Private Health Insurance Provisions of H.R. 3962

[Excerpt] This report summarizes key provisions affecting private health insurance, including provisions to raise revenues, in Division A of H.R. 3962, the Affordable Health Care for America Act, as introduced in the House of Representatives on October 29, 2009. H.R. 3962 is based on H.R. 3200, America’s Affordable Health Choices Act of 2009, which was originally introduced on July 14, 2009, and was reported separately on October 14, 2009, by three House Committees— Education and Labor, Energy and Commerce, and Ways and Means. Division A of H.R. 3962 focuses on reducing the number of uninsured, restructuring the private health insurance market, setting minimum standards for health benefits, and providing financial assistance to certain individuals and, in some cases, small employers. In general, H.R. 3962 would require individuals to maintain health insurance and employers to either provide insurance or pay a payroll assessment, with some exceptions. Several insurance market reforms would be made, such as modified community rating and guaranteed issue and renewal. Both the individual and employer mandates would be linked to acceptable health insurance coverage, which would meet required minimum standards and incorporate the market reforms included in the bill. Acceptable coverage would include (1) coverage under a qualified health benefits plan (QHBP), which could be offered either through the newly created Health Insurance Exchange (the Exchange) or outside the Exchange through new employer plans; (2) grandfathered employment based plans; (3) grandfathered nongroup plans; and (4) other coverage, such as Medicare and Medicaid. The Exchange would offer private plans alongside a public option. Based on income, certain individuals could qualify for subsidies toward their premium costs and cost-sharing (deductibles and copayments); these subsidies would be available only through the Exchange. In the individual market (the nongroup market), a plan could be grandfathered indefinitely, but only if no changes were made to the terms and conditions of that plan, including benefits and cost-sharing, and premiums were only increased as allowed by statute. Most of these provisions would be effective beginning in 2013. The Exchange would not be an insurer; it would provide eligible individuals and small businesses with access to insurers’ plans in a comparable way. The Exchange would consist of a selection of private plans as well as a public option. Individuals wanting to purchase the public option or a private health insurance not through an employer or a grandfathered nongroup plan could only obtain such coverage through the Exchange. They would only be eligible to enroll in an Exchange plan if they were not enrolled in Medicare, Medicaid, and acceptable employer coverage as a full-time employee. The public option would be established by the Secretary of Health and Human Services (HHS), would offer three different cost-sharing options, and would vary premiums geographically. The Secretary would negotiate payment rates for medical providers, and items and services. The bill would also require that the Health Choices Commissioner to establish a Consumer Operated and Oriented Plan (CO-OP) program under which the Commissioner would make grants and loans for the establishment of not-for-profit, member-run health insurance cooperatives. These co-operatives would provide insurance through the Exchange. Only within the Exchange, credits would be available to limit the amount of money certain individuals would pay for premiums and for cost-sharing (deductibles and copayments). (Although Medicaid is beyond the scope of this report, H.R. 3962 would extend Medicaid coverage for most individuals under 150% of poverty; individuals would be ineligible for Exchange coverage if they were eligible for Medicaid.

Liquid Metal Sources in Ion Microscopy and Secondary Ion Mass Spectrometry

This paper reports on state-of-the-art developments in liquid metal sources and some of the finer points of their operating characteristics that are especially relevant to the satisfactory functioning of analytical ion scanning microscopes equipped with secondary ion mass spectrometers. Such effects include unwanted emissions from the source and their exclusion by means of filters and mass separators in the ion-optical column. The design of the ion-optical column is also discussed and some applications of this rapidly advancing form of analytical microscopy are described

Justice Policy Reform for High-Risk Juveniles: Using Science to Achieve Large-Scale Crime Reduction

After a distinctly punitive era, a period of remarkable reform in juvenile crime regulation has begun. Practical urgency has fueled interest in both crime reduction and research on the prediction and malleability of criminal behavior. In this rapidly changing context, high-risk youth – the small proportion of the population where crime is concentrated – present a conundrum. Research indicates that these are precisely the individuals to intensively treat to maximize crime reduction, but there are both real and imagined barriers to doing so. Institutional placement or criminal court processing can exclude these youths from interventions that would better protect public safety. In this article, we synthesize relevant research to help resolve this challenge in a manner that is consistent with the law’s core principles. In our view, adolescence offers unique opportunities for risk reduction that could (with modifications) be realized in the juvenile justice system in cooperation with other social institutions

