The passage of the Patient Protection and Affordable Care Act (ACA) resulted in significant changes to the ways Americans will access and purchase health insurance. A key feature of the ACA, and one that may have the biggest impact on state budgets and personnel, is the requirement for states to have a health insurance exchange (HIX) up and functioning by January 1, 2014.
This paper outlines the steps which states must take should they elect the Federally Facilitated Exchange (FFE) model and includes a high-level roadmap for implementing the FFE at the state level. Cognosante summarizes the recommended actions for states to adopt the FFE model and highlights key areas and actions required to achieve successful implementation.
In this brief, Elena Jarocinska summarizes the main thrust of Russian federal fiscal institutions and discusses their specific features. She describes the evolution of federal fiscal regulations since the establishment of the Russian federal state. As a conclusion, she offers the following policy recommendations: tax autonomy of subnational governments which is currently very limited should be increased; federal aid should be further formalized and made more transparent; regulations should not be changed from year to year to provide for a more stable environment; and subnational interests should be better protected at the institutional level.
Authored by: Elena Jarocinska
Published in 2014
Budget of the United States Government, Fiscal Year 2013 contains the Budget Message of the President, information on the President’s priorities, budget overviews organized by agency, and summary tables.
In this brief, Elena Jarocinska summarizes the main thrust of Russian federal fiscal institutions and discusses their specific features. She describes the evolution of federal fiscal regulations since the establishment of the Russian federal state. As a conclusion, she offers the following policy recommendations: tax autonomy of subnational governments which is currently very limited should be increased; federal aid should be further formalized and made more transparent; regulations should not be changed from year to year to provide for a more stable environment; and subnational interests should be better protected at the institutional level.
Authored by: Elena Jarocinska
Published in 2014
Budget of the United States Government, Fiscal Year 2013 contains the Budget Message of the President, information on the President’s priorities, budget overviews organized by agency, and summary tables.
This presentation by Nikolay Begchin, Russian Federation, was made at the 10th Meeting of CESEE Senior Budget Officials held in Den Haag on 26-27 June 2014. Find more information at http://www.oecd.org/gov/budgeting/10thannualmeetingofseniorbudgetofficialsfromcentraleasternandsoutheasterneuropeanceseecountries.htm
The article is structured as follows. We start with the policy framework in all three countries and then proceed to the discussion of major macroeconomic parameters, including data for the economy as a whole, the fiscal policy and external sectors, and labour market. In the end, we provide conclusions.
Municipal bond prices moved lower during the second quarter, as fears about the Federal Reserve tapering its stimulus program rattled the financial markets. While a handful of states still face some budget pressure for the remainder of their 2013 fiscal year, 45 states reported that they are likely to meet or exceed their revenue projections for fiscal year 2013. Interest-rate volatility and the longer term prospect of higher rates have reinforced our bias toward a more limited duration stance. We continue to overweight essential-service revenue bonds, as well as the A-rated and BBB-rated segments of the market. Our outlook calls for defaults to remain low and continued gradual economic recovery.
Recently several countries, including Estonia, Latvia, Lithuania, Hungary, Poland, Romania and Slovakia, have at least partially reversed their earlier moves towards compulsory defined-contribution schemes. This paper concentrates on Poland, which just reduced contributions going to the mandatory second pillar from 7.3 to 2.3% of earnings with that amount diverted to the public pension regime (ZUS).
Trying to solve the problem of public finance sustainability by radically shrinking the second tier of the pension system has obvious costs in terms of poverty among old-age pensioners. Their incomes will fall sharply relative to those of working-age population. Partially reversing pension reform will also cost Poland in terms of risk spreading and capital market development. It will also undermine the population's trust in the system. There is no alternative for achieving public finance sustainability but to restrain current spending and/or raise taxes. The pensionable age should be raised further (probably to 70 by mid-century), even in the general scheme, to deal with the long-run demographic challenge and be equalized across the two sexes. The authorities should move to unify pension provision systems, in particular by phasing out the farmers' regime (KRUS) and making pensions for miners and others with special regimes closer to actuarially neutral.
Authored by: Peter Jarrett
Published in 2011
Azerbaijan’s current fiscal stance is quite strong; however, this stability is completely based on oil-related revenues. In the meantime, the situation with alternative sources of fiscal revenues is uncertain. A large part of fiscal management is built on opacity and an assessment of budget spending efficiency has never been done. It is likely that Azerbaijan will only be able to maintain its fiscal stability through the next ten years or so, i.e. until the end of the active oil-extraction period. In the more distant future, a substantial fiscal correction will be necessary.
