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Hydrogen-oxidizing hydrogenase activity was detected in Helicobacter hepaticus and compared to the activity in Helicobacter pylori for characteristics associated with hydrogen uptake respiratory hydrogenases. Intact whole cells could couple H2 oxidation to oxygen uptake, and no H2 uptake was observed without oxygen available to complete the respiratory pathway. The H. hepaticus enzyme coupled H2 oxidation to reduction of many positive potential acceptors, and it underwent anaerobic or reductive activation. H. hepaticus had a strong affinity for molecular H2 (apparent Km of 2.5 μM), and microelectrode measurements on the livers of live mice demonstrated that H2 is available in the host tissue at levels 20-fold greater than the apparent whole-cell Km value.
Although most of the member species of Helicobacter are not colonizers of the gastric mucosa, the gastric colonizer (Helicobacter pylori) receives the bulk of the research attention. Nevertheless, the enterohepatic types are beginning to be studied as important natural colonizers and emergent pathogens of animals (3, 18). They colonize the intestinal tract (and sometimes the liver) of humans and other mammals, and many have been considered to be part of the normal intestinal flora (see references 17 and 18). One member of this diverse group of helicobacters is Helicobacter hepaticus; it was originally isolated from strains of mice with a high incidence of hepatitis and liver tumors (4, 7). Since then, the correlation of this bacterium with liver diseases (chronic active hepatitis, typhlitis, and hepatocellular tumors) and irritable bowel disease-like symptoms has become stronger (see references 3 and 18), but H. hepaticus has not been isolated from the human liver. Nevertheless, the fact that hepatic helicobacters are associated with diseased liver tissue in other animals, including primates (5, 6, 8), has sparked increased attention to H. hepaticus physiology. Similarly, the reports correlating the presence of Helicobacter sp. DNA with (human) patients having primary liver carcinomas have further fueled interest in hepatic helicobacters (3).
Recently members of our group showed that H2 uptake-type hydrogenase activity is a bacterial characteristic that is important for conferring colonizing ability to H. pylori (16). Hydrogen oxidation is carried out by many diverse respiratory bacteria, since it is one of several possible reducing substrates common in nature (10). The low-potential electrons can be coupled to energy-conserving processes, and this ability likely helps H. pylori persist in the energy-poor environment of the gastric mucosa. The affinity of the H. pylori bacteria for the high-energy diffusible substrate (H2) combined with microelectrode measurements to assess H2 levels in the stomachs of live mice allowed us to conclude that the characterized H2-oxidizing electron transport chain observed in laboratory-grown H. pylori (12) is saturated with H2 while the bacterium is established in the host (16). H2 has been measured as an excreted product from the intestinal tracts of humans and rodents (due to its production by intestinal flora), and it has been speculated to be carried through the vascular systems of animals (11, 22). Our goal was to determine the availability of H2 and its potential metabolism as a respiratory substrate for possible energy conservation by H. hepaticus. As with our related stomach hydrogen measurement work, we detected ample molecular hydrogen levels in the livers of live mice, and this level far exceeded the estimation of affinity of H. hepaticus for H2 (apparent Km value). Here an H2-oxidizing hydrogenase enzyme within H. hepaticus was partially characterized and compared to the H. pylori H2-oxidizing system for some primary characteristics associated with the uptake-type hydrogenases.
After we initiated the present study, a partial genomic sequence analysis of H. hepaticus was reported; 56 coding regions were identified, and one of these is a partial ortholog (85% identity) of hydB of Wolinella succinogenes (9). This would indicate that the bacterium contains the large subunit of a NiFe hydrogenase. Hydrogenases can either evolve or consume H2, and they play diverse roles enzymologically and physiologically (21). To aid in determining the presence of a putative H2 uptake hydrogenase in H. hepaticus, direct amperometric (14) hydrogenase assays were carried out. H. hepaticus ATCC 51449 was grown on blood agar plates in anaerobic jars in an atmosphere of 5% CO2, 10% H2, and the balance N2. Bacteria were incubated at 37°C for 5 days and harvested by resuspending cells from cotton swabs into phosphate-buffered saline (PBS) and then centrifuging (10,000 rpm in a Beckman-Coulter Microfuge-18 for 10 min). The pellet was resuspended, and the centrifugation step was repeated. The suspended cells (in 2 to 3 ml of PBS) were adjusted to approximately 2 × 109 cells per ml in PBS. This corresponds to an optical density at 600 nm of about 1.0 and required the initial use of more than 25 blood agar plates to conduct just 6 to 10 independent hydrogenase assays. For comparison between H. hepaticus and H. pylori, the latter bacteria were grown and treated the same way except that 2 days' growth was sufficient for cell harvest (and to avoid appearance of undesired coccoid cells).