Children’s Act Evaluation and Emotion Attribution Reasoning Regarding Different Moral Transgressions

This study investigated patterns of reasoning regarding different types of moral transgressions and different measures of moral development in children 6–8 years of age (N = 130). The findings documented different patterns of reasoning for each measure and for transgressions including different moral principles. Children distinguished between their understanding of their emotional response to a transgression and the moral violation that has occurred, using much more moral reasoning when justifying act evaluations and much more self-interest reasoning when justifying emotion attributions. Children also differentiated between different types of moral violations—that is, transgressions including different moral principles. Stories about others’ welfare elicited reasoning related to others’ welfare, stories about fairness elicited reasoning related to equality/rights/fairness, and a multifaceted story elicited both types of moral reasoning

Castilleja and Pedicularis are confirmed as telial hosts for white pine blister rust in whitebark pine ecosystems of Oregon and Washington

The primary objective of this research was to determine if native species within the genera Castilleja and Pedicularis are naturally infected by white pine blister rust (Cronartium ribicola) in whitebark pine ecosystems of the Oregon and Washington Cascade Range. Secondary objectives were to monitor the phenology of aecial and telial hosts to determine if there is sufficient time for C. ribicola to complete its lifecycle within high-elevation stands, and to evaluate the extent and variety of susceptible native hosts within these genera through field and growth chamber inoculation. These objectives were approached through fieldwork in 2008 and 2009 in whitebark pine ecosystems at Mt. Rainier, Mt. Adams, Mt. Hood, Mt. Bachelor, Tumalo Mtn. and Crater Lake. Forty-nine observational study plots were established (28 in 2008 and 21 in 2009) and monitored three to six times per season. Natural C. ribicola infection was detected on 84 Pedicularis racemosa plants and five Castilleja plants (C. applegatei, C. miniata, and C. parviflora). Field observations provided evidence that there is sufficient time for C. ribicola to complete its lifecycle on hosts within high-elevation whitebark pine stands. In 2009, 18 field inoculation plots were established at Mt. Rainier and Crater Lake. Field inoculation confirmed the susceptibility of two additional species within these genera, C. arachnoidea and P. bracteosa. The species identity of the rust on field specimens was verified through PCR and genetic sequencing of the ITS1-5.8S-ITS2 region of DNA. All four Castilleja species inoculated in the growth chamber developed infection, with an overall infection incidence of 62% (167 out of 270 plants). Improved understanding of the role of these newly recognized hosts in white pine blister rust epidemiology should be used to prioritize sites for the restoration of ecologically-valuable whitebark pine

Identifying Psychiatric Patients at Risk for Repeated Involvement in Violence: The Next Step Toward Intensive Community Treatment Programs

Recent studies indicate that a small, but critical subgroup of psychiatric patients is involved in a disproportionately large number of violent incidents among the mentally ill. This subgroup is an appropriate focus for intensive community-based treatment programs designed to reduce violence. However, little research has been conducted on methods for identifying patients who repeatedly become involved in violent incidents. This article describes a large follow-up study in which these patients were identified using a simple screening process that is feasible for routine use. This screening process efficiently and effectively identified a small minority of patients who were at risk for repeated involvement in violence. Patients deemed “at risk” by the screening process had an average of 7 violent incidents during a six-month follow-up period. The characteristics of these patients are described, and implications of the screening tool for conducting future research, targeting individuals for more intensive treatment services, and developing violence-focused treatment programs are discussed

Dietary restriction in ILSXISS mice is associated with widespread changes in splicing regulatory factor expression levels.