Authored by: Dmytro Boyarchuk
Published in 2012
Health Insurance Exchanges: Early Lessons from Real-World Assessments Cognizant
Succeeding in the health benefits exchange and individual insurance markets will require health plans to design and implement consumer-oriented market segmentation strategies, including profiling, 360-degree customer views and analytics capabilities to evaluate product performance.
This presentation by Nikolay Begchin, Russian Federation, was made at the 10th Meeting of CESEE Senior Budget Officials held in Den Haag on 26-27 June 2014. Find more information at http://www.oecd.org/gov/budgeting/10thannualmeetingofseniorbudgetofficialsfromcentraleasternandsoutheasterneuropeanceseecountries.htm
The article is structured as follows. We start with the policy framework in all three countries and then proceed to the discussion of major macroeconomic parameters, including data for the economy as a whole, the fiscal policy and external sectors, and labour market. In the end, we provide conclusions.
Municipal bond prices moved lower during the second quarter, as fears about the Federal Reserve tapering its stimulus program rattled the financial markets. While a handful of states still face some budget pressure for the remainder of their 2013 fiscal year, 45 states reported that they are likely to meet or exceed their revenue projections for fiscal year 2013. Interest-rate volatility and the longer term prospect of higher rates have reinforced our bias toward a more limited duration stance. We continue to overweight essential-service revenue bonds, as well as the A-rated and BBB-rated segments of the market. Our outlook calls for defaults to remain low and continued gradual economic recovery.
Recently several countries, including Estonia, Latvia, Lithuania, Hungary, Poland, Romania and Slovakia, have at least partially reversed their earlier moves towards compulsory defined-contribution schemes. This paper concentrates on Poland, which just reduced contributions going to the mandatory second pillar from 7.3 to 2.3% of earnings with that amount diverted to the public pension regime (ZUS).
Trying to solve the problem of public finance sustainability by radically shrinking the second tier of the pension system has obvious costs in terms of poverty among old-age pensioners. Their incomes will fall sharply relative to those of working-age population. Partially reversing pension reform will also cost Poland in terms of risk spreading and capital market development. It will also undermine the population's trust in the system. There is no alternative for achieving public finance sustainability but to restrain current spending and/or raise taxes. The pensionable age should be raised further (probably to 70 by mid-century), even in the general scheme, to deal with the long-run demographic challenge and be equalized across the two sexes. The authorities should move to unify pension provision systems, in particular by phasing out the farmers' regime (KRUS) and making pensions for miners and others with special regimes closer to actuarially neutral.
Authored by: Peter Jarrett
Published in 2011
Azerbaijan’s current fiscal stance is quite strong; however, this stability is completely based on oil-related revenues. In the meantime, the situation with alternative sources of fiscal revenues is uncertain. A large part of fiscal management is built on opacity and an assessment of budget spending efficiency has never been done. It is likely that Azerbaijan will only be able to maintain its fiscal stability through the next ten years or so, i.e. until the end of the active oil-extraction period. In the more distant future, a substantial fiscal correction will be necessary.
Authored by: Dmytro Boyarchuk
Published in 2012
Health Insurance Exchanges: Early Lessons from Real-World Assessments Cognizant
Succeeding in the health benefits exchange and individual insurance markets will require health plans to design and implement consumer-oriented market segmentation strategies, including profiling, 360-degree customer views and analytics capabilities to evaluate product performance.
Amazon Machine Learning Case Study: Predicting Customer ChurnAmazon Web Services
We do a deeper dive into Amazon Machine Learning, using a specific business problem as an example – predicting if the customer is about to leave your service, also known as customer churn. We examine several practical aspects of building and using a model, including the use of the recipe language for training data manipulation and modeling the costs of false positive/negative errors.
Successfully Implementing a Federally-Facilitated ExchangeCognosante
The Affordable Care Act directs the Secretary of Health and Human Services to establish and operate a Federally-Facilitated Exchange in any state that does not elect to establish a state-based exchange. As the deadline for state submission of a state blueprint and declaration letter approaches, many states are faced with implementing a FFE by the statutorily required enrollment date of October 1, 2013. While a FFE allows states to meet federal timeline mandates, its implementation provides states with limited options and flexibility. Cognosante's latest white paper helps states understand how to successfully implement a Federally-Facilitated Exchange.