H. hepaticus whole cells were able to couple H2 oxidation to respiratory O2 consumption. No H2 uptake was observed anaerobically. However, we immediately noticed that the rate of H2 oxidation was lower than we routinely observe for H. pylori. To address this observation rigorously, H2 oxidation activity by H. hepaticus was compared to those of two common H. pylori strains grown in the same conditions (blood agar plates incubated in a 10% H2-containing atmosphere). Table 1 documents that the H2-O2 respiratory pathway for H. hepaticus is only about 10% of the rate (on a per-cell basis) for H. pylori. The H2 oxidation by whole cells was dependent on the inclusion of oxygen, since no H2 uptake (or evolution) was observed under anaerobic conditions.
Uptake-type hydrogenases are reported to undergo an anaerobic activation (sometimes referred to as reductive activation) phenomenon. This is characterized by a much higher enzyme activity when conditions are highly reducing, or anaerobic. When O2 was present in the reaction mixture, the H. hepaticus enzyme had only 16% of the anaerobic H2-oxidizing rate (Table 1). This amount of anaerobic activation is similar to what we observe for cells of H. pylori (Table 1) and what we had observed for membranes obtained from a clinical H. pylori isolate previously (12). For the systems in which this anaerobic activation has been studied in detail (2, 20), the achievement of full activity under reducing conditions is related to the rate of electron acceptor reduction (i.e., hydrogenase turnover).
Hydrogen-oxidizing hydrogenases are known for having high affinities for their substrate. To ascertain the usefulness of the H. hepaticus enzyme to possible in vivo growth of the bacterium, a whole-cell Michaelis constant (apparent Km) for hydrogen was determined. The whole-cell Km for molecular hydrogen was determined using a Lineweaver-Burk plot of whole-cell hydrogenase activities at limiting hydrogen concentrations as described previously (13). This apparent Km was found to be 2.5 μM (average for three experiments), indicating a high affinity for hydrogen. This apparent Km was determined on live intact whole cells with O2 available as the only terminal electron acceptor in the H2-oxidizing respiratory chain. Therefore, our reported apparent Km is for the entire functioning hydrogen-oxidizing system.
The characteristics of hydrogenase in H. hepaticus are similar to what was reported for H. pylori, so it is likely the H. hepaticus system is also membrane bound and involved in energy conservation. It likely involves reduction of other membrane-associated electron transport proteins after the "H2 splitting" step. Therefore, the dye-mediated redox potential range at which this H2-oxidizing system functions was determined. Typically, H2 uptake hydrogenases function with redox acceptors of positive potential but not with negative redox potential acceptors (15). As for H. pylori, the H. hepaticus enzyme was able to couple H2 oxidation to reduction of the positive acceptors (Table 2) but not the negative potential acceptor benzyl viologen. These experiments were conducted in the absence of oxygen. An interesting difference between the H. pylori and H. hepaticus systems is the suitability of cytochrome c as an acceptor of hydrogenase. The midrange redox potential cytochrome c functioned as a very good acceptor for the H. hepaticus hydrogenase; this may mean that the in vivo acceptor of electrons from hydrogenase in H. hepaticus is poised at a higher redox potential (quinone or cytochrome) than the initial acceptor in the membrane of H. pylori. We have previously shown that hydrogen oxidation in H. pylori is linked to cytochrome reduction, with these heme-containing components functioning as intermediate electron carriers prior to reduction of the terminal (O2-binding) oxidases (12). However, performance of these difference spectral experiments was not possible for H. hepaticus, since H2-oxidizing membrane particles could not be obtained. The membrane isolation was done in a way that restricted oxygen (use of argon-sparged buffers during and after cell disruption, and transfer of extracts via an argon-sparged syringe), but was not done under strictly anaerobic conditions, so it is possible that O2 labile factors exist in the H2-O2 respiratory chain. Nevertheless, since H2 oxidation is coupled to O2 uptake, and it is coupled to reduction of dyes of positive potential there may be (as yet unidentified) heme-containing components in the H. hepaticus membrane that are involved in conserving the energy from electrons initially provided from H2.
