Insuring the Healthy or Insuring the Sick? The Dilemma of Regulating the Individual Health Insurance Market -- Short Case Studies of Six States

Looks at a range of regulatory strategies used to make individual health insurance policies more accessible and affordable. Assesses the effectiveness of regulatory reforms in Iowa, Kansas, Kentucky, Massachusetts, New Jersey, and Washington

Characterization of virulence factors in the newly described <i>Salmonella enterica</i> serotype Keurmassar emerging in Senegal (sub-Saharan Africa)

From 2000 to 2001, nine strains of Salmonella enterica belonging to the new serotype Keurmassar have been isolated from human and poultry samples at the Senegalese National Salmonella and Shigella Reference Laboratory at the Pasteur Institute, in Dakar. All strains carried virulence factors including Salmonella Pathogenicity Islands (SPI)-1, -2, -3 and -5 encoded genes. Strains did not harbour virulence plasmid. Ribotyping analysis revealed a single clone identical to Salmonella Decatur isolated in Zimbabwe. These data suggest that strains are closely related, and may have been spread clonally. In this new serotype, insertion sequence IS200 is not present

Climate, snowmelt dynamics and atmospheric deposition interact to control dissolved organic carbon export from a northern forest stream over 26 years

Increasing concentrations of dissolved organic carbon (DOC) have been identified in many freshwater systems over the last three decades. Studies have generally nominated atmospheric deposition as the key driver of this trend, with changes in climatic factors also contributing. However, there is still much uncertainty concerning net effects of these drivers on DOC concentrations and export dynamics. Changes in climate and climate mediated snowfall dynamics in northern latitudes have not been widely considered as causal factors of changes in long-term DOC trends, despite their disproportionate role in annual DOC export. We leveraged long-term datasets (1988–2013) from a first-order forested tributary of Lake Superior to understand causal factors of changes in DOC concentrations and exports from the watershed, by simultaneously evaluating atmospheric deposition, temperature, snowmelt timing, and runoff. We observed increases in DOC concentrations of approximately 0.14 mg C l−1 yr−1 (mean = 8.12 mg C l−1) that were related with declines in sulfate deposition (0.03 mg SO24− l−1 yr−1). Path analysis revealed that DOC exports were driven by runoff related to snowmelt, with peak snow water equivalences generally being lower and less variable in the 21st century, compared with the 1980s and 1990s. Mean temperatures were negatively related (direct effects) to maximum snow water equivalences (−0.71), and in turn had negative effects on DOC concentrations (−0.58), the timing of maximum discharge (−0.89) and DOC exports (indirect effect, −0.41). Based on these trends, any future changes in climate that lessen the dominance of snowmelt on annual runoff dynamics—including an earlier peak discharge—would decrease annual DOC export in snowmelt dominated systems. Together, these findings further illustrate complex interactions between climate and atmospheric deposition in carbon cycle processes, and highlight the importance of long-term monitoring efforts for understanding the consequences of a changing climate

Palliative care among heart failure patients in primary care: A comparison to cancer patients using english family practice data

© 2014 Gadoud et al. Introduction: Patients with heart failure have a significant symptom burden and other palliative care needs often over a longer period than patients with cancer. It is acknowledged that this need may be unmet but by how much has not been quantified in primary care data at the population level. Methods: This was the first use of Clinical Practice Research Datalink, the world's largest primary care database to explore recognition of the need for palliative care. Heart failure and cancer patients who had died in 2009 aged 18 or over and had at least one year of primary care records were identified. A palliative approach to care among patients with heart failure was compared to that among patients with cancer using entry onto a palliative care register as a marker for a palliative approach to care. Results: Among patients with heart failure, 7% (234/3 122) were entered on the palliative care register compared to 48% (3 669/7 608) of cancer patients. Of heart failure patients on the palliative care register, 29% (69/234) were entered onto the register within a week of their death. Conclusions: This confirms that the stark inequity in recognition of palliative care needs for people with heart failure in a large primary care dataset. We recommend a move away from prognosis based criteria for palliative care towards a patient centred approach, with assessment of and attention to palliative needs including advance care planning throughout the disease trajectory

What are the main symptoms and concerns reported by patients with advanced chronic heart failure?—a secondary analysis of the Palliative care Outcome Scale (POS) and Integrated Palliative care Outcome Scale (IPOS)

