1) 2017 Inflationary Adjustments; 2) Final Rules: Excepted Benefits, Lifetime and Annual Limits, and Short-Term, Limited-Duration Insurance; and 3) Whistleblower and Retaliation Protections
Health Reform Bulletin 131 | The ACA Remains The Law of The LandCBIZ, Inc.
As has been covered extensively in the press, Congress went on its summer recess without repealing, replacing or modifying the Affordable Care Act. What this means for employers is that it is “business as usual”, including all reporting obligations, as more fully described below. So where does health care reform stand at this point? The answer to this question is far from clear.
Health Reform Bulletin - PCOR & Transitional Reinsurance Fee RemindersCBIZ, Inc.
This HRB is a reminder of the following upcoming Affordable Care Act (ACA) fees due yet in 2014:
1. The Patient-Centered Outcomes Research (PCOR) Fee
2. The Transitional Reinsurance Fee
This contains a summary chart that can be used as a quick reference of who this fee applies to, when it is due, how it is paid and links to the complete Health Reform Bulletins pertinent to each fee.
Health Reform: Interim Guidance on Expatriate Plans; Updates on ACA Reportin...CBIZ, Inc.
This Health Care Reform Bulletin provides information on the following topics:
a. Interim Guidance on Expatriate Health Coverage
b. Updates on Section 6055/6056 Reporting
i. Revised and Increased Reporting Penalties
ii. E-filing requirements for Employers
c. Final Rules: Preventive Services
d. Reminder on PCOR Fees and Transitional Reinsurance
i. Checklist for PCOR and Transitional Reinsurance Fee
What’s in Your Rule Book? A Common Sense Approach to Plan Documentation.CBIZ, Inc.
Two recent eligibility opportunities, one created as a result of a US Supreme Court decision and the other enacted by law, are a wake-up call for plan sponsors of welfare and pension benefit plans to review and update, as appropriate, the terms of their plans. As is well known by now, the Supreme Court’s ruling in United States v. Windsor1 extended federal tax and benefit rights to couples in a same-sex marriage. In addition, the Affordable Care Act (ACA) incents employers to extend
eligibility to their workforce or risk an excise tax penalty. Plan sponsors should review their plan documents in light of these recent developments to ensure that the plan language is current and compliant.
Health Reform - Additional IRS Approaches to the Cadillac Tax; Transitional R...CBIZ, Inc.
Guidance on:
1. Additional IRS Approaches to Cadillac Tax. On July 30, 2015, the IRS released a second pronouncement (IRS Notice 2015-52), which like the first, does not carry the weight of the law or regulation, but rather is an effort to test the waters to see how the law should be formulated. The new guidance expands the discussion with regard to identifying taxpayers liable for the excise tax, employer aggregation, allocation of the tax, payment of the applicable tax and determining the cost of applicable coverage.
2. Transitional Reinsurance Fee Process for 2015 Benefit Year. In preparation for reporting and paying the transitional reinsurance fees for the 2015 benefit year, the Centers for Medicare and Medicaid services released an overview of the process and procedures
3. State Innovation Waivers. The Affordable Care Act includes a provision that takes effect in 2017 which would allow a state to apply for an innovation waiver; pursuant to which the state could be relieved from certain aspects of the ACA.
4. Applicability of ACA’s Employer Shared Responsibility Provisions. On July 31, 2015, President Obama signed the Surface Transportation and Veterans Health Care Choice Improvement Act of 2015 (H.R. 3236); now Public Law 114-41). This law provides that for purposes of determining whether an employer is an applicable large employer with regard to employee enrollment in minimum essential health coverage under an eligible employer sponsored plan, individuals covered for medical care under TRICARE or the Veterans Administration are not counted. In addition, a recent lawsuit challenged the applicability of the ACA’s employer shared responsibility mandate to a Native American tribe.
Health Care Reform -- 2016 Compliance Checklistntoscano50
The Affordable Care Act (ACA) has made a number of significant changes to group health plans since the law was enacted over four years ago. Many of these key reforms became effective in 2014 and 2015, including health plan design changes, increased wellness program incentives and the employer shared responsibility penalties.
Additional reforms take effect in 2016 for employers sponsoring group health plans. To prepare for 2016, employers should review upcoming requirements and develop a compliance strategy.
The document provides a summary of the key provisions and implementation timelines of the Affordable Care Act (ACA) health reform legislation passed by Congress and signed into law by President Obama in 2010. It outlines what is required in the immediate future in 2010, as well as changes phased in between now and 2014 such as establishing insurance exchanges, essential benefits packages, and penalties for individuals and employers who do not obtain qualified health insurance coverage. The summary concludes by encouraging questions and feedback from readers to help with understanding and implementing the complex health reform law.
The Health Care and Education Affordability Reconciliation Act of 2010 was recently passed by the House and will be signed into law 03/30/2010. NAHU (National Association for Health Underwriters) published a comprehensive timeline of the changes coming over the next few years. Please contact me with any questions.
Health Reform Bulletin 131 | The ACA Remains The Law of The LandCBIZ, Inc.
As has been covered extensively in the press, Congress went on its summer recess without repealing, replacing or modifying the Affordable Care Act. What this means for employers is that it is “business as usual”, including all reporting obligations, as more fully described below. So where does health care reform stand at this point? The answer to this question is far from clear.
Health Reform Bulletin - PCOR & Transitional Reinsurance Fee RemindersCBIZ, Inc.
This HRB is a reminder of the following upcoming Affordable Care Act (ACA) fees due yet in 2014:
1. The Patient-Centered Outcomes Research (PCOR) Fee
2. The Transitional Reinsurance Fee
This contains a summary chart that can be used as a quick reference of who this fee applies to, when it is due, how it is paid and links to the complete Health Reform Bulletins pertinent to each fee.
Health Reform: Interim Guidance on Expatriate Plans; Updates on ACA Reportin...CBIZ, Inc.
This Health Care Reform Bulletin provides information on the following topics:
a. Interim Guidance on Expatriate Health Coverage
b. Updates on Section 6055/6056 Reporting
i. Revised and Increased Reporting Penalties
ii. E-filing requirements for Employers
c. Final Rules: Preventive Services
d. Reminder on PCOR Fees and Transitional Reinsurance
i. Checklist for PCOR and Transitional Reinsurance Fee
What’s in Your Rule Book? A Common Sense Approach to Plan Documentation.CBIZ, Inc.
Two recent eligibility opportunities, one created as a result of a US Supreme Court decision and the other enacted by law, are a wake-up call for plan sponsors of welfare and pension benefit plans to review and update, as appropriate, the terms of their plans. As is well known by now, the Supreme Court’s ruling in United States v. Windsor1 extended federal tax and benefit rights to couples in a same-sex marriage. In addition, the Affordable Care Act (ACA) incents employers to extend
eligibility to their workforce or risk an excise tax penalty. Plan sponsors should review their plan documents in light of these recent developments to ensure that the plan language is current and compliant.
Health Reform - Additional IRS Approaches to the Cadillac Tax; Transitional R...CBIZ, Inc.
Guidance on:
1. Additional IRS Approaches to Cadillac Tax. On July 30, 2015, the IRS released a second pronouncement (IRS Notice 2015-52), which like the first, does not carry the weight of the law or regulation, but rather is an effort to test the waters to see how the law should be formulated. The new guidance expands the discussion with regard to identifying taxpayers liable for the excise tax, employer aggregation, allocation of the tax, payment of the applicable tax and determining the cost of applicable coverage.