We determined hydrogen concentrations in the liver of live adult mice amperometrically, using a modified Clark-type microelectrode model H2-50 (Unisense A/S, Aarhus, Denmark) (Table 3). The electrode had a tip diameter of 50 μm. Female C57BL mice (Jackson Labs, Bar Harbor, ME) were anesthetized with halothane. Mice were kept alive but fully anesthetized for the entire procedure and euthanatized immediately after the last measurement. The liver was surgically exposed and the microelectrode was inserted into the liver tissue; most measurements were taken upon passing the probe less than 1.0 mm into the liver, so as not to damage the (fragile) probe. Indeed probe damage was encountered in some initial measurements in attempts to insert the probe deeper into the tissue. The hydrogen readings were recorded after the signal had stabilized (about 5 to 7 s). The procedure was repeated at up to 12 sites per mouse liver. Standard curves of H2 were obtained as described by the manufacturer by use of their calibration chamber. The average hydrogen levels were over 50 μM, thus exceeding the apparent Km by 20-fold, and slightly exceeding the levels we reported for mouse stomach H2 levels (16). The tissue H2 measurements together would support a hypothesis that H2 is available in many tissues within the animal and warrants further considering the availability of hydrogen as an energy reservoir for use by infectious bacteria within the host animals.
The source of the microelectrode-determined H2 is likely the vascular system transporting H2 that originated from colonic fermentations, and the large variation in measured values is not surprising considering the mouse liver is (surgically) partially exposed to the air atmosphere. This air exposure would presumably result in lower measured levels than occur in the intact animal. Hydrogen excretion from the intestinal tract of rodents has been documented (1), but the levels of the gas we found associated with the specific tissues (stomach and liver) of live mice were not expected. Of course, the usefulness of this small and diffusible, but highly energetic, substrate for H. hepaticus liver colonization must await critical animal studies using gene targeted H. hepaticus mutants lacking H2 utilizing ability.
We thank Richard Seyler for help with growing H. hepaticus for initial hydrogenase assays and Sue Maier for help with animal hydrogen measurements.
The Georgia Research Foundation and the Georgia Research Alliance supported this work.
- Received 10 October 2002.
- Accepted 27 January 2003.
- American Society for Microbiology


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Anevia, a leading provider of OTT and IPTV software solutions, announces the launch of its Dynamic Ad Insertion solution. Anevia's end-to-end OTT video-delivery offering already included ad-enabling and ad-preparation components. With the addition of ad-stitching and ad-routing capabilities in the Anevia NEA-CDN, the end-to-end video-delivery offering now comes with a complete pre-integrated DAI solution – reducing the need for testing, and making deployment faster and simpler.
Anevia (https://anevia.com), a leading provider of OTT and IPTV software solutions, has chosen IBC 2019 as the venue for the European launch of its NEA-CDN 5 cloud-native Content Delivery Network solution.
Anevia (www.anevia/com), a leading provider of OTT and IPTV software solutions, and SKYmedia Corporation LLC, one of Mongolia's leading telecommunication resource providers, announce the completion of an OTT video-delivery solution for SKYmedia's new Sky GO service. Based in Ulaanbaatar, the SKYmedia group provides a wide range of capabilities including mobile phone and broadband data connectivity.
Imagine Communications, empowering the media and entertainment industry through transformative innovation, today introduced Imagine Communications IOX Storage, an all-purpose shared storage approach optimised for its Versio¢ playout and automation and Telurio¢ Over-the-Top (OTT) and cloud DVR solutions. Versio IOX Storage and Telurio IOX Storage enable media companies to seamlessly and cost-efficiently expand the performance, scale, flexibility, reliability and collaborative capabilities of their media storage operations. Designed for high-performance and advanced content distribution environments, Versio IOX Storage and Telurio IOX Storage have been architected to enable media companies to shape and configure storage resources to meet the exacting needs of each operation in the workflow, including production, playout and distribution. Both solutions will be showcased at IBC2016.
Imagine Communications, empowering the media and entertainment industry through transformative innovation, will showcase at NAB Show 2016 its latest product advances and initiatives aimed at assisting broadcasters and other media companies through the next phase of the ongoing modernization of their production, playout and distribution facilities. The media and entertainment industrys largest tradeshow and exhibition, beginning April 18th in Las Vegas, will be the venue for Imagine Communications to unveil its latest market-ready innovations, showcase its industry-leading technology portfolio and initiate a discussion on how media companies can successfully navigate current and future challenges to stay ahead of the competitive curve and seize new monetization opportunities.


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Lloyd Fontillas appointed APT General Manager and Executive Tournament Director:
At opening day festivities of the APT Philippines Championships 2018, Asian Poker Tour CEO Jeff Mann announced the promotion of Lloyd Fontillas to the position of General Manager and Executive Tournament Director. Fontillas is one of the most highly experienced and well... Read more
PokerMaster to Run Online Satellites to APT Macau Championships:
The Asian Poker Tour (APT) and PokerMaster Pty Ltd (PokerMaster) have announced a partnership to offer players online promotions to the upcoming APT Macau Championships 2018. The satellite promotions on PokerMaster kick off on March 12th and run until April 12th. ... Read more
APT Inks Deal with Hong Kong Poker Players' Association for Online Streaming:
The Asian Poker Tour (APT) and Hong Kong Poker Players' Association (HKPPA) have signed a partnership agreement to live stream APT events in Chinese starting with this month's APT Championships Philippines 2018. The stream will broadcast in Hong Kong and mainland China... Read more
The Asian Poker Tour in 2018:
With 2018 on the horizon, the Asian Poker Tour (APT) announces a list of upcoming changes to look forward to along with the schedule of events for next year's season. Here is a closer look what's in store for 2018…... Read more
APT and RWM Extend Partnership for a Further Three Years – Dates Confirmed for Two Events in 2018:
The Asian Poker Tour (APT) has announced it has signed a new three-year exclusive agreement with its long-standing partner in the Philippines, Resorts World Manila (RWM). The agreement will guarantee players another three years of APT events at the very... Read more
APT and Geutebruck Sign Two-Year Partnership for APT KoreaAPT Korea :
We are pleased to announce the signing of a new two year agreement with Geutebruck Korea Inc., the company that operates the poker rooms at Paradise Casino Walkerhill in Seoul and Paradise City Incheon. Confirmed Korea Events for 2018: June 15-24... Read more
APT Kicks Off 2018 in Vietnam:
For the first time since the inception of the Asian Poker Tour, the annual APT Kickoff event will be changing locations from the islands of the Philippines to the exotic country of Vietnam. In partnership with host venue Pro Poker... Read more
APT Championships 2018 in Macau During Golden Week:
Following the announcement of the five-year partnership between the Asian Poker Tour and Macau Billionaire Poker, the APT has now secured its schedule for the APT Macau Championships 2018. The exciting twelve-day event will be held in the gambling capital... Read more
Up next: APT Noumea 2017 from October 20th to the 29thAPT Noumea :
From October 20-29, 2017, the Asian Poker Tour will be returning to the gorgeous shores of New Caledonia for its next big poker festival, the APT Noumea 2017 to be held in partnership with host-venue Casinos de Noumea. The ten-day... Read more


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San Francisco just designated the first transgender district in a truly historic move
When many of us think about San Francisco, we think of it as basically a love-filled safe haven for members of the LGBTQ+ community. Now, San Francisco is naming its first transgender district, and wow. This is seriously such a historic move! The transgender district acts as a symbol of inclusivity in such a big, big way.
There are still many battles to be won when it comes to trans rights, but there's definitely been slow-but-sure progress toward equality for trans people. We hope that this is one of only many steps that will be taken by lawmakers from all over in making sure justice and empowerment for trans people is a priority.
San Francisco's transgender district will be located in part of Tenderloin, San Francisco, and will be called Compton's TLGBT District as a nod to the Compton Cafeteria riots, the first trans protests in our country's history.
