Evaluating the Harris County TexHealth 3-Share Plan: An exploratory study

An important health issue in the United States today is the large number of people who have problems accessing needed health care because they lack health insurance coverage. Providing health insurance coverage for the working uninsured is a particularly significant challenge in Texas, which has the highest percentage of uninsured in the nation. In response to the low rate of employer-sponsored coverage in the Houston area and the growing numbers of uninsured, the Harris County Health Care Alliance (HCHA) developed and implemented the Harris County 3-Share Plan. A 3-Share Plan is not insurance, but provides health coverage in the form of a benefits package to employers who subscribe to the program and offer it to their employees. ^ A cross sectional study design was conducted to describe 3-Share employer and employee participants and evaluate their outcomes after its first year of operation. Between September and December 2011, 85% of employers enrolled in the 3-Share Plan completed a survey about the affordability of the 3-Share Plan, their satisfaction with the Plan, and the Plan's impact on employee recruitment, retention, productivity, and absenteeism. Forty-five percent of employees enrolled in the 3-Share Plan responded to a survey asking about the affordability of the 3-Share plan, accessibility of health care, availability of providers on the plan, health plan availability, utilization of primary care providers and the ER, and satisfaction with the plan. ^ A summary of the findings shows employers and employees say that they joined the plan because of the low-cost, and once they had participated in the Plan, the majority of employers and employees found that it is affordable for them. The majority of employees say they are getting access easily and without delay, but for those who aren't able to get access, or are delayed, the main cause is related to non-financial barriers to care. Ultimately, employees are satisfied with the 3-Share, and they plan to continue with health coverage under the 3-Share Plan. The 3-Share Plan will keep people in a system of care, and promote health, which will benefit the individuals, the businesses and the community of Harris County.^

Evaluating the Harris County TexHealth 3-Share plan: An exploratory study

An important health issue in the United States today is the large number of people who have problems accessing needed health care because they lack health insurance coverage. Providing health insurance coverage for the working uninsured is a particularly significant challenge in Texas, which has the highest percentage of uninsured in the nation. In response to the low rate of employer-sponsored coverage in the Houston area and the growing numbers of uninsured, the Harris County Health Care Alliance (HCHA) developed and implemented the Harris County 3-Share Plan. A 3-Share Plan is not insurance, but provides health coverage in the form of a benefits package to employers who subscribe to the program and offer it to their employees. ^ A cross sectional study design was conducted to describe 3-Share employer and employee participants and evaluate their outcomes after its first year of operation. Between September and December 2011, 85% of employers enrolled in the 3-Share Plan completed a survey about the affordability of the 3-Share Plan, their satisfaction with the Plan, and the Plan's impact on employee recruitment, retention, and productivity. Forty-five percent of employees enrolled in the 3-Share Plan responded to a survey asking about the affordability of the 3-Share plan, accessibility of providers on the plan, satisfaction, and utilization of primary care providers and the ER. ^ A summary of the findings shows employers and employees say that they joined the plan because of the low-cost, and once they had participated in the Plan, the majority of employers and employees found that it is affordable for them. The majority of employees say they are getting access easily and without delay, but for those who aren't able to get access, or are delayed, the main cause is related to non-financial barriers to care. Ultimately, employees are satisfied with the 3-Share, and they plan to continue with health coverage under the 3-Share Plan. The 3-Share Plan will keep people in a system of care, and promote health, which will benefit the individuals, the businesses and the community of Harris County.^

Risk factors for diabetic retinopathy in Mexican Americans in Starr County, Texas

