State Trends in Premiums and Deductibles, 2003-2011: Eroding Protection and Rising Costs Underscore Need for Action

Rapidly rising health insurance premiums and higher cost-sharing continue to strain the budgets of U.S. working families and employers. Analysis of state trends in private employer-based health insurance from 2003 to 2011 reveals that premiums for family coverage increased 62 percent across states -- rising far faster than income for middle- and low-income families. At the same time, deductibles more than doubled in large and small firms. Workers are thus paying more but getting less-protective benefits. If trends continue at their historical rate, the average premium for family coverage will reach nearly $25,000 by 2020. The Affordable Care Act's reforms should begin to moderate costs while improving coverage. But with private insurance costs projected to increase faster than incomes over the next decade, further efforts are needed. If annual premium growth slowed by one percentage point, by 2020 employers and families would save$2,029 annually for family coverage.View the related infographic

Application of Phase Change Materials for heat storage in water tanks

I PCM (Phase Change Materials) mostrano un'elevata entalpia di fusione con la capacità, in un volume relativamente piccolo, di immagazzinare o rilasciare grandi quantità di energia come calore latente durante la fusione e la solidificazione. Inoltre, i PCM in pratica richiedono che le loro temperature di transizione di fase superiore e inferiore siano all'interno dell'intervallo di temperatura operativa per una data applicazione e posseggano un'elevata conducibilità termica per un efficiente trasferimento di calore con un comportamento di scambio di fase congruente per evitare la separazione irreversibile dei loro costituenti. Durante lo sviluppo dei PCM, sono stati studiati molti gruppi diversi di materiali, tra cui composti inorganici (sale e idrati salini), composti organici come paraffine, acidi grassi e persino materiali polimerici come il PEG. La relazione tra la struttura fondamentale e le proprietà di immagazzinamento dell'energia di questi PCM è stata esaminata negli anni per determinare i meccanismi di accumulazione/emissione di calore con riferimento alle loro caratteristiche finali di immagazzinamento dell'energia. La tesi mira a studiare l'applicazione dei Phase Change Materials in un serbatoio d'acqua per aumentare la capacità di accumulo termico negli impianti di riscaldamento degli edifici. La possibilità di utilizzare l'acqua come acqua calda sanitaria è stata esclusa dallo studio, per cui si è ipotizzato di utilizzarla solo per il riscaldamento o il raffreddamento a pavimento

Energy Management Mechanisms Employed at the Human-Material Interface of Traditional and Minimalist Shod Running

From recreational to elite athletes, greater than 50% of runners sustain overuse injuries each year, prompting substantial research efforts to identify causes of—and solutions to—the high injury rate. Different shoe types and material property degradation have been related to injury. Two popular footwear types are traditional shoes with thick graded soles and minimalist running footwear with thinner foam and/or non-graded soles. Notwithstanding 45 years of significant modifications to shoe design features, gained knowledge in kinesiology, and advanced technologies in polymer science, runner injury rates have not decreased and EVA foam has remained the primary running shoe midsole material since the 1970s. The purpose of this dissertation is to improve comprehensive understanding of energy management during multi-scale degradation of EVA foam and biomechanical responses of human runners. The grand challenge of this research was to navigate, adapt, and weave together polymer and kinesiology techniques to: (i) quantify midsole foam macroscopic, microscopic, and molecular-level degradation, and (ii) characterize human responses to the dynamic material properties of contemporary footwear. In the pursuit of human-material interactions, we first investigated fundamental energy management mechanisms. In Chapter II, we determined that humans innately reduced their impact preparatory mechanisms when foam thickness was increased from 0 – 50 mm. In Chapter III, we compared and defined molecular-level EVA foam degradation by thermal, UV, and mechanical exposures. The latter three chapters substantiated (Chapter IV) and utilized (Chapter IV-VI) a biofidelic footwear midsole mechanical ageing protocol informed by human running input variables. We determined that: (i) the foam midsole managed 90% of the shoe’s energy and inaccurate sample geometries overestimated energy absorption by 20% (Chapter IV), (ii) traditional and minimalist shoe energy management differences were due to thickness, wherein 66% thicker foams absorbed ­­83% more energy but degraded at a 49% faster rate (Chapter V), and (iii) subject-specific biomechanics were altered by unique degradation patterns induced from wearing and mechanically ageing traditional and minimalist shoes (Chapter VI). Overall, this dissertation improved multidisciplinary protocols, contributed data informed by end-use conditions, and incorporated body and shoe variables simultaneously, which is critical to future studies correlating energy management to running injuries

