonary arterial hypertension should be tested for ACA in order to establish a prompt diagnosis and treatment of ssSSc. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Effects of Cone-Shaped Bend Inlet Cannulas of an Axial Blood Pump on Thrombus Formation: An Experiment and Simulation Study.

PubMed

Liu, Guangmao; Zhou, Jianye; Sun, Hansong; Zhang, Yan; Chen, Haibo; Hu, Shengshou

2017-04-05

BACKGROUND Cannula shape and connection style influence the risk of thrombus formation in the blood pump by varying the blood flow characteristics inside the pump. Inlet cannulas should be designed based on the need for anatomical fit and reducing the risk of thrombus generation in the blood pump. The effects on thrombus formation of the cone-shaped bend inlet cannulas of axial blood pumps should be studied. MATERIAL AND METHODS The cannulas were designed as cone-shaped, with 1 bent section connecting 2 straight sections. Both the silicone tube and novel cone-shaped cannula were simulated for comparison. The flow fields of a blood pump with inlet cannula were simulated by computational fluid dynamics (CFD) at flows of 2.0, 2.5, and 3.0 liters per minute (lpm), with pump rotational speeds of 7500, 8000, and 8500 rpm, respectively. Then, 6 two-dimensional (2D) particle image velocimetry (PIV) tests were conducted and the velocity distributions were analyzed. RESULTS A low-velocity region was located inside the pump entrance when a soft silicone tube was used. At 8500 rpm and 3.0 lpm working condition, the minimum velocity inside the pump with cone-shaped cannulas was 2.5×10^-1 m/s. The cone-shaped cannulas eliminated the low-velocity region inside the pump. Both CFD and PIV results showed that the low-velocity region did not spread to the entrance of the blood pump within the flow range from 2.0 lpm to 7.0 lpm. CONCLUSIONS The designed cone-shaped bent cannulas can eliminate the low-velocity region inside the blood pump and reduce the risk of thrombus formation in the blood pump.

G2(+)M study on N-alkylamino cation affinities of neutral main-group element hydrides: trends across the periodic table.

PubMed

Geng, Song; Wu, Ding-Lu; Yang, Jing; Wei, Xi-Guang; Zhu, Jun; Zhang, Hai-Bo; Ren, Yi; Lau, Kai-Chung

2014-05-08

We have made an extensive theoretical exploration of gas-phase N-alkylamino cation affinities (NAAMCA), including amino cation affinities (AMCA) and N-dimethylamino cation affinities (NDMAMCA), of neutral main-group element hydrides of groups 15-17 and periods 2-4 in the periodic table by using the G2(+)M method. Some similarities and differences are found between NAAMCA and the corresponding alkyl cation affinities (ACA) of H(n)X. Our calculations show that the AMCA and NDMAMCA are systematically lower than the corresponding proton affinities (PA) for H(n)X. In general, there is no linear correlation between NAAMCA and PA of H(n)X. Instead, the correlations exist only within the central elements X in period 2, or periods 3-4, which is significantly different from the reasonable correlations between ACA and PA for all H(n)X. NAAMCA (H(n)X) are weaker than NAAMCA (H(n-1)X(-)) by more than 700 kJ/mol and generally stronger than ACA (H(n)X), with three exceptions: H2ONR2(+)(R = H, Me) and HFNH2(+). These new findings can be rationalized by the negative hyperconjugation and Pauli repulsion.

Synthesis of novel Eu(III) luminescent probe based on 9- acridinecarboxylic acid skelton for sensing of ds-DNA.

PubMed

Azab, Hassan A; Hussein, Belal H M; El-Falouji, Abdullah I

2012-03-01

Eu(III)-9-acridinecarboxylate (9-ACA) complex was synthesized and characterized by elemental analysis, conductivity measurement, IR spectroscopy, thermal analysis, mass spectroscopy, (1)H-NMR, fluorescence and ultraviolet spectra. The results indicated that the composition of this complex is [Eu(III)-(9-ACA)(2)(NCS)(C(2)H(5)OH)(2)] 2.5 H(2)O and the oxygen of the carbonyl group coordinated to Eu(III). The interaction between the complex with nucleotides guanosine 5'- monophosphate (5'-GMP), adenosine 5'-diphosphates (5'-ADP), inosine (5'-IMP) and CT-DNA was studied by fluorescence spectroscopy. The fluorescence intensity of Eu(III)-9-acridinecarboxylate complex was enhanced with the addition of CT-DNA. The effect of pH values on the fluorescence intensity of Eu(III) complex was investigated. Under experimental conditions, the linear range was 9-50 ng mL(-1) for calf thymus DNA (CT- DNA) and the corresponding detection limit was 5 ng mL(-1). The results showed that Eu(III)-(9-ACA)(2) complex binds to CT-DNA with stability constant of 2.41 × 10(4) M.

Multiple pump housing

DOEpatents

Donoho, II, Michael R.; Elliott; Christopher M.

2010-03-23

A fluid delivery system includes a first pump having a first drive assembly, a second pump having a second drive assembly, and a pump housing. At least a portion of each of the first and second pumps are located in the housing.

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...

Coping among Nonclinical College-Age Children of Alcoholics.

ERIC Educational Resources Information Center

Wright, Deborah M.; Heppner, P. Paul

1991-01-01

Compared 40 adult children of alcoholics (ACAs) to 40 non-ACAs on problem-solving appraisal, perceived social support, shame, suicidal ideation, and substance use; examined gender differences among ACAs; explored relations between problem-solving appraisal, perceived social support, and shame in predicting suicidal ideation and substance use. ACAs…

American Camping Association Annual Report, 2000.

ERIC Educational Resources Information Center

American Camping Association, Martinsville, IN.

The American Camping Association (ACA) is a community of camp professionals dedicated to enriching the lives of children and adults through the camp experience. This annual report describes ACA activities during 2000, grouped in five areas: (1) expansion of services and other development of ACA's 24 regional sections and partnerships with other…

Advanced Connectivity Analysis (ACA): a Large Scale Functional Connectivity Data Mining Environment.

PubMed

Chen, Rong; Nixon, Erika; Herskovits, Edward

2016-04-01

Using resting-state functional magnetic resonance imaging (rs-fMRI) to study functional connectivity is of great importance to understand normal development and function as well as a host of neurological and psychiatric disorders. Seed-based analysis is one of the most widely used rs-fMRI analysis methods. Here we describe a freely available large scale functional connectivity data mining software package called Advanced Connectivity Analysis (ACA). ACA enables large-scale seed-based analysis and brain-behavior analysis. It can seamlessly examine a large number of seed regions with minimal user input. ACA has a brain-behavior analysis component to delineate associations among imaging biomarkers and one or more behavioral variables. We demonstrate applications of ACA to rs-fMRI data sets from a study of autism.

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.

Adenylyl cyclase localization to the uropod of aggregating Dictyostelium cells requires RacC

PubMed Central

Wang, C.; Jung, D.; Cao, Z.; Chung, C. Y.

2015-01-01

The localization of adenylyl cyclase A (ACA) to uropod of cells is required for the stream formation during Dictyostelium development. RacC is a Dictyostelium orthologue of Cdc42. We identified a streaming defect of racC− cells as they are clearly less polarized and form smaller and fragmented streams. ACA-YFP is mainly associated with intracellular vesicular structures, but not with the plasma membrane in racC− cells. racC− cells have a slightly higher number of vesicles than Ax3 cells, suggesting that the defect of ACA trafficking is not simply due to the lack of vesicle formation. While the ACA-YFP vesicles traveled with an average velocity of 9.1 µm/min in Ax3 cells, a slow and diffusional movement without direction with an average velocity of 4 µm/min was maintained in racC− cells. Images acquired by using total internal reflection fluorescence (TIRF) microscopy and fluorescence recovery after photobleaching (FRAP) analysis revealed that a significantly decreased number of ACA-YFP vesicles appeared near the cell membrane, indicating a defect in ACA-YFP vesicle trafficking. These results suggest an important role of RacC in the rapid and directional movements of ACA vesicles on microtubules to the plasma membrane, especially to the back of polarized cell. PMID:26315268

Quality of Artemisinin-Containing Antimalarials in Tanzania's Private Sector--Results from a Nationally Representative Outlet Survey.

PubMed

Act Consortium Drug Quality Project Team And The Impact Study Team

2015-06-01

Ensuring that artemisinin-containing antimalarials (ACAs) are of good quality is a key component of effective malaria treatment. There are concerns that a high proportion of ACAs are falsified or substandard, though estimates are rarely based on representative data. During a nationally representative survey in Tanzania, ACAs were purchased from private retail drug outlets, and the active pharmaceutical ingredient (API) was measured. All 1,737 ACAs contained the labeled artemisinin derivative, with 4.1% being outside the 85-115% artemisinin API range defined as acceptable quality. World Health Organization (WHO) prequalified drugs had 0.1 times the odds of being poor quality compared with non-prequalified ACAs for the artemisinin component. When partner components of combination therapies were also considered, 12.1% were outside the acceptable API range, and WHO prequalified ACAs had 0.04 times the odds of being poor quality. Although the prevalence of poor quality ACAs was lower than reported elsewhere, the minority of samples found to be substandard is a cause for concern. Improvements in quality could be achieved by increasing the predominance of WHO prequalified products in the market. Continued monitoring of quality standards is essential. © The American Society of Tropical Medicine and Hygiene.

Guide-substrate base-pairing requirement for box H/ACA RNA-guided RNA pseudouridylation.

PubMed

De Zoysa, Meemanage D; Wu, Guowei; Katz, Raviv; Yu, Yi-Tao

2018-06-05

Box H/ACA RNAs are a group of small RNAs found in abundance in eukaryotes (as well as in archaea). Although their sequences differ, eukaryotic box H/ACA RNAs all share the same unique hairpin-hinge-hairpin-tail structure. Almost all of them function as guides that primarily direct pseudouridylation of rRNAs and spliceosomal snRNAs at specific sites. Although box H/ACA RNA-guided pseudouridylation has been extensively studied, the detailed rules governing this reaction, especially those concerning the guide RNA-substrate RNA base-pairing interactions that determine the specificity and efficiency of pseudouridylation, are still not exactly clear. This is particularly relevant given that the lengths of the guide sequences involved in base-pairing vary from one box H/ACA RNA to another. Here, we carry out a detailed investigation into guide-substrate base-pairing interactions, and identify the minimum number of base-pairs (8), required for RNA-guided pseudouridylation. In addition, we find that the pseudouridylation pocket, present in each hairpin of box H/ACA RNA, exhibits flexibility in fitting slightly different substrate sequences. Our results are consistent across three independent pseudouridylation pockets tested, suggesting that our findings are generally applicable to box H/ACA RNA-guided RNA pseudouridylation. Published by Cold Spring Harbor Laboratory Press for the RNA Society.

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

Nakata, Kouhei; Kawai, Nobuyuki; Sato, Morio, E-mail: morisato@mail.wakayama-med.ac.jp

Purpose: This study was designed to compare the strength among bone marrow nails created to treat long bone fractures using interventional procedures. Methods: Twelve resected intact tibiae of healthy swine were used. A circumferential bone fracture was made in nine tibiae and restored with the following created bone marrow nails: acrylic cement alone (ACA) (n = 3), acrylic-cement-filled bare metallic stent (AC-FBMS) (n = 3), and acrylic-cement-filled covered metallic (AC-FCMS) stent (n = 3). The remaining intact tibiae (n = 3) were used as controls. Results: A bone marrow nail was successfully achieved within 30 min in all swine. Themore » maximum injection volume of acrylic cement for creating ACA, AC-FBMS, and AC-FCMS was 1.7 {+-} 0.3, 3.2 {+-} 0.4, and 2.9 {+-} 0.4 mL, respectively. The thickness of bone marrow nail created in the ACA, AC-FBMS, and AC-FCMS groups was 3.6 {+-} 1.0, 10.3 {+-} 0.26, and 9.6 {+-} 0.32 mm, respectively (AC-FBMS group versus AC-FCMS group, p = 0.038), probably because of leakage of acrylic cement surrounding the interstices. The maximum bending power (kilonewton) and bending strength (newton/mm{sup 2}) in the normal long bone, ACA, AC-FBMS, and AC-FCMS groups were: 1.70 {+-} 0.25 and 79.2 {+-} 16.1; 0.21 {+-} 0.11 and 8.8 {+-} 2.8; 0.46 {+-} 0.06 and 18.2 {+-} 1.6; and 0.18 {+-} 0.04 and 7.8 {+-} 2.7, respectively. Conclusions: Although the maximum bending power and bending strength of AC-FBMS were not satisfactory, it was the most robust of the three marrow nails for restoring fractured long bone.« less

General Electric Company Hanford Works, Project C-431-A Production Facility-Section A, design report

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

Colburn, R.T.

1951-03-29

The 100-C project is to be located adjacent to the present 100-B Area. It is planned to build an addition to the present 181-B river pump house using the same elevations for pump settings, intakes, and floors as for the present pump house, thus maintaining the same suction conditions and flood protection as B Area. The 105 Building will be located on higher ground than B Area and therefore, protection against possible flood damage is assured. This report is divided into the following sections: (1) general description of project; (2) addition to existing river pump house; (3) raw water linesmore » from 181-B addition to 183-C lead house; (4) the 183-C filter plant; (5) 190-C process pump house; (6) power house addition; (7) high tanks; (8) retention basins; (9) outside streamlines; (10) primary substation; (11) outside underground lines; (12) outside electric lines; (13) roads, railroads, walks, fences; (14) structural design of all buildings; and (15) architectural design of all buildings.« less

Specialty, Political Affiliation, and Perceived Social Responsibility Are Associated with U.S. Physician Reactions to Health Care Reform Legislation.

PubMed

Antiel, Ryan M; James, Katherine M; Egginton, Jason S; Sheeler, Robert D; Liebow, Mark; Goold, Susan Dorr; Tilburt, Jon C

2013-06-25

Little is known about how U.S. physicians' political affiliations, specialties, or sense of social responsibility relate to their reactions to health care reform legislation. To assess U.S. physicians' impressions about the direction of U.S. health care under the Affordable Care Act (ACA), whether that legislation will make reimbursement more or less fair, and examine how those judgments relate to political affiliation and perceived social responsibility. A cross-sectional, mailed, self-reported survey. Simple random sample of 3,897 U.S. physicians. Views on the ACA in general, reimbursement under the ACA in particular, and perceived social responsibility. Among 2,556 physicians who responded (RR2: 65 %), approximately two out of five (41 %) believed that the ACA will turn U.S. health care in the right direction and make physician reimbursement less fair (44 %). Seventy-two percent of physicians endorsed a general professional obligation to address societal health policy issues, 65 % agreed that every physician is professionally obligated to care for the uninsured or underinsured, and half (55 %) were willing to accept limits on coverage for expensive drugs and procedures for the sake of expanding access to basic health care. In multivariable analyses, liberals and independents were both substantially more likely to endorse the ACA (OR 33.0 [95 % CI, 23.6-46.2]; OR 5.0 [95 % CI, 3.7-6.8], respectively), as were physicians reporting a salary (OR 1.7 [95 % CI, 1.2-2.5]) or salary plus bonus (OR 1.4 [95 % CI, 1.1-1.9) compensation type. In the same multivariate models, those who agreed that addressing societal health policy issues are within the scope of their professional obligations (OR 1.5 [95 % CI, 1.0-2.0]), who believe physicians are professionally obligated to care for the uninsured / under-insured (OR 1.7 [95 % CI, 1.3-2.4]), and who agreed with limiting coverage for expensive drugs and procedures to expand insurance coverage (OR 2.3 [95 % CI, 1.8-3.0]), were all significantly more likely to endorse the ACA. Surgeons and procedural specialists were less likely to endorse it (OR 0.5 [95 % CI, 0.4-0.7], OR 0.6 [95 % CI, 0.5-0.9], respectively). Significant subsets of U.S. physicians express concerns about the direction of U.S. health care under recent health care reform legislation. Those opinions appear intertwined with political affiliation, type of medical specialty, as well as perceived social responsibility.

33. PLAN OF DEER ISLAND PUMPING STATION SHOWING EXISTING PUMPING ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

33. PLAN OF DEER ISLAND PUMPING STATION SHOWING EXISTING PUMPING PLAN AND LOCATION OF PROPOSED ADDITIONS, METROPOLITAN WATER AND SEWERAGE BOARD, METROPOLITAN SEWERAGE WORKS, JULY 1908. Aperture card 6417. - Deer Island Pumping Station, Boston, Suffolk County, MA

Readmissions, Observation, and the Hospital Readmissions Reduction Program.

PubMed

Zuckerman, Rachael B; Sheingold, Steven H; Orav, E John; Ruhter, Joel; Epstein, Arnold M

2016-04-21

The Hospital Readmissions Reduction Program, which is included in the Affordable Care Act (ACA), applies financial penalties to hospitals that have higher-than-expected readmission rates for targeted conditions. Some policy analysts worry that reductions in readmissions are being achieved by keeping returning patients in observation units instead of formally readmitting them to the hospital. We examined the changes in readmission rates and stays in observation units over time for targeted and nontargeted conditions and assessed whether hospitals that had greater increases in observation-service use had greater reductions in readmissions. We compared monthly, hospital-level rates of readmission and observation-service use within 30 days after hospital discharge among Medicare elderly beneficiaries from October 2007 through May 2015. We used an interrupted time-series model to determine when trends changed and whether changes differed between targeted and nontargeted conditions. We assessed the correlation between changes in readmission rates and use of observation services after adoption of the ACA in March 2010. We analyzed data from 3387 hospitals. From 2007 to 2015, readmission rates for targeted conditions declined from 21.5% to 17.8%, and rates for nontargeted conditions declined from 15.3% to 13.1%. Shortly after passage of the ACA, the readmission rate declined quickly, especially for targeted conditions, and then continued to fall at a slower rate after October 2012 for both targeted and nontargeted conditions. Stays in observation units for targeted conditions increased from 2.6% in 2007 to 4.7% in 2015, and rates for nontargeted conditions increased from 2.5% to 4.2%. Within hospitals, there was no significant association between changes in observation-unit stays and readmissions after implementation of the ACA. Readmission trends are consistent with hospitals' responding to incentives to reduce readmissions, including the financial penalties for readmissions under the ACA. We did not find evidence that changes in observation-unit stays accounted for the decrease in readmissions.

Glaucoma anterior chamber morphometry based on optical Scheimpflug images.

PubMed

Alonso, Ruiz Simonato; Ambrósio Junior, Renato; Paranhos Junior, Augusto; Sakata, Lisandro Massanori; Ventura, Marcelo Palis

2010-01-01

To compare the performance of gonioscopy and noncontact morphometry with anterior chamber tomography (High Resolution Pentacam - HR) using optical Scheimpflug images in the evaluation of the anterior chamber angle (ACA). Transversal study. 112 eyes from 74 subjects evaluated at the Glaucoma Department, Fluminense Federal University, underwent gonioscopy and Pentacam HR. Using gonioscopy, the ACA was graded using the Shaffer Classification (SC) by a single experienced examiner masked to the Pentacam HR findings. Narrow angle was determined in eyes in which the posterior trabecular meshwork could not be seen in two or more quadrants on non-indentation gonioscopy (SC Grade 2 or less). Pentacam HR images of the nasal and temporal quadrants were evaluated by custom software to automatically obtain anterior chamber measurements, such as: anterior chamber angle (ACA), anterior chamber volume (ACV) and anterior chamber depth (ACD). Based on gonioscopy results, 74 (60.07%) eyes of patients classified as open-angle (SC 3 and 4) and 38 (33.93%) eyes of patients classified as narrow-angle (SC 1 and 2). Noncontact morphometry with Scheimpflug images revealed a mean ACA of 39.20 ± 5.31 degrees for open-angle and 21.18 ± 7.98 degrees for narrow-angle. The open-angle group showed significant greater ACV and ACD values when compared to narrow-angle group (ACV of 193 ± 36 mm³ vs. 90 ± 25 mm³, respectively, p<0.001; and ACD of 3,09 ± 0,42 mm vs. 1,55 ± 0,64 mm, respectively, p<0.0001.). In screening eyes with open-angle and narrow-angle with the Pentacam ACA of 20º (SC Grade 2) using the ROC curves, the analysis showed 52.6% of sensitivity and 100% of specificity. The Pentacam showed ability in detecting eyes at risk for angle closure analyzing ACV and ACD.

Novel purification of 1'S-1'-Acetoxychavicol acetate from Alpinia galanga and its cytotoxic plus antiproliferative activity in colorectal adenocarcinoma cell line SW480.

PubMed

Baradwaj, R G; Rao, M V; Senthil Kumar, T

2017-07-01

Alpinia galanga (L.) Willd. is a valuable medicinal crop found in specific tropical regions of southeast Asia. Its crude extracts are well known for their wide medicinal properties and many compounds identified from these extracts are of great interest currently. 1'S-1'-Acetoxychavicol acetate (ACA) obtained from rhizomes of A.galanga is one such well-illustrated compound. This study strives to progress and simplifies the purification protocol for ACA from A.galanga rhizomes. It also studies the cytotoxicity and antiproliferative activity of ACA against Dukes' type B, colorectal adenocarcinoma (SW480). HPLC standardisation was carried out for purification of ACA from rhizomes of Alpinia galanga. MTT assay was executed to estimate the IC 50 value of ACA against SW480 cell line. This value was used to study the apoptosis, nuclear morphological changes and mitochondrial membrane permeability using Acridine orange/ethidium bromide, DAPI, and JC-1 staining. The DNA fragmentation assay was used to substantiate the nuclear fragmentation of DNA observed in the DAPI staining. Further, cell cycle analysis was performed using flow cytometry to study the exact stage of the cell cycle where SW480 cells are arrested due to ACA, western blot analysis of relevant genes were done to further understand at molecular level. A comprehensive 1.89g of 1'S-1'-Acetoxychavicol acetate (ACA) was recovered from 500g of A.galanga rhizomes. ACA significantly suppressed the proliferation of SW480 cells at an IC 50 of 80μM (48h). The mode of SW480 cell death due to ACA was initially identified as apoptosis and cell cycle halted at G 0 /G 1 checkpoint with considerable DNA damage and mitochondrial depolarization. The expression of p21 was increased and concomitantly Cyclin D was downregulated in ACA treated in comparison to control. This study suggests that 1'S-1'-Acetoxychavicol acetate has potent anti-colorectal adenocarcinoma activity. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

The Response AC/A Ratio Before and After the Onset of Myopia

PubMed Central

Mutti, Donald O.; Mitchell, G. Lynn; Jones-Jordan, Lisa A.; Cotter, Susan A.; Kleinstein, Robert N.; Manny, Ruth E.; Twelker, J. Daniel; Zadnik, Karla

2017-01-01

Purpose To investigate the ratio of accommodative convergence per diopter of accommodative response (AC/A ratio) before, during, and after myopia onset. Methods Subjects were 698 children aged 6 to 14 years who became myopic and 430 emmetropic children participating in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error. Refractive error was measured using cycloplegic autorefraction, near work by parent survey, and the AC/A ratio by simultaneously monitoring convergence and accommodative response. The response AC/A ratios of children who became myopic were compared with age-, sex-, and ethnicity-matched model estimates for emmetropic children from 5 years before through 5 years after the onset of myopia. Results The response AC/A ratio was not significantly different between the two groups 5 years before onset, then increased monotonically in children who became myopic until reaching a plateau at myopia onset of about 7 Δ/D compared to about 4 Δ/D for children who remained emmetropic (differences between groups significant at P < 0.01 from 4 years before onset through 5 years after onset). A higher AC/A ratio was associated with greater accommodative lag but not with the rate of myopia progression regardless of the level of near work. Conclusions An increasing AC/A ratio is an early sign of becoming myopic, is related to greater accommodative lag, but does not affect the rate of myopia progression. The association with accommodative lag suggests that the AC/A ratio increase is from greater neural effort needed per diopter of accommodation rather than change in the accommodative convergence crosslink gain relationship. PMID:28291868

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

Off-pump versus on-pump coronary artery revascularization: effects on pulmonary function.

PubMed

e Silva, Ana M R P; Saad, Roberto; Stirbulov, Roberto; Rivetti, Luiz A

2010-07-01

Many studies have shown important changes in lung function tests after coronary artery surgeries. It is controversial if off-pump surgery can give a better and shorter recovery than the on-pump. A prospective study was conducted on 42 patients submitted to coronary artery surgery and divided into two groups: 21 off-pump using intraluminal shunt (G (I)) and 21 on-pump (G (II)), matched by the anatomical location of the coronary arteries lesions. All patients had spirometric evaluation, blood gas measurements and alveolo-arterial oxygen gradient (A-aDO(2)), at the fourth and 10th postoperative days (PO(4) and PO(10)). Preoperatively, G(I) and G(II) had similar results (P>0.372). Spirometry showed decreases at PO(4) and remained decreased until PO(10) for both groups, with significant differences between the groups. The blood gas measurements showed reduction in arterial oxygen pressure (PaO(2)) and carbon dioxide pressure (PaCO(2)), while there was an increase in A-aDO(2) at PO(4) and PO(10) in both groups. The results suggest that different changes occur in pulmonary function when the surgery is performed with or without cardiopulmonary bypass. The off-pump patients showed significantly greater improvement than the on-pump group.

30 CFR 74.4 - Specifications of sampler unit.

Code of Federal Regulations, 2010 CFR

2010-07-01

... is not required. (7) Battery. The power supply for the pump shall be a suitable battery located in... centimeters) of water measured at the inlet of the pump; and (ii) for not less than 10 hours at a flow rate of 2 liters per minute against a resistance of 15 inches (38 centimeters) of water measured at the...

Defining the Field: Revisiting the ACA 1995 Definition of Communication Studies.

ERIC Educational Resources Information Center

Korn, Charles J.; Morreale, Sherwyn P.; Boileau, Don M.

2000-01-01

Presents results of a survey of Association for Communication Administration (ACA) members concerning their awareness and use of the 1995 ACA Definition of the Field of Communication. Finds that 40% of administrators who responded were unaware of the definition. Urges the need to further promote the definition of the field. (NH)

76 FR 41263 - Notice of Intent To Award Affordable Care Act (ACA) Funding, EH10-1004

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-13

... Intent To Award Affordable Care Act (ACA) Funding, EH10-1004 Notice of Intent to award Affordable Care Act (ACA) funding to National Association for Public Health Statistics and Information Systems... under funding opportunity EH10-1004, ``National Environmental Public Health Tracking Program.'' AGENCY...

76 FR 59703 - Notice of Intent To Award Affordable Care Act (ACA) Funding, RFA-TP-08-001

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-27

... Intent To Award Affordable Care Act (ACA) Funding, RFA- TP-08-001 AGENCY: Centers for Disease Control and... of Intent to award Affordable Care Act (ACA) funding to Preparedness and Emergency Response Research... continuation application under Funding Opportunity Announcement RFA-TP- 08-001, ``Preparedness and Emergency...

A Critical Examination of the Assessment Analysis Capabilities of OCLC ACAS

ERIC Educational Resources Information Center

Lyons, Lucy E.

2005-01-01

Over 500 libraries have employed OCLC's iCAS and its successor Automated Collection Assessment and Analysis Services (ACAS) as bibliometric tools to evaluate monograph collections. This examination of ACAS reveals both its methodological limitations and its feasibility as an indicator of collecting patterns. The results can be used to maximize the…

75 FR 57819 - Notice of Revision; Notice of the Advisory Committee on Apprenticeship (ACA) Open Meeting and New...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-22

... DEPARTMENT OF LABOR Employment and Training Administration Notice of Revision; Notice of the Advisory Committee on Apprenticeship (ACA) Open Meeting and New Members AGENCY: Employment and Training... that the Committee Charter has been recently renewed. The current 2009 ACA charter remains in effect...

Effects Of The ACA's Health Insurance Marketplaces On The Previously Uninsured: A Quasi-Experimental Analysis.

PubMed

Goldman, Anna L; McCormick, Danny; Haas, Jennifer S; Sommers, Benjamin D

2018-04-01

Descriptive studies have suggested that the Affordable Care Act's (ACA's) health insurance Marketplaces improved access to care. However, no evidence from quasi-experimental studies is available to support these findings. We used longitudinal survey data to compare previously uninsured adults with incomes that made them eligible for subsidized Marketplace coverage (138-400 percent of the federal poverty level) to those who had employer-sponsored insurance before the ACA with incomes in the same range. Among the previously uninsured group, the ACA led to a significant decline in the uninsurance rate, decreased barriers to medical care, increased the use of outpatient services and prescription drugs, and increased diagnoses of hypertension, compared to a control group with stable employer-sponsored insurance. Changes were largest among previously uninsured people with incomes of 138-250 percent of poverty, who were eligible for the ACA's cost-sharing reductions. Our quasi-experimental approach provides rigorous new evidence that the ACA's Marketplaces led to improvements in several important health care outcomes, particularly among low-income adults.

The alternative strategy for designing covalent drugs through kinetic effects of pi-stacking on the self-assembled nanoparticles: a model study with antibiotics

NASA Astrophysics Data System (ADS)

Du, Libo; Suo, Siqingaowa; Zhang, Han; Jia, Hongying; Liu, Ke Jian; Zhang, Xue Ji; Liu, Yang

2016-11-01

It is still a huge challenge to find a new strategy for rationally designing covalent drugs because most of them are discovered by serendipity. Considering that the effect of covalent drugs is closely associated with the kinetics of the reaction between drug molecule and its target protein, here we first demonstrate an example of the kinetic effect of pi-stacking of drug molecules on covalent antimicrobial drug design. When PEGylated 7-aminocephalosporanic acid (PEG-ACA) is used as a substrate drug, pi-stacking of the ACA group via the self-assembly of PEG-ACA on the surface of gold nanoparticles (i.e. Au@ACA) exhibits antibacterial activity against E. coli fourfold higher than a PEG-ACA monomer does. The reason can be reasonably attributed to the kinetic rate enhancement for the covalent reaction between Au@ACA and penicillin binding proteins. We believe that the self-assembly of functional groups onto the surface of gold nanoparticles represents a new strategy for covalent drug design.

Photocopy of drawing located at National Archives, Sand Bruno, California ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Photocopy of drawing located at National Archives, Sand Bruno, California (Navy # 110-A-1 2 of 5. Scofiled Construction Company Mare Island Office, Mare Island Cal. Plan of operating floor, September 2, 1908. - Mare Island Naval Shipyard, Pump House, California Avenue, east side between Dry Dock 1 & Dry Dock 2, near Ninth Street, Vallejo, Solano County, CA

Integrating Membrane Transport with Male Gametophyte Development and Function through Transcriptomics.

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

Bock KW; D Honys; JM. Ward

Male fertility depends on the proper development of the male gametophyte, successful pollen germination, tube growth and delivery of the sperm cells to the ovule. Previous studies have shown that nutrients like boron, and ion gradients or currents of Ca2+, H+, and K+ are critical for pollen tube growth. However, the molecular identities of transporters mediating these fluxes are mostly unknown. As a first step to integrate transport with pollen development and function, a genome-wide analysis of transporter genes expressed in the male gametophyte at four developmental stages was conducted. About 1269 genes encoding classified transporters were collected from themore » Arabidopsis thaliana genome. Of 757 transporter genes expressed in pollen, 16% or 124 genes, including AHA6, CNGC18, TIP1.3 and CHX08, are specifically or preferentially expressed relative to sporophytic tissues. Some genes are highly expressed in microspores and bicellular pollen (COPT3, STP2, OPT9); while others are activated only in tricellular or mature pollen (STP11, LHT7). Analyses of entire gene families showed that a subset of genes, including those expressed in sporophytic tissues, were developmentally-regulated during pollen maturation. Early and late expression patterns revealed by transcriptome analysis are supported by promoter::GUS analyses of CHX genes and by other methods. Recent genetic studies based on a few transporters, including plasma membrane H+ pump AHA3, Ca2+ pump ACA9, and K+ channel SPIK, further support the expression patterns and the inferred functions revealed by our analyses. Thus, revealing the distinct expression patterns of specific transporters and unknown polytopic proteins during microgametogenesis provides new insights for strategic mutant analyses necessary to integrate the roles of transporters and potential receptors with male gametophyte development.« less

Integrating membrane transport with male gametophyte development and function through transcriptomics.

PubMed

Bock, Kevin W; Honys, David; Ward, John M; Padmanaban, Senthilkumar; Nawrocki, Eric P; Hirschi, Kendal D; Twell, David; Sze, Heven

2006-04-01

Male fertility depends on the proper development of the male gametophyte, successful pollen germination, tube growth, and delivery of the sperm cells to the ovule. Previous studies have shown that nutrients like boron, and ion gradients or currents of Ca2+, H+, and K+ are critical for pollen tube growth. However, the molecular identities of transporters mediating these fluxes are mostly unknown. As a first step to integrate transport with pollen development and function, a genome-wide analysis of transporter genes expressed in the male gametophyte at four developmental stages was conducted. Approximately 1,269 genes encoding classified transporters were collected from the Arabidopsis (Arabidopsis thaliana) genome. Of 757 transporter genes expressed in pollen, 16% or 124 genes, including AHA6, CNGC18, TIP1.3, and CHX08, are specifically or preferentially expressed relative to sporophytic tissues. Some genes are highly expressed in microspores and bicellular pollen (COPT3, STP2, OPT9), while others are activated only in tricellular or mature pollen (STP11, LHT7). Analyses of entire gene families showed that a subset of genes, including those expressed in sporophytic tissues, was developmentally regulated during pollen maturation. Early and late expression patterns revealed by transcriptome analysis are supported by promoter::beta-glucuronidase analyses of CHX genes and by other methods. Recent genetic studies based on a few transporters, including plasma membrane H+ pump AHA3, Ca2+ pump ACA9, and K+ channel SPIK, further support the expression patterns and the inferred functions revealed by our analyses. Thus, revealing the distinct expression patterns of specific transporters and unknown polytopic proteins during microgametogenesis provides new insights for strategic mutant analyses necessary to integrate the roles of transporters and potential receptors with male gametophyte development.

Literature Search through Mixed-Membership Community Discovery

NASA Astrophysics Data System (ADS)

Eliassi-Rad, Tina; Henderson, Keith

We introduce a new approach to literature search that is based on finding mixed-membership communities on an augmented co-authorship graph (ACA) with a scalable generative model. An ACA graph contains two types of edges: (1) coauthorship links and (2) links between researchers with substantial expertise overlap. Our solution eliminates the biases introduced by either looking at citations of a paper or doing a Web search. A case study on PubMed shows the benefits of our approach.

Incompletely obliterated cranial arteriovenous fistulae are safely and effectively treated with adjuvant ε-aminocaproic acid.

PubMed

Howard, Brian M; Grossberg, Jonathan A; Prater, Adam; Cawley, C Michael; Dion, Jacques E; Tong, Frank C

2018-07-01

Administration of ε-aminocaproic acid (εACA), as adjuvant therapy following incompletely embolized cranial dural arteriovenous (dAVFs) and direct carotid artery to cavernous sinus fistulae (CCFs), is a strategy to promote post-procedural thrombosis. However, the efficacy of εACA to treat incompletely obliterated dAVFs and CCFs has not been published. The purpose of this study was to determine if administration of εACA following incomplete embolization of cranial dAVFs or CCFs was associated with an increased likelihood of cure on follow-up imaging compared with patients not given adjuvant εACA. A retrospective cohort study was performed. All patients who underwent treatment of a dAVF or CCF at our institution between 1998 and 2016 were reviewed (n=262). Patients with residual shunting following the first attempted endovascular embolization were included in the analysis (n=52). The study groups were those treated with εACA following incomplete obliteration of the fistula and those who were not. The primary outcome was obliteration of the fistula on initial follow-up imaging. Complication rates between cohorts were compared. 20 (38%) patients with incompletely obliterated fistulae were treated with adjuvant εACA. A trend towards an improved rate of complete obliteration on initial follow-up imaging was observed in the group treated with εACA (55% vs 34% in the group not treated with εACA, p=0.14). No difference in clinical outcomes or thromboembolic complications was observed between the groups. In summary, these data suggest that administration of εACA is a safe adjuvant therapy in the management of cranial dAVFs and CCFs that are incompletely treated endovascularly. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Public Response to Obamacare on Twitter

PubMed Central

Zheng, Kai; Liu, Yang; Levy, Helen

2017-01-01

Background The Affordable Care Act (ACA), often called “Obamacare,” is a controversial law that has been implemented gradually since its enactment in 2010. Polls have consistently shown that public opinion of the ACA is quite negative. Objective The aim of our study was to examine the extent to which Twitter data can be used to measure public opinion of the ACA over time. Methods We prospectively collected a 10% random sample of daily tweets (approximately 52 million since July 2011) using Twitter’s streaming application programming interface (API) from July 10, 2011 to July 31, 2015. Using a list of key terms and ACA-specific hashtags, we identified tweets about the ACA and examined the overall volume of tweets about the ACA in relation to key ACA events. We applied standard text sentiment analysis to assign each ACA tweet a measure of positivity or negativity and compared overall sentiment from Twitter with results from the Kaiser Family Foundation health tracking poll. Results Public opinion on Twitter (measured via sentiment analysis) was slightly more favorable than public opinion measured by the Kaiser poll (approximately 50% vs 40%, respectively) but trends over time in both favorable and unfavorable views were similar in both sources. The Twitter-based measures of opinion as well as the Kaiser poll changed very little over time: correlation coefficients for favorable and unfavorable public opinion were .43 and .37, respectively. However, we found substantial spikes in the volume of ACA-related tweets in response to key events in the law’s implementation, such as the first open enrollment period in October 2013 and the Supreme Court decision in June 2012. Conclusions Twitter may be useful for tracking public opinion of health care reform as it appears to be comparable with conventional polling results. Moreover, in contrast with conventional polling, the overall amount of tweets also provides a potential indication of public interest of a particular issue at any point in time. PMID:28550002

Disproportionate-share hospital payment reductions may threaten the financial stability of safety-net hospitals.

PubMed

Neuhausen, Katherine; Davis, Anna C; Needleman, Jack; Brook, Robert H; Zingmond, David; Roby, Dylan H

2014-06-01

Safety-net hospitals rely on disproportionate-share hospital (DSH) payments to help cover uncompensated care costs and underpayments by Medicaid (known as Medicaid shortfalls). The Affordable Care Act (ACA) anticipates that insurance expansion will increase safety-net hospitals' revenues and will reduce DSH payments accordingly. We examined the impact of the ACA's Medicaid DSH reductions on California public hospitals' financial stability by estimating how total DSH costs (uncompensated care costs and Medicaid shortfalls) will change as a result of insurance expansion and the offsetting DSH reductions. Decreases in uncompensated care costs resulting from the ACA insurance expansion may not match the act's DSH reductions because of the high number of people who will remain uninsured, low Medicaid reimbursement rates, and medical cost inflation. Taking these three factors into account, we estimate that California public hospitals' total DSH costs will increase from $2.044 billion in 2010 to $2.363-$2.503 billion in 2019, with unmet DSH costs of $1.381-$1.537 billion. Project HOPE—The People-to-People Health Foundation, Inc.

ACA dependent coverage provision reduced high out-of-pocket health care spending for young adults.

PubMed

Busch, Susan H; Golberstein, Ezra; Meara, Ellen

2014-08-01

Since September 2010 the Affordable Care Act (ACA) has required that insurers allow children to remain as dependents on their parents' private insurance plans until age twenty-six. Studies have shown that this provision increased coverage rates among young adults. In this article we analyze whether the provision also protected young adults from large and uncertain out-of-pocket expenses. We found that the policy was associated with a statistically significant reduction in the share of young adults facing annual out-of-pocket expenditures greater than $1,500 (decreasing from 4.2 percent to 2.9 percent), compared to an increase in the proportion of their slightly older peers facing such expenditures (increasing from 4.4 percent to 5.4 percent), a net difference of -2.4 percentage points, or 57 percent. We conclude that the dependent coverage provision in the ACA provides financial protection for young adults at a time when they often face high debt burden but low wages. Project HOPE—The People-to-People Health Foundation, Inc.

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.

Cell-Wall-Bound Proteinase of Lactobacillus delbrueckii subsp. lactis ACA-DC 178: Characterization and Specificity for β-Casein

PubMed Central

Tsakalidou, E.; Anastasiou, R.; Vandenberghe, I.; van Beeumen, J.; Kalantzopoulos, G.

1999-01-01

Lactobacillus delbrueckii subsp. lactis ACA-DC 178, which was isolated from Greek Kasseri cheese, produces a cell-wall-bound proteinase. The proteinase was removed from the cell envelope by washing the cells with a Ca2+-free buffer. The crude proteinase extract shows its highest activity at pH 6.0 and 40°C. It is inhibited by phenylmethylsulfonyl fluoride, showing that the enzyme is a serine-type proteinase. Considering the substrate specificity, the enzyme is similar to the lactococcal PI-type proteinases, since it hydrolyzes β-casein mainly and α- and κ-caseins to a much lesser extent. The cell-wall-bound proteinase from L. delbrueckii subsp. lactis ACA-DC 178 liberates four main peptides from β-casein, which have been identified. PMID:10223997

The ACA's 65th Birthday Challenge: Moving from Medicaid to Medicare.

PubMed

Ndumele, Chima D; Sommers, Benjamin D; Trivedi, Amal N

2015-11-01

The Affordable Care Act (ACA) expanded Medicaid to millions of low-income near-elderly Americans, facilitating access to health care services, but did not change income eligibility for Medicaid for those 65 years and older. Therefore, following the ACA's coverage expansion, many newly-insured older enrollees will face a complex insurance transition on their 65th birthday: they will lose Medicaid coverage and transition from Medicaid to Medicare as their primary insurer. This transition in primary health insurance coverage includes changes to benefits, patient cost-sharing, and provider reimbursement, which could have profound consequences on the use of health services and associated health outcomes for low-income seniors. Using data from 2012, we estimate that 1.6 million current Medicaid beneficiaries and an additional 1.6 to 2.9 million low-income individuals who will gain Medicaid coverage under the ACA will be likely to make this transition in the next decade. Primary care physicians and policymakers can help mitigate the potential consequences of this insurance transition by preparing patients for Medicare's more restrictive insurance coverage, encouraging patients to sign up for available low-income subsidies, and understanding how the loss of Medicaid coverage impacts out-of-pocket costs.

Attachment method for stacked integrated circuit (IC) chips

DOEpatents

Bernhardt, A.F.; Malba, V.