The prevalence of diabetes in Mexican Americans is disproportionately higher than in non-Hispanic whites. The rate of diabetic retinopathy resulting from prolonged diabetes is also greater in Mexican Americans than in non-Hispanic whites. A longitudinal study was carried out on data collected from Mexican Americans in Starr County, Texas to assess the association between socioeconomic and acculturation factors with diabetic retinopathy prevalence, incidence, and progression in those free of diabetic retinopathy or who had only early non-proliferative diabetic retinopathy. A multivariable analysis was done. ^ The incidence rate was 12.78 cases per year and the progression rate was 8.55 cases per year. The baseline characteristics of the population revealed that more people with occupations synonymous with lower income jobs like trade workers and machine operators had early non-proliferative diabetic retinopathy. A multivariable analysis revealed that those with early non-proliferative diabetic retinopathy were more likely to have been born in Mexico as compared to those free of diabetic retinopathy. Surprisingly, a multivariable analysis also showed that those that progressed in diabetic retinopathy disease status were more likely to have been employed as compared to those that did not. ^ This analysis reveals that Mexican Americans are heterogeneous in socioeconomic and acculturation factors that may be used to deter the incidence and progression of diabetic retinopathy severity. These findings could be targeted to create culturally sensitive intervention programs that will improve the detection and treatment of diabetic retinopathy in the work arena in addition to programs that will impact those that do not work. Workplace preventative health screenings and dissemination of language-specific informational brochures is warranted to curb the rates of progression in those employed. ^ A limitation of this study is the narrow surrogates used for assessing socioeconomic and acculturation status. To fully evaluate these variables, a study using a questionnaire with a multitude of surrogates for socioeconomic and acculturation factors should be employed.^

Stability and potential application of spliced nuclear pre -mRNA introns

A major portion of this thesis work was dedicated to study the nature and significance of spliced introns. The initial work was focused on studying the IVS1$\sb{\rm C\beta 1}$ intron from a T-cell receptor (TCR)-$\beta$ gene. Compared to an intron lariat control from adenovirus pre-mRNA that was spliced in vitro, IVS1$\sb{\rm C\beta 1}$ was debranched less efficiently by HeLa S100 extracts, although IVS1$\sb{\rm C\beta 1}$ also used the consensus branchpoint in vivo. Subcellular-fractionation analysis showed that most IVS1$\sb{\rm C\beta 1}$ lariats cofractionated with pre-mRNA in the nucleus, consistent with the possibility that intron degradation releases splicing factors which will be available for further rounds of splicing. The half-life of IVS1$\sb{\rm C\beta 1}$ from the endogenous TCR-$\beta$ gene was measured using the general transcription inhibitor actinomycin D to be about $\sim$15 min, which was similar to that of unstable mRNAs such as c-myc mRNA.^ The general transcription inhibitor DRB was also used for intron stability analysis. Unexpectedly, DRB decreased intron and pre-mRNA levels only initially, it later increased the levels of intron-containing RNAs. Inhibition of transcription initiation appeared to be the major early effect (the reduction phase); whereas enhanced premature transcription termination was dominant later (the induction phase).^ Having established the procedures for studying in vivo spliced introns, this approach was applied to study the mechanism of nonsense-mediated downregulation (NMD), a phenomena in which premature termination codons (PTCs) decrease the levels of mRNAs. In this study, the novel intron-oriented approach was applied to study the mechanism of NMD. The levels of spliced introns immediately upstream and downstream of a PTC-bearing exon in a TCR-$\beta$ gene were identified and analyzed along with their pre-mRNA. Although PTC reduced the mRNA levels by 4 to 9 fold, the steady-state levels of spliced introns and the pre-mRNA-to-intron ratios were not significantly altered, indicating that the PTC did not significantly inhibit TCR-$\beta$ RNA splicing. Consistent with this conclusion, the half-lives of the PTC$\sp+$ and PTC$\sp-$ pre-mRNA were similar. The protein synthesis inhibitor cyclohexmide (CHX) upregulated the levels of the PTC$\sp+$ mRNA over 10 fold without affecting the levels of the spliced introns, suggesting that the reversal effect of CHX was through stabilization, not production. These results indicated that inhibition of splicing could not be the major mechanism for the NMD pathway of the TCR-$\beta$ gene, instead, suggesting that mRNA destabilization may be more important. (Abstract shortened by UMI.) ^

IFMIF suitability for evaluation of fusion functional materials

The International FusionMaterials Irradiation Facility (IFMIF) is a future neutron source based on the D-Li stripping reaction, planned to test candidate fusionmaterials at relevant fusion irradiation conditions. During the design of IFMIF special attention was paid to the structural materials for the blanket and first wall, because they will be exposed to the most severe irradiation conditions in a fusion reactor. Also the irradiation of candidate materials for solid breeder blankets is planned in the IFMIF reference design. This paper focuses on the assessment of the suitability of IFMIF irradiation conditions for testing functionalmaterials to be used in liquid blankets and diagnostics systems, since they are been also considered within IFMIF objectives. The study has been based on the analysis and comparison of the main expected irradiation parameters in IFMIF and DEMO reactor.