HIX 2.0: New Alternatives for State Participation in Health Insurance ExchangesCognizant
By examining the pluses and minuses of emerging forms of health insurance exchanges, states can make informed decisions on cost and performance trade-offs and arrive at an optimal HIX model that suits their operational needs and those of their constituents.
Grants Management in the Era of Accountability: Performance Measures in the Uniform Guidance Shane Jernigan Senior Instructional Designer, Grants & Assistance Division Management Concepts Executive Summary Successful management of Federal grants has always required skill, practice, patience, and even a little luck. As policymakers and the public have grown increasingly concerned about “wasteful government spending,” grants managers have had to adapt to new regulations and additional oversight. In this “Era of Accountability,” Federal awarding agencies and non- Federal recipient entities must remain vigilant in protecting Federal funds from waste, fraud, and abuse.
States typically use two types of payment system to provide Medicaid benefits: fee-for-service (FFS) and managed care. In FFS Medicaid, the state reimburses health care providers for the services they deliver to beneficiaries. In contrast, in Medicaid managed care, states pay private health insurance plans or provider groups (called managed care organizations or MCOs) to provide services to enrollees. In this presentation, we use individual-level data to examine trends in the proportion of Medicaid beneficiaries who receive benefits through managed care and the proportion of Medicaid spending that consists of payments for managed care. We also use qualitative data about state programs’ characteristics to examine the changes in state policies that have affected enrollment in and spending for Medicaid managed care.
From 1999 to 2012, the share of Medicaid beneficiaries enrolled in managed care grew from 64 percent to 89 percent. The share of Medicaid spending attributed to payments for managed care was much smaller, however, rising from 15 percent to 37 percent during that period. The percentage of beneficiaries enrolled in managed care exceeds the percentage of Medicaid spending that pays for managed care for three main reasons. First, although many beneficiaries are enrolled in MCOs that cover a broad range of benefits (under “comprehensive” Medicaid managed care programs), many of those beneficiaries receive some benefits through FFS Medicaid. Second, many beneficiaries are enrolled in MCOs that cover only a narrow range of benefits and receive most of their services through FFS Medicaid. Third, enrollment in managed care is more common among beneficiaries in eligibility groups that have lower average Medicaid spending.
Medicaid managed care grew primarily because state policies expanded the scope of comprehensive managed care programs in three ways. First, comprehensive managed care programs became more likely to cover an entire state rather than only certain counties, cities, or regions. Second, mandatory enrollment in comprehensive managed care became more common among all eligibility groups. Third, states increased the scope of services included in their contracts with MCOs; the most pronounced increases occurred for long-term services.
Presentation by Alice Burns, Ben Layton, Noelia Duchovny, and Lyle Nelson, all of CBO’s Health, Retirement, and Long-Term Analysis Division, at the Association for Public Policy Analysis and Management’s Fall Research Conference.
International Financial Reporting Standard (IFRS) for
Small and Medium-sized Entities
The IFRS for SMEs is intended for use by small and medium-sized entities (SMEs). This section describes
the characteristics of SMEs.
The FreeBalance white paper describes how integration between donor and government financials systems reduces transaction costs and corruption through automation. This improves efficiency and effectiveness by data harmonization. The white paper also details how manual methods of integration compromises data quality and timeliness resulting in less coordination and less effective aid
Final project week 4 accelerating digital financial services adoption in bang...Md. Ashraful Alam
This digital artifact has been prepared as part of the WBG group course on Unlocking Investment and Finance in Emerging Markets and Developing Economies (EMDEs) course
The DATA Act: A Revolution in Federal Government TransparencyOmar Toor
On May 9, 2014, the Digital Accountability and Transparency Act (DATA Act), was signed into law. The Act, drawing some lessons from both the Federal Funding Accountability and Transparency Act of 2006 (FFATA) and the American Recovery and Reinvestment Act of 2009 (ARRA), is the nation’s first legislative mandate for data transparency. It requires the Department of the Treasury (Treasury) and the White House Office of Management and Budget (OMB) to transform U.S. federal spending from disconnected documents into open, standardized data, and to publish that data online.
www.pwc.com/publicsector
Performance Budgeting in the USA by Scott Pattison OECD Governance
Presentation by Scott Pattison at the 10th annual meeting of the Senior Budget Officials Performance and Results Network held on 24-25 November 2014. Find more information at http://www.oecd.org/gov/budgeting
Zambia Draft Renewable Energy Feed-in Tarriff GuidelinesJerry Sakala
The Energy Regulation Board (ERB), with the support of the USAID Trade Hub Southern Africa (SATH) has developed the draft Renewable Energy Feed in Tariffs (REFiT) Regulatory Framework. The REFiT Regulatory Framework was developed in line with REFiT Policy of 2015 developed by the Ministry of Mines Energy and Water Development. The REFiT regulatory framework was presented to stakeholders on Tuesday 22nd September 2015.
The REFiT Regulatory framework outlines the following:
REFiT Indicative Tariffs for solar projects;
Rules and Guidelines for RE projects to be implemented under the REFiT Policy of 2015; and
Guidelines for REFiT Power Purchase Agreements, and application procedures for project developers.
These rules and guidelines are only applicable to small scale renewable energy systems as defined in the REFiT Policy of 2015.
Similar to A Roadmap for States Using the Federally Facilitated Exchange (20)
SmartStream, as an EMR extender, searches for whether the patient has completed a behavioral health assessment
whenever he schedules an appointment or his insurance is verified. If no current assessment exists, SmartStream
will send a notification to the patient to complete a behavioral health assessment, M3, or ‘Monitor My Mood’. The notification will include an automated hyper-link to M3 and is sent using secure email or secure mobile messaging. The objective is for the patient to complete the behavioral health assessment BEFORE their scheduled office visit.
National statistics show that as of 2010, “85% adults and 75% teens own cell phones”. Plus “Ethnic minority groups
are more likely to own a mobile phone and use mobile phones to access health information”. With this knowledge and leveraging the ubiquitous use of cell phones, SmartStream provides a way for students with asthma to enter their peak flow meter readings into mobile devices.
SmartStream™ is an intelligent health information delivery system capable of data stream mining of real-time data feeds so the most current information is used. With SmartStream™ Collaborate, our rapid deployment offering, we can deploy a solution tailored to your specific needs in as few as 90 days.
eSante™ MITA provides support for Medicaid Management Information Systems (MMIS) architecture projects and Medicaid Information Technology Architecture (MITA) State Self Assessments (SS-A).
Cognosante: MITA 3.0 SS-A Methodology DemonstrationCognosante
Cognosante looks forward to meeting your MITA 3.0 SS-A needs using our unmatched MITA knowledge, experience, and flexible methodology. Cognosante will ensure your MITA SS-A is a valuable, long-term asset that supports your enterprise.
Cognosante’s ICD-10 Policy Transformation and Remediation solution helps our customers make the ICD-10 transition smoothly by reducing potential risks and preventing oversights.
Improve EPSDT Service Quality Through Meaningful Use of ITCognosante
The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. A legal standard of coverage and access for low-income children. EPSDT has remained a central component of Medicaid, because of the operational and financial capacity it gives states to create appropriate pediatric health care systems (its ability to finance early, preventive, and on going healthcare for children at medical and social risk remains unparalleled in public or private health insurance). This paper provides an ntroduction to EPSDT, an overview of current EPSDT service and quality monitoring, and how EPSDT can be better supported through Meaningful Use of health IT.
MMIS Solutions: A New Approach to Forming MMIS Project TeamsCognosante
It’s not just about filling the boxes on your organization chart – it’s about forming a project team that ensures the success of your MMIS project. Among the most important phases of the MMIS Design, Development and Implementation (DDI) project is the planning phase, and within the planning phase, there is no more important step than establishing a strong MMIS DDI project team. The project team represents the most important contributing factor to the success or failure of the MMIS DDI project. While the approach to forming an MMIS DDI project team may seem similar to other state information technology (IT) projects, it is far from the norm. The size, complexity and risk associated with MMIS DDI projects require a greater level of detailed planning and creativity when forming the project team .
How Should Medicaids Respond to the ICD-10 Postponement?Cognosante
“HHS Secretary Kathleen Sebelius Announces Delay of ICD-10 until October 1, 2014” was the title of a CMS press release dated April 9, 2012. The news came in response to political pressures to postpone the original October 2013 deadline and ongoing industry concerns related to the bumpy transition to the new 5010 versions of electronic transactions. This paper outlines three key actions states can take to ensure the continuity of their ICD-10 transition efforts in the 'extra year.'
Consumer Assistance and Health Insurance Exchanges: Analysis of Options Avail...Cognosante
The enactment of the Patient Protection and Affordable Care Act (ACA) and the subsequent upholding of the majority of the law by the United States Supreme Court will continue to result in significant changes to the way Americans access health insurance. A key feature of the ACA, and one that may have the biggest impact on state budgets and personnel, is the requirement to have a Health Insurance Exchange (HIX) available and functioning by government-defined deadlines. The Consumer Assistance function of the exchange provides the primary means by which applicants and consumers receive information about the HIX and their options, as well as make health plan enrollment choices.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
2. A Roadmap for States Using the Federally Facilitated Exchange
September 2012
Contents
INTRODUCTION ............................................................................................................................................ 1
EXCHANGE BASICS ...................................................................................................................................... 1
IMPLEMENTATION AND OPERATIONS OPTIONS ................................................................................................ 2
STATE ROADMAP TO FFE IMPLEMENTATION ........................................................................................... 2
STATE CONSIDERATIONS AND ACTIONS .................................................................................................... 4
OTHER CONSIDERATIONS ............................................................................................................................... 5
FUNDING ....................................................................................................................................................... 5
ABOUT COGNOSANTE .................................................................................................................................. 6
Exhibits
Exhibit 1. Health Insurance Exchange Timeline........................................................................................... 1
Exhibit 2. Comparison of the SBE, SPE, and FFE Options .......................................................................... 2
Exhibit 3. State Roadmap to FFE Implementation ....................................................................................... 3
Exhibit 4. FFE and State Business Area-Required Actions .......................................................................... 4
Exhibit 5. Exchange Funding Opportunities ................................................................................................. 5
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3. A Roadmap for States Using the Federally Facilitated Exchange
September 2012
INTRODUCTION
The passing of the Patient Protection and Affordable Care Act (ACA) and the subsequent upholding of
the majority of the law by the Supreme Court have resulted in significant changes to the way Americans
access health insurance. A key feature of the ACA, and one that may have the biggest impact on state
budgets and personnel, is the requirement to have a health insurance exchange (HIX) available and
functioning by a government-defined deadline.
States have the option of implementing a state-based exchange (SBE) that fulfills the HIX requirement.
Those that cannot or choose not to implement a functional SBE by the deadline may participate in the
Federally Facilitated Exchange (FFE) provided by the Department of Health and Human Services (HHS).
This document summarizes the actions for a state to adopt the FFE and highlights the key areas and tasks
required to achieve successful implementation.
EXCHANGE BASICS
As shown below, States must have a HIX in operation by January 1, 2014, and they must submit a
blueprint by November 16, 2012. For states that do not have an approved or conditionally approved HIX
by January 1, 2013, a FFE will be implemented by the Centers for Medicare & Medicaid Services (CMS).
CMS considers the FFE to be an interim solution until states implement their own SBEs, which must be
an easy-to-use and efficient operation that establishes consistent rules and business processes to ensure a
seamless and high-quality customer experience.
Exhibit 1. Health Insurance Exchange Timeline
CMS and the Center for Consumer Information and Insurance Oversight (CCIIO) are currently building
the FFE. HIX business functions and system components included in the FFE are web portal; plan
management; eligibility management; enrollment; financial management; consumer assistance; Small
Business Health Options Program (SHOP); and marketing & outreach. Business functions and system
components not included in the FFE are interfaces between the federal data services hub (DSH) and state
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4. A Roadmap for States Using the Federally Facilitated Exchange
September 2012
systems, in-person consumer assistance, health plan licensing and insurance commissioner
responsibilities.
Implementation and Operations Options
Should a state not create its own SBE, there are two options for FFE implementation and operations: full
FFE implementation, or a state partnership exchange (SPE).
In full implementation, CMS provides, hosts, and operates all system components and business functions
included in the FFE scope above. The state is responsible for all interfaces with state systems and in-
person consumer assistance. In a SPE, the state may opt to operate plan management, consumer
assistance or both. A side-by-side comparison of the SBE, SPE, and FFE options is shown below.
Areas/Business Functions SBE SPE FFE
Web Portal State Federal Federal
Plan Management State Federal or State Federal
Eligibility Determination State Federal and State Federal and State
Enrollment Management State Federal Federal and State
Financial Management State Federal Federal
Consumer Assistance State Federal and/or State Federal
Marketing & Outreach State Federal Federal
SHOP State Federal Federal
Exhibit 2. Comparison of the SBE, SPE, and FFE Options
Regardless of the exchange model selected, the Federal Data Services Hub (DSH) is at the center of all
transactions to and from the FFE and the only point to which any partnered entity can connect with
federal systems, including the FFE.
STATE ROADMAP TO FFE IMPLEMENTATION
States electing the FFE Exchange model will be required to plan, coordinate, and implement various
components to support the FFE. State actions should be in coordination with CMS actions to ensure an
on-time launch of a fully-functioning FFE. A high level roadmap for implementing a FFE at the state
level is shown in the below figure
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5. A Roadmap for States Using the Federally Facilitated Exchange
September 2012
Exhibit 3. State Roadmap to FFE Implementation
Use or disclosure of data contained on this sheet is subject to the restriction on the title page of this white paper.
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6. A Roadmap for States Using the Federally Facilitated Exchange
September 2012
STATE CONSIDERATIONS AND ACTIONS
Each FFE business area requires distinct actions by the FFE and the state, as shown in the following table.
Exhibit 4. FFE and State Business Area-Required Actions
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7. A Roadmap for States Using the Federally Facilitated Exchange
September 2012
Other Considerations
States must determine how to implement and operate interfaces between state systems and the FFE,
including individual account transfers, Department of Insurance (DOI) (risk adjustment, plan
management, reinsurance), and Health Insurance Portability and Accountability Act (HIPAA)
transactions. States must also implement governance and protocols for data collection, coordination, and
reconciliation functions. This includes coordinating eligibility determination processes and operations,
coordinating and reconciling processes and data for enrollment and disenrollment from plans, and
collection of eligibility source data for support of audits.
States’ data systems may need to be modified to accept, generate, and transmit HIPAA transactions. For
example, if eligibility determinations are received by a state’s Medicaid Management Information
Systems (MMIS), the MMIS must be able to accept the HIPAA health plan enrollment transaction. If the
state continues to determine eligibility for non-MAGI medical assistance programs, the system must be
able to generate and transmit a HIPAA health plan enrollment transaction to the FFE as a notice of an
individual’s health insurance coverage. The FFE will be entity reporting to the IRS on individual
coverage status and must have a record of all enrollments to avoid levying an erroneous consumer
penalty.
Communication between the State and the FFE is essential to Payment error rate measurement (PERM)
and payment accuracy measurement (PAM). PERM and PAM audits cover the entire path of claim
payment, from whether a client is eligible to accuracy and merit of the actual provider service payment. If
a client is deemed eligible by the FFE, the state must record that to protect against culpability and
potential financial liability for erroneous payments.
FUNDING
The ACA provides funding to states to establish a HIX (SBE or SPE) or build interfaces to the FFE.
Grant funds are available to build and test interfaces to the DSH to support certain functions of the FFE.
Establishment grants will be awarded through the end of 2014. They are available for three years after
award and can be used to sustain the first year of operation. Exchange funding opportunities are shown in
the below table.
Funding Source Funding Type Eligible Start Date Funding Expiration Date
Establishment One Grant Block Grant Quarterly through One year after grant award
10/15/2014 (extension available on request, up
to 5 years)
Establishment Two Grant (through Block Grant Quarterly through Three years after grant award
end of start-up year) 10/15/2014 (extension available on request, up
to 5 years)
Medicaid Modernization APD 90% FFP 2011 12/31/2015
Funding for DDI (cost-allocated
portions only)
Medicaid Modernization APD 75% FFP Upon certification of Dependent on DDI implementation
Funding for Operations (cost- Eligibility system by 12/31/2015
allocated portions only)
Regular Medicaid and SCHIP 50% FFP Anytime None
Funding (non-Medicaid (Medicaid)/ 65%
Modernization) (SCHIP)
Brokers, Health Plans, Employers Fees 10/1/2013 (?) End of Exchange
State General Fund 100% State 10/1/2013 End of Exchange
Funds
Advertisers Fees 10/1/2012 (?) End of Exchange
Exhibit 5. Exchange Funding Opportunities
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8. A Roadmap for States Using the Federally Facilitated Exchange
September 2012
ABOUT COGNOSANTE
Cognosante has consulted with states such as Utah, Oregon and the District of Columbia on the
implementation of their HIX programs; we understand the challenges states face and we are actively
working with our clients to find the best possible solutions to these challenges. Cognosante currently
supports CMS in the development of the FFE, giving us a unique understanding of FFE systems and how
they integrate with other state systems. Our expertise results from the combined knowledge of the ACA,
exchanges, and the FFE and our understanding of how health care reform can impact other state programs
such as Medicaid and CHIP; and our proven ability and capacity to implement and operate consumer
assistance centers to scale.
Use or disclosure of data contained on this sheet is subject to the restriction on the title page of this white paper.
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