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this record Dietary restriction (DR) represents one of the most reproducible interventions to extend lifespan and improve health outcomes in a wide range of species, but substantial variability in DR response has been observed, both between and within species. The mechanisms underlying this variation in effect are still not well characterised. Splicing regulatory factors have been implicated in the pathways linked with DR-induced longevity in C. elegans and are associated with lifespan itself in mice and humans. We used qRT-PCR to measure the expression levels of a panel of 20 age- and lifespan-associated splicing regulatory factors in brain, heart and kidney derived from three recombinant inbred strains of mice with variable lifespan responses to short-term (2 months) or long-term (10 months) 40% DR to determine their relationship to DR-induced longevity. We identified 3 patterns of association; i) splicing factors associated with DR alone, ii) splicing factors associated with strain alone or iii) splicing factors associated with both DR and strain. Tissue specific variation was noted in response to short term or long-term DR, with the majority of effects noted in brain following long term DR in the positive responder strain TejJ89. Association in heart and kidney were less evident, and occurred following short term DR. Splicing factors associated with both DR and strain may be mechanistically involved in strain-specific differences in response to DR. We provide here evidence concordant with a role for some splicing factors in the lifespan modulatory effects of DR across different mouse strains and in different tissues

Integrin-Mediated Host Cell Invasion by Type 1–Piliated Uropathogenic Escherichia coli

Uropathogenic Escherichia coli (UPEC), the primary causative agent of urinary tract infections, typically express filamentous adhesive organelles called type 1 pili that mediate both bacterial attachment to and invasion of bladder urothelial cells. Several host proteins have previously been identified as receptors for type 1 pili, but none have been conclusively shown to promote UPEC entry into host bladder cells. Using overlay assays with FimH, the purified type 1 pilus adhesin, and mass spectroscopy, we have identified β1 and α3 integrins as key host receptors for UPEC. FimH recognizes N-linked oligosaccharides on these receptors, which are expressed throughout the urothelium. In a bladder cell culture system, β1 and α3 integrin receptors co-localize with invading type 1–piliated bacteria and F-actin. FimH-mediated bacterial invasion of host bladder cells is inhibited by β1 and α3 integrin–specific antibodies and by disruption of the β1 integrin gene in the GD25 fibroblast cell line. Phosphorylation site mutations within the cytoplasmic tail of β1 integrin that alter integrin signaling also variably affect UPEC entry into host cells, by either attenuating or boosting invasion frequencies. Furthermore, focal adhesion and Src family kinases, which propagate integrin-linked signaling and downstream cytoskeletal rearrangements, are shown to be required for FimH-dependent bacterial invasion of target host cells. Cumulatively, these results indicate that β1 and α3 integrins are functionally important receptors for type 1 pili–expressing bacteria within the urinary tract and possibly at other sites within the host

The relationship between psychological distress and multiple tender points across the adult lifespan

Multiple tender points are common in the population and, in studies of mid-life adults, are strongly associated with high levels of psychological distress. Whether this relationship occurs in older adults is unclear. This cross-sectional study investigated whether high levels of psychological distress would be associated with a high tender point count and whether the relationship would be moderated by age. Three thousand three hundred and seventy-nine individuals were mailed a questionnaire which included the Hospital Anxiety and Depression (HAD) scale, the Pain Catastrophising Scale (PCS), the Brief Illness Perception Questionnaire (Brief IPQ), and the Pittsburgh Sleep Quality Index (PSQI). A random sample of approximately 10% of subjects who returned the questionnaire undertook a physical assessment, including a manual tender point count assessment.A total of 2385 (71%) subjects completed the questionnaire, of whom 798 (33%) were invited to take part in the physical assessment and 290 (12%) participated. Of the 290 participants the median age was 64 years (range 34-97) and 63% were female. The median HAD score was 9 (IQR 5-14) and the median number of tender points was 3 (range 0-7).Increasing HAD score was positively and significantly associated with tender point count, but this relationship was not moderated by age. In a final multivariable model, sex, HAD score and PSQI score were independent predictors of multiple tender points.Psychological distress was associated with multiple tender points independent of age. Psychological distress and trouble sleeping were important, potentially modifiable factors associated with the outcome

Individual Mandate and Related Information Requirements under ACA

Report that describes the individual mandate under Section 1501 and Section 10106 of the Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended)