Restructuring Medicare's Benefit Design: Implications for Beneficiaries and Spending

Estimates the effects of options for restructuring Medicare's fee-for-service benefit design, including a $550 deductible for Parts A and B, a 20 percent coinsurance on nearly all services, and a$5,500 limit on cost sharing for Medicare-covered services

Engaging Development Partners in Efforts to Reverse Malnutrition Trends in Pakistan

After two decades of failed efforts to launch a national nutrition programme and nutrition action largely limited to low coverage interventions, a promising multisectoral nutrition scenario is unfolding in Pakistan led by provincial and regional officials and a well?coordinated group of development partners. The process has emerged from the confluence of three recent events in the country: the floods of 2010 and 2011; the passing of a constitutional amendment in 2010 which had the effect of dissolving the federal government's Ministry of Health and devolving responsibilities for health and nutrition to the provinces and regions; and a National Nutrition Survey in 2011 with results indicating that chronic malnutrition in the country had actually deteriorated over the previous decade. This article discusses the paths leading from these events to the present opportunities to address malnutrition aggressively and systematically, examines the sensitisation, advocacy and strategy development processes employed, and presents both the potential promise and the risks involved in the new provincial and regional nutrition undertakings

Subsidized food consumption systems in low income countries : the Pakistan experience

"#2063"--handwritten on coverIncludes bibliographical reference

Addressing malnutrition multisectorally : what have we learned from recent international experience? Case studies from Peru, Brazil, Bangladesh

In this report, authors Jim Levinson and Yarlini Balarajan of UNICEF New York and Alessandra Marini of the World Bank present three major case studies from Peru, Brazil and Bangladesh, but also a historical review of multisectoral nutrition activities in several other countries around the world. The report offers conclusions and lessons learned focusing on the value of combining nutrition-specific and nutrition-sensitive interventions that functions together in targeted areas, the importance of nutrition-related related results-based incentives to generate action on sub-national levels, and the importance of advocacy at the policy level.MDG Achievement Fund Secretariat, Cooperación Español

Identification of the active site residues in the nsP2 proteinase of sindbis virus

The nonstructural polyproteins of Sindbis virus are processed by a virus-encoded proteinase which is located in the C-terminal domain of nsP2. Here we have performed a mutagenic analysis to identify the active site residues of this proteinase. Substitution of other amino acids for either Cys-481 or His-558 completely abolished proteolytic processing of Sindbis virus polyproteins in vitro. Substitutions within this domain for a second cysteine conserved among alphaviruses, for four other conserved histidines, or for a conserved serine did not affect the activity of the enzyme. These results suggest that nsP2 is a papain-like proteinase whose catalytic dyad is composed of Cys-481 and His-558. Since an asparagine residue has been implicated in the active site of papain, we changed the four conserved asparagine residues in the C-terminal half of nsP2 and found that all could be substituted without total loss of activity. Among papain-like proteinases, the residue following the catalytic histidine is alanine or glycine in the plant and animal enzymes, and the presence of Trp-559 in alphaviruses is unusual. A mutant enzyme containing Ala-559 was completely inactive, implying that Trp-559 is essential for a functional proteinase. All of these mutations were introduced into a full-length clone of Sindbis virus from which infectious RNA could be transcribed in vitro, and the effects of these changes on viability were tested. In all cases it was found that mutations which abolished proteolytic activity were lethal, whether or not these mutations were in the catalytic residues, indicating that proteolysis of the nonstructural polyprotein is essential for Sindbis replication

