The Effect of the Affordable Care Act on the Financial Stability of the Healthcare System

This paper explores published articles that report on results from research conducted about the successes of the Affordable Care Act and its relationship to the financial health of the healthcare industry. While efforts of the ACA to move healthcare towards financial stability have broad sweeping implications across the healthcare industry it is not clear whether the efforts were enough to stem the rising costs of healthcare in the United States. Ellis and Orszag (2007), theorized that the changes under the ACA to further educate patients on treatments would lead to a reduction in healthcare expenditures. Regulatory changes to the insurance marketplaces and acquisition and usage of healthcare insurance have played a prolific role in changing the face of the healthcare industry. Changes in policy, procedure and staffing have already begun to impact the costs of healthcare in America but flaws still exist in the system that are not directly addressed by the ACA. Cutler (2015) states, “The healthcare industry must make efforts to cut costs as the current situation of cost compared to economic growth is unsustainable” (p. 337). This paper examines the steps already taken by the ACA to achieve balance in healthcare expenditures and to prevent healthcare costs from further spiraling out of control

Exile Vol. XXXV No. 1

ARTWORK Untitled by Eric Whitney (cover) Untitled by Rory Herbster 7 Little Boy by Eric Whitney 45 FICTION Through the Window Pane by Jennifer Read 4 to whom i may concern by Chris Campi 19 For Lack of Sleep by Amy Judge 26 Jonathan by Jim Cox 39 Skin Deep by Eric Whitney 51 NON-FICTION A Theopoetic by Robert Marshall 11 POETRY Clay Pot by Christopher Collette 1 Ars Poetica by Mans Agantyr 2 Bible Thumber by Chris Rynd 6 Play by Amy Judge 9 Satellites by Andrew C. Carinston 10 Music - Love? by Shammon J. Salser 15 Allusion by Rosemary Walsh 17 Self Portrait by Margaret Dawson 18 On Our Way by Lynn Pendleton 21 They called her Mitzi... by Jen Miller 22 Storms of Illusion by Kevin Merriman 23 Beauty by Andrew C. Carington 24 Thoughts of a Husband by Kent Lambert 25 The Music of the Sum by Zach Smith 31 Don\u27t Think by Mary Forsythe 32 Aspiration by Tim Emrick 33 Where We Go Together by Man Angantyr 35 Sunset by Chris Byrd 36 The Child of my Fatalism by Jennifer Peterson 37 Untitled by Kent Lambert 38 Terribly close to being... by Michael Payne 44 Anne Frank\u27s House by Mary Forsythe 47 Invitation by Kevin Merriman 48 Height Protest by Jen Miller 49 Dancer by Bradford Cover 50 Ars Poetica by Amy Judge 55 Editorial decision is shared equally among the Editorial Board members -title page NOTE: The author of the poem Satellites is listed as Andrew C. Carinston in the published table of contents. This is likely a misspelling as there are four instances of an Andrew C. Carington elsewhere in this edition, including the attribution on the page where Satellites is published. NOTE: The author of the poem Where We Go Together is listed as Man Angantyr in the published table of contents. This is likely a misspelling as there are four instances of an Mans Angantyr elsewhere in this edition, including the attribution on the pages where Where We Go Together is published. NOTE: Chris Byrd is listed as the author of the poem Sunset in the published version. However a note in the received version indicates that the author is actually Chris Rynd, whose poem Bible Thumper is also published in this issue. No Chris Byrd is listed among the contributors to this issue. NOTE: The author of the poem Music = Love? is listed as Shammon J. Salser in the published table of contents. This is likely a misspelling. Where Music = Love? appears the author is listed as Shannon J. Salser. The same is true of the contributors section. NOTE: Though the published table of contents is followed here, the poem by Zach Smith that is published on page 31 is listed as The Music of the Sun on page 31

A Targeted Liquid Chromatography-Tandem Mass Spectrometry Method for Simultaneous Quantification of Peptides from the Carboxyl-terminal Region of Type III Procollagen, Biomarkers of Collagen Turnover

