Be Careful What You Wish For: Popular Music in an Age in Which “Information Wants to be Free”

This article posits that the widespread adoption of music recording files as the “preferred” form for the storage, retrieval, and dissemination of music is not, and never has been driven by users/listeners; that this is an oversimplified understanding of what has happened since roughly the turn of the century. Instead, the article makes the historically-based argument that what has happened has been driven by the industry side of the equation – even in the face of what is, again, an oversimplified understanding: that the record industry has undeniably suffered and contracted in size and revenue as a result of the digital turn. The overarching significance of this argument is an attempt to bring some much needed perspective to the many analyses of what has been going on in the realm of popular music and the music industry, and to suggest what the consequence of this state of affairs might mean for the future of both the music and its industry

The Medicare Prescription Drug Proposals and Health Insurance Risk

In order to facilitate a better understanding of the complex issues raised by Senate and House proposals to establish a prescription drug benefit for Medicare beneficiaries, this paper briefly addresses some fundamentals of the health insurance market, defines key risk-sharing mechanisms, including risk corridors and reinsurance, and identifies the relevant risk provisions in the bills. Other issues related to cost management strategies and program design, which may have an impact on cost and adverse selection, are also discussed

Medicaid Prescription Drug Coverage: State Efforts to Control Costs

This paper provides a brief summary of the Medicaid prescription drug benefit. It explains the mechanisms being used by states to control their prescription drug spending within the Medicaid program. The paper also highlights some of the concerns that have been expressed with these mechanisms and the litigation that has been initiated in several states as a result of these efforts. It takes a closer look at three states with cost containment strategies that have been the focus of increased scrutiny

Health Insurance Coverage for Small Employers

For workers of small employers, access to affordable health insurance coverage is a growing concern. This paper examines the problems these firms and their employees face in obtaining health insurance coverage they can afford. The degree to which these challenges become obstacles varies greatly, depending on, for instance, the size of the employer and the characteristics of its employees. Reviewed here are these challenges to access, as well as some of the efforts made through state and federal reforms to address them, including rules regarding guaranteed issue and guaranteed renewability. This paper also explores some of the more recent initiatives designed to help small employers, including group purchasing arrangements (such as association health plans) and health savings accounts

Average Wholesale Price for Prescription Drugs: Is There a More Appropriate Pricing Mechanism?

This paper defines the average wholesale price (AWP), an important benchmark for prescription drug pricing and reimbursement. The paper briefly explains the AWP\u27s various uses in the pricing of prescription drugs, highlights some of the problems that have emerged as a result of the way it is reported and used, and explores some of the possibilities for reform. The paper also contains a glossary of commonly used terms, as well as an appendix that lists the state Medicaid reimbursement formulas

‚Entdeckungsgeschichten‘ der Quantenphysik: Zur narratologischen Erforschung einer naturwissenschaftlichen Erzählform

Scholars examining the significance of narration in the natural sciences currently face a striking research discrepancy: On the one hand, there is broad agreement that narrating plays a crucial role in the representation, popularization and even in the production of scientific knowledge. On the other hand, only a few case studies to date have discussed the specific narrative techniques employed in discourses or genres of the natural sciences and their function. Hence, this article aims to draw attention to the particular features of a distinctive narrative form produced by quantum physicists in the first half of the 20th century: the ‘narrative of discovery’. Pioneering physicists such as Max Planck or Werner Heisenberg unfold the complicated paths to their respective major discoveries much as a gripping story, which follows numerous blind alleys and failures in extensive scientific-technical detail. The high degree of both narrativity and ‘scientificality’ apparent in these narratives of discovery indicates, as the article argues, that the physicists strove to construct the genesis of their groundbreaking discoveries in a narrative way in order to achieve a deeper understanding of the discovery itself