1999-08-03

An attachment method for stacked integrated circuit (IC) chips is disclosed. The method involves connecting stacked chips, such as DRAM memory chips, to each other and/or to a circuit board. Pads on the individual chips are rerouted to form pads on the side of the chip, after which the chips are stacked on top of each other whereby desired interconnections to other chips or a circuit board can be accomplished via the side-located pads. The pads on the side of a chip are connected to metal lines on a flexible plastic tape (flex) by anisotropically conductive adhesive (ACA). Metal lines on the flex are likewise connected to other pads on chips and/or to pads on a circuit board. In the case of a stack of DRAM chips, pads to corresponding address lines on the various chips may be connected to the same metal line on the flex to form an address bus. This method has the advantage of reducing the number of connections required to be made to the circuit board due to bussing; the flex can accommodate dimensional variation in the alignment of chips in the stack; bonding of the ACA is accomplished at low temperature and is otherwise simpler and less expensive than solder bonding; chips can be bonded to the ACA all at once if the sides of the chips are substantially coplanar, as in the case for stacks of identical chips, such as DRAM. 12 figs.

Assessing the Role of State and Local Public Health in Outreach and Enrollment for Expanded Coverage: A Case Study on New Orleans, Louisiana.

PubMed

Williams, Malcolm V; Lopez, Christian; Martin, Laurie T; Armstrong, Courtney

2017-01-01

The Patient Protection and Affordable Care Act (ACA) laid the groundwork for a substantial increase in the number of people who have access to health insurance through Medicaid expansion or health insurance marketplaces. During the first open-enrollment season, states used a variety of strategies to reach out to and enroll newly eligible people. Typically, they used federal and state funding to develop navigator programs. Program design differed by location, and, although many stakeholders were involved in these efforts, state and local health departments (LHDs) were, and remain, a relatively untapped resource. This article is one in a series designed to highlight innovative models and best practices that leverage LHD involvement in ACA outreach and enrollment and to facilitate knowledge transfer to other geographic regions looking to leverage the full range of roles for LHDs in ACA outreach and enrollment. Each case study was designed to capture nuanced differences in how health departments support these efforts in their communities, identify facilitators and barriers to these approaches, and develop lessons learned from these activities. These studies identify compelling models for how state and local health departments can implement similar activities in their own communities. Further, they provide guidance and insight into the role LHDs can play now, and help redefine that role in the future, as states continue to enroll residents in health insurance coverage moving forward. This article focuses on a case study on New Orleans, Louisiana.

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.

Expected and Unexpected Consequences of the Affordable Care Act: The Impact on Patients and Surgeons-Pro and Con Arguments.

PubMed

Rudnicki, Marek; Armstrong, John H; Clark, Clancy; Marcus, Stuart G; Sacks, Lee; Moser, A James; Reid-Lombardo, K Marie

2016-02-01

The Patient Protection and Affordable Care Act (PPACA), called the Affordable Care Act (ACA) or "ObamaCare" for short, was enacted in 2010. The Public Policy and Advocacy Committee of the Society for Surgery of the Alimentary Tract (SSAT) hosted a debate with an expert panel to discuss the ACA and its impact on surgical care after the first year of patient enrollment. The purpose of this debate was to focus on the impact of ACA on the public and surgeons. At the core of the ACA are insurance industry reforms and expanded coverage, with a goal of improved clinical outcomes and reduced costs of care. We have observed supportive and opposing views on ACA. Nonetheless, we will witness major shifts in health care delivery as well as restructuring of our relationship with payers, institutions, and patients. With the rapidly changing health care landscape, surgeons will become key members of health systems and will likely need to lead transition from solo-practice to integrated care systems. The full effects of the ACA remain unrealized, but its implementation has begun to change the map of the American health care system and will surely impact the practice of surgery. Herein, we provide a synopsis of the "pro" and "con" arguments for the expected and unexpected consequences of the ACA on society and surgeons.

Uncompensated Care Decreased At Hospitals In Medicaid Expansion States But Not At Hospitals In Nonexpansion States.

PubMed

Dranove, David; Garthwaite, Craig; Ody, Christopher

2016-08-01

One pillar of the Affordable Care Act (ACA) was its expected impact on the growing burden of uncompensated care costs for the uninsured at hospitals. However, little is known about how this burden changed as a result of the ACA's enactment. We examine how the Affordable Care Act (ACA)'s coverage expansions affected uncompensated care costs at a large, diverse sample of hospitals. We estimate that in states that expanded Medicaid under the ACA, uncompensated care costs decreased from 4.1 percentage points to 3.1 percentage points of operating costs. The reductions in Medicaid expansion states were larger at hospitals that had higher pre-ACA uncompensated care burdens and in markets where we predicted larger gains in coverage through expanded eligibility for Medicaid. Our estimates suggest that uncompensated care costs would have decreased from 5.7 percentage points to 4.0 percentage points of operating costs in nonexpansion states if they had expanded Medicaid. Thus, while the ACA decreased the variation in uncompensated care costs across hospitals within Medicaid expansion states, the difference between expansion and nonexpansion states increased substantially. Policy makers and researchers should consider how the shifting uncompensated care burden affects other hospital decisions as well as the distribution of supplemental public funding to hospitals. Project HOPE—The People-to-People Health Foundation, Inc.

Buprenorphine Treatment and Patient Use of Health Services after the Affordable Care Act in an Integrated Health Care System

PubMed Central

Campbell, Cynthia I.; Parthasarathy, Sujaya; Young-Wolff, Kelly C.; Satre, Derek D.

2017-01-01

Introduction The Affordable Care Act (ACA) was expected to benefit patients with substance use disorders, including opioid use disorders (OUDs). This study examined buprenorphine use and health services utilization by patients with OUDs pre- and post-ACA in a large health care system. Methods Using electronic health record data, we examined demographic and clinical characteristics (substance use, psychiatric and medical conditions) of two patient cohorts using buprenorphine: those newly enrolled in 2012 (“pre-ACA”, N=204) and in 2014 (“post-ACA”, N=258). Logistic and negative binomial regressions were used to model persistent buprenorphine use, and to examine whether persistent use was related to health services utilization. Results Buprenorphine patients were largely similar pre- and post-ACA, although more post-ACA patients had a marijuana use disorder (p<.01). Post-ACA patients were more likely to have high deductible benefit plans (p<.01). Use of psychiatry services was lower post-ACA (IRR: 0.56, p<.01), and high deductible plans were also related to lower use of psychiatry services (IRR: 0.30, p<.01). Conclusion The relationship between marijuana use disorder and prescription opioid use is complex, and deserves further study, particularly with increasingly widespread marijuana legalization. Access to psychiatry services may be more challenging for buprenorphine patients post-ACA, especially for patients with deductible plans. PMID:28426332

Community Benefit Spending By Tax-Exempt Hospitals Changed Little After ACA.

PubMed

Young, Gary J; Flaherty, Stephen; Zepeda, E David; Singh, Simone Rauscher; Rosen Cramer, Geri

2018-01-01

Provisions of the Affordable Care Act (ACA) encouraged tax-exempt hospitals to invest broadly in community health benefits. Four years after the ACA's enactment, hospitals had increased their average spending for all community benefits by 0.5 percentage point, from 7.6 percent of their operating expenses in 2010 to 8.1 percent in 2014.

The impact of additional cytogenetic abnormalities at diagnosis and during therapy with tyrosine kinase inhibitors in Chronic Myeloid Leukaemia.

PubMed

Crisan, A M; Coriu, D; Arion, C; Colita, A; Jardan, C

2015-01-01

Chronic Myeloid Leukemia's (CML) treatment was optimized since the development of tyrosine kinase inhibitors (TKI) and an increased overall survival during TKI was noticed. During the TKI era, protocols for assessing response and resistance to treatment were developed. Additional chromosomal abnormalities (ACAs) are strongly associated with disease progression but their prognostic impact and influence on treatment response are yet to be defined. The aim of this study was to analyze the impact of ACAs on time to achieve complete cytogenetic response (CCyR), treatment and overall survival. Since 2005 until 2013, the data from the Hematology and Bone Marrow Transplantation Department of Fundeni Clinical Institute was collected. In this observational retrospective single centre study, 28 CML patients with ACAs at diagnosis and during TKI treatment were included. From ACAs at diagnosis group, the most frequent major route ACAs were trisomy 8, trisomy 19 and second Philadelphia (Ph) chromosome and the most frequent minor route ACAs were monosomies and structural abnormalities (inversions and translocations). From the ACAs during the TKI group, the most frequent major route cytogenetic abnormalities in Ph positive and negative cells were trisomy 8, trisomy 19 and second Ph chromosome and the most frequent minor route cytogenetic abnormalities in Ph positive and negative cells were marker chromosomes and structural abnormalities (inversions, translocations and dicentric chromosomes). In both groups, the time to CCyR was longer and long-term results were inferior in comparison with standard patients but the differences were not significant and in accordance to published data. The 12 months follow-up after the study's end showed that 26 patients were alive and in long-term CCyR and 2 deaths were reported. CML = Chronic Myeloid Leukemia, BCR-ABL1 = Break Cluster Region - Abelson gene, TKI = tyrosine kinase inhibitor treatment, ACAs = additional cytogenetic abnormalities, CCyR = complete cytogenetic response, PCyR = partial cytogenetic response, mCyR = minor cytogenetic response, MMR = major molecular response, HSCT = hematopoietic stem cell transplant, HLA = human leukocyte antigens, CP = chronic phase, AP = accelerated phase, BP = blast phase, OS = overall survival, CBA = chromosome banding analysis, +8 = trisomy 8, i(17q) = isochromosome (17q), +Ph = second Philadelphia chromosome, -7 = monosomy 7, -17 = monosomy 17, +17 = trisomy 17, -21 = monosomy 21, +21 = trisomy 21, -Y = loss of Y chromosome, ELN = European LeukemiaNet, IMA600 = Imatinib 600 mg daily, IMA400 = Imatinib 400 mg daily, NILO600 = Nilotinib 600 mg daily, DASA100 = Dasatinib 100mg daily, DASA140 = Dasatinib 140 mg daily.

A Critical Analysis of Obamacare: Affordable Care or Insurance for Many and Coverage for Few?

PubMed

Manchikanti, Laxmaiah; Helm Ii, Standiford; Benyamin, Ramsin M; Hirsch, Joshua A

2017-03-01

The Affordable Care Act (ACA), of 2010, or Obamacare, was the most monumental change in US health care policy since the passage of Medicaid and Medicare in 1965. Since its enactment, numerous claims have been made on both sides of the aisle regarding the ACA's success or failure; these views often colored by political persuasion. The ACA had 3 primary goals: increasing the number of the insured, improving the quality of care, and reducing the costs of health care. One point often lost in the discussion is the distinction between affordability and access. Health insurance is a financial mechanism for paying for health care, while access refers to the process of actually obtaining that health care. The ACA has widened the gap between providing patients the mechanism of paying for healthcare and actually receiving it. The ACA is applauded for increasing the number of insured, quite appropriately as that has occurred for over 20 million people. Less frequently mentioned are the 6 million who have lost their insurance. Further, in terms of how health insurance is been provided, the majority the expansion was based on Medicaid expansion, with an increase of 13 million. Consequently, the ACA hasn't worked well for the working and middle class who receive much less support, particularly those who earn more than 400% of the federal poverty level, who constitute 40% of the population and don't receive any help. As a result, exchange enrollment has been a disappointment and the percentage of workers obtaining their health benefits from their employer has decreased steadily. Access to health care has been uneven, with those on Medicaid hampered by narrow networks, while those on the exchanges or getting employer benefits have faced high out-of-pocket costs.The second category relates to cost containment. President Obama claimed that the ACA provided significant cost containment, in that costs would have been even much higher if the ACA was not enacted. Further, he attributed cost reductions generally to the ACA, not taking into account factors such as the recession, increased out-of-pocket costs, increasing drug prices, and reduced coverage by insurers.The final goal was improvement in quality. The effort to improve quality has led to the creation of dozens of new agencies, boards, commissions, and other government entities. In turn, practice management and regulatory compliance costs have increased. Structurally, solo and independent practices, which lack the capability to manage these new regulatory demands, have declined. Hospital employment, with its associated increased costs, has been soaring. Despite a focus on preventive services in the management of chronic disease, only 3% of health care expenditures have been spent on preventive services while the costs of managing chronic disease continue to escalate.The ACA is the most consequential and comprehensive health care reform enacted since Medicare. The ACA has gained a net increase in the number of individuals with insurance, primarily through Medicaid expansion. The reduction in costs is an arguable achievement, while quality of care has seemingly not improved. Finally, access seems to have diminished.This review attempts to bring clarity to the discussion by reviewing the ACA's impact on affordability, cost containment and quality of care. We will discuss these aspects of the ACA from the perspective of proponents, opponents, and a pragmatic point of view.Key words: Affordable Care Act (ACA), Obamacare, Medicare, Medicaid, Medicare Modernization Act (MMA), cost of health care, quality of health care, Merit-Based Incentive Payments System (MIPS).

Down-Regulation of MicroRNA-210 Confers Sensitivity towards 1’S-1’-Acetoxychavicol Acetate (ACA) in Cervical Cancer Cells by Targeting SMAD4

PubMed Central

Phuah, Neoh Hun; Azmi, Mohamad Nurul; Awang, Khalijah; Nagoor, Noor Hasima

2017-01-01

MicroRNAs (miRNAs) are short non-coding RNAs that regulate genes posttranscriptionally. Past studies have reported that miR-210 is up-regulated in many cancers including cervical cancer, and plays a pleiotropic role in carcinogenesis. However, its role in regulating response towards anti-cancer agents has not been fully elucidated. We have previously reported that the natural compound 1’S-1’-acetoxychavicol acetate (ACA) is able to induce cytotoxicity in various cancer cells including cervical cancer cells. Hence, this study aims to investigate the mechanistic role of miR-210 in regulating response towards ACA in cervical cancer cells. In the present study, we found that ACA down-regulated miR-210 expression in cervical cancer cells, and suppression of miR-210 expression enhanced sensitivity towards ACA by inhibiting cell proliferation and promoting apoptosis. Western blot analysis showed increased expression of mothers against decapentaplegic homolog 4 (SMAD4), which was predicted as a target of miR-210 by target prediction programs, following treatment with ACA. Luciferase reporter assay confirmed that miR-210 binds to sequences in 3′UTR of SMAD4. Furthermore, decreased in SMAD4 protein expression was observed when miR-210 was overexpressed. Conversely, SMAD4 protein expression increased when miR-210 expression was suppressed. Lastly, we demonstrated that overexpression of SMAD4 augmented the anti-proliferative and apoptosis-inducing effects of ACA. Taken together, our results demonstrated that down-regulation of miR-210 conferred sensitivity towards ACA in cervical cancer cells by targeting SMAD4. These findings suggest that combination of miRNAs and natural compounds could provide new strategies in treating cervical cancer. PMID:28401751

Down-Regulation of MicroRNA-210 Confers Sensitivity towards 1'S-1'-Acetoxychavicol Acetate (ACA) in Cervical Cancer Cells by Targeting SMAD4.

PubMed

Phuah, Neoh Hun; Azmi, Mohamad Nurul; Awang, Khalijah; Nagoor, Noor Hasima

2017-04-01

MicroRNAs (miRNAs) are short non-coding RNAs that regulate genes posttranscriptionally. Past studies have reported that miR-210 is up-regulated in many cancers including cervical cancer, and plays a pleiotropic role in carcinogenesis. However, its role in regulating response towards anti-cancer agents has not been fully elucidated. We have previously reported that the natural compound 1'S-1'-acetoxychavicol acetate (ACA) is able to induce cytotoxicity in various cancer cells including cervical cancer cells. Hence, this study aims to investigate the mechanistic role of miR-210 in regulating response towards ACA in cervical cancer cells. In the present study, we found that ACA down-regulated miR-210 expression in cervical cancer cells, and suppression of miR-210 expression enhanced sensitivity towards ACA by inhibiting cell proliferation and promoting apoptosis. Western blot analysis showed increased expression of mothers against decapentaplegic homolog 4 (SMAD4), which was predicted as a target of miR-210 by target prediction programs, following treatment with ACA. Luciferase reporter assay confirmed that miR-210 binds to sequences in 3'UTR of SMAD4. Furthermore, decreased in SMAD4 protein expression was observed when miR-210 was overexpressed. Conversely, SMAD4 protein expression increased when miR-210 expression was suppressed. Lastly, we demonstrated that overexpression of SMAD4 augmented the anti-proliferative and apoptosis-inducing effects of ACA. Taken together, our results demonstrated that down-regulation of miR-210 conferred sensitivity towards ACA in cervical cancer cells by targeting SMAD4. These findings suggest that combination of miRNAs and natural compounds could provide new strategies in treating cervical cancer.

Minimizing transfusions in primary cranial vault remodeling: the role of aminocaproic acid.

PubMed

Oppenheimer, Adam J; Ranganathan, Kavitha; Levi, Benjamin; Strahle, Jennifer M; Kapurch, Joseph; Muraszko, Karin M; Buchman, Steven R

2014-01-01

Cranial vault remodeling (CVR) for craniosynostosis is a procedure with the potential for significant blood loss. Aminocaproic acid (ACA) has been used at our institution during CVR for its antifibrinolytic effects. The purpose of this study was to investigate the effect of ACA on blood loss and transfusion rates during primary CVR. Three hundred eighty-three patients with craniosynostosis underwent primary CVR at a single institution by a single surgeon over 15 years. Patients were included if they received either ACA or no antifibrinolytic. The estimated blood loss (EBL) and volume of blood transfused was recorded. Thrombotic-related complications were identified. Comparisons were made between subgroups using independent Student t test and Fisher exact test. Among the study population, 148 patients met inclusion criteria. ACA was given to 30 patients, while 118 patients received no antifibrinolytic. There was no difference in the average intraoperative EBL between the ACA (322 mL) and control groups (327 mL, P > 0.05). Additionally, the incidence of transfusion was not significantly different between subgroups (97% vs. 86%, respectively, P > 0.05). Patients treated with ACA, however, received lower average perioperative transfusion volumes (25.5 mL/kg) compared to control patients (53.3 mL/kg, P < 0.0001). Furthermore, patients in the ACA subgroup were less likely to require a second unit of blood (21% vs. 43%, P < 0.0001) and therefore had fewer exposures to donor blood antigens (ARR = 22%, NNT = 4.6). The use of intraoperative ACA minimizes blood transfusion volumes and donor exposures in children who undergo primary CVR for craniosynostosis. Antifibrinolytics should be considered for routine use in pediatric craniofacial surgery.

Impact of heterogeneity on groundwater salinization due to coastal pumping

NASA Astrophysics Data System (ADS)

Yu, X.; Michael, H. A.

2017-12-01

Groundwater abstraction causes and accelerates seawater intrusion in many coastal areas. In heterogeneous aquifers, preferential flow paths can lead to fast intrusion, while low permeability layers can serve as barriers. The extent to which different types of heterogeneous aquifers are vulnerable to pumping-induced seawater intrusion has not been well studied. Here we show that the connectedness of pumping location and local boundary condition drive salinization patterns. Salinization patterns in homogeneous aquifers were relatively simple and only related to the hydraulic properties and pumping rate. The salinization rates and patterns in heterogeneous aquifers were much more complicated and related to pumping location, rate and depth, preferential flow path locations, and local boundary conditions. An intrusion classification approach was developed with three types in homogeneous aquifers and four types in heterogeneous aquifers. After classification the main factors of salinized areas, intrusion rates and salinization time could be identified. The ranges of these salinization assessment criteria suggested different aspect of groundwater vulnerability in each class. We anticipate the classification approach to be a starting point for more comprehensive groundwater abstraction vulnerability assessment (including consideration of pumping rates, locations and depths, connectivity, preferential flow paths, etc.), which is critical for coastal water resources management.

The Affordable Care Act and Abortion Comparing the U.S. and Western Europe.

PubMed

McFarlane, Deborah R

2015-01-01

The 2010 Affordable Health Care Act (ACA) treats abortion differently than any other health service, precluding public funding for abortion and imposing other restrictions on American states. To determine whether the ACA's abortion restrictions are uniquely American or have counterparts in other national health systems, this study employs a cross-sectional design comparing abortion restrictions in the ACA with those in 17 Western European countries. Using a six-item scale, the intensity of abortion restrictions is compared across Western European nations. A similar scale is employed for a five-state sample of state-level abortion restrictions. Although the United States is not alone in having abortion restrictions, how abortion is proscribed in the ACA has no counterpart in Western Europe. Unlike many Western European countries, the ACA's restrictions focus on abortion funding, not the length of gestation or the health of the pregnant woman.

Affordable Care Act and Diabetes Mellitus.

PubMed

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

2015-12-01

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

Ethical Guidelines for Counselors when Working with Clients with Terminal Illness Requesting Physician Aid in Dying

ERIC Educational Resources Information Center

Kurt, Layla J.; Piazza, Nick J.

2012-01-01

In 2005, the American Counseling Association (ACA) introduced a new ethical standard for counselors working with clients with terminal illness who are considering hastened death options. The authors' purpose is to inform counselors of the Death With Dignity Act and explore relevant ethical guidelines in the "ACA Code of Ethics" (ACA, 2005).

New Mandates and Imperatives in the Revised "ACA Code of Ethics"

ERIC Educational Resources Information Center

Kaplan, David M.; Kocet, Michael M.; Cottone, R. Rocco; Glosoff, Harriet L.; Miranti, Judith G.; Moll, E. Christine; Bloom, John W.; Bringaze, Tammy B.; Herlihy, Barbara; Lee, Courtland C.; Tarvydas, Vilia M.

2009-01-01

The first major revision of the "ACA Code of Ethics" in a decade occurred in late 2005, with the updated edition containing important new mandates and imperatives. This article provides interviews with members of the Ethics Revision Task Force that flesh out seminal changes in the revised "ACA Code of Ethics" in the areas of confidentiality,…

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.

Impact of Educational and Patient Decision Aids on Decisional Conflict Associated with Total Knee Arthroplasty

PubMed Central

de Achaval, Sofia; Fraenkel, Liana; Volk, Robert J.; Cox, Vanessa; Suarez-Almazor, Maria E.

2012-01-01

Our objective was to examine the impact of a videobooklet patient decision aid supplemented by an interactive values clarification exercise on decisional conflict in patients with knee osteoarthritis (OA) considering total knee arthroplasy. 208 patients participated in the study (mean age 63 years; 68% female; 66% White). Participants were randomized to 1 of 3 groups: (1) Educational booklet on OA management (control); (2) Patient decision aid (videobooklet) on OA management; and (3) Patient decision aid (videobooklet) + adaptive conjoint analysis ACA tool. The ACA tool enables patients to consider competing attributes (i.e. specific risks/benefits) by asking them to rate a series of paired-comparisons. The primary outcome was the decisional conflict scale ranging from 0 to 100. Differences between groups were analyzed using analysis of variance (ANOVA) and Tukey's honestly significant difference tests. Overall, decisional conflict decreased significantly in all groups (p<0.05). The largest reduction in decisional conflict was observed for participants in the videobooklet decision aid group (21 points). Statistically significant differences in pre vs. post-intervention total scores favored the videobooklet group compared to the control group (21 vs. 10) and to the videobooklet plus ACA group (21 vs. 14; p<0.001). Changes in the decisional conflict score for the control compared to the videobooklet decision aid + ACA group were not significantly different. In our study, an audiovisual patient decision aid decreased decisional conflict more than printed material alone, or than the addition of a more complex computer-based ACA tool requiring more intense cognitive involvement and explicit value choices. PMID:21954198

Photocopy of drawing located at National Archives, San Bruno, California ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Photocopy of drawing located at National Archives, San Bruno, California (Navy # 110-A-14 of 5. Scofiled Construction Company Mare Island office, Mare Island Cal. Louvers details; September 2, 1908. - Mare Island Naval Shipyard, Pump House, California Avenue, east side between Dry Dock 1 & Dry Dock 2, near Ninth Street, Vallejo, Solano County, CA

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.

Grandfathered, Grandmothered, And ACA-Compliant Health Plans Have Equivalent Premiums.

PubMed

Whitmore, Heidi; Gabel, Jon R; Satorius, Jennifer L; Green, Matthew

2017-02-01

Many small employers offer employees health plans that are not fully compliant with Affordable Care Act (ACA) provisions such as covering preventive services without cost sharing. These "grandfathered" and "grandmothered" plans accounted for about 65 percent of enrollment in the small-group market in 2014. Premium costs for these and ACA-compliant plans were equivalent. Project HOPE—The People-to-People Health Foundation, Inc.

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 substantially improved the financial revenues. Despite the controversies, implementation of ACA has the potential to substantially improve the financial outcomes of trauma centers through Medicaid expansion. Economic and value-based evaluation, level III.

Public Response to Obamacare on Twitter.

PubMed

Davis, Matthew A; Zheng, Kai; Liu, Yang; Levy, Helen

2017-05-26

The Affordable Care Act (ACA), often called "Obamacare," is a controversial law that has been implemented gradually since its enactment in 2010. Polls have consistently shown that public opinion of the ACA is quite negative. The aim of our study was to examine the extent to which Twitter data can be used to measure public opinion of the ACA over time. We prospectively collected a 10% random sample of daily tweets (approximately 52 million since July 2011) using Twitter's streaming application programming interface (API) from July 10, 2011 to July 31, 2015. Using a list of key terms and ACA-specific hashtags, we identified tweets about the ACA and examined the overall volume of tweets about the ACA in relation to key ACA events. We applied standard text sentiment analysis to assign each ACA tweet a measure of positivity or negativity and compared overall sentiment from Twitter with results from the Kaiser Family Foundation health tracking poll. Public opinion on Twitter (measured via sentiment analysis) was slightly more favorable than public opinion measured by the Kaiser poll (approximately 50% vs 40%, respectively) but trends over time in both favorable and unfavorable views were similar in both sources. The Twitter-based measures of opinion as well as the Kaiser poll changed very little over time: correlation coefficients for favorable and unfavorable public opinion were .43 and .37, respectively. However, we found substantial spikes in the volume of ACA-related tweets in response to key events in the law's implementation, such as the first open enrollment period in October 2013 and the Supreme Court decision in June 2012. Twitter may be useful for tracking public opinion of health care reform as it appears to be comparable with conventional polling results. Moreover, in contrast with conventional polling, the overall amount of tweets also provides a potential indication of public interest of a particular issue at any point in time. ©Matthew A Davis, Kai Zheng, Yang Liu, Helen Levy. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 26.05.2017.

The role of interactions between accommodation and vergence in human visual development

NASA Astrophysics Data System (ADS)

Teel, Danielle F. W.

Even in early infancy accommodation and vergence interact through neural coupling such that accommodation drives vergence (AC/A ratio) and vergence drives accommodation (CA/C ratio), to assist coordination and development of clear and single binocular vision. Infants have narrow inter-pupillary distances (IPD) requiring less vergence in angular units (degrees or prism diopters), and are typically hyperopic, requiring larger accommodative responses (diopters) than adults. The relative demands also change with emmetropization (decreasing hyperopia) and head growth (increasing IPD) over time. Therefore, adult-like couplings may not be optimal during development and the couplings may play a role in abnormality such as esotropia. A range of cues can drive accommodation and vergence. In addition to blur and disparity, proximity in the form of looming, size and perceived distance has been shown to influence the interactions between accommodation and vergence in adults. The role of this cue in measures of coupling is also poorly understood and may impact key clinical AC/A estimates in young children. Utilizing principles of eccentric photorefraction and Purkinje image eye tracking, this research examines the AC/A and CA/C ratios in infants, preschoolers and adults as a function of age, refractive error and interpupillary distance, plus the role proximity, specifically looming and size cues, plays in estimating the AC/A ratio in three year olds and adults. The AC/A (PD/D) was significantly higher in adults than three-year-olds or infants but similar across age groups in MA/D units. The CA/C was higher in infants than adults or three-year-olds (D/MA and D/PD). Although, not fully reciprocally related, a significant negative relationship was found between the response AC/A and CA/C. Similarly, higher AC/As (PD/D) and lower CA/Cs (D/PD) were associated with larger IPDs and less hyperopia. Although, not statistically significant the absence of proximity resulted in a trend toward a lower AC/A than in it's presence for children. These results provide insight into methods of measuring the AC/A ratio in children and determining whether the couplings are optimized to prevent over-convergence or under-accommodation during development and growth.

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 explained by population changes alone and are significantly different from trends in ED use before ACA implementation. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Comparing Laser Peripheral Iridotomy to Cataract Extraction in Narrow Angle Eyes Using Anterior Segment Optical Coherence Tomography

PubMed Central

Melese, Ephrem; Peterson, Jeffrey R.; Feldman, Robert M.; Baker, Laura A.; Bell, Nicholas P.; Chuang, Alice Z.

2016-01-01

Purpose To evaluate the changes in anterior chamber angle (ACA) parameters in primary angle closure (PAC) spectrum eyes before and after cataract extraction (CE) and compare to the changes after laser peripheral iridotomy (LPI) using anterior segment optical coherence tomography (ASOCT). Methods Twenty-eight PAC spectrum eyes of 18 participants who underwent CE and 34 PAC spectrum eyes of 21 participants who underwent LPI were included. ASOCT images with 3-dimensional mode angle analysis scans were taken with the CASIA SS-1000 (Tomey Corp., Nagoya, Japan) before and after CE or LPI. Mixed-effect model analysis was used to 1) compare best-corrected visual acuity, intraocular pressure, and ACA parameters before and after CE; 2) identify and estimate the effects of potential contributing factors affecting changes in ACA parameters; and 3) compare CE and LPI treatment groups. Results The increase in average angle parameters (TISA750 and TICV750) was significantly greater after CE than LPI. TICV750 increased by 102% (2.114 [±1.203] μL) after LPI and by 174% (4.546 [± 1.582] μL) after CE (P < 0.001). Change of TICV750 in the CE group was significantly affected by age (P = 0.002), race (P = 0.006), and intraocular lens power (P = 0.037). Conclusions CE results in greater anatomic changes in the ACA than LPI in PAC spectrum eyes. ASOCT may be used to follow anatomic changes in the angle after intervention. PMID:27606482

Quality of Artemisinin-Based Combination Formulations for Malaria Treatment: Prevalence and Risk Factors for Poor Quality Medicines in Public Facilities and Private Sector Drug Outlets in Enugu, Nigeria

PubMed Central

Kaur, Harparkash; Allan, Elizabeth Louise; Mamadu, Ibrahim; Hall, Zoe; Ibe, Ogochukwu; El Sherbiny, Mohamed; van Wyk, Albert; Yeung, Shunmay; Swamidoss, Isabel; Green, Michael D.; Dwivedi, Prabha; Culzoni, Maria Julia; Clarke, Siân; Schellenberg, David; Fernández, Facundo M.; Onwujekwe, Obinna

2015-01-01

Background Artemisinin-based combination therapies are recommended by the World Health Organisation (WHO) as first-line treatment for Plasmodium falciparum malaria, yet medication must be of good quality for efficacious treatment. A recent meta-analysis reported 35% (796/2,296) of antimalarial drug samples from 21 Sub-Saharan African countries, purchased from outlets predominantly using convenience sampling, failed chemical content analysis. We used three sampling strategies to purchase artemisinin-containing antimalarials (ACAs) in Enugu metropolis, Nigeria, and compared the resulting quality estimates. Methods ACAs were purchased using three sampling approaches - convenience, mystery clients and overt, within a defined area and sampling frame in Enugu metropolis. The active pharmaceutical ingredients were assessed using high-performance liquid chromatography and confirmed by mass spectrometry at three independent laboratories. Results were expressed as percentage of APIs stated on the packaging and used to categorise each sample as acceptable quality, substandard, degraded, or falsified. Results Content analysis of 3024 samples purchased from 421 outlets using convenience (n=200), mystery (n=1,919) and overt (n=905) approaches, showed overall 90.8% ACAs to be of acceptable quality, 6.8% substandard, 1.3% degraded and 1.2% falsified. Convenience sampling yielded a significantly higher prevalence of poor quality ACAs, but was not evident by the mystery and overt sampling strategies both of which yielded results that were comparable between each other. Artesunate (n=135; 4 falsified) and dihydroartemisinin (n=14) monotherapy tablets, not recommended by WHO, were also identified. Conclusion Randomised sampling identified fewer falsified ACAs than previously reported by convenience approaches. Our findings emphasise the need for specific consideration to be given to sampling frame and sampling approach if representative information on drug quality is to be obtained. PMID:26018221

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 Cancer Society. © 2017 American Cancer Society.

Communication and Shared Practices are Bringing NASA STEM Resources to Camp Youth

NASA Astrophysics Data System (ADS)

LaConte, K.; Shaner, A.; Shipp, S.; Garst, B.; Bialeschki, M. D.; Netting, R.; Erickson, K.

2015-11-01

In 2012, NASA and the American Camp Association (ACA) entered into an alliance to further both organizations' goals and objectives with regard to science, technology, engineering, and mathematics (STEM) education. This alliance is providing camp staff—and their young audiences—access to NASA's resources. NASA disseminates resources (e.g., pathways for requesting guest presenters, informal learning lesson plans), conducts ACA professional development (online and at ACA conferences), and coordinates efforts around key events (e.g., spacecraft launches). ACA promotes awareness of NASA resources through their communications and services. Together, the organizations are working to inspire a new generation of scientists, engineers, explorers, educators, and innovators to pursue STEM careers.

Special topical approach to the treatment of acne. Suppression of sweating with aluminum chloride in an anhydrous formulation.

PubMed

Hurley, H J; Shelley, W B

1978-12-01

A new topical approach to acne treatment--the use of aluminum chloride hexahydrate in anhydrous ethanol (ACAE)--was studied in 141 patients. Using sequential treatment schedules, paired comparison techniques, and various concentrations of ACAE, we established maximal efficacy with minimal local irritation for the 6.25% strength solution. Clinical efficacy and lack of toxicity of this formulation were confirmed by the additional clinical study of 65 patients. The antiperspirant and antibacterial actions of 6.25% ACAE solution were then verified on acne skin areas. It is postulated that the clinical improvement in acne that follows the topical use of ACAE results from one or both of these actions.

Effects of acetic acid or sodium acetate infused into the rumen or abomasum on feeding behavior and metabolic response of cows in the postpartum period.

PubMed

Gualdrón-Duarte, Laura B; Allen, Michael S

2018-03-01

Effects of continuous isomolar infusions of acetic acid (AcA) or sodium acetate (NAc) infused into the rumen (RU) or into the abomasum (AB) on feeding behavior, dry matter intake (DMI), and metabolic response of cows in the early postpartum period were evaluated. Six rumen-cannulated multiparous Holstein cows (11.8 ± 3.9 d in milk; mean ± SD) were utilized in a 6 × 6 Latin square design experiment balanced for carryover effects with a 2 × 3 factorial arrangement of treatments. Treatments were AcA and NAc, with sodium chloride (CON) as a control, infused at a rate of ˜0.75 mol/h (0.5 L/h) into the RU or AB for the first 8 h following feeding, with a rest day between infusion days. Treatment sequences were assigned randomly to cows. Feeding behavior was recorded by a computerized data acquisition system and blood was sampled at 0, 4, and 8 h relative to the start of infusion. We hypothesized that AcA is more hypophagic than NAc, and that infusion into the AB is more hypophagic than infusion into the RU. Dry matter intakes (DMI) for the CON treatments were similar at 6.2 kg/8 h for RU and 6.1 kg/8 h for AB, and the AcA and NAc treatments interacted with site of infusion to affect DMI. The NAc-RU treatment did not reduce DMI (7.0 kg/8 h), whereas AcA-RU (2.6 kg/8 h), AcA-AB (3.7 kg/8 h), and NAc-AB (4.0 kg/8 h) decreased DMI compared with CON. Following infusions of AcA compared with NAc, there was a residual effect on DMI for the remainder of the day, but treatments did not affect DMI during the rest day. Treatments increased plasma acetate and β-hydroxybutyrate concentrations over time (interaction) and decreased plasma insulin concentration compared with CON. Plasma glucose concentration decreased over time after AcA-AB infusion compared with other treatments and CON. Plasma nonesterified fatty acid concentration increased over time for AcA compared with NAc and CON, suggesting an increase in lipolysis to compensate the decrease in DMI. In contrast to the other treatments, NAc-RU did not decrease DMI compared with control but we cannot determine the reason for this from the data available from the current study. Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Can biosimilars help achieve the goals of US health care reform?

PubMed

Boccia, Ralph; Jacobs, Ira; Popovian, Robert; de Lima Lopes, Gilberto

2017-01-01

The US Patient Protection and Affordable Care Act (ACA) aims to expand health care coverage, contain costs, and improve health care quality. Accessibility and affordability of innovative biopharmaceuticals are important to the success of the ACA. As it is substantially more difficult to manufacture them compared with small-molecule drugs, many of which have generic alternatives, biologics may increase drug costs. However, biologics offer demonstrated improvements in patient care that can reduce expensive interventions, thus lowering net health care costs. Biosimilars, which are highly similar to their reference biologics, cost less than the originators, potentially increasing access through reduced prescription drug costs while providing equivalent therapeutic results. This review evaluates 1) the progress made toward enacting health care reform since the passage of the ACA and 2) the role of biosimilars, including the potential impact of expanded biosimilar use on access, health care costs, patient management, and outcomes. Barriers to biosimilar adoption in the USA are noted, including low awareness and financial disincentives relating to reimbursement. The evaluated evidence suggests that the ACA has partly achieved some of its aims; however, the opportunity remains to transform health care to fully achieve reform. Although the future is uncertain, increased use of biosimilars in the US health care system could help achieve expanded access, control costs, and improve the quality of care.

You Can't Make Me Do It, but I Could Be Persuaded: A Federalism Perspective on the Affordable Care Act.

PubMed

Haeder, Simon F; Weimer, David L

2015-04-01

The Affordable Care Act (ACA) seeks to change fundamentally the US health care system. The responses of states have been diverse and changing. What explains these diverse and dynamic responses? We examine the decision making of states concerning the creation of Pre-existing Condition Insurance Plan programs and insurance marketplaces and the expansion of Medicaid in historical context. This frames our analysis and its implications for future health reform in broader perspective by identifying a number of characteristics of state-federal grants programs: (1) slow and uneven implementation; (2) wide variation across states; (3) accommodation by the federal government; (4) ideological conflict; (5) state response to incentives; (6) incomplete take-up rates of eligible individuals; and (7) programs as stepping-stones and wedges. Assessing the implementation of the three main components of the ACA, we find that partisanship exerts significant influence, yet less so in the case of Medicaid expansion. Moreover, factors specific to the insurance market also play an important role. Finally, we conclude by applying the themes to the ACA and offer an outlook for its continuing implementation. Specifically, we expect a gradual move toward universal state participation in the ACA, especially with respect to Medicaid expansion. Copyright © 2015 by Duke University Press.

Analysis of anticentromere autoantibodies using cloned autoantigen CENP-B.

PubMed Central

Earnshaw, W C; Machlin, P S; Bordwell, B J; Rothfield, N F; Cleveland, D W

1987-01-01

A cDNA clone encoding CENP-B, the 80-kDa human centromere autoantigen, was used to construct a panel of hybrid proteins containing four different regions of CENP-B. These have allowed us to identify three independent epitopes on CENP-B that are targets of autoantibodies. Two of these are recognized concurrently in greater than or equal to 90% of patient sera containing anticentromere autoantibodies (ACA), conclusively demonstrating that this autoimmune response is polyclonal. When present and previous data are combined, ACA are shown to recognize at least five independent epitopes on CENP-B. A radioimmunoassay based on cloned CENP-B has demonstrated that sera from greater than or equal to 96% of patients with ACA recognize the cloned antigen, thus defining a region of the protein that is recognized by virtually all patients with ACA. These findings have significant implications for models that seek to explain the origin of ACA and for the future detection of this group of autoantibodies in the clinical setting. Images PMID:2440036

Analysis of anticentromere autoantibodies using cloned autoantigen CENP-B.

PubMed

Earnshaw, W C; Machlin, P S; Bordwell, B J; Rothfield, N F; Cleveland, D W

1987-07-01

A cDNA clone encoding CENP-B, the 80-kDa human centromere autoantigen, was used to construct a panel of hybrid proteins containing four different regions of CENP-B. These have allowed us to identify three independent epitopes on CENP-B that are targets of autoantibodies. Two of these are recognized concurrently in greater than or equal to 90% of patient sera containing anticentromere autoantibodies (ACA), conclusively demonstrating that this autoimmune response is polyclonal. When present and previous data are combined, ACA are shown to recognize at least five independent epitopes on CENP-B. A radioimmunoassay based on cloned CENP-B has demonstrated that sera from greater than or equal to 96% of patients with ACA recognize the cloned antigen, thus defining a region of the protein that is recognized by virtually all patients with ACA. These findings have significant implications for models that seek to explain the origin of ACA and for the future detection of this group of autoantibodies in the clinical setting.

Frequency and prognostic significance of additional cytogenetic abnormalities to the Philadelphia chromosome in young and older adults with acute lymphoblastic leukemia.

PubMed

Motlló, Cristina; Ribera, Josep-Maria; Morgades, Mireia; Granada, Isabel; Montesinos, Pau; Mercadal, Santiago; González-Campos, José; Moreno, María-José; Barba, Pere; Cervera, Marta; Barrios, Manuel; Novo, Andrés; Bernal, Teresa; Hernández-Rivas, Jesús-María; Abella, Eugenia; Amigo, María-Luz; Tormo, Mar; Martino, Rodrigo; Lavilla, Esperanza; Bergua, Juan; Serrano, Alfons; García-Belmonte, Daniel; Guàrdia, Ramon; Grau, Javier; Feliu, Evarist

2018-01-01

About 25-35% of adult patients with acute lymphoblastic leukemia show the Philadelphia (Ph) chromosome. Few series have evaluated the prognosis of additional cytogenetic alterations (ACA) to the Ph chromosome. We analyzed the frequency, type and prognostic significance ofACA in adults (18-60 years) treated in the ALL-Ph-08 trial. Fifty-two out of 74 patients (70%) showed ACA and 19 (26%) presented monosomies associated with t(9;22) (monosomal karyotype, MK). Similar complete response (CR) rate, CR duration, overall survival and event-free survival (EFS) were observed in patients with or without ACA, but patients with MK showed shorter CR duration and EFS than the remaining. On multivariate analysis, the only variable with prognostic impact for CR duration and EFS was the presence of MK (p = .003 and p = .036, respectively). Although ACA associated with the Ph chromosome are frequent, only monosomies were associated with poor prognosis in this group of patients.

How the affordable care act and mental health parity and addiction equity act greatly expand coverage of behavioral health care.