2. Transitional Reinsurance Fee Process for 2015 Benefit Year. In preparation for reporting and paying the transitional reinsurance fees for the 2015 benefit year, the Centers for Medicare and Medicaid services released an overview of the process and procedures
3. State Innovation Waivers. The Affordable Care Act includes a provision that takes effect in 2017 which would allow a state to apply for an innovation waiver; pursuant to which the state could be relieved from certain aspects of the ACA.
4. Applicability of ACA’s Employer Shared Responsibility Provisions. On July 31, 2015, President Obama signed the Surface Transportation and Veterans Health Care Choice Improvement Act of 2015 (H.R. 3236); now Public Law 114-41). This law provides that for purposes of determining whether an employer is an applicable large employer with regard to employee enrollment in minimum essential health coverage under an eligible employer sponsored plan, individuals covered for medical care under TRICARE or the Veterans Administration are not counted. In addition, a recent lawsuit challenged the applicability of the ACA’s employer shared responsibility mandate to a Native American tribe.
Health Care Reform -- 2016 Compliance Checklistntoscano50
The Affordable Care Act (ACA) has made a number of significant changes to group health plans since the law was enacted over four years ago. Many of these key reforms became effective in 2014 and 2015, including health plan design changes, increased wellness program incentives and the employer shared responsibility penalties.
Additional reforms take effect in 2016 for employers sponsoring group health plans. To prepare for 2016, employers should review upcoming requirements and develop a compliance strategy.
The document provides a summary of the key provisions and implementation timelines of the Affordable Care Act (ACA) health reform legislation passed by Congress and signed into law by President Obama in 2010. It outlines what is required in the immediate future in 2010, as well as changes phased in between now and 2014 such as establishing insurance exchanges, essential benefits packages, and penalties for individuals and employers who do not obtain qualified health insurance coverage. The summary concludes by encouraging questions and feedback from readers to help with understanding and implementing the complex health reform law.
The Health Care and Education Affordability Reconciliation Act of 2010 was recently passed by the House and will be signed into law 03/30/2010. NAHU (National Association for Health Underwriters) published a comprehensive timeline of the changes coming over the next few years. Please contact me with any questions.
The document provides an overview and update on the status of federal health care reform in the United States. It discusses the key provisions of the 2010 Patient Protection and Affordable Care Act including the individual mandate, upcoming employer mandates, health insurance exchanges, and tax credits. It also summarizes recent regulatory delays and developments in implementation at the federal and state level in Oregon.
The document discusses the Supreme Court ruling on the Affordable Care Act and its implications. It summarizes that the individual mandate was found to be permissible as a tax. It also limits the federal government's ability to take away state Medicaid funds. Employers must now prepare for new reporting and plan requirements related to health care reform.
Health Reform Bulletin 135 | Repeal of Individual Penalty Mandate, Review of ...CBIZ, Inc.
While there has been much energy over the past year focused on repealing, replacing, or repealing and replacing the Affordable Care Act (ACA), the bulk of the law remains in full force and effect.
This notwithstanding, Congress passed the “Tax Cuts and Jobs Act” (H.R. 1) on December 20, 2017; the President is expected to sign the bill into law. This tax reform bill repeals the individual penalty mandate. As background, beginning in 2014, all individuals residing in the United States are required to maintain a minimum level of health coverage, or be subject to a tax penalty. This tax penalty will be repealed, effective for tax years beginning January 1, 2019.
Although many key reforms of the Affordable Care Act (ACA) are effective for 2014, additional reforms will become effective in 2015 for employers sponsoring group health plans. For 2015, the most significant ACA change is the shared responsibility penalty for applicable large employers. To prepare for 2015, employers should review upcoming requirements and develop a compliance strategy. This Legislative Brief provides a health care reform checklist for 2015.
The following Health Reform Checklist is intended to guide you through the general compliance requirements of
t he Affordable Care Act (ACA) as you prepare now for 2015 and beyond.
In general, these items apply to all employers.
Health Care Reform - Summary 2010 to 2012Banyanllc
This document provides an overview of key provisions in the 2010 health care reform legislation that employers need to consider for 2010 through 2012. It outlines 30 provisions, including requiring coverage of adult children up to age 26, eliminating lifetime limits on coverage, establishing internal and external claims appeal processes, prohibiting pre-existing condition exclusions for children, providing free preventive care, and increasing the tax on indoor tanning services. The summary provides details on who each provision applies to, a brief description, and the effective date. It notes many provisions take effect for plan years beginning after September 23, 2010 and that further guidance is still needed to clarify some aspects of the new rules.
Health Reform Bulletin 120 | Proposed Reliant Regulations.CBIZ, Inc.
The latest HRB provides insight into the following: Proposed Regulations: Expatriate Health Plans, Excepted Benefit Plans, Essential Health Benefits relating to Lifetime and Annual Limits, and Individual Shared Responsibility Requirements; IRS Releases Draft 2016 Forms 1094/1095.
CBO prepares cost estimates for proposed legislation to assist Congress. The estimates identify the budgetary effects and impact on health insurance coverage over 10 years. To estimate the cost of repealing the ACA individual mandate, CBO used its HISIM model and additional analysis. This showed repealing the mandate would increase the federal deficit by $338 billion from 2018-2027 by reducing penalty revenues and increasing uninsured populations.
What Does Health Reform Mean For You A Consumers Guidekmacaller
A dynamite guide for everything you never wanted to know about Health Care Reform! Did I say "never?" Wish I didn\'t have to deal with this stuff but alas, I do.
Learn how you can successfully navigate the Affordable Care Act, "Obama Care".
This easy to read outline will benefit your family and business.
Call (816-224-9466) for more information today.
Health care reform continues with implementation of the Affordable Care Act. Starting in 2014, employers face new requirements and penalties related to health insurance coverage for employees. Exchanges will offer individuals and small businesses the ability to purchase qualified health plans, and individuals will be subject to penalties if they do not obtain compliant coverage. Reporting of health plan costs and coverage will also be required of employers.
The document provides a timeline for key provisions of the Affordable Care Act (ACA) being implemented between 2010-2014. Some 2010 provisions included requiring plans to cover adult children up to age 26, prohibiting pre-existing condition exclusions for children, covering preventive care with no cost sharing, and establishing a high-risk pool. An improved claims/appeals process and rebates for the Medicare Part D "donut hole" also took effect in 2010. Future provisions will expand insurance coverage and reforms through 2014.
Model COBRA Continuation Coverage General NoticeJason White, CBC
This document provides a model general notice of COBRA continuation coverage rights that plan administrators can use to inform individuals of their rights under the Consolidated Omnibus Budget Reconciliation Act (COBRA) when their group health plan coverage would otherwise end due to certain qualifying events. The notice explains what COBRA continuation coverage is, when it becomes available, how to elect it, how long it lasts, and how it works. It also notes that individuals may have other coverage options besides COBRA continuation coverage.
Health Reform Bulletin 133 | Executive Order Directing Modifications to the A...CBIZ, Inc.
An Executive Order, signed on October 12, 2017, promotes modifications of certain aspects of the Affordable Care Act (ACA) (also see press statement). In a nutshell, this Executive Order directs the ACA’s governing agencies (Health and Human Services/Labor/Treasury) to address three
elements: formation of association health plans, expansion of short-term, limited-duration insurance, and expanding the rules to allow individual premium to be reimbursed through health reimbursement arrangements (HRAs). Briefly, this Executive Order directs the governing agencies to
This document provides a summary of developments in health care reform for the fourth quarter of 2011. It highlights what to expect in 2012, including Supreme Court arguments on the constitutionality of the individual mandate in March. It also summarizes new publications and tools available, recent news items such as litigation updates and regulations issued, and answers a frequently asked question on automatic enrollment requirements.
