Maintaining Health Insurance During a Recession: Likely COBRA Eligibility

Assesses laid-off workers' eligibility and financial ability to extend employer-sponsored insurance through COBRA. Recommends extending COBRA and providing premium assistance, as well as expanding Medicaid and State Children's Health Insurance Programs

How Health Care Reform Can Lower the Costs of Insurance Administration

Examines the sources of U.S. insurance administration costs and estimates potential cost savings from the creation of a national insurance exchange to replace the individual and small-group markets as part of a public-private approach to reform

Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help, 2009 Update

Provides an annual assessment of the uninsurance of 19- to 29-year-olds and their demographics, incomes, and health status. Outlines federal and state actions to expand access to coverage and suggests policy options to address the impact of the recession

Patch size effects on plant species decline in an experimentally fragmented landscape

This is the publisher's version, also available electronically from http://www.esa.org/esa.Understanding local and global extinction is a fundamental objective of both basic and applied ecology. Island biogeography theory (IBT) and succession theory provide frameworks for understanding extinction in changing landscapes. We explore the relative contribution of fragment size vs. succession on species' declines by examining distributions of abundances for 18 plant species declining over time in an experimentally fragmented landscape in northeast Kansas, USA. If patch size effects dominate, early-successional species should persist longer on large patches, but if successional processes dominate, the reverse should hold, because in our system woody plant colonization is accelerated on large patches. To compare the patterns in abundance among patch sizes, we characterize joint shifts in local abundance and occupancy with a new metric: rank occupancy–abundance profiles (ROAPs). As succession progressed, statistically significant patch size effects emerged for 11 of 18 species. More early-successional species persisted longer on large patches, despite the fact that woody encroachment (succession) progressed faster in these patches. Clonal perennial species persisted longer on large patches compared to small patches. All species that persisted longer on small patches were annuals that recruit from the seed bank each year. The degree to which species declined in occupancy vs. abundance varied dramatically among species: some species declined first in occupancy, others remained widespread or even expanded their distribution, even as they declined in local abundance. Consequently, species exhibited various types of rarity as succession progressed. Understanding the effect of fragmentation on extinction trajectories requires a species-by-species approach encompassing both occupancy and local abundance. We propose that ROAPs provide a useful tool for comparing the distribution of local abundances among landscape types, years, and species

Community-level consequences of mycorrhizae depend on phosphorus availability

This is the publisher's version, also available electronically from http://www.esa.org/esa.In grasslands, arbuscular mycorrhizal fungi (AMF) mediate plant diversity; whether AMF increase or decrease diversity depends on the relative mycotrophy in dominant vs. subordinate plants. In this study we investigated whether soil nutrient levels also influence the ability of AMF to mediate plant species coexistence. First, we developed a conceptual model that predicts the influence of AMF on diversity along a soil nutrient gradient for plant communities dominated by mycotrophic and non-mycotrophic species. To test these predictions, we manipulated phosphorus to create a soil nutrient gradient for mesocosm communities composed of native prairie grasses and then compared community properties for mesocosms with and without AMF. We found that, where P was limiting, AMF increased plant diversity and productivity, and also altered community structure; however, at high P, AMF had little influence on aboveground communities. Compositional differences among treatments were due largely to a trade-off in the relative abundance of C3 vs. C4 species. Our study emphasizes how environmental constraints on mutualisms may govern community- and ecosystem-level properties

Front and Center: Ensuring That Health Reform Puts People First

Outlines the failures of the healthcare system and the benefits of the Commonwealth Fund's comprehensive reform plan for the uninsured, the underinsured, those who cannot afford out-of-pocket costs or premiums, and others without adequate access to care

