The Lack of a Structured Universal Healthcare System in the United States: How This Affects the Lives of Millions of Americans and What Can Be Done About It

The purpose of this research is to explore on a deeper level the healthcare system of the United States, its background, and other factors that could provide possible solutions to simplify the fragmented healthcare system. The ultimate goal is the formation of concise ideas that could make the system, which prevents millions of Americans from obtaining adequate medical attention, substantially better. The paper will offer a better insight into the four different models of healthcare insurance found around the world in other developed countries with the purpose of establishing a comparison with that of the United States. The changes implemented by the Patient Protection and Affordable Care Act of 2010 are also analyzed to arrive at the conclusion of whether it has helped more American citizens get access to medical attention. Quality Improvement tools and thorough analysis of different methods from a financial, managerial, legal, and administrative perspective are used to provide valuable information that could aid in the implementation of modifications to the healthcare system of the United States in the near future.

Surface velocity fields, digital elevation models, ice front positions and grounding line derived from remote sensing data at Dinsmoor-Bombardier-Edgeworth glacier system, Antarctic Peninsula (1992-2014)

The northern Antarctic Peninsula is one of the fastest changing regions on Earth. The disintegration of the Larsen-A Ice Shelf in 1995 caused tributary glaciers to adjust by speeding up, surface lowering, and overall increased ice-mass discharge. In this study, we investigate the temporal variation of these changes at the Dinsmoor-Bombardier-Edgeworth glacier system by analyzing dense time series from various spaceborne and airborne Earth observation missions. Precollapse ice shelf conditions and subsequent adjustments through 2014 were covered. Our results show a response of the glacier system some months after the breakup, reaching maximum surface velocities at the glacier front of up to 8.8 m/d in 1999 and a subsequent decrease to ~1.5 m/d in 2014. Using a dense time series of interferometrically derived TanDEM-X digital elevation models and photogrammetric data, an exponential function was fitted for the decrease in surface elevation. Elevation changes in areas below 1000 m a.s.l. amounted to at least 130±15 m130±15 m between 1995 and 2014, with change rates of ~3.15 m/a between 2003 and 2008. Current change rates (2010-2014) are in the range of 1.7 m/a. Mass imbalances were computed with different scenarios of boundary conditions. The most plausible results amount to -40.7±3.9 Gt-40.7±3.9 Gt. The contribution to sea level rise was estimated to be 18.8±1.8 Gt18.8±1.8 Gt, corresponding to a 0.052±0.005 mm0.052±0.005 mm sea level equivalent, for the period 1995-2014. Our analysis and scenario considerations revealed that major uncertainties still exist due to insufficiently accurate ice-thickness information. The second largest uncertainty in the computations was the glacier surface mass balance, which is still poorly known. Our time series analysis facilitates an improved comparison with GRACE data and as input to modeling of glacio-isostatic uplift in this region. The study contributed to a better understanding of how glacier systems adjust to ice shelf disintegration.

Performance comparison of direct power control for brushless doubly-fed wind power generator with different control winding structure

A novel open-winding brushless doubly-fed generator (BDFG) system with two two-level bidirectional converters is proposed. This topology is equivalent to a three-level bidirectional converter connected to the typical BDFG, but solves the unbalanced-voltage-division problem of DC capacitor in the three-level converter, and has lower converter capacity, more flexible control mode, and better fault-tolerant ability. The direct power control (DPC) based on the twelve sections is adopted to implement the power tracking of the open-winding BDFG system, which is compared with the typical BDFG DPC system based on the six and twelve sections to verify the advantages of the proposed scheme.