News Flash October 27 2014 Transitional Reinsurance Fee Counts Due By Nove...Annette Wright, GBA, GBDS
The document summarizes the requirements for transitional reinsurance fees established by the Affordable Care Act. Employers with self-insured health plans must submit enrollment counts and payment by November 17, 2014. They can pay the full 2014 fee by January 15, 2015 or pay in two installments. Late payments will incur interest and penalties. The document provides details on calculating enrollment counts, submitting forms through Pay.gov, and the penalty process for late payments.
Health Reform Alert - Implementation Guidance FAQsCBIZ, Inc.
The ACA’s governing agencies (Labor, HHS and IRS) have issued their 18th set of implementation FAQs, further defining certain aspects of the Affordable Care Act, as well as how the law coordinates with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). Following are highlights of this guidance.
Learn more at www.cbiz.com
This document lists a property for sale consisting of 28 acres of land zoned for commercial and retail development located in Linden, Virginia near the interchange of Interstate 66 and Route 55. The land is listed for $1 million cash and can support over 90,000 square feet of commercial space. It has excellent visibility and access being located near major roads with over 35,000 daily trips on I-66 and more than 17,000 daily trips on the immediate frontage. Concept plans show the land could be divided into 18 parcels or developed as a single retail center.
Wrangling text, Wrangling People - The Life of a Technical EditorBeth Agnew, CPTC™
Technical editing is about more than dealing with words, context, and message, it's about the people who create that content and who care about the outcomes.
The document discusses a Cloud Storage API that provides a common library allowing developers to access either Amazon S3 or Nirvanix IMFS storage services with the same code, avoiding vendor lock-in and allowing switching between providers by changing configuration parameters only, while focusing on website features rather than storage integration challenges and differences between provider APIs and pricing.
The document provides an overview and update on the status of federal health care reform in the United States. It discusses the key provisions of the 2010 Patient Protection and Affordable Care Act including the individual mandate, upcoming employer mandates, health insurance exchanges, and tax credits. It also summarizes recent regulatory delays and developments in implementation at the federal and state level in Oregon.
The document discusses the Supreme Court ruling on the Affordable Care Act and its implications. It summarizes that the individual mandate was found to be permissible as a tax. It also limits the federal government's ability to take away state Medicaid funds. Employers must now prepare for new reporting and plan requirements related to health care reform.
Health Reform Bulletin 135 | Repeal of Individual Penalty Mandate, Review of ...CBIZ, Inc.
While there has been much energy over the past year focused on repealing, replacing, or repealing and replacing the Affordable Care Act (ACA), the bulk of the law remains in full force and effect.
This notwithstanding, Congress passed the “Tax Cuts and Jobs Act” (H.R. 1) on December 20, 2017; the President is expected to sign the bill into law. This tax reform bill repeals the individual penalty mandate. As background, beginning in 2014, all individuals residing in the United States are required to maintain a minimum level of health coverage, or be subject to a tax penalty. This tax penalty will be repealed, effective for tax years beginning January 1, 2019.
Although many key reforms of the Affordable Care Act (ACA) are effective for 2014, additional reforms will become effective in 2015 for employers sponsoring group health plans. For 2015, the most significant ACA change is the shared responsibility penalty for applicable large employers. To prepare for 2015, employers should review upcoming requirements and develop a compliance strategy. This Legislative Brief provides a health care reform checklist for 2015.
The following Health Reform Checklist is intended to guide you through the general compliance requirements of
t he Affordable Care Act (ACA) as you prepare now for 2015 and beyond.
In general, these items apply to all employers.
Health Care Reform - Summary 2010 to 2012Banyanllc
This document provides an overview of key provisions in the 2010 health care reform legislation that employers need to consider for 2010 through 2012. It outlines 30 provisions, including requiring coverage of adult children up to age 26, eliminating lifetime limits on coverage, establishing internal and external claims appeal processes, prohibiting pre-existing condition exclusions for children, providing free preventive care, and increasing the tax on indoor tanning services. The summary provides details on who each provision applies to, a brief description, and the effective date. It notes many provisions take effect for plan years beginning after September 23, 2010 and that further guidance is still needed to clarify some aspects of the new rules.
Health Reform Bulletin 120 | Proposed Reliant Regulations.CBIZ, Inc.
The latest HRB provides insight into the following: Proposed Regulations: Expatriate Health Plans, Excepted Benefit Plans, Essential Health Benefits relating to Lifetime and Annual Limits, and Individual Shared Responsibility Requirements; IRS Releases Draft 2016 Forms 1094/1095.
CBO prepares cost estimates for proposed legislation to assist Congress. The estimates identify the budgetary effects and impact on health insurance coverage over 10 years. To estimate the cost of repealing the ACA individual mandate, CBO used its HISIM model and additional analysis. This showed repealing the mandate would increase the federal deficit by $338 billion from 2018-2027 by reducing penalty revenues and increasing uninsured populations.
What Does Health Reform Mean For You A Consumers Guidekmacaller
A dynamite guide for everything you never wanted to know about Health Care Reform! Did I say "never?" Wish I didn\'t have to deal with this stuff but alas, I do.
Learn how you can successfully navigate the Affordable Care Act, "Obama Care".
This easy to read outline will benefit your family and business.
Call (816-224-9466) for more information today.
Health care reform continues with implementation of the Affordable Care Act. Starting in 2014, employers face new requirements and penalties related to health insurance coverage for employees. Exchanges will offer individuals and small businesses the ability to purchase qualified health plans, and individuals will be subject to penalties if they do not obtain compliant coverage. Reporting of health plan costs and coverage will also be required of employers.
The document provides a timeline for key provisions of the Affordable Care Act (ACA) being implemented between 2010-2014. Some 2010 provisions included requiring plans to cover adult children up to age 26, prohibiting pre-existing condition exclusions for children, covering preventive care with no cost sharing, and establishing a high-risk pool. An improved claims/appeals process and rebates for the Medicare Part D "donut hole" also took effect in 2010. Future provisions will expand insurance coverage and reforms through 2014.
Model COBRA Continuation Coverage General NoticeJason White, CBC
This document provides a model general notice of COBRA continuation coverage rights that plan administrators can use to inform individuals of their rights under the Consolidated Omnibus Budget Reconciliation Act (COBRA) when their group health plan coverage would otherwise end due to certain qualifying events. The notice explains what COBRA continuation coverage is, when it becomes available, how to elect it, how long it lasts, and how it works. It also notes that individuals may have other coverage options besides COBRA continuation coverage.
Health Reform Bulletin 133 | Executive Order Directing Modifications to the A...CBIZ, Inc.
An Executive Order, signed on October 12, 2017, promotes modifications of certain aspects of the Affordable Care Act (ACA) (also see press statement). In a nutshell, this Executive Order directs the ACA’s governing agencies (Health and Human Services/Labor/Treasury) to address three
elements: formation of association health plans, expansion of short-term, limited-duration insurance, and expanding the rules to allow individual premium to be reimbursed through health reimbursement arrangements (HRAs). Briefly, this Executive Order directs the governing agencies to
This document provides a summary of developments in health care reform for the fourth quarter of 2011. It highlights what to expect in 2012, including Supreme Court arguments on the constitutionality of the individual mandate in March. It also summarizes new publications and tools available, recent news items such as litigation updates and regulations issued, and answers a frequently asked question on automatic enrollment requirements.
News Flash October 27 2014 Transitional Reinsurance Fee Counts Due By Nove...Annette Wright, GBA, GBDS
The document summarizes the requirements for transitional reinsurance fees established by the Affordable Care Act. Employers with self-insured health plans must submit enrollment counts and payment by November 17, 2014. They can pay the full 2014 fee by January 15, 2015 or pay in two installments. Late payments will incur interest and penalties. The document provides details on calculating enrollment counts, submitting forms through Pay.gov, and the penalty process for late payments.
