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landscaperomaha402 · 3 years ago

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Best Ground Maintenance Service Near Omaha Nebraska | Landscaping Services Of Omaha More information is at: https://landscapingservicesofomaha.com/grounds-maintenance-service-near-me/

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newstfionline · 4 years ago

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Saturday, December 19, 2020

Tax cuts for the wealthy aren’t trickling down (CBS News) Do tax cuts for the wealthy really help the overall economy and “trickle down” to everyone else? It’s not a trickle question. David Hope of the London School of Economics and Julian Limberg of King’s College London examined 18 developed countries and did the math. “Per capita gross domestic product and unemployment rates were nearly identical after five years in countries that slashed taxes on the rich and in those that didn’t, the study found. But the analysis discovered one major change: The incomes of the rich grew much faster in countries where tax rates were lowered. Instead of trickling down to the middle class, tax cuts for the rich may not accomplish much more than help the rich keep more of their riches and exacerbate income inequality.” 50 years of tax cuts for the rich failed to trickle down.

Suspected Russian Cyberattack Strikes at Heart of U.S. Government (Foreign Policy) As more details are revealed about Russia’s alleged hack of the U.S. government, it’s becoming clear that the breach is much worse than previously thought. On Thursday, the U.S. Cybersecurity and Infrastructure Security Agency warned that is “poses a grave risk” to federal, state, and local governments as well as private companies and organizations. There is a growing list of reported victims: the Centers for Disease Control, the Defense Department, State Department, Commerce Department, Department of Homeland Security, Treasury Department, the U.S. Postal Service, the National Institutes of Health, and the Department of Energy were all affected. “This is, I think, appears to be at this point the most serious cyberattack this country has ever endured,” Sen. Angus King, I-Maine said on NPR. Microsoft, which is helping to respond to the hack, noted that “the attack unfortunately represents a broad and successful espionage-based assault on both the confidential information of the U.S. Government and the tech tools used by firms to protect them … ongoing investigations reveal an attack that is remarkable for its scope, sophistication and impact.”

California hospitals buckle as virus cases surge (AP) Hospitals across California have all but run out of intensive care beds for COVID-19 patients, ambulances are backing up outside emergency rooms, and tents for triaging the sick are going up as the nation’s most populous state emerges as the latest epicenter of the U.S. outbreak. On Thursday, California reported a staggering 52,000 new cases in a single day—equal to what the entire U.S. was averaging in mid-October—and a one-day record of 379 deaths. More than 16,000 people are in the hospital with the coronavirus across the state, more than triple the number a month ago. Patients are being cared for at several overflow locations, including a former NBA arena in Sacramento, a former prison and a college gymnasium.

‘Unbelievable’ snowfall blankets parts of the Northeast (AP) The Northeast’s first whopper snowstorm of the season buried parts of upstate New York under more than 3 feet (1 meter) of snow, broke records in cities and towns across the region, and left plow drivers struggling to clear the roads as snow piled up at more than 4 inches (10 centimeters) per hour. “It was a very difficult, fast storm and it dropped an unbelievable amount of snow,” Tom Coppola, highway superintendent in charge of maintaining 100 miles (160 kilometers) of roads in the Albany suburb of Glenville, said Thursday. “It’s to the point where we’re having trouble pushing it with our plows.” The storm dropped 30 inches (76 centimeters) on Glenville between 1 a.m. and 6 a.m. Thursday, leaving a silent scene of snow-clad trees, buried cars and laden roofs when the sun finally peeked through at noon. Much of Pennsylvania saw accumulations in the double digits. Boston had more than 9 inches (23 centimeters) of snow early Thursday morning.

1 in 5 prisoners in the US has had COVID-19, 1,700 have died (AP) One in every five state and federal prisoners in the United States has tested positive for the coronavirus, a rate more than four times as high as the general population. In some states, more than half of prisoners have been infected, according to data collected by The Associated Press and The Marshall Project. As the pandemic enters its 10th month—and as the first Americans begin to receive a long-awaited COVID-19 vaccine—at least 275,000 prisoners have been infected, more than 1,700 have died and the spread of the virus behind bars shows no sign of slowing. New cases in prisons this week reached their highest level since testing began in the spring, far outstripping previous peaks in April and August. As the virus spreads largely unchecked behind bars, prisoners can’t social distance and are dependent on the state for their safety and well-being.

Shut down by corona, Berlin restaurant opens for homeless (AP) The coronavirus pandemic hasn’t made life on the streets of Berlin any easier for Kaspars Breidaks. For three months, the 43-year-old Latvian has faced homeless shelters operating at reduced capacity so that people can be kept at a safe distance from one another. And with fewer Berliners going outdoors, it’s much harder to raise money by panhandling or collecting bottles to sell for recycling. But on a chilly winter morning this week Breidaks found himself with a free hot meal and a place to warm up, after the German capital’s biggest restaurant, the Hofbraeu Berlin—itself closed down due to coronavirus lockdown restrictions—shifted gears to help the homeless. It was a clear win-win proposition, said Hofbraeu manager Bjoern Schwarz. As well as helping out the homeless during tough times the city-funded project also gives needed work to employees—and provides the restaurant with welcome income. In cooperation with the city and two welfare organizations, the restaurant quickly developed a concept to take in up to 150 homeless people in two shifts every day until the end of the winter, and started serving meals on Tuesday.

