ACA Implementation Monitoring and Tracking Site Visit Report: Colorado

Assesses Colorado's progress in implementing federal healthcare reform legislation, including ongoing planning for the health insurance exchange, enrollment and subsidy determination, and Medicaid expansion, as well as work remaining on insurance reforms

Police use-of-force policies should be replaced by those based more closely on legal principles

In the United States, many police forces determine how much force to use when dealing with suspects through a continuum which ranks different levels of force based on resistance. In new research which examines more than 700 use of force incidents in one city, Scott M. Mourtgos, Ian T. Adams and Samuel R. Baty find that there is very little difference in how police use less-lethal force, despite this apparent ranking. They argue that rather than using continuums to determine the level of force to use, US police forces should base their use of force on legal principles

A Gravitational Theory of the Quantum

The synthesis of quantum and gravitational physics is sought through a finite, realistic, locally causal theory where gravity plays a vital role not only during decoherent measurement but also during non-decoherent unitary evolution. Invariant set theory is built on geometric properties of a compact fractal-like subset $I_U$ of cosmological state space on which the universe is assumed to evolve and from which the laws of physics are assumed to derive. Consistent with the primacy of $I_U$, a non-Euclidean (and hence non-classical) state-space metric $g_p$ is defined, related to the $p$-adic metric of number theory where $p$ is a large but finite Pythagorean prime. Uncertain states on $I_U$ are described using complex Hilbert states, but only if their squared amplitudes are rational and corresponding complex phase angles are rational multiples of $2 \pi$. Such Hilbert states are necessarily $g_p$-distant from states with either irrational squared amplitudes or irrational phase angles. The gappy fractal nature of $I_U$ accounts for quantum complementarity and is characterised numerically by a generic number-theoretic incommensurateness between rational angles and rational cosines of angles. The Bell inequality, whose violation would be inconsistent with local realism, is shown to be $g_p$-distant from all forms of the inequality that are violated in any finite-precision experiment. The delayed-choice paradox is resolved through the computational irreducibility of $I_U$. The Schr\"odinger and Dirac equations describe evolution on $I_U$ in the singular limit at $p=\infty$. By contrast, an extension of the Einstein field equations on $I_U$ is proposed which reduces smoothly to general relativity as $p \rightarrow \infty$. Novel proposals for the dark universe and the elimination of classical space-time singularities are given and experimental implications outlined

High levels of intraspecific genetic divergences revealed for Antarctic springtails: evidence for small-scale isolation during Pleistocene glaciation

We examined levels of genetic variability within and among populations of three Antarctic springtail species (Arthropoda: Collembola) and tested the hypothesis that genetic divergences occur among glacially-isolated habitats. The study was conducted in southern Victoria Land, Ross Dependency, Antarctica, and samples were collected from locations in the vicinity of the Mackay Glacier. We analyzed mtDNA (cytochrome c oxidase subunit I; COI) sequence variability for 97 individuals representing three species (Gomphiocephalus hodgsoni, N = 67; Cryptopygus nivicolus, N = 20; and Antarcticinella monoculata, N = 8). Haplotype diversity and genetic divergences were calculated and used to indicate population variability and also to infer divergence times of isolated populations using molecular clock estimates. Two of the three species showed high levels of genetic divergence. Gomphiocephalus hodgsoni, a widespread and common species, showed 7.6% sequence divergence on opposite sides of the Mackay Glacier. The more range restricted C. nivicolus showed 4.0% divergence among populations. The third species, A. monoculata, was found in only one location. Molecular clock estimates based on sequence divergences suggest that populations separated within the last 4 Mya. We conclude that habitat fragmentation resulting from Pliocene (5 Mya) and Pleistocene (2 Mya to 10 Kya) glaciations has promoted and maintained high levels of diversity among isolated springtail populations on relatively small spatial scales. The region surrounding the Mackay Glacier is likely to have provided refugia for springtail populations during glacial maxima and remains an area of high genetic and species diversity for Collembola within the Ross Sea region

Is there a role for DAZL in human female fertility?

The RNA binding protein deleted in azoospermia-like (Dazl) is a key determinant of germ cell maturation and entry into meiosis in rodents and other animal species. Although the complex phenotype of Dazl deficiency in both sexes, with defects at multiple stages of germ cell development and during meiosis, demonstrates its obligate significance in fertility in animal models, its involvement in human fertility is less clear. As an RNA binding protein, identification of the in vivo mRNA targets of DAZL is necessary to understand its influence. Thus far, only a small number of Dazl targets have been identified, which typically have pivotal roles in germ cell development and meiotic progression. However, it is likely that there are a number of additional germ cell and meiosis-relevant transcripts whose translation is affected in the absence of Dazl. Efforts to identify these RNA targets have mainly been focused on spermatogenesis, and restricted to mouse. In women, prophase I occurs in fetal life and it is during this period that the ovarian follicle pool is established, thus factors that have a role in determining the quality and quantity of the ovarian reserve may have significant impact on reproductive outcomes later in adult life. Here, we suggest that DAZL may be one such factor, and there is a need for greater understanding of the role of DAZL in human oogenesis and its contribution to lifelong female fertility

Age- and Lesion-Related Comorbidity Burden Among US Adults With Congenital Heart Disease: A Population-Based Study.

Background As patients with congenital heart disease (CHD) are living longer, understanding the comorbidities they develop as they age is increasingly important. However, there are no published population-based estimates of the comorbidity burden among the US adult patients with CHD. Methods and Results Using the IBM MarketScan commercial claims database from 2010 to 2016, we identified adults aged ≥18 years with CHD and 2 full years of continuous enrollment. These were frequency matched with adults without CHD within categories jointly defined by age, sex, and dates of enrollment in the database. A total of 40 127 patients with CHD met the inclusion criteria (mean [SD] age, 36.8 [14.6] years; and 48.2% were women). Adults with CHD were nearly twice as likely to have any comorbidity than those without CHD (P<0.001). After adjusting for covariates, patients with CHD had a higher prevalence risk ratio for "previously recognized to be common in CHD" (risk ratio, 9.41; 95% CI, 7.99-11.1), "other cardiovascular" (risk ratio, 1.73; 95% CI, 1.66-1.80), and "noncardiovascular" (risk ratio, 1.47; 95% CI, 1.41-1.52) comorbidities. After adjusting for covariates and considering interaction with age, patients with severe CHD had higher risks of previously recognized to be common in CHD and lower risks of other cardiovascular comorbidities than age-stratified patients with nonsevere CHD. For noncardiovascular comorbidities, the risk was higher among patients with severe than nonsevere CHD before, but not after, the age of 40 years. Conclusions Our data underscore the unique clinical needs of adults with CHD compared with their peers. Clinicians caring for CHD may want to use a multidisciplinary approach, including building close collaborations with internists and specialists, to help provide appropriate care for the highly prevalent noncardiovascular comorbidities