Health Reform Alert - Implementation Guidance FAQsCBIZ, Inc.
The ACA’s governing agencies (Labor, HHS and IRS) have issued their 18th set of implementation FAQs, further defining certain aspects of the Affordable Care Act, as well as how the law coordinates with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). Following are highlights of this guidance.
Learn more at www.cbiz.com
This document lists a property for sale consisting of 28 acres of land zoned for commercial and retail development located in Linden, Virginia near the interchange of Interstate 66 and Route 55. The land is listed for $1 million cash and can support over 90,000 square feet of commercial space. It has excellent visibility and access being located near major roads with over 35,000 daily trips on I-66 and more than 17,000 daily trips on the immediate frontage. Concept plans show the land could be divided into 18 parcels or developed as a single retail center.
Wrangling text, Wrangling People - The Life of a Technical EditorBeth Agnew, CPTC™
Technical editing is about more than dealing with words, context, and message, it's about the people who create that content and who care about the outcomes.
The document discusses a Cloud Storage API that provides a common library allowing developers to access either Amazon S3 or Nirvanix IMFS storage services with the same code, avoiding vendor lock-in and allowing switching between providers by changing configuration parameters only, while focusing on website features rather than storage integration challenges and differences between provider APIs and pricing.
This document discusses language acquisition and the differences between acquiring a native language and acquiring a second language. It addresses how children acquire language naturally while adults must make a more conscious effort. The document references theories from scholars like Skinner, Chomsky, and Krashen and defines key terms such as native language and mother tongue using examples. Personal experiences with language learning difficulties are also shared.
The document summarizes the forms of the present simple, present continuous, past simple, and past continuous tenses in English. It provides examples of:
1) Regular verbs using -s, -es endings in the present simple (e.g. "He plays").
2) The present continuous formed using "to be" plus the -ing form of the verb (e.g. "I am watching TV").
3) The past simple using regular -ed endings and irregular past forms (e.g. "You watched a movie").
4) The past continuous formed using "was/were" plus the -ing form (e.g. "I was studying when he called").
Redis is an open-source, in-memory data structure store that can act as a database, cache, and message broker. It supports many different data types like strings, hashes, lists, sets, sorted sets, bitmaps, and hyperloglogs. Redis provides fast performance, replication, clustering, transactions, pub/sub capabilities and scripting through Lua. While data is stored in-memory for speed, Redis can be configured to periodically persist data to disk for durability.
The document provides an outline for a week 1 development environment setup course, including installing Windows 8, Visual Studio 2012, SQL Server 2012, and various development tools. It discusses setting up the development environment, creating a basic "Hello World" console and web application, and provides an introduction to object-oriented programming concepts like inheritance, interfaces, abstraction, and encapsulation.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Memcached is an open-source in-memory key-value store used for caching data to improve performance. It stores items in memory with optional expiration times. Clients communicate with Memcached servers using simple get and set commands to retrieve or store values associated with keys. Memcached is commonly used to cache database query results and API responses to improve response times by avoiding repeated disk access. It is widely adopted by large websites and applications to speed up dynamic content.
Diseño empresarial para la empresa Run Run, C.A.Yolimar Zapata
La empresa RUN RUN C.A. se dedica a la venta de repuestos para vehículos en Maturín, Venezuela. Su misión es satisfacer las necesidades de sus clientes con atención personalizada y productos de calidad a precios justos. Sus objetivos estratégicos incluyen incrementar su cartera de clientes en un 30% y ampliar su oferta de productos en un 50% para fin de año. La empresa analiza opciones de financiamiento como créditos bancarios para expandirse.
Redis : Database, cache, pub/sub and more at Jelly button gamesRedis Labs
Nir Shney-Dor of Jelly button games talks about how he uses Redis across many different use cases - as a persistent db, cache, for pub/sub, leaderboards etc etc..Fun walkthrough of all the uses one can put Redis to.
11 Slides to Make a Perfect Pitch to Investors for Your Mobile appAkhilesh Choudhary
Are you Looking to get Investors for your App? - Here are The 11 Essentials Slides You Need to Have in Your Pitch.
Are you looking to raise money for your mobile application, an impressive pitch is a key component to grab the attention of investors. Here is the art and science to create a great pitch. Learn how you can excite about your idea and engages them in a conversation about your app idea and lead them to an investment.
Small Business Employment Index - December 2016CBIZ, Inc.
In December, 30 percent of companies in the SBEI increased hiring, 50 percent made no change to staff totals, and 20 percent cut payroll totals. Industries that showed gains in employment include Real Estate, Manufacturing, Health Care, Retail and Non Profits, both of which are seasonal. Regionally, all four sectors across the country saw employment improve.
Statewide Insurance Brokers is a full-service general insurance broker based in Western Australia that has been operating since 1970. As a member of the Steadfast broker network, Statewide can access over 100 Australian and international insurance companies to provide commercial and personal insurance policies to its clients. Statewide aims to provide expert advice and exceptional service to clients through qualified staff and a commitment to upholding principles of excellent customer service, value, and professional expertise.
The Age Of New Reality Marketing V5.1 FinalTony Mooney
It\'s been a bug-bear of mine for many years that the average marketing skill set has not moved on very much from the 1960\'s model of 4 \'P\'s (Product, Price, Promotion, Place). Or that marketing is still largely synonomous with advertising - and spam advertising at that. This is a presentation I did to a marketing forum out in Singapore, where I\'ve tried to outline the new capabilities of the marketer of the 21st century. I also postulate the (controversial) perspective that a chunk of this new capability - especially around data and decisioning - might be better out sourced, leaving the internal marketing skills to be concentrated on strategy and proposition. See what you think. [Sorry you won\'t have my spoken narrative just yet but the slides are reasonably self explanatory]
Health Reform Bulletin 116 | Year-End Wrap Up Dec. 29, 2015CBIZ, Inc.
The document summarizes new laws and guidance affecting the Affordable Care Act. Key points include:
- New laws delay several ACA taxes, including the "Cadillac tax" until 2020 and pause insurer fees and medical device taxes.
- IRS guidance provides details on employer shared responsibility rules, including affordability calculations and penalty amounts.
- Deadlines for reporting health coverage on Forms 1095-B and 1095-C were extended to March 31, 2016 for furnishing to individuals and May 31, 2016 for filing with the IRS.
Health Reform Bulletin 116 Year End Wrap Up 12-29-15Daniel Michels
The most recent CBIZ Health Reform Bulletin: Year-End Wrap Up (HRB 116). This issue includes specific information and guidance on:
1. Late breaking development, IRS delays new Affordable Care Act's (ACA) reporting and disclosure obligations!
2. On December 18, 2015 Consolidate Appropriations Act, 2016, and the Protecting Americans from Tax Hikes (PATH) Act of 2015 (H. R. 2029; now Public Law No. 114-113) were signed by the President, and amend several provisions of the Affordable Care Act.
3. The IRS Issued guidance relating to ACA implementation
4. Year-End Reminders
May 2017 Summary of the American Health Care Act T.docxalfredacavx97
May 2017
Summary of the American Health Care Act
This summary describes key provisions of H.R. 1628, the American Health Care Act, as approved by the House
of Representatives on May 4, 2017, as a plan to repeal and replace the Affordable Care Act (ACA) through the
Fiscal Year 2017 budget reconciliation process.
American Health Care Act
H.R. 1628
Date plan
announced
March 6, 2017; passed by the House of Representatives on May 4, 2017
Overall
approach
Repeal ACA mandates (2016), standards for health plan actuarial values (2020),
and, premium and cost sharing subsidies (2020).