Propagation of Nuclear Data Uncertainties in Transmutation Calculations Using ACAB Code

The assessment of the accuracy of parameters related to the reactor core performance (e.g., ke) and f el cycle (e.g., isotopic evolution/transmutation) due to the uncertainties in the basic nuclear data (ND) is a critical issue. Different error propagation techniques (adjoint/forward sensitivity analysis procedures and/or Monte Carlo technique) can be used to address by computational simulation the systematic propagation of uncertainties on the final parameters. To perform this uncertainty assessment, the ENDF covariance les (variance/correlation in energy and cross- reactions-isotopes correlations) are required. In this paper, we assess the impact of ND uncertainties on the isotopic prediction for a conceptual design of a modular European Facility for Industrial Transmutation (EFIT) for a discharge burnup of 150 GWd/tHM. The complete set of uncertainty data for cross sections (EAF2007/UN, SCALE6.0/COVA-44G), radioactive decay and fission yield data (JEFF-3.1.1) are processed and used in ACAB code.

The role of spatial and temporal radiation deposition in inertial fusion chambers: the case of HiPER¿

The first wall armour for the reactor chamber of HiPER will have to face short energy pulses of 5 to 20 MJ mostly in the form of x-rays and charged particles at a repetition rate of 5–10 Hz. Armour material and chamber dimensions have to be chosen to avoid/minimize damage to the chamber, ensuring the proper functioning of the facility during its planned lifetime. The maximum energy fluence that the armour can withstand without risk of failure, is determined by temporal and spatial deposition of the radiation energy inside the material. In this paper, simulations on the thermal effect of the radiation–armour interaction are carried out with an increasing definition of the temporal and spatial deposition of energy to prove their influence on the final results. These calculations will lead us to present the first values of the thermo-mechanical behaviour of the tungsten armour designed for the HiPER project under a shock ignition target of 48 MJ. The results will show that only the crossing of the plasticity limit in the first few micrometres might be a threat after thousands of shots for the survivability of the armour.

Propagation of nuclear data uncertainties in fuel cycle calculations using MONTE-CARLO Technique

The uncertainty propagation in fuel cycle calculations due to Nuclear Data (ND) is a important important issue for : issue for : • Present fuel cycles (e.g. high burnup fuel programme) • New fuel cycles designs (e.g. fast breeder reactors and ADS) Different error propagation techniques can be used: • Sensitivity analysis • Response Response Surface Method Surface Method • Monte Carlo technique Then, p p , , in this paper, it is assessed the imp y pact of ND uncertainties on the decay heat and radiotoxicity in two applications: • Fission Pulse Decay ( y Heat calculation (FPDH) • Conceptual design of European Facility for Industrial Transmutation (EFIT)

Temperature Evolution and Light Species Diffusion in Armor and Structural Material for Inertial Fusion Reactor Chambers: a Case for HiPER 4a

One of the most advance designs for HiPER fusion reactor is a spherical chamber 10 m in diameter based on dry wall concept. In this system, the first wall will have to withstand short energy pulses of 5 to 20 MJ at a repetition rate of 0.5-10 Hz mostly in form of X-rays and charged particles. To avoid melting of the inner surface, the first wall consists on a thin armor attached to the structural material. Thickness (th) and material of each layer have to be chosen to assure the proper functioning of the facility during its planned lifetime.

¿Impact from road transport of radioactive wastes in Spain?