PubMed

Beronio, Kirsten; Glied, Sherry; Frank, Richard

2014-10-01

The Patient Protection and Affordable Care Act (ACA) will expand coverage of mental health and substance use disorder benefits and federal parity protections to over 60 million Americans. The key to this expansion is the essential health benefit provision in the ACA that requires coverage of mental health and substance use disorder services at parity with general medical benefits. Other ACA provisions that should improve access to treatment include requirements on network adequacy, dependent coverage up to age 26, preventive services, and prohibitions on annual and lifetime limits and preexisting exclusions. The ACA offers states flexibility in expanding Medicaid (primarily to childless adults, not generally eligible previously) to cover supportive services needed by those with significant behavioral health conditions in addition to basic benefits at parity. Through these various new requirements, the ACA in conjunction with Mental Health Parity and Addiction Equity Act (MHPAEA) will expand coverage of behavioral health care by historic proportions.

A search for H/ACA snoRNAs in yeast using MFE secondary structure prediction.

PubMed

Edvardsson, Sverker; Gardner, Paul P; Poole, Anthony M; Hendy, Michael D; Penny, David; Moulton, Vincent

2003-05-01

Noncoding RNA genes produce functional RNA molecules rather than coding for proteins. One such family is the H/ACA snoRNAs. Unlike the related C/D snoRNAs these have resisted automated detection to date. We develop an algorithm to screen the yeast genome for novel H/ACA snoRNAs. To achieve this, we introduce some new methods for facilitating the search for noncoding RNAs in genomic sequences which are based on properties of predicted minimum free-energy (MFE) secondary structures. The algorithm has been implemented and can be generalized to enable screening of other eukaryote genomes. We find that use of primary sequence alone is insufficient for identifying novel H/ACA snoRNAs. Only the use of secondary structure filters reduces the number of candidates to a manageable size. From genomic context, we identify three strong H/ACA snoRNA candidates. These together with a further 47 candidates obtained by our analysis are being experimentally screened.

Magnetic and structural transitions in La1-xAxCoO3 ( A=Ca , Sr, and Ba)

NASA Astrophysics Data System (ADS)

Kriener, M.; Braden, M.; Kierspel, H.; Senff, D.; Zabara, O.; Zobel, C.; Lorenz, T.

2009-06-01

We report thermal-expansion, lattice-constant, and specific-heat data of the series La1-xAxCoO3 for 0≤x≤0.30 with A=Ca , Sr, and Ba. For the undoped compound LaCoO3 , the thermal-expansion coefficient α(T) exhibits a pronounced maximum around T=50K caused by a temperature-driven spin-state transition from a low-spin state of the Co3+ ions at low temperatures toward a higher spin state at higher temperatures. The partial substitution of the La3+ ions by divalent Ca2+ , Sr2+ , or Ba2+ ions causes drastic changes in the macroscopic properties of LaCoO3 . The large maximum in α(T) is suppressed and completely vanishes for x≳0.125 . For A=Ca three different anomalies develop in α(T) with further increasing x , which are visible in specific-heat data as well. Together with temperature-dependent x-ray data, we identify several phase transitions as a function of the doping concentration x and temperature. From these data we propose an extended phase diagram for La1-xCaxCoO3 .

Using Aminocaproic Acid to Reduce Blood Loss After Primary Unilateral Total Knee Arthroplasty.

PubMed

Churchill, Jessica L; Toney, Victor A; Truchan, Susan; Anderson, Michael J

2016-01-01

xtensive blood loss after total knee arthroplasty (TKA) is common, and affected patients often require blood transfusions. Studies suggest that antifibrinolytic agents such as aminocaproic acid (ACA) reduce blood loss and blood transfusion rates in patients undergoing TKA. We conducted a study to evaluate whether a single intravenous 10-g dose of ACA given during primary unilateral TKA would decrease perioperative blood loss, raise postoperative hemoglobin levels, and reduce postoperative blood transfusion rates. We retrospectively reviewed the charts of 50 comparable cemented primary unilateral TKAs. Twenty-five patients had been given a single intraoperative 10-g dose of ACA (antifibrinolytic group), and the other 25 had not been given ACA (control group). Postoperative drain output was decreased significantly (P < .0001) in the antifibrinolytic group (155 mL) compared with the control group (410 mL), as was the number of units of blood transfused after surgery (antifibrinolytic group, 0 units; control group, 10 units; P < .002). There were no adverse events in the antifibrinolytic group. In TKA, perioperative blood loss and blood transfusion rates were reduced significantly in patients given a single intraoperative intravenous 10-g dose of ACA compared with patients not given antifibrinolytics. The positive effects of ACA were obtained without adverse events or complications.

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.

Estimating the Counterfactual: How Many Uninsured Adults Would There Be Today Without the ACA?

PubMed

Blumberg, Linda J; Garrett, Bowen; Holahan, John

2016-01-01

Time lags in receiving data from long-standing, large federal surveys complicate real-time estimation of the coverage effects of full Affordable Care Act (ACA) implementation. Fast-turnaround household surveys fill some of the void in data on recent changes to insurance coverage, but they lack the historical data that allow analysts to account for trends that predate the ACA, economic fluctuations, and earlier public program expansions when predicting how many people would be uninsured without comprehensive health care reform. Using data from the Current Population Survey (CPS) from 2000 to 2012 and the Health Reform Monitoring Survey (HRMS) data for 2013 and 2015, this article develops an approach to estimate the number of people who would be uninsured in the absence of the ACA and isolates the change in coverage as of March 2015 that can be attributed to the ACA. We produce counterfactual forecasts of the number of uninsured absent the ACA for 9 age-income groups and compare these estimates with 2015 estimates based on HRMS relative coverage changes applied to CPS-based population estimates. As of March 2015, we find the ACA has reduced the number of uninsured adults by 18.1 million compared with the number who would have been uninsured at that time had the law not been implemented. That decline represents a 46% reduction in the number of nonelderly adults without insurance. The approach developed here can be applied to other federal data and timely surveys to provide a range of estimates of the overall effects of reform. © The Author(s) 2016.

The modernization of American public law: health care reform and popular constitutionalism.

PubMed

Super, David A

2014-04-01

The Patient Protection and Affordable Care Act (ACA) transformed U.S. public law in crucial ways extending far beyond health care. As important as were the doctrinal shifts wrought by National Federation of Independent Business v. Sebelius, the ACA's structural changes to public law likely will prove far more important should they become entrenched. The struggle over the ACA has triggered the kind of "constitutional moment" that has largely replaced Article V's formal amendment procedure since the Prohibition fiasco. The Court participates in this process, but the definitive and enduring character of these constitutional moments' outcomes springs from broad popular engagement. Despite the Court's ruling and the outcome of the 2012 elections, the battle over whether to implement or shelve the ACA will continue unabated, both federally and in the states, until We the People render a clear decision. Whether the ACA survives or fails will determine the basic principles that guide the development of federalism, social insurance, tax policy, and privatization for decades to come. In each of these areas, the New Deal bequeathed us a delicate accommodation between traditionalist social values and modernizing norms of economic efficiency and interest group liberalism. This balance has come under increasing stress, with individual laws rejecting tradition far more emphatically than the New Deal did. But absent broad popular engagement, no definitive new principles could be established. The ACA's entrenchment would elevate technocratic norms across public law, the first change of our fundamental law since the civil rights revolution. The ACA's failure would rejuvenate individualistic, moralistic, pre-New Deal norms and allow opponents to attempt a counterrevolution against technocracy.

Photocopy of drawing located at National Archives, San Bruno, California ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Photocopy of drawing located at National Archives, San Bruno, California (Navy # 110-A-1 3 of 5). Scofiled Construction Company Mare Island Office, Mare Island Cal, details of doors windows and terra cotta, September 2, 1908. - Mare Island Naval Shipyard, Pump House, California Avenue, east side between Dry Dock 1 & Dry Dock 2, near Ninth Street, Vallejo, Solano County, CA

A Comparitive Study of Anticardiolipin Antibodies among Systemic Lupus Erythematosus Patients from Western and Eastern India.

PubMed

Doley, D; Kakati, S; Saikia, L; Rajadhyaksha, A; Nadkar, Milind; Khadilkar, P; Patwardhan, M; Pradhan, V

2017-03-01

Anti-phospholipid antibodies (APA) like anticardiolipin antibodies (ACA) are important cause of venous and arterial thrombosis and other occlusive vascular diseases. Prevalence of these antibodies in SLE patients at the time of diagnosis is not known in Indian SLE patients. This study was conducted to evaluate the prevalence of ACA in SLE patients from Eastern and Western India and to correlate them with disease activity. Seventy SLE patients from Assam Medical College, Dibrugarh, Assam and 85 SLE patients from Rheumatology Department, KEM Hospital, Mumbai were studied. SLE disease activity was evaluated by SLE Disease Activity Index (SLEDAI) score at the time of evaluation. All patients studied were in an active stage of disease. Demographic data showed significant variations in the clinical manifestations of SLE between two regions. Renal manifestations were higher (42.9%) among SLE patients from Eastern region as compared with 37.6% patients from Western region. These patients were categorized as Lupus Nephritis (LN) and patients that did not show any renal manifestations were categories as non-LN. ACA to IgG and IgM subclasses were tested by ELISA. IgGACA positivity was 20%, 12.9% and IgM-ACA positivity was 18.6%, 12.9% where asIgG + IgM ACA positivity as found in 12.9%, 3.5% patients respectively among SLE patients from Eastern and Western India. ACA positivity was higher among LN patients from Eastern India whereas the same was higher among non-LN patients from Western India. Hence detection of ACA alongwith associated clinical manifestations were helpful to evaluate their possible association with disease severity in SLE patients. A long term follow up of patients having ACA antibodies without thrombotic event is needed to detect their possible thrombotic event in future along with their clinical presentation from these two different geographic regions from India.

Perceived Impacts of Health Care Reform on Large Urban Health Departments

PubMed Central

Leider, Jonathon P.; Castrucci, Brian C.; Russo, Pamela; Hearne, Shelley

2015-01-01

Context: The Patient Protection and Affordable Care Act (ACA) is changing the landscape of health systems across the United States, as well as the functioning of governmental public health departments. As a result, local health departments are reevaluating their roles, objectives, and the services they provide. Objective: We gathered perspectives on the current and future impact of the ACA on governmental public health departments from leaders of local health departments in the Big Cities Health Coalition, which represents some of the largest local health departments in the country. Design: We conducted interviews with 45 public health officials in 16 participating Big Cities Health Coalition departments. We analyzed data reflecting participants' perspectives on potential changes in programs and services, as well as on challenges and opportunities created by the ACA. Results: Respondents uniformly indicated that they expected ACA to have a positive impact on population health. Most participants expected to conduct more population-oriented activities because of the ACA, but there was no consensus about how the ACA would impact the clinical services that their departments could offer. Local health department leaders suggested that the ACA might create a broad range of opportunities that would support public health as a whole, including expanded insurance coverage for the community, greater opportunity to collaborate with Accountable Care Organizations, increased focus on core public health issues, and increased integration with health care and social services. Conclusions: Leaders of some of the largest health departments in the United States uniformly acknowledged that realignments in funding prompted by the ACA are changing the roles that their offices can play in controlling infectious diseases, providing robust maternal and child health services, and more generally providing a social safety net for health care services in their communities. Health departments will continue to need strong leaders to strengthen and maintain their critical role in protecting and promoting the health of the public they serve. PMID:25423059

LMFBR with booster pump in pumping loop

DOEpatents

Rubinstein, H.J.

1975-10-14

A loop coolant circulation system is described for a liquid metal fast breeder reactor (LMFBR) utilizing a low head, high specific speed booster pump in the hot leg of the coolant loop with the main pump located in the cold leg of the loop, thereby providing the advantages of operating the main pump in the hot leg with the reliability of cold leg pump operation.

Role of Endocrine Gland-Derived Vascular Endothelial Growth Factor (EG-VEGF) and Its Receptors in Adrenocortical Tumors.

PubMed

Heck, Dorothee; Wortmann, Sebastian; Kraus, Luitgard; Ronchi, Cristina L; Sinnott, Richard O; Fassnacht, Martin; Sbiera, Silviu

2015-12-01

Angiogenesis is essential for tumor growth and metastasis. Endocrine gland-derived vascular endothelial growth factor (EG-VEGF) is an angiogenic factor predominantly expressed in steroidogenic organs like the adrenal gland, ovary, testes, and placenta. EG-VEGF has antiapoptotic, mitogenic, and chemoattractive properties mediated via the two G protein-coupled receptors prokineticin receptor 1 (PKR1) and prokineticin receptor 2 (PKR2). We investigated the expression of EG-VEGF and its receptors in a large number of normal adrenal glands (NAG), adrenocortical adenomas (ACA), and carcinomas (ACC) using real-time PCR (NAG, n = 12; ACA, n = 24; and ACC, n = 30) and immunohistochemistry (NAG, n = 9; ACA, n = 23; and ACC, n = 163) and evaluated its impact on patients' survival. EG-VEGF, PKR1, and PKR2 mRNA and protein are expressed in NAG and the vast majority of ACA and ACC samples. The mean EG-VEGF mRNA expression was significantly lower in ACC (606.5 ± 77.1 copies) compared to NAG (4,043 ± 1,111) and cortisol-producing adenomas (CPA) (4,433 ± 2,378) (p < 0.01 and p < 0.05, respectively). However, cytoplasmic and nuclear EG-VEGF protein expression was either significantly higher or similar in ACC (H score 2.4 ± 0.05, p < 0.05 and 1.7 ± 0.08, n.s., respectively) compared to NAG (1.8 ± 0.14 and 1.7 ± 0.2). Nuclear protein expression of either EG-VEGF or PKR1 or both is predictive for a higher mortality compared to patients without nuclear expression (hazard ratio (HR) = 5.15; 95% confidence interval (CI) = 1.24-21.36, n = 100, p = 0.02 independent of age, sex, and tumor stage). These findings suggest that EG-VEGF and its receptor PKR1 might play a role in the pathogenesis of adrenocortical tumors and could serve as prognostic markers for this rare malignant disease.

STAR FORMATION AND FEEDBACK: A MOLECULAR OUTFLOW–PRESTELLAR CORE INTERACTION IN L1689N

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

Lis, D. C.; Pagani, L.; Wootten, H. A.

2016-08-20

We present Herschel ,{sup 11} ALMA Compact Array (ACA), and Caltech Submillimeter Observatory observations of the prestellar core in L1689N, which has been suggested to be interacting with a molecular outflow driven by the nearby solar-type protostar IRAS 16293-2422. This source is characterized by some of the highest deuteration levels observed in the interstellar medium. The change in the NH{sub 2}D line velocity and width across the core provides clear evidence of an interaction with the outflow, traced by the high-velocity water emission. Quiescent, cold gas characterized by narrow line widths is seen in the NE part of the core,more » while broader, more disturbed line profiles are seen in the W/SW part. Strong N{sub 2}D{sup +} and ND{sub 3} emission is detected with ACA extending S/SW from the peak of the single-dish NH{sub 2}D emission. The ACA data also reveal the presence a compact dust continuum source with a mean size of ∼1100 au, a central density of (1–2) × 10{sup 7} cm{sup −3}, and a mass of 0.2–0.4 M {sub ⊙}. The dust emission peak is displaced ∼5″ to the south with respect to the N{sub 2}D{sup +} and ND{sub 3} emission, as well as the single-dish dust continuum peak, suggesting that the northern, quiescent part of the core is characterized by spatially extended continuum emission, which is resolved out by the interferometer. We see no clear evidence of fragmentation in this quiescent part of the core, which could lead to a second generation of star formation, although a weak dust continuum source is detected in this region in the ACA data.« less

Evidence that convergence rather than accommodation controls intermittent distance exotropia.

PubMed

Horwood, Anna M; Riddell, Patricia M

2012-03-01

This study considered whether vergence drives accommodation or accommodation drives vergence during the control of distance exotropia for near fixation. High accommodative convergence to accommodation (AC/A) ratios are often used to explain this control, but the role of convergence to drive accommodation (the CA/C relationship) is rarely considered. Atypical CA/C characteristics could equally, or better, explain common clinical findings. Nineteen distance exotropes, aged 4-11 years, were compared while controlling their deviation with 27 non-exotropic controls aged 5-9 years. Simultaneous vergence and accommodation responses were measured to a range of targets incorporating different combinations of blur, disparity and looming cues at four fixation distances between 2 m and 33 cm. Stimulus and response AC/A and CA/C ratios were calculated. Accommodation responses for near targets (p = 0.017) and response gains (p = 0.026) were greater in the exotropes than in the controls. Despite higher clinical stimulus AC/A ratios, the distance exotropes showed lower laboratory response AC/A ratios (p = 0.02), but significantly higher CA/C ratios (p = 0.02). All the exotropes, whether the angle changed most with lenses ('controlled by accommodation') or on occlusion ('controlled by fusion'), used binocular disparity not blur as their main cue to target distance. Increased vergence demand to control intermittent distance exotropia for near also drives significantly more accommodation. Minus lens therapy is more likely to act by correcting overaccommodation driven by controlling convergence, rather than by inducing blur-driven vergence. The use of convergence as a major drive to accommodation explains many clinical characteristics of distance exotropia, including apparently high near stimulus AC/A ratios. © 2012 The Authors. Acta Ophthalmologica © 2012 Acta Ophthalmologica Scandinavica Foundation.

Evidence that convergence rather than accommodation controls intermittent distance exotropia

PubMed Central

Horwood, Anna M; Riddell, Patricia M

2015-01-01

Purpose This study considered whether vergence drives accommodation or accommodation drives vergence during the control of distance exotropia for near fixation. High accommodative convergence to accommodation (AC/A) ratios are often used to explain this control, but the role of convergence to drive accommodation (the CA/C relationship) is rarely considered. Atypical CA/C characteristics could equally, or better, explain common clinical findings. Methods 19 distance exotropes, aged 4-11 years, were compared while controlling their deviation with 27 non-exotropic controls aged 5-9 years. Simultaneous vergence and accommodation responses were measured to a range of targets incorporating different combinations of blur, disparity and looming cues at four fixation distances between 2m and 33cm. Stimulus and response AC/A and CA/C ratios were calculated. Results Accommodation responses for near targets (p=0.017) response gains (p=0.026) were greater in the exotropes than the controls. Despite higher clinical stimulus AC/A ratios, the distance exotropes showed lower laboratory response AC/A ratios (p=0.02), but significantly higher CA/C ratios (p=0.02). All the exotropes, whether the angle changed most with lenses (“controlled by accommodation”) or on occlusion (“controlled by fusion”), used binocular disparity not blur as their main cue to target distance. Conclusions Increased vergence demand to control intermittent distance exotropia for near also drives significantly more accommodation. Minus lens therapy is more likely to act by correcting over-accommodation driven by controlling convergence, rather than by inducing blur-driven vergence. The use of convergence as a major drive to accommodation explains many clinical characteristics of distance exotropia, including apparently high near stimulus AC/A ratios. PMID:22280437

The Effect of the Affordable Care Act's Young Adult Insurance Expansions on Hospital-Based Behavioral Health Care

PubMed Central

Golberstein, Ezra; Busch, Susan H.; Zaha, Rebecca; Greenfield, Shelly F.; Beardslee, William R.; Meara, Ellen

2014-01-01

Objective Insurance coverage for young adults has increased since 2010, when the Affordable Care Act (ACA) required insurers to permit children on parental policies until age 26 as dependents. This study estimated changes in young adults’ use of hospital-based services with diagnosis codes for mental illness and substance abuse associated with the dependent coverage provision. Method Quasi-experimental comparison of national sample of non-birth hospital inpatient admissions to general hospitals (n=2,670,463 total, n=430,583 with primary behavioral health diagnosis) and California emergency department (ED) visits with behavioral health diagnoses (n=11,139,689). Data spanned 2005 to 2011. Estimates compared young adults who were and were not targeted by the ACA dependent coverage provision (19 to 25 versus 26 to 29 year olds), estimating changes in utilization before and after 2010. Primary outcomes included: quarterly inpatient admissions for primary diagnosis of any behavioral health disorder per 1000 population; ED visits with any behavioral health diagnosis per 1000 population; and payer source. Results Dependent coverage expansion was associated with 0.14 per 1000 more (p<0.001) inpatient admissions for behavioral health for 19-25 (ACA covered) versus 26-29 (then ACA uncovered) year olds. The coverage expansion was associated with 0.45 fewer behavioral health ED visits per 1000 (p=0.001) in California. The probability that inpatient admissions nationally, and ED visits in California were uninsured, decreased significantly (p<0.001). Conclusions ACA dependent coverage provisions produced modest increases in general hospital psychiatric inpatient admissions and higher rates of insurance coverage for young adult children nationally. Lower ED visit rates were observed in California. PMID:25263817

The Impact of the Affordable Care Act on North Carolinian Breast Cancer Patients Seeking Financial Support for Treatment.

PubMed

Obeng-Gyasi, Samilia; Tolnitch, Lisa; Greenup, Rachel A; Shelley Hwang, E

2016-10-01

The Affordable Care Act (ACA) was instated on 23 March 2010 to improve healthcare quality, reduce costs, and increase access. The Pretty in Pink Foundation (PIPF), a non-profit 501(C)(3) organization in North Carolina, provides financial assistance and in-kind support to individuals seeking help with breast cancer care. The objective of this study was to determine whether sociodemographic variables and treatment services varied among PIPF recipients since enactment of the ACA. North Carolinians who received financial assistance from the PIPF between 1 January 2013 and 31 December 2014 were included in the study, and the cohort was divided into two groups based on receipt of assistance before or after the enactment of the ACA. Descriptive statistics were tabulated as frequencies. Comparative univariate analysis between both groups was conducted using the χ (2) and Mann-Whitney U tests. All tests were two-sided and a p value <0.05 was considered statistically significant. All analyses were conducted using Stata. Overall, 1016 individuals fulfilled the inclusion criteria, and the median age of the cohort was 49 years (interquartile range 45-55). The ACA groups did not differ significantly by age, race, and sex; however, the groups varied with respect to income, employment, and clinical stage. In addition, the groups differed on the types of services for which they received financial assistance, but no difference was observed between groups with respect to insurance status. Since the enactment of the health insurance market component of the ACA, there has been a reduction in subjects receiving assistance from the PIPF; however, no change in their insurance status has been observed.

The Impact of the Affordable Care Act on North Carolinian Breast Cancer Patients Seeking Financial Support for Treatment

PubMed Central

Obeng-Gyasi, Samilia; Tolnitch, Lisa; Greenup, Rachel A.; Hwang, E. Shelley

2018-01-01

Background The Affordable Care Act (ACA) was instated on 23 March 2010 to improve healthcare quality, reduce costs, and increase access. The Pretty in Pink Foundation (PIPF), a non-profit 501(C)(3) organization in North Carolina, provides financial assistance and in-kind support to individuals seeking help with breast cancer care. The objective of this study was to determine whether sociodemographic variables and treatment services varied among PIPF recipients since enactment of the ACA. Methods North Carolinians who received financial assistance from the PIPF between 1 January 2013 and 31 December 2014 were included in the study, and the cohort was divided into two groups based on receipt of assistance before or after the enactment of the ACA. Descriptive statistics were tabulated as frequencies. Comparative univariate analysis between both groups was conducted using the χ2 and Mann–Whitney U tests. All tests were two-sided and a p value<0.05 was considered statistically significant. All analyses were conducted using Stata. Results Overall, 1016 individuals fulfilled the inclusion criteria, and the median age of the cohort was 49 years (interquartile range 45–55). The ACA groups did not differ significantly by age, race, and sex; however, the groups varied with respect to income, employment, and clinical stage. In addition, the groups differed on the types of services for which they received financial assistance, but no difference was observed between groups with respect to insurance status. Conclusion Since the enactment of the health insurance market component of the ACA, there has been a reduction in subjects receiving assistance from the PIPF; however, no change in their insurance status has been observed. PMID:27411550

Box H/ACA snoRNAs are preferred substrates for the trimethylguanosine synthase in the divergent unicellular eukaryote Trichomonas vaginalis

PubMed Central

Simoes-Barbosa, Augusto; Chakrabarti, Kausik; Pearson, Michael; Benarroch, Delphine; Shuman, Stewart; Johnson, Patricia J.

2012-01-01

The 2,2,7-trimethylguanosine caps of eukaryal snRNAs and snoRNA are formed by the enzyme Tgs1, which catalyzes sequential guanine-N2 methylations of m7G caps. Atypically, in the divergent unicellular eukaryote Trichomonas vaginalis, spliceosomal snRNAs lack a guanosine cap and the recombinant T. vaginalis trimethylguanosine synthase (TvTgs) produces only m2,7G in vitro. Here, we show by direct metabolic labeling that endogenous T. vaginalis RNAs contain m7G, m2,7G, and m2,2,7G caps. Immunodepletion of TvTgs from cell extracts and TvTgs add-back experiments demonstrate that TvTgs produces m2,7G and m2,2,7G caps. Expression of TvTgs in yeast tgs1Δ cells leads to the formation of m2,7G and m2,2,7G caps and complementation of the lethality of a tgs1Δ mud2Δ strain. Whereas TvTgs is present in the nucleus and cytosol of T. vaginalis cells, TMG-containing RNAs are localized primarily in the nucleolus. Molecular cloning of anti-TMG affinity-purified T. vaginalis RNAs identified 16 box H/ACA snoRNAs, which are implicated in guiding RNA pseudouridylation. The ensemble of new T. vaginalis H/ACA snoRNAs allowed us to predict and partially validate an extensive map of pseudouridines in T. vaginalis rRNA. PMID:22847815

System-level Analysis of Chilled Water Systems Aboard Naval Ships

DTIC Science & Technology

2015-06-24

developed one-dimensional partial differen- tial equation models that simulate time-dependent hy- drodynamics and heat transport in a piping network...Thermal zone extents. 2) Piping path and diameter. 3) Specifications and locations of chillers, heat ex- changers, pumps and valves. The framework of the... pipes and provides boundary conditions for the end of the connecting pipes . Pumps, valves, bends and heat exchangers are such components. These

16. DIAGONAL VIEW TO NORTHWEST OF 1895 ENGINE/PUMP HOUSE SHOWING ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

16. DIAGONAL VIEW TO NORTHWEST OF 1895 ENGINE/PUMP HOUSE SHOWING REPLACEMENT DIESEL ENGINE LOCATIONS AND ASSOCIATED COOLING EQUIPMENT WITH PIPING - Deer Island Pumping Station, Boston, Suffolk County, MA

Simulated Ground-Water Withdrawals by Cabot WaterWorks from the Mississippi River Valley Alluvial Aquifer, Lonoke County, Arkansas

USGS Publications Warehouse

Czarnecki, John B.

2007-01-01

Cabot WaterWorks, located in Lonoke County, Arkansas, plans to increase ground-water withdrawals from the Mississippi River Valley alluvial aquifer from a 2004 rate of approximately 2.24 million gallons per day to between 4.8 and 8 million gallons per day by the end of 2049. The effects of increased pumping from several wells were simulated using a digital model of ground-water flow. The proposed additional withdrawals by Cabot WaterWorks were specified in three 1-square-mile model cells with increased pumping beginning in 2007. Increased pumping was specified at various combined rates for a period of 44 years. In addition, augmented pumping from wells owned by Grand Prairie Water Users Association, located about 2 miles from the nearest Cabot WaterWorks wells, was added to the model beginning in 2007 and continuing through to the end of 2049 in 10 of the 16 scenarios analyzed. Eight of the scenarios included reductions in pumping rates in model cells corresponding to either the Grand Prairie Water Users Association wells or to wells contained within the Grand Prairie Area Demonstration Project. Drawdown at the end of 44 years of pumping at 4.8 million gallons per day from the Cabot WaterWorks wells ranged from 15 to 25 feet in the three model cells; pumping at 8 million gallons per day resulted in water-level drawdown ranging from about 15 to 40 feet. Water levels in those cells showed no indication of leveling out at the end of the simulation period, indicating non-steady-state conditions after 44 years of pumping. From one to four new dry cells occurred in each of the scenarios by the end of 2049 when compared to a baseline scenario in which pumping was maintained at 2004 rates, even in scenarios with reduced pumping in the Grand Prairie Area Demonstration Project; however, reduced pumping produced cells that were no longer dry when compared to the baseline scenario at the end of 2049. Saturated thickness at the end of 2049 in the three Cabot WaterWorks wells ranged from about 52 to 68.5 feet for pumping rates of 4.8 million gallons per day, and from about 38 to 64 feet for pumping rates of 8 million gallons per day, the latter causing water level to fall below half the aquifer thickness in the most heavily pumped of the three cells.

Effect of aminocaproic acid on clot strength and clot lysis of canine blood determined by use of an in vitro model of hyperfibrinolysis.

PubMed

Brown, Jamie C; Brainard, Benjamin M; Fletcher, Daniel J; Nie, Ben; Arnold, Robert D; Schmiedt, Chad W

2016-11-01

OBJECTIVE To determine pharmacodynamic and pharmacokinetic profiles of aminocaproic acid (ACA) by use of a thromboelastography (TEG)-based in vitro model of hyperfibrinolysis and high-performance liquid chromatography-mass spectrometry. ANIMALS 5 healthy adult dogs. PROCEDURES A single dose of injectable ACA (20, 50, or 100 mg/kg) or an ACA tablet (approximately 100 mg/kg) was administered orally. Blood samples were collected at 0, 15, 30, 45, 60, 90, 120, and 240 minutes after ACA administration for pharmacokinetic analysis. Samples were obtained at 0, 60, and 240 minutes for pharmacodynamic analysis by use of a TEG model of hyperfibrinolysis. RESULTS No adverse effects were detected. In the hyperfibrinolysis model, after all doses, a significantly higher TEG maximum amplitude (clot strength), compared with baseline, was detected at 60 and 240 minutes. Additionally, the percentage of fibrinolysis was reduced from the baseline value at 60 and 240 minutes, with the greatest reduction at 60 minutes. At 240 minutes, there was significantly less fibrinolysis for the 100 mg/kg dose than the 20 mg/kg dose. Maximum plasma ACA concentration was dose dependent. There was no significant difference in pharmacokinetic parameters between 100 mg/kg formulations. CONCLUSIONS AND CLINICAL RELEVANCE In an in vitro model of hyperfibrinolysis, ACA inhibited fibrinolysis at all doses tested. At 240 minutes after administration, the 100 mg/kg dose inhibited fibrinolysis more effectively than did the 20 mg/kg dose. Thus, ACA may be useful for in vivo prevention of fibrinolysis in dogs. IMPACT FOR HUMAN MEDICINE These data may improve research models of hyperfibrinolytic diseases.

1'-Acetoxychavicol acetate ameliorates age-related spatial memory deterioration by increasing serum ketone body production as a complementary energy source for neuronal cells.

PubMed

Kojima-Yuasa, Akiko; Yamamoto, Tomiya; Yaku, Keisuke; Hirota, Shiori; Takenaka, Shigeo; Kawabe, Kouichi; Matsui-Yuasa, Isao

2016-09-25

1'-Acetoxychavicol acetate (ACA) is naturally obtained from the rhizomes and seeds of Alpinia galangal. Here, we examined the effect of ACA on learning and memory in senescence-accelerated mice prone 8 (SAMP8). In mice that were fed a control diet containing 0.02% ACA for 25 weeks, the learning ability in the Morris water maze test was significantly enhanced in comparison with mice that were fed the control diet alone. In the Y-maze test, SAMP8 mice showed decreased spontaneous alterations in comparison with senescence-accelerated resistant/1 (SAMR1) mice, a homologous control, which was improved by ACA pretreatment. Serum metabolite profiles were obtained by GC-MS analysis, and each metabolic profile was plotted on a 3D score plot. Based upon the diagram, it can be seen that the distribution areas for the three groups were completely separate. Furthermore, the contents of β-hydroxybutyric acid and palmitic acid in the serum of SAMP8-ACA mice were higher than those of SAMP8-control mice and SAMR1-control mice. We also found that SAMR1 mice did not show histological abnormalities, whereas histological damage in the CA1 region of the hippocampus in SAMP8-control mice was observed. However, SAMP8-ACA mice were observed in a similar manner as SAMR1 mice. These findings confirm that ACA increases the serum concentrations of β-hydroxybutyric acid and palmitic acid levels and thus these fuels might contribute to the maintenance of the cognitive performance of SAMP8 mice. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

What's at Stake in U.S. Health Reform: A Guide to the Affordable Care Act and Value-Based Care.

PubMed

Rambur, Betty A

2017-05-01

The U.S. presidential election of 2016 accentuated the divided perspectives on the Patient Protection and Affordable Care Act of 2010, commonly known as Obamacare. The perspectives included a pledge from then candidate Donald J. Trump to "repeal and replace on day one"; Republican congressional leaders' more temperate suggestions in the first weeks of the Trump administration to "repair" the Affordable Care Act (ACA); and President Trump's February 5, 2017 statement-16 days after inauguration-that a Republican replacement for the ACA may not be ready until late 2017 or 2018. The swirling rhetoric, media attention, and the dizzying rate of U.S. health and payment reforms both within and outside of the ACA makes it difficult for nurses, both United States and globally, to discern which health policy issues are grounded in the ACA and which aspects reflect payer-driven "volume to value" reimbursement changes. Moreover, popular and controversial elements of the ACA-for example, the clause that prohibits insurance carriers to deny coverage to those with preexisting health conditions and the more controversial individual mandate that bears Supreme Court support as a constitutional provision-are paired in ways that might be unclear to those unfamiliar with nuances of insurance rate determination. To support nurses' capacity to maximize their impact on health policy, this overview distills the 906-page ACA into major themes and describes payment reform legislation and initiatives that are external to the ACA. Understanding the political and societal forces that affect health care policy and delivery is necessary for nurses to effectively lead and advocate for the best interests of their patients.

Dual-Pump CARS Development and Application to Supersonic Combustion

NASA Astrophysics Data System (ADS)

Magnotti, Gaetano

Successful design of hypersonic air-breathing engines requires new computational fluid dynamics (CFD) models for turbulence and turbulence-chemistry interaction in supersonic combustion. Unfortunately, not enough data are available to the modelers to develop and validate their codes, due to difficulties in taking measurements in such a harsh environment. Dual-pump coherent anti-Stokes Raman spectroscopy (CARS) is a non-intrusive, non-linear, laser-based technique that provides temporally and spatially resolved measurements of temperature and absolute mole fractions of N2, O2 and H2 in H2-air flames. A dual-pump CARS instrument has been developed to obtain measurements in supersonic combustion and generate databases for the CFD community. Issues that compromised previous attempts, such as beam steering and high irradiance perturbation effects, have been alleviated or avoided. Improvements in instrument precision and accuracy have been achieved. An axis-symmetric supersonic combusting coaxial jet facility has been developed to provide a simple, yet suitable flow to CFD modelers. The facility provides a central jet of hot "vitiated air" simulating the hot air entering the engine of a hypersonic vehicle flying at Mach numbers between 5 and 7. Three different silicon carbide nozzles, with exit Mach number 1, 1.6 and 2, are used to provide flows with the effects of varying compressibility. H2 co-flow is available in order to generate a supersonic combusting free jet. Dual-pump CARS measurements have been obtained for varying values of flight and exit Mach numbers at several locations. Approximately one million Dual-pump CARS single shots have been collected in the supersonic jet for varying values of flight and exit Mach numbers at several locations. Data have been acquired with a H2 co-flow (combustion case) or a N 2 co-flow (mixing case). Results are presented and the effects of the compressibility and of the heat release are discussed.

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.

Demographic, Insurance, and Health Characteristics of Newly Enrolled HIV-Positive Patients After Implementation of the Affordable Care Act in California

PubMed Central

Parthasarathy, Sujaya; Altschuler, Andrea; Silverberg, Michael J.; Storholm, Erik; Campbell, Cynthia I.

2016-01-01

Objectives. To examine changes in HIV-positive patient enrollment in a large health care delivery system before and after key Affordable Care Act (ACA) provisions went into effect in 2014. Methods. Analyses compared HIV-positive patients newly enrolled in Kaiser Permanente Northern California between January and June 2012 (n = 339) to those newly enrolled between January and June 2014 through the California insurance exchange or via other mechanisms (n = 549). Results. After the ACA, the HIV-positive patient enrollment increased. These new enrollees were more likely to be male (93.6% vs 89.1%; P = .01), to be enrolled in high-deductible benefit plans (≥ $1000; 18.8% vs 5.5%; P = .01), and to have better HIV viral control (HIV RNA levels below limits of quantification 79.5% vs 73.6%; P = .05) compared with pre-ACA new enrollees. Among post-ACA new enrollees, there were more patients in the lowest and highest age groups. Post-ACA exchange enrollees (22%) were more likely to be male and to have high-deductible plans than those enrolled through other mechanisms. Conclusions. More men, higher deductibles, and better HIV viral control characterize newly enrolled HIV-positive patients after the ACA in California. Public health implications. Evolving characteristics of HIV-positive enrollees may affect HIV policy, patient care needs, and service utilization. PMID:27077361

In vitro evaluation of encapsulated primary rat hepatocytes pre- and post-cryopreservation at -80°C and in liquid nitrogen.

PubMed

Durkut, Serap; Elçin, A Eser; Elçin, Y Murat

2015-02-01

Encapsulation techniques have the potential to protect hepatocytes from cryoinjury. In this study, we comparatively evaluated the viability and metabolic function of primary rat hepatocytes encapsulated in calcium alginate microbeads, in chitosan tripolyphosphate beads, and in three-layered alginate-chitosan-alginate (ACA) microcapsules, before and after cryopreservation at -80°C and in liquid nitrogen (LN2) for 1 and 3 months. Findings demonstrated that LN2 was atop of -80°C in regard to preservation of viability (> 90%) and hepatic functions. LN2-cryopreserved hepatocytes encapsulated in ACA microcapsules retained metabolic function post-thawing, with > 90% of the albumin, total protein and urea syntheses activities, and > 80% of oxidative function.

Analysis of pumping tests: Significance of well diameter, partial penetration, and noise

USGS Publications Warehouse

Heidari, M.; Ghiassi, K.; Mehnert, E.

1999-01-01

The nonlinear least squares (NLS) method was applied to pumping and recovery aquifer test data in confined and unconfined aquifers with finite diameter and partially penetrating pumping wells, and with partially penetrating piezometers or observation wells. It was demonstrated that noiseless and moderately noisy drawdown data from observation points located less than two saturated thicknesses of the aquifer from the pumping well produced an exact or acceptable set of parameters when the diameter of the pumping well was included in the analysis. The accuracy of the estimated parameters, particularly that of specific storage, decreased with increases in the noise level in the observed drawdown data. With consideration of the well radii, the noiseless drawdown data from the pumping well in an unconfined aquifer produced good estimates of horizontal and vertical hydraulic conductivities and specific yield, but the estimated specific storage was unacceptable. When noisy data from the pumping well were used, an acceptable set of parameters was not obtained. Further experiments with noisy drawdown data in an unconfined aquifer revealed that when the well diameter was included in the analysis, hydraulic conductivity, specific yield and vertical hydraulic conductivity may be estimated rather effectively from piezometers located over a range of distances from the pumping well. Estimation of specific storage became less reliable for piezemeters located at distances greater than the initial saturated thickness of the aquifer. Application of the NLS to field pumping and recovery data from a confined aquifer showed that the estimated parameters from the two tests were in good agreement only when the well diameter was included in the analysis. Without consideration of well radii, the estimated values of hydraulic conductivity from the pumping and recovery tests were off by a factor of four.The nonlinear least squares method was applied to pumping and recovery aquifer test data in confined and unconfined aquifers with finite diameter and partially penetrating piezometers and observation wells. Noiseless and moderately noisy drawdown data from observation points located less than two saturated thicknesses of the aquifer from the pumping well produced a set of parameters that agrees very well with piezometer test data when the diameter of the pumping well was included in the analysis. The accuracy of the estimated parameters decreased with increasing noise level.

The impact of the Affordable Care Act on Medicare Advantage plan availability and enrollment.

PubMed

Afendulis, Christopher C; Landrum, Mary Beth; Chernew, Michael E

2012-12-01

To assess the impact of the Patient Protection and Affordable Care Act's (ACA) changes in Medicare Advantage (MA) payment rates on the availability of and enrollment in MA plans. Secondary data on MA plan offerings, contract offerings, and enrollment by state and county, in 2010-2011. We estimated regression models of the change in the number of plans, the number of contracts, and enrollment as a function of quartiles of FFS spending and pre-ACA MA payment generosity. Counties in the lowest quartile of spending are treated most generously by the ACA. Relative to counties in the highest quartile of spending, the number of plans in counties in the first, second, and third quartiles rose by 12 percent, 7.6 percent, and 5.4 percent, respectively. Counties with more generous MA payment rates before the ACA lost significantly more plans. We did not find a similar impact on the change in contracts or enrollment. The ACA-induced MA payment changes reduced the number of plan choices available for Medicare beneficiaries, but they have yet affected enrollment patterns. © Health Research and Educational Trust.

Medicaid Expansion and ACA Repeal: Evidence From Ohio.

PubMed

Seiber, Eric E; Berman, Micah L

2017-06-01

To examine the health insurance coverage options for Medicaid expansion enrollees if the Affordable Care Act (ACA) is repealed, using evidence from Ohio, where more than half a million adults have enrolled in the state's Medicaid program through the ACA expansion. The Ohio Medicaid Assessment Survey interviewed 42 000 households in 2015. We report data from a unique battery of questions designed to identify insurance coverage immediately prior to Medicaid enrollment. Ninety-five percent of new Medicaid enrollees in Ohio did not have a private health insurance option immediately before enrollment. These new enrollees are predominantly older, low-income Whites with a high school education or less. Only 5% of new Medicaid enrollees were eligible for an employer-sponsored insurance plan to which they could potentially return in the case of repeal of the ACA. The vast majority of Medicaid expansion enrollees would have no plausible pathway to obtaining private-sector insurance if the ACA were repealed. Demographic similarities between the expansion population and 2016 exit polls suggest that coverage losses would fall disproportionately on members of the winning Republican coalition.

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.

Despite Resources From The ACA, Most States Do Little To Help Addiction Treatment Programs Implement Health Care Reform.

PubMed

Andrews, Christina; Abraham, Amanda; Grogan, Colleen M; Pollack, Harold A; Bersamira, Clifford; Humphreys, Keith; Friedmann, Peter

2015-05-01

The Affordable Care Act (ACA) dramatically expands health insurance for addiction treatment and provides unprecedented opportunities for service growth and delivery model reform. Yet most addiction treatment programs lack the staffing and technological capabilities to respond successfully to ACA-driven system change. In light of these challenges, we conducted a national survey to examine how Single State Agencies for addiction treatment--the state governmental organizations charged with overseeing addiction treatment programs--are helping programs respond to new requirements under the ACA. We found that most Single State Agencies provide little assistance to addiction treatment programs. Most agencies are helping programs develop collaborations with other health service programs. However, fewer than half reported providing help in modernizing systems to support insurance participation, and only one in three provided assistance with enrollment outreach. In the absence of technical assistance, it is unlikely that addiction treatment programs will fully realize the ACA's promise to improve access to and quality of addiction treatment. Project HOPE—The People-to-People Health Foundation, Inc.