Candida albicans Is Resistant to Polyglutamine Aggregation and Toxicity

Acknowledgments We thank the Donnelly Sequencing Centre for sequencing, and Jonathan Krieger at the SikKids Proteomics, Analytics, Robotics & Chemical Biology Centre at The Hospital for Sick Children for mass spectrometry analysis. M.D.L. is supported by a Sir Henry Wellcome Postdoctoral Fellowship (Wellcome Trust grant 096072), T.K. is supported by a Queen Elizabeth II Graduate Scholarship in Science and Technology (University of Toronto), M.L.D. is supported by a Canadian Institutes of Health Research (CIHR) Operating grant 325538, L.E.C. is supported by a Canada Research Chair in Microbial Genomics and Infectious Disease, by CIHR grants MOP-119520 and MOP-86452, and by the Natural Sciences and Engineering Research Council (NSERC) of Canada (grants 06261 and 462167).Peer reviewedPublisher PD

Variation in suspected cancer referral pathways in primary care:comparative analysis across the International Benchmarking Cancer Partnership

BACKGROUND: International variations in cancer outcomes persist and may be influenced by differences in the accessibility and organisation of cancer patient pathways. More evidence is needed to understand to what extent variations in the structure of primary care referral pathways for cancer investigation contribute to differences in the timeliness of diagnoses and cancer outcomes in different countries. AIM: To explore the variation in primary care referral pathways for the management of suspected cancer across different countries. DESIGN AND SETTING: Descriptive comparative analysis using mixed methods across the International Cancer Benchmarking Partnership (ICBP) countries. METHOD: Schematics of primary care referral pathways were developed across 10 ICBP jurisdictions. The schematics were initially developed using the Aarhus statement (a resource providing greater insight and precision into early cancer diagnosis research) and were further supplemented with expert insights through consulting leading experts in primary care and cancer, existing ICBP data, a focused review of existing evidence on the management of suspected cancer, published primary care cancer guidelines, and evaluations of referral tools and initiatives in primary care. RESULTS: Referral pathway schematics for 10 ICBP jurisdictions were presented alongside a descriptive comparison of the organisation of primary care management of suspected cancer. Several key areas of variation across countries were identified: inflexibility of referral pathways, lack of a managed route for non-specific symptoms, primary care practitioner decision-making autonomy, direct access to investigations, and use of emergency routes. CONCLUSION: Analysing the differences in referral processes can prompt further research to better understand the impact of variation on the timeliness of diagnoses and cancer outcomes. Studying these schematics in local contexts may help to identify opportunities to improve care and facilitate discussions on what may constitute best referral practice

A Weakened Transcriptional Enhancer Yields Variegated Gene Expression

Identical genes in the same cellular environment are sometimes expressed differently. In some cases, including the immunoglobulin heavy chain (IgH) locus, this type of differential gene expression has been related to the absence of a transcriptional enhancer. To gain additional information on the role of the IgH enhancer, we examined expression driven by enhancers that were merely weakened, rather than fully deleted, using both mutations and insulators to impair enhancer activity. For this purpose we used a LoxP/Cre system to place a reporter gene at the same genomic site of a stable cell line. Whereas expression of the reporter gene was uniformly high in the presence of the normal, uninsulated enhancer and undetectable in its absence, weakened enhancers yielded variegated expression of the reporter gene; i.e., the average level of expression of the same gene differed in different clones, and expression varied significantly among cells within individual clones. These results indicate that the weakened enhancer allows the reporter gene to exist in at least two states. Subtle aspects of the variegation suggest that the IgH enhancer decreases the average duration (half-life) of the silent state. This analysis has also tested the conventional wisdom that enhancer activity is independent of distance and orientation. Thus, our analysis of mutant (truncated) forms of the IgH enhancer revealed that the 250 bp core enhancer was active in its normal position, ∼1.4 kb 3′ of the promoter, but inactive ∼6 kb 3′, indicating that the activity of the core enhancer was distance-dependent. A longer segment – the core enhancer plus ∼1 kb of 3′ flanking material, including the 3′ matrix attachment region – was active, and the activity of this longer segment was orientation-dependent. Our data suggest that this 3′ flank includes binding sites for at least two activators