Defining the Problem and Searching for Solutions: Insurers, Employers, and State Government

Panel discussion: Some solutions to the uninsured problem happening right here in Cleveland. The Health Policy Coalition is a group which presents health insurance reform ideas to Congress. Charles Weller talked about the Coalition. Powell Woods described the Cleveland Health Quality Choice Program as follows: Cleveland Health Quality Choice is based upon the principle that if we figure out a way to reward high quality and cost efficiency as the twin lynch pins of reimbursement in our health purchasing system, we can drive both quality and efficiency gains in the system which can help produce savings which will in turn help underwrite the problem of coverage for the uninsured. E. John Polk discussed employee health insurance programs offered by the Council of Smaller Enterprises (COSE). Kenneth Seminatore represented Blue Cross and Blue Shield of Ohio. He proposed that the price escalation problem be solved by well-managed competition, such as that created by the 1987 of Senate Bill 124, the Health Insurance Reform Act. Mr. Seminatore also mentioned the problem of mandated benefits, stating, A study by Dr. John Goodman of Dallas indicates that perhaps 20 percent of the uninsured nationally are uninsured because they\u27re priced out of the market by mandated benefits they neither want, their insurance companies don\u27t want to offer, and they can\u27t afford. He also proposed Medicaid buy-in for the working poor

Defining the Problem and Searching for Solutions: Insurers, Employers, and State Government

Panel discussion: Some solutions to the uninsured problem happening right here in Cleveland. The Health Policy Coalition is a group which presents health insurance reform ideas to Congress. Charles Weller talked about the Coalition. Powell Woods described the Cleveland Health Quality Choice Program as follows: Cleveland Health Quality Choice is based upon the principle that if we figure out a way to reward high quality and cost efficiency as the twin lynch pins of reimbursement in our health purchasing system, we can drive both quality and efficiency gains in the system which can help produce savings which will in turn help underwrite the problem of coverage for the uninsured. E. John Polk discussed employee health insurance programs offered by the Council of Smaller Enterprises (COSE). Kenneth Seminatore represented Blue Cross and Blue Shield of Ohio. He proposed that the price escalation problem be solved by well-managed competition, such as that created by the 1987 of Senate Bill 124, the Health Insurance Reform Act. Mr. Seminatore also mentioned the problem of mandated benefits, stating, A study by Dr. John Goodman of Dallas indicates that perhaps 20 percent of the uninsured nationally are uninsured because they\u27re priced out of the market by mandated benefits they neither want, their insurance companies don\u27t want to offer, and they can\u27t afford. He also proposed Medicaid buy-in for the working poor

The Fermi GBM Gamma-Ray Burst Spectral Catalog: Four Years Of Data

In this catalog we present the updated set of spectral analyses of GRBs detected by the Fermi Gamma-Ray Burst Monitor (GBM) during its first four years of operation. It contains two types of spectra, time-integrated spectral fits and spectral fits at the brightest time bin, from 943 triggered GRBs. Four different spectral models were fitted to the data, resulting in a compendium of more than 7500 spectra. The analysis was performed similarly, but not identically to Goldstein et al. 2012. All 487 GRBs from the first two years have been re-fitted using the same methodology as that of the 456 GRBs in years three and four. We describe, in detail, our procedure and criteria for the analysis, and present the results in the form of parameter distributions both for the observer-frame and rest-frame quantities. The data files containing the complete results are available from the High-Energy Astrophysics Science Archive Research Center (HEASARC).Comment: Accepted for publication in ApJ

Direct and inverse pumping in flows with homogeneous and non-homogeneous swirl

The conditions in which meridional recirculations appear in swirling flows above a fixed wall are analysed. In the classical Bodew\"adt problem, where the swirl tends towards an aysmptotic value away from the wall, the well-known "tea-cup effect" drives a flow away from the plate at the centre of the vortex. Simple dimensional arguments applied to a single vortex show that if the intensity of the swirl decreases away from the wall, the sense of the recirculation can be inverted, and that the associated flow rate scales with the swirl gradient. Only if the flow is quasi-2D, does the classical tea-cup effect take place. This basic theory is confirmed by numerical simulations of a square array of steady, electrically driven vortices. Experiments in the turbulent regimes of the same configuration reveal that these mechanisms are active in the average flow and in its fluctuating part. The mechanisms singled out in this letter provide an explanation for previously observed phenomena in electrolyte flows. They also put forward a possible mechanism for the generation of helicity in flows close to two-dimensionality, which plays a key role in the transition between 2D and 3D turbulence

A phlogopite-bearing lithospheric mantle source for Europe's largest REE-HFSE belt: Gardar Rift, SW Greenland