Modify ACA premium tax credits for 2018-2019 to increase amount for younger
adults and reduce for older adults; allow tax credits to apply to coverage sold outside
of exchanges and to catastrophic policies. In 2020, replace ACA income-based tax
credits with flat tax credits adjusted for age. Eligibility for new tax credits phases out
at income levels between $75,000 and $115,000
Retain private market rules, including requirement to guarantee issue coverage,
prohibition on pre-existing condition exclusions, requirement to extend dependent
coverage to age 26. Modify age rating limit to permit variation of 5:1, unless states
adopt different ratios, effective 2018. Retain essential health benefits requirement,
with state option to waive. Retain prohibition on health status rating with state
option to waive for individual market applicants who have not maintained continuous
coverage.
Retain health insurance marketplaces, annual Open Enrollment periods (OE), and
special enrollment periods (SEPs).
Impose late enrollment penalty for people who don’t stay continuously covered.
Establish Patient and State Stability Fund with federal funding of $115 billion over
9 years available to all states, and additional funding of $8 billion over 5 years for
states that elect community rating waivers. States may use funds to provide financial
help to high-risk individuals, promote access to preventive services, provide cost
sharing subsidies, and for other purposes. In 2020, $15 billion of funds shall be used
only for services related to maternity coverage and newborn care, and mental health
and substance use disorders. [For 2018-2026, a further $15 billion is allocated
through the fund for Federal Invisible Risk Sharing Program (reinsurance). This
program is established as part of the fund, though administered by CMS to make
payments directly to health insurers.] In states that don’t successfully apply for
grants, funds will be used for reinsurance program.
Repeal funding for Prevention and Public Health Fund at the end of Fiscal Year
2018 and rescind any unobligated funds remaining at the end of FY 2018. Provide
supplemental funding for community health centers of $422 million for FY 2017
Encourage use of Health Savings Accounts by increasing annual tax free
co.
Health Reform Bulletin 137 | Delay of Certain ACA Taxes and Fees; Benefit and...CBIZ, Inc.
On January 22, 2018, President Trump signed H.R. 195. Along with providing short-term government funding, it also extends funding of the Children's Health Insurance Program (CHIP) for six years through 2023. This program provides low-cost health coverage to children in families who do not qualify for Medicaid, as well as for pregnant women residing in certain states.
Health Reform Bulletin 128 | House Passes the American Health Care ActCBIZ, Inc.
On May 4, 2017, the House passed the American Health Care Act of 2017 (“AHCA”, H. R. 1628). Since the initial bill was officially introduced on March 20, 2017 (see The GOP Proposal to Repeal and Replace the Affordable Care Act, HRB 127, 3/10/17), there have been several amendments made to the law’s text. The bill will now progress to the Senate for consideration; its fate in the Senate is unclear at this point. Every indication is that the bill with undergo significant scrutiny and probably substantial change. Following is a brief overview of certain provisions of the bill passed by the House.
Health Reform Bulletin 124 | Qualified Small Employer HRAs and Year-end Remin...CBIZ, Inc.
On December 13, 2016, President Obama signed the 21st Century Cures Act (H.R. 34). In part, this law re-establishes the ability of small employers, those not subject to the Affordable Care Act’s employer shared responsibility provisions, to provide their employees a stand-alone health reimbursement arrangement (HRA), known as a “qualified small employer HRA”.
Health Reform Bulletin 124 | Qualified Small Employer HRAs and Year-end Remin...CBIZ, Inc.
In December 13, 2016, President Obama signed the 21st Century Cures Act (H.R. 34). In part, this law re-establishes the ability of small employers, those not subject to the Affordable Care Act’s employer shared responsibility provisions, to provide their employees a stand-alone health reimbursement arrangement (HRA), known as a “qualified small employer HRA”.
The IRS issued Notice 2015-16 seeking comments on key issues related to the upcoming "Cadillac tax" on high-cost employer health plans. The notice focuses on defining "applicable coverage", determining the cost of coverage, and applying the annual dollar limits. The IRS specifically requests input on topics like the treatment of health reimbursement arrangements, on-site medical clinics, and how dollar limits should apply when employees have multiple types of coverage. Comments are requested by May 15 to help guide future rulemaking around calculating and assessing the 40% excise tax.
Health Reform Bulletin 125 | Updated Employer Shared Responsibility Guidance,...CBIZ, Inc.
The latest HRB has been released. Get updates on the following: 1) Updated Employer Shared Responsibility Guidance; 2) ACA Implementation Guidance; 3) Gender Identity Discrimination: Preliminary Injunction Issued; 4) Final Rules - Premium Tax Credit; and 5) 2018 Benefit and Payment Parameters.
Healthcare Check-in: The Latest Developments in Health and Welfare Plansbenefitexpress
We work in an exciting industry – which means quick changes are the norm, and adaptability is a necessity. Keep your compliance plans up to date with a download of all legislative changes since our last update webinar. This webinar covered legislation that's passed in the last six months, what's on the way, and what it means for your organization.
What Changes to Expect from the new Healthcare Law, presented by The National Federation of Independent Business, the leading small business association.
The document provides an overview of key provisions and timelines in the Senate healthcare reform bill that was passed in 2010:
- Individuals can keep current health policies on a grandfathered basis until 2014 when state health insurance exchanges will be set up.
- Small businesses are eligible for tax credits to help pay employee premiums starting in 2010.
- Several new consumer protections and benefit requirements go into effect for plans in 2010-2014, including coverage of preexisting conditions for children, preventive care with no cost sharing, and allowing adult children to stay on parents' plans until age 26.
- Health insurance exchanges with standardized plans will be set up in each state starting in 2014, along with penalties for individuals
How Does Obamacare Impact Your Business Planning?Tilson
The Supreme Court has upheld the PPACA and its implementation is full steam ahead. Now is the time to begin preparing for the impact on your business and your employees. Many have forgotten the complexity, decisions, and regulatory requirements of this legislation. As we all know, the devil is in the details.
Frequently asked questions about Obamacareexchangeenvoy
The document summarizes key provisions of the Affordable Care Act (ACA) related to health insurance exchanges, the individual mandate, employer penalties, and dependent coverage requirements. It explains that the ACA requires states to establish health insurance exchanges by 2014 to offer qualified health plans. It also outlines the individual mandate requiring most individuals to have minimum essential health coverage beginning in 2014, and penalties for employers not offering coverage. The ACA extends dependent coverage to age 26.
Healthcare check in the latest developments in health and welfare plansbenefitexpress
We work in an exciting industry—which means quick changes are the norm, and adaptability is a necessity.
Keep your compliance plan up-to-date with a download of recent legislative changes.
We'll cover legislation that's passed, what's on the way, and what it means for your organization.
Topics Covered Include:
• IRS Information Letters
• Tax Reform Legislation
• Wellness Regulations - EEOC, AARP
• Comprehensive Guidance on QSEHRAs
• ACA: Elimination of Individual Mandate Penalty
• Employer Tax Credit for Paid Family and Medical Leave
• DOL Annual Adjustments to Employee Benefit Plan Penalties
• “Good Faith” Penalty Relief
• Final Disability Claim Regulations
• Cadillac Tax Updates
• And More!
Presented by Larry Grudzien, Attorney at Law
The document provides a summary of the key provisions and implementation timelines of the Affordable Care Act (ACA) health reform legislation passed by Congress and signed into law by President Obama in 2010. It outlines what is required immediately in 2010, and what will be required annually from 2011 through 2014, including establishing health insurance exchanges, essential benefits packages, employer and individual mandates, subsidies and penalties. The implementation is described as bringing challenges for years to come through ongoing rulemaking and changes.