© Annals of Palliative Medicine. All rights reserved. There is a lack of valid disease-specific patient-reported outcome measures (PROMs) for detecting symptoms and concerns in patients with advanced chronic heart failure (CHF). The Palliative care Outcome Scale (POS) and Integrated Palliative care Outcome Scale (IPOS) are specifically developed to capture the main symptoms and concerns of people severely affected by advanced disease. The aim of this study was to determine whether POS and IPOS captures the main symptoms and concerns self-reported by patients with advanced CHF. A secondary analysis of existing POS/IPOS data collected in three longitudinal studies was conducted. POS and IPOS start with an open-ended question for patients to report their main problems and concerns, followed by subsequent closed questions on a range of symptoms and other concerns. Descriptive statistics were used to report the results. The 102 participants from the three datasets had median age 81 years (SD ±9.84 years); 62% male; 87% white. A total of 107 concerns were reported in the first, open POS/IPOS question seeking the patient’s main concerns. Of these, 83 (77%) were reflected in the subsequent IPOS/POS closed questions. The high correspondence between the free-text responses and the closed questions indicates that most issues are captured by the POS/IPOS items. In conclusion, the generic versions of POS and IPOS do capture the main problems and concerns of patients with advanced CHF. Minor adaptations and further psychometric validation of POS and IPOS are needed in this population

Analisis dan Perancangan Sistem Informasi Pendistribusian Gas Lpg Bersubsidi dengan Metodologi Object Oriented Studi Kasus PT. Xyz

Kemajuan peradaban dan populasi manusia, serta revolusi industri telah membawa manusia pada era eksploitasi Sumber Daya Alam(SDA) sehingga persediaannya terus berkurang secara signifikan. SDA mutlak diperlukan untuk menunjang kebutuhan manusia. Indonesia merupakan negara dengan tingkat biodiversitas tertinggi kedua di dunia setelah Brazil. Berdasarkan sifatnya dapat digolongkan menjadi SDA yang dapat diperbaharui dan SDA tak dapat diperbaharui seperti tumbuhan, hewan, mikroorganisme, sinar matahari, angin, dan air. Minyak bumi, emas, besi, Gas dan berbagai bahan tambang lainnya adalah SDA tak dapat diperbaharui yang jumlahnya terbatas karena penggunaanya lebih cepat daripada proses pembentukannya. LPG adalah kependekan dari Liquefied Petroleum Gas. LPG merupakan gas hasil produksi dari kilang minyak atau kilang gas, yang komponen utamanya adalah gas propane (C3H8) dan butane (C4H10) yang dicairkan. Menimbang bahwa dalam rangka untuk menjamin penyediaan dan pengadaan bahan bakar di dalam negeri dan mengurangi subsidi Bahan Bakar Minyak (BBM) guna meringankan beban keuangan negara, perlu dilakukan substitusi penggunaan minyak tanah ke LPG maka keluar Peraturan Presiden Republik Indonesia Nomor 104 Tahun 2007 tentang penyediaan, pendistribusian, dan penetapan harga LPG. PT. XYZ menjadi salah satu Badan Usaha yang menyelenggarakan penyediaan dan pendistribusian LPG bersubsidi. Dalam prosesnya dibutuhkan laporan – laporan mengenai pendistribusian, terutama pada data penerima subsidi. Data ini sangat banyak sehingga menyulitkan jika dilakukan secara manual. PT. XYZ membantu proses pendistribusian untuk menghindari kecurangan – kecurangan yang mungkin dilakukan pada saat pendistribusian. PERTAMINA sebagai pemberi subsidi mengharapkan distribusi merata di seluruh wilayah Indonesia. Untuk mengurangi kesalahan dan kecurangan pada saat distrubisi Gas maka dibutuhkan Sistem informasi, dengan sistem informasi proses pendistrubusian Gas akan lebih cepat dan akurat sehingga Perusahaan dapat bekerja secara baik, efektif, dan efisien. Anaisis dan perancangan sistem menggunakan Metodologi Object Oriented dan UML, database yang digunakan adalah Mysql Server dengan Microsoft Visual Studio 2005 sebagai bahasa program nya

Identifying Effective Classroom Practices Using Student Achievement Data

Recent research has confirmed both the importance of teachers in producing student achievement growth and in the variability across teachers in the ability to do that. Such findings raise the stakes on our ability to identify effective teachers and teaching practices. This paper combines information from classroom-based observations and measures of teachers’ ability to improve student achievement as a step toward addressing these challenges. We find that classroom based measures of teaching effectiveness are related in substantial ways to student achievement growth. Our results point to the promise of teacher evaluation systems that would use information from both classroom observations and student test scores to identify effective teachers. Our results also offer information on the types of practices that are most effective at raising achievement.

Editorial : The Challenges of Interdisciplinary Publishing

Peer reviewedPublisher PD

"Appearance potent"? A content analysis of UK gay and straight men's magazines.

With little actual appraisal, a more 'appearance potent' (i.e., a reverence for appearance ideals) subculture has been used to explain gay men's greater body dissatisfaction in comparison to straight men's. This study sought to assess the respective appearance potency of each subculture by a content analysis of 32 issues of the most read gay (Attitude, Gay Times) and straight men's magazines (Men's Health, FHM) in the UK. Images of men and women were coded for their physical characteristics, objectification and nudity, as were the number of appearance adverts and articles. The gay men's magazines featured more images of men that were appearance ideal, nude and sexualized than the straight men's magazines. The converse was true for the images of women and appearance adverts. Although more research is needed to understand the effect of this content on the viewer, the findings are consistent with a more appearance potent gay male subculture