Alkaline-silicate complexes host some of the world's largest resources of rare-earth elements and high-field-strength elements (REE & HFSE) and represent the most fractionated magmatic systems on our planet. Geochemical evidence indicates that they are mantle melts, but while various studies highlight a role for lithospheric mantle, we do not know the precise origin of their contained REE and HFSE, and whether enrichment of the mantle source for these magmas can be attributed to specific geodynamic processes or events. We present new Nd-Hf isotope measurements (Image 1/Image 2 & Image 3/Image 4 ) made by LA-MC-ICP-MS, as well as a compilation of existing isotopic data for a suite of alkaline igneous rocks from the Gardar Province, a Mesoproterozoic continental rift in southern Greenland. Neodymium and hafnium isotopes are unaffected by crystal fractionation and can directly fingerprint the source of REE and HFSE. The dataset covers both phases of Gardar magmatism (1325–1261 and 1184–1140 Ma) and incorporates mafic dyke swarms and km-scale intrusive complexes, including Ilimmaasaq (Ilímaussaq) and Motzfeldt, which host some of the world's largest REE and HFSE deposits. The majority of Gardar complexes have a narrow range of positive median initial εNd (0 to +3.3) and εHf values (+0.2 to +6.0). Only two granite intrusions and the Eriksfjord basaltic lavas have crustally contaminated Nd-Hf isotope compositions, with the vast majority of Gardar igneous rocks preserving the isotope signature of their mantle source. Considering the diversity of rock types in the Gardar Province, initial εNd -εHf compositions are remarkably homogeneous, indicating a derivation of the Gardar's REE and HFSE from a laterally-extensive mantle melt source. Several Gardar systems have low initial εHf for a given εNd (Image 5εHf to -9.7), a distinctive signature as few geological processes decouple the Nd and Hf isotope systems. The decoupled Nd-Hf isotope signatures are consistent with contributions from isotopically-matured phlogopite-bearing metasomatic veins (commonly known as PIC: phlogopite-ilmenite-clinopyroxene) in the lithospheric mantle. The metasomatising fluids that formed these source rocks were introduced via Palaeoproterozoic subduction, but the Gardar isotopic signatures indicate that REE and HFSE enrichment of these metasomes was not derived from subducted sediment; instead it is likely that metals were scavenged from the mantle wedge overlying the ancient subduction zone. The Gardar Nd-Hf isotope evolution trends overlap with a global compilation of kimberlites through time and allow us to tie the origin of the PIC metasomes to the regional geodynamic history of South Greenland. We identify PIC metasomes as a key metal source for the Gardar and by extension perhaps other REE-mineralised igneous provinces globally

The spread of marine anoxia on the northern Tethys margin during the Paleocene-Eocene Thermal Maximum

Records of the paleoenvironmental changes that occurred during the Paleocene-Eocene Thermal Maximum (PETM) are preserved in sedimentary rocks along the margins of the former Tethys Ocean and Peri-Tethys. This paper presents new geochemical data that constrain paleoproductivity, sediment delivery, and seawater redox conditions, from three sites that were located in the Peri-Tethys region. Trace and major element, iron speciation, and biomarker data indicate that water column anoxia was established during episodes when inputs of land-derived higher plant organic carbon and highly weathered detrital clays and silts became relatively higher. Anoxic conditions are likely to have been initially caused by two primary processes: (i) oxygen consumption by high rates of marine productivity, initially stimulated by the rapid delivery of terrestrially derived organic matter and nutrients, and (ii) phosphorus regeneration from seafloor sediments. The role of the latter process requires further investigation before its influence on the spread of deoxygenated seawater during the PETM can be properly discerned. Other oxygen-forcing processes, such as temperature/salinity-driven water column stratification and/or methane oxidation, are considered to have been relatively less important in the study region. Organic carbon enrichments occur only during the initial stages of the PETM as defined by the negative carbon isotope excursions at each site. The lack of observed terminal stage organic carbon enrichment does not support a link between PETM climate recovery and the sequestration of excess atmospheric CO2 as organic carbon in this region; such a feedback may, however, have been important in the early stages of the PETM

The state of the Martian climate

60°N was +2.0°C, relative to the 1981–2010 average value (Fig. 5.1). This marks a new high for the record. The average annual surface air temperature (SAT) anomaly for 2016 for land stations north of starting in 1900, and is a significant increase over the previous highest value of +1.2°C, which was observed in 2007, 2011, and 2015. Average global annual temperatures also showed record values in 2015 and 2016. Currently, the Arctic is warming at more than twice the rate of lower latitudes

Human Herpesvirus-8 Infection Leads to Expansion of the Preimmune/Natural Effector B Cell Compartment

BACKGROUND: Human herpesvirus-8 (HHV-8) is the etiological agent of Kaposi's sarcoma (KS) and of some lymphoproliferative disorders of B cells. Most malignancies develop after long-lasting viral dormancy, and a preventing role for both humoral and cellular immune control is suggested by the high frequency of these pathologies in immunosuppressed patients. B cells, macrophages and dendritic cells of peripheral lymphoid organs and blood represent the major reservoir of HHV-8. Due to the dual role of B cells in HHV-8 infection, both as virus reservoir and as agents of humoral immune control, we analyzed the subset distribution and the functional state of peripheral blood B cells in HHV-8-infected individuals with and without cKS. METHODOLOGY/PRINCIPAL FINDINGS: Circulating B cells and their subsets were analyzed by 6-color flow cytometry in the following groups: 1- patients HHV-8 positive with classic KS (cKS) (n = 47); 2- subjects HHV-8 positive and cKS negative (HSP) (n = 10); 3- healthy controls, HHV-8 negative and cKS negative (HC) (n = 43). The number of B cells belonging to the preimmune/natural effector compartment, including transitional, pre-naïve, naïve and MZ-like subsets, was significantly higher among HHV-8 positive subjects, with or without cKS, while was comparable to healthy controls in the antigen-experienced T-cell dependent compartment. The increased number of preimmune/natural effector B cells was associated with increased resistance to spontaneous apoptosis, while it did not correlate with HHV-8 viral load. CONCLUSIONS/SIGNIFICANCE: Our results indicate that long-lasting HHV-8 infection promotes an imbalance in peripheral B cell subsets, perturbing the equilibrium between earlier and later steps of maturation and activation processes. This observation may broaden our understanding of the complex interplay between viral and immune factors leading HHV-8-infected individuals to develop HHV-8-associated malignancies