Japan: Snow traps 1,000 drivers in frozen traffic jam (BBC) Rescuers are trying to free more than 1,000 vehicles which have been stranded on a highway for two days after a heavy snow storm struck Japan. Authorities have distributed food, fuel and blankets to the drivers on the Kanetsu expressway, which connects the capital Tokyo to Niigata, in the north. The snow, which began on Wednesday evening, has caused multiple traffic jams along the road. Officials have been using a combination of heavy machinery and physical labour to dig out the vehicles one by one, but around 1,000 cars were still stranded on the road as of Friday noon.

‘Nightmare’ Australia Housing Lockdown Called Breach of Human Rights (NYT) The sudden lockdown this summer of nine public housing towers in Melbourne that left 3,000 people without adequate food and medication and access to fresh air during the city’s second coronavirus wave breached human rights laws, an investigation found. The report, released on Thursday by the ombudsman in the state of Victoria, of which Melbourne is the capital, said that the residents had been effectively placed under house arrest for 14 days in July without warning. It deprived them of essential supports, as well as access to activities like outdoor exercise, the report said. The lockdown was not “compatible with residents’ human rights, including their right to humane treatment when deprived of liberty,” Deborah Glass, the Victorian ombudsman, wrote. The report recommended the state government apologize publicly to tower residents, as well as improve relationships and procedures at similarly high-risk accommodations in the city so that they might be better prepared for future outbreaks. Though Australia has won global praise for successfully slowing the spread of the coronavirus in the country, the report was a scathing rebuke of state officials’ decision to apply stringent measures to the public housing residents, who said they felt trapped and traumatized and suspected discrimination. Several described it as a “nightmare.”

Fiji says two dead as powerful cyclone tears across Pacific nation (Reuters) A powerful cyclone pounded Fiji, killing two people and leaving a trail of destruction across the Pacific Island nation, authorities said on Friday. Cyclone Yasa, a top category five storm, made landfall over Bua province on the northern island of Vanua Levu on Thursday evening, bringing torrential rain, widespread flooding and winds of up to 285 km per hour (177 miles) across the archipelago. Scores of houses were destroyed, while power was cut to some areas and roads blocked by fallen trees and flash flooding, authorities said. Officials with the Red Cross said authorities were scrambling to help affected communities. Adverse weather has hampered efforts by aid groups to dispatch assistance, with waves of more than 3 metres (10 ft) preventing ships leaving Suva.

Radio stations may be the real “e-learning” revolution (Rest of World) The impact of a student’s socioeconomic status on their access to education during the pandemic is playing out globally, exposing just how closely tied internet access is to educational opportunity. In Sub-Saharan Africa, over 85% of households lack access to the internet at home and 89% of students do not have access to a computer outside of school. On the African continent, expensive and unreliable internet reaches only 40% of the population. Many governments, companies, and NGOs think that throwing millions of dollars behind providing tablets is the best way to improve the quality of education, but this impulse overlooks infrastructural issues like access to the internet, teacher training, and the cost of upkeep that students need to use the tablets in the first place. “Even if we did have a device for every student, they would have nowhere to charge them,” Reshma Patel, the executive director of Impact Network, a nonprofit that provides education for over 6,000 kids in rural Zambia through community schools, told Rest of World. Impact-run schools adapted radio lessons, since a majority of their students live in homes without electricity. Faced with the shutdown of the 43 schools she supervises, Patel relied on the “forgotten stepchild of tech interventions” to reach students: radio. On the continent, radio has long been a window to the external world. Shoeshoe Qhu works as the station manager at Voice of Wits 88.1 FM, a university radio station in Johannesburg, South Africa. She grew up in a mountainous village of 100 homesteads without electricity or running water. While there wasn’t television, there was radio. As long as her family had access to batteries and a receiver, it was free. “If you wanted to hear what was happening everywhere else, you could only get it through the radio,” Qhu said. “I grew up with radio, and it gave me access to the world,” she added. “It meant everything.”

Watch those passwords (NYT) Dutch hacker Victor Gevers claims to have logged in to President Trump’s Twitter account six years ago by guessing the password: “yourefired.” Then he did it again. On Oct. 16, Gevers, 44, made an accurate guess, “maga2020!,” on his fifth try, according to Dutch prosecutors. Hacking is a crime in the Netherlands. But on Wednesday, Dutch officials said they would not press charges because Gevers had met the bar for “responsible disclosure,” demonstrating how easy it could be to gain access to the U.S. president’s handle: @realdonaldtrump.

#headlines #news

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sylviajackson5 · 5 years ago

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Tree Care Services Rochester Ny

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Arborists offer professional tree service

Randall professional services

Patios. 150 lee road

Monster tree service

Best Tree Service in Rochester NY. We offer a great deal of tree care services, including:.

