Medicare Prescription Drugs: Medical Necessity Meets Fiscal Insanity

Medicare is facing severe financial strains that threaten its future viability. On a per capita basis, Medicare spending is increasing at twice the rate of the gross domestic product, and, according to Medicare's chief actuary, the program is facing a breathtaking funding shortfall of $62 trillion -- nearly six times larger than the much -- discussed shortfall in Social Security. The newly enacted Medicare prescription drug benefit could cost more than$700 billion over the next 10 years and will only add to the program's financial woes. That new drug law would provide a sizable net benefit to retirees and older workers without existing coverage, even if Congress immediately funded it through higher Medicare payroll taxes.Workers born before 1965 -- baby boomers and current retirees -- would receive a net gain of about $20,000 per capita. Younger workers and all future generations, however, would suffer net losses of between$2,500 and $4,000 per capita. Furthermore, failure to include meaningful Medicare reforms in the drug program may cause steeper cost escalations, diluting its benefits. Congress should revisit the Medicare prescription drug program and insist on significant market-based reforms, not merely an ever-expanding array of benefits

Financing the U.S. Health System: Issues and Options for Change

Explores key issues of health reform and options for financing health care -- redirecting funds to more effective uses, rolling back tax cuts, modifying tax exclusions for health benefits, an employer play-or-pay model, and a value-added tax

Flowering Patterns of Understory Herbs 30 Years after Disturbance of Subalpine Old-Growth Forests by Tephra from Mount St. Helens

Premise of research. We sought to determine the role of flowering in recovery of understory herbs from a major disturbance and to determine the effects of plant and environmental factors on flowering patterns. Methodology. We counted flowering and nonflowering shoots in permanent plots eight to 10 times over a 30-year period for all 48 understory herb species in four subalpine old-growth conifer forests that received tephra (aerially transported volcanic ejecta) from the 1980 eruptions of Mount St. Helens, Washington. We defined two measures of flowering and related them to environmental and plant characteristics. Pivotal results. Patterns of flowering varied widely among species both among and within growth forms. Flowering increased with time, especially where it was initially low (for evergreen clonal plants, species that also grow in early seral habitats, and plants in deep tephra and from herb-poor sites). Some significant differences that occurred during the first 20 years disappeared by year 30. Percent of shoots flowering declined as shoot density increased, but the significance of this relationship declined until it became nonsignificant by year 25. There was a significant but weak relationship between the proportion of shoots flowering for a species and its proportional increase in shoot numbers during the 30 years of vegetation redevelopment; some species expanded populations only by flowering, while others became dominant while flowering little. Conclusions. Flowering patterns changed with time; this constitutes an important aspect of successional change. Studies of flowering and other aspects of sexual reproduction are important for understanding mechanisms of succession.This is the publisher’s final pdf. The published article is copyrighted by the University of Chicago Press and can be found at: http://www.journals.uchicago.edu/toc/ijps/currentKeywords: succession, coniferous forest, volcanic tephra, forest herbs, flowering, Mount St. Helen

Leaf-level physiology in four subalpine plants in tephra-impacted forests during drought

Ecological impacts of climate change in the Pacific Northwest may hinge on acclimation to drier summers, highlighting the importance of plant physiological studies in forests. Evaluating dominant forest plant species under old-growth and managed forest conditions is similarly important as timber harvest might change microclimates and alter drought effects on plants. We examined water potential and gas exchange rates of four dominant plant species in understories of subalpine forests of the Pacific Northwest region of the United States during 2015 - a year with drought conditions representative of future climate projections. We examined two conifer species (Abies amabilis Douglas ex J. Forbes and Tsuga heterophylla (Raf.) Sarg.) and two huckleberry species (Vaccinium membranaceum Douglas ex Torr. and Vaccinium ovalifolium Sm.) in old-growth and formerly clear-cut forests at two elevations. Contrary to expectations, we found no evidence of hydraulic stress, and there were no significant differences between old-growth and clear-cut stands, consistent with an edaphic buffering effect in this volcanic landscape. Variation in stem elongation rates among years also indicated the lack of a strong drought response in 2015. Water potential, photosynthesis, and stomatal conductance varied among species and among elevations. In combination, our results help constrain expected physiological activity of understory species in subalpine forests and emphasize the importance of the edaphic context (e.g., tephra deposits) in framing expectations for the responses to drought

Protein-Protein Fusion Catalyzed by Sortase A

Chimeric proteins boast widespread use in areas ranging from cell biology to drug delivery. Post-translational protein fusion using the bacterial transpeptidase sortase A provides an attractive alternative when traditional gene fusion fails. We describe use of this enzyme for in vitro protein ligation and report the successful fusion of 10 pairs of protein domains with preserved functionality — demonstrating the robust and facile nature of this reaction

TRY plant trait database - enhanced coverage and open access

Plant traits-the morphological, anatomical, physiological, biochemical and phenological characteristics of plants-determine how plants respond to environmental factors, affect other trophic levels, and influence ecosystem properties and their benefits and detriments to people. Plant trait data thus represent the basis for a vast area of research spanning from evolutionary biology, community and functional ecology, to biodiversity conservation, ecosystem and landscape management, restoration, biogeography and earth system modelling. Since its foundation in 2007, the TRY database of plant traits has grown continuously. It now provides unprecedented data coverage under an open access data policy and is the main plant trait database used by the research community worldwide. Increasingly, the TRY database also supports new frontiers of trait-based plant research, including the identification of data gaps and the subsequent mobilization or measurement of new data. To support this development, in this article we evaluate the extent of the trait data compiled in TRY and analyse emerging patterns of data coverage and representativeness. Best species coverage is achieved for categorical traits-almost complete coverage for 'plant growth form'. However, most traits relevant for ecology and vegetation modelling are characterized by continuous intraspecific variation and trait-environmental relationships. These traits have to be measured on individual plants in their respective environment. Despite unprecedented data coverage, we observe a humbling lack of completeness and representativeness of these continuous traits in many aspects. We, therefore, conclude that reducing data gaps and biases in the TRY database remains a key challenge and requires a coordinated approach to data mobilization and trait measurements. This can only be achieved in collaboration with other initiatives

Antigen-specific B-cell receptor sensitizes B cells to infection by influenza virus

Influenza A virus-specific B lymphocytes and the antibodies they produce protect against infection. However, the outcome of interactions between an influenza haemagglutinin-specific B cell via its receptor (BCR) and virus is unclear. Through somatic cell nuclear transfer we generated mice that harbour B cells with a BCR specific for the haemagglutinin of influenza A/WSN/33 virus (FluBI mice). Their B cells secrete an immunoglobulin gamma 2b that neutralizes infectious virus. Whereas B cells from FluBI and control mice bind equivalent amounts of virus through interaction of haemagglutinin with surface-disposed sialic acids, the A/WSN/33 virus infects only the haemagglutinin-specific B cells. Mere binding of virus is not sufficient for infection of B cells: this requires interactions of the BCR with haemagglutinin, causing both disruption of antibody secretion and FluBI B-cell death within 18 h. In mice infected with A/WSN/33, lung-resident FluBI B cells are infected by the virus, thus delaying the onset of protective antibody release into the lungs, whereas FluBI cells in the draining lymph node are not infected and proliferate. We propose that influenza targets and kills influenza-specific B cells in the lung, thus allowing the virus to gain purchase before the initiation of an effective adaptive response.National Institutes of Health (U.S.