Health Care Opinion Leaders' Views on Health Reform, Implementation, and Post-Reform Priorities

Presents survey results on healthcare experts' views on the comprehensive health reform law enacted in March 2010, including premium subsidies, new insurance market rules, and alternative payment methods; implementation challenges; and long-term issues

A Reanalysis of Small Scale Velocity Dispersion in the CfA1 Survey

The velocity dispersion of galaxies on scales of $r\sim1h^{-1}$ Mpc, $\sigma_{12}(r)$, may be estimated from the anisotropy of the galaxy-galaxy correlation function in redshift space. We present a reanalysis of the CfA1 survey, correct an error in the original analysis of Davis and Peebles (1983), and find that $\sigma_{12}(r)$ is extremely sensitive to the details of how corrections for infall into the Virgo cluster are applied. We conclude that a robust value of $\sigma_{12}$ cannot be obtained from this survey. We also discuss results from other redshift surveys, including the effect of removing clusters.Comment: 12 pages, uuencoded(latex file + 2 Postscript figures), uses aas macro

News That Matters: An Assessment of Chicago's Information Landscape

The Community News Matters project of The Chicago Community Trust conducted surveys and focus groups of the general public, local leaders and low-income residents to assess the level to which critical information needs of democracies are being well-met in the Chicago region and to identify critical information gaps and deficiencies in Chicago's information landscape that may need to be addressed

Finding Resources for Health Reform and Bending the Health Care Cost Curve

Examines policy options for slowing healthcare spending growth, improving outcomes, and financing comprehensive reform, including changes to Medicare Advantage and hospital pay-for-performance. Compares their estimated budget impact over ten years

When Legal Incapacity Becomes a Lack of Personhood: Why a Ward\u27s Ability to Sue in Their Own Name Should be a Fundamental Aspect of Virginia Guardianship

It is a fundamental failing of any legal system when it is unable to protect the most vulnerable within its population. Whether we are comfortable admitting it or not, guardian abuse of incapacitated wards has been well-documented across all fifty states. Virginia is no exception, and this lack of oversight leaves one of our most vulnerable populations without recourse. This Note argues that by simply granting a ward the ability to bring suit in their own name, Virginia may strike a significant blow to the dysfunction that systematically infects the guardianship process. This Note highlights Virginia statute and case law to draw attention to ineffective guardianship regulations that put incapacitated persons at risk. This Note will analyze Virginia statute and how the overall lack of agency for wards leaves a gaping hole for guardianship abuse to fester. This Note will also examine two recent cases, Lopez-Rosario v. Habib and Cook v. Radford Community Center, that continued to restrict a ward’s ability to bring suit in their own name. Finally, this Note will address how the legal system has failed incapacitated wards by trying their hands behind their backs—if a ward cannot bring suit in their own name, then there is little recourse for abuse suffered at the hands of a guardian. To conclude, this Note will discuss potential steps forward, and methods that Virginia courts and legislature can take to ensure that a vulnerable population does not continue to slip through the cracks of the legal system

Alcohol Use As A Precipitant And Comorbidity In Primary Headache

Migraine and tension-type headache (tth) are two of the most prevalent pain conditions diagnosed throughout the world and can be extremely disabling with many economic, social, physical and psychological health costs. A plethora of research indicates a strong, positive association between co-occurring psychiatric disorders (e.g., major depressive disorder, anxiety, panic) and migraine and tth, however co-occurring alcohol-use disorders are relatively unexplored. The limited studies that have explored alcohol-use disorders have produced mixed findings, potentially as a result of differing methodology, sample source, and the debated precipitating nature of alcohol use on headache. An abundance of research suggests that many environmental and physiological factors precipitate or trigger headache, including stress, hormonal fluctuations (in women), weather events, and changes in sleep and eating habits, although prevalence rates for many triggers vary greatly across studies, including alcohol (6.1- 51.5%). The inconsistencies in trigger endorsement may be influenced by the retrospective nature of most prior studies, medical advice to avoid known triggers, and various assessment approaches. Given the conflicting data regarding alcohol use and headache, the purpose of the current study was to examine existing literature related to alcohol and headache using a meta-analysis and in-depth qualitative review. The meta-analysis explored the precipitating effects of alcohol on migraine and tth. The meta-analysis and subsequent meta-regressions were run in r statistical software utilizing dersimonian-laird random-effects methods. Forty-five articles met inclusion criteria for the study. Results of the meta-analysis found significant heterogeneity across and within these 45 studies 2 = 0.95; i2 = 97.5% (95% ci: 97.1% to 97.8%), which limited interpretation. Overall, 22% (95% ci: .17 to .28) of headache sufferers ever queried about alcohol as a trigger endorsed its precipitating effect. This precipitating effect did not significantly differ between migraine and tth (p = .15) nor between migraine with and without aura (p = .90). Twenty-eight percent of individuals endorsed red wine as a trigger, 14% endorsed spirits, 12% endorsed white wine, and 10% endorsed beer or sparkling wine; however difference in endorsement rates was not significantly different (p = .06). The precipitating effect in relation to frequency and quantity of consumption was not analyzed statistically due to too few studies meeting inclusion criteria. Endorsement rates were not impacted by method of assessment. These findings aggregate the literature on alcohol as a trigger for headache and indicate future directions in research on this topic. The in-depth qualitative review highlighted three main areas of current research in nine studies that explored alcohol-use disorders (auds) and headache: 1) alcohol-use disorders among headache sufferers, 2) headache disorders among individuals diagnosed with alcohol-use disorders, and 3) problematic alcohol use (pau) assessed with validated measures among headache sufferers. In studies that explored rates of auds in headache samples, migraineurs without aura and tth sufferers did not endorse high rates of auds, however migraineurs with aura and migraineurs among a chronic pain sample did endorse higher rates of aud compared to individuals without migraine. Additionally, in studies that examined rates of headache disorders among substance use disorders inpatients, risk of migraine was significant among individuals with an alcohol dependence (but not alcohol abuse) diagnosis. Furthermore, in studies that investigated pau in headache samples, tth sufferers reported moderate rates (16.1%) of pau whereas migraineurs reported comparatively low rates (4.6%-5.2%). However, differences in validated measures used limit comparisons of these endorsement rates. Differences in this area of research suggest the need for a more uniform approach to future research on this topic

Relations Between Alcohol Use And Migraine Among Young Adults

Migraine is one of the most prevalent neurological disorders diagnosed throughout the world and can be extremely disabling, with many economic, social, physical and psychological health costs. Many environmental and physiological factors have been shown to precipitate migraine, including stress, hormonal fluctuations (in women), weather events, and changes in sleep and eating habits. In retrospective studies, a sizeable proportion of migraineurs also identify alcohol as a trigger for migraine attacks, but comparatively little research has explored the nature of alcohol consumption (frequency, quantity, type, rate, time of day) in relation to other aspects of migraine. Given limited and conflicting data regarding alcohol use and migraine, the purpose of the current study was to assess whether specific alcohol-related variables differentiate migraineurs from healthy controls and to determine the extent to which these alcohol variables are associated with migraine-related variables. College students are a population of interest because of their high rates of alcohol consumption and the documented high prevalence of migraine during the college years. The sample consisted of 192 college students with a mean age of 19.84 years (SD = 3.65), with 87 (45.3%) meeting ICHD-II criteria for episodic migraine and 6 (3.1%) for chronic migraine. Migraineurs did not differ significantly on assessed alcohol-related variables compared to controls (F (4,181) = 1.603, p = .176, partial η2 = .036). A multivariate regression analysis among the migraineurs only found that the primary predictor variables (frequency and quantity of alcohol consumption, severity of alcohol-related negative consequences, and number of binge episodes) in aggregate did not predict the combination of migraine variables (frequency, severity, and disability; F [12, 204] = 1.326, p = .206). However, a linear regression analysis controlling for anxiety, depression, and gender confirmed that alcohol variables significantly predicted headache-related disability, accounting for 10.6% of unique variance in disability (p \u3c.05), but did not predict migraine severity or frequency in individual analyses. Headache self-efficacy was unrelated to alcohol-related variables. An argument is advanced for similarities between migraineurs and non-migraine controls on alcohol-related variables. Findings extend previous research and suggest the need for future studies exploring the role of alcohol use on migraine via experimental methods

Halloween- Time for Fanciful Goodies

Our custom of observing the night of October 31 as Halloween comes from American colonial times, when it was popular to observe Allhallows and All Souls. The colonists gathered at their farm homes to carry on folk customs such as ducking for apples, throwing apple peelings over their shoulders to find the initials of their future bridegrooms, and roasting nuts on the hearth. They discovered that the American pumpkins were excellent for making jack-o\u27lanterns, so started the traditional carved pumpkin faces that glow at night

Health Care Opinion Leaders' Views on Health Reform and the Role of States

Presents findings of a survey of experts about the relative authority of states and the federal government over the individual mandate, health insurance exchanges, provider payment methods, and other reform provisions and barriers to implementation