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Roof Inspections Can Help You Avoid Expensive Repairs The roof of your home is important to keep you, your family, and belongings safe. To get the longest life from your roofing system, it is important to have it inspected yearly. An inspection will help locate problems due to moisture, which could lead to expensive roofing repairs. The yearly maintenance job of an inspection

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The Learning Tree Child Care … or verified by Care.com. Care.com does not provide medical advice, diagnosis or treatment or engage in any conduct that requires a professional license. Care.com and …

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antoinenohra · 2 years ago

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WHAT IS ROOT CANAL TREATMENT, AND WHEN DOES THE DENTIST DEEM IT NECESSARY ?

Dr Antoine Nohra the Albany Dentist at Amity Dental Centre is expert in root canal procedure used to work exclusive root canal for Six years in Qatar now providing Albany community the best service in Root canal Treatment.

When you hear the dentist saying the tooth needs root canal treatment would your heart sink a little bit? At Amity Dental Centre we understand that many patients are nervous about root canal treatment. However, we tend to reassure the patient that this specialized treatment is always pain-free and essential to save the tooth from being extracted — an outcome nobody wants. It really is nothing to be scared of.

Root canal treatment, also known as endodontics, is performed when the pulp or nerve of a tooth becomes infected. This happens when a patient neglect a sensitive tooth that has a hole becoming sore from time to time and can result also from untreated tooth decay, accident or injury. You may or may not be aware that your tooth has been damaged; the first sign that something is wrong is usually toothache.

Dr Antoine Nohra, the Albany Dentist at Amity Dental Centre dentist is expert in root canal procedure he usually uses special files to clean the tooth of infection. After cleaning the space inside the root this is then filled to stop further infection occurring. In most cases, the tooth is then ready to have a porcelain crown to give it extra strength following the procedure. All of this is done under local anesthetic under the same roof at Amity Dental Centre, so you should experience no pain or discomfort.

The root canal procedure and the crown are performed by the dentist in Albany Dr Antoine Nohra who is highly skilled and experienced and is also known for his kind, compassionate nature, which make patients relaxed the hole procedure from start to finish.

Most patients who have had the procedure at our Amity Dental centre report it feels no different to having a standard filling, although your appointment might be longer because this is delicate, skilled work. You may need two or more appointments with the dentist to complete the root canal procedure to ensure all infection has cleared.

Some teeth have more canals than others (the front teeth often have one, the back teeth two or more) so the number of appointments will depend on which tooth is involved.

This entry was posted in Root Canal

by Dr Antoine Nohra

More from Antoine Nohra

Owner and publisher of https://www.albanydentist.com.au

October 23 2022

Dentist Albany

Antoine Nohra Oct 23, 2022

#Albany Dentist #Dentist Albany #Albany Dentist WA #Dentist Albany WA #Dr Antoine Nohra

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hikingmysteries · 4 years ago

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From a Great Camp

Camp Santanoni is one of the earliest examples of the “Great Camps of the Adirondacks”. For lovers of this architecture, photos and descriptions hardly do it justice. It was the brainchild of Robert C. Pruyn (1847–1934), a prominent Albany banker and businessman. Pruyn acquired 12,900 acres (52.2 km²) just south of the Adirondack High Peaks. He hired three architects to design a summer residential complex.

It turned out to be a sprawling wilderness retreat of extravagant proportions. The complex numbered 45 buildings and was regarded as the grandest of all such Adirondack camps. It consisted of three main groupings of buildings: The Gate Lodge complex; the farm complex; and the Main Camp. These were built from 1892 to 1907.

The scale of such an endeavour in such a location is incredible. The Gate Lodge not only signified entry, it was a monumental, stone, arch structure holding six staff bedrooms, a caretaker’s home, and assorted barns, wagon sheds and other buildings.

The farm complex was a massive set of barns, three farmhouses and workers cottages, a stone creamery, workshop, chicken house, kennels, smoke house, root cellar and other service buildings. The family raised imported and domestic breeds of cattle, sheep, goats, pigs and poultry. It supplied the camp with its meat and produce, while surplus dairy products were sold in Newcomb and sent to Albany for the Pruyns and their friends. Many Newcomb residents today still own milk bottles with “Santanoni” embossed in raised letters.

The Main Camp held an excellent view toward the Adirondack High Peaks. The central lodge was actually a grouping of six separate buildings. It held the main living and dining lodge with seven bedrooms, a kitchen and service building with seven staff bedrooms, all connected by a common roof and porch system. 1500 spruce trees were used in the log construction. The structural and decorative features defined rustic chic for its time, including a liberal use of birchbark wall coverings that exists today. A boathouse, artist’s studio, workshop, icehouse, and additional staff quarters made up the camp.

Pruyn’s heirs sold it to the Melvin family, leaders in the business and professional community of Syracuse, in 1953. And that is where this story begins.

Douglas Legg, also known as “Dougie,” disappeared when he was 8 years old from the camp. He was a grandson of the Melvin family. This took place on a July afternoon in 1971. The young boy and his uncle started out on hike on the familiar terrain. Due to the risk of poison ivy, the uncle sent him back to the camp to change from shorts into pants. They were about a half mile away from the camp at the time.

Dougie was last seen by his older brother and a cousin about 50-60 yards from the main lodge. He never met back up with his uncle, and he was never seen from or heard from again. According to an article from the time, he was a “mini woodsman.”