Comparison of oscillatory behavior on InP electrodes in KOH solutions

The observation of current oscillations under potential sweep conditions when an n-InP electrode is anodized in a KOH electrolyte is reported and compared to the oscillatory behavior noted during anodization in an (NH4)2S electrolyte. In both cases oscillations are observed above 1.7 V (SCE). The charge per cycle was found to increase linearly with potential for the InP/KOH system but was observed to be independent of potential for the InP/(NH4)2S system. The period of the oscillations in the InP/KOH was found to increase with applied potential. In this case the oscillations are asymmetrical and the rising and falling segments have a different dependence on potential. Although the exact mechanism is not yet know for either system, transmission electron microscopy studies show that in both cases, the electrode is covered by a thick porous film in the oscillatory region.

Tissue Equivalent Phantom Design for Optimization of a Coherent Scatter Imaging System

Scatter in medical imaging is typically cast off as image-related noise that detracts from meaningful diagnosis. It is therefore typically rejected or removed from medical images. However, it has been found that every material, including cancerous tissue, has a unique X-ray coherent scatter signature that can be used to identify the material or tissue. Such scatter-based tissue-identification provides the advantage of locating and identifying particular materials over conventional anatomical imaging through X-ray radiography. A coded aperture X-ray coherent scatter spectral imaging system has been developed in our group to classify different tissue types based on their unique scatter signatures. Previous experiments using our prototype have demonstrated that the depth-resolved coherent scatter spectral imaging system (CACSSI) can discriminate healthy and cancerous tissue present in the path of a non-destructive x-ray beam. A key to the successful optimization of CACSSI as a clinical imaging method is to obtain anatomically accurate phantoms of the human body. This thesis describes the development and fabrication of 3D printed anatomical scatter phantoms of the breast and lung.

The purpose of this work is to accurately model different breast geometries using a tissue equivalent phantom, and to classify these tissues in a coherent x-ray scatter imaging system. Tissue-equivalent anatomical phantoms were designed to assess the capability of the CACSSI system to classify different types of breast tissue (adipose, fibroglandular, malignant). These phantoms were 3D printed based on DICOM data obtained from CT scans of prone breasts. The phantoms were tested through comparison of measured scatter signatures with those of adipose and fibroglandular tissue from literature. Tumors in the phantom were modeled using a variety of biological tissue including actual surgically excised benign and malignant tissue specimens. Lung based phantoms have also been printed for future testing. Our imaging system has been able to define the location and composition of the various materials in the phantom. These phantoms were used to characterize the CACSSI system in terms of beam width and imaging technique. The result of this work showed accurate modeling and characterization of the phantoms through comparison of the tissue-equivalent form factors to those from literature. The physical construction of the phantoms, based on actual patient anatomy, was validated using mammography and computed tomography to visually compare the clinical images to those of actual patient anatomy.

(Table 1) Comparison of diatom-bound and bulk sedimentary d15N values of ODP Holes 175-1082A and 175-1084A

The Matuyama Diatom Maximum (MDM) is a time of peak opal accumulation from 2.6 to ~2.0 Ma within the Benguela Current upwelling system that was initiated by increased influence of Southern Ocean water on the eastern South Atlantic. We measured opal, total organic carbon (TOC), and CaCO3 fluxes and C and N stable isotopes in sediments deposited from 2.4 to 1.95 Ma at Sites 1082 and 1084 to explore the biogeochemical dynamics within the Benguela region. The infusion of Southern Ocean water delivered dissolved nutrients and Southern Ocean flora and fauna, resulting in local opal accumulation increasing up to 8 g/cm**2/ky and the production of diatom mats. Some d15N measurements of diatom-bound organic matter indicate that the mats grew within the Benguela region. The bulk sediment d15N records are taken to reflect changes in the d15N of nitrate in the incoming water, where lower values at 2.4 Ma reflect less nitrate utilization in the Antarctic. A long-term increase in relative nitrate uptake in the Southern Ocean is evidenced by the gradual increase in d15N toward 1.9 Ma.

(Table 1) Age comparison between the GPTS and ODP Site 181-1123 age model for each chron base within the Middle Miocene section

Today the deep western boundary current (DWBC) east of New Zealand is the most important route for deep water entering the Pacific Ocean. Large-scale changes in deep water circulation patterns are thought to have been associated with the development of the East Antarctic Ice Sheet (EAIS) close to the main source of bottom water for the DWBC. Here we reconstruct the changing speed of the southwest Pacific DWBC during the middle Miocene from ~15.5-12.5 Ma, a period of significant global ice accumulation associated with EAIS growth. Sortable silt mean grain sizes from Ocean Drilling Program Site 1123 reveal variability in the speed of the Pacific inflow on the timescale of the 41 kyr orbital obliquity cycle. Similar orbital period flow changes have recently been demonstrated for the Pleistocene epoch. Collectively, these observations suggest that a strong coupling between changes in the speed of the deep Pacific inflow and high-latitude climate forcing may have been a persistent feature of the global thermohaline circulation system for at least the past 15 Myr. Furthermore, long-term changes in flow speed suggest an intensification of the DWBC under an inferred increase in Southern Component Water production. This occurred at the same time as decreasing Tethyan outflow and major EAIS growth between ~15.5 and 13.5 Ma. These results provide evidence that a major component of the deep thermohaline circulation was associated with the middle Miocene growth of the EAIS and support the view that this time interval represents an important step in the development of the Neogene icehouse climate.

The morphological response of Emiliania huxleyi to seawater carbonate chemistry changes: an inter-strain comparison

Four strains of the coccolithophore Emiliania huxleyi (RCC1212, RCC1216, RCC1238, RCC1256) were grown in dilute batch culture at four CO2 levels ranging from ~200 µatm to ~1200 µatm. Coccolith morphology was analyzed based on scanning electron micrographs. Three of the four strains did not exhibit a change in morphology over the CO2 range tested. One strain (RCC1256) displayed an increase in the percentage of malformed coccoliths with increasing CO2 concentration. We conclude that the sensitivity of the coccolith-shaping machinery to carbonate chemistry changes is strain-specific. Although it has been shown before that carbonate chemistry related changes in growth- and calcification rate are strain-specific, there seems to be no consistent correlation between coccolith morphology and growth or calcification rate. We did not observe an increase in the percentage of incomplete coccoliths in RCC1256, indicating that the coccolith-shaping machinery per se is affected by acidification and not the signalling pathway that produces the stop-signal for coccolith growth.

What do we expect from an ombudsman? Narratives of everyday engagement with the informal justice system in Germany and the UK

This paper looks at expectations people have of informal justice mechanisms through a rich empirical dataset of 2775 recent ombudsman users in Germany and the United Kingdom. In a cross-cultural comparison the ombudsman, as a model of justice is explored. Not much is known about people’s expectations towards the ombudsman model; this paper starts to fill the gap. Four roles became apparent as cross-cultural narratives in the dataset; people who interact with ombudsmen expect them to be interpreters, advocates, allies and instruments. The identified roles are largely common to both countries, but in some aspects they show national specificities. These national specificities are seen mainly in the use of language; in Germany it is more legalistic in comparison to the UK. I argue that this might be related to what has been described as the general legal culture of each country and the institutional set-up.

The difficulty of measuring culture and diversity. Comparison of three international models of cultural measurement: FCS-2009, ESSnet-2012 and CAB-2015

The growing interest in quantifying the cultural and creative industries, visualize the economic contribution of activities related to culture demands first of all the construction of internationally comparable analysis frameworks. Currently there are three major bodies which address this issue and whose comparative study is the focus of this article: the UNESCO Framework for Cultural Statistics (FCS-2009), the European Framework for Cultural Statistics (ESSnet-Culture 2012) and the methodological resource of the “Convenio Andrés Bello” group for working with the Satellite Accounts on Culture in Ibero-America (CAB-2015). Cultural sector measurements provide the information necessary for correct planning of cultural policies which in turn leads to sustaining industries and promoting cultural diversity. The text identifies the existing differences in the three models and three levels of analysis, the sectors, the cultural activities and the criteria that each one uses in order to determine the distribution of the activities by sector. The end result leaves the impossibility of comparing cultural statistics of countries that implement different frameworks.

Late-career international migration and reproductive work. A comparison between Peruvian and Ukrainian women in the Southern Europe

Research on the relationship between reproductive work and women´s life trajectories including the experience of labour migration has mainly focused on the case of relatively young mothers who leave behind, or later re-join, their children. While it is true that most women migrate at a younger age, there are a significant number of cases of men and women who move abroad for labour purposes at a more advanced stage, undertaking a late-career migration. This is still an under-estimated and under-researched sub-field that uncovers a varied range of issues, including the global organization of reproductive work and the employment of migrant women as domestic workers late in their lives. By pooling the findings of two qualitative studies, this article focuses on Peruvian and Ukrainian women who seek employment in Spain and Italy when they are well into their forties, or older. A commonality the two groups of women share is that, independently of their level of education and professional experience, more often than not they end up as domestic and care workers. The article initially discusses the reasons for late-career female migration, taking into consideration the structural and personal determinants that have affected Peruvian and Ukrainian women’s careers in their countries of origin and settlement. After this, the focus is set on the characteristics of domestic employment at later life, on the impact on their current lives, including the transnational family organization, and on future labour and retirement prospects. Apart from an evaluation of objective working and living conditions, we discuss women’s personal impressions of being domestic workers in the context of their occupational experiences and family commitments. In this regard, women report varying levels of personal and professional satisfaction, as well as different patterns of continuity-discontinuity in their work and family lives, and of optimism towards the future. Divergences could be, to some extent, explained by the effect of migrants´ transnational social practices and policies of states.

The Standard ISO 15489-1 in German and Spanish: an Interlinguistic Comparison

The aim of this paper is to deepen in the terminology of Records Management established by ISO standards, through a concrete example such as an interlinguistic comparison between UNE ISO 15489-1 and DIN ISO 15489-1, that is, between the Spanish and German versions of the ISO 15489-1. For that, the text is divided into two major and complementary parts, which are similar to both analytical perspectives adopted: the semantic one and the pragmatic one. The first one compares the words per se, taking into account the significant or word form as well as the significance or meaning. In the second part, examples of use from both languages are discussed, concerning the three terms considered essential in the text (Record, Records Management System and Records Management). The main conclusion lies in understanding how important the language is as a discrete tool of work for all information scientists, specially concerning to the standards, where the translators must show their best linguistic strategies to go unnoticed.

Distribution, occurrence and biotoxin composition of the main shellfish toxin producing microalgae within European waters: A comparison of methods of analysis.

Harmful algal blooms (HABs) are a natural global phenomena emerging in severity and extent. Incidents have many economic, ecological and human health impacts. Monitoring and providing early warning of toxic HABs are critical for protecting public health. Current monitoring programmes include measuring the number of toxic phytoplankton cells in the water and biotoxin levels in shellfish tissue. As these efforts are demanding and labour intensive, methods which improve the efficiency are essential. This study compares the utilisation of a multitoxin surface plasmon resonance (multitoxin SPR) biosensor with enzyme-linked immunosorbent assay (ELISA) and analytical methods such as high performance liquid chromatography with fluorescence detection (HPLC-FLD) and liquid chromatography–tandem mass spectrometry (LC–MS/MS) for toxic HAB monitoring efforts in Europe. Seawater samples (n = 256) from European waters, collected 2009–2011, were analysed for biotoxins: saxitoxin and analogues, okadaic acid and dinophysistoxins 1/2 (DTX1/DTX2) and domoic acid responsible for paralytic shellfish poisoning (PSP), diarrheic shellfish poisoning (DSP) and amnesic shellfish poisoning (ASP), respectively. Biotoxins were detected mainly in samples from Spain and Ireland. France and Norway appeared to have the lowest number of toxic samples. Both the multitoxin SPR biosensor and the RNA microarray were more sensitive at detecting toxic HABs than standard light microscopy phytoplankton monitoring. Correlations between each of the detection methods were performed with the overall agreement, based on statistical 2 × 2 comparison tables, between each testing platform ranging between 32% and 74% for all three toxin families illustrating that one individual testing method may not be an ideal solution. An efficient early warning monitoring system for the detection of toxic HABs could therefore be achieved by combining both the multitoxin SPR biosensor and RNA microarray.