Participation without representation? Senior opinion, legislative behavior, and federal health reform.

PubMed

Bradley, Katharine W V; Chen, Jowei

2014-04-01

Why do legislators sometimes engage in behavior that deviates from the expressed policy preferences of constituents who participate in politics at high rates? We examine this puzzle in the context of Democratic legislators' representation of their senior citizen constituents on the Patient Protection and Affordable Care Act of 2010 (ACA). We find that legislators' roll-call votes on the ACA did not reflect the stated preferences of their respective senior constituents; by contrast, these roll-call votes did reflect the preferences of nonsenior adults. We draw upon a theoretical framework developed by Mansbridge to explain this apparent nonresponsiveness to seniors on the ACA. This framework distinguishes between promissory representation, whereby legislators merely respond to constituents' preferences, and anticipatory representation, whereby legislators respond to constituents' underlying policy interests, even when such interests conflict with expressed preferences. By considering the Medicare provisions in the ACA and analyzing Democratic legislators' floor speeches on health reform, we provide preliminary evidence that members of Congress engaged in anticipatory representation of their senior constituents by attempting to educate seniors about how the ACA serves their policy interests.

Critical Anthropology of Global Health "takes a stand" statement: a critical medical anthropological approach to the U.S.'s Affordable Care Act.

PubMed

Horton, Sarah; Abadía, Cesar; Mulligan, Jessica; Thompson, Jennifer Jo

2014-03-01

The Affordable Care Act (ACA) of 2010--the U.S.'s first major health care reform in over half a century-has sparked new debates in the United States about individual responsibility, the collective good, and the social contract. Although the ACA aims to reduce the number of the uninsured through the simultaneous expansion of the private insurance industry and government-funded Medicaid, critics charge it merely expands rather than reforms the existing fragmented and costly employer-based health care system. Focusing in particular on the ACA's individual mandate and its planned Medicaid expansion, this statement charts a course for ethnographic contributions to the on-the-ground impact of the ACA while showcasing ways critical medical anthropologists can join the debate. We conclude with ways that anthropologists may use critiques of the ACA as a platform from which to denaturalize assumptions of "cost" and "profit" that underpin the global spread of market-based medicine more broadly. © 2014 by the American Anthropological Association.

Health care spending and utilization by race/ethnicity under the Affordable Care Act's dependent coverage expansion.

PubMed

Chen, Jie; Bustamante, Arturo Vargas; Tom, Sarah E

2015-07-01

We estimated the effect of the ACA expansion of dependents' coverage on health care expenditures and utilization for young adults by race/ethnicity. We used difference-in-difference models to estimate the impact of the ACA expansion on health care expenditures, out-of-pocket payments (OOP) as a share of total health care expenditure, and utilization among young adults aged 19 to 26 years by race/ethnicity (White, African American, Latino, and other racial/ethnic groups), with adults aged 27 to 30 years as the control group. In 2011 and 2012, White and African American young adults aged 19 to 26 years had significantly lower total health care spending compared with the 27 to 30 years cohort. OOP, as a share of health care expenditure, remained the same after the ACA expansion for all race/ethnicity groups. Changes in utilization following the ACA expansion among all racial/ethnic groups for those aged 19 to 26 years were not significant. Our study showed that the impact of the ACA expansion on health care expenditures differed by race/ethnicity.

Neem gum as a binder in a formulated paracetamol tablet with reference to Acacia gum BP.

PubMed

Ogunjimi, Abayomi Tolulope; Alebiowu, Gbenga

2014-04-01

This study determined the physical, compressional, and binding properties of neem gum (NMG) obtained from the trunk of Azadirachta indica (A Juss) in a paracetamol tablet formulation in comparison with official Acacia gum BP (ACA). The physical and flow properties were evaluated using density parameters: porosity, Carr's index, Hausner's ratio, and flow rate. Compressional properties were analyzed using Heckel and Kawakita equations. The tensile strength, brittle fracture index, and crushing strength-friability/disintegration time ratio were used to evaluate the mechanical properties of paracetamol tablets while the drug release properties of the tablets were assessed using disintegration time and dissolution times. Tablet formulations containing NMG exhibited faster onset and higher amount of plastic deformation during compression than those containing ACA. Neem gum produced paracetamol tablets with lower mechanical strength; however, the tendency of the tablets to cap or laminate was lower when compared to those containing ACA. Inclusion of NMG improved the balance between binding and disintegration properties of paracetamol tablets produced than those containing ACA. Neem gum produced paracetamol tablets with lower disintegration and dissolution times than those containing ACA.

Locating hot and cold-legs in a nuclear powered steam generation system

DOEpatents

Ekeroth, D.E.; Corletti, M.M.

1993-11-16

A nuclear reactor steam generator includes a reactor vessel for heating water and a steam generator with a pump casing at the lowest point on the steam generator. A cold-leg pipe extends horizontally between the steam generator and the reactor vessel to return water from the steam generator to the reactor vessel. The bottom of the cold-leg pipe is at a first height above the bottom of the reactor vessel. A hot-leg pipe with one end connected to the steam generator and a second end connected to the reactor vessel has a first pipe region extending downwardly from the steam generator to a location between the steam generator and the reactor vessel at which a bottom of the hot-leg pipe is at a second height above the bottom of the reactor vessel. A second region extends from that location in a horizontal direction at the second height to the point at which the hot-leg pipe connects to the reactor vessel. A pump is attached to the casing at a location below the first and second heights and returns water from the steam generator to the reactor vessel over the cold-leg. The first height is greater than the second height and the bottom of the steam generator is at a height above the bottom of the reactor vessel that is greater than the first and second heights. A residual heat recovery pump is below the hot-leg and has an inlet line from the hot-leg that slopes down continuously to the pump inlet. 2 figures.

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.

Premium subsidies, the mandate, and Medicaid expansion: Coverage effects of the Affordable Care Act.

PubMed

Frean, Molly; Gruber, Jonathan; Sommers, Benjamin D

2017-05-01

Using premium subsidies for private coverage, an individual mandate, and Medicaid expansion, the Affordable Care Act (ACA) has increased insurance coverage. We provide the first comprehensive assessment of these provisions' effects, using the 2012-2015 American Community Survey and a triple-difference estimation strategy that exploits variation by income, geography, and time. Overall, our model explains 60% of the coverage gains in 2014-2015. We find that coverage was moderately responsive to price subsidies, with larger gains in state-based insurance exchanges than the federal exchange. The individual mandate's exemptions and penalties had little impact on coverage rates. The law increased Medicaid among individuals gaining eligibility under the ACA and among previously-eligible populations ("woodwork effect") even in non-expansion states, with no resulting reductions in private insurance. Overall, exchange premium subsidies produced 40% of the coverage gains explained by our ACA policy measures, and Medicaid the other 60%, of which 1/2 occurred among previously-eligible individuals. Copyright © 2017 Elsevier B.V. All rights reserved.

Changes in Health Insurance Coverage and Barriers to Health Care Access Among Individuals with Serious Psychological Distress Following the Affordable Care Act.

PubMed

Novak, Priscilla; Anderson, Andrew C; Chen, Jie

2018-05-12

The Affordable Care Act (ACA) aims to expand health insurance coverage and minimize financial barriers to receiving health care services for individuals. However, little is known about how the ACA has impacted individuals with mental health conditions. This study finds that the implementation of the ACA is associated with an increase in rate of health insurance coverage among nonelderly adults with serious psychological distress (SPD) and a reduction in delaying and forgoing necessary care. The ACA also reduced the odds of an individual with SPD not being able to afford mental health care. Mental health care access among racial and ethnic minority populations and people with low income has improved during 2014-2016, but gaps remain.

Hotfire testing of a SSME HPOTP with an annular hydrostatic bearing

NASA Technical Reports Server (NTRS)

Nolan, Steven A.; Hibbs, Robert I.; Genge, Gary G.

1994-01-01

A new fluid film bearing package has been tested in the Space Shuttle Main Engine (SSME) High Pressure Oxygen Turbopump (HPOTP). This fluid film element functions as both the pump end bearing and the preburner pump rear wear ring seal. Most importantly, it replaces a duplex ball bearing package which has been the primary life limiting component in the turbopump. The design and predicted performance of the turbopump are reviewed. Results are presented for measured pump and bearing performance during testing on the NASA Technology Test Bed (TTB) Engine located at MSFC. The most significant results were obtained from proximity probes located in the bearing bore which revealed large subsynchronous precession at ten percent of shaft speed during engine start which subsided prior to mainstage power levels and reappeared during engine shutdown at equivalent power levels below 65% of nominal. This phenomenon has been attributed to rotating stall in the diffuser. The proximity probes also revealed the location of the bearing in the bore for different operating speeds. Pump vibration characteristics were improved as compared to pumps tested with ball bearings. After seven starts and more than 700 seconds of testing, the pump showed no signs of performance degradation.

Are we prepared for Affordable Care Act provisions of care coordination? Case managers' self-assessments and views on physicians' roles.

PubMed

Moreo, Kathleen; Moreo, Natalie; Urbano, Frank L; Weeks, Matthew; Greene, Laurence

2014-01-01

Care coordination, traditionally the purview of the case management field, is recognized as a national priority for improving health care delivery and patient outcomes. With reforms of the Affordable Care Act (ACA) of 2010, case managers face new challenges and opportunities in providing care coordination services. The evolving roles of case managers as members of interprofessional care teams will be influenced by new policies that enable physicians to be reimbursed for care coordination. This qualitative study aimed to evaluate case managers' self-assessed readiness for ACA reforms of care coordination and their perceptions of physicians' understanding of case management and ability to lead care coordination efforts in evolving models. Provisions of care coordination in the ACA affect case managers in all practice settings. The majority of this study's participants represented hospital and managed care settings. An invitation to complete an 11-item online survey was sent by e-mail to 8,110 case managers in an opt-in database maintained by a health care continuing education company. Survey questions were designed to assess respondents' (1) self-reported levels of knowledge and preparation for ACA care coordination provisions and (2) beliefs about the readiness and abilities of physicians to administer care coordination services. In addition, demographic data and open-ended comments regarding physicians' roles in conducting care coordination were collected. Over a restricted 9-day period, 834 case managers representing various health care settings responded to the survey. The majority of respondents (63%) indicated that more than 50% of their day is dedicated to performing care coordination activities. However, 80% of all respondents reported being "not at all knowledgeable" or only "somewhat knowledgeable" about the new care coordination provisions in the ACA. Only 8% admitted to being "very prepared" to implement ACA changes. The majority of respondents (68%) perceive their case management departments to be at least "somewhat prepared" to implement necessary changes. Whereas 67% of respondents expect physicians to have at least a "moderate role" in implementing care coordination services, only 12% believe that physicians have more than "some" understanding of the processes of care coordination and case managers' roles. These qualitative study findings suggest that case managers from multiple practice settings perceive a lack of preparedness, knowledge, and understanding among themselves and physicians regarding ACA reforms that may significantly affect the delivery of care coordination services. The findings call for new initiatives in interprofessional education to address the knowledge gaps and enhance understanding of the collaborative roles among case managers and physicians.

Collateral Flow and White Matter Disease in Patients with Internal Carotid Artery Occlusion.

PubMed

Ishikawa, Mami; Sugawara, Hitoshi; Nagai, Mutsumi; Kusaka, Gen; Tanaka, Yuichi; Naritaka, Heiji

2017-01-01

When an internal carotid artery (ICA) occludes, a patient may develop cerebral infarction (CI). We investigated whether CI caused by ICA occlusion (ICAO) is associated with collateral flow through the anterior and posterior communicating arteries (ACoA and PCoA). In 100 patients with ICAO, we investigated CI and white matter disease by performing an MRI and the anatomy of the ACoA and PCoA were investigated by performing magnetic resonance angiography. All patients were divided into the symptomatic CI group or the no-CI group. The collateral flow pathway was estimated by the anterior cerebral artery (ACA)-PCoA score and the collateral flow volume after ICAO was estimated by the middle cerebral artery (MCA) flow score, based on how well the MCA was visualized. Of 100 patients with ICAO, the symptomatic CI group included 36 patients. ACA-PCoA score and white matter disease grades were significantly higher in the CI group (indicating poor collateral flow). More than 80% of patients with an ACA-PCoA score of 4 (poor collateral) experienced symptomatic CI. Thirty-one symptomatic CI patients (86%) had an MCA flow score of 1 or 2 (decreased MCA flow). The ACA-PCoA score and white matter disease grade may suggest an increased risk of CI following ICAO. © 2016 S. Karger AG, Basel.

Characterizing the Effects of a Vertical Time Threshold for a Class of Well-Clear Definitions

NASA Technical Reports Server (NTRS)

Upchurch, Jason M.; Munoz, Cesar A.; Narkawicz, Anthony J.; Consiglio, Maria C.; Chamberlain James P.

2015-01-01

A fundamental requirement for the integration of unmanned aircraft into civil airspace is the capability of aircraft to remain well clear of each other and avoid collisions. This requirement has led to a broad recognition of the need for an unambiguous, formal definition of well clear. It is further recognized that any such definition must be interoperable with existing airborne collision avoidance systems (ACAS). A particular class of well-clear definitions uses logic checks of independent distance thresholds as well as independent time thresholds in the vertical and horizontal dimensions to determine if a well-clear violation is predicted to occur within a given time interval. Existing ACAS systems also use independent distance thresholds, however a common time threshold is used for the vertical and horizontal logic checks. The main contribution of this paper is the characterization of the effects of the decoupled vertical time threshold on a well-clear definition in terms of (1) time to well-clear violation, and (2) interoperability with existing ACAS. The paper provides governing equations for both metrics and includes simulation results to illustrate the relationships. In this paper, interoperability implies that the time of well-clear violation is strictly less than the time a resolution advisory is issued by ACAS. The encounter geometries under consideration in this paper are initially well clear and consist of constant-velocity trajectories resulting in near-mid-air collisions.

Old Receptors, New Treatment Strategies for Breast Cancer

DTIC Science & Technology

2012-04-01

48. Page DL, Gray R, Allred DC, Dressler LG, Hatfield AK, Martino S, et al. Prediction of node-negative breast cancer outcome by his- tologic grading...GCG GTC ACA GTG ACC TGC GAG GTC ACA GTG ACC TGC GAG GTC ACA GTG ACC TGC GA-30 and 50-AGC TTC GCA GGT CAC TGT GAC CTC GCA GGT CAC TGT GAC CTC GCA GGT...VS, Bobseine K, Gray Jr LE. Development and characterization of a cell line thatstablyexpresses anestrogen-responsive luciferase reporter

Early impact of the Patient Protection and Affordable Care Act on insurance among young adults with cancer: Analysis of the dependent insurance provision.

PubMed

Parsons, Helen M; Schmidt, Susanne; Tenner, Laura L; Bang, Heejung; Keegan, Theresa H M

2016-06-01

The Patient Protection and Affordable Care Act (ACA) included provisions to extend dependent health care coverage up to the age of 26 years in 2010. The authors examined the early impact of the ACA (before the implementation of insurance exchanges in 2014) on insurance rates in young adults with cancer, a historically underinsured group. Using National Cancer Institute Surveillance, Epidemiology, and End Results data for 18 cancer registries, the authors examined insurance rates before (pre) (January 2007-September 2010) versus after (post) (October 2010-December 2012) dependent insurance provisions among young adults aged 18 to 29 years when diagnosed with cancer during 2007 through 2012. Using multivariate generalized mixed effect models, the authors conducted difference-in-differences analysis to examine changes in overall and Medicaid insurance after the ACA among young adults who were eligible (those aged 18-25 years) and ineligible (those aged 26-29 years) for policy changes. Among 39,632 young adult cancer survivors, the authors found an increase in overall insurance rates in those aged 18 to 25 years after the dependent provisions (83.5% for pre-ACA vs 85.4% for post-ACA; P<.01), but not among individuals aged 26 to 29 years (83.4% for pre-ACA vs 82.9% for post-ACA; P = .38). After adjusting for patient sociodemographics and cancer characteristics, the authors found that those aged 18 to 25 years had a 3.1% increase in being insured compared with individuals aged 26 to 29 years (P<.01); however, there were no significant changes noted in Medicaid enrollment (P = .17). The findings of the current study identify an increase in insurance rates for young adults aged 18 to 25 years compared with those aged 26 to 29 years (1.9% vs -0.5%) that was not due to increases in Medicaid enrollment, thereby demonstrating a positive impact of the ACA dependent care provisions on insurance rates in this population. Cancer 2016;122:1766-73. © 2016 American Cancer Society. © 2016 American Cancer Society.

Risk Factors for Visual Impairment in an Uninsured Population and the Impact of the Affordable Care Act.

PubMed

Guo, Weixia; Woodward, Maria A; Heisler, Michele; Blachley, Taylor; Corneail, Leah; Cederna, Jean; Kaplan, Ariane D; Newman Casey, Paula Anne

2016-01-01

To assess risk factors for visual impairment in a high-risk population of people: those without medical insurance. Secondarily, we assessed risk factors for remaining uninsured after implementation of the Affordable Care Act (ACA) and evaluated whether the ACA changed demand for local safety net ophthalmology clinic services one year after its implementation. In a retrospective cohort study of patients who attended a community-academic partnership free ophthalmology clinic in Southeastern, Michigan between September 2012 - March 2015, we assessed the prevalence of presenting with visual impairment, the most common causes of presenting with visual impairment and used logistic regression to assess socio-demographic risk factors for visual impairment. We assessed the initial impact of the ACA on clinic utilization. We also analyzed risk factors for remaining uninsured one year after implementation of the ACA private insurance marketplace and Medicaid expansion in the state of Michigan. Among 335 patients, one-fifth (22%) presented with visual impairment; refractive error was the leading cause for presenting with visual impairment. Unemployment was the single significant risk factor for presenting with visual impairment after adjusting for multiple confounding factors (OR = 3.05, 95% CI 1.19-7.87, p=0.01). There was no difference in proportion of visual impairment or type of vision-threatening disease between the insured and uninsured (p=0.26). Seventy six percent of patients remained uninsured one year after ACA implementation. Patients who were white, spoke English as a first language and were US Citizens were more likely to gain insurance coverage through the ACA in our population (p≤ 0.01). There was a non-significant decline in the mean number of patient treated per clinic (52 to 43) before and after ACA implementation (p=0.69). Refractive error was a leading cause for presenting with visual impairment in this vulnerable population, and being unemployed significantly increased the risk for presenting with visual impairment. The ACA did not significantly reduce the need for our free ophthalmology services. It is critically important to continue to support safety net specialty care initiatives and policy change to provide care for those in need.

Risk Factors for Visual Impairment in an Uninsured Population and the Impact of the Affordable Care Act

PubMed Central

Guo, Weixia; Woodward, Maria A; Heisler, Michele; Blachley, Taylor; Corneail, Leah; Cederna, Jean; Kaplan, Ariane D; Newman Casey, Paula Anne

2017-01-01

Purpose To assess risk factors for visual impairment in a high-risk population of people: those without medical insurance. Secondarily, we assessed risk factors for remaining uninsured after implementation of the Affordable Care Act (ACA) and evaluated whether the ACA changed demand for local safety net ophthalmology clinic services one year after its implementation. Methods In a retrospective cohort study of patients who attended a community-academic partnership free ophthalmology clinic in Southeastern, Michigan between September 2012 – March 2015, we assessed the prevalence of presenting with visual impairment, the most common causes of presenting with visual impairment and used logistic regression to assess socio-demographic risk factors for visual impairment. We assessed the initial impact of the ACA on clinic utilization. We also analyzed risk factors for remaining uninsured one year after implementation of the ACA private insurance marketplace and Medicaid expansion in the state of Michigan. Results Among 335 patients, one-fifth (22%) presented with visual impairment; refractive error was the leading cause for presenting with visual impairment. Unemployment was the single significant risk factor for presenting with visual impairment after adjusting for multiple confounding factors (OR = 3.05, 95% CI 1.19–7.87, p=0.01). There was no difference in proportion of visual impairment or type of vision-threatening disease between the insured and uninsured (p=0.26). Seventy six percent of patients remained uninsured one year after ACA implementation. Patients who were white, spoke English as a first language and were US Citizens were more likely to gain insurance coverage through the ACA in our population (p≤ 0.01). There was a non-significant decline in the mean number of patient treated per clinic (52 to 43) before and after ACA implementation (p=0.69). Conclusion Refractive error was a leading cause for presenting with visual impairment in this vulnerable population, and being unemployed significantly increased the risk for presenting with visual impairment. The ACA did not significantly reduce the need for our free ophthalmology services. It is critically important to continue to support safety net specialty care initiatives and policy change to provide care for those in need. PMID:28593201

Symptomatic Cerebral Vasospasm and Delayed Cerebral Ischemia Following Transsphenoidal Resection of a Craniopharyngioma.

PubMed

Ricarte, Irapuá Ferreira; Funchal, Bruno F; Miranda Alves, Maramélia A; Gomes, Daniela L; Valiente, Raul A; Carvalho, Flávio A; Silva, Gisele S

2015-09-01

Vasospasm has been rarely described as a complication associated with craniopharyngioma surgery. Herein we describe a patient who developed symptomatic vasospasm and delayed cerebral ischemia after transsphenoidal surgery for a craniopharyngioma. A 67-year-old woman became drowsy 2 weeks after a transsphenoidal resection of a craniopharyngioma. A head computed tomography (CT) was unremarkable except for postoperative findings. Electroencephalogram and laboratory studies were within the normal limits. A repeated CT scan 48 hours after the initial symptoms showed bilateral infarcts in the territory of the anterior cerebral arteries (ACA). Transcranial Doppler (TCD) showed increased blood flow velocities in both anterior cerebral arteries (169 cm/second in the left ACA and 145 cm/second in the right ACA) and right middle cerebral artery (164 cm/second) compatible with vasospasm. A CT angiography confirmed the findings. She was treated with induced hypertension and her level of consciousness improved. TCD velocities normalized after 2 weeks. Cerebral vasospasm should be considered in the differential diagnosis of patients with altered neurologic status in the postoperative period following a craniopharyngioma resection. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Development of an Unsaturated Region Below a Perennial River

NASA Astrophysics Data System (ADS)

Su, G. W.; Zhou, Q.; Constantz, J.; Hatch, C.

2004-12-01

Field observations at the Russian River Bank Filtration Facility in Sonoma County, California indicate that an unsaturated region exists below the streambed near two adjacent groundwater pumping wells located along the riverbank. Understanding the conditions that give rise to unsaturated flow below the streambed is critical for improving and optimizing riverbank well pumping operations. To investigate the development of an unsaturated region below a perennial river near pumping wells, a three-dimensional model was developed using the multi-phase subsurface flow model, TOUGH2. The model is based on the region around the two pumping wells in the Russian River Bank Filtration Facility. The pumping wells consist of 9 perforated pipes that are projected horizontally into the aquifer at a depth of approximately 20 m below the land surface. A grid was developed for the TOUGH2 model with finer resolution near the wells to represent individual pipes. The effect of varying the pumping operation and the streambed permeability on the extent of the unsaturated region was investigated with the TOUGH2 model. The formation remained saturated below the streambed when only one of the wells was pumped at a rate of 1600 m3/hr, but an unsaturated region developed below the streambed when the two wells each pumped at a rate of 1600 m3/hr. This unsaturated region was deeper when the permeability of the streambed was lower than the aquifer material compared to when the streambed and aquifer permeabilities were the same.

View of slow sand filters with pump house/chlorinator in foreground. ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

View of slow sand filters with pump house/chlorinator in foreground. Clear well tank located behind pump house and trees. - Hawaii Volcanoes National Park Water Collection System, Hawaii Volcanoes National Park, Volcano, Hawaii County, HI

Dual-Pump CARS Development and Application to Supersonic Combustion

NASA Technical Reports Server (NTRS)

Magnotti, Gaetano; Cutler, Andrew D.

2012-01-01

A dual-pump Coherent Anti-Stokes Raman Spectroscopy (CARS) instrument has been developed to obtain simultaneous measurements of temperature and absolute mole fractions of N2, O2 and H2 in supersonic combustion and generate databases for validation and development of CFD codes. Issues that compromised previous attempts, such as beam steering and high irradiance perturbation effects, have been alleviated or avoided. Improvements in instrument precision and accuracy have been achieved. An axis-symmetric supersonic combusting coaxial jet facility has been developed to provide a simple, yet suitable flow to CFD modelers. Approximately one million dual-pump CARS single shots have been collected in the supersonic jet for varying values of flight and exit Mach numbers at several locations. Data have been acquired with a H2 co-flow (combustion case) or a N2 co-flow (mixing case). Results are presented and the effects of the compressibility and of the heat release are discussed.

Mutation tryptophan to leucine at position 222 of haemagglutinin could facilitate H3N2 influenza A virus infection in dogs

PubMed Central

Yang, Guohua; Li, Shoujun; Blackmon, Sherry; Ye, Jianqiang; Bradley, Konrad C.; Cooley, Jim; Smith, Dave; Hanson, Larry; Cardona, Carol; Steinhauer, David A.; Webby, Richard; Liao, Ming

2013-01-01

An avian-like H3N2 influenza A virus (IAV) has recently caused sporadic canine influenza outbreaks in China and Korea, but the molecular mechanisms involved in the interspecies transmission of H3N2 IAV from avian to canine species are not well understood. Sequence analysis showed that residue 222 in haemagglutinin (HA) is predominantly tryptophan (W) in the closely related avian H3N2 IAV, but was leucine (L) in canine H3N2 IAV. In this study, reassortant viruses rH3N2-222L (canine-like) and rH3N2-222W (avian-like) with HA mutation L222W were generated using reverse genetics to evaluate the significance of the L222W mutation on receptor binding and host tropism of H3N2 IAV. Compared with rH3N2-222W, rH3N2-222L grew more rapidly in MDCK cells and had significantly higher infectivity in primary canine tracheal epithelial cells. Tissue-binding assays demonstrated that rH3N2-222L had a preference for canine tracheal tissues rather avian tracheal tissues, whereas rH3N2-222W favoured slightly avian rather canine tracheal tissues. Glycan microarray analysis suggested both rH3N2-222L and rH3N2-222W bound preferentially to α2,3-linked sialic acids. However, the rH3N2-222W had more than twofold less binding affinity than rH3N2-222L to a set of glycans with Neu5Aca2–3Galb1–4(Fuca-)-like or Neu5Aca2–3Galb1–3(Fuca-)-like structures. These data suggest the W to L mutation at position 222 of the HA could facilitate infection of H3N2 IAV in dogs, possibly by increasing the binding affinities of the HA to specific receptors with Neu5Aca2–3Galb1–4(Fuca-) or Neu5Aca2–3Galb1–3(Fuca-)-like structures that are present in dogs. PMID:23994833

76 FR 76155 - Nevada Hydro Company, Inc.; Notice of Preliminary Permit Application Accepted for Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-06

... elevation of 2,830 feet above mean sea level (msl); (2) a powerhouse with two reversible pump-turbine units... Diego Gas & Electric Company transmission line located to the south. Applicant Contact: Arnold B...

Timing of electron and proton transfer in the ba(3) cytochrome c oxidase from Thermus thermophilus.

PubMed

von Ballmoos, Christoph; Lachmann, Peter; Gennis, Robert B; Ädelroth, Pia; Brzezinski, Peter

2012-06-05

Heme-copper oxidases are membrane-bound proteins that catalyze the reduction of O(2) to H(2)O, a highly exergonic reaction. Part of the free energy of this reaction is used for pumping of protons across the membrane. The ba(3) oxidase from Thermus thermophilus presumably uses a single proton pathway for the transfer of substrate protons used during O(2) reduction as well as for the transfer of the protons that are pumped across the membrane. The pumping stoichiometry (0.5 H(+)/electron) is lower than that of most other (mitochondrial-like) oxidases characterized to date (1 H(+)/electron). We studied the pH dependence and deuterium isotope effect of the kinetics of electron and proton transfer reactions in the ba(3) oxidase. The results from these studies suggest that the movement of protons to the catalytic site and movement to a site located some distance from the catalytic site [proposed to be a "proton-loading site" (PLS) for pumped protons] are separated in time, which allows individual investigation of these reactions. A scenario in which the uptake and release of a pumped proton occurs upon every second transfer of an electron to the catalytic site would explain the decreased proton pumping stoichiometry compared to that of mitochondrial-like oxidases.

Are women benefiting from the Affordable Care Act? A real-world evaluation of the impact of the Affordable Care Act on out-of-pocket costs for contraceptives.

PubMed

Law, A; Wen, L; Lin, J; Tangirala, M; Schwartz, J S; Zampaglione, E

2016-05-01

The Affordable Care Act (ACA) mandated that, starting between August 1, 2012 and July 31, 2013, health plans cover most Food and Drug Administration (FDA)-approved contraceptive methods for women without cost sharing. This study examined the impact of the ACA on out-of-pocket expenses for contraceptives. Women (ages 15-44years) with claims for any contraceptives in years 2011, 2012 and 2013 were identified from the MarketScan Commercial database. The proportions of women using contraceptives [including permanent contraceptives (PCs) and non-PCs: oral contraceptives (OCs), injectables, patches, rings, implants and intrauterine devices (IUDs)] in study years were determined, as well as changes in out-of-pocket expenses for contraceptives during 2011-2013. Demographics, including age, U.S. geographic region of residence and health plan type, were also evaluated. The number of women identified with any contraceptive usage in 2011 was 2,447,316 (mean age: 27.6years), in 2012 was 2,515,296 (mean age: 27.4years) and in 2013 was 2,243,253 (mean age: 27.4years). In 2011, 2012 and 2013, the proportions of women with any contraceptive usage were 26.3%, 26.2% and 26.9%, respectively. Over the three study years, mean total out-of-pocket expenses for PCs and non-PCs decreased from $298 to $82 and from $94 to $30, respectively. For non-PCs, mean total out-of-pocket expenses for OCs and IUDs decreased from $86 to $26 and from $83 to $20. Implementation of the ACA has saved women a substantial amount in out-of-pocket expenses for contraceptives. Mean total out-of-pocket expenses for FDA-approved contraceptives decreased approximately 70% from 2011 to 2013. Implementation of the ACA has saved women a substantial amount in out-of-pocket expenses for contraceptives. Longer-term studies, including clinical outcomes, are warranted. Copyright © 2016 Elsevier Inc. All rights reserved.

76 FR 28438 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-17

... announced below concerns ``Affordable Care Act (ACA): Childhood Obesity Research Funding Opportunity..., discussion, and evaluation of ``Affordable Care Act (ACA): Childhood Obesity Research Funding Opportunity...

Clonal Evolution and Blast Crisis Correlate with Enhanced Proteolytic Activity of Separase in BCR-ABL b3a2 Fusion Type CML under Imatinib Therapy.

PubMed

Haaß, Wiltrud; Kleiner, Helga; Weiß, Christel; Haferlach, Claudia; Schlegelberger, Brigitte; Müller, Martin C; Hehlmann, Rüdiger; Hofmann, Wolf-Karsten; Fabarius, Alice; Seifarth, Wolfgang

2015-01-01

Unbalanced (major route) additional cytogenetic aberrations (ACA) at diagnosis of chronic myeloid leukemia (CML) indicate an increased risk of progression and shorter survival. Moreover, newly arising ACA under imatinib treatment and clonal evolution are considered features of acceleration and define failure of therapy according to the European LeukemiaNet (ELN) recommendations. On the basis of 1151 Philadelphia chromosome positive chronic phase patients of the randomized CML-study IV, we examined the incidence of newly arising ACA under imatinib treatment with regard to the p210BCR-ABL breakpoint variants b2a2 and b3a2. We found a preferential acquisition of unbalanced ACA in patients with b3a2 vs. b2a2 fusion type (ratio: 6.3 vs. 1.6, p = 0.0246) concurring with a faster progress to blast crisis for b3a2 patients (p = 0.0124). ESPL1/Separase, a cysteine endopeptidase, is a key player in chromosomal segregation during mitosis. Separase overexpression and/or hyperactivity has been reported from a wide range of cancers and cause defective mitotic spindles, chromosome missegregation and aneuploidy. We investigated the influence of p210BCR-ABL breakpoint variants and imatinib treatment on expression and proteolytic activity of Separase as measured with a specific fluorogenic assay on CML cell lines (b2a2: KCL-22, BV-173; b3a2: K562, LAMA-84). Despite a drop in Separase protein levels an up to 5.4-fold increase of Separase activity under imatinib treatment was observed exclusively in b3a2 but not in b2a2 cell lines. Mimicking the influence of imatinib on BV-173 and LAMA-84 cells by ESPL1 silencing stimulated Separase proteolytic activity in both b3a2 and b2a2 cell lines. Our data suggest the existence of a fusion type-related feedback mechanism that posttranslationally stimulates Separase proteolytic activity after therapy-induced decreases in Separase protein levels. This could render b3a2 CML cells more prone to aneuploidy and clonal evolution than b2a2 progenitors and may therefore explain the cytogenetic results of CML patients.

Participatory Evaluation of a Community Mobilization Effort to Enroll Wyandotte County, Kansas, Residents Through the Affordable Care Act

PubMed Central

Sepers, Charles E.; McKain, Wesley

2015-01-01

Successful implementation of the Affordable Care Act (ACA) depends on the capacity of local communities to mobilize for action. Yet the literature offers few systematic investigations of what communities are doing to ensure support for enrollment. In this empirical case study, we report implementation and outcomes of Enroll Wyandotte, a community mobilization effort to facilitate enrollment through the ACA in Wyandotte County, Kansas. We describe mobilization activities during the first round of open enrollment in coverage under the ACA (October 1, 2013–March 31, 2014), including the unfolding of community and organizational changes (e.g., new enrollment sites) and services provided to assist enrollment over time. The findings show an association between implementation measures and newly created accounts under the ACA (the primary outcome). PMID:25905820

Change in the accommodative convergence per unit of accommodation ratio after bilateral laser in situ keratomileusis for myopia in orthotropic patients: prospective evaluation.

PubMed

Prakash, Gaurav; Choudhary, Vandana; Sharma, Namrata; Titiyal, Jeewan S

2007-12-01

To analyze the effect of bilateral laser in situ keratomileusis (LASIK) on the accommodative convergence per unit of accommodation (AC/A) ratio in otherwise normal orthotropic myopic patients. Cornea and refractive services of a tertiary-care ophthalmic center. This prospective clinical trial consisted of 61 myopic patients who had bilateral LASIK. Those with manifest tropia, previous squint surgery, amblyopia, or absent or impaired binocularity or those in whom monovision was planned were excluded. The preoperative examination included visual acuity, cycloplegic refraction, assessment of binocularity, a prism cover test, and evaluation of the stimulus AC/A ratio by the gradient method. All patients had LASIK using the Zyoptix platform (Bausch & Lomb). Postoperative evaluation included uncorrected and best corrected visual acuities, residual refraction, and the AC/A ratio. All patients had a follow-up of 9 months. There was significant decrease in the mean AC/A ratio at the 1-week and 1-month follow-ups. The AC/A progressively recovered to near preoperative values between 3 months and 9 months after surgery (analysis of variance test). There was a significant reduction in the number of symptomatic patients from the first month onward (chi square = 89.23; P<.001). The AC/A ratio varied after LASIK, stabilizing between 3 months and 9 months after surgery. This suggests that the maximum variation in the accommodation-convergence relationship after LASIK occurs in the first 3 months.

A New Method of Producing a Natural Antibacterial Peptide by Encapsulated Probiotics Internalized with Inulin Nanoparticles as Prebiotics.

PubMed

Cui, Lian-Hua; Yan, Chang-Guo; Li, Hui-Shan; Kim, Whee-Soo; Hong, Liang; Kang, Sang-Kee; Choi, Yun-Jaie; Cho, Chong-Su

2018-04-28

Synbiotics are a combination of probiotics and prebiotics, which lead to synergistic benefits in host welfare. Probiotics have been used as an alternative to antibiotics. Among the probiotics, Pediococcus acidilactici (PA) has shown excellent antimicrobial activity against Salmonella Gallinarum (SG) as a major poultry pathogen and has improved the production performances of animals. Inulin is widely used as a prebiotic for the improvement of animal health and growth. The main aim of this study is to investigate the effect of the antimicrobial activity of inulin nanoparticles (INs)-internalized PA encapsulated into alginate/chitosan/alginate (ACA) microcapsules (MCs) in future in vivo application. The prepared phthalyl INs (PINs) were characterized by DLS and FE-SEM. The contents of phthal groups in phthalyl inulin were estimated by ¹H-NMR measurement as 25.1 mol.-%. The sizes of the PINs measured by DLS were approximately 203 nm. Internalization into PA was confirmed by confocal microscopy and flow cytometry. Antimicrobial activity of PIN-internalized probiotics encapsulated into ACA MCs was measured by co-culture antimicrobial assays on SG. PIN-internalized probiotics had a higher antimicrobial ability than that of ACA MCs loaded with PA/inulin or PA. Interestingly, when PINs were treated with PA and encapsulated into ACA MCs, as a natural antimicrobial peptide, pediocin was produced much more in the culture medium compared with other groups inulin-loaded ACA MCs and PA-encapsulated into ACA MCs.

Estimating the Counterfactual

PubMed Central

Blumberg, Linda J.; Garrett, Bowen; Holahan, John

2016-01-01

Time lags in receiving data from long-standing, large federal surveys complicate real-time estimation of the coverage effects of full Affordable Care Act (ACA) implementation. Fast-turnaround household surveys fill some of the void in data on recent changes to insurance coverage, but they lack the historical data that allow analysts to account for trends that predate the ACA, economic fluctuations, and earlier public program expansions when predicting how many people would be uninsured without comprehensive health care reform. Using data from the Current Population Survey (CPS) from 2000 to 2012 and the Health Reform Monitoring Survey (HRMS) data for 2013 and 2015, this article develops an approach to estimate the number of people who would be uninsured in the absence of the ACA and isolates the change in coverage as of March 2015 that can be attributed to the ACA. We produce counterfactual forecasts of the number of uninsured absent the ACA for 9 age-income groups and compare these estimates with 2015 estimates based on HRMS relative coverage changes applied to CPS-based population estimates. As of March 2015, we find the ACA has reduced the number of uninsured adults by 18.1 million compared with the number who would have been uninsured at that time had the law not been implemented. That decline represents a 46% reduction in the number of nonelderly adults without insurance. The approach developed here can be applied to other federal data and timely surveys to provide a range of estimates of the overall effects of reform. PMID:27076474

Synthesis of layered perovskite oxides, ACa[sub 2-x]La[sub x]Nb[sub 3-x]Ti[sub x]O[sub 10] (A = K, Rb, Cs), and characterization of new solid acids, HCa[sub 2-x]La[sub x]Nb[sub 3-x]Ti[sub x]O[sub 10] (O < x [le] 2), exhibiting variable Bronsted acidity

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

Gopalakrishnan, J.; Uma, S.; Bhat, V.

1993-01-01

Layered perovskite oxides of the formula ACa[sub 2-x]La[sub x]Nb[sub 3-x]Ti[sub x]O[sub 10] (A = K, Rb, Cs and 0 , x [le] 2) have been prepared. The members adopt the structures of the parent ACa[sub 2]Nb[sub 3]O[sub 10]. Interlayer alkali cations in the niobium-titanium oxide series can be ion-exchanged with Li[sup +], Na[sup +], NG[sub 4][sup +], of H[sup +] to give new derivatives. Intercalation of the protonated derivatives with organic bases reveals that the Bronsted acidity of the solid solution series, HCa[sub 2-x]La[sub x]Nb[sub 3-x]Ti[sub x]O[sub 10], depends on the titanium content. While the x = 1 member (HCaLaNb[submore » 2]TiO[sub 10]) is nearly as acidic as the parent HCa[sub 2]Nb[sub 3]O[sub 10], the x = 2 member (HLA[sub 2]NbTi[sub 2]O[sub 10]) is a weak acid hardly intercalating organic bases with pK[sub a] [approximately] 11.3. The variation of acidity is probably due to an ordering of Nb/Ti atoms in the triple octahedral perovskite slabs, [Ca[sub 2-x]La[sub x]Nb[sub 3-x]Ti[sub x]O[sub 10

One-dimensional model of inertial pumping

NASA Astrophysics Data System (ADS)

Kornilovitch, Pavel E.; Govyadinov, Alexander N.; Markel, David P.; Torniainen, Erik D.

2013-02-01

A one-dimensional model of inertial pumping is introduced and solved. The pump is driven by a high-pressure vapor bubble generated by a microheater positioned asymmetrically in a microchannel. The bubble is approximated as a short-term impulse delivered to the two fluidic columns inside the channel. Fluid dynamics is described by a Newton-like equation with a variable mass, but without the mass derivative term. Because of smaller inertia, the short column refills the channel faster and accumulates a larger mechanical momentum. After bubble collapse the total fluid momentum is nonzero, resulting in a net flow. Two different versions of the model are analyzed in detail, analytically and numerically. In the symmetrical model, the pressure at the channel-reservoir connection plane is assumed constant, whereas in the asymmetrical model it is reduced by a Bernoulli term. For low and intermediate vapor bubble pressures, both models predict the existence of an optimal microheater location. The predicted net flow in the asymmetrical model is smaller by a factor of about 2. For unphysically large vapor pressures, the asymmetrical model predicts saturation of the effect, while in the symmetrical model net flow increases indefinitely. Pumping is reduced by nonzero viscosity, but to a different degree depending on the microheater location.

One-dimensional model of inertial pumping.

PubMed

Kornilovitch, Pavel E; Govyadinov, Alexander N; Markel, David P; Torniainen, Erik D

2013-02-01

A one-dimensional model of inertial pumping is introduced and solved. The pump is driven by a high-pressure vapor bubble generated by a microheater positioned asymmetrically in a microchannel. The bubble is approximated as a short-term impulse delivered to the two fluidic columns inside the channel. Fluid dynamics is described by a Newton-like equation with a variable mass, but without the mass derivative term. Because of smaller inertia, the short column refills the channel faster and accumulates a larger mechanical momentum. After bubble collapse the total fluid momentum is nonzero, resulting in a net flow. Two different versions of the model are analyzed in detail, analytically and numerically. In the symmetrical model, the pressure at the channel-reservoir connection plane is assumed constant, whereas in the asymmetrical model it is reduced by a Bernoulli term. For low and intermediate vapor bubble pressures, both models predict the existence of an optimal microheater location. The predicted net flow in the asymmetrical model is smaller by a factor of about 2. For unphysically large vapor pressures, the asymmetrical model predicts saturation of the effect, while in the symmetrical model net flow increases indefinitely. Pumping is reduced by nonzero viscosity, but to a different degree depending on the microheater location.