The disappearance sparked a massive search, mostly funded by the very wealthy family. Almost 1,000 volunteers along with planes equipped with heat-detecting infrared FLIR tried their best. All efforts were unsuccessful over a 6-week period. It is still unknown if Dougie simply wandered off and was lost, succumbing to the elements, or if foul play was involved.

Given the mystery, several theories have sprung up. In 1993, 22 years after Dougie disappeared, a woman undergoing psychiatric treatment believed a boy fitting Dougie’s description was kidnapped and murdered by one of her relatives. It proved to be false. The subsequent news coverage generated what investigators believe is the most credible tip.

A man on leave from the Navy in 1973, two years after Douglas Legg disappeared, was hunting in the area when he separated from his friend to chase a deer. He crossed a peninsula leading to a 21-acre island in Newcomb Lake. This is a half mile from the main lodge. He stumbled upon a small skull and partial skeleton which he believed to be human. He told his friend of his find but was worried about returning on time from Navy leave and he was on land he should not have been on, so never reported the find. Neither man was aware of the disappearance.

The man who had chased the deer heard from his friend in 1993 when the friend saw a news story on the renewed search. He immediately called the police to report his experience. The story fit with the last known sighting as the original hike was around Newcomb Lake.

Police theorize that Dougie, attempting to follow his uncle, stumbled across the peninsula and thinking he was still following the lake shoreline became disoriented in the thick, dense growth and perished on the island. The area was searched in 1971, yet, police are not sure how thoroughly due to the large number of volunteers and extremely dense vegetation.

The man, then living in Montana, was flown back to help. The remains could not be located. Authorities believe it was buried under inches of sediment and moss from the passing years. This new search covered a very small area.

In the early 1970’s the Melvin family, not caring to return to the scene of the tragedy, quickly contracted with the newly formed Adirondack Conservancy Committee to purchase the entire camp. The furnishings were removed, and the Conservancy then resold the property to the state of New York for incorporation into the State Forest Preserve.

Now called the Santanoni Preserve, it is open to visitors. Though not up to its former glory and grandeur, the scale and quality of build impresses. Preservation efforts are ongoing. The state encourages cross country skiing, wagon rides, and … hikes.

#Santonini #Camp #Adirondaks #hiking #trekking #hikers #mysteries #hikingmysteries #missing

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pratikshame-blog · 5 years ago

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Precast Construction Market Forecast and Trends Analysis Research Report

The global precast construction market was valued at around US$ 111 Bn in 2017. It is anticipated to expand at a CAGR of approximately 5.1% during the forecast period, according to a new report titled ‘Precast Construction Market: Global Industry Analysis, Size, Share, Growth, Trends, and Forecast, 2018–2026’ published by Transparency Market Research (TMR). The report infers that the use of precast construction reduces the lead time and provides better dynamics such as durability and sustainability to the structure as compared to the use of conventional construction techniques. This is expected to drive the precast construction market during the forecast period. Asia Pacific and Europe are leading regions of the precast construction market. The precast construction market in Asia Pacific is projected to expand at a CAGR of more than 6% during the forecast period, owing to a rise in investments in residential and infrastructure projects in the region.

Planning to lay down strategy for the next few years? Our report can help shape your plan better.

Reduction in Construction Time and Structural Properties of Precast Concrete Products to Boost Market Growth

Precast construction saves up to 20% of the total construction time as compared to conventional construction methods. It helps in saving valuable lead time and in reducing the risk of delay or monetary loss in the project, which is expected to boost the precast construction market. The raw materials used in precast construction are inorganic, natural, and recycled resources. Production of precast construction components involves minimal processing or chemical treatment, which results in low embodied energy value (carbon emissions). Thus, a reduction in carbon emission through the precast construction technology is projected to drive the precast construction market during the forecast period. Important parameters such as temperature, mix design, and stripping time are monitored and controlled in a factory environment while producing precast components. A factory-controlled prefabrication environment and elimination of rectification work render high quality and esthetic value to products, thereby augmenting their demand. Precast concrete products are resistant to friction, impact, acid, corrosion, abrasion, and other environmental factors. Precast concrete structures have a longer service life and require minimal repair and maintenance. High structural strength, increased durability, and better rigidity are driving demand for precast construction products.

Use of high-quality machinery, equipment, and materials; extensive preproject planning; and high investments in the construction industry are estimated to offer lucrative opportunities to the precast construction market during the forecast period. However, high initial cost and logistical and material handling damages are anticipated to hamper the market.

Floor & Roof System Segment to Gain Momentum

The report presents a detailed segmentation of the global precast construction market based on its structure system and end-use. In terms of structure system, the floor & roof system segment constituted a major share of the global precast construction market in 2017. Floor & roof systems enable a large span capacity besides providing excellent sound transmission and heat resistance characteristics. Moreover, they provide load distribution properties and are ideally used in garages, gymnasiums, paper mills, office & commercial buildings, industrial buildings (food processing industry, paper mills), condominiums, apartments, hotels, educational institutions, sewage & water treatment plants, etc.. They are also used as thermal mass to reduce the need for air conditioning. The floor & roof system segment is expected to expand rapidly, due to the high adoption rate of floor & roof systems in the precast construction market.