Transports of radioactive wastes in Spain are becoming issues of renewed interest, due to the increased mobility of these materials which can be expected after the building and operation of the planned central repository for this country in a near future. Such types of residues will be mainly of the medium and high activity classes and have raised concerns on the safety of the operations, the radiological protection of the individuals, the compliance with the legal regulations and their environmental consequences of all kind. In this study, relevant information for the assessment of radiological risk of road transport were taken into account, as the sources and destination of the radioactive transports, the amount of traveling to be done, the preferred routes and populations affected, the characterization of the residues and containers, their corresponding testing, etc. These data were supplied by different organizations fully related with these activities, like the nuclear power stations, the companies in charge of radioactive transports, the enterprises for inspection and control of the activities, etc., as well as the government institutions which are responsible for the selection and location of the storage facility and other decisions on the nuclear policies of the country. Thus, we have developed a program for computing the data in such a form that by entering the radiation levels at one meter of the transport loads and by choosing a particular displacement, the computer application is capable to calculate the corresponding radiological effects, like the global estimated impact, its relevance to the population in general or on those people living and driving near the main road routes, the doses received by the most exposed individuals (e.g. the workers for loading or driving the vehicle), or the probability of detrimental on the human health. The results of this work could be of help for a better understanding and management of these activities and their related impacts; at the same time that the generated reports of the computer application are considered of particular interest as innovative and complementary information to the current legal documentation, which is basically required for transporting radioactive wastes in the country, according with the international safety rules (like IAEA and ADR).Though main studies are still in progress, as the definite location for the Spanish storage facility has not been decided yet, preliminary results with the existing transports of residues of medium activity indicate that the radiological impact is very low in conventional operations. Nevertheless, the management of these transports is complex and laborious, making it convenient to progress further in the analysis and quantification of this kind of events, which constitutes one of the main objectives of the present study for the radioactive road mobility in Spain.

Interactive Graphic Simulation: An Advanced Methodology to Improve the Teaching-Learning Process in Nuclear Engineering Education and Training

Nowadays, computer simulators are becoming basic tools for education and training in many engineering fields. In the nuclear industry, the role of simulation for training of operators of nuclear power plants is also recognized of the utmost relevance. As an example, the International Atomic Energy Agency sponsors the development of nuclear reactor simulators for education, and arranges the supply of such simulation programs. Aware of this, in 2008 Gas Natural Fenosa, a Spanish gas and electric utility that owns and operate nuclear power plants and promotes university education in the nuclear technology field, provided the Department of Nuclear Engineering of Universidad Politécnica de Madrid with the Interactive Graphic Simulator (IGS) of “José Cabrera” (Zorita) nuclear power plant, an industrial facility whose commercial operation ceased definitively in April 2006. It is a state-of-the-art full-scope real-time simulator that was used for training and qualification of the operators of the plant control room, as well as to understand and analyses the plant dynamics, and to develop, qualify and validate its emergency operating procedures.

Motivating Young Students to Start a Career in Nuclear: The Basic Course of Science and Nuclear Technology, An Educational Activity of Spanish Young Generation in Nuclear (JÓVENES NUCLEARES)

The main objective of this course, conducted by Jóvenes Nucleares (Spanish Young Generation in Nuclear, JJNN), a non-profit organization that depends on the Spanish Nuclear Society (SNE) is to pass on basic knowledge about Science and Nuclear Technology to the general public, mostly students and introduce them to its most relevant points. The purposes of this course are to provide general information, to answer the most common questions about Nuclear Energy and to motivate the young students to start a career in nuclear. Therefore, it is directed mainly to high school and university students, but also to general people that wants to learn about the key issues of such an important matter in our society. Anybody could attend the course, as no specific scientific education is required. The course is done at least once a year, during the Annual Meeting of the Spanish Nuclear Society, which takes place in a different Spanish city each time. The course is done also to whichever university or institution that asks for it to JJNN, with the only limit of the presenter´s availability. The course is divided into the following chapters: Physical nuclear and radiation principles, Nuclear power plants, Nuclear safety, Nuclear fuel, Radioactive waste, Decommission of nuclear facilities, Future nuclear power plants, Other uses of nuclear technology, Nuclear energy, climate change and sustainable development. The course is divided into 15 minutes lessons on the above topics, imparted by young professionals, experts in the field that belongs either to the Spanish Young Generation in Nuclear, either to companies and institutions related with nuclear energy. At the end of the course, a 200 pages book with the contents of the course is handed to every member of the audience. This book is also distributed in other course editions at high schools and universities in order to promote the scientific dissemination of the Nuclear Technology. As an extra motivation, JJNN delivers a course certificate to the assistants. At the end of the last edition course, in Santiago de Compostela, the assistants were asked to provide a feedback about it. Some really interesting lessons were learned, that will be very useful to improve next editions of the course. As a general conclusion of the courses it can be said that many of the students that have assisted to the course have increased their motivation in the nuclear field, and hopefully it will help the young talents to choose the nuclear field to develop their careers