Effects of diurnal, lighting, and angle-of-incidence variation on anterior segment optical coherence tomography (AS-OCT) angle metrics.

PubMed

Akil, Handan; Dastiridou, Anna; Marion, Kenneth; Francis, Brian A; Chopra, Vikas

2017-03-23

First reported study to assess the effect of diurnal variation on anterior chamber angle measurements, as well as, to re-test the effects of lighting and angle-of-incidence variation on anterior chamber angle (ACA) measurements acquired by time-domain anterior segment optical coherence tomography (AS-OCT). A total of 30 eyes from 15 healthy, normal subjects underwent anterior chamber imaging using a Visante time-domain AS-OCT according to an IRB-approved protocol. For each eye, the inferior angle was imaged twice in the morning (8 am - 10 am) and then again in the afternoon (3 pm - 5 pm), under light meter-controlled conditions with ambient room lighting 'ON' and lights 'OFF', and at 5° angle of incidence increments. The ACA metrics measured for each eye were: angle opening distance (AOD, measured 500 and 750 μm anterior from scleral spur), the trabecular-iris-space area (TISA, measured 500 and 750 μm anterior from scleral spur), and scleral spur angle. Measurements were performed by masked, certified Reading Center graders using the Visante's Internal Measurement Tool. Differences in measurements between morning and afternoon, lighting variations, and angle of incidence were compared. Mean age of the participants was 31.2 years (range 23-58). Anterior chamber angle metrics did not differ significantly from morning to afternoon imaging, or when the angle of incidence was offset by 5° in either direction away from the inferior angle 6 o'clock position. (p-value 0.13-0.93). Angle metrics at the inferior corneal limbus, 6 o'clock position (IC270), with room lighting 'OFF', showed a significant decrease (p < 0.05) compared to room lighting 'ON'. There does not appear to be significant diurnal variation in AS-OCT parameters in normal individuals, but lighting conditions need to be strictly controlled since variation in lighting led to significant variability in AS-OCT parameters. No changes in ACA parameters were noted by varying the angle-of-incidence, which gives confidence in being able to perform longitudinal studies in approximately the same area (plus/minus 5° of original scan location).

76 FR 10578 - Cuffs Run Pumped Storage, LLC; Notice of Preliminary Permit Application Accepted for Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-25

... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Project No. 13880-000] Cuffs Run Pumped..., Motions To Intervene, and Competing Applications On November 18, 2010, Cuffs Run Pumped Storage, LLC filed... to study the feasibility of the Cuffs Run Pumped Storage Project, located on Cuffs Run and the...

Simulation of the shallow groundwater-flow system near Mole Lake, Forest County, Wisconsin

USGS Publications Warehouse

Fienen, Michael N.; Juckem, Paul F.; Hunt, Randall J.

2011-01-01

The shallow groundwater system near Mole Lake, Forest County, Wis. was simulated using a previously calibrated regional model. The previous model was updated using newly collected water-level measurements and refinements to surface-water features. The updated model was then used to calculate the area contributing recharge for one existing and two proposed pumping locations on lands of the Sokaogon Chippewa Community. Delineated 1-, 5-, and 10-year areas contributing recharge for existing and proposed wells extend from the areas of pumping to the northeast of the pumping locations. Steady-state pumping was simulated for two scenarios: a base pumping scenario using pumping rates that reflect what the Tribe expects to pump and a high pumping scenario, in which the rate was set to the maximum expected from wells installed in this area. In the base pumping scenario, pumping rates of 32 gallons per minute (gal/min; 46,000 gallons per day (gal/d)) from the existing well and 30 gal/min (43,000 gal/d) at each of the two proposed wells were simulated. The high pumping scenario simulated a rate of 70 gal/min (101,000 gal/d) from each of the three pumping wells to estimate of the largest areas contributing recharge that might be expected given what is currently known about the shallow groundwater system. The areas contributing recharge for both the base and high pumping scenarios did not intersect any modeled surface-water bodies; however, the high pumping scenario had a larger areal extent than the base pumping scenario and intersected a septic separator.

Delineation of water sources for public-supply wells in three fractured-bedrock aquifer systems in Massachusetts

USGS Publications Warehouse

Lyford, Forest P.; Carlson, Carl S.; Hansen, Bruce P.

2003-01-01

Fractured-bedrock aquifer systems in West Newbury, Maynard, and Paxton, Massachusetts, were studied to advance methods of data collection and analysis for delineating contributing areas to public-supply wells completed in fractured rock and for determining the effects of pumping on streams and wetlands. Contributing areas, as defined for this study, include all areas through which ground water flows from recharge areas to wells. In West Newbury, exploratory public-supply wells at two locations were completed in phyllite of the Eliot Formation. Aquifer testing indicated that subhorizontal and steeply dipping fractures that parallel two sets of foliation form elongated transmissive zones in the bedrock aquifer near the two well locations and also form a vertical hydraulic connection to surficial materials consisting of till at one location and marine clay at the other location. Recharge to bedrock is largely through a thin veneer of till over bedrock, but leakage through thick drumlin tills also recharges bedrock. Simulated contributing areas for the three supply wells pumped at a combined rate of 251 gallons per minute encompass about 1.3 square miles and extend to ground-water divides within most of a subbasin of the Artichoke River. Pumping likely would reduce streamflow in the Artichoke River subbasin by approximately the pumping rate. Pumping is likely to affect wetland areas underlain by till near the wells because of the vertical hydraulic connection to surficial materials. In Maynard, three exploratory public-supply wells were completed in coarse-grained schist of the Nashoba Formation. Aquifer testing indicated that a dense network of fractures in bedrock forms a laterally extensive transmissive zone in bedrock that is well connected vertically to surficial materials consisting of sandy till, lacustrine silts, sand and gravel, and wetland deposits. The simulated contributing area for the three supply wells pumped at a combined rate of 780 gallons per minute encompasses about 1.8 square miles of the Fort Pond Brook drainage area. Pumping likely would reduce streamflow in Fort Pond Brook by about the same amount as the pumping rate, and wetland-water levels within a 2,000-foot radius from the wells are likely to be lowered below the land surface by pumping. In Paxton, three existing supply wells are completed in granofels and schist of the Paxton and Littleton Formations. Aquifer testing demonstrated that a shallow bedrock well completed to a depth of 150 feet is closely connected hydraulically to overlying till. Two deep wells, however, receive much of their water from fractures at depths below 500 feet. Ground-water flow in bedrock appears to be mostly through parting fractures along a foliation set that dips gently (10 degrees) eastward. These parting fractures at depth are poorly connected vertically to shallow bedrock

[Effects of orthokeratology lenses on the magnitude of accommodative lag and accommodativeconvergence/accommodation].

PubMed

Ren, Qiujin; Yue, Hui; Zhou, Qing

2016-02-01

To evaluate the change in accommodative lag and accommodation convergence/accommodation (AC/A) after patients with myopia wear orthokeratology lenses. 
 A total of 48 myopic subjects (a test group), who wore orthokeratology lenses regularly, and 48 myopic subjects (a control group), who wore spectacles regularly, were enrolled for this study from January 2011 to January 2013 in Optometric Center, the Forth Hospital of Changsha. Accommodative lag was measured by fused cross cylinder method, where the patients should gaze at the front optotypes 40 cm away. Gradient of the AC/A ratio was measured by Von Grafe method to check closer distance heterophoria. Accommodative lag and AC/A ratio were analyzed by statistics.
 After 1-year follow-up, accommodative lag and AC/A rate in patients with low or moderate myopia in the test group was decreased in 1, 3, 6 months or 1 year compared with that in the control group (P<0.05). 
 Compared with spectacles, orthokeratology lenses are able to decrease accommodative lag and high AC/A rate in patients with low or moderate myopia. The relationship between accommodation and convergence is improved by orthokeratology lenses. Orthokeratology is an effective way to control myopia.

Framing, Engagement, and Policy Change: Lessons for the ACA.

PubMed

Karch, Andrew; Rosenthal, Aaron

2017-04-01

Supporters of the Patient Protection and Affordable Care Act (ACA) sometimes speculate that public attitudes toward the law will shift if proponents succeed in focusing attention on its more popular components, but the scholarly literature on framing effects provides ample reason to question their assertion. This article contends that engagement, an alternative rhetorical strategy where advocates address the same policy dimensions as their opponents, is a more promising approach. Extending the engagement literature to the elite context in which most ACA-related decisions are made, it argues that elite-level engagement necessitates the additional task of linking policy change to opponents' broader philosophical and policy goals. Current debates surrounding the application of sales taxes to electronic commerce-a policy arena that seems far removed from health care policy but overlaps with the ACA in ways that make it an appropriate source of lesson drawing-illustrate the potential of an engagement strategy. Recently, many conservative lawmakers who previously opposed policy change have instead embraced online sales taxes as a mechanism for additional tax cuts. Analogous connections may facilitate the diffusion of ACA provisions that presently receive hostile receptions in Republican-leaning states. Copyright © 2017 by Duke University Press.

Is the swiss health care system a model for the United States?

PubMed

Chaufan, Claudia

2014-01-01

Both supporters and critics of the Patient Protection and Affordable Care Act (ACA) have argued that it is similar to Switzerland's Federal Law on Health Insurance (LAMal), which currently governs Swiss health care, and have either praised or condemned the ACA on the basis of this alleged similarity. I challenge these observers on the grounds that they overlook critical problems with the Swiss model, such as its inequities in access, and critical differences between it and the ACA, such as the roots in, and continuing commitment to, social insurance of the Swiss model. Indeed, the daunting challenge of attempting to impose the tightly regulated model of operation of the Swiss model on mega-corporations like UnitedHealth, WellPoint, or Aetna is likely to trigger no less ferocious resistance than a fully public, single-payer system would. I also conclude that the ACA might unravel in ways unintended or even opposed by its designers and supporters, as employers, confronted with ever-rising costs, retreat from sponsoring insurance, and workers react in outrage as they confront the unaffordable underinsurance mandated by the ACA. A new political and ideological landscape may then ensue that finally ushers in a truly national health program.

Local Television News Coverage of the Affordable Care Act: Emphasizing Politics Over Consumer Information.

PubMed

Gollust, Sarah E; Baum, Laura M; Niederdeppe, Jeff; Barry, Colleen L; Fowler, Erika Franklin

2017-05-01

To examine the public health and policy-relevant messages conveyed through local television news during the first stage of Affordable Care Act (ACA) implementation, when about 10 million Americans gained insurance. We conducted a content analysis of 1569 ACA-related local evening television news stories, obtained from sampling local news aired between October 1, 2013, and April 19, 2014. Coders systematically collected data using a coding instrument tracking major messages and information sources cited in the news. Overall, only half of all ACA-related news coverage focused on health insurance products, whereas the remainder discussed political disagreements over the law. Major policy tools of the ACA-the Medicaid expansion and subsidies available-were cited in less than 10% of news stories. Number of enrollees (27%) and Web site glitches (33%) were more common features of coverage. Sources with a political affiliation were by far the most common source of information (> 40%), whereas research was cited in less than 4% of stories. The most common source of news for Americans provided little public health-relevant substance about the ACA during its early implementation, favoring political strategy in coverage.

Challenges facing the United States of America in implementing universal coverage.

PubMed

Rice, Thomas; Unruh, Lynn Y; Rosenau, Pauline; Barnes, Andrew J; Saltman, Richard B; van Ginneken, Ewout

2014-12-01

In 2010, immediately before the United States of America (USA) implemented key features of the Affordable Care Act (ACA), 18% of its residents younger than 65 years lacked health insurance. In the USA, gaps in health coverage and unhealthy lifestyles contribute to outcomes that often compare unfavourably with those observed in other high-income countries. By March 2014, the ACA had substantially changed health coverage in the USA but most of its main features--health insurance exchanges, Medicaid expansion, development of accountable care organizations and further oversight of insurance companies--remain works in progress. The ACA did not introduce the stringent spending controls found in many European health systems. It also explicitly prohibits the creation of institutes--for the assessment of the cost-effectiveness of pharmaceuticals, health services and technologies--comparable to the National Institute for Health and Care Excellence in the United Kingdom of Great Britain and Northern Ireland, the Haute Autorité de Santé in France or the Pharmaceutical Benefits Advisory Committee in Australia. The ACA was--and remains--weakened by a lack of cross-party political consensus. The ACA's performance and its resulting acceptability to the general public will be critical to the Act's future.

Health Care Spending and Utilization by Race/Ethnicity Under the Affordable Care Act’s Dependent Coverage Expansion

PubMed Central

Bustamante, Arturo Vargas; Tom, Sarah E.

2015-01-01

Objectives. We estimated the effect of the ACA expansion of dependents’ coverage on health care expenditures and utilization for young adults by race/ethnicity. Methods. We used difference-in-difference models to estimate the impact of the ACA expansion on health care expenditures, out-of-pocket payments (OOP) as a share of total health care expenditure, and utilization among young adults aged 19 to 26 years by race/ethnicity (White, African American, Latino, and other racial/ethnic groups), with adults aged 27 to 30 years as the control group. Results. In 2011 and 2012, White and African American young adults aged 19 to 26 years had significantly lower total health care spending compared with the 27 to 30 years cohort. OOP, as a share of health care expenditure, remained the same after the ACA expansion for all race/ethnicity groups. Changes in utilization following the ACA expansion among all racial/ethnic groups for those aged 19 to 26 years were not significant. Conclusions. Our study showed that the impact of the ACA expansion on health care expenditures differed by race/ethnicity. PMID:25905850

Uninsured Primary Care Visit Disparities Under the Affordable Care Act

PubMed Central

Angier, Heather; Hoopes, Megan; Marino, Miguel; Huguet, Nathalie; Jacobs, Elizabeth A.; Heintzman, John; Holderness, Heather; Hood, Carlyn M.; DeVoe, Jennifer E.

2017-01-01

PURPOSE Health insurance coverage affects a patient’s ability to access optimal care, the percentage of insured patients on a clinic’s panel has an impact on the clinic’s ability to provide needed health care services, and there are racial and ethnic disparities in coverage in the United States. Thus, we aimed to assess changes in insurance coverage at community health center (CHC) visits after the Patient Protection and Affordable Care Act (ACA) Medicaid expansion by race and ethnicity. METHODS We undertook a retrospective, observational study of visit payment type for CHC patients aged 19 to 64 years. We used electronic health record data from 10 states that expanded Medicaid and 6 states that did not, 359 CHCs, and 870,319 patients with more than 4 million visits. Our analyses included difference-in-difference (DD) and difference-in-difference-in-difference (DDD) estimates via generalized estimating equation models. The primary outcome was health insurance type at each visit (Medicaid-insured, uninsured, or privately insured). RESULTS After the ACA was implemented, uninsured visit rates decreased for all racial and ethnic groups. Hispanic patients experienced the greatest increases in Medicaid-insured visit rates after ACA implementation in expansion states (rate ratio [RR] = 1.77; 95% CI, 1.56–2.02) and the largest gains in privately insured visit rates in nonexpansion states (RR = 3.63; 95% CI, 2.73–4.83). In expansion states, non-Hispanic white patients had twice the magnitude of decrease in uninsured visits compared with Hispanic patients (DD = 2.03; 95% CI, 1.53–2.70), and this relative change was more than 2 times greater in expansion states compared with nonexpansion states (DDD = 2.06; 95% CI, 1.52–2.78). CONCLUSION The lower rates of uninsured visits for all racial and ethnic groups after ACA implementation suggest progress in expanding coverage to CHC patients; this progress, however, was not uniform when comparing expansion with nonexpansion states and among all racial and ethnic minority subgroups. These findings suggest the need for continued and more equitable insurance expansion efforts to eliminate health insurance disparities. PMID:28893813

Evaluation of Future Fuels in a High Pressure Common Rail System - Part 1 Cummins XPI

DTIC Science & Technology

2012-10-01

compressed against the underside of the pump head to maintain contact with the pump camshaft. The underside of the pump head is shown in Figure 5...Figure 5. High Pressure Pump Head Unclassified 8 The two barrel retainers located on the underside of the pump head hold the ceramic plungers...which develop the high pressures within the pump. The plungers are driven into the barrels by the tappets as the shaft turns. They are forced back out

76 FR 28790 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial review.

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-18

... announced below concerns Affordable Care Act (ACA): Childhood Obesity Research Funding Opportunity... ``Affordable Care Act (ACA): Childhood Obesity Research Funding Opportunity Announcement (FOA) DP11-007, Panel...

76 FR 41261 - Notice of Intent To Award Affordable Care Act (ACA) Funding, EH10-1003

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-13

... activities including prevention research and health screenings, such as the Community Transformation Grant Program, the Education and Outreach Campaign for Preventative Benefits, and Immunization Programs. The ACA...

Comparison of results of medial rectus muscle recession using augmentation, Faden procedure, and slanted recession in the treatment of high accommodative convergence/accommodation ratio esotropia.

PubMed

Gharabaghi, Davoud; Zanjani, Leila Kazemi

2006-01-01

According to the literature, accommodative esotropia has an unpredictable course when nonsurgical treatment is considered, especially in cases with a high accommodative convergence/accommodation ratio (AC/A). The aim of this study was to compare the results of augmented recession, slanted recession, and recession with posterior fixation suture of the medial rectus muscles in the treatment of high AC/A esotropia. Twenty-eight children (4 to 14 years old) with high AC/A esotropia with a near-distance disparity greater than 10 PD were included in a prospective, randomized, blinded clinical trial. Nine children underwent recession of both medial rectus muscles and posterior fixation suture (Faden procedure), 9 children underwent augmented recession of the medial rectus muscles, and 10 children underwent slanted recession of both medial rectus muscles. The amount of esodeviation was measured before strabismus surgery and at least 6 months postoperatively. In the augmented recession group, the mean near-distance disparity was reduced from 16.33 +/- 2.17 PD preoperatively to 7.55 +/- 3.87 PD postoperatively (54.21%; P = .056). In the Faden procedure group, it was reduced from 15.22 +/- 4.08 PD to 2.55 +/- 4.03 PD (80.7%; P = .056). In the slanted recession group, it was reduced from 15.50 +/- 4.30 PD to 4.10 +/- 4.80 PD (67.55%; P = .056). The Faden procedure had the best outcome, but slanted recession also was successful. Because of our good results and an easy, non-invasive approach without any additional complications, we recommend slanted recession to treat high AC/A esotropia.

[Active surveillance for prostate cancer: usefulness of endorectal MR at 1.5 Tesla with pelvic phased array coil in detecting significant tumors].

PubMed

Luyckx, F; Hallouin, P; Barré, C; Aillet, G; Chauveau, P; Hétet, J-F; Bouchot, O; Rigaud, J

2011-02-01

To describe and assess MRI signs of significant tumor in a series of patients who all underwent radical prostatectomy and also fulfilled criteria to choose active surveillance according to French "SurAcaP" protocol. The clinical reports of 681 consecutive patients operated on for prostate cancer between 2002 and 2007 were reviewed retrospectively. All patients had endorectal MR (1.5 Tesla) with pelvic phased array coil. (1.5 T erMR PPA). Sixty-one patients (8.9%) fulfilled "SurAcaP" protocol criteria. Preoperative data (MR+core biopsy) were assessed by comparison to whole-mount step section pathology. 85.3% of the 61 patients entering SurAcaP protocol had significant tumor at pathology. (Non Organ Confined Disease (Non OCD)=8.2%, Gleason sum score>6=39.2%). A new exclusion criterion has been assessed: T3MRI±NPS>1 as a predictor tool of significant tumor. ("T3MRI±NPS>1"=Non OCD at MR±number of positive sextants involved in tumor at MR and/or Core Biopsy > to 1). Sensitivity, specificity, PPV, NPV of the criterion "T3MRI±NPS>1" in predicting significant tumor were, respectively: 77%, 33%, 86%, 20%. Adding this criterion to other criteria of the "SurAcaP" protocol could allow the exclusion of all Non OCD, and a decrease in Gleason sum Score>6 rates (20%). Endorectal MR at 1.5 Tesla with pelvic-phased array coil should be considered when selecting patients for active surveillance in the management of prostate cancer. A criterion based upon MR and core biopsy findings, called "T3MR±NSP>1" may represent an exclusion citeria due to its ability to predict significant tumor. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Anesthesia specific differences in a cardio-pulmonary resuscitation rat model; halothane versus sevoflurane.

PubMed

Esser, Torben; Keilhoff, Gerburg; Ebmeyer, Uwe

2016-12-01

Our asphyxia cardiac arrest (ACA) rat model is well established. The original model was designed in the 1990th using halothane and nitrous oxide for pre-insult anesthesia. Because of its hepato-toxicity and its potential to induce severe liver failures, halothane is no longer used in clinical anesthesia for several years. In order to minimize the health risk for our laboratory staff as well as to keep the experimental settings of our model on a clinically oriented basis we decided to replace halothane by sevoflurane. In this study we intended to determine if the change of the narcotic gas regiment causes changes in the neurological damage and how far our model had to be adjusted. Adult rats were subjected to 5min of ACA followed by resuscitation. There were four treatment groups: ACA - halothane, ACA - sevoflurane and with halothane or sevoflurane sham operated animals. Vital and blood parameters were monitored during the 45min post-resuscitation intensive care phase. After a survival time of 7 days histological evaluation of the hippocampus was performed. We observed that resuscitated rats anesthetized prior by sevoflurane (i) have had a lower heart rate and a higher MAP compared to halothane anesthetized animals; (ii) The neurological damaged were significantly reduced in the hippocampal CA1 region in sevoflurane treated rats. Using sevoflurane instead of halothane for anesthesia requires some physiological and experimental changes. However the model keeps its validity. Sevoflurane caused less pronounced neurodegeneration in the CA1 region of the hippocampus. This had to be considered in further resuscitation-studies containing sevoflurane as anesthetic. Institutional protocol number for animal studies: 42502-2-2-947 Uni MD. Copyright © 2016 Elsevier B.V. All rights reserved.

Risk factors and consequences of unexpected trapping for ruptured anterior communicating artery aneurysms

PubMed Central

Fukuda, Hitoshi; Iwasaki, Koichi; Murao, Kenichi; Yamagata, Sen; Lo, Benjamin W.Y.; Macdonald, R. Loch

2014-01-01

Background: While clipping cerebral aneurysms at the neck is optimal, in some cases this is not possible and other strategies are necessary. The purpose of this study was to describe the incidence, risk factors, and outcomes for inability to clip reconstruct ruptured anterior communicating artery (ACoA) aneurysms. Methods: Of the 70 cases of ruptured ACoA aneurysms between January 2006 and December 2013, our institutional experience revealed four cases of small ACoA aneurysms that had been considered clippable prior to operation but required trapping. When a unilateral A2 segment of anterior cerebral artery (ACA) was compromised by trapping, revascularization was performed by bypass surgery. Clinical presentation, angiographic characteristics, operative approach, intraoperative findings, and treatment outcomes were assessed. Results: Very small aneurysm under 3 mm was a risk factor for unexpected trapping. The reason for unexpected trapping was laceration of the aneurysmal neck in two cases, and lack of clippaple component due to disintegration of entire aneurysmal wall at the time of rupture in the others. Aneurysms with bilateral A1 were treated with sole trapping through pterional approach in two cases. The other two cases had hypoplastic unilateral A1 segment of ACA and were treated with combination of aneurysm trapping and revascularization of A2 segment of ACA through interhemispheric approach. No patients had new cerebral infarctions of cortical ACA territory from surgery. Cognitive dysfunction was observed in three cases, but all patients became independent at 12-month follow up. Conclusions: Unexpected trapping was performed when ruptured ACoA aneurysms were unclippable. Trapping with or without bypass can result in reasonable outcomes, with acceptable risk of cognitive dysfunction. PMID:25101201

Airport Landside. Volume II. The Airport Landside Simulation Model (ALSIM) Description and Users Guide.

DTIC Science & Technology

1982-06-01

liii i i E-- .!ju a’sh " al !i 1. 5535 U, ;, , ,i l 0i I-J I I l l l l . . .... . . .. . .. i TABLE OF CONTENTS Section Page 1. INTRODUCTION...1Mti34S.GATZa34.SAGal?.tNTut.- ARY PLTPI~s9lO,ACaII. PAXvITI .TPAX.,I. AftRLNu9*T!M~vl1t4,GAT~u?1, SAGeS, ARRY FLT?4Ca3O,ACv74?.PAXw36S.TPAA.GO. AzIf ...tKTsl.PAX*T7. ,PA~fG. AIRLtZNuI2.TtIMEUli2I.SAGai7.0AT1522. ACmg. AMR PL’ axI2.4Tat .PAAa2Q0.TPAXsO. AlRLl~s12.TIMEnt240.IA~ al ?.GAr~o25, ACaI. ARR

Effects of the ACA on Health Care Cost Containment.

PubMed

Weiner, Janet; Marks, Clifford; Pauly, Mark

2017-02-01

This brief reviews the evidence on how key ACA provisions have affected the growth of health care costs. Coverage expansions produced a predictable jump in health care spending, amidst a slowdown that began a decade ago. Although we have not returned to the double-digit increases of the past, the authors find little evidence that ACA cost containment provisions produced changes necessary to "bend the cost curve." Cost control will likely play a prominent role in the next round of health reform and will be critical to sustaining coverage gains in the long term.

Optimal hydraulic design of new-type shaft tubular pumping system

NASA Astrophysics Data System (ADS)

Zhu, H. G.; Zhang, R. T.; Zhou, J. R.

2012-11-01

Based on the characteristics of large flow rate, low-head, short annual operation time and high reliability of city flood-control pumping stations, a new-type shaft tubular pumping system featuring shaft suction box, siphon-type discharge passage with vacuum breaker as cutoff device was put forward, which possesses such advantages as simpler structure, reliable cutoff and higher energy performance. According to the design parameters of a city flood control pumping station, a numerical computation model was set up including shaft-type suction box, siphon-type discharge passage, pump impeller and guide vanes. By using commercial CFD software Fluent, RNG κ-epsilon turbulence model was adopted to close the three-dimensional time-averaged incompressible N-S equations. After completing optimal hydraulic design of shaft-type suction box, and keeping the parameters of total length, maximum width and outlet section unchanged, siphon-type discharge passages of three hump locations and three hump heights were designed and numerical analysis on the 9 hydraulic design schemes of pumping system were proceeded. The computational results show that the changing of hump locations and hump heights directly affects the internal flow patterns of discharge passages and hydraulic performances of the system, and when hump is located 3.66D from the inlet section and hump height is about 0.65D (D is the diameter of pump impeller), the new-type shaft tubular pumping system achieves better energy performances. A pumping system model test of the optimal designed scheme was carried out. The result shows that the highest pumping system efficiency reaches 75.96%, and when at design head of 1.15m the flow rate and system efficiency were 0.304m3/s and 63.10%, respectively. Thus, the validity of optimal design method was verified by the model test, and a solid foundation was laid for the application and extension of the new-type shaft tubular pumping system.

Dual-pump CARS measurements in a hydrogen diffusion flame in cross-flow with AC dielectric barrier discharge

NASA Astrophysics Data System (ADS)

Nishihara, Munetake; Freund, Jonathan B.; Glumac, Nick G.; Elliott, Gregory S.

2018-03-01

This paper presents dual-pump coherent anti-Stokes Raman scattering (CARS) measurements for simultaneous detection of flow temperature and relative concentration, applied to the characterization of a discharge-coupled reacting jet in a cross flow. The diagnostic is hydrogen Q-branch based, providing a much wider dynamic range compared to detection in the S-branch. For a previously developed dielectric barrier discharge, aligned co-axially with the fuel jet, OH planar laser induced fluorescence measurements show that the disturbance in the flame boundary leads to mixing enhancement. The H2-N2 dual-pump CARS measurement was used to map two-dimensional temperature distributions. The increase of the maximum temperature was up to 300 K, with 50% more H2 consumption, providing the reason for the decrease in the flame length by 25%. The increase of the relative H2O-H2 fraction was accompanied with a temperature increase, which indicates local equivalence ratios of below 1. The H2-O2 dual-pump measurements confirmed that the fuel-oxidizer ratios remain in the fuel-lean side at most of the probed locations.

Entrainment of Juvenile and Adult American Shad at a Pumped Storage Facility

DOE PAGES

Mathur, Dilip; Heisey, Paul G.; Royer, Doug D.; ...

2017-12-13

The American Shad Alosa sapidissima has been targeted for restoration to the upper Susquehanna River, and entrainment losses at hydroelectric facilities on the river, including the Muddy Run Pumped Storage Facility, are of concern for the potential growth of the American Shad population. Based on the integration of pumping volume, time of entrainment, and literature–reported diel emigration of juvenile American Shad, the entrainment rate (N = 145; 53 exposed to pumping) was estimated at 3.5%. The entrainment rate for adults (N = 507) was estimated at 0.3–3.9%. Using multistate mark–recapture models, the estimated entrainment probabilities (Ψ) of radio–tagged juveniles weremore » higher during periods of extended pumping (>1 h; Ψ = 0.093; 95% confidence interval [CI] = 0.054–0.156) than at periods of no pumping or short–duration pumping (<1 h; Ψ < 0.0001; 95% CI = 0.0–0.001); the high extended pumping occurred between 2300 and 0600 hours. Entrainment probabilities for adults were low (Ψ < 0.02); the highest probability occurred for fish detected downstream of the intake during the peak portion of the run (Ψ = 0.015; 95% CI = 0.004–0.047). Entrainment probability for most adult fish did not differ from zero. The low values of Ψ for both life stages were attributed to (1) the deep location of the intake (intake ceiling >11.7 m below the water surface), (2) the surface orientation of American Shad (upper 3.1 m), (3) the low overlap between high–volume pumping and peak emigration/migration times, (4) the pumping volume relative to prevailing river flows, and (5) the prolonged, robust swimming speed of American Shad, particularly that of adults (>2.2 m/s), which exceeded the intake velocity (0.2–0.9 m/s). Entrainment of juveniles increased with co–occurrence of low incoming river flows, high pumping volume, and peak emigration times. Furthermore, quantification of migratory species’ entrainment at pumped storage facilities requires integration of diel migration/emigration times with the frequency, timing, and duration of pumping volume.« less

Entrainment of Juvenile and Adult American Shad at a Pumped Storage Facility

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

Mathur, Dilip; Heisey, Paul G.; Royer, Doug D.

The American Shad Alosa sapidissima has been targeted for restoration to the upper Susquehanna River, and entrainment losses at hydroelectric facilities on the river, including the Muddy Run Pumped Storage Facility, are of concern for the potential growth of the American Shad population. Based on the integration of pumping volume, time of entrainment, and literature–reported diel emigration of juvenile American Shad, the entrainment rate (N = 145; 53 exposed to pumping) was estimated at 3.5%. The entrainment rate for adults (N = 507) was estimated at 0.3–3.9%. Using multistate mark–recapture models, the estimated entrainment probabilities (Ψ) of radio–tagged juveniles weremore » higher during periods of extended pumping (>1 h; Ψ = 0.093; 95% confidence interval [CI] = 0.054–0.156) than at periods of no pumping or short–duration pumping (<1 h; Ψ < 0.0001; 95% CI = 0.0–0.001); the high extended pumping occurred between 2300 and 0600 hours. Entrainment probabilities for adults were low (Ψ < 0.02); the highest probability occurred for fish detected downstream of the intake during the peak portion of the run (Ψ = 0.015; 95% CI = 0.004–0.047). Entrainment probability for most adult fish did not differ from zero. The low values of Ψ for both life stages were attributed to (1) the deep location of the intake (intake ceiling >11.7 m below the water surface), (2) the surface orientation of American Shad (upper 3.1 m), (3) the low overlap between high–volume pumping and peak emigration/migration times, (4) the pumping volume relative to prevailing river flows, and (5) the prolonged, robust swimming speed of American Shad, particularly that of adults (>2.2 m/s), which exceeded the intake velocity (0.2–0.9 m/s). Entrainment of juveniles increased with co–occurrence of low incoming river flows, high pumping volume, and peak emigration times. Furthermore, quantification of migratory species’ entrainment at pumped storage facilities requires integration of diel migration/emigration times with the frequency, timing, and duration of pumping volume.« less

Evaluation of an automotive rear-end collision avoidance system

DOT National Transportation Integrated Search

2006-04-01

This report presents the results of an independent evaluation of the Automotive Collision Avoidance System (ACAS). The ACAS integrates forward collision warning (FCW) and adaptive cruise control (ACC) functions for light-vehicle applications. The FCW...

78 FR 2445 - Notice of Intent To Renew the Advisory Committee on Apprenticeship (ACA) Charter

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-11

... and partners for its ongoing operational effectiveness. Apart from the ACA, there is no single..., veterans, women, minorities and other under-utilized and disadvantaged populations; and (5) efforts to...

Messy but Fair: The ACA's Hospital Value-Based Purchasing Program and the Notice-and-Comment Process.

PubMed

Pan, Janus

2017-01-01

The Centers for Medicare and Medicaid Services (CMS) promulgated a new Medicare program called the Value-Based Purchasing Program (VBPP) as part of the 2010 Affordable Care Act (ACA). Like many other regulatory agencies, CMS used the Notice-and-Comment process to issue proposed rules, solicit public comments, and then publish final rules. Conventional literature suggests that CMS should disproportionately favor business interests during the Notice-and-Comment process, mainly due to the business interests' greater resources and capacity to draft well-reasoned comments. However, this article argues against this presumption and contends instead that CMS listens equally well to both business interest comments and private citizen comments during the formation of the VBPP. With regard to the VBPP and the ACA, CMS appears to be resisting disproportionate sway by business interests and is instead privileging the ACA's goal of improving healthcare quality.

The Future of Health Care Reform: What Is Driving Enrollment?

PubMed

Callaghan, Timothy H; Jacobs, Lawrence R

2017-04-01

Against a backdrop of ongoing operational challenges, insurance market turbulence, and the ever present pull of partisanship, enrollment in the ACA's programs has soared and significant variations have developed across states in terms of their pace of coverage expansion. Our article explores why ACA enrollment has varied so dramatically across states. We explore the potential influence of party control, presidential cueing, administrative capacity, the reverberating effects of ACA policy decisions, affluence, and unemployment on enrollment. Our multivariate analysis finds that party control dominated early state decision making, but that relative enrollment in insurance exchanges and the Medicaid expansion are driven by a changing mix of political and administrative factors. Health politics is entering a new era as Republicans replace the ACA and devolve significant discretion to states to administer Medicaid and other programs. Our findings offer insights into future directions in health reform and in learning and diffusion. Copyright © 2017 by Duke University Press.

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

The Atacama Compact Array: An Overview

NASA Astrophysics Data System (ADS)

Iguchi, S.; Wilson, T. L.

2010-01-01

When completed, ALMA will comprise a 12-meter diameter antennas array (12-m Array) of a minimum of fifty antennas, and the ACA (Atacama Compact Array), composed of four 12-meter diameter antennas and twelve 7-meter diameter antennas. Out of the fifty antennas of the 12-m Array, one-half are provided by the North American partners of ALMA, the other half by the European partners. The sixteen antennas that will comprise the ACA are provided by the East Asian Partners of ALMA. In the last issue of the ALMA Science Newsletter, we outlined the testing of the prototype ALMA 12-meter diameter antennas and the procurement process for these antennas. In that article, only a short account was given of the antennas for the Atacama Compact Array (ACA). In the following we give an overview of the ACA, starting with an introduction to imaging using interferometers.

Undermining the ACA through the executive branch and federalism: what the Trump administration's approach to health reform means for older Americans.

PubMed

Jones, David K; Gusmano, Michael K; Nadash, Pamela; Miller, Edward Alan

2018-04-12

The ACA has survived multiple existential threats in the legislative and judicial branches, including dozens of congressional attempts at repeal and two major Supreme Court cases. Even as it seems that the ACA is here to stay, what the law accomplishes is far from settled. The Trump administration is using executive powers to weaken the law, in many cases using the same powers that President Obama used to strengthen the effects of the reform. States have responded by seeking flexibility to pursue reforms, such as work requirements, that could not pass Congress and that were not allowed by the Obama administration. There is no indication that the ACA is imploding as President Trump has predicted and seems to desire, although these changes have a real and substantial impact on the lives of many Americans, including the near-elderly in unique ways.

53. (Credit JTL) Interior view looking southwest at two high ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

53. (Credit JTL) Interior view looking southwest at two high service engines with Worthington-Snow engine in foreground. Electric high service booster pump is located on the far right between the two high service pumping engines. Grating is immediate foreground covers # 3 low service pump pit. - McNeil Street Pumping Station, McNeil Street & Cross Bayou, Shreveport, Caddo Parish, LA

Prevalence of substandard and falsified artemisinin-based combination antimalarial medicines on Bioko Island, Equatorial Guinea.

PubMed

Kaur, Harparkash; Allan, Elizabeth Louise; Mamadu, Ibrahim; Hall, Zoe; Green, Michael D; Swamidos, Isabel; Dwivedi, Prabha; Culzoni, Maria Julia; Fernandez, Facundo M; Garcia, Guillermo; Hergott, Dianna; Monti, Feliciano

2017-01-01

Poor-quality artemisinin-containing antimalarials (ACAs), including falsified and substandard formulations, pose serious health concerns in malaria endemic countries. They can harm patients, contribute to the rise in drug resistance and increase the public's mistrust of health systems. Systematic assessment of drug quality is needed to gain knowledge on the prevalence of the problem, to provide Ministries of Health with evidence on which local regulators can take action. We used three sampling approaches to purchase 677 ACAs from 278 outlets on Bioko Island, Equatorial Guinea as follows: convenience survey using mystery client (n=16 outlets, 31 samples), full island-wide survey using mystery client (n=174 outlets, 368 samples) and randomised survey using an overt sampling approach (n=88 outlets, 278 samples). The stated active pharmaceutical ingredients (SAPIs) were assessed using high-performance liquid chromatography and confirmed by mass spectrometry at three independent laboratories. Content analysis showed 91.0% of ACAs were of acceptable quality, 1.6% were substandard and 7.4% falsified. No degraded medicines were detected. The prevalence of medicines without the SAPIs was higher for ACAs purchased in the convenience survey compared with the estimates obtained using the full island-wide survey-mystery client and randomised-overt sampling approaches. Comparable results were obtained for full island survey-mystery client and randomised overt. However, the availability of purchased artesunate monotherapies differed substantially according to the sampling approach used (convenience, 45.2%; full island-wide survey-mystery client, 32.6%; random-overt sampling approach, 21.9%). Of concern is that 37.1% (n=62) of these were falsified. Falsified ACAs were found on Bioko Island, with the prevalence ranging between 6.1% and 16.1%, depending on the sampling method used. These findings underscore the vital need for national authorities to track the scale of ineffective medicines that jeopardise treatment of life-threatening diseases and value of a representative sampling approach to obtain/measure the true prevalence of poor-quality medicines.

Insurance cancellations in context: stability of coverage in the nongroup market prior to health reform.

PubMed

Sommers, Benjamin D

2014-05-01

Recent cancellations of nongroup health insurance plans generated much policy debate and raised concerns that the Affordable Care Act (ACA) may increase the number of uninsured Americans in the short term. This article provides evidence on the stability of nongroup coverage using US census data for the period 2008-11, before ACA provisions took effect. The principal findings are threefold. First, this market was characterized by high turnover: Only 42 percent of people with nongroup coverage at the outset of the study period retained that coverage after twelve months. Second, 80 percent of people experiencing coverage changes acquired other insurance within a year, most commonly from an employer. Third, turnover varied across groups, with stable coverage more common for whites and self-employed people than for other groups. Turnover was particularly high among adults ages 19-35, with only 21 percent of young adults retaining continuous nongroup coverage for two years. Given estimates from 2012 that 10.8 million people were covered in this market, these results suggest that 6.2 million people leave nongroup coverage annually. This suggests that the nongroup market was characterized by frequent disruptions in coverage before the ACA and that the effects of the recent cancellations are not necessarily out of the norm. These results can serve as a useful pre-ACA baseline with which to evaluate the law's long-term impact on the stability of nongroup coverage.

Fisher: a program for the detection of H/ACA snoRNAs using MFE secondary structure prediction and comparative genomics - assessment and update.

PubMed

Freyhult, Eva; Edvardsson, Sverker; Tamas, Ivica; Moulton, Vincent; Poole, Anthony M

2008-07-21

The H/ACA family of small nucleolar RNAs (snoRNAs) plays a central role in guiding the pseudouridylation of ribosomal RNA (rRNA). In an effort to systematically identify the complete set of rRNA-modifying H/ACA snoRNAs from the genome sequence of the budding yeast, Saccharomyces cerevisiae, we developed a program - Fisher - and previously presented several candidate snoRNAs based on our analysis 1. In this report, we provide a brief update of this work, which was aborted after the publication of experimentally-identified snoRNAs 2 identical to candidates we had identified bioinformatically using Fisher. Our motivation for revisiting this work is to report on the status of the candidate snoRNAs described in 1, and secondly, to report that a modified version of Fisher together with the available multiple yeast genome sequences was able to correctly identify several H/ACA snoRNAs for modification sites not identified by the snoGPS program 3. While we are no longer developing Fisher, we briefly consider the merits of the Fisher algorithm relative to snoGPS, which may be of use for workers considering pursuing a similar search strategy for the identification of small RNAs. The modified source code for Fisher is made available as supplementary material. Our results confirm the validity of using minimum free energy (MFE) secondary structure prediction to guide comparative genomic screening for RNA families with few sequence constraints.

Cracked shaft detection on large vertical nuclear reactor coolant pump

NASA Technical Reports Server (NTRS)

Jenkins, L. S.

1985-01-01

Due to difficulty and radiation exposure associated with examination of the internals of large commercial nuclear reactor coolant pumps, it is necessary to be able to diagnose the cause of an excessive vibration problem quickly without resorting to extensive trial and error efforts. Consequently, it is necessary to make maximum use of all available data to develop a consistent theory which locates the problem area in the machine. This type of approach was taken at Three Mile Island, Unit #1, in February 1984 to identify and locate the cause of a continuously climbing vibration level of the pump shaft. The data gathered necessitated some in-depth knowledge of the pump internals to provide proper interpretation and avoid misleading conclusions. Therefore, the raw data included more than just the vibration characteristics. Pertinent details of the data gathered is shown and is necessary and sufficient to show that the cause of the observed vibration problem could logically only be a cracked pump shaft in the shaft overhang below the pump bearing.