To understand key trends, Download Sample Report at https://www.transparencymarketresearch.com/sample/sample.php?flag=S&rep_id=20921

Building Works Segment to Maintain its Dominance

In terms of end-use, the building works segment is projected to hold a dominant share of the global precast construction market during the forecast period. The segment is likely to expand at significant growth rate from 2018 to 2026. The residential segment, which is a sub-segment of the building works segment, is projected to expand at a rapid pace during the forecast period. Precast concrete construction offers diverse attributes such as low floor-to-floor height, deflection control, low noise transmission, involvement of high-strength materials, and long spans. Such attributes are effective for the residential construction industry. Demand for precast construction products in the residential construction industry is expected to rise due to their direct cost reduction, improved constructional efficiency, and superior structural performance.

Asia Pacific Accelerates in the Market

Asia Pacific and Europe were key regions of the precast concrete market in 2017. The precast concrete market in Asia Pacific is anticipated to expand rapidly owing to cross-border investments and business expansion of companies in high-growth areas, such as India and Southeast Asia. A rise in population, rapid urbanization, and robust economic growth are major macroeconomic drivers of the precast construction market. Regulatory bodies and major firms across the region are encouraging and promoting constructional activities. China is expected to become a key region of the precast concrete market, owing to the revival of the Silk Road and proposals of construction on it. The precast market in Middle East & Africa is also projected to expand at a robust pace.

To obtain all-inclusive information on forecast analysis of global market, request a PDF brochure here

Prominent Players in the Global Precast Concrete Market

The report also provide profiles of leading players operating in the global precast concrete market such as Bison Manufacturing Limited, Cemex S.A.B. de C.V., China National Building Material Company Limited, Coltman Precast Concrete Limited, CRH plc, Elematic Oyj, LafargeHolcim, Larsen & Toubro Limited., Taisei Corporation, and Weckenmann Anlagentechnik GmbH & Co. KG. These players offer sustainable and durable solutions to clients. Innovation of modern construction equipment and techniques through R&D is one of the approaches adopted by them.

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#Precast Construction Market

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pharm-studies-blog · 7 years ago

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Study Guide

4 MCO (MANAGED CARE ORGANIZATION)

HMO (Health Maintenance Organization): Started out as closed systems; SELF MAINTAIN

Restricted: Patient couldn’t go outside the network or they have to pay out of pocket

Employers tend to prefer HMO: premiums + managed care costs are lower

As a result, it became the dominant form of MCO

Staff HMO: Owned by HMO in business

IPA (Individual Practice Association): Physician practices that come together and form an association that’s contracted with HMO

As a result of losing market shares to PPOS, MCO implemented the

POS (Point of Service): Allows you to have coverage when you need it, you pay it when you get it (Similar to PPO)

Requires referral

There was a drop in consumers in 2003-2005 because Medicare Part D came out

BUT If you have large amount of drugs, it’s cheaper to be in MA than part D

PPO (Preferred Provider Organization): consists of physicians, hospitals, labs that voluntarily come together to create their own managed care system

Open: Patient could go outside of network but just paying a little more but NOT out of pocket

If you stay within the network, you pay little to nothing

Don’t need referral

ABSOLUTELY CANNOT join Medicare part D

Private Fee for Service Plan (PFFs): Like old indemnity insurances where plan contracts health care providers and figure out how much they will contribute

NOT RESTRICTED

Doctors may refuse care, they do have network but all plans are different

Don’t need referral

Medicare Special Needs Plan (SNP): designed for particular disease groups

May NOT cover everything and it’s unique to ONLY THAT disease

Requires referral

GOVERNMENT PROGRAMS

MediCARE: healthcare funded by federal government for 65+/renal disease/disabled (Earned)

Consists of: Plan A, B, C (Managed Care/Medicare Advantage), D covering social services, medications, medical supplies, transportation to hospital

You must wait until you’re in the U.S. 5 years before you sign up for the application regardless age!

Part A (GOV PAYER/ UNIFORM/FLEXIBLE): Hospital care (Sitting in the ER is NOT hospital; inpatient HOSPITAL CARE

Missing enrollment period isn’t a big deal but if you don’t pay 40 quarters, you double the amount to pay

Can’t terminate unless you LOSE SS OR DIE

You get this AFTER you pay your 40 quarters but no copay, co-insurance

NO PREMIUM but DEDUCTIBLE if in hospital (worth 3-4 days)

Deductible Per Benefit Period: Benefit Period is how frequently the patient goes in and out of the hospital, if it’s within 60 days, it’s within the same benefit period

Life time reserve day: 60 days to cover your expensive (NOT RENEWABLE)

There are certain types of services attached per disease and not everyone can quality for PT/OT unless the doctor justifies

Nursing home admission: 3 requirements (day 21 no copay, 21-100 pay, 100+ out of pocket)

Have Part A coverage and days left

Admitted for at least 3 days in the hospital

Decided that you need daily care

Skilled nursing homes have earlier but smaller copays that lasts longer

Part B (GOV PAYER/UNIFORM/SICKNESS MODEL/FLEXIBLE): Voluntary: Covers medical services and lab tests + equipment

Missing enrollment period IS A BIG DEAL b/c for every 12 month you’re out of the plan, you pay a 10% penalty forever unless you have CREDIBLE COVERAGE

Can terminate but have consequences and if you’re late for paying

You can’t sign up for part B UNLESS YOU HAVE part A

Must be a U.S. resident (Domestic residence issue) that’s lawfully admitted to the U.S.