Compliance Overview - Employee Benefits Compliance Checklist for Large Employersntoscano50
Federal law imposes numerous requirements on the group health coverage that employers provide to their employees. Many federal compliance laws apply to all group health plans, regardless of the size of the sponsoring employer. However, there are some additional requirements for large employers. For this purpose, a large employer is one with 50 or more employees.
Unlike smaller employers, large employers must comply with the Affordable Care Act’s (ACA) employer shared responsibility rules, the ACA’s Form W-2 reporting rules and the Family and Medical Leave Act’s (FMLA) requirements.
This Compliance Overview provides a checklist for employee benefit laws applicable to large employers.
This document discusses the implications of the Mental Health Parity and Addiction Equity Act of 2008 for employer-provided health plans. It addresses whether moving mental health benefits to an employee assistance program (EAP) would avoid the Act's requirements and analyzes different types of excepted benefits that are not subject to the Act. The document also outlines potential cost exemptions and opt-out provisions for certain self-funded government plans.
BIZGrowth Strategies — Cybersecurity Special Edition 2023CBIZ, Inc.
As cybercriminals continue to advance and evolve, a stagnant cyber risk management approach is simply not an option. Further, the prevalence of cyber breaches means cybersecurity is not solely an IT concern. It takes a robust set of processes and people from across your organization, working together toward a common goal. We offer fresh insights to help protect your organization from cyberthreats in multiple operational areas. Articles include:
- How Cybercriminals Are Weaponizing Artificial Intelligence
- Employee Benefits Cyber Risk Exposure Scorecard
- Closing the Security Gap: Managing Vendor Cyber Risk
- Retirement Plan Sponsor Cybersecurity Checklist
- Protect Your Digital Frontline With Employee Training
BIZGrowth Strategies - Back to Basics Special EditionCBIZ, Inc.
Amid the increasing complexity of today’s business landscape, it can be of great benefit to shut out the noise and simply get back to the basics. Summer offers the rare opportunity for organizations to slow down and sweat the small stuff.
In this issue, our experts address seven key topics intended to help leaders guide their teams to stability and refocus on the foundational elements of success, including:
- Talent Management 101: How to Attract & Retain Great Employees
- Exploring the What, Why & How Behind the Employee Experience
- The Shifting Normal: 3 Ways Leaders Can Embrace Change & Conquer Challenge
- What is Financial Wellbeing & Why Should Employers Care?
- D&O Insurance Application Basics to Protect Your Leaders
- Your Life Insurance Policy May Be One of Your Biggest Assets
- Understanding Labor Law Poster Compliance
Welcome to our newly branded newsletter, "The Advantage." The articles in this issue provide insights to help you:
■ Have conversations around tough decisions during periods of economic uncertainty
■ Evaluate fast-growing artificial intelligence tools like ChatGPT
■ Recognize colleagues who are key allies in supporting women in the workplace
■ Navigate career shifts along the path to successful leadership
■ Manage workplace culture in a hybrid model
■ Garner inspiration from the 2023 Women Transforming Business finalists and winners
BIZGrowth Strategies - Workforce & Talent Optimization Special EditionCBIZ, Inc.
Amid today’s economic uncertainty, we know you need strategies and solutions that will help your business thrive. With workforce and talent concerns running high for employers across the nation, our experts developed these articles with those critical issues top of mind. We offer fresh insights designed to attract, retain, engage and motivate your employees — all while protecting your bottom line and managing emerging risks. Articles include:
- Unlock Success with Effective Performance Management
- How Employers Can Benefit from Financial Wellbeing Programs
- How to Talk About Hard Decisions During a Recession
- Cost-Effective Health Plan Perks to Consider in 2023
- 3 HR Strategies to Recession-Proof Your Organization
- Responding to Employment Practices Liability (EPL) Claims
- Versatility — Important in Life & Life Insurance
BIZGrowth Newsletter - Economic Slowdown Solutions Special EditionCBIZ, Inc.
The "Economic Slowdown Solutions Special Edition" newsletter includes articles that present tips, strategies and ideas to help your organization master economic uncertainty and recessionary concerns. Topics include:
- Considerations for a Reduction in Force
- Tips to Prepare for Risk Management Challenges
- Tactics to Recession-Proof Your Benefits Strategy
- HR Best Practices
- Recruitment Strategies to Keep You Competitive
- 3 Innovations to Stay Nimble
- Disability Insurance for Business Owners
BIZGrowth Strategies - Cybersecurity Special EditionCBIZ, Inc.
Cyberattacks are becoming more frequent and sophisticated, making a recovery from them increasingly difficult. Without preparation, a cyberattack can be devastating to your business, having severe operational, financial, legal and reputational implications.
The prevalence of cyber breaches also means cybersecurity is no longer solely an IT concern. Elevating your information security from functional to effective takes a robust set of elements, processes and people working together toward a common goal.
Our professionals have developed these articles and resources to help you protect your organization from these attacks.
Connections Help Law Practice Efficiently Obtain $5 Million Line of CreditCBIZ, Inc.
A 15-attorney law firm operated on a contingency and hourly fee basis. While it had a strong outlook for contingency cases, the costs incurred to work...
Custom Communication Plan & Active Enrollment Result in Increased ConsumerismCBIZ, Inc.
The firm embarked on a multi-year strategic plan to build a culture of wellbeing and engagement. They wanted
to educate employees to become more engaged and wise health care consumers...
Experienced Consulting Approach Leads Engineering Firm to the Right CFOCBIZ, Inc.
The Chief Financial Officer of a leading multi-disciplined engineering and consulting
firm indicated he was considering retiring. After initially considering a search process as an in-house project, the company’s leadership agreed...
Check out the latest edition for articles on Preventing Social Engineering Attacks, Triumphing in the Talent War, 3 Signs It’s Time for a Compensation Study, Strategies to Protect Your Retirement & Tips for a Successful OSHA Inspection.
Inflation, Interest Rates & the Disruption to CRECBIZ, Inc.
From assessing the various sectors to analyzing the future of your investments, learn more from our experienced team leaders on the wide-spread trends of commercial real estate property and sales.
CBIZ Quarterly Manufacturing and Distribution "Hot Topics" Newsletter (May-Ju...CBIZ, Inc.
CBIZ Quarterly Manufacturing and Distribution "Hot Topics" Newsletter (May-Jun 2022) provides you with news and guidance on the labor crisis, how to retain top talent during the Great Resignation, the business impacts of the Russia-Ukraine War, and the benefit of long-term bonus plans.
Rethinking Total Compensation to Retain Top TalentCBIZ, Inc.
Even with a developed recruiting program, strong company culture and great work-life balance, it’s difficult for companies to attract and retain the best employees without an all-inclusive compensation strategy. Add in the combination of high inflation, talent shortages and the Great Resignation, and we’re left with a hyper-competitive labor market. As a result, employers must think outside of the box to retain top performers and explore new ways to increase the value of total compensation offered. Learn how in this article.
Common Labor Shortage Risks & Tips to Mitigate Your ExposuresCBIZ, Inc.
No industry is safe from the risks of the current labor market. Employee shortages can influence multiple liabilities, but a proactive strategy can help protect your organization. In this article, learn measures to minimize labor shortage liability risks across all industries, as well as influential industry risks for construction, manufacturing and trucking.
How the Great Resignation Affects the Tax FunctionCBIZ, Inc.
Talent shortages remain a challenge universally, but it may be hitting financial roles within businesses particularly hard. The
pressures to meet tax reform obligations coupled with the
job changeover opportunities that emerged during the Great Resignation have left many tax departments feeling under-resourced. If your company is experiencing a similar situation, here are steps you can take to support your tax function.