Commentary: Euthyroid Sick Syndrome in Patients With COVID-19

Recent data from case reports and small clinical studies indicates thyroid disorders characterized by reduction of T3 levels are found associated with adverse events and all causes of mortality in Covid-19 patients (1–7). In this scenario the paper from Zuo et al. (4) consistently describes the presence of the euthyroid sick syndrome (EES) correlating with Covid-19 disease severity but not with non-invasive or invasive ventilation. None of these reports clarify the clinical meaning of these endocrine disturbances, and their pathogenesis remains elusive. In this respect, hypotheses include they represent a stress-evoked response or are generated by a direct attack of the virus to the gland. This latter hypothesis is sustained by findings demonstrating gland cell types can be target of viruses from bat origin. Consistently, it has been reported that i) human thyrocytes express the mRNA for ACE2 (8), the host receptor of the virus Spike protein, ii) viral particles were detected in the follicular epithelium of patients who died of SARS and also of Covid-19 presenting subacute thyroiditis (9) iii) Covid-19 patients may present, where measured, high levels of pro-calcitonin (PCT). Overall, these intriguing data would need to be confirmed by larger clinical studies to establish conclusively the causal relationship, if any, among thyroid diseases and virus infection, and, more importantly, their clinical relevance as possible prognostic indicators of mortality and of severe cardiovascular events (10). However, in the light of the present data, we like to share some considerations on the possibility that reduced serum T3 levels, as observed in EES, because they are not representative of its tissue-specific levels, coincide with accumulation of T3 metabolites, i.e. thyromimetics. The accumulation of such compounds in the olfactory epithelium and skeletal muscle could offer a pathogenic hypothesis for the onset of anosmia and sarcopenia, two fingerprint manifestations of Covid-19 infection. In extra thyroid tissues, T3 levels are controlled by type 1, 2, and 3 deiodinases (DIO1, DIO2, and DIO3 respectively), enzymes removing iodide ions with respect to their position on the aromatic rings and that have a high specific tissue expression. In particular, DIO2 and DIO3 are the main isoforms expressed in neurons and skeletal muscle, and they are rapidly modulated at inflammatory conditions, including ESS (4) and, in general, infective agent attacks (11, 12). At conditions of reduced DIO2 activity, T4 metabolism is mainly driven towards revT3, the alternative metabolite with a very low intrinsic activity at thyroid hormone receptors and considered among the source of other iodinated metabolites belonging to three different chemical classes including thyronamines and thyroacetic acids. These metabolites are indicated as endogenous thyromimetics accumulating in thyroid hormone target tissues and sharing the same but not all the biological effects of T3 (13). Among these compounds, the 3-iodothyronamine (T1AM) is the more characterized in term of pharmacokinetic and pharmacodynamics features (13). Pharmacologically administered T1AM elicited neurological and metabolic effects with high potency. The mechanism of several of these effects remains to be clarified, and possible targets have been described including the trace amine associated receptors (TAAR1-5), while its affinity at thyroid hormone receptors is negligible. TAARs are evolutionarily conserved in vertebrates including humans, exerting an indispensable role in olfaction (14). T1AM, and possibly other thyronamines by the means of their nature as “amines in trace”, is a high affinity ligand for TAAR1 and is described as an inverse agonist at the TAAR5 (15). The olfactory epithelium expresses several TAAR isoforms including TAAR5 but also ACE2 and TMPRSS2, the host virus receptors. According to its pharmacodynamics, T1AM is expected to reduce the basal activity of TAAR5. Down-regulation of TAARs (and anosmia) is reported as a secondary event to immune innate signaling activation induced by virus infection (16). It is then possible to postulate accumulation of T1AM, as result of an increase of revT3 concentration, might have a role in increasing the threshold of olfactory receptor activation thus participating to Covid-19 induced anosmia. The fast recovery from this adverse event experienced by some Covid-19 patients would be consistent with the short half-life of T1AM. In those where anosmia persists even after infection resolution, desensitization effects could add to more complex damages at neurological circuits. Sarcopenia associated with Covid-19 is likely secondary to the cytokine storm and of a long bed rest even if a direct attack of the virus to the skeletal myocytes cannot be excluded since satellite cells and adult myofibers express ACE2 (17). Sarcopenia has a negative impact on patient recovery (18), and it represents a negative prognostic factor for cardiovascular complications (19). Since T3 strongly controls skeletal muscle regenerative capacity and metabolic functions (20), reduced levels of T3 together with vascular inflammation and cachexia, might trigger skeletal muscle catabolism and an incorrect myogenic program of satellite cells. In addition, a role for calcitonin in controlling satellite cell quiescence and their escape from fiber niche, a condition exposing satellite cells to aging and a fibrotic fate, has been described recently (21). In the skeletal muscle, Ju et al. (2017) reported T1AM activated catabolic pathways involved in sarcopenia including AMPK activation (22). Overall, anosmia and sarcopenia have an inflammatory ground which includes a crucial balance between DIO2/DIO3, thus controlling T3 local production (23, 24). Accumulation of revT3 and of T1AM may act in concert as pathogenic events in these Covid-19 clinical manifestations. The role of thyromimetics in Covid-19 related anosmia and sarcopenia is a hypothesis which needs to be confirmed by clinical data. In this respect we launched the opportunity to include the evaluation of thyromimetics among the biomarkers of the thyroid function. Covid-19 pandemic might offer an extraordinary opportunity for investigating the role of the thyroid and to assign a physiopathological role to endogenous thyromimetics

Assessing the Role of Sleep, Grief, Anxiety, and Depression in a Miscarriage Population

Miscarriage occurs at a relatively high rate in women who become pregnant with bereavement, anxiety, and depression as commonly experienced consequences of miscarriage. All of these consequences are connected to sleep disturbance, which to date has been neglected within the field of miscarriage research. Sleep is an important facet of miscarriage to evaluate because it is a modifiable behavior that may be a key component to include in follow-up care. We hypothesized that sleep disturbance would coincide with bereavement, anxiety, and depression not only among women who miscarried, but also among the partners of women who miscarried. It was proposed that sleep disturbance, in general, and insomnia, in specific, would be significantly associated with bereavement, anxiety, and depression. Furthermore, bereavement would account for sleep disturbance while controlling for depression. Eighty-eight women and 67 male partners who have experienced a miscarriage within the last year completed surveys on sleep and mood. Findings showed that both women who miscarried and partners of women who have miscarried experienced elevated sleep disturbance, bereavement, anxiety, and insomnia. Both sleep disturbance and insomnia were found to be associated with anxiety and depression. Women reported significantly more mood and sleep disturbance than partners, with the exception of depression and bereavement. Sleep disturbance was associated with female bereavement levels but not partner levels; insomnia was not related to either female or partner bereavement levels. Bereavement did not significantly predict sleep quality after controlling for depression. Future studies should seek to further clarify the relationships among bereavement and sleep by attempting to provide sleep therapy post miscarriage to see if bereavement is significantly improved against a control group who receives treatment as usual. Using a prospective longitudinal design to follow participants throughout their bereavement process would better assist in understanding for whom, under what context, and during which specific time periods bereavement and sleep are most exacerbated, leading to when treatment may be most helpful.M.S., Psychology -- Drexel University, 201