ACA requires: preventative services (“Welcome to Medicare” free screening NOW FREE)

Flu + pneumonia immunizations are covered

Monthly premium comes from SS

Under Original Medicare plan, there is ALWAYS a 20% (co-pay, co-insurance) for the patient

Part C (Medicare Advantage INSURANCE PLANS WELLNESS MODEL/ restricted):

MUST HAVE A + B in order to apply for C

Get more coverage but more restricted TRADE OFF

Part D (INSURANCE PLANS/restricted): allowed consumers to stay in original Medicare plan and get drug plan (Managed care didn’t allow that)

Starts in JAN; NO set premium varying from plan to plan

When implemented, the numbers were very underestimated

Not every plan is the same and not every drug is covered

Used the star system and had the DONUT HOLE

Government sets a basis for each plan + classes of drug

Will only cover for people in the U.S. (Exception: IN TRANSIT: If you’re on your way to the U.S. and you’re sick, they will cover it)

Medicare card is connected to SS, violates their own rules for SS, no picture!

Usually pay nothing for Medicare approved services but 20% of most other medical services

PAYS FOR

Hospice care: Will NOT pay for treatments, out patient treatment, ambulance, room and board, 0 copay for hospice care and max $5 for drugs

Home health services: Covered in some part of B + A (24 hr care and home made services)

Custodial care (sleep, eat bathe): NOT covered

Private rooms: NOT covered unless necessary such as contagious disease

Clinical trials: May be covered

Mental health: Started to get covered (wasn’t covered before)

MediCAID (WELLNESS): funded by state + federal government for the poor (income too low) Give

There is a state and local component (Albany have different plans from that of NYC)

Locally: Can make Medicaid managed care mandatory and can only offer one insurance plan to choose from (LEGAL)

Not really a problem in NYC b/c 1 million people under Medicaid

Family could be all PEOPLE LIVING IN SAME ROOF

States can ask federal government to increase income so more people can qualify for Medicaid SUCH AS 150 + 200% increase

Based on MONTHLY basis of NET INCOME, MEDICAID INCOME, RESOURCE INCOME

Pregnant: 154% poverty level up to 1 year, 223% if pregnant again while baby is within 1y/o

Number in family for 1: ALWAYS higher because first person usually cover expenses for everybody but not enough to need TWICE as much for the next person

HEALTH CARE YELP

NCQA (National Committee on Quality Assurance): Founded to compare the quality of managed care plans that stand outside and have no connection with outside industry

Gathers outcomes research and provide database of HEDIS (Health plan employer data information set) now stands for Health care effectiveness data information plan

They ask a series of questions on each domain (same) to employers + patients on surveys

Medicare + Medicaid: must have to report HEDIS data!

Star system: for Medicare part D

Cut off is 3 stars of 3 year response, if quality is low, gov. notifies you/ window is cases by case

CHIP

CHILD HEALTH PLUS 1998: NY’s version of CHIP; ALL came from STATE taxes

For children whose parents make too much $$ to qualify for Medicaid

HEALTHNY: For employers of smaller businesses

BIGGER THE GROUP, SMALLER THE PREMIUM

Typically no premium unless the parents made more money but premim don’t go above 3

**CANNOT DOUBLE DIP, you either get MEDICAID OR SCHIP, NOT BOTH**

· 2008: SCHIP was not reauthorized but NY kept it running

#health care #medicaid #medicare #chip #studyblr #pharmacy #law

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gordonwilliamsweb · 5 years ago

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The Other COVID Risks: How Race, Income, ZIP Code Influence Who Lives Or Dies

It started with a headache in late March. Then came the body aches.

At first, Shalondra Rollins’ doctor thought it was the flu. By April 7, three days after she was finally diagnosed with COVID-19, the 38-year-old teaching assistant told her mom she was feeling winded. Within an hour, she was in an ambulance, conscious but struggling to breathe, bound for a hospital in Jackson, Mississippi.

An hour later, she was dead.

“I never in a million years thought I would get a call saying she was gone,” said her mother, Cassandra Rollins, 55. “I want the world to know she wasn’t just a statistic. She was a wonderful person. She was loved.”

Shalondra Rollins, a mother of two, had a number of factors that put her at higher risk of dying from COVID-19. Like her mother, she had diabetes. She was black, with a low-salary job.

And she lived in Mississippi, whose population is among the unhealthiest in the country.

She was one of 193 Mississippi residents who have died of COVID-19, and one of more than 4,800 with confirmed illnesses.

Doctors know that people with underlying health conditions ― such as the 40% of Americans who live with diabetes, hypertension, asthma and other chronic diseases ― are more vulnerable to COVID-19. So are patients without access to intensive care or mechanical ventilators.

Yet some public health experts contend that social and economic conditions ― long overlooked by government leaders, policymakers and the public ― are even more powerful indicators of who will survive the pandemic. A toxic mix of racial, financial and geographic disadvantage can prove deadly.