While employee turnover is inevitable, there are several strategies companies can implement to help combat the Great Resignation, and at the center of all these strategies is technology that can benefit employers and their staff. In this article, learn how your organization can use technology to enhance the recruiting and onboarding processes, which will help attract top talent, while setting new hires up for success.
Experienced Consulting Approach Leads Engineering Firm to the Right CFOCBIZ, Inc.
The Chief Financial Officer of a leading multi-disciplined engineering and consulting firm indicated he was considering retiring. After initially considering a search process as an in-house project, the company’s leadership agreed to secure the assistance of an executive search professional.
BIZGrowth Strategies - The Great Resignation Special EditionCBIZ, Inc.
The Great Resignation continues to plague organizations across the country. It has exacerbated a host of employer challenges, including attraction, retention and engagement of top talent, as well as mitigating new risks. Our experts have developed these articles and linked resources to help your organization combat the mass employee exodus.
Kansas businesses have an opportunity for state tax incentives of which you may want to be aware.
Recent changes to the Kansas High Performance Incentive Program (HPIP) make it more broadly available
than it was in the past.
CBIZ Quarterly Commercial Real Estate "Hot Topics" Newsletter (Jan-Feb 2022)CBIZ, Inc.
The January 2022 issue of CBIZ’s Commercial Real Estate Quarterly Hot Topics Newsletter is now available! Learn about the impact of changes lease accounting, post-pandemic calculation companies are using to reassess office space needs, tax planning knowns and unknowns and the impact of rising construction costs on insurance costs. Plus – access strategies to combat the great resignation and safeguard against the unexpected.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
- Video recording of this lecture in English language: https://youtu.be/RvdYsTzgQq8
- Video recording of this lecture in Arabic language: https://youtu.be/ECILGWtgZko
- 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
Congestive Heart failure is caused by low cardiac output and high sympathetic discharge. Diuretics reduce preload, ACE inhibitors lower afterload, beta blockers reduce sympathetic activity, and digitalis has inotropic effects. Newer medications target vasodilation and myosin activation to improve heart efficiency while lowering energy requirements. Combination therapy, following an assessment of cardiac function and volume status, is the most effective strategy to heart failure care.
Gene therapy can be broadly defined as the transfer of genetic material to cure a disease or at least to improve the clinical status of a patient.
One of the basic concepts of gene therapy is to transform viruses into genetic shuttles, which will deliver the gene of interest into the target cells.
Safe methods have been devised to do this, using several viral and non-viral vectors.
In the future, this technique may allow doctors to treat a disorder by inserting a gene into a patient's cells instead of using drugs or surgery.
The biggest hurdle faced by medical research in gene therapy is the availability of effective gene-carrying vectors that meet all of the following criteria:
Protection of transgene or genetic cargo from degradative action of systemic and endonucleases,
Delivery of genetic material to the target site, i.e., either cell cytoplasm or nucleus,
Low potential of triggering unwanted immune responses or genotoxicity,
Economical and feasible availability for patients .
Viruses are naturally evolved vehicles that efficiently transfer their genes into host cells.
Choice of viral vector is dependent on gene transfer efficiency, capacity to carry foreign genes, toxicity, stability, immune responses towards viral antigens and potential viral recombination.
There are a wide variety of vectors used to deliver DNA or oligo nucleotides into mammalian cells, either in vitro or in vivo.
The most common vector system based on retroviruses, adenoviruses, herpes simplex viruses, adeno associated viruses.
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Jim Jacob Roy
In this presentation , SBP ( spontaneous bacterial peritonitis ) , which is a common complication in patients with cirrhosis and ascites is described in detail.
The reference for this presentation is Sleisenger and Fordtran's Gastrointestinal and Liver Disease Textbook ( 11th edition ).
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...Donc Test
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
Helminthiasis or Worm infestation in Children for Nursing students
Health Reform Bulletin 122 | 2017 Inflationary Adjustments and more
1. Subject: 1) 2017 Inflationary Adjustments; 2) Final Rules: Excepted Benefits, Lifetime and
Annual Limits, and Short-Term, Limited-Duration Insurance; and 3) Whistleblower
and Retaliation Protections
Date: November 14, 2016
2017 Inflationary Adjustments
In Revenue Procedure 2016-55, the IRS released 2017 inflationary or cost of living adjustments
relating to several types of benefits, as follows:
Small Business Tax Credit (SBTC). Small businesses and tax-exempt employers who provide
health care coverage to their employees under a qualified health care arrangement are entitled
to a tax credit, as established by the Affordable Care Act. To be eligible for the small business
tax credit, the employer must employ less than 25 full-time equivalent employees whose average
annual wages are less than $52,400 (indexed for 2017; the wage ceiling in 2016 was $51,800).
The tax credit phases out for eligible small employers when the number of its full-time employees
(FTEs) exceeds 10; or, when the average annual wages for the FTEs exceeds $26,200 in the
2017 tax year (the phase-out wage limit for 2016 was $25,900).
As a reminder, only qualified health plan coverage purchased through a SHOP marketplace is
available for the tax credit, and only for a 2-consecutive year period.
Individual Shared Responsibility Penalty. The Affordable Care Act imposes a penalty for
individuals who fail to maintain minimum essential coverage (MEC). For 2017, the flat dollar
penalty amount for failure to maintain MEC remains unchanged from 2016 ($695). Thus, the
penalty is calculated based on the greater of 2.5% of family income; or $695 per adult, $347.50
per child (family maximum: $2,085).
Premium Tax Credit for Coverage under a Qualified Health Plan. Individuals who buy coverage
through the marketplace and meet certain income criteria may be eligible for an advance credit
payment wherein a portion of the premium is made directly to the insurer to cover the cost of
coverage. The amount of an individual’s premium tax credit is reduced by the amount of any
advance credit payments made during the year. If the advance credit payment for a taxable year
exceeds the premium tax credit limit, the individual would owe the excess as additional tax,
subject to certain inflationary limits.
For tax years beginning in 2017, the limitation on tax imposed for excess advance credit
payments is determined using the following table (note, these amounts are the same as 2016
limits):
November 14, 2016 – HRB 122 Page 1
2. CBIZ Health Reform Bulletin
Household Income
(as percent of poverty line)
Limitation amount for unmarried
individuals
(other than surviving spouse and
health of household)
Limitation amount for all other
taxpayers
Under 200% $300 $600
Between 200% and 300% $750 $1,500
Between 300% and 400% $1,275 $2,550
Increase in Tax Information Reporting Penalties
The IRS can assess penalties when certain tax information is not provided on a timely basis.
Specifically, penalties may be assessed for failure to file information returns or provide payee
statements, such as the Form W-2 and Form 1099, and notably, the Affordable Care Act’s Forms
1094 and 1095, or related payee statements. Beginning in 2017, these penalties will increase,
as follows:
The penalty for failure to file a correct information return is $260 for each return for which
the failure occurs, with the total penalty cap of $3,218,500 for a calendar year.
The penalty for failure to provide a correct payee statement is $260 for each statement for
which the failure occurs, with the total penalty cap of $3,218,500 for a calendar year.
Special rules apply that increase the per-statement and total penalties if there is intentional
disregard of the requirement to file the returns and furnish the required statements.
Sunset of AGI Threshold Exemption for Itemized Medical Expenses
Among the many provisions of the Affordable Care Act, the law increased the percentage
threshold for itemized deductions of unreimbursed medical expenses. Beginning in the 2013 tax
year, the threshold increased from 7.5% of an individual’s adjusted gross income (AGI) to 10%.
The ACA provided for a temporary exemption of the increased AGI threshold for individuals aged
65 or over. This exemption applies to tax years beginning after December 31, 2012 and ending
before January 1, 2017. Thus, beginning next year, the 10% itemization threshold will apply to
taxpayers aged 65 and over.