According to our friends at LGBTQ Nation, San Francisco Supervisor Jane Kim is completely thrilled about this new development that makes San Francisco even more inclusive and welcoming.
Kim explained,
There's obviously more work to be done, but this transgender district is a promise that San Francisco and, hopefully, the rest of the country is doing the work it takes locally to make our country a more loving and safe place for trans people.


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Green Leaves - Styling Book by studio ROOF
Green Leaves - Styling Book by studio ROOF
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By Jeffrey C. Hall
The sphere of genetics is quickly evolving and new scientific breakthroughs are occuring because of advances in wisdom won from genetics learn. This sequence constantly publishes vital experiences of the broadest curiosity to geneticists and their colleagues in affiliated disciplines.
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Schooling, Sociology
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M. (2008). Letting the genome out of the bottle—will we get our wish? N. Engl. J. Med. 358, 105–107. Hunter, D. , Jacobs, K. , Cox, D. , Hankinson, S. , et al. (2007a). A genome-wide association study identifies alleles in FGFR2 associated with risk of sporadic postmenopausal breast cancer. Nat. Genet. 39, 870–874. Hunter, D. , Hoover, R. , and Chanock, S. J. (2007b). Scanning the horizon: What is the future of genome-wide association studies in accelerating discoveries in cancer etiology and prevention?
Lander, E. , and Altshuler, D. (2002). Human genome sequence variation and the influence of gene history, mutation and recombination. Nat. Genet. 32, 135–142. , Milne, R. , Fernandez, L. , et al. (2006). Evaluating HapMap SNP data transferability in a large-scale genotyping project involving 175 cancerassociated genes. Hum. Genet. 118, 669–679. Richards, R. , and Sutherland, G. R. (1993). Fragile X syndrome unstable element, p(CCG)n, and other simple tandem repeat sequences are binding sites for specific nuclear proteins.
1993) have been added over time. 3; Wilson, 1994, 1998). The Framingham investigators have assigned "weights" to these risk factors and have developed "prediction scores" to predict the development of CHD (Truett et al. 1967). , 2001). 4. III. PHENOTYPIC AND GENETIC ARCHITECTURE OF COMPLEX TRAITS Biological variation may be understood at two levels: phenotypic and genetic. Many of the CVD risk factors such as HDL-cholesterol (HDL-C), total cholesterol, and blood pressure are quantitative traits.


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Poor nutrition may be one of the easiest conditions to self-diagnose. Look at the food pyramid and the suggested servings. Look at your diet. Are you getting the recommended daily amounts of fruits and vegetables? Enough calcium? Read the labels and compare what you eat to what you need. You may discover that even if your weight is ideal, you are not getting enough nutrition.
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The total fat in your daily diet should average no more than 30 percent of your total calories consumed. And saturated fat should be no more than 10 percent of those 30 percent of calories. The amount of fat and saturated fat you eat depends on the foods you select and consume that have fat in them. Consider consulting with a nutrition professional to learn more about how to calculate your fat needs and to not exceed what are healthy amounts. There are many tools available to help you determine how much fat you should consume each day based on your current energy and nutrition needs. Reading food labels is one way to begin to identify where and how much fat is in particular food items.
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The overall effect is a tighter, more toned physique, but body weight could stay the same or even increase. Therefore, the obsession with numbers on a scale is unfounded; one can greatly improve appearance, enhance fitness levels, and eliminate unwanted fat all while maintaining a constant weight. Focus instead on a combination of body fat measurements in trouble spots and the image in the mirror.


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Looking Chic in College: How to Mix Fast Fashion with High End
It's your fashion world; we're just living in it. Challenge the status quo. Wear something new, creative, and innovative. Dare to be different. OK, enough of these one-liners; Do I have your attention yet? In a world driven by social media influencers flaunting their Valentino pumps and Chanel handbags, the line between what's affordable and what's typical gets blurred quite normal. The affluent, posh lifestyle portrayed on the Internet is most likely out of reach for the average college student and I've never been happier. This now translates to exciting challenges for a budget conscious fashionista like myself.