“Most epidemics are guided missiles attacking those who are poor, disenfranchised and have underlying health problems,” said Dr. Thomas Frieden, a former director of the Centers for Disease Control and Prevention.

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Federal health officials have known for nearly a decade which communities are most likely to suffer devastating losses ― both in lives and jobs ― during a disease outbreak or other major disaster. In 2011, the CDC created the Social Vulnerability Index to rate all the nation’s counties on factors such as poverty, housing and access to vehicles that predict their ability to prepare, cope and recover from disasters.

Download The Data

Download the county-level data (.zip)

Yet the country has neglected to respond to warning signs that these communities ― where people already live sicker and die younger than those in more affluent areas ― could be devastated by a pandemic, said Dr. Otis Brawley, a professor at Johns Hopkins University.

“This is a failure of American society to take care of the Americans who need help the most,” Brawley said. Although vulnerable counties are scattered throughout the country, they are concentrated across the South, in a belt of deprivation stretching from coastal North Carolina to the Mexican border and deserts of the Southwest.

Some of the most vulnerable communities are in Mississippi, which has the highest poverty rate of any state; Indian reservations in New Mexico, the second-poorest state, where thousands of households lack running water; and cities such as Memphis, Tennessee, a hot spot for asthma that recently ranked among the bottom 15 metro areas in offering safe, livable housing to its residents.

The first U.S. COVID-19 cases were detected in metropolitan areas, with Hispanics and blacks making up a disproportionate number of deaths in New York City. Outbreaks are now flaring in rural communities, the South and Upper Midwest. Both the New Orleans and Albany, Georgia, areas have infection rates above 1% of their populations. More than 1,600 people have been diagnosed with COVID-19 in the Sioux Falls, South Dakota, home to a meat-packing plant that employs immigrants and refugees from around the world.

Whether COVID-19 patients live or die probably depends more on their baseline health than whether they have access to an intensive care bed, Brawley said. Some hospitals report that only about 20% of COVID-19 patients on ventilators survive.

Many public health experts fear that COVID-19 will follow the same trajectory as HIV and AIDS, which began as a disease of big coastal cities ― New York, Los Angeles and San Francisco ― but quickly entrenched in the black community and in the South, which is considered the epicenter of the nation’s HIV/AIDS outbreak today.

Like HIV and AIDS, the first COVID-19 cases in the United States were diagnosed in “jet-setters and people who traveled to Europe and other places,” said Dr. Carlos del Rio, professor of infectious diseases at the Emory University Rollins School of Public Health. “As it settles in America, [COVID-19] is now disproportionately impacting minority populations, just like HIV.”

Mississippi: The Legacy Of Segregation

One in 5 Mississippi residents live in poverty.

It is also in the heart of the “Stroke Belt,” a band of 11 Southern states where obesity, hypertension and smoking contribute to an elevated rate of strokes. Blacks make up 38% of the state population ― but more than half of COVID-19 infections in which race is known. They also account for nearly two-thirds of deaths from the virus, according to the state health department.

Medical and socioeconomic conditions put Mississippians at higher risk of COVID-19 in several ways, said Frieden, now CEO of Resolve to Save Lives, a global public health initiative.

People in low-income or minority communities are more likely to work in jobs that expose them to the virus ― in factories or grocery stores and public transit, for example. They’re less likely to have paid sick leave and more likely to live in crowded housing. They have high rates of chronic illness. They also have less access to health care, especially routine preventive services. Mississippi is one of 14 states that have not expanded Medicaid.

“If they do have chronic conditions such as hypertension or diabetes,” Frieden said, “the health system doesn’t work as well for them, and they are less likely to have it under control.”

Minority communities suffer the legacy of segregation, which has trapped generations in a downward economic spiral, said Dr. Steven Woolf, a professor at Virginia Commonwealth University in Richmond.

“The fact that African Americans are more likely to die of heart disease is not an accident,” Woolf said. “COVID-19 is a very fresh, vivid example of an old problem.”

Research shows that “stress, economic disadvantage, economic deprivation not only affect the people experiencing it, but it’s passed on from one generation to another,” Woolf said.

Tonja Sesley-Baymon, president and CEO of the Memphis Urban League, noted that social distancing is a privilege of the affluent. Just getting to work can put people at risk if they ride the bus. “If you take public transportation, social distancing is not an option for you,” she said.

Cassandra Rollins with daughter Shalondra(Courtesy of the Rollins family)

Dr. LouAnn Woodward, the University of Mississippi Medical Center’s top executive, has treated many people in the emergency room whose life-threatening crises could have been prevented with routine care. She’s seen diabetes patients with blood sugar levels high enough to put them in a coma.

Health insurance is only part of the problem, she said. When Woodward asked one woman why she waited so long to seek treatment for her breast tumor, the woman said, “I just got a ride.”

Cassandra Rollins, the youngest of 11 siblings, knows hardship. Two of her sisters were murdered. She helped raise their children, who are now grown.

She raised four of her own children as a single mother. Shalondra, the eldest, often acted as a second mom to her brother 18 years younger. Shalondra even attended her brother’s parent-teacher conferences when her mother couldn’t leave work.

In September, her brother died by suicide at age 20.

When her daughter was diagnosed with COVID-19, Cassandra Rollins said, “we had just gotten to a point where we didn’t cry every day.”