Background The development of analytical approaches to help reduce the risk of growth hormone (GH) doping is important to fair competition and the health of athletes. However, the reliable detection of GH use remains challenging. The identification of novel biomarkers of GH administration could lead to a better understanding of the physiological response to GH, more sensitive detection of the illicit use of GH in sport, and better management of patients treated for GH disorders. Methods We developed a targeted liquid chromatography-tandem mass spectrometry method to simultaneously quantify the carboxyl-terminal propeptide of type III procollagen (P-III-CP) and type III collagen degradation products in human serum. Following proteolysis, we instituted a simple acid precipitation step to reduce digested sample complexity before peptide immunoenrichment, which improved the recovery of one target peptide from serum. We evaluated the concentration of each biomarker at different age ranges and after GH administration in healthy participants. Results The assay was linear over an estimated concentration range of 0.3 to1.0 nM and 0.1 to 0.4 nM for each surrogate peptide of P-III-CP and collagen fragments, respectively. Intra-day and inter-day coefficients of variation were <= 15%. Biomarker concentrations appeared to vary with age and to reflect age-specific collagen turnover. Moreover, their concentrations changed after GH administration. Conclusions Our method quantifies the proteins belonging to the family of P-III-CP and type III collagen degradation products in human serum, which could be used to detect GH administration in athletes and better understand diseases involving GH therapy or altered type III collagen turnover

A novel DPH5-related diphthamide-deficiency syndrome causing embryonic lethality or profound neurodevelopmental disorder

PurposeDiphthamide is a post-translationally modified histidine essential for messenger RNA translation and ribosomal protein synthesis. We present evidence for DPH5 as a novel cause of embryonic lethality and profound neurodevelopmental delays (NDDs).MethodsMolecular testing was performed using exome or genome sequencing. A targeted Dph5 knockin mouse (C57BL/6Ncrl-Dph5em1Mbp/Mmucd) was created for a DPH5 p.His260Arg homozygous variant identified in 1 family. Adenosine diphosphate-ribosylation assays in DPH5-knockout human and yeast cells and in silico modeling were performed for the identified DPH5 potential pathogenic variants.ResultsDPH5 variants p.His260Arg (homozygous), p.Asn110Ser and p.Arg207Ter (heterozygous), and p.Asn174LysfsTer10 (homozygous) were identified in 3 unrelated families with distinct overlapping craniofacial features, profound NDDs, multisystem abnormalities, and miscarriages. Dph5 p.His260Arg homozygous knockin was embryonically lethal with only 1 subviable mouse exhibiting impaired growth, craniofacial dysmorphology, and multisystem dysfunction recapitulating the human phenotype. Adenosine diphosphate-ribosylation assays showed absent to decreased function in DPH5-knockout human and yeast cells. In silico modeling of the variants showed altered DPH5 structure and disruption of its interaction with eEF2.ConclusionWe provide strong clinical, biochemical, and functional evidence for DPH5 as a novel cause of embryonic lethality or profound NDDs with multisystem involvement and expand diphthamide-deficiency syndromes and ribosomopathies

Clinical application of a scale to assess genomic healthcare empowerment (GEmS): Process and illustrative case examples

The Genome Empowerment Scale (GEmS), developed as a research tool, assesses perspectives of parents of children with undiagnosed disorders about to undergo exome or genome sequencing related to the process of empowerment. We defined genomic healthcare empowerment as follows: perceived ability to understand and seek new information related to the genomic sequencing, manage emotions related to the diagnostic process and outcomes, and utilize genomic sequencing information to the betterment of the individual/child and family. The GEmS consists of four scales, two are primarily emotion-focused (Meaning of a Diagnosis, and Emotional Management of the Process) and two are action-oriented (Seeking Information and Support, and Implications and Planning). The purpose of this research was to provide a strategy for interpreting results from the GEmS and present illustrative cases. These illustrations should serve to facilitate use of the GEmS in the clinical and research arena, particularly with respect to guiding genetic counseling processes for parents of children with undiagnosed conditions