A budget never looked so good. Living modestly does not mean you have to compromise your look. Let these designer duds inspire you to push your style to the cutting edge. You may be wondering how you can stay on top of the latest trends while at the same time staying within your means? The answer is simple: Fast fashion and yearly designer investments. If you learn how to correctly pair your low-end outfits with high-end accessories, no one will ever know. Trust me, I am the queen of making Forever 21, Zara, and Topshop look like a million bucks.
With the holiday season approaching, it's the perfect opportunity to consolidate your gifts and put them toward the purchase of that expensive item you Google again and again. Stray from the Dior sunglasses you have been eyeing or the Gucci mules you are been dying to slip your feet into – these looks will be out before you can even swipe your credit card. It's time to invest in simple, quality, timeless pieces that will carry you from college to the real world.
Below is my diary on dressing chic for less. There are three upscale staples that I think every fashionista must incorporate into their closets:
1. The interlocking GG Gucci Belt. Opt for the thin version, which sells for $350. The sleek black leather with the gold Gucci logo gives you that subtle pop of designer. Pair this item with fast fashion apparel from Forever 21, Zara, and Topshop.
2. Givenchy Antigona Handbag: $1,790. This classic shaped handbag is highly styled and will take you from leggings, to jeans, to a suit. Start saving now for this piece; you're going to want it. I can hear the vintage bells ringing.
3. Stuart Weitzman Over the Knee Boots. Starting at $655, this boot will be in the forefront of fashion for years to come. The classic aesthetic, yet fashion-forward edginess these boots portray add that extra sugar and spice to your daily wardrobe. Mix the pattern of a plaid mini skirt with a cable-knit sweater to bring your street-style to the next level.
And so you have it, there's no real secret for looking well dressed in fast fashion. Once you understand the materials, fabric-type, and sewing form in each of the items you're purchasing…just kidding! Don't be afraid of the messy racks at Forever 21 or the abstract designs at Topshop. Spend some time exploring the stores, or shopping online, duh, to find the looks that best suit your style. Make a designer wish list for the coming holidays and you will be on your way to succeeding in Dressing Chic For Less 101.
XX, Fe


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Who is Eligible?
Health insurance is available to regular employees who are scheduled to work 19 or more hours per week, or have a contract of at least 50%. The District offers comprehensive health insurance from two different providers for eligible employees. You may enroll in health insurance through either Group Health Cooperative of South Central Wisconsin (GHC) or Dean Health Plan. These carriers provide you with a diverse range of networks and providers, yet have the exact same type of coverage (co-pays, etc.), but with slightly different employee premiums (what you pay per period for your coverage).
Plan Options
For either carrier (GHC or Dean Health Plan), you can enroll in the Health Maintenance Plan (HMO), the Point-of-Service Plan (POS) or the Preferred Provider Organization Plan (PPO). The PPO plan is only available to employees who do not live in South Central Wisconsin. The POS and PPO plans provide greater access to non-network services when referrals are not available. The POS and PPO plans have higher employee premiums and all out-of-network services are subject to an annual deductible and insurance co-pay.
How Much Does it Cost?
Health insurance premiums are based on the carrier you select (GHC or Dean Health Plan), the plan type you choose (HMO or POS), the coverage tier (single/family) and your payroll frequency. Your premium contribution rate is based on a sliding scale and varies by type of employee and plan type. Contributions for HMO plans are between 1.25% and 10% of the total monthly cost of the insurance. Contributions for POS plans are between 2.50% and 20%. As a benefit to its employees, the District pays the remaining percentage. Premiums are paid by pre-tax payroll deductions. See the Resources box on this page to determine what your cost will be.
Additional Benefits
Listed below are some of the programs in place to help you utilize all of the benefits available through the health insurance plans:
- Wellness incentives are provided for specific healthy behaviors.
- Complementary medicine provides discounts for specific healthy activities.
- Nurse Line provides highly trained, registered nurses who can answer your medical questions and provide advice without an appointment or cost.
- GHC Nurse Line: 608-661–7350
- Dean Nurse Line: 800-576-8773
- MyChart online and mobile applications are provided so that you can access your benefit and claim information virtually anywhere.