The Navajo: Health Suffers In Food Deserts

The coronavirus is battering impoverished communities. More than 1,200 COVID-19 cases and 48 deaths have been diagnosed in the Navajo Nation, the country’s largest Indian reservation, located on 27,000 square miles at the junction of Arizona, New Mexico and Utah.

There are few hospitals in the region, an area the size of West Virginia, and most lack intensive care units.

The communities that make up the Navajo Nation have among the worst scores on the CDC’s Social Vulnerability Index. Thirty-nine percent of residents live in poverty.

With a shortage of adequate housing, many live in modest homes with up to 10 people under one roof, said Jonathan Nez, Navajo Nation president. That can make it harder to contain the virus.

“We’re social people,” Nez said. “We take care of our elders at home.”

The first residents tested positive in mid-March, and cases skyrocketed within weeks. In the eight counties comprising the Navajo, Hopi and Zuni nations, 1,930 residents have tested positive and 79 have died. That’s more cases per 100,000 residents than the Washington, D.C., area.

The Navajo Nation has taken aggressive steps to control the outbreak, including weekend curfews enforced by checkpoints and patrols.

But more than 30% of its households lack a toilet or running water, according to the Navajo Water Project, a nonprofit that installs plumbing in homes. Residents often drive long distances to fill containers with water, Nez said.

Having no running water makes it difficult to properly wash hands to prevent coronavirus infections.

Navajo patients with diabetes have long struggled to clean skin infections, said Dr. Valory Wangler, chief medical officer at Rehoboth McKinley Christian Health Care Services in Gallup, New Mexico.

Maintaining a healthy weight on the reservation is challenging, Nez said. Residents commonly spend hours daily traveling by car to and from work, leaving little time to exercise or cook. While the region has fast-food restaurants, far fewer stores sell fresh fruits and vegetables, he said, adding, “we’re in a food desert.”

Memphis: Childhood Diseases Take Their Toll

Most children with COVID-19 are at low risk of death. But many adults felled by the disease suffer the long-term effects of health damage they suffered as children, such as lead exposure or asthma, said Brawley of Johns Hopkins.

More than 208,000 homes in Memphis, Tennessee, pose potential lead hazards. Lead ― toxic at any level ― can cause brain damage and lead to hypertension and kidney disease, conditions that increase the risk of complications in COVID-19 patients.

Shelby County, which includes Memphis, is home to 937,000 residents, 14% of the state’s population. Its COVID-19 burden is outsized, representing one-quarter of the cases and deaths in Tennessee. Where race is known, most patients have been black.

The National Center for Healthy Housing ranked Memphis the worst metropolitan area for housing in 2013, although its rating has since improved slightly.

Memphis, with older housing stock and one of the poorest big U.S. cities, is a hot spot for asthma, which afflicts up to 13.5% of its children. The CDC has said that people with asthma may be at higher risk from COVID-19, although some hospitals haven’t seen higher death rates in this population.

Blacks are almost three times as likely to die of asthma as whites, according to the Health and Human Services’ Office of Minority Health. Many children develop asthma after being exposed to tobacco smoke or substandard housing with dust mites, cockroaches, rodents and molds. Some suffer for a lifetime.

Many poor people can’t afford asthma medications and have no regular source of medical care to monitor their disease, said Dr. Robin Womeodu, chief medical officer at Methodist University Hospital.

Asthma patients often go through “a revolving door in and out of the emergency department,” with an increased risk of death, she said.

Health experts say these health risks could remain long after the pandemic passes.

“The question is, ‘Do we value all life equally?’” said Dr. James Hildreth, president and CEO of Meharry Medical College in Nashville, a historically black college. “If we do, we will find a way to address these things.”

KHN data editor Elizabeth Lucas contributed to this report.

METHODOLOGY

Kaiser Health News analyzed COVID-19 case rates across the country and compared them to a number of demographic factors. KHN obtained COVID-19 data by county from The New York Times and populations from 2019 U.S. Census Bureau Population Estimates to calculate cases per 100,000 residents. The national map displays COVID-19 case rates per 100,000 by commuting zone, defined as a group of counties that approximate local economies and can cross state boundaries.

The charts comparing COVID-19 cases in Mississippi and Shelby County, Tennessee, by population and race are irrespective of Hispanic ethnicity because ethnicity is coded separately in the data.

DATA SOURCES

COVID-19 cases and deaths by county: The New York Times

Commuting zone definitions: Urban Institute, with adjustments for recent county boundary changes

Hospitals and ICU beds: Kaiser Health News analysis, Centers for Medicare & Medicaid Services

Population: U.S. Census Bureau Population Estimates, 2019

Race, ethnicity and age: U.S. Census Bureau American Community Survey, 2018

Health insurance: U.S. Census Bureau Small Area Health Insurance Estimates, 2018

Poverty: U.S. Census Bureau Small Area Income and Poverty Estimates, 2018

Social Vulnerability: Centers for Disease Control and Prevention Social Vulnerability Index, 2018

The Other COVID Risks: How Race, Income, ZIP Code Influence Who Lives Or Dies published first on https://nootropicspowdersupplier.tumblr.com/

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dinafbrownil · 5 years ago