Distribution, occurrence and biotoxin composition of the main shellfish toxin producing microalgae within European waters: A comparison of methods of analysis.

Harmful algal blooms (HABs) are a natural global phenomena emerging in severity and extent. Incidents have many economic, ecological and human health impacts. Monitoring and providing early warning of toxic HABs are critical for protecting public health. Current monitoring programmes include measuring the number of toxic phytoplankton cells in the water and biotoxin levels in shellfish tissue. As these efforts are demanding and labour intensive, methods which improve the efficiency are essential. This study compares the utilisation of a multitoxin surface plasmon resonance (multitoxin SPR) biosensor with enzyme-linked immunosorbent assay (ELISA) and analytical methods such as high performance liquid chromatography with fluorescence detection (HPLC-FLD) and liquid chromatography–tandem mass spectrometry (LC–MS/MS) for toxic HAB monitoring efforts in Europe. Seawater samples (n = 256) from European waters, collected 2009–2011, were analysed for biotoxins: saxitoxin and analogues, okadaic acid and dinophysistoxins 1/2 (DTX1/DTX2) and domoic acid responsible for paralytic shellfish poisoning (PSP), diarrheic shellfish poisoning (DSP) and amnesic shellfish poisoning (ASP), respectively. Biotoxins were detected mainly in samples from Spain and Ireland. France and Norway appeared to have the lowest number of toxic samples. Both the multitoxin SPR biosensor and the RNA microarray were more sensitive at detecting toxic HABs than standard light microscopy phytoplankton monitoring. Correlations between each of the detection methods were performed with the overall agreement, based on statistical 2 × 2 comparison tables, between each testing platform ranging between 32% and 74% for all three toxin families illustrating that one individual testing method may not be an ideal solution. An efficient early warning monitoring system for the detection of toxic HABs could therefore be achieved by combining both the multitoxin SPR biosensor and RNA microarray.

Spatio-temporal characteristics of Agulhas leakage: a model inter-comparison study

Investigating the variability of Agulhas leakage, the volume transport of water from the Indian Ocean to the South Atlantic Ocean, is highly relevant due to its potential contribution to the Atlantic Meridional Overturning Circulation as well as the global circulation of heat and salt and hence global climate. Quantifying Agulhas leakage is challenging due to the non-linear nature of this process; current observations are insufficient to estimate its variability and ocean models all have biases in this region, even at high resolution . An Eulerian threshold integration method is developed to examine the mechanisms of Agulhas leakage variability in six ocean model simulations of varying resolution. This intercomparison, based on the circulation and thermo- haline structure at the Good Hope line, a transect to the south west of the southern tip of Africa, is used to identify features that are robust regardless of the model used and takes into account the thermohaline biases of each model. When determined by a passive tracer method, 60 % of the magnitude of Agulhas leakage is captured and more than 80 % of its temporal fluctuations, suggesting that the method is appropriate for investigating the variability of Agulhas leakage. In all simulations but one, the major driver of variability is associated with mesoscale features passing through the section. High resolution (<1/10 deg.) hindcast models agree on the temporal (2–4 cycles per year) and spatial (300–500 km) scales of these features corresponding to observed Agulhas Rings. Coarser resolution models (<1/4 deg.) reproduce similar time scale of variability of Agulhas leakage in spite of their difficulties in representing the Agulhas rings properties. A coarser resolution climate model (2 deg.) does not resolve the spatio-temporal mechanism of variability of Agulhas leakage. Hence it is expected to underestimate the contribution of Agulhas Current System to climate variability.