Currently, there are some legislative proposals moving through the halls of Congress to revoke
the increased threshold for all tax payers which would also include those in the 65 and over
bracket. We will keep you informed if any of these proposals are enacted.
Patient-Centered Outcomes Research Institute Fee
The Patient Centered Outcome Research (PCOR) fee is required to be reported annually to the
IRS on the second quarter Form 720 and paid by its due date, July 31, is based on the average
number of lives covered under the policy or plan. For plan years ending between October 1,
2015 and October 1, 2016, the fee was $2.17. The fee increases to $2.26 for policy and plan
years ending between October 1, 2016 and October 1, 2017, according to IRS Notice 2016-
64. For additional information about the PCOR fee, see IRS webpage, questions and answers
and chart of plans subject to the fees.
Final Rules: Excepted Benefits, Short-Term Limited-Duration Insurance, and Lifetime and
Annual Limits – Essential Health Benefits
The tri-agency governance of the ACA (Departments of Labor, Treasury and Health and Human
Services) released final rules on October 31, 2016 addressing excepted benefits, lifetime and
annual limits, and short-term limited duration insurance. These regulations make certain
clarifications to the proposed rules issued this summer (see CBIZ HRB 120 - Proposed Regulations,
7/13/16), as follows.
November 14, 2016 – HRB 122 Page 2
3. CBIZ Health Reform Bulletin
Excepted Benefits. Certain types of health plans are excepted from the provisions of the ACA.
The final regulations address supplemental coverage and travel insurance as excepted benefits.
Supplemental coverage. The final regulations clarify that to be excepted, supplemental
coverage must be specifically designed to fill gaps in the primary coverage, such as cover
cost sharing (coinsurance or deductibles), non-essential health benefits or both. These plans
cannot be dependent on coordination.
Travel Insurance. The final regulations affirm that certain travel-related insurance products
are deemed to be excepted benefits and thus, exempt from ACA market provisions. For this
purpose, travel insurance means coverage for personal risks incident to planned travel,
which may include interruption or cancellation of a trip or event, loss of baggage or personal
effects, damages to accommodations or rental vehicles, and sickness, accident, disability, or
death occurring during travel, provided that the health benefits are not offered on a stand-
alone basis and are incidental to other coverage.
Travel insurance does not include major medical plans that provide comprehensive medical
protection for travelers with trips lasting 6 months or longer, including, for example, those
working overseas as an expatriate or military personnel being deployed.
Short-term, limited-duration insurance is generally intended to fill temporary coverage gaps when
individuals transition between coverages. The final regulations affirm the proposal of limiting
short term coverage to a period of less than 3 months to coordinate with the one-time exemption
from the minimum essential coverage (MEC) requirement. These types of plans must also
provide notification in application and enrollment materials that such coverage does not meet
the requirements of MEC and thus, the individual may be subject to individual shared
responsibility penalty. The regulations provide model language for notification purposes:
“THIS IS NOT QUALIFYING HEALTH COVERAGE (“MINIMUM ESSENTIAL COVERAGE”) THAT
SATISFIES THE HEALTH COVERAGE REQUIREMENT OF THE AFFORDABLE CARE ACT. IF YOU
DON'T HAVE MINIMUM ESSENTIAL COVERAGE, YOU MAY OWE AN ADDITIONAL PAYMENT
WITH YOUR TAXES.”
Essential Health Benefits (EHB) – Lifetime and Annual Dollar Limits
For purposes of the essential health benefit calculation, these regulations affirm the
methodology for determining a benchmark plan. As a reminder, a self-funded plan can use any
of the 51 state-based benchmark plans, or the Federal Employee Health Benefit Plan-based
benchmark plan, to make its EHB determination. Now that states have selected their
benchmark plans, the number of options have been reduced to some degree. Details about
each state’s particular benchmark plan can be found on the Center for Consumer Information &
Insurance Oversight’s website (http://www.cms.gov/cciio/resources/data-resources/ehb.html).
The EHB determination is important for compliance with the no annual or lifetime limit, as well as
for the cost share restrictions of the ACA.
These regulations do not finalize certain other topics addressed in the proposed regulations,
specifically the fixed indemnity policies covering specified disease or illness and expatriate health
coverage. The government continues to mull over how best to handle these types of arrangements.
Effective date. These final regulations become effective on December 30, 2016, and apply to group
health plans and insurers beginning on the first day of the first plan year beginning on or after
January 1, 2017.
November 14, 2016 – HRB 122 Page 3
4. CBIZ Health Reform Bulletin
Whistleblower and Retaliation Protections
The ACA includes a whistleblower provision to protect employees from adverse employment action or
retaliation from either obtaining government assistance through premium assistance or a cost share
by participating in the marketplace, as well as affording protection from alleged violations of ACA
compliance by employers. To this end, the Department of Labor’s Occupational Safety and Health
Administration (OSHA) is charged with handling and enforcing these protections on behalf of
individuals. On October 13, 2016, OSHA released final rules relating to whistleblower protections
and procedures for filing complaints that clarify the interim rules issued several years ago (see HRB
67, Whistleblower Protections for ACA Violations, 2/28/13).
As background, the whistleblower provisions are intended to protect employee rights to benefits such
that an employee cannot be punished or retaliated against for challenging an employer’s compliance
with the market reform provisions of the ACA. Included among these provisions are:
Coverage of dependents;
Discrimination based on health status;
Prohibition of plan rescissions; and
Annual and lifetime limits for health plans.
Further, the whistleblower law protects individuals from retaliation for seeking government
assistance, which would come in the form of health coverage premium assistance or a cost share by
purchasing coverage through the marketplace. Individuals who fall below 400% of the federal
poverty level may be entitled to such government assistance if their employers do not offer adequate
coverage at an affordable rate.
For this purpose, an adverse employment action or retaliation includes anything that affects any of
the terms, conditions or privileges of employment, including the provision of benefits. Examples of
retaliation include threatening or refusing to hire or re-hire; firing; demoting; reducing hours, or
denying employee benefits.
The final OSHA regulations revise some of the procedures that an individual would follow for
purposes of filing a complaint. The complaint, whether oral or written, must be filed with OSHA
within 180 days of alleged retaliation; the complaint can be submitted online via OSHA’s website
(http://www.osha.gov/whistleblower/WBComplaint.html). OSHA then has 60 days to respond to the
complaint and issue a preliminary order to correct a deemed violation. Both parties to the complaint
would then have 30 days to file an objection and request a hearing before an administrative law
judge. If no hearing is requested, the provisions of the preliminary order stand.
It should also be noted that these rules do not, in any way, limit an individual’s rights under other
laws, such as ERISA Section 510 that prohibits interference with one’s protected rights.
About the Author: Karen R. McLeese is Vice President of Employee Benefit Regulatory Affairs for CBIZ Benefits
& Insurance Services, Inc., a division of CBIZ, Inc. She serves as in-house counsel, with particular emphasis on
monitoring and interpreting state and federal employee benefits law. Ms. McLeese is based in the CBIZ Kansas
City office.
The information contained herein is not intended to be legal, accounting, or other professional advice, nor are these
comments directed to specific situations. The information contained herein is provided as general guidance and may be
affected by changes in law or regulation. The information contained herein is not intended to replace or substitute for
accounting or other professional advice. Attorneys or tax advisors must be consulted for assistance in specific situations.
This information is provided as-is, with no warranties of any kind. CBIZ shall not be liable for any damages whatsoever in
connection with its use and assumes no obligation to inform the reader of any changes in laws or other factors that could
affect the information contained herein.
November 14, 2016 – HRB 122 Page 4