Microorganisms of food ice cubes and their transfer to drinks

The present work was carried out to investigate the microbiological characteristics of the ice cubes produced at different levels: 1) home-made (HM) from domestic freezers; 2) produced by ice machines in bars and pubs (BP); 3) produced by ice industries (IN). BP samples were collected from the box stocks. HM and BP samples were transferred into sterile stomacher bags. IN samples were provided in the manufacturers\u2019 plastic bags. Samples were transported into thermal insulated boxes. Five samples per each production level, forming a total of 15 samples (HM1-HM5, BP1-BP5, IN1-IN5), were collected in duplicate in two consecutive months. Each ice sample was thawed in 1 L sterile Dhuram\u2019s bottle at room temperature and subjected to the membrane filtration analyses. Total mesophilic microorganisms (TMM), total psychrotrophic microorganisms (TPM), pseudomonads, members of the Enterobacteriaceae family, coliforms, enterococci, yeasts and moulds were investigated. When the amounts of colonies were uncountable, 1 mL of sample was directly inoculated into agar media. All results were expressed as colony forming units (CFU)/100 mL of thawed ice. TMM were in the range 100-9600, 312-6300 and 130-4000 for HM, BP and IN samples, respectively. Three HM and two IN samples were negative for the presence of TPM. The highest concentration (960) was found for IN2. Pseudomonads were detected in all HM samples but the highest levels were registered for BP1 (390) and IN2 (384). Except IN4, Enterobacteriaceae were found in all samples. All INs and 4 HM samples did not displayed coliforms. By contrast, they were hosted in all BP samples, ranging from 1 to 184. Enterococci were never found in HM samples, but detected in two INs and 3 BPs. Except IN1, moulds were always registered, while yeasts developed from the majority of HM and IN samples and two BP samples. The colonies representative for the different morphologies were randomly picked up from plates, purified to homogeneity and subjected to a phenotypic grouping. Yeasts and bacteria were subjected to the genetic identification by sequencing of D1/D2 domains of 26S rRNA gene and partial sequencing of 16S rRNA gene, respectively, while moulds were identified phenotypically. So far, the species mostly represented among bacteria, as evaluated only by the forward 16S rRNA gene sequence, were Bacillus spp., Pseudomonas spp., Pantoea spp., Pantoea agglomerans, Enterococcus faecium, and Agrobacterium tumefaciens. Candida intermedia and Pichia guillermondii were identified among yeasts and Penicillium spp. among moulds. The work was also aimed to monitor the microbial transfer from ice to humans through drinks. To this purpose, each microorganism was inoculated singly in sterile mineral water to produce contaminated ice cubes using disposable ice cube trays. Inoculums occurred at the highest concentrations found in the ice cubes analysed. The concentrations of the microorganisms were followed in six different types of drinks, including alcoholic (vodka and whiskey), moderate alcoholic (Martini), sparkling (tonic water), sugary (peach tea) and sugary sparkling (coke) drinks. In order to simulate the contamination of drinks by ice during consumption, six ice cubes (corresponding to 60 mL) containing each microorganism were added to 100 mL of each drink (simulating a bar administration) in sterile cups and, after 1 h, the entire volume was analysed by membrane filtration. A physiological solution was used as control. So far, the tests were performed with Penicillium spp. and P. agglomerans. Penicillium was not influenced by the different drinks, since, after 1 h, its level did not change. Regarding P. agglomerans, which is an opportunistic pathogen causing urinary tract infections, its concentration in peach tea was superimposable to that found in physiological solution, while it decreased in all other drinks. In particular, the concentration of this bacterium almost halved in vodka, coke and tonic water, diminished consistently in Martini and completely disappeared in whiskey. Experimentations are in progress to determine the behaviour of the other microorganisms in these systems. These data evidenced that the worst hygienic characteristics were found in BP samples, while the majority of ice cubes produced in specialized industries were characterized by acceptable microbiological parameters. This work indicated that the concentration of P. agglomerans is reduced by alcohol and CO2, but further in vivo assays are necessary to better clarify their role on the other ice microorganisms

The Dirac Sea Contribution To The Energy Of An Electroweak String

We present a systematic determination of the order hbar fermionic energy shift when an electroweak string is perturbed. We show that the combined effect of zero modes, bound states and continuum states is to lower the total fermionic ground state energy of the string when the Higgs instability of the string is excited. The effect of the Dirac sea is thus to destabilise the string. However, this effect can be offset by populating positive energy states. Fermions enhance the stability of an electroweak string with sufficiently populated fermionic bound states.Comment: 57 pages, 11 figure

QuickSNP: an automated web server for selection of tagSNPs

Although large-scale genetic association studies involving hundreds to thousands of SNPs have become feasible, the associated cost is substantial. Even with the increased efficiency introduced by the use of tagSNPs, researchers are often seeking ways to maximize resource utilization given a set of SNP-based gene-mapping goals. We have developed a web server named QuickSNP in order to provide cost-effective selection of SNPs, and to fill in some of the gaps in existing SNP selection tools. One useful feature of QuickSNP is the option to select only gene-centric SNPs from a chromosomal region in an automated fashion. Other useful features include automated selection of coding non-synonymous SNPs, SNP filtering based on inter-SNP distances and information regarding the availability of genotyping assays for SNPs and whether they are present on whole genome chips. The program produces user-friendly summary tables and results, and a link to a UCSC Genome Browser track illustrating the position of the selected tagSNPs in relation to genes and other genomic features. We hope the unique combination of features of this server will be useful for researchers aiming to select markers for their genotyping studies. The server is freely available and can be accessed at the URL http://bioinformoodics.jhmi.edu/quickSNP.pl