Segmentation and Quantification for Angle-Closure Glaucoma Assessment in Anterior Segment OCT.

PubMed

Fu, Huazhu; Xu, Yanwu; Lin, Stephen; Zhang, Xiaoqin; Wong, Damon Wing Kee; Liu, Jiang; Frangi, Alejandro F; Baskaran, Mani; Aung, Tin

2017-09-01

Angle-closure glaucoma is a major cause of irreversible visual impairment and can be identified by measuring the anterior chamber angle (ACA) of the eye. The ACA can be viewed clearly through anterior segment optical coherence tomography (AS-OCT), but the imaging characteristics and the shapes and locations of major ocular structures can vary significantly among different AS-OCT modalities, thus complicating image analysis. To address this problem, we propose a data-driven approach for automatic AS-OCT structure segmentation, measurement, and screening. Our technique first estimates initial markers in the eye through label transfer from a hand-labeled exemplar data set, whose images are collected over different patients and AS-OCT modalities. These initial markers are then refined by using a graph-based smoothing method that is guided by AS-OCT structural information. These markers facilitate segmentation of major clinical structures, which are used to recover standard clinical parameters. These parameters can be used not only to support clinicians in making anatomical assessments, but also to serve as features for detecting anterior angle closure in automatic glaucoma screening algorithms. Experiments on Visante AS-OCT and Cirrus high-definition-OCT data sets demonstrate the effectiveness of our approach.

Minocycline reduces neuronal death and attenuates microglial response after pediatric asphyxial cardiac arrest.

PubMed

Tang, Minke; Alexander, Henry; Clark, Robert S B; Kochanek, Patrick M; Kagan, Valerian E; Bayir, Hülya

2010-01-01

The mechanisms leading to delayed neuronal death after asphyxial cardiac arrest (ACA) in the developing brain are unknown. This study aimed at investigating the possible role of microglial activation in neuronal death in developing brain after ACA. Postnatal day-17 rats were subjected to 9 mins of ACA followed by resuscitation. Rats were randomized to treatment with minocycline, (90 mg/kg, intraperitoneally (i.p.)) or vehicle (saline, i.p.) at 1 h after return of spontaneous circulation. Thereafter, minocycline (22.5 mg/kg, i.p.) was administrated every 12 h until sacrifice. Microglial activation (evaluated by immunohistochemistry using ionized calcium-binding adapter molecule-1 (Iba1) antibody) coincided with DNA fragmentation and neurodegeneration in CA1 hippocampus and cortex (assessed by deoxynucleotidyltransferase-mediated dUTP nick-end labeling (TUNEL), Fluoro-Jade-B and Nissl stain). Minocycline significantly decreased both the microglial response and neuronal degeneration compared with the vehicle. Asphyxial CA significantly enhanced proinflammatory cytokine and chemokine levels in hippocampus versus control (assessed by multiplex bead array assay), specifically tumor necrosis factor-alpha (TNF-alpha), macrophage inflammatory protein-1alpha (MIP-1alpha), regulated upon activation, normal T-cell expressed and secreted (RANTES), and growth-related oncogene (GRO-KC) (P<0.05). Minocycline attenuated ACA-induced increases in MIP-1alpha and RANTES (P<0.05). These data show that microglial activation and cytokine production are increased in immature brain after ACA. The beneficial effect of minocycline suggests an important role for microglia in selective neuronal death after pediatric ACA, and a possible therapeutic target.

OGLE-IV Transient Search report 31 December 2016, part 1

NASA Astrophysics Data System (ADS)

Wyrzykowski, L.; Hamanowicz, A.; Kostrzewa-Rutkowska, Z.; Klencki, J.; Sitek, M.; Udalski, A.; Kozlowski, S.; Ulaczyk, K.; Soszynski, I.; Mroz, P.; Szymanski, M. K.; Poleski, R.; Pietrukowicz, P.; Pawlak, M.; Skowron, J.

2016-12-01

The OGLE-IV Transient Detection System (Wyrzykowski et al. 2014, AcA,64,197; Kozlowski et al. 2013; Klencki et al. 2016, AcA, 66,15) announces discovery of 52 transients discovered in last three months.

Pump CFD code validation tests

NASA Technical Reports Server (NTRS)

Brozowski, L. A.

1993-01-01

Pump CFD code validation tests were accomplished by obtaining nonintrusive flow characteristic data at key locations in generic current liquid rocket engine turbopump configurations. Data were obtained with a laser two-focus (L2F) velocimeter at scaled design flow. Three components were surveyed: a 1970's-designed impeller, a 1990's-designed impeller, and a four-bladed unshrouded inducer. Two-dimensional velocities were measured upstream and downstream of the two impellers. Three-dimensional velocities were measured upstream, downstream, and within the blade row of the unshrouded inducer.

Pump tank divider plate for sump suction sodium pumps

DOEpatents

George, John A.; Nixon, Donald R.

1977-01-01

A circular plate extends across the diameter of "sump suction" pump, with a close clearance between the edge of the plate and the wall of the pump tank. The plate is located above the pump impeller, inlet and outlet flow nozzles but below the sodium free surface and effectively divides the pump tank into two separate chambers. On change of pump speed, the close fitting flow restriction plate limits the rate of flow into or out of the upper chamber, thereby minimizing the rate of level change in the tank and permitting time for the pump cover gas pressure to be varied to maintain an essentially constant level.

Mechanism of the AAA+ ATPases pontin and reptin in the biogenesis of H/ACA RNPs.

PubMed

Machado-Pinilla, Rosario; Liger, Dominique; Leulliot, Nicolas; Meier, U Thomas

2012-10-01

The AAA+ ATPases pontin and reptin function in a staggering array of cellular processes including chromatin remodeling, transcriptional regulation, DNA damage repair, and assembly of macromolecular complexes, such as RNA polymerase II and small nucleolar (sno) RNPs. However, the molecular mechanism for all of these AAA+ ATPase associated activities is unknown. Here we document that, during the biogenesis of H/ACA RNPs (including telomerase), the assembly factor SHQ1 holds the pseudouridine synthase NAP57/dyskerin in a viselike grip, and that pontin and reptin (as components of the R2TP complex) are required to pry NAP57 from SHQ1. Significantly, the NAP57 domain captured by SHQ1 harbors most mutations underlying X-linked dyskeratosis congenita (X-DC) implicating the interface between the two proteins as a target of this bone marrow failure syndrome. Homing in on the essential first steps of H/ACA RNP biogenesis, our findings provide the first insight into the mechanism of action of pontin and reptin in the assembly of macromolecular complexes.

Mechanism of the AAA+ ATPases pontin and reptin in the biogenesis of H/ACA RNPs

PubMed Central

Machado-Pinilla, Rosario; Liger, Dominique; Leulliot, Nicolas; Meier, U. Thomas

2012-01-01

The AAA+ ATPases pontin and reptin function in a staggering array of cellular processes including chromatin remodeling, transcriptional regulation, DNA damage repair, and assembly of macromolecular complexes, such as RNA polymerase II and small nucleolar (sno) RNPs. However, the molecular mechanism for all of these AAA+ ATPase associated activities is unknown. Here we document that, during the biogenesis of H/ACA RNPs (including telomerase), the assembly factor SHQ1 holds the pseudouridine synthase NAP57/dyskerin in a viselike grip, and that pontin and reptin (as components of the R2TP complex) are required to pry NAP57 from SHQ1. Significantly, the NAP57 domain captured by SHQ1 harbors most mutations underlying X-linked dyskeratosis congenita (X-DC) implicating the interface between the two proteins as a target of this bone marrow failure syndrome. Homing in on the essential first steps of H/ACA RNP biogenesis, our findings provide the first insight into the mechanism of action of pontin and reptin in the assembly of macromolecular complexes. PMID:22923768

Nearly Half Of Small Employers Using Tobacco Surcharges Do Not Provide Tobacco Cessation Wellness Programs.

PubMed

Pesko, Michael F; Bains, Jaskaran; Maclean, Johanna Catherine; Cook, Benjamin Lê

2018-03-01

The Affordable Care Act (ACA) allowed employer plans in the small-group marketplace to charge tobacco users up to 50 percent more for premiums-known as tobacco surcharges-but only if the employer offered a tobacco cessation program and the employee in question failed to participate in it. Using 2016 survey data collected by the Henry J. Kaiser Family Foundation and Health Research and Educational Trust on 278 employers eligible for Small Business Health Options Program, we examined the prevalence of tobacco surcharges and tobacco cessation programs in the small-group market under this policy and found that 16.2 percent of small employers used tobacco surcharges. Overall, 47 percent of employers used tobacco surcharges but failed to offer tobacco cessation counseling. Wellness program prevalence was lower in states that allowed tobacco surcharges, and 10.8 percent of employers in these states were noncompliant with the ACA by charging tobacco users higher premiums without offering cessation programs. Efforts should be undertaken to improve the monitoring and enforcement of ACA tobacco rating rules.

Rotary blood pump

NASA Technical Reports Server (NTRS)

Benkowski, Robert J. (Inventor); Kiris, Cetin (Inventor); Kwak, Dochan (Inventor); Rosenbaum, Bernard J. (Inventor); Bacak, James W. (Inventor); DeBakey, Michael E. (Inventor)

1999-01-01

A blood pump that comprises a pump housing having a blood flow path therethrough, a blood inlet, and a blood outlet; a stator mounted to the pump housing, the stator having a stator field winding for producing a stator magnetic field; a flow straightener located within the pump housing, and comprising a flow straightener hub and at least one flow straightener blade attached to the flow straightener hub; a rotor mounted within the pump housing for rotation in response to the stator magnetic field, the rotor comprising an inducer and an impeller; the inducer being located downstream of the flow straightener, and comprising an inducer hub and at least one inducer blade attached to the inducer hub; the impeller being located downstream of the inducer, and comprising an impeller hub and at least one impeller blade attached to the impeller hub; and preferably also comprising a diffuser downstream of the impeller, the diffuser comprising a diffuser hub and at least one diffuser blade. Blood flow stagnation and clot formation within the pump are minimized by, among other things, providing the inducer hub with a diameter greater than the diameter of the flow straightener hub; by optimizing the axial spacing between the flow straightener hub and the inducer hub, and between the impeller hub and the diffuser hub; by optimizing the inlet angle of the diffuser blades; and by providing fillets or curved transitions between the upstream end of the inducer hub and the shaft mounted therein, and between the impeller hub and the shaft mounted therein.

Hydraulic jet pumping in a remote location

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

Tjondrodiputro, B.; Gaul, R.B.; Gower, G.H.

1986-12-01

Hydraulic jet pumping equipment was installed in six Sembakung field (N.E. Kalimantan) wells by Atlantic Richfield Indonesia Inc., for Pertamina during 1983, and this article presents the experience acquired in the process of installing and operating this type of artificial-lift equipment in a remote location. Characteristics of the wells and equipment are reviewed, and possible future installations in similar circumstances are discussed. Sembakung oil field, discovered in late 1975, contained 17 wells after complete development. By 1983, some were flowing weakly and several zones were dead, indicating the need for some form of artificial lift. The choice of artificial liftmore » methods was limited by the lack of gas-lift gas, absence of a field-wide power distribution system, unavailability of a rod pumping well servicing unit, and lack of roads in the marshy environment. Thus, hydraulic (free-type) jet pumping was selected as the optimum technique. Jet pumps were installed in six of 17 wells in the field at the end of 1983. Downhole equipment was installed using a heli-rig, and all surface equipment was delivered to location using helicopters. Since startup, some operating problems occurred, but they have all been resolved. Well pumping rates range from 340 to 650 bpd gross, with 0 to 50% BSandW. The jet-pumped wells produced satisfactorily through July 1984, at which time operations were turned over to Pertamina Unit IV at the conclusion of the contractual term.« less

The Affordable Care Act Decreased the Proportion of Uninsured Patients in a Safety Net Orthopaedic Clinic.

PubMed

Gil, Joseph A; Goodman, Avi D; Kleiner, Justin; Kamal, Robin N; Baker, Laurence C; Akelman, Edward

2018-05-01

The Patient Protection and Affordable Care Act (ACA) was approved in 2010, substantially altering the economics of providing and receiving healthcare services in the United States. One of the primary goals of this legislation was to expand insurance coverage for under- and uninsured residents. Our objective was to examine the effect of the ACA on the insurance status of patients at a safety net clinic. Our institution houses a safety net clinic that provides the dominant majority of orthopaedic care for uninsured patients in our state. Therefore, our study allows us to accurately examine the magnitude of the effect on insurance status in safety net orthopaedic clinics. (1) Did the ACA result in a decrease in the number of uninsured patients at a safety net orthopaedic clinic that provides the dominant majority of orthopaedic care for the uninsured in the state? (2) Did the proportion of patients insured after passage of the ACA differ across age or demographic groups in one state? We retrospectively examined our longitudinally maintained adult orthopaedic surgery clinic database from January 2009 to March 2015 and collected visit and demographic data, including zip code income quartile. Based on the data published by the Rhode Island Department of Health, our clinic provides the dominant majority of orthopaedic care for uninsured patients in our state. Therefore, examination of the changes in the proportion of insurance status in our clinic allows us to assess the effect of the ACA on the state level. Univariate and multivariable logistic regression analyses were used to determine the relationship between demographic variables and insurance status. Adjusted odds ratios and 95% CIs were calculated for the proportion of uninsured visits. The proportion of uninsured visits before and after implementation of the ACA was evaluated with an interrupted time-series analysis. The reduction in the proportion of patients without insurance between demographic groups (ie, race, gender, language spoken, and income level) also was compared using an interrupted time-series design. There was a 36% absolute reduction (95% CI, 35%-38%; p < 0.001) in uninsured visits (73% relative reduction; 95% CI, 71%-75%; p < 0.001). There was an immediate 28% absolute reduction (95% CI, 21%-34%; p < 0.001) at the time of ACA implementation, which continued to decline thereafter. After controlling for potential confounding variables such as gender, race, age, and income level, we found that patients who were white, men, younger than 65 years, and seen after January 2014 were more likely to have insurance than patients of other races, women, older patients, and patients treated before January 2014. After the ACA was implemented, the proportion of patients with health insurance at our safety net adult orthopaedic surgery clinic increased substantially. The reduction in uninsured patients was not equal across genders, races, ages, and incomes. Future studies may benefit from identifying barriers to insurance acquisition in these subpopulations. The results of this study could affect orthopaedic practices in the United States by guiding policy decisions regarding health care. Level III, therapeutic study.

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

PubMed

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

2011-01-01

The Patient Protection and Affordable Care Act (the ACA, for short) became law with President Obama's signature on March 23, 2010. It represents the most significant transformation of the American health care system since Medicare and Medicaid. It is argued that it will fundamentally change nearly every aspect of health care, from insurance to the final delivery of care. The length and complexity of the legislation and divisive and heated debates have led to massive confusion about the impact of ACA. It also became one of the centerpieces of 2010 congressional campaigns. Essentials of ACA include: 1) a mandate for individuals and businesses requiring as a matter of law that nearly every American have an approved level of health insurance or pay a penalty; 2) a system of federal subsidies to completely or partially pay for the now required health insurance for about 34 million Americans who are currently uninsured - subsidized through Medicaid and exchanges; 3) extensive new requirements on the health insurance industry; and 4) numerous regulations on the practice of medicine. The act is divided into 10 titles. It contains provisions that went into effect starting on June 21, 2010, with the majority of provisions going into effect in 2014 and later. The perceived major impact on practicing physicians in the ACA is related to growing regulatory authority with the Independent Payment Advisory Board (IPAB) and the Patient Centered Outcomes Research Institute (PCORI). In addition to these specifics is a growth of the regulatory regime in association with further discounts in physician reimbursement. With regards to cost controls and projections, many believe that the ACA does not fix the finances of our health care system - neither public nor private. It has been suggested that the Congressional Budget Office (CBO) and the administration have used creative accounting to arrive at an alleged deficit reduction; however, if everything is included appropriately and accounted for, we will be facing a significant increase in deficits rather than a reduction. When posed as a global question, polls suggest that public opinion continues to be against the health insurance reform. The newly elected Republican congress is poised to pass a bill aimed at repealing health care reform. However, advocates of the repeal of health care reform have been criticized for not providing a meaningful alternative approach. Those criticisms make clear that it is not sufficient to provide vague arguments against the ACA without addressing core issues embedded in health care reform. It is the opinion of the authors that while some parts of the ACA may be reformed, it is unlikely to be repealed. Indeed, the ACA already is growing roots. Consequently, it will be extremely difficult to repeal. In this manuscript, we look at reducing the regulatory burden on the public and providers and elimination of IPAB and PCORI. The major solution lies in controlling the drug and durable medical supply costs with appropriate negotiating capacity for Medicare, and consequently for other insurers.

Estimation of daily flow rate of photovoltaic water pumping systems using solar radiation data

NASA Astrophysics Data System (ADS)

Benghanem, M.; Daffallah, K. O.; Almohammedi, A.

2018-03-01

This paper presents a simple model which allows us to contribute in the studies of photovoltaic (PV) water pumping systems sizing. The nonlinear relation between water flow rate and solar power has been obtained experimentally in a first step and then used for performance prediction. The model proposed enables us to simulate the water flow rate using solar radiation data for different heads (50 m, 60 m, 70 m and 80 m) and for 8S × 3P PV array configuration. The experimental data are obtained with our pumping test facility located at Madinah site (Saudi Arabia). The performances are calculated using the measured solar radiation data of different locations in Saudi Arabia. Knowing the solar radiation data, we have estimated with a good precision the water flow rate Q in five locations (Al-Jouf, Solar Village, AL-Ahsa, Madinah and Gizan) in Saudi Arabia. The flow rate Q increases with the increase of pump power for different heads following the nonlinear model proposed.

Linear induction pump

DOEpatents

Meisner, John W.; Moore, Robert M.; Bienvenue, Louis L.

1985-03-19

Electromagnetic linear induction pump for liquid metal which includes a unitary pump duct. The duct comprises two substantially flat parallel spaced-apart wall members, one being located above the other and two parallel opposing side members interconnecting the wall members. Located within the duct are a plurality of web members interconnecting the wall members and extending parallel to the side members whereby the wall members, side members and web members define a plurality of fluid passageways, each of the fluid passageways having substantially the same cross-sectional flow area. Attached to an outer surface of each side member is an electrically conductive end bar for the passage of an induced current therethrough. A multi-phase, electrical stator is located adjacent each of the wall members. The duct, stators, and end bars are enclosed in a housing which is provided with an inlet and outlet in fluid communication with opposite ends of the fluid passageways in the pump duct. In accordance with a preferred embodiment, the inlet and outlet includes a transition means which provides for a transition from a round cross-sectional flow path to a substantially rectangular cross-sectional flow path defined by the pump duct.

Refugee Resettlement Patterns and State-Level Health Care Insurance Access in the United States.

PubMed

Agrawal, Pooja; Venkatesh, Arjun Krishna

2016-04-01

We sought to evaluate the relationship between state-level implementation of the Patient Protection and Affordable Care Act (ACA) and resettlement patterns among refugees. We linked federal refugee resettlement data to ACA expansion data and found that refugee resettlement rates are not significantly different according to state-level insurance expansion or cost. Forty percent of refugees have resettled to states without Medicaid expansion. The wide state-level variability in implementation of the ACA should be considered by federal agencies seeking to optimize access to health insurance coverage among refugees who have resettled to the United States.

Towards Verification and Validation for Increased Autonomy

NASA Technical Reports Server (NTRS)

Giannakopoulou, Dimitra

2017-01-01

This presentation goes over the work we have performed over the last few years on verification and validation of the next generation onboard collision avoidance system, ACAS X, for commercial aircraft. It describes our work on probabilistic verification and synthesis of the model that ACAS X is based on, and goes on to the validation of that model with respect to actual simulation and flight data. The presentation then moves on to identify the characteristics of ACAS X that are related to autonomy and to discuss the challenges that autonomy pauses on VV. All work presented has already been published.

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.

Structural Characterization of a Human-Type Corrinoid Adenosyltransferase Confirms That Coenzyme B[subscript 12] Is Synthesized through a Four-Coordinate Intermediate

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

St. Maurice, Martin; Mera, Paola; Park, Kiyoung

ATP:cob(I)alamin adenosyltransferases (ACAs) catalyze the transfer of the 5{prime}-deoxyadenosyl moiety from ATP to the upper axial ligand position of cobalamin in the synthesis of coenzyme B{sub 12}. For the ACA-catalyzed reaction to proceed, cob(II)alamin must be reduced to cob(I)alamin in the enzyme active site. This reduction is facilitated through the generation of a four-coordinate cob(II)alamin intermediate on the enzyme. We have determined the high-resolution crystal structure of a human-type ACA from Lactobacillus reuteri with a four-coordinate cob(II)alamin bound in the enzyme active site and with the product, adenosylcobalamin, partially occupied in the active site. The assembled structures represent snapshots ofmore » the steps in the ACA-catalyzed formation of the cobalt-carbon bond of coenzyme B{sub 12}. The structures define the corrinoid binding site and provide visual evidence for a base-off, four-coordinate cob(II)alamin intermediate. The complete structural description of ACA-mediated catalysis reveals the molecular features of four-coordinate cob(II)alamin stabilization and provides additional insights into the molecular basis for dysfunction in human patients suffering from methylmalonic aciduria.« less

Racial Differences in Awareness of the Affordable Care Act and Application Assistance Among Low-Income Adults in Three Southern States

PubMed Central

Garcia Mosqueira, Adrian; Hua, Lynn M.; Sommers, Benjamin D.

2015-01-01

The Affordable Care Act (ACA) expanded Medicaid eligibility to adults with incomes under 138% of the federal poverty level, leading to substantial reductions in uninsured rates among low-income adults. Despite large gains in coverage, studies suggest that Latinos may be less likely than other racial/ethnic groups to apply and enroll in health insurance, and they remain the group with the highest uninsured rate in the United States. We explore two potential factors related to racial/ethnic differences in ACA enrollment—awareness of the law and receipt of application assistance such as navigator services. Using a survey of nearly 3000 low-income U.S. citizens (aged 19-64) in 3 states in late 2014, we find that Latinos had significantly lower levels of awareness of the ACA relative to other groups, even after adjusting for demographic covariates. Higher education was the strongest positive predictor of ACA awareness. In contrast, Latinos were much more likely to receive assistance from navigators or social workers when applying, relative to other racial/ethnic groups. Taken together, these results highlight the importance of ACA outreach efforts to increase awareness among low-income and less educated populations, two groups that are overrepresented in the Latino population, to close existing disparities in coverage. PMID:26453675

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.

Design and development of a unit element microstrip antenna for aircraft collision avoidance system

NASA Astrophysics Data System (ADS)

De, Debajit; Sahu, Prasanna Kumar

2017-10-01

Aircraft/traffic alert and collision avoidance system (ACAS/TCAS) is an airborne system which is designed to provide the service as a last defense equipment for avoiding mid-air collisions between the aircraft. In the existing system, four monopole stub-elements are used as ACAS directional antenna and one blade type element is used as ACAS omnidirectional antenna. The existing ACAS antenna has some drawbacks such as low gain, large beamwidth, frequency and beam tuning/scanning issues etc. Antenna issues like unwanted signals reception may create difficulties to identify the possible threats. In this paper, the focus is on the design and development of a unit element microstrip antenna which can be used for ACAS application and to overcome the possible limitations associated with the existing techniques. Two proposed antenna models are presented here, which are single feed and dual feed microstrip dual patch slotted antenna. These are designed and simulated in CST Microwave Studio tool. The performance and other antenna characteristics have been explored from the simulation results followed by the antenna fabrication and measurement. A good reflection coefficient, Voltage Standing Wave Ratio (VSWR), narrow beamwidth, perfect directional radiation pattern, high gain and directivity make this proposed antenna a good candidate for this application.

Risk Adjustment, Reinsurance Improved Financial Outcomes For Individual Market Insurers With The Highest Claims.

PubMed

Jacobs, Paul D; Cohen, Michael L; Keenan, Patricia

2017-04-01

The Affordable Care Act (ACA) reformed the individual health insurance market. Because insurers can no longer vary their offers of coverage based on applicants' health status, the ACA established a risk adjustment program to equalize health-related cost differences across plans. The ACA also established a temporary reinsurance program to subsidize high-cost claims. To assess the impact of these programs, we compared revenues to claims costs for insurers in the individual market during the first two years of ACA implementation (2014 and 2015), before and after the inclusion of risk adjustment and reinsurance payments. Before these payments were included, for the 30 percent of insurers with the highest claims costs, claims (not including administrative expenses) exceeded premium revenues by $90-$397 per enrollee per month. The effect was reversed after these payments were included, with revenues exceeding claims costs by $0-$49 per month. The risk adjustment and reinsurance programs were relatively well targeted in the first two years. While there is ongoing discussion regarding the future of the ACA, our findings can shed light on how risk-sharing programs can address risk selection among insurers-a pervasive issue in all health insurance markets. Project HOPE—The People-to-People Health Foundation, Inc.

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

46 CFR 27.301 - What are the requirements for fire pumps, fire mains, and fire hoses on towing vessels?

Code of Federal Regulations, 2014 CFR

2014-10-01

... place where the remote fire pump control is located. (c) The fire main must have a sufficient number of... 46 Shipping 1 2014-10-01 2014-10-01 false What are the requirements for fire pumps, fire mains... the requirements for fire pumps, fire mains, and fire hoses on towing vessels? By April 29, 2005, you...

Y,REE,Nb,Ta,Ti-oxide (AB 2O 6) minerals from REL-REE euxenite-subtype pegmatites of the Třebíč Pluton, Czech Republic; substitutions and fractionation trends

NASA Astrophysics Data System (ADS)

Škoda, Radek; Novák, Milan

2007-04-01

Aeschynite-group minerals (AGM) and euxenite-group minerals (EGM) occur in REL-REE euxenite-subtype pegmatites from the Třebíč Pluton, Czech Republic. They form strongly metamictized, light brown to black, equigranular to needle-like, subhedral to anhedral grains enclosed in blocky K-feldspar and less commonly in albite, and blocky quartz, and in the graphic unit (quartz and K-feldspar). Both AGM and EGM are homogeneous to slightly heterogeneous in BSE images. They are not commonly associated with the other primary Y,REE,Ti,Nb-bearing minerals, i.e. allanite-(Ce), monazite-(Ce), titanite, and ilmenite, which occur within the same textural-paragenetic unit. Aeschynite-(Y), aeschynite-(Ce), aeschynite-(Nd), nioboaeschynite-(Ce), tantalaeschynite-(Ce), vigezzite and polycrase-(Y) were identified using EMP and canonical discrimination analysis [Ercit, T.S., 2005a. Identification and alteration trends of granitic-pegmatite-hosted (Y,REE,U,Th)-(Nb,Ta,Ti) oxide minerals: a statistical approach. Can. Mineral. 43, 4 1291-1303.]. The exchange vector ACa B(Nb,Ta) A(Y,REE) - 1 BTi - 1 or its combination with the exchange vector ACa 2B(Nb,Ta) 3A(U,Th) - 1 A(Y,REE) - 1 BTi - 3 have been elucidated for the AGM. The exchange vector ACa A(U,Th) A(Y,REE) - 2 is predominant in the EGM. The AGM are enriched in HREE, whereas LREE are concentrated in the EGM. Weak to none-existent geochemical fractionations, as expressed by the U/(U + Th), Y/(Y + REE), Ta/(Ta + Nb) and (Nb + Ta)/(Ti + Nb + Ta) ratios, were noted for single grains from both the AGM and EGM, as well as in grains of polycrase-(Y) from four different textural-paragenetic units located in the Vladislav pegmatite. Simultaneous increase of U/(U + Th) and Y/(Y + REE) in the AGM during fractionation is typical. The Ta/(Ta + Nb) fractionation is usually weak and contradicts the Y/(Y + REE) and U/(U + Th) fractionation trends. This unusual behavior of Nb and Ta may be controlled by associated Ti-rich minerals (titanite, ilmenite, rutile), the composition of parental melt and/or by elevated F activity. The AGM and EGM from pegmatites of the Třebíč Pluton are quite similar in composition to those from REL-REE euxenite-subtype pegmatites in the Trout Creek Pass, Chaffee County, Colorado, USA, which are generally Ca,U,Th-depleted, show lower Ta/(Ta+Nb), and lower variation in HREE/LREE.

Superconducting Sr 2- xAxCuO 2F 2+ δ( A=Ca, Ba): Synthetic Pathways and Associated Structural Rearrangements

NASA Astrophysics Data System (ADS)

Francesconi, M. G.; Slater, P. R.; Hodges, J. P.; Greaves, C.; Edwards, P. P.; Al-Mamouri, M.; Slaski, M.

1998-01-01

The low-temperature fluorination of a range of insulating alkaline earth cuprates Sr2-xAxCuO3(A=Ca (0≤x≤2);A=Ba (0≤x≤0.6)) can result in superconducting oxide fluorides Sr2-xAxCuO2F2+δ. In contrast, conventional high-temperature solid-state reactions produce thermodynamically more stable mixtures of oxides and fluorides. Various soft-chemistry fluorination pathways (utilizing F2gas, NH4F,MF2[M=Cu, Zn, Ni, Ag]) are compared with respect to their efficacy and mechanisms. Attention is also focused on the structural features of the mixed-oxide precursor and the final-oxide fluorides to highlight the remarkable structural rearrangements that occur during the low-temperature fluorination. The effects of fluorination of other Sr-Cu-O systems are used to identify the structural requirements of the precursor oxide in order to achieve such transformations.

Tunable Infrared Semiconductor Lasers

DTIC Science & Technology

2013-12-20

stripe to different positions of an addressable chirped, location-dependent period grating to select the different lasing wavelengths. Interferometric...grating or vernier effects. Our tuning mechanism is to shift the pump stripe to different positions of an addressable chirped, location-dependent period... stripe is applied and the lateral direction is the perpendicular direction across the pump stripe and parallel to the grating lines.  The chirped

Performance of a vane driven-gear pump

NASA Technical Reports Server (NTRS)

Heald, R H

1921-01-01

Given here are the results of a test conducted in a wind tunnel on the performance of a vane-driven gear pump used to pump gasoline upward into a small tank located within the upper wing from which it flows by gravity to the engine carburetor. Information is given on the efficiency of the pump, the head resistance of the vanes, the performance and characteristics of the unit with and without housing about the vanes, the pump performance when motor driven, and resistance and power characteristics.

Study on the Pumped Materials along Rail Bed in Taiwan

NASA Astrophysics Data System (ADS)

Kuo, Chihping; Hsu, Chihhao; Wu, Chinwei; Wang, Hongyi

2016-04-01

The Neiwan Line is a railway branch line in Taiwan operated by the Taiwan Railways Administration. It is located in Hsinchu County. This line was completed on 11 September 1951. Although this line is a branch line, its standards are comparable to those of a main line except that it is not electrified. The materials for constructing railway subgrade were general in-situ topsoil which deposited in Pliocene. This line suffers the subgrade mud pumping frequently. Railway subgrade mud pumping is one of the most common defects on railway constructions. Most cases of the pumping phenomenon are caused in mud, say silt or ML in USCS. However, field observation and loggings show that not only silt but also other kinds of soil, such as sand or clay, pump as well in this study. Thirty pumping samples were collected in a sectional zone which length is about 12kM. In the 30 samples, 12 ones are Sand, 10 ones are Silt, 6 ones are Clay, and 2 ones are Gravel. Under very similar conditions, such as natural geological material, train operations, the reasons why different soil caused pumping is well discussed in this paper.

How do distracted and normal driving differ : an analysis of the ACAS naturalistic driving data

DOT National Transportation Integrated Search

2007-05-01

To determine how distracted and normal driving differ, this report re-examines : driving performance data from the advanced collision avoidance system (ACAS) field : operational test (FOT), a naturalistic driving study (96 drivers, 136,792 miles). : ...

OGLE-IV Transient Search report 25 September 2017 part 1

NASA Astrophysics Data System (ADS)

Wyrzykowski, L.; Gromadzki, M.; Hamanowicz, A.; Rybicki, K.; Klencki, J.; Kozlowski, S.; Udalski, A.; Poleski, R.; Szymanski, M. K.; Skowron, J.; Ulaczyk, K.; Pawlak, M.; Mroz, P.; Soszynski, I.; Pietrukowicz, P.; Sitek, M.; Ihanec, N.

2017-09-01

The OGLE-IV Transient Detection System (Wyrzykowski et al. 2014, AcA,64,197; Kozlowski et al. 2013; Klencki et al. 2016, AcA, 66,15) announces discovery of 50 new on-going and recently finished transients discovered since Jan 2017.

SHINE Vacuum Pump Test Verification

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

Morgan, Gregg A; Peters, Brent

2013-09-30

Normetex pumps used world-wide for tritium service are no longer available. DOE and other researchers worldwide have spent significant funds characterizing this pump. Identification of alternate pumps is required for performance and compatibility with tritium gas. Many of the pumps that could be used to meet the functional performance requirements (e.g. pressure and flow conditions) of the Normetex pump have features that include the use of polymers or oils and greases that are not directly compatible with tritium service. This study assembles a test system to determine the flow characteristics for candidate alternate pumps. These tests are critical to themore » movement of tritium through the SHINE Tritium Purification System (TPS). The purpose of the pump testing is two-fold: (1) obtain baseline vacuum pump characteristics for an alternate (i.e. ''Normetex replacement'') pump intended for use in tritium service; and (2) verify that low pressure hydrogen gas can be transported over distances up to 300 feet by the candidate pumps. Flow rates and nominal system pressures have been identified for the SHINE Mo-99 production process Tritium Purification System (TPS). To minimize the line sizes for the transfer of low pressure tritium from the Neutron Driver Accelerator System (NDAS) to the primary processing systems in the TPS, a ''booster'' pump has been located near the accelerator in the design. A series of pump tests were performed at various configurations using hydrogen gas (no tritium) to ensure that this concept is practical and maintains adequate flow rates and required pressures. This report summarizes the results of the tests that have been performed using various pump configurations. The current design of the Tritium Purification System requires the ''booster'' pump to discharge to or to be backed by another vacuum pump. Since Normetex pumps are no longer manufactured, a commercially available Edwards scroll pump will be used to back the booster pump. In this case the ''booster pump'' is an Adixen Molecular Drag Pump (MDP 5011) and the backing pump is an Edwards (nXDS15iC) scroll pump. Various configurations of the two pumps and associated lengths of 3/4 inch tubing (0 feet to 300 feet) were used in combination with hydrogen and nitrogen flow rates ranging from 25-400 standard cubic centimeters per minute (sccm) to determine whether the proposed pump configuration meets the design criteria for SHINE. The results of this study indicate that even under the most severe conditions (300 feet of tubing and 400 sccm flow rate) the Adixen 5011 MDP can serve as a booster pump to transport gases from the accelerator (NDAS) to the TPS. The Target Gas Receiving System pump (Edwards nXDS15iC) located approximately 300 feet from the accelerator can effectively back the Adixen MDP. The molecular drag pump was able to maintain its full rotational speed even when the flow rate was 400 sccm hydrogen or nitrogen and 300 feet of tubing was installed between the drag pump and the Edwards scroll pump. In addition to maintaining adequate rotation, the pressure in the system was maintained below the target pressure of 30 torr for all flow rates, lengths of tubing, and process gases. This configuration is therefore adequate to meet the SHINE design requirements in terms of flow and pressure.« less

Quantifying interactions between accommodation and vergence in a binocularly normal population.

PubMed

Sweeney, Laura E; Seidel, Dirk; Day, Mhairi; Gray, Lyle S

2014-12-01

Stimulation of the accommodation system results in a response in the vergence system via accommodative vergence cross-link interactions, and stimulation of the vergence system results in an accommodation response via vergence accommodation cross-link interactions. Cross-link interactions are necessary in order to ensure simultaneous responses in the accommodation and vergence systems. The crosslink interactions are represented most comprehensively by the response AC/A (accommodative vergence) and CA/C (vergence accommodation) ratios, although the stimulus AC/A ratio is measured clinically, and the stimulus CA/C ratio is seldom measured in clinical practice. The present study aims to quantify both stimulus and response AC/A and CA/C ratios in a binocularly normal population, and determine the relationship between them. 25 Subjects (mean ± SD age 21.0 ± 1.9 years) were recruited from the university population. A significant linear relationship was found between the stimulus and response ratios, for both AC/A (r² = 0.96, p < 0.001) and CA/C ratios (r² = 0.40, p < 0.05). Good agreement was found between the stimulus and response AC/A ratios (95% CI -0.06 to 0.24 MA/D). Stimulus and response CA/C ratios are linearly related. Stimulus CA/C ratios were higher than response ratios at low values, and lower than response ratios at high values (95% CI -0.46 to 0.42 D/MA). Agreement between stimulus and response CA/C ratios is poorer than that found for AC/A ratios due to increased variability in vergence responses when viewing the Gaussian blurred target. This study has shown that more work is needed to refine the methodology of CA/C ratio measurement.

Efficacy and safety of tranexamic acid versus ϵ-aminocaproic acid in cardiovascular surgery.

PubMed

Falana, Olabisi; Patel, Gourang

2014-12-01

Blood conservation is a major concern in the management of surgical patients because of transfusion-related complications, limited supply, and health care costs. Tranexamic acid (TXA) and ϵ-aminocaproic acid (ϵACA) are lysine analogue antifibrinolytics used to reduce surgical bleeding and transfusions. To evaluate the efficacy and safety of TXA compared with ϵACA in the management of cardiovascular surgical bleeding at an academic medical center. This single-center, retrospective, observational cohort study included 120 patients undergoing cardiovascular surgery with or without cardiopulmonary bypass, who received at least 1 dose of perioperative TXA or ϵACA. The efficacy outcome-massive perioperative bleeding-was a composite end point of chest tube drainage >1500 mL in any 8-hour period after surgery, perioperative transfusion of 10 or more units of packed red blood cells, reoperation for bleeding, or death from hemorrhage within 30 days. The safety outcomes were incidence of thromboembolic events, postoperative renal dysfunction, seizure, and 30-day all-cause mortality. The primary end point-massive perioperative bleeding-occurred in 10 patients (16.7%) in the TXA group compared with 5 patients (8.3%) in the ϵACA group (P = 0.17). There were no significant differences in the secondary end points of 30-day all-cause mortality, thromboembolic events, renal dysfunction, and seizure. There were no differences in the efficacy and safety outcomes between TXA and ϵACA in the management of cardiovascular surgical bleeding at our institution. Considering the substantial cost difference and comparable efficacy and safety, ϵACA may have better value over TXA for reducing cardiovascular surgical bleeding. © The Author(s) 2014.

Continuous multichannel monitoring of cave air carbon dioxide using a pumped non-dispersive infrared analyser

NASA Astrophysics Data System (ADS)

Mattey, D.

2012-04-01

The concentration of CO2 in cave air is one of the main controls on the rate of degassing of dripwater and on the kinetics of calcite precipitation forming speleothem deposits. Measurements of cave air CO2reveal great complexity in the spatial distribution among interconnected cave chambers and temporal changes on synoptic to seasonal time scales. The rock of Gibraltar hosts a large number of caves distributed over a 300 meter range in altitude and monthly sampling and analysis of air and water combined with continuous logging of temperature, humidity and drip discharge rates since 2004 reveals the importance of density-driven seasonal ventilation which drives large-scale advection of CO2-rich air though the cave systems. Since 2008 we have deployed automatic CO2 monitoring systems that regularly sample cave air from up to 8 locations distributed laterally and vertically in St Michaels Cave located near the top of the rock at 275m asl and Ragged Staff Cave located in the heart of the rock near sea level. The logging system is controlled by a Campbell Scientific CR1000 programmable datalogger which controls an 8 port manifold connected to sampling lines leading to different parts of the cave over a distance of up to 250 meters. The manifold is pumped at a rate of 5l per minute drawing air through 6mm or 8mm id polythene tubing via a 1m Nafion loop to reduce humidity to local ambient conditions. The outlet of the primary pump leads to an open split which is sampled by a second low flow pump which delivers air at 100ml/minute to a Licor 820 CO2 analyser. The software selects the port to be sampled, flushes the line for 2 minutes and CO2 analysed as a set of 5 measurements averaged over 10 second intervals. The system then switches to the next port and when complete shuts down to conserve power after using 20 watts over a 30 minute period of analysis. In the absence of local mains power (eg from the show cave lighting system) two 12v car batteries will power the system for analysis at 4h intervals for about 1 month. Two logging systems sampling cave air from 13 locations over a vertical range of 275m have run continuously for up to 5 years and return a very detailed picture of cave ventilation patterns and their responses to local weather and seasonal change.

Driving performance analysis of the ACAS FOT data and recommendations for a driving workload manager.

DOT National Transportation Integrated Search

2006-12-01

This report contains analyses of driving performance data from the Advanced Collision Avoidance System (ACAS) Field Operational Test (FOT), with data from nearly 100 drivers and over 100,000 miles of driving. The analyses compared normal and distract...

OGLE-IV Transient Search report 26 August 2016

NASA Astrophysics Data System (ADS)

Wyrzykowski, L.; Sitek, M.; Kostrzewa-Rutkowska, Z.; Udalski, A.; Kozlowski, S.; Klencki, J.

2016-08-01

The OGLE-IV Transient Detection System (Wyrzykowski et al. 2014, AcA,64,197; Kozlowski et al. 2013; Klencki et al. 2016, AcA, 66,15) announces resumption of operation in the beginning of 2016B season and discovery of 45 new on-going transients.

The Cbf5-Nop10 Complex is a Molecular Bracket that Organizes Box H/ACA RNPs

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

Hamma, Tomoko; Reichow, Steve L.; Varani, Gabriele

2005-12-01

Box H/ACA ribonucleoprotein particles (RNPs) catalyze RNA pseudouridylation and direct processing of ribosomal RNA, and are essential architectural components of vertebrate telomerases. H/ACA RNPs comprise four proteins and a multihelical RNA. Two proteins, Cbf5 and Nop10, suffice for basal enzymatic activity in an archaeal in vitro system. We now report their cocrystal structure at 1.95-A resolution. We find that archaeal Cbf5 can assemble with yeast Nop10 and with human telomerase RNA, consistent with the high sequence identity of the RNP componenets between archaea and eukarya. Thus, the Cbf5-Nop10 architecture is phylogenetically conserved. The structure shows how Nop10 buttresses the activemore » site of Cbf5, and it reveals two basic troughs that bidirectionally extend the active site cleft. Mutagenesis results implicate an adjacent basic patch in RNA binding. This tripartite RNA-binding surface may function as a molecular bracket that organizes the multihelical H/ACA and telomerase RNAs.« less

Agrobacterium-mediated transformation in Alpinia galanga (Linn.) Willd. for enhanced acetoxychavicol acetate production.