Sensemaking as a framework for understanding how aspiring anti-racist leaders enact their learnings from a principal preparation program to disrupt the racial discipline gap

This dissertation emerges from an acknowledgement that robust research has shown that students of color receive a disproportionate number of disciplinary actions in American public schools compared to their white peers – a problem called the racial discipline gap. Few studies have studied school leaders’ sensemaking of the role of race in school disciplinary outcomes. Even fewer have considered how a specific type of leader – one known for aspiring to be anti-racist – makes sense of and frames the discipline gap and enacts the learnings from their principal preparation program to disrupt racial disparities in discipline outcomes. The perspective of the school principal has been found to be among the strongest predictor for rates of out-of-school suspension and expulsion. The findings from this study suggest that the sensemaking and problem-framing of the racial discipline gap by new school leaders is directly shaped by their identity as aspiring anti-racist leaders and the learnings from an anti-racist principal preparation program and their school contexts. The aspiring anti-racist leaders frame the problem at macro and micro levels, and enact both first and some second-order type change initiatives to interrupt factors of race from becoming patterns of race in school discipline. They demonstrate a limited approach to offering professional development to engage teachers in culturally relevant discussions and their formal data collection practices appear to be limited. This creates a blind spot for them in fully understanding the ways race intersects with discipline in their schools.Educational Administratio

The Effect of Gender on Fitness Motivational Factors: An Examination of St. John Fisher College Undergraduate Students

Gender and the effect it has on physical fitness motivational factors for St. John Fisher undergraduate students was examined, in the context of factors such as reasons for participation (health/functioning, appearance, achievement, social) factors that contribute to commitment (feeling in control, seeing physical changes, social) and qualities important in a fitness facility (location, staff and training aids, extra amenities, operating hours, quality/type of equipment, group classes offered, membership prices/packages). Significant gender differences were found in health and functioning, achievement, social reasons, location, and group classes

Nationwide Climate Assessment of Canadian Viticulture Utilizing Google Earth Engine

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Part I: The Quadratic Pade Method For Calculating Local Densities Of States Part Ii: Classical Stochasticity And Ionisation In A Square Potential Well Driven By An Oscillating Laser Field

Part I. A new method of calculating local densities of states from the moments of the Hamiltonian is developed and studied. A finite number of moments of the Hamiltonian at a given lattice site are first calculated. The quadratic Pade approximant, which is a special case of the Hermite-Pade approximant, is then used to obtain an approxi- mation for the local Green function. The local density of states is then obtained from there.;The new method was tested on several cases, which included regular lattices, a regular binary alloy, the semi-infinite simple cubic lattice, and a realistic model for the valence band of silicon. The results have been compared with those obtained from other methods.;The new method produces fairly accurate results in most parts of the energy band(s) if the number of singularity points is small. The accuracy obtained is comparable to or better than that of other methods of similar generality and complexity.;Part II. A square potential well can be experimentally fabricated, and used in quantum well lasers. By irradiating it with a driving laser beam the quantum well laser can be made tunable.;When the number of quantum emergy levels is fairly large, the behaviour of the electrons in the well can be studied by means of classical dynamics. The presence of the oscillating laser field causes the motion of the electrons to become stochastic, and thus they can escape from the well into the conduction band.;Stochasticity and ionisation have been studied by looking at the solutions to the classical equations of motion. Their dependence on the frequency and intensity of the driving laser has been studied for square wells of different dimensions.;The classical ionisation rate has been found to bear the charac- teristics of a multiphoton ionisation process. This unusual behaviour has been explained as the effect of the higher harmonics of the oscillating square potential well, as seen by the electron.;Finally, an experimental study of this physical system has been suggested, in which the classical predictions of this study can be tested