Conceptual design of the liquid metal laboratory of the TECHNOFUSION facility

The application of liquid metal technology in fusion devices requires R&D related to many phenomena: interaction between liquid metals and structural material as corrosion, erosion and passivation techniques; magneto-hydrodynamics; free surface fluid-dynamics and any other physical aspect that will be needed for their safe reliable operation. In particular, there is a significant shortage of experimental facilities dedicated to the development of the lithium technology. In the framework of the TECHNOFUSION project, an experimental laboratory devoted to the lithium technology development is proposed, in order to shed some light in the path to IFMIF and the design of chamber's first wall and divertors. The conceptual design foresee a development in two stages, the first one consisting on a material testing loop. The second stage proposes the construction of a mock-up of the IFMIF target that will allow to assess the behaviour of a free-surface lithium target under vacuum conditions. In this paper, such conceptual design is addressed.

An approach to stakeholders involvement in the preparedness for nuclear and radiological emergency response & recovery in Spain

The elaboration of a generic decision-making strategy to address the evolution of an emergency situation, from the stages of response to recovery, and including a planning stage, can facilitate timely, effective and consistent decision making by the response organisations at every level within the emergency management structure and between countries, helping to ensure optimal protection of health, environment, and society. The degree of involvement of stakeholders in this process is a key strategic element for strengthening the local preparedness and response and can help a successful countermeasures strategy. A significant progress was made with the multi-national European project EURANOS (2004-2009) which brought together best practice, knowledge and technology to enhance the preparedness for Europe's response to any radiation emergency and long term contamination. The subsequent establishment of a European Technology Platform and the recent launch of the research project NERIS-TP ("Towards a self sustaining European Technology Platform (NERIS-TP) on Preparedness for Nuclear and Radiological Emergency Response and Recovery") are aimed to continue with the remaining tasks for gaining appropriate levels of emergency preparedness at local level in most European countries. One of the objectives of the NERIS-TP project is: Strengthen the preparedness at the local/national level by setting up dedicated fora and developing new tools or adapting the tools developed within the EURANOS projects (such as the governance framework for preparedness, the handbooks on countermeasures, the RODOS system, and the MOIRA DSS for long term contamination in catchments) to meet the needs of local communities. CIEMAT and UPM in close interaction with the Nuclear Safety Council will explore, within this project, the use and application in Spain of such technical tools, including other national tools and information and communication strategies to foster cooperation between local, national and international stakeholders. The aim is identify and involve relevant stakeholders in emergency preparedness to improve the development and implementation of appropriate protection strategies as part of the consequence management and the transition to recovery. In this paper, an overview of the "state of the art" on this area in Spain and the methodology and work Plan proposed by the Spanish group within the project NERIS to grow the stakeholder involvement in the preparedness to emergency response and recovery is presented.

Characterization of an 241AmBe neutron irradiation facility by different spectrometric techniques

An automated panoramic irradiator with a 3 Ci 241Am-Be neutron source is installed in a bunker-type large room at the Universidad Politécnica de Madrid (UPM). It was recently modified and a neutron spectrometry campaign was organized to characterize the neutron fields in different measurement points along the irradiation bench. Four research groups working with different Bonner Sphere Spectrometers (BSS) and using different spectral unfolding codes took part to this exercise. INFN-LNF used a BSS formed by 9 spheres plus bare detector, with cylindrical, almost point like, 6LiI(Eu) scintillator (4 mm x 4 mm, from Ludlum); UAZ-UPM employed a similar system but with only 6 spheres plus bare detector; UAB worked with a 3He filled proportional counter at 8kPa filling pressure, cylindrical 9 mm x 10 mm (05NH1 from Eurisys) with 11 spheres configuration; and CIEMAT used 12 spheres with an spherical 3He SP9 counter (Centronic Ltd., UK) with very high sensitivity due to the large diameter (3.2 cm) and the filling pressure of the order of 228 kPa. Each group applied a different spectral unfolding method: INFN and UAB worked with FRUIT ver. 3.0 with their own response matrixes; UAZ-UPM used the BUNKIUT unfolding code with the response matrix UTA4 and CIEMAT employed the GRAVEL-MAXED-IQU package with their own response matrix. The paper shows the main results obtained in terms of neutron spectra at fixed distances from the source as well as total neutron fluence rate and ambient dose equivalent rate H*(10) determined from the spectra. The latter are compared with the readings of a common active survey-meter (LB 6411). The small differences in the results of the various groups are discussed.