PubMed

Rao, Kiranmayee; Chodisetti, Bhuvaneswari; Mangamoori, Lakshmi Narasu; Giri, Archana

2012-09-01

Agrobacterium-mediated transformations ensure elevated amounts of secondary metabolite accumulation with genetic and biosynthetic stability. In the present study, Alpinia galanga rich in bioactive compounds was genetically transformed using different strains of Agrobacterium rhizogenes viz. LBA 9402, A(4), 532, 2364 and PRTGus. Even though a higher growth rate was obtained with the LBA 9402 strain, maximum acetoxychavicol acetate accumulation (ACA) was seen in the PRTGus transformant. PRTGus root line has shown 10.1 fold higher ACA content in comparison to the control roots. The lowest ACA production was shown by the A(4) transformant (4.9 fold). The quantification of ACA in the transformed roots was carried out by using HPLC, which was found to be in the order of PRTGus > LBA 9402 > 2364 > 532 > A(4). The fast growth rate of hairy roots, genetic stability and their ability to synthesize more than one metabolite offer a promising system for the production of valuable secondary metabolites.

Medicaid Reimbursement of Mental Health Peer-Run Organizations: Results of a National Survey.

PubMed

Ostrow, Laysha; Steinwachs, Donald; Leaf, Philip J; Naeger, Sarah

2017-07-01

This study sought to understand whether knowledge of the Affordable Care Act (ACA) was associated with willingness of mental health peer-run organizations to become Medicaid providers. Through the 2012 National Survey of Peer-Run Organizations, organizational directors reported their organization's willingness to accept Medicaid reimbursement and knowledge about the ACA. Multinomial logistic regression was used to model the association between willingness to accept Medicaid and the primary predictor of knowledge of the ACA, as well as other predictors at the organizational and state levels. Knowledge of the ACA, Medicaid expansion, and discussions about healthcare reform were not significantly associated with willingness to be a Medicaid provider. Having fewer paid staff was associated with not being willing to be a Medicaid provider, suggesting that current staffing capacity is related to attitudes about becoming a Medicaid provider. Organizations had both ideological and practical concerns about Medicaid reimbursement. Concerns about Medicaid reimbursement can potentially be addressed through alternative financing mechanisms that should be able to meet the needs of peer-run organizations.

The H/ACA RNP assembly factor SHQ1 functions as an RNA mimic.

PubMed

Walbott, Hélène; Machado-Pinilla, Rosario; Liger, Dominique; Blaud, Magali; Réty, Stéphane; Grozdanov, Petar N; Godin, Kate; van Tilbeurgh, Herman; Varani, Gabriele; Meier, U Thomas; Leulliot, Nicolas

2011-11-15

SHQ1 is an essential assembly factor for H/ACA ribonucleoproteins (RNPs) required for ribosome biogenesis, pre-mRNA splicing, and telomere maintenance. SHQ1 binds dyskerin/NAP57, the catalytic subunit of human H/ACA RNPs, and this interaction is modulated by mutations causing X-linked dyskeratosis congenita. We report the crystal structure of the C-terminal domain of yeast SHQ1, Shq1p, and its complex with yeast dyskerin/NAP57, Cbf5p, lacking its catalytic domain. The C-terminal domain of Shq1p interacts with the RNA-binding domain of Cbf5p and, through structural mimicry, uses the RNA-protein-binding sites to achieve a specific protein-protein interface. We propose that Shq1p operates as a Cbf5p chaperone during RNP assembly by acting as an RNA placeholder, thereby preventing Cbf5p from nonspecific RNA binding before association with an H/ACA RNA and the other core RNP proteins.

The H/ACA RNP assembly factor SHQ1 functions as an RNA mimic

PubMed Central

Walbott, Hélène; Machado-Pinilla, Rosario; Liger, Dominique; Blaud, Magali; Réty, Stéphane; Grozdanov, Petar N.; Godin, Kate; van Tilbeurgh, Herman; Varani, Gabriele; Meier, U. Thomas; Leulliot, Nicolas

2011-01-01

SHQ1 is an essential assembly factor for H/ACA ribonucleoproteins (RNPs) required for ribosome biogenesis, pre-mRNA splicing, and telomere maintenance. SHQ1 binds dyskerin/NAP57, the catalytic subunit of human H/ACA RNPs, and this interaction is modulated by mutations causing X-linked dyskeratosis congenita. We report the crystal structure of the C-terminal domain of yeast SHQ1, Shq1p, and its complex with yeast dyskerin/NAP57, Cbf5p, lacking its catalytic domain. The C-terminal domain of Shq1p interacts with the RNA-binding domain of Cbf5p and, through structural mimicry, uses the RNA–protein-binding sites to achieve a specific protein–protein interface. We propose that Shq1p operates as a Cbf5p chaperone during RNP assembly by acting as an RNA placeholder, thereby preventing Cbf5p from nonspecific RNA binding before association with an H/ACA RNA and the other core RNP proteins. PMID:22085966

An early look at changes in employer-sponsored insurance under the Affordable Care Act.

PubMed

Blavin, Fredric; Shartzer, Adele; Long, Sharon K; Holahan, John

2015-01-01

Critics frequently characterize the Affordable Care Act (ACA) as a threat to the survival of employer-sponsored insurance. The Medicaid expansion and Marketplace subsidies could adversely affect employers' incentives to offer health insurance and workers' incentives to take up such offers. This article takes advantage of timely data from the Health Reform Monitoring Survey for June 2013 through September 2014 to examine, from the perspective of workers, early changes in offer, take-up, and coverage rates for employer-sponsored insurance under the ACA. We found no evidence that any of these rates have declined under the ACA. They have, in fact, remained constant: around 82 percent, 86 percent, and 71 percent, respectively, for all workers and around 63 percent, 71 percent, and 45 percent, respectively, for low-income workers. To date, the ACA has had no effect on employer coverage. Economic incentives for workers to obtain coverage from employers remain strong. Project HOPE—The People-to-People Health Foundation, Inc.

The Effect of Eliminating the Affordable Care Act's Tax Credits in Federally Facilitated Marketplaces.

PubMed

Saltzman, Evan; Eibner, Christine

2015-07-15

In this study, RAND Corporation researchers assess the expected change in enrollment and premiums in the Patient Protection and Affordable Care Act (ACA)-compliant individual market in federally facilitated marketplace (FFM) states if the U.S. Supreme Court decides to eliminate subsidies in FFM states. The analysis used the Comprehensive Assessment of Reform Efforts (COMPARE) microsimulation model, an economic model developed by RAND researchers, to assess the impact of proposed health reforms. The authors found that enrollment in the ACA-compliant individual market, including plans sold in the marketplaces and those sold outside of the marketplaces that comply with ACA regulations, would decline by 9.6 million, or 70 percent, in FFM states if subsidies were eliminated. They also found that unsubsidized premiums in the ACA-compliant individual market would increase 47 percent in FFM states. This corresponds to a $1,610 annual increase for a 40-year-old nonsmoker purchasing a silver plan.

Policy Dilemmas in Latino Health Care and Implementation of the Affordable Care Act

PubMed Central

Ortega, Alexander N.; Rodriguez, Hector P.; Bustamante, Arturo Vargas

2016-01-01

The changing Latino demographic in the United States presents a number of challenges to health care policy makers, clinicians, organizations, and other stakeholders. Studies have demonstrated that Latinos tend to have worse patterns of access to, and utilization of, health care than other ethnic and racial groups. The implementation of the Affordable Care Act (ACA) of 2010 may ameliorate some of these disparities. However, even with the ACA, it is expected that Latinos will continue to have problems accessing and using high-quality health care, especially in states that are not expanding Medicaid eligibility as provided by the ACA. We identify four current policy dilemmas relevant to Latinos’ health and ACA implementation: (a) the need to extend coverage to the undocumented; (b) the growth of Latino populations in states with limited insurance expansion; (c) demands on public and private systems of care; and (d) the need to increase the number of Latino physicians while increasing the direct patient-care responsibilities of nonphysician Latino health care workers. PMID:25581154

Impact of ACA Health Reforms for People With Mental Health Conditions.

PubMed

Thomas, Kathleen C; Shartzer, Adele; Kurth, Noelle K; Hall, Jean P

2018-02-01

This brief report explores the impact of health reform for people with mental illness. The Health Reform Monitoring Survey was used to examine health insurance, access to care, and employment for 1,550 people with mental health conditions pre- and postimplementation of the Affordable Care Act (ACA) and by state Medicaid expansion status. Multivariate logistic regressions with predictive margins were used. Post-ACA reforms, people with mental health conditions were less likely to be uninsured (5% versus 13%; t=-6.89, df=50, p<.001) and to report unmet need due to cost of mental health care (17% versus 21%; t=-3.16, df=50, p=.002) and any health services (46% versus 51%; t=-3.71, df=50, p<.001), and they were more likely to report a usual source of care (82% versus 76%; t=3.11, df=50, p=.002). These effects were experienced in both Medicaid expansion and nonexpansion states. Findings underscore the importance of ACA improvements in the quality of health insurance coverage.

Potential impact of ACA-related insurance expansion on trauma care reimbursement

PubMed Central

Scott, John W; Upadhyaya, Pooja; Najjar, Peter; Tsai, Thomas C; Scott, Kirstin W; Shrime, Mark G; Cutler, David M; Salim, Ali; Haider, Adil H

2017-01-01

Introduction Nearly one-quarter of trauma patients are uninsured and hospitals recoup less than 20% of inpatient costs for their care. This study examines changes to hospital reimbursement for inpatient trauma care if the full coverage expansion provisions of the Affordable Care Act (ACA) were in effect. Methods We abstracted nonelderly adults (ages 18–64y) admitted for trauma from the Nationwide Inpatient Sample (NIS) during 2010—the last year prior to most major ACA coverage expansion policies. We calculated national and facility-level reimbursements and trauma-related contribution margins using NIS-supplied cost-to-charge ratios and published reimbursement rates for each payer type. Using US census data, we developed a probabilistic microsimulation model to determine the proportion of pre-ACA uninsured trauma patients that would be expected to gain private insurance, Medicaid, or remain uninsured after full implementation of the ACA. We then estimated the impact of these coverage changes on national and facility-level trauma reimbursement for this population. Results 145,849 patients (representing 737,852 patients nationwide) were included. National inpatient trauma costs for 18–64y patients totaled $14.8 billion (95%CI:12.5,17.1). Pre-expansion reimbursements totaled $13.7 billion (10.8,14.7), yielding a national margin of −7.9% (−10.6, −5.1). Post-expansion projected reimbursements totaled $15.0 billion (12.7,17.3), increasing the margin by 9.3 absolute percentage-points to +1.4% (−0.3,+3.2). Of the 263 eligible facilities, 90 (34.2%) had a positive trauma-related contribution margin in 2010, which increased to 171 (65.0%) using post-expansion projections. Those facilities with the highest proportion of uninsured and racial/ethnic minorities experienced the greatest gains. Conclusion Health insurance coverage expansion for uninsured trauma patients has the potential to increase national reimbursement for inpatient trauma care by over one billion dollars and nearly double the proportion of hospitals with a positive margin for trauma care. These data suggest that insurance coverage expansion has the potential to improve trauma centers’ financial viability and their ability to provide care for their communities. Level of Evidence Level II: Sensible costs and alternatives; values obtained from limited sources; multi-way sensitivity analyses Study Type Policy Analysis / Economic Analysis PMID:28431415

Acinar cell cystadenoma of the pancreas: a benign neoplasm or non-neoplastic ballooning of acinar and ductal epithelium?

PubMed

Singhi, Aatur D; Norwood, Stephanie; Liu, Ta-Chiang; Sharma, Rajni; Wolfgang, Christopher L; Schulick, Richard D; Zeh, Herbert J; Hruban, Ralph H

2013-09-01

Acinar cell cystadenoma (ACA) of the pancreas was initially described as a non-neoplastic cyst of the pancreas and, at that time, referred to as "acinar cystic transformation." In subsequent studies, these lesions were given the designation of "-oma," despite the relative lack of evidence supporting a neoplastic process. To characterize these lesions further, we examined the clinical, pathologic, and immunohistochemical features of 8 ACAs. The majority of patients were female (7 of 8, 88%) and ranged in age from 18 to 57 years (mean, 43 y). Grossly, the cysts involved the head (n=5), body (n=1), or the entire pancreas (n=2). ACAs were either multilocular (n=4) or unilocular (n=4) and ranged in size from 1.8 to 15 cm (mean, 6.8 cm). Histologically, multilocular ACAs were lined by patches of acinar and ductal epithelium. Immunolabeling, including double-labeling for cytokeratin 19 and chymotrypsin, highlighted the patchy pattern of the ductal and acinar cells lining the cysts. In some areas, the cysts with patches of acinar and ductal differentiation formed larger locules with incomplete septa as they appeared to fuse with other cysts. In contrast, the unilocular cases were lined by 1 to 2 cell layers of acinar cells with little intervening ductal epithelium. Nuclear atypia, mitotic figures, necrosis, infiltrative growth, and associated invasive carcinoma were absent in all cases. In addition, we assessed the clonal versus polyclonal nature of ACAs, occurring in women, using X-chromosome inactivation analysis of the human androgen receptor (AR) gene. Five of 7 cases were informative and demonstrated a random X-chromosome inactivation pattern. Clinical follow-up information was available for all patients, and follow-up ranged from 10 months to 7.8 years (mean, 3.6 y), with no evidence of recurrence or malignant transformation. We hypothesize that early lesions are marked by acinar dilatation that expands into and incorporates smaller ductules and later larger ducts. As the cysts increase in size, they fuse forming larger cysts. Later lesions demonstrate a unilocular cyst lined by predominantly acinar epithelium with scattered ductal cells. The term cystadenoma, with its neoplastic connotation, does not seem to accurately reflect the histologic, immunohistochemical, or molecular features of these lesions. We suggest readopting the term "acinar cystic transformation" until the non-neoplastic versus neoplastic origin of these lesions can be resolved.

Implementation of the affordable care act: a case study of a service line co-management company.

PubMed

Lanese, Bethany

2016-09-19

Purpose The purpose of this paper is to test and measure the outcome of a community hospital in implementing the Affordable Care Act (ACA) through a co-management arrangement. RQ1: do the benefits of a co-management arrangement outweigh the costs? RQ2: does physician alignment aid in the effective implementation of the ACA directives set for hospitals? Design/methodology/approach A case study of a 350-bed non-profit community hospital co-management company. The quantitative data are eight quarters of quality metrics prior and eight quarters post establishment of the co-management company. The quality metrics are all based on standardized national requirements from the Joint Commission and Centers for Medicare and Medicaid Services guidelines. These measures directly impact the quality initiatives under the ACA that are applicable to all healthcare facilities. Qualitative data include survey results from hospital employees of the perceived effectiveness of the co-management company. A paired samples difference of means t-test was conducted to compare the timeframe before co-management and post co-management. Findings The findings indicate that the benefits of a co-management arrangement do outweigh the costs for both the physicians and the hospital ( RQ1). The physicians benefit through actual dollar payout, but also with improved communication and greater input in running the service line. The hospital benefits from reduced cost - or reduced penalties under the ACA - as well as better communication and greater physician involvement in administration of the service line. RQ2: does physician alignment aid in the effective implementation of the ACA directives set for hospitals? The hospital improved in every quality metric under the co-management company. A paired sample difference of means t-test showed a statistically significant improvement in five of the six quality metrics in the study. Originality/value Previous research indicates the potential effectiveness of co-management companies in improving healthcare delivery and hospital-physician relations (Sowers et al., 2013). The current research takes this a step further to show that the data do in fact support these concepts. The hospital and the physicians carrying out the day-to-day actions have shared goals, better communication, and improved quality metrics under the co-management company. As the number of co-management companies increases across the USA, more research can be directed at determining their overall impact on quality care.

Hydraulic and Thermal Response to Intermittent Pumping in Unconfined Alluvial Aquifers along a Regulated Stream

NASA Astrophysics Data System (ADS)

Maharjan, Madan

Groundwater response to stream stage fluctuations was studied using a year-long time series of stream stage and well heads in Glen Dale and New Martinsville, WV. Stream stage fluctuations exerted primary control over groundwater levels, especially during high flows. The location and operation of river pools created by dams alter groundwater flow paths and velocities. Aquifers are more prone to surface water infiltration in the upper reaches of pools than in lower reaches. Aquifer diffusivity is heterogeneous within and between the two sites. Temperature fluctuations were observed for 2.5 years in 14 wells in three alluvial aquifers. Temperature signals have 2 components corresponding to pump-on and pump-off periods. Both components vary seasonality at different magnitudes. While pump-off temperatures fluctuated up to 3.8o C seasonally, short-term temperature shifts induced by turning the pump on were 0.2 to 2.5o C. Pumping-induced temperature shifts were highest in magnitude in summer and winter. Groundwater temperature lagged behind that of surface water by approximately six months. Pumping induced and seasonal temperature shifts were spatially and temporally complex but indicate stream exfiltration is a major driver for a number of these wells. Numerical simulation of aquifer response to pumping show different conditions before and after well-field development. During pre-development, the stream was losing at high flow and gaining at low flow. During post-development, however, the stream was losing at high flow and spatially variable at low flow. While bank storage gained only during high stage, stream exfiltration occurred year-round. Pumping induced stream exfiltration by creating an extensive cone of depression beneath the stream in both upstream and downstream directions. Spatially and temporally variable groundwater-surface water interaction next to a regulated stream were studied using analytical and numerical models, based on field observations. Seasonality plays an important role in these interactions, but human activity may also alter its intensity.

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 dictate the systemic and health impacts that will become its legacy. This reality opens up ample opportunity to bolster public health aspects and interpretations of the law, and to simultaneously augment the corresponding components of the right to health. © 2011 American Society of Law, Medicine & Ethics, Inc.

Cerebral blood flow velocity and vasomotor reactivity before and after shunting surgery in patients with normal pressure hydrocephalus.

PubMed

Lee, E J; Hung, Y C; Chang, C H; Pai, M C; Chen, H H

1998-01-01

The purpose of this study was to evaluate pre- and post-shunting haemodynamic changes and their correlation with the clinical results in normal pressure hydrocephalus (NPH). Accordingly, eleven demented patients with clinical signs suggestive of NPH received examinations of cerebral blood flow velocity (BFV) and vasomotor reactivity (VMR) by transcranial Doppler sonography with carbogen testing before and after shunt treatment. Computerized tomography (CT), clinical assessment and neuropsychological grading were performed prior to and at 3 months following surgery. A control group consisting of 10 patients was included to establish baseline data. The pre-operative CBF studies in the anterior cerebral artery (ACA) and the middle cerebral artery (MCA) revealed the NPH patients did not have significant decreases of BFVs, but had significant decreases of carbogen VMR (P < 0.05). After shunting, there were no significant changes of the BFVs as compared with the pre-shunting data. The post-shunting VMR of the ACA was significantly higher than the pre-shunting one (p < 0.05), but there was no variation in that of the MCA. Both the values of post-shunting VMR in ACA and the post-shunting increase in VMR in MCA of the 7 shunt-responsive patients who improved mentally and in other symptoms were significantly higher than those of patients without improvement (p < 0.05). In addition, the five patients with gait improvement showed significantly higher values of post-shunting VMR of ACA and the post-shunting increase of VMR for both ACA and MCA when compared with those patients without gait improvement (p < 0.05, respectively). Our study supports the view that patients with NPH had various degrees of impaired VMR in both the ACA and the MCA, but showed insignificant reduction in BFVs, indicating a compensatory mechanism of CBF over time to accommodate the subnormal state of cerebral perfusion pressure. Shunt placement would improve the VMR in responsive patients. Postoperatively, an increase of VMR tends to accompany improvement of the functional state: that in the MCA alone is associated with symptomatic improvement in mental function and that increase in VMR in both the ACA and the MCA with improvement in gait, respectively.

Conserved composition of mammalian box H/ACA and box C/D small nucleolar ribonucleoprotein particles and their interaction with the common factor Nopp140.

PubMed

Yang, Y; Isaac, C; Wang, C; Dragon, F; Pogacic, V; Meier, U T

2000-02-01

Small nucleolar ribonucleoprotein particles (snoRNPs) mainly catalyze the modification of rRNA. The two major classes of snoRNPs, box H/ACA and box C/D, function in the pseudouridylation and 2'-O-methylation, respectively, of specific nucleotides. The emerging view based on studies in yeast is that each class of snoRNPs is composed of a unique set of proteins. Here we present a characterization of mammalian snoRNPs. We show that the previously characterized NAP57 is specific for box H/ACA snoRNPs, whereas the newly identified NAP65, the rat homologue of yeast Nop5/58p, is a component of the box C/D class. Using coimmunoprecipitation experiments, we show that the nucleolar and coiled-body protein Nopp140 interacts with both classes of snoRNPs. This interaction is corroborated in vivo by the exclusive depletion of snoRNP proteins from nucleoli in cells transfected with a dominant negative Nopp140 construct. Interestingly, RNA polymerase I transcription is arrested in nucleoli depleted of snoRNPs, raising the possibility of a feedback mechanism between rRNA modification and transcription. Moreover, the Nopp140-snoRNP interaction appears to be conserved in yeast, because depletion of Srp40p, the yeast Nopp140 homologue, in a conditional lethal strain induces the loss of box H/ACA small nucleolar RNAs. We propose that Nopp140 functions as a chaperone of snoRNPs in yeast and vertebrate cells.

Conserved Composition of Mammalian Box H/ACA and Box C/D Small Nucleolar Ribonucleoprotein Particles and Their Interaction with the Common Factor Nopp140

PubMed Central

Yang, Yunfeng; Isaac, Cynthia; Wang, Chen; Dragon, François; Pogac̆ić, Vanda; Meier, U. Thomas

2000-01-01

Small nucleolar ribonucleoprotein particles (snoRNPs) mainly catalyze the modification of rRNA. The two major classes of snoRNPs, box H/ACA and box C/D, function in the pseudouridylation and 2′-O-methylation, respectively, of specific nucleotides. The emerging view based on studies in yeast is that each class of snoRNPs is composed of a unique set of proteins. Here we present a characterization of mammalian snoRNPs. We show that the previously characterized NAP57 is specific for box H/ACA snoRNPs, whereas the newly identified NAP65, the rat homologue of yeast Nop5/58p, is a component of the box C/D class. Using coimmunoprecipitation experiments, we show that the nucleolar and coiled-body protein Nopp140 interacts with both classes of snoRNPs. This interaction is corroborated in vivo by the exclusive depletion of snoRNP proteins from nucleoli in cells transfected with a dominant negative Nopp140 construct. Interestingly, RNA polymerase I transcription is arrested in nucleoli depleted of snoRNPs, raising the possibility of a feedback mechanism between rRNA modification and transcription. Moreover, the Nopp140-snoRNP interaction appears to be conserved in yeast, because depletion of Srp40p, the yeast Nopp140 homologue, in a conditional lethal strain induces the loss of box H/ACA small nucleolar RNAs. We propose that Nopp140 functions as a chaperone of snoRNPs in yeast and vertebrate cells. PMID:10679015

Effects of the Affordable Care Act's Dependent Coverage Mandate on Private Health Insurance Coverage in Urban and Rural Areas.

PubMed

Look, Kevin A; Kim, Nam Hyo; Arora, Prachi

2017-01-01

To evaluate the impact of the Affordable Care Act's (ACA) dependent coverage mandate on insurance coverage among young adults in metropolitan and nonmetropolitan areas. A cross-sectional analysis was conducted using data from 2006-2009 and 2011 waves of the Medical Expenditure Panel Survey. A difference-in-difference analysis was used to compare changes in full-year private health insurance coverage among young adults aged 19-25 years with an older cohort aged 27-34 years. Separate regressions were estimated for individuals in metropolitan and nonmetropolitan areas and were tested for a differential impact by area of residence. Full-year private health insurance coverage significantly increased by 9.2 percentage points for young adults compared to the older cohort after the ACA mandate (P = .00). When stratifying the regression model by residence area, insurance coverage among young adults significantly increased by 9.0 percentage points in metropolitan areas (P = .00) and 10.1 percentage points in nonmetropolitan areas (P = .03). These changes were not significantly different from each other (P = .82), which suggests the ACA mandate's effects were not statistically different by area of residence. Although young adults in metropolitan and nonmetropolitan areas experienced increased access to private health insurance following the ACA's dependent coverage mandate, it did not appear to directly impact rural-urban disparities in health insurance coverage. Despite residents in both areas gaining insurance coverage, over one-third of young adults still lacked access to full-year health insurance coverage. © 2016 National Rural Health Association.

Comparative in vivo evaluation of two novel 99mTc labelled bombesin derivatives

NASA Astrophysics Data System (ADS)

Gourni, Eleni; Bouziotis, Penelope; Zikos, Christos; Loudos, George; Xanthopoulos, Stavros; Fani, Melpomeni; Archimandritis, Spyridon C.; Varvarigou, Alexandra D.

2006-12-01

Bombesin (BN), a 14 amino acid peptide, is an analogue of human gastrin-releasing-peptide (GRP) that binds to GRP receptors (GRP-R) with high affinity and specificity. In addition to this physiological role, GRP, through its interaction with GRP-R, promotes tumour growth in a number of human cancer cell lines. The GRP receptors are over-expressed on a variety of human cancer cells. Aim of the present work is the study of two novels BN-like peptides, by investigating the radiochemical and radiopharmacological behaviour of their complexes with metals. The derivatives under study are: Gly-Gly-Cys-Aca-BN [2-14] where Aca: 6-amino-hexanoic acid. Pyroglutamic acid in the bombesin molecule has been replaced by the chemical group Gly-Gly-Cys-Aca, which bears an amino-acid combination capable of complexing a variety of radiometals. The other derivative under study is: Gly-Gly-Cys-Aca-BN [7-14]. This moiety of the peptide has been chosen because it has been proven to be a potent GRP agonist. The peptide derivatives were synthesized by SPPS, according to the Fmoc strategy and were identified by reverse phase high performance liquid chromatography (RP-HPLC). Radiolabelling with 99mTc was performed via the precursor 99mTc-gluconate. The stability of the radiolabelled species was examined with time. In vivo studies of the two 99mTc-labelled derivatives were performed, comparatively, in normal mice, attention being focused on GRP receptor-bearing organs, and in experimentally induced prostate cancer models. Experimental tumours were imaged in a small field-of-view animal gamma camera.

Hotfire testing of a SSME HPOTP with an annular hydrostatic bearing

NASA Technical Reports Server (NTRS)

Nolan, Steven A.; Hibbs, Robert I.; Genge, Gary G.

1993-01-01

A new fluid film bearing package has been tested in the SSME High Pressure Oxygen Turbopump (HPOTP). This fluid film element functions as both the pump end bearing and the preburner pump rear wear ring seal. Most important, it replaces a duplex ball bearing package which has been the primary life limiting component in the turbopump. The design and predicted performance of the turbopump are reviewed. Results are presented for measured pump and bearing performance. The most significant results were obtained from proximity probes located in the bearing bore which revealed large subsynchronous precession at 10 percent of shaft speed during engine start which subsided prior to mainstage power levels and reappeared during engine shutdown at equivalent power levels below 65 percent of nominal. This phenomenon has been attributed to rotating stall in the diffuser. The proximity probes also revealed the location of the bearing in the bore for different operating speeds. Pump vibration characteristics were improved as compared to pumps tested with ball bearings. After seven starts and more than 700 seconds of testing, the pump showed no signs of performance degradation.

Michigan E85 Infrastructure

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

Sandstrom, Matthew M.

2012-03-30

This is the final report for a grant-funded project to financially assist and otherwise provide support to projects that increase E85 infrastructure in Michigan at retail fueling locations. Over the two-year project timeframe, nine E85 and/or flex-fuel pumps were installed around the State of Michigan at locations currently lacking E85 infrastructure. A total of five stations installed the nine pumps, all providing cost share toward the project. By using cost sharing by station partners, the $200,000 provided by the Department of Energy facilitated a total project worth $746,332.85. This project was completed over a two-year timetable (eight quarters). The firstmore » quarter of the project focused on project outreach to station owners about the incentive on the installation and/or conversion of E85 compatible fueling equipment including fueling pumps, tanks, and all necessary electrical and plumbing connections. Utilizing Clean Energy Coalition (CEC) extensive knowledge of gasoline/ethanol infrastructure throughout Michigan, CEC strategically placed these pumps in locations to strengthen the broad availability of E85 in Michigan. During the first and second quarters, CEC staff approved projects for funding and secured contracts with station owners; the second through eighth quarters were spent working with fueling station owners to complete projects; the third through eighth quarters included time spent promoting projects; and beginning in the second quarter and running for the duration of the project was spent performing project reporting and evaluation to the US DOE. A total of 9 pumps were installed (four in Elkton, two in Sebewaing, one in East Lansing, one in Howell, and one in Whitmore Lake). At these combined station locations, a total of 192,445 gallons of E85, 10,786 gallons of E50, and 19,159 gallons of E30 were sold in all reporting quarters for 2011. Overall, the project has successfully displaced 162,611 gallons (2,663 barrels) of petroleum, and reduced regional GHG emissions by 375 tons in the first year of station deployment.« less

Refugee Resettlement Patterns and State-Level Health Care Insurance Access in the United States

PubMed Central

Venkatesh, Arjun Krishna

2016-01-01

We sought to evaluate the relationship between state-level implementation of the Patient Protection and Affordable Care Act (ACA) and resettlement patterns among refugees. We linked federal refugee resettlement data to ACA expansion data and found that refugee resettlement rates are not significantly different according to state-level insurance expansion or cost. Forty percent of refugees have resettled to states without Medicaid expansion. The wide state-level variability in implementation of the ACA should be considered by federal agencies seeking to optimize access to health insurance coverage among refugees who have resettled to the United States. PMID:26890186

[Correlations between the dimensions of clinical learning environments from the perspective of medical residents].

PubMed

Hamui Sutton, Alicia; Flores Hernández, Fernando; Gutiérrez Barreto, Samuel; Castro Ramírez, Senyasen; Lavalle Montalvo, Carlos; Vilar Puig, Pelayo

2014-01-01

The aim of the present study was to establish correlations between the dimensions of clinical learning environments (ACA) considering variables like: health institutions, hospital offices, specialty, and year of residency. 4,189 doctors were evaluated through an online survey in 2012. The results revealed that the dimension of "educational processes" correlated best with others; specialties with the best ACA from the view of the medical residents were Internal Medicine and Surgery; and the third year residents had less favorable perceptions of their ACA. The pursuance of the academic program is relevant to physicians in training and teachers play an important role in the educational process.

Control of respiration in fish, amphibians and reptiles.

PubMed

Taylor, E W; Leite, C A C; McKenzie, D J; Wang, T

2010-05-01

Fish and amphibians utilise a suction/force pump to ventilate gills or lungs, with the respiratory muscles innervated by cranial nerves, while reptiles have a thoracic, aspiratory pump innervated by spinal nerves. However, fish can recruit a hypobranchial pump for active jaw occlusion during hypoxia, using feeding muscles innervated by anterior spinal nerves. This same pump is used to ventilate the air-breathing organ in air-breathing fishes. Some reptiles retain a buccal force pump for use during hypoxia or exercise. All vertebrates have respiratory rhythm generators (RRG) located in the brainstem. In cyclostomes and possibly jawed fishes, this may comprise elements of the trigeminal nucleus, though in the latter group RRG neurons have been located in the reticular formation. In air-breathing fishes and amphibians, there may be separate RRG for gill and lung ventilation. There is some evidence for multiple RRG in reptiles. Both amphibians and reptiles show episodic breathing patterns that may be centrally generated, though they do respond to changes in oxygen supply. Fish and larval amphibians have chemoreceptors sensitive to oxygen partial pressure located on the gills. Hypoxia induces increased ventilation and a reflex bradycardia and may trigger aquatic surface respiration or air-breathing, though these latter activities also respond to behavioural cues. Adult amphibians and reptiles have peripheral chemoreceptors located on the carotid arteries and central chemoreceptors sensitive to blood carbon dioxide levels. Lung perfusion may be regulated by cardiac shunting and lung ventilation stimulates lung stretch receptors.

A Novel Method for Estimating Shortwave Direct Radiative Effect of Above-Cloud Aerosols Using CALIOP and MODIS Data

NASA Technical Reports Server (NTRS)

Zhang, Zhibo; Meyer, Kerry G.; Platnick, Steven; Oreopoulos, Lazaros; Lee, Dongmin; Yu, Hongbin

2014-01-01

This paper describes an efficient and unique method for computing the shortwave direct radiative effect (DRE) of aerosol residing above low-level liquid-phase clouds using CALIOP and MODIS data. It addresses the overlap of aerosol and cloud rigorously by utilizing the joint histogram of cloud optical depth and cloud top pressure while also accounting for subgrid-scale variations of aerosols. The method is computationally efficient because of its use of grid-level cloud and aerosol statistics, instead of pixel-level products, and a pre-computed look-up table based on radiative transfer calculations. We verify that for smoke over the southeast Atlantic Ocean the method yields a seasonal mean instantaneous (approximately 1:30PM local time) shortwave DRE of above cloud aerosol (ACA) that generally agrees with more rigorous pixel-level computation within 4 percent. We also estimate the impact of potential CALIOP aerosol optical depth (AOD) retrieval bias of ACA on DRE. We find that the regional and seasonal mean instantaneous DRE of ACA over southeast Atlantic Ocean would increase, from the original value of 6.4 W m(-2) based on operational CALIOP AOD to 9.6 W m(-2) if CALIOP AOD retrieval are biased low by a factor of 1.5 (Meyer et al., 2013) and further to 30.9 W m(-2) if CALIOP AOD retrieval are biased low by a factor of 5 as suggested in (Jethva et al., 2014). In contrast, the instantaneous ACA radiative forcing efficiency (RFE) remains relatively invariant in all cases at about 53 W m(-2) AOD(-1), suggesting a near linear relation between the instantaneous RFE and AOD. We also compute the annual mean instantaneous shortwave DRE of light-absorbing aerosols (i.e., smoke and polluted dust) over global oceans based on 4 years of CALIOP and MODIS data. We find that the variability of the annual mean shortwave DRE of above-cloud light-absorbing aerosol is mainly driven by the optical depth of the underlying clouds. While we demonstrate our method using CALIOP and MODIS data, it can also be extended to other satellite data sets, as well as climate model outputs.

Planetary Defense. Department of Defense Cost for the Detection, Exploration, and Rendezvous Mission of Near-Earth Objects

DTIC Science & Technology

1997-01-01

or even impact the Earth. In the past 15 years, research on NEOs has dra­ mati cally increased as astrono mers and ge­ olo gists real ize the Earth...fig. 7). In 1989, astrono mers discov ered an aster­ oid labeled 1989FC after its closest approach to Earth. This illus trates a disturb ing fact...Cur rently only astrono mers on shoestring, aca demic budgets are trying to locate and track NEOs, making esti mates of NEO popu­ la tions very impre

Self-potential response to periodic pumping test: a numerical study

NASA Astrophysics Data System (ADS)

Konosavsky, Pavel; Maineult, Alexis; Narbut, Mikhail; Titov, Konstantin

2017-09-01

We numerically model self-potential responses associated with periodic pumping test experiments by sequential calculation of the hydraulic response and the coupled electrical potential. We assume the pumping test experiments with a fully saturated confined aquifer. Application of different excitation functions leads to quasi-linear trends in electrical records whose direction and intensity depend on the form of the excitation function. The hydraulic response is phase shifted compared to the excitation function; the phase shift increases quasi-linearly with the distance from the pumping well. For the electrical signals, we investigated separately the cases of conducting and insulating casings of the pumping well. For the conducting casing the electrical signals are larger in magnitude than that for the insulating casing; they reproduce the drawdown signals in the pumping well at any distance from the well and exhibit any phase shift with the increased distance. For the insulating casing, the electrical signals are phase shifted and their shape depends on the distance from the pumping well. Three characteristic regimes were found for the phase shift, φ, with the increased distance and for various hydraulic diffusivity values. At small distances φ increases quasi-linearly; at intermediate distances φ attends the value of π/2 and stay about this value (for relatively small diffusivity values); and at large distances φ attends the value of π and, stay about this value at larger distances. This behaviour of the electrical signals can be explained by two electrical sources of reverse polarity. They are (i) linear, time independent, and located at the pumping interval of the well; and (ii) volumetric, time dependent, with maximum value located in the aquifer at the distance corresponding to maximum variation of the hydraulic head magnitude with time. We also model the variation of the amplitude and phase of the hydraulic and electrical signals with increased excitation function period, and we show the characteristic periods corresponding to transition of the periodic pumping test regime to the classical pumping test regime, when the excitation function is considered as the step-function. This transition depends on the distance from the pumping well and the hydraulic diffusivity value of aquifer. Finally, with this modelling of saturated flow we reproduced in sufficient details the field data previously obtained by Maineult et al.

18 CFR 154.402 - ACA expenditures.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 18 Conservation of Power and Water Resources 1 2011-04-01 2011-04-01 false ACA expenditures. 154.402 Section 154.402 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REGULATIONS UNDER NATURAL GAS ACT RATE SCHEDULES AND TARIFFS Limited Rate Changes § 154...

18 CFR 154.402 - ACA expenditures.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 18 Conservation of Power and Water Resources 1 2012-04-01 2012-04-01 false ACA expenditures. 154.402 Section 154.402 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REGULATIONS UNDER NATURAL GAS ACT RATE SCHEDULES AND TARIFFS Limited Rate Changes § 154...

18 CFR 154.402 - ACA expenditures.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false ACA expenditures. 154.402 Section 154.402 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REGULATIONS UNDER NATURAL GAS ACT RATE SCHEDULES AND TARIFFS Limited Rate Changes § 154...

18 CFR 154.402 - ACA expenditures.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 18 Conservation of Power and Water Resources 1 2014-04-01 2014-04-01 false ACA expenditures. 154.402 Section 154.402 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REGULATIONS UNDER NATURAL GAS ACT RATE SCHEDULES AND TARIFFS Limited Rate Changes § 154...

18 CFR 154.402 - ACA expenditures.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 18 Conservation of Power and Water Resources 1 2013-04-01 2013-04-01 false ACA expenditures. 154.402 Section 154.402 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REGULATIONS UNDER NATURAL GAS ACT RATE SCHEDULES AND TARIFFS Limited Rate Changes § 154...

Celebrations: American Camping Association Annual Report 1986.

ERIC Educational Resources Information Center

American Camping Association, Martinsville, IN.

The 1986 American Camping Association (ACA) annual report reviews the year's achievements and outlines goals for the future. An introductory message from ACA President Jean McMullan notes successful fund raising to improve the association's national headquarters, passage of federal legislation exempting camps from paying federal unemployment…

76 FR 61090 - Endangered and Threatened Species; Counterpart Regulations

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-03

...), Interior. ACTION: Notice of availability. SUMMARY: The U.S. Forest Service and Bureau of Land Management..., National Fire Plan Counterpart Regulation Alternative Consultation Agreements (ACAs). DATES: This is... actions that support the National Fire Plan. Upon entering into an ACA with the Services, action agencies...

ACA: Phoenix of-or Cooked in-This Dumpster Fire of an Election.

PubMed

Kirkner, Richard Mark

2016-10-01

Hillary Clinton and Donald Trump promise divergent approaches to the ACA if elected. Basically, Clinton wants to improve it; Trump promises to dismantle it. Of course, no president acts in a vacuum, and a lot will also depend on which party controls Congress.

Near Heterophoria in Early Childhood

PubMed Central

Babinsky, Erin; Sreenivasan, Vidhyapriya; Candy, T. Rowan

2015-01-01

Purpose. The purpose of this study was to measure near heterophoria in young children to determine the impact of early growth and development on the alignment of the eyes. Methods. Fifty young children (≥2 and <7 years of age; range of spherical equivalent refractive error −1.25 diopters [D] to +3.75 D) and 13 adults participated. Their eye position and accommodation responses, in the absence of optical correction, were measured using simultaneous Purkinje image tracking and photorefraction technology (MCS PowerRefractor, PR). The resulting heterophorias, and both accommodative convergence/accommodation (AC/A) and convergence accommodation/convergence (CA/C) ratios were then computed as a function of age, refractive error, and an alternating cover test. Results. The mean heterophoria after approximately 60 seconds of dissociation at a 33-cm viewing distance was 5.0 prism diopters (pd) of exophoria (SD ± 3.7) in the children (78% of children > 2 pd exophoric) and 5.6 pd of exophoria (SD ± 4.7) in adults (69% of adults > 2pd exophoric; a nonsignificant difference), with no effect of age between 2 and 6 years. In these children, heterophoria was not significantly correlated with AC/A (r = 0.25), CA/C (r = 0.12), or refractive error (r = 0.21). The mean difference between heterophoria measurements from the PR and the clinical cover test was −2.4 pd (SD = ±3.4), with an exophoric bias in the PR measurements. Conclusions. Despite developmental maturation of interpupillary distance, refractive error, and AC/A, in a typical sample of young children the predominant dissociated position is one of exophoria. PMID:25634983

The Impact Of State Policies On ACA Applications And Enrollment Among Low-Income Adults In Arkansas, Kentucky, And Texas.

PubMed

Sommers, Benjamin D; Maylone, Bethany; Nguyen, Kevin H; Blendon, Robert J; Epstein, Arnold M

2015-06-01

States are taking variable approaches to the Affordable Care Act (ACA) Medicaid expansion, Marketplace design, enrollment outreach, and application assistance. We surveyed nearly 3,000 low-income adults in late 2014 to compare experiences in three states with markedly different policies: Kentucky, which expanded Medicaid, created a successful state Marketplace, and supported outreach efforts; Arkansas, which enacted the private option and a federal-state partnership Marketplace, but with legislative limitations on outreach; and Texas, which did not expand Medicaid and passed restrictions on navigators. We found that application rates, successful enrollment, and positive experiences with the ACA were highest in Kentucky, followed by Arkansas, with Texas performing worst. Limited awareness remains a critical barrier: Fewer than half of adults had heard some or a lot about the coverage expansions. Application assistance from navigators and others was the strongest predictor of enrollment, while Latino applicants were less likely than others to successfully enroll. Twice as many respondents felt that the ACA had helped them as hurt them (although the majority reported no direct impact), and advertising was strongly associated with perceptions of the law. State policy choices appeared to have had major impacts on enrollment experiences among low-income adults and their perceptions of the ACA. Project HOPE—The People-to-People Health Foundation, Inc.