Creating a common trajectory: Shared decision making and distributed cognition in medical consultations

The growing literature on shared decision making and patient centered care emphasizes the patient’s role in clinical care, but research on clinical reasoning almost exclusively addresses physician cognition. In this article, we suggest clinical cognition is distributed between physicians and patients and assess how distributed clinical cognition functions during interactions between medical professionals and patients with Multiple Sclerosis (MS). A combination of cognitive task analysis and discourse analysis reveals the distribution of clinical reasoning between 24 patients and 3 medical professionals engaged in MS management. Findings suggest that cognition was distributed between patients and physicians in all major tasks except for the interpretation of MRI results. Otherwise, patients and physicians collaborated through discourse to develop a common trajectory to guide clinical reasoning. The patients’ role in clinical cognition expands the concept of patient-centered care and suggests the need to optimize physician-patient distributed cognition rather than physician cognition in isolation

Facile synthesis of 7-alkyl-1,2,3,4-tetrahydro-1,8-naphthyridines as arginine mimetics using a Horner-Wadsworth-Emmons-based approach

Integrin inhibitors based on the tripeptide sequence Arg-Gly-Asp (RGD) are potential therapeutics for the treatment of idiopathic pulmonary fibrosis (IPF). Herein, we describe an expeditious three-step synthetic sequence of Horner-Wadsworth-Emmons olefination, diimide reduction, and global deprotection to synthesise cores for these compounds in high yields (63-83% over 3 steps) with no need for chromatography. Key to this transformation is the phosphoramidate protecting group, which is stable to metalation steps

The feasibility of implementing the ICHOM Standard Set for Hip and Knee Osteoarthritis: a mixed-methods evaluation in public and private hospital settings.

Background: There is growing international momentum for standardising patient outcome assessment and using patient-reported outcome measures (PROMs) to capture outcomes that matter to patients. The International Consortium for Health Outcomes Measurement (ICHOM) Standard Sets were developed to capture the outcomes of care for costly conditions including osteoarthritis. This study evaluated the feasibility of implementing the ICHOM Standard Set for Hip and Knee Osteoarthritis in \u27real world\u27 public and private hospital settings. Methods: A mixed-methods design was used to capture comprehensive data on patient outcomes, implementation costs, and the implementation experiences of patients, clinicians and administrative staff. The ICHOM Standard Set was implemented at two hospital sites (1 public, 1 private) in May 2016. Patients undergoing primary hip or knee replacement for osteoarthritis were recruited from pre-admission clinics and a private orthopaedic clinic. Baseline Standard Set data were collected before surgery and at pre-determined post-operative timepoints. Data on the costs of Standard Set implementation were also collected. Semi-structured interviews were conducted with key stakeholders ( Results: The cost of Standard Set implementation and ongoing data collection for 17 months totalled $AUD94,955. Preference data (collected prior to completing the Standard Set) revealed that most participants preferred paper-based (83%) or web-based questionnaire completion (14%), with only a small proportion preferring iPad-based completion (3%). Several PROMs within the Standard Set were responsive to change (effect size range 0.19-0.85), with significant improvements in important health outcomes identified 6 weeks after surgery. Patient interviews showed a variable understanding of why patient-reported data collection is undertaken; however, patients perceived that PROMs provided relevant information to treating clinicians, and that the burden of questionnaire completion was minimal. Staff interviews revealed that PROMs are considered valuable, dedicated personnel are required to support data collection, gaps in information technology resources must be addressed, and that the Standard Set offers benefits beyond what currently-used measures provide. Conclusion: The Standard Set can be feasibly implemented in hospital settings, but with important caveats around staffing and technical support, consideration of patient preferences, and promotion of active clinician engagement