Disparities in Insurance Coverage, Health Services Use, and Access Following Implementation of the Affordable Care Act: A Comparison of Disabled and Nondisabled Working-Age Adults.

PubMed

Kennedy, Jae; Wood, Elizabeth Geneva; Frieden, Lex

2017-01-01

The objective of this study was to assess trends in health insurance coverage, health service utilization, and health care access among working-age adults with and without disabilities before and after full implementation of the Affordable Care Act (ACA), and to identify current disability-based disparities following full implementation of the ACA. The ACA was expected to have a disproportionate impact on working-age adults with disabilities, because of their high health care usage as well as their previously limited insurance options. However, most published research on this population does not systematically look at effects before and after full implementation of the ACA. As the US Congress considers new health policy reforms, current and accurate data on this vulnerable population are essential. Weighted estimates, trend analyses and analytic models were conducted using the 1998-2016 National Health Interview Surveys (NHIS) and the 2014 Medical Expenditure Panel Survey. Compared with working-age adults without disabilities, those with disabilities are less likely to work, more likely to earn below the federal poverty level, and more likely to use public insurance. Average health costs for this population are 3 to 7 times higher, and access problems are far more common. Repeal of key features of the ACA, like Medicaid expansion and marketplace subsidies, would likely diminish health care access for working-age adults with disabilities.

New methods for the assessment of accommodative convergence.

PubMed

Asakawa, Ken; Ishikawa, Hitoshi; Shoji, Nobuyuki

2009-01-01

The authors introduced a new objective method for measuring horizontal eye movements based on the first Purkinje image with the use of infrared charge-coupled device (CCD) cameras and compared stimulus accommodative convergence to accommodation (AC/A) ratios as determined by a standard gradient method. The study included 20 patients, 5 to 9 years old, who had intermittent exotropia (10 eyes) and accommodative esotropia (10 eyes). Measurement of horizontal eye movements in millimeters (mm), based on the first Purkinje image, was obtained with a TriIRIS C9000 instrument (Hamamatsu Photonics K.K., Hamamatsu, Japan). The stimulus AC/A ratio was determined with the far gradient method. The average values of horizontal eye movements (mm) and eye deviation (Delta) (a) before and (b) after an accommodative stimulus of 3.00 diopters (D) were calculated with the following formula: horizontal eye movements (mm/D) and stimulus AC/A ratio (Delta/D) = (b - a)/3. The average values of the horizontal eye movements and the stimulus AC/A ratio were 0.5 mm/D and 3.8 Delta/D, respectively. Correlation analysis showed a strong positive correlation between these two parameters (r = 0.92). Moreover, horizontal eye movements are directly proportional to the AC/A ratio measured with the gradient method. The methods used in this study allow objective recordings of accommodative convergence to be obtained in many clinical situations. Copyright 2009, SLACK Incorporated.

Reduced-rank approximations to the far-field transform in the gridded fast multipole method

NASA Astrophysics Data System (ADS)

Hesford, Andrew J.; Waag, Robert C.

2011-05-01

The fast multipole method (FMM) has been shown to have a reduced computational dependence on the size of finest-level groups of elements when the elements are positioned on a regular grid and FFT convolution is used to represent neighboring interactions. However, transformations between plane-wave expansions used for FMM interactions and pressure distributions used for neighboring interactions remain significant contributors to the cost of FMM computations when finest-level groups are large. The transformation operators, which are forward and inverse Fourier transforms with the wave space confined to the unit sphere, are smooth and well approximated using reduced-rank decompositions that further reduce the computational dependence of the FMM on finest-level group size. The adaptive cross approximation (ACA) is selected to represent the forward and adjoint far-field transformation operators required by the FMM. However, the actual error of the ACA is found to be greater than that predicted using traditional estimates, and the ACA generally performs worse than the approximation resulting from a truncated singular-value decomposition (SVD). To overcome these issues while avoiding the cost of a full-scale SVD, the ACA is employed with more stringent accuracy demands and recompressed using a reduced, truncated SVD. The results show a greatly reduced approximation error that performs comparably to the full-scale truncated SVD without degrading the asymptotic computational efficiency associated with ACA matrix assembly.

Reduced-Rank Approximations to the Far-Field Transform in the Gridded Fast Multipole Method.

PubMed

Hesford, Andrew J; Waag, Robert C

2011-05-10

The fast multipole method (FMM) has been shown to have a reduced computational dependence on the size of finest-level groups of elements when the elements are positioned on a regular grid and FFT convolution is used to represent neighboring interactions. However, transformations between plane-wave expansions used for FMM interactions and pressure distributions used for neighboring interactions remain significant contributors to the cost of FMM computations when finest-level groups are large. The transformation operators, which are forward and inverse Fourier transforms with the wave space confined to the unit sphere, are smooth and well approximated using reduced-rank decompositions that further reduce the computational dependence of the FMM on finest-level group size. The adaptive cross approximation (ACA) is selected to represent the forward and adjoint far-field transformation operators required by the FMM. However, the actual error of the ACA is found to be greater than that predicted using traditional estimates, and the ACA generally performs worse than the approximation resulting from a truncated singular-value decomposition (SVD). To overcome these issues while avoiding the cost of a full-scale SVD, the ACA is employed with more stringent accuracy demands and recompressed using a reduced, truncated SVD. The results show a greatly reduced approximation error that performs comparably to the full-scale truncated SVD without degrading the asymptotic computational efficiency associated with ACA matrix assembly.

Reduced-Rank Approximations to the Far-Field Transform in the Gridded Fast Multipole Method

PubMed Central

Hesford, Andrew J.; Waag, Robert C.

2011-01-01

The fast multipole method (FMM) has been shown to have a reduced computational dependence on the size of finest-level groups of elements when the elements are positioned on a regular grid and FFT convolution is used to represent neighboring interactions. However, transformations between plane-wave expansions used for FMM interactions and pressure distributions used for neighboring interactions remain significant contributors to the cost of FMM computations when finest-level groups are large. The transformation operators, which are forward and inverse Fourier transforms with the wave space confined to the unit sphere, are smooth and well approximated using reduced-rank decompositions that further reduce the computational dependence of the FMM on finest-level group size. The adaptive cross approximation (ACA) is selected to represent the forward and adjoint far-field transformation operators required by the FMM. However, the actual error of the ACA is found to be greater than that predicted using traditional estimates, and the ACA generally performs worse than the approximation resulting from a truncated singular-value decomposition (SVD). To overcome these issues while avoiding the cost of a full-scale SVD, the ACA is employed with more stringent accuracy demands and recompressed using a reduced, truncated SVD. The results show a greatly reduced approximation error that performs comparably to the full-scale truncated SVD without degrading the asymptotic computational efficiency associated with ACA matrix assembly. PMID:21552350

Effect of the accountable care act of 2010 on clinical trial insurance coverage.

PubMed

Kircher, Sheetal M; Benson, Al B; Farber, Matthew; Nimeiri, Halla S

2012-02-10

The Affordable Care Act (ACA) of 2010 implemented dramatic changes in our health care system. The new law requires that insurers and health plans provide coverage for individuals participating in clinical trials. Currently, there are states that already have laws or agreements requiring clinical trial coverage, but there remain deficiencies that will need to be addressed to achieve compliance with the new law. State mandates were reviewed to determine current laws and agreements. The ACA was reviewed to outline its provisions, and these were compared with current mandates to identify deficiencies. Eighteen states meet the requirements set forth by the ACA either through a state law or agreement; 33 states do not meet the requirements. Of these 33 states, 15 do not have any existing laws or agreements in place regarding clinical trials. In states that have deficient policies in place, the most common deficiency is the lack of phase I coverage. The second most common deficiency in policy is coverage of only therapeutic studies. Most states currently do not meet the requirements of the ACA and will be required to make changes by 2014. The implications of the ACA with regard to insurance coverage of clinical trials remain unclear as implementation of the legislation unfolds. State governments can take steps to ensure insurance coverage by creating and expanding agreements with insurance companies.

The Ca2+ pump inhibitor, thapsigargin, inhibits root gravitropism in Arabidopsis thaliana.

PubMed

Urbina, Daniela C; Silva, Herman; Meisel, Lee A

2006-01-01

Thapsigargin, a specific inhibitor of most animal intracellular SERCA-type Ca2+ pumps present in the sarcoplasmic/endoplasmic reticulum, was originally isolated from the roots of the Mediterranean plant Thapsia gargancia L. Here, we demonstrate that this root-derived compound is capable of altering root gravitropism in Arabidopsis thaliana. Thapsigargin concentrations as low as 0.1 microM alter root gravitropism whereas under similar conditions cyclopiazonic acid does not. Furthermore, a fluorescently conjugated thapsigargin (BODIPY FL thapsigargin) suggests that target sites for thapsigargin are located in intracellular organelles in the root distal elongation zone and the root cap, regions known to regulate root gravitropism.

78 FR 46936 - Combined Notice of Filings

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-02

...: Filings Instituting Proceedings Docket Numbers: RP13-1103-000. Applicants: Northern Border Pipeline Company. Description: ACA Filing 2013 to be effective 10/1/2013. Filed Date: 7/25/13. Accession Number... Gas Transmission System. Description: ACA Filing 2013 to be effective 10/1/2013. Filed Date: 7/25/13...

75 FR 56578 - Renewal of the Advisory Committee on Apprenticeship (ACA), and an Open Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-16

... the ACA Co-Chairs Regulatory Update on CFR 29.29 and CFR 29.30 Future Opportunities and Challenges for... President, Training and Development, Independent Electrical Contractors, Inc., Alexandria, Virginia. Mr.... Liz Elvin, Senior Director, Workforce Development, AGC of America, Arlington, Virginia. Mr. Frederick...

78 FR 49501 - Combined Notice of Filings

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-14

... Numbers: RP13-1177-000. Applicants: Garden Banks Gas Pipeline, LLC. Description: Compliance with New ACA...: Central Kentucky Transmission Company. Description: ACA 2013 to be effective 10/1/2013. Filed Date: 8/1/13... intervention is necessary to become a party to the proceeding. Filings in Existing Proceedings Docket Numbers...

Supporting IAAOC Members: Potential Localized Services

ERIC Educational Resources Information Center

Lambert, Simone F.

2010-01-01

For the past 37 years, the International Association of Addictions and Offender Counselors (IAAOC), a division of the American Counseling Association (ACA), has provided a home for offender counselors and eventually addictions counselors. Throughout that time, the organization's structure has mirrored that of ACA. For instance, the IAAOC (2004)…

77 FR 65395 - Air Cargo Advance Screening (ACAS) Pilot Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-26

... DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection Air Cargo Advance Screening (ACAS) Pilot Program Correction In notice document 2012-26031 appearing on pages 65006-65009 in the issue of October 24, 2012 make the following correction: On page 65007, in the first column, under the...

76 FR 41262 - Notice of Intent To Award Affordable Care Act (ACA) Funding, EH11-1103

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-13

... Intent To Award Affordable Care Act (ACA) Funding, EH11-1103 Notice of Intent to award Affordable Care... opportunity EH11-1103, ``National Environmental Public Health Tracking Program-Network Implementation... under funding opportunity EH11-1103, ``National Environmental Public Health Tracking Program-Network...

76 FR 19765 - Toutant Hydropower Inc.; Notice of Application Accepted for Filing, Soliciting Comments, Motions...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-08

... refurbished and re-installed small ``fire pump'' turbine direct coupled to a 120 kilowatt, 2300 volt, AC synchronous vertically mounted generator. The ``fire pump'' turbine is located in the southwest corner of the existing turbine pit. The ``fire pump'' turbine has a rated maximum hydraulic capacity of 106 cubic feet...

Space Shuttle Main Engine structural analysis and data reduction/evaluation. Volume 3B: High pressure fuel turbo-pump preburner pump bearing assembly analysis

NASA Technical Reports Server (NTRS)

Power, Gloria B.; Violett, Rebeca S.

1989-01-01

The analysis performed on the High Pressure Oxidizer Turbopump (HPOTP) preburner pump bearing assembly located on the Space Shuttle Main Engine (SSME) is summarized. An ANSYS finite element model for the inlet assembly was built and executed. Thermal and static analyses were performed.

A new slit lamp-based technique for anterior chamber angle estimation.

PubMed

Gispets, Joan; Cardona, Genís; Tomàs, Núria; Fusté, Cèlia; Binns, Alison; Fortes, Miguel A

2014-06-01

To design and test a new noninvasive method for anterior chamber angle (ACA) estimation based on the slit lamp that is accessible to all eye-care professionals. A new technique (slit lamp anterior chamber estimation [SLACE]) that aims to overcome some of the limitations of the van Herick procedure was designed. The technique, which only requires a slit lamp, was applied to estimate the ACA of 50 participants (100 eyes) using two different slit lamp models, and results were compared with gonioscopy as the clinical standard. The Spearman nonparametric correlation between ACA values as determined by gonioscopy and SLACE were 0.81 (p < 0.001) and 0.79 (p < 0.001) for each slit lamp. Sensitivity values of 100 and 87.5% and specificity values of 75 and 81.2%, depending on the slit lamp used, were obtained for the SLACE technique as compared with gonioscopy (Spaeth classification). The SLACE technique, when compared with gonioscopy, displayed good accuracy in the detection of narrow angles, and it may be useful for eye-care clinicians without access to expensive alternative equipment or those who cannot perform gonioscopy because of legal constraints regarding the use of diagnostic drugs.

Young Adults' Selection and Use of Dependent Coverage under the Affordable Care Act.

PubMed

Chen, Weiwei

2018-01-01

The dependent coverage expansion under the Affordable Care Act (ACA) required health insurance policies that cover dependents to offer coverage for policyholder' children up to age 26. It has been well documented that the provision successfully reduced the uninsured rate among the young adults. However, less is known about whether dependent coverage crowded out other insurance types and whether young adults used dependent coverage as a fill-in-the-gap short-term option. Using data from the Survey of Income and Program Participation 2008 Panel, the paper assesses dependent coverage uptake and duration before and after the ACA provision among young adults aged 19-26 versus those aged 27-30. Regressions for additional coverage outcomes were also performed to estimate the crowd-out rate. It was found that the ACA provision had a significant positive impact on dependent coverage uptake and duration. The estimated crowd-out rate ranges from 27 to 42%, depending on the definition. Most dependent coverage enrollees used the coverage for 1 or 2 years. Differences in dependent coverage uptake and duration remained among racial groups. Less healthy individuals were also less likely to make use of dependent coverage.

Young Adults’ Selection and Use of Dependent Coverage under the Affordable Care Act

PubMed Central

Chen, Weiwei

2018-01-01

The dependent coverage expansion under the Affordable Care Act (ACA) required health insurance policies that cover dependents to offer coverage for policyholder’ children up to age 26. It has been well documented that the provision successfully reduced the uninsured rate among the young adults. However, less is known about whether dependent coverage crowded out other insurance types and whether young adults used dependent coverage as a fill-in-the-gap short-term option. Using data from the Survey of Income and Program Participation 2008 Panel, the paper assesses dependent coverage uptake and duration before and after the ACA provision among young adults aged 19–26 versus those aged 27–30. Regressions for additional coverage outcomes were also performed to estimate the crowd-out rate. It was found that the ACA provision had a significant positive impact on dependent coverage uptake and duration. The estimated crowd-out rate ranges from 27 to 42%, depending on the definition. Most dependent coverage enrollees used the coverage for 1 or 2 years. Differences in dependent coverage uptake and duration remained among racial groups. Less healthy individuals were also less likely to make use of dependent coverage. PMID:29445721

Anterior segment optical coherence tomography parameters in phacomorphic angle closure and mature cataracts.

PubMed

Mansouri, Mohammadreza; Ramezani, Farshid; Moghimi, Sasan; Tabatabaie, Ali; Abdi, Fatemeh; He, Mingguang; Lin, Shan C

2014-10-21

To describe anterior segment optical coherence tomography (AS-OCT) parameters in phacomorphic angle closure eyes, mature cataract eyes, and their fellow eyes, and identify those parameters that could be used to differentiate phacomorphic angle closure eyes from those with mature cataract and no phacomorphic angle closure. In this cross-sectional study, a total of 33 phacomorphic angle closure subjects and 34 control patients with unilateral mature cataracts were enrolled. All patients underwent AS-OCT imaging and A-scan biometry of both eyes. Anterior chamber depth (ACD), anterior chamber area (ACA), iris thickness, iris curvature, lens vault (LV), and angle parameters, including angle opening distance (AOD750) and trabecular-iris space area (TISA750), were measured in qualified images using customized software and compared among eyes with phacomorphic angle closure, mature cataract eyes, and their fellow eyes. There was no significant difference in axial length among the four groups. Phacomorphic angle closure had the smallest angle (AOD750, TISA750) and anterior chamber parameters (ACD, ACA, anterior chamber width) and the greatest LV among the groups. This pattern was similar when comparing fellow eyes of mature cataract patients and fellow eyes of phacomorphic angle closure. Anterior chamber area less than 18.62 mm(2), ACD less than 2.60 mm, LV greater than 532.0 μm, and AOD750 less than 0.218 mm had the highest odds ratios (ORs) for distinguishing fellow eyes of phacomorphic angle closure versus fellow eyes of mature cataracts, with OR values of 9.90, 8.31, 7.91, and 7.91, respectively. Logistic regression showed that ACA less than 18.62 was the major parameter associated with fellow eyes of phacomorphic angle closure (OR = 10.96, P < 0.001). Anterior chamber depth, ACA, AOD750, and LV are powerful indicators in differentiating phacomorphic angle closure eyes from those with mature cataract and their fellow eyes. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

77 FR 21765 - Nevada Hydro Company, Inc.; Notice of Preliminary Permit Application Accepted for Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-11

... level (msl); (2) a powerhouse with two reversible pump-turbine units with a total installed capacity of... California Edison located north of the proposed project and to an existing San Diego Gas & Electric Company...

Prevalence of substandard and falsified artemisinin-based combination antimalarial medicines on Bioko Island, Equatorial Guinea

PubMed Central

Kaur, Harparkash; Allan, Elizabeth Louise; Mamadu, Ibrahim; Hall, Zoe; Green, Michael D; Swamidos, Isabel; Dwivedi, Prabha; Culzoni, Maria Julia; Fernandez, Facundo M; Garcia, Guillermo; Hergott, Dianna; Monti, Feliciano

2017-01-01

Introduction Poor-quality artemisinin-containing antimalarials (ACAs), including falsified and substandard formulations, pose serious health concerns in malaria endemic countries. They can harm patients, contribute to the rise in drug resistance and increase the public’s mistrust of health systems. Systematic assessment of drug quality is needed to gain knowledge on the prevalence of the problem, to provide Ministries of Health with evidence on which local regulators can take action. Methods We used three sampling approaches to purchase 677 ACAs from 278 outlets on Bioko Island, Equatorial Guinea as follows: convenience survey using mystery client (n=16 outlets, 31 samples), full island-wide survey using mystery client (n=174 outlets, 368 samples) and randomised survey using an overt sampling approach (n=88 outlets, 278 samples). The stated active pharmaceutical ingredients (SAPIs) were assessed using high-performance liquid chromatography and confirmed by mass spectrometry at three independent laboratories. Results Content analysis showed 91.0% of ACAs were of acceptable quality, 1.6% were substandard and 7.4% falsified. No degraded medicines were detected. The prevalence of medicines without the SAPIs was higher for ACAs purchased in the convenience survey compared with the estimates obtained using the full island-wide survey-mystery client and randomised-overt sampling approaches. Comparable results were obtained for full island survey-mystery client and randomised overt. However, the availability of purchased artesunate monotherapies differed substantially according to the sampling approach used (convenience, 45.2%; full island-wide survey-mystery client, 32.6%; random-overt sampling approach, 21.9%). Of concern is that 37.1% (n=62) of these were falsified. Conclusion Falsified ACAs were found on Bioko Island, with the prevalence ranging between 6.1% and 16.1%, depending on the sampling method used. These findings underscore the vital need for national authorities to track the scale of ineffective medicines that jeopardise treatment of life-threatening diseases and value of a representative sampling approach to obtain/measure the true prevalence of poor-quality medicines. PMID:29082025

Bedside Testing for Chronic Pelvic Pain: Discriminating Visceral from Somatic Pain

PubMed Central

Jarrell, John; Giamberardino, Maria Adele; Robert, Magali; Nasr-Esfahani, Maryam

2011-01-01

Objectives. This study was done to evaluate three bedside tests in discriminating visceral pain from somatic pain among women with chronic pelvic pain. Study Design. The study was an exploratory cross-sectional evaluation of 81 women with chronic pelvic pain of 6 or more months' duration. Tests included abdominal cutaneous allodynia (aCA), perineal cutaneous allodynia (pCA), abdominal and perineal myofascial trigger points (aMFTP) and (pMFTP), and reduced pain thresholds (RPTs). Results. Eighty-one women were recruited, and all women provided informed consent. There were 62 women with apparent visceral pain and 19 with apparent somatic sources of pain. The positive predictive values for pelvic visceral disease were aCA-93%, pCA-91%, aMFTP-93%, pMFTP-81%, and RPT-79%. The likelihood ratio (+) and 95% C.I. for the detection of visceral sources of pain were aCA-4.19 (1.46, 12.0), pCA-2.91 (1.19, 7.11), aMTRP-4.19 (1.46, 12.0), pMFTP-1.35 (0.86, 2.13), and RPT-1.14 (0.85, 1.52), respectively. Conclusions. Tests of cutaneous allodynia, myofascial trigger points, and reduced pain thresholds are easily applied and well tolerated. The tests for cutaneous allodynia appear to have the greatest likelihood of identifying a visceral source of pain compared to somatic sources of pain. PMID:22135736

A Survey of Biodynamic Test Devices and Methods,

DTIC Science & Technology

1984-04-01

aca-a) *Cavfcr:.,: ( CncD : all tgat A~rply) Rane of Acceir!racion buration v.1 Sne __________ _________ _________ U.2. 1/2 Sn _______ _______ ______ e...State University. Dayton. Ohio 45435, USA. 12. )istribution Statement This document is distributed in accordance with A(VARI) policies and

Progression of scoliosis in patients with spastic quadriplegia after the insertion of an intrathecal baclofen pump.

PubMed

Ginsburg, Glen M; Lauder, Anthony J

2007-11-15

Medical and radiographic review of 19 consecutive patients with spastic quadriplegia before and after intrathecal baclofen pump insertion with special attention paid to progression of scoliosis. Many orthopedic surgeons who treat spastic quadriplegic patients have noticed a trend of marked scoliosis progression after the administration of intrathecal baclofen (ITB) via subcutaneous pump and catheter. The purpose of this study is to quantify scoliosis progression in this patient population before and after baclofen administration and compare this to published natural history data. The authors had noted rapid progression of scoliosis in spastic quadriplegic patients after intrathecal baclofen pump insertion. This had been noted at other centers, but no significant statistical analysis had been done comparing prepump to postpump scoliosis progression in these patients. To document the magnitude and rate of scoliosis progressions after the placement of an ITB pump, the charts and radiographs of 19 consecutive nonambulatory patients with spastic quadriplegia and an ITB pump were reviewed. To document the rate of scoliosis progression, each patient had at least 2 pre and 2 postpump insertion spinal radiographs made. All radiographs were made with the patients in the supine position without orthoses. A board-certified orthopedic surgeon reviewed these radiographs. Skeletal maturity was assessed using Risser grading. Catheter tip location and rate of baclofen administration were recorded. For 19 patients with complete radiographic data, average Cobb angles were 10.2 degrees before pump insertion and 25 degrees at an average of 20.9 months after pump insertion (P < 0.0001). These 19 patients had a mean rate of change in their Cobb angles of 1.825%/year before pump insertion and 10.95 degrees /year at an average of 23.9 months after pump insertion (P = 0.024). These results represent a 6-fold increase in the curve progression rate after pump insertion. There was no association between catheter tip location or rate of Baclofen infusion on curve progression. In published data, the rate of progression of scoliosis in skeletally immature nonambulatory patients with cerebral palsy was 4.5 degrees /year. In this study, the average rate of progression of the scoliosis for the immature was 9.02 degrees /year. For the skeletally mature bed-ridden patients, the worst-case natural history progression was 4.4 degrees /year. The comparable rate of change in skeletally mature (Risser 5) nonambulatory patients (n = 6) in this study was 28.4 degrees /year. This study demonstrates a significant increase in the rate of scoliotic curve progression after ITB pump placement when compared with published natural history data. The evidence of the beneficial effects of ITB on spasticity has been confirmed, and as larger, prospective randomized studies are conducted, the authors think that support for continued use of this treatment will increase. However, early bracing and spinal fusion may be warranted to prevent significant increases in spinal deformity if scoliosis is anticipated to progress more than 10 degrees /yr for patients with spastic quadriplegia and ITB pump. The authors are now performing spinal fusions for curves that exceed 40 degrees to 50 degrees in the presence of an ITB pump as recommended by previous reviews of scoliosis and accompanying quadriplegia.

Three Words and the Future of the Affordable Care Act.

PubMed

Bagley, Nicholas

2015-06-01

As an essential part of its effort to achieve near universal coverage, the Affordable Care Act (ACA) extends sizable tax credits to most people who buy insurance on the newly established health care exchanges. Yet several lawsuits have been filed challenging the availability of those tax credits in the thirty-four states that refused to set up their own exchanges. The lawsuits are premised on a strained interpretation of the ACA that, if accepted, would make a hash of other provisions of the statute and undermine its effort to extend coverage to the uninsured. The courts should reject this latest effort to dismantle a critical feature of the ACA. Copyright © 2015 by Duke University Press.

Groundwater and surface-water interaction and effects of pumping in a complex glacial-sediment aquifer, phase 2, east-central Massachusetts

USGS Publications Warehouse

Eggleston, Jack R.; Zarriello, Phillip J.; Carlson, Carl S.

2015-12-31

Model simulations indicate that under average base-flow conditions, the Birch Road wells have a small effect on flow in the Sudbury River during most months, even at the maximum pumping rate of 4.9 ft3/s (3.17 Mgal/d). Maximum percent streamflow depletion in the Sudbury River caused by simulated pumping takes place during simulated drought conditions, when streamflow decreased by as much as 21 percent under maximum continuous pumping. Simulations also indicate that groundwater withdrawals at the Birch Road site could be managed so that adverse streamflow impacts are substantially ameliorated. Under the most ecologically conservative simulated drought conditions, simulated streamflow depletion was reduced from 21 percent to 3 percent by pumping at the maximum rate for 6 months rather than for 12 months. Simulations that return 10 percent of the Birch Road well withdrawals to Pod Meadow Pond indicate a modest reduction in the Sudbury River streamflow depletion and provide a larger percentage increase to streamflow just downstream of the pond. The groundwater model also indicates that well locations can have a large effect on the sustainable pumping rate and so should be chosen carefully. The model provides a tool for evaluating alternative pumping rates and schedules not included in this analysis.

Estimation of the groundwater resources of the bedrock aquifers at the Kettle Moraine Springs State Fish Hatchery, Sheboygan County, Wisconsin

USGS Publications Warehouse

Dunning, Charles; Feinstein, Daniel T.; Buchwald, Cheryl A.; Hunt, Randall J.; Haserodt, Megan J.

2017-10-12

Groundwater resources information was needed to understand regional aquifer systems and water available to wells and springs for rearing important Lake Michigan fish species at the Kettle Moraine Springs State Fish Hatchery in Sheboygan County, Wisconsin. As a basis for estimating the groundwater resources available, an existing groundwater-flow model was refined, and new groundwater-flow models were developed for the Kettle Moraine Springs State Fish Hatchery area using the U.S. Geological Survey (USGS) finite-difference code MODFLOW. This report describes the origin and construction of these groundwater-flow models and their use in testing conceptual models and simulating the hydrogeologic system.The study area is in the Eastern Ridges and Lowlands geographical province of Wisconsin, and the hatchery property is situated on the southeastern edge of the Kettle Moraine, a north-south trending topographic high of glacial origin. The bedrock units underlying the study area consist of Cambrian, Ordovician, and Silurian units of carbonate and siliciclastic lithology. In the Sheboygan County area, the sedimentary bedrock sequence reaches a thickness of as much as about 1,600 feet (ft).Two aquifer systems are present at the Kettle Moraine Springs State Fish Hatchery. A shallow system is made up of Silurian bedrock, consisting chiefly of dolomite, overlain by unconsolidated Quaternary-age glacial deposits. The glacial deposits of this aquifer system are the typical source of water to local springs, including the springs that have historically supplied the hatchery. The shallow aquifer system, therefore, consists of the unconsolidated glacial aquifer and the underlying bedrock Silurian aquifer. Most residential wells in the area draw from the Silurian aquifer. A deeper confined aquifer system is made up of Cambrian- and Ordovician-age bedrock units including sandstone formations. Because of its depth, very few wells are completed in the Cambrian-Ordovician aquifer system (COAS) near the Kettle Moraine Springs State Fish Hatchery.Three groundwater-flow models were used to estimate the water resources available to the hatchery from bedrock aquifers under selected scenarios of well placement and seasonal water requirements and subject to constraints on the effects of pumping on neighboring wells, local springs, and creeks. Model input data (recharge, water withdrawal, and boundary conditions) for these models were compiled from a number of data and information sources.The first model, named the “KMS model,” (KMS stands for Kettle Moraine Springs) is an inset model derived from a published USGS regional Lake Michigan Basin model and was constructed to simulate groundwater pumping from the semiconfined Silurian aquifer. The second model, named the “Pumping Test model,” was constructed to evaluate an aquifer pumping test conducted in the COAS as part of this project. The Pumping Test model was also used to simulate the local effects of 20 years of groundwater pumping from this deep bedrock aquifer for future hatchery operations. The third model, named the “LMB modified model,” is a version of the published Lake Michigan Basin (LMB) model that was modified with aquifer parameters refined in an area around the hatchery (approximately a 5-mile radius circle, corresponding to the area stressed by the aquifer pumping test). This LMB modified model was applied to evaluate regional effects of pumping from the confined COAS.The available Silurian aquifer groundwater resource was estimated using the KMS model with three scenarios—named “AllConstraints,” “Constraints2,” and “Constraints3”—that specified local water-level and flow constraints such as drawdown at nearby household wells, water levels inside pumping well boreholes, and flow in local streams and springs. Each scenario utilized the MODFLOW Groundwater Management Process (GWM) to select three locations from six candidate locations that provided the greatest combined flow while satisfying the constraints. The three constraint scenarios provided estimates of 430 gallons per minute (gal/min), 480 gal/min, and 520 gal/min pumping from three wells—AllConstraints, Constraints2, and Constraints3, respectively. The same three wells were selected for the scenarios that estimated 480 gal/min and 520 gal/min; the scenario that estimated 430 gal/min shared two of these same wells, but the third selected well was different.The available COAS groundwater resource was estimated by two scenarios with each conducted over a period of 20 years with the Pumping Test model and the LMB modified model. The Pumping Test model was used to simulate local effects of pumping, and the LMB modified model was used to simulate regional effects of pumping. The scenarios simulate a range of total and seasonal pumping rates potentially linked to site activities. Scenario 1 simulates two wells completed in the Cambrian-Ordovician aquifer system, each pumping for 8 months at 300 gal/min, followed by pumping for 4 months at 600 gal/min. The average yearly pumping rate of Scenario 1 is 800 gal/min. Scenario 2 simulates three wells completed in the Cambrian-Ordovician aquifer system pumping for 8 months at 200 gal/min, followed by pumping for 4 months at 500 gal/min. The average yearly pumping rate of Scenario 2 is 900 gal/min. The Pumping Test model simulations confirmed that drawdown in the boreholes of the pumping wells at the selected 2-well or 3-well rates will meet the desired condition that the pumping water level remains at least 100 ft above the highest Cambrian-Ordovician unit open to the well.The LMB modified model was used to evaluate the regional drawdown of the pumping from the confined COAS under the same 2-well and 3-well scenarios. At the nearest known existing COAS well, Campbellsport production well #4, the simulated drawdown for Scenario 1 after 20 years of cyclical pumping with two pumping wells averaging a total of 800 gal/min is 16.9 ft, whereas the simulated drawdown for Scenario 2 after 20 years of pumping with three pumping wells averaging a total of 900 gal/min is 19.0 ft. The total deep aquifer thickness at the Campbellsport location is on the order of 620 ft, meaning that the simulated drawdown for either scenario is about 3 percent of the confined aquifer thickness.The models developed as part of this project are archived in the project data release. The archive includes the model input and output files as well as MODFLOW source code and executables. (Haserodt and others, 2017).

A Novel Method for Measuring Anterior Segment Area of the Eye on Ultrasound Biomicroscopic Images Using Photoshop

PubMed Central

Wu, Ziqiang; Lin, Jialiu; Huang, Jingjing

2015-01-01

Purpose To describe a novel method for quantitative measurement of area parameters in ocular anterior segment ultrasound biomicroscopy (UBM) images using Photoshop software and to assess its intraobserver and interobserver reproducibility. Methods Twenty healthy volunteers with wide angles and twenty patients with narrow or closed angles were consecutively recruited. UBM images were obtained and analyzed using Photoshop software by two physicians with different-level training on two occasions. Borders of anterior segment structures including cornea, iris, lens, and zonules in the UBM image were semi-automatically defined by the Magnetic Lasso Tool in the Photoshop software according to the pixel contrast and modified by the observers. Anterior chamber area (ACA), posterior chamber area (PCA), iris cross-section area (ICA) and angle recess area (ARA) were drawn and measured. The intraobserver and interobserver reproducibilities of the anterior segment area parameters and scleral spur location were assessed by limits of agreement, coefficient of variation (CV), and intraclass correlation coefficient (ICC). Results All of the parameters were successfully measured by Photoshop. The intraobserver and interobserver reproducibilities of ACA, PCA, and ICA were good, with no more than 5% CV and more than 0.95 ICC, while the CVs of ARA were within 20%. The intraobserver and interobserver reproducibilities for defining the spur location were more than 0.97 ICCs. Although the operating times for both observers were less than 3 minutes per image, there was significant difference in the measuring time between two observers with different levels of training (p<0.001). Conclusion Measurements of ocular anterior segment areas on UBM images by Photoshop showed good intraobserver and interobserver reproducibilties. The methodology was easy to adopt and effective in measuring. PMID:25803857

Legislative Actions to Repeal, Defund, or Delay the Affordable Care Act

DTIC Science & Technology

2013-11-22

Public Health Sciences Track, pursuant to ACA Section 5315. • Removed the maintenance of effort requirement for use of monies in the Community Health...Office (GAO) study of the costs and processes of ACA implementation, and a Medicare actuarial analysis of the impact of the ACA’s private insurance

77 FR 75195 - Notice of a Virtual Meeting of the Advisory Committee on Apprenticeship (ACA)

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-19

... Office of Apprenticeship's (OA) homepage: http://www.doleta.gov/oa/ . The ACA is a discretionary... will be prominently posted on the OA homepage: http://www.doleta.gov/oa/ . Members of the public are... OA's homepage: http://www.doleta.gov/oa/ . All meeting participants, whether attending virtually or...

77 FR 39516 - Notice of a Public Meeting of the Advisory Committee on Apprenticeship (ACA)

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-03

.... Department of Labor, Frances Perkins Building, 200 Constitution Avenue NW., Washington, DC 20210. The ACA is..., 200 Constitution Avenue NW., Washington, DC 20210. FOR FURTHER INFORMATION CONTACT: The Designated... Administration, U.S. Department of Labor, 200 Constitution Avenue NW., Room N-5311, Washington, DC 20210...

Evaluation of Anterior Segment Parameters in Obesity

PubMed Central

Uzun, Feyzahan; Karaca, Emine Esra; Kalaycı, Mustafa

2015-01-01

Purpose To investigate anterior segment parameters in obese patients in comparison to healthy individuals. Methods Thirty-four obese subjects and 34 age-sex-matched healthy subjects were enrolled in this prospective cross-sectional study. Ophthalmological examinations including intraocular pressure (IOP), central corneal thickness (CCT), anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA), and axial length (AL) measurements were performed on each subject. Height and weight of all subjects were recorded and body mass index (BMI) was calculated. Results IOP was significantly higher in the obese group (p = 0.003). The mean ACD in obese subjects was significantly lower than that in control subjects (p = 0.036). AL, ACV, ACA and CCT were not significantly different between the groups. There was a positive correlation between BMI and IOP (r = 0.404, p < 0.001). ACD and ACA were negatively correlated with BMI. Conclusions IOP was significantly higher and ACD was significantly lower in obese subjects. AL, ACV, ACA and CCT were not significantly different between the groups. The impact of obesity on anterior chamber parameters should be further investigated. PMID:26240505

Westerly jet stream and past millennium climate change in Arid Central Asia simulated by COSMO-CLM model

NASA Astrophysics Data System (ADS)

Fallah, Bijan; Sodoudi, Sahar; Cubasch, Ulrich

2016-05-01

This study tackles one of the most debated questions around the evolution of Central Asian climate: the "Puzzle" of moisture changes in Arid Central Asia (ACA) throughout the past millennium. A state-of-the-art Regional Climate Model (RCM) is subsequently employed to investigate four different 31-year time slices of extreme dry and wet spells, chosen according to changes in the driving data, in order to analyse the spatio-temporal evolution of the moisture variability in two different climatological epochs: Medieval Climate Anomaly (MCA) and Little Ice Age (LIA). There is a clear regime behavior and bimodality in the westerly Jet phase space throughout the past millennium in ACA. The results indicate that the regime changes during LIA show a moist ACA and a dry East China. During the MCA, the Kazakhstan region shows a stronger response to the westerly jet equatorward shift than during the LIA. The out-of-phase pattern of moisture changes between India and ACA exists during both the LIA and the MCA. However, the pattern is more pronounced during the LIA.

Effect of Nano-SiO₂ on the Early Hydration of Alite-Sulphoaluminate Cement.

PubMed

Sun, Jinfeng; Xu, Zhiqiang; Li, Weifeng; Shen, Xiaodong

2017-05-03

The impact of nano-SiO₂ on the early hydration properties of alite-sulphoaluminate (AC$A) cement was investigated with a fixed water to solid ratio ( w / s ) of one. Nano-SiO₂ was used in partial substitution of AC$A cement at zero, one and three wt %. Calorimetry, X-ray diffraction (XRD), thermogravimetric/derivative thermogravimetric (TG/DTG), mercury intrusion porosimetry (MIP) and scanning electron microscopy (SEM) analyses were used to characterize the hydration and hydrates of the blended cement. The hydration of the AC$A cement was significantly promoted, resulting in an increase of the heat released with the addition of nano-SiO₂. Phase development composition analysis showed that nano-SiO₂ had no effect on the type of crystalline hydration products of the AC$A cement. Moreover, nano-SiO₂ showed significant positive effects on pore refinement where the total porosity decreased by 54.09% at three days with the inclusion of 3% nano-SiO₂. Finally, from the SEM observations, nano-SiO₂ was conducive to producing a denser microstructure than that of the control sample.

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

Bamberger, Judith A.; Enderlin, Carl W.

Million-gallon double-shell tanks at Hanford are used to store transuranic, high-level, and low-level radioactive wastes. These wastes consist of a large volume of salt-laden solution covering a smaller volume of settled sludge primarily containing metal hydroxides. These wastes will be retrieved and processed into immobile waste forms suitable for permanent disposal. Retrieval is an important step in implementing these disposal scenarios. The retrieval concept evaluated is to use submerged dual-nozzle jet mixer pumps with horizontally oriented nozzles located near the tank floor that produce horizontal jets of fluid to mobilize the settled solids. The mixer pumps are oscillated through 180more » about a vertical axis so the high velocity fluid jets sweep across the floor of the tank. After the solids are mobilized, the pumps will continue to operate at a reduced flow rate producing lower velocity jets sufficient to maintain the particles in a uniform suspension (concentration uniformity). Several types of waste and tank configurations exist at Hanford. The jet mixer pump systems and operating conditions required to mobilize sludge and maintain slurry uniformity will be a function of the waste type and tank configuration. The focus of this work was to conduct a 1/12-scale experiment to develop an analytical model to relate slurry uniformity to tank and mixer pump configurations, operating conditions, and sludge properties. This experimental study evaluated concentration uniformity in a 1/12-scale experiment varying the Reynolds number (Re), Froude number (Fr), and gravitational settling parameter (Gs) space. Simulant physical properties were chosen to obtain the required Re and Gs where Re and Gs were varied by adjusting the kinematic viscosity and mean particle diameter, respectively. Test conditions were achieved by scaling the jet nozzle exit velocity in a 75-in. diameter tank using a mock-up of a centrally located dual-opposed jet mixer pump located just above the tank floor. Concentration measurements at sampling locations throughout the tank were used to assess the degree of uniformity achieved during each test. Concentration data was obtained using a real time in-situ ultrasonic attenuation probe and post-test analysis of discrete batch samples. The undissolved solids concentration at these locations was analyzed to determine whether the tank contents were uniform (≤ ±10% variation about mean) or nonuniform (> ±10% variation about mean) in concentration. Concentration inhomogeneity was modeled as a function of dimensionless parameters. The parameters that best describe the maximum solids volume fraction that can be suspended were found to be 1) the Fr based on nozzle average discharge velocity and tank contents level and 2) the dimensionless particle size based on nozzle diameter. The dependence on the jet Re does not appear to be statistically significant.« less

Geographic profiling as a novel spatial tool for targeting infectious disease control.

PubMed

Le Comber, Steven C; Rossmo, D Kim; Hassan, Ali N; Fuller, Douglas O; Beier, John C

2011-05-18

Geographic profiling is a statistical tool originally developed in criminology to prioritise large lists of suspects in cases of serial crime. Here, we use two data sets--one historical and one modern--to show how it can be used to locate the sources of infectious disease. First, we re-analyse data from a classic epidemiological study, the 1854 London cholera outbreak. Using 321 disease sites as input, we evaluate the locations of 13 neighbourhood water pumps. The Broad Street pump--the outbreak's source--ranks first, situated in the top 0.2% of the geoprofile. We extend our study with an analysis of reported malaria cases in Cairo, Egypt, using 139 disease case locations to rank 59 mosquitogenic local water sources, seven of which tested positive for the vector Anopheles sergentii. Geographic profiling ranks six of these seven sites in positions 1-6, all in the top 2% of the geoprofile. In both analyses the method outperformed other measures of spatial central tendency. We suggest that geographic profiling could form a useful component of integrated control strategies relating to a wide variety of infectious diseases, since evidence-based targeting of interventions is more efficient, environmentally friendly and cost-effective than untargeted intervention.