Have Questions? Contact the Benefits Helpdesk at email@example.com or at (608) 663-1692
GHC's LGBTQ Primary Care Doctor List
Telephone: 608-828-4853
Nurse on Call: 608-661–7350
GHC HMO Summary of Benefits (SBC)
GHC POS Summary of Benefits (SBC)
GHC PPO Summary of Benefits (SBC)
Telephone: 800-279-1301
Nurse on Call: 800-576-8773
Select "Commercial HMO/POS"
Dean HMO Summary of Benefits (SBC)
Dean HMO Summary Plan Document
Dean POS Summary of Benefits (SBC)
Dean POS Summary Plan Document
Dean PPO Summary of Benefits (SBC)


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Supplemental Comments on the Voiding of the Medicaid Work Requirement
The decision of the Federal District Court for the District of Columbia in Stewart v. Azar voiding the approval of the Kentucky work requirements for Medicaid eligibility was the subject of a recent blog here on July 17. There are two subsequent publications worth noting to supplement discussion of the issue.
The judgment implementing Judge Boasberg's ruling was entered on June 28, 2018. Pursuant to Rule 4 of the Federal Rules of Appellate Procedure, there is a 60-day period following entry of judgment in a matter in which the United States Government is a party for the filing of a notice of appeal as of right.
Although the time for appeal has not expired, from a July 30 Health Affairs blog reporting on the posting of an announcement at Medicaid.gov, it appears that rather than appealing Judge Boasberg's ruling, CMS is reopening the comment period on the proposed waiver of Medicaid requirements in the Kentucky demonstration program at issue. The manifest purpose is to supplement and develop the record to show that the program is likely to assist in promoting Medicaid's coverage objective. This is the type of information that Judge Boasberg had indicated the agency had not obtained or utilized in the first place.
That blog author provides a comprehensive review of the deficiencies in the original administrative process and how the agency had "sidestepped" its obligations.
Rather than weighing the value of the project in light of its impact on coverage—which [Judge Boasberg] concluded, is Medicaid's core purpose as stated in the statute itself—officials simply had created a new program objective, to improve health. Without citing to the statute or offering any supporting evidence, the HHS approval letter simply claimed that (1) Medicaid's purpose is to improve health; (2) work improves health; and therefore (3) mandatory work requirements coupled with other coverage restrictions are likely to promote Medicaid's purpose.
The blog goes on to identify several types of highly relevant evidence that should be developed to sustain the validity of the Section 1115 waiver analysis and decision-making. The first is the quantification of the cumulative impact of the key demonstration components, including the precise nature of a steady, year-round work requirement (hours worked per week; weeks worked per year); the premiums; the reporting rules; the lock-out periods; the reinstatement opportunities; and the benefit and coverage restrictions. The second would examine the impact of the loss of coverage among the affected population on their access and utilization of medical services resources and resulting health outcomes. A third type of evidence concerns if, and to what extent, any of these work requirements for deeply impoverished people actually can result in gains in employment, income and financial independence of the type that makes health care and insurance coverage affordable, with access to coverage pathways. "In other words, what is required is solid evidence regarding the mitigating effects of a non-consensual experiment that places Medicaid coverage at high risk for tens of thousands, if not hundreds of thousands, of working-age adults. This evidence cannot simply be tautological claims about the health benefits of work and community engagement."
This notion of "mitigating effects" of placing Medicaid coverage at risk was picked up and further developed in a very recent August 8 article in the New England Journal of Medicine entitled "Mitigating the Risks of Medicaid Work Requirements." The three authors are from the University of Michigan's Medical School, School of Public Health, and the Gerald R. Ford School of Public Policy. As a reminder, Michigan is one of the states in addition to the Kentucky program in the case before Judge Boasberg that had received Section 1115 waiver approval from the Secretary of HHS.
These physician authors identified several policy questions concerning the work requirements that "deserve more attention." That list starts with a determination of the potential health consequences of work requirements for persons enrolled in Medicaid. They question the role to be played by physicians in determining whether a person is to be exempted from work requirements on the basis of some medical reason. Lastly, they pose the question of how to reduce the medical risks for enrollees who could be harmed by losing their coverage as a result of the Medicaid work requirements.
They questioned the original observation by CMS that work and community engagement were "associated with better health" and that working would improve the health of Medicaid recipients, commenting that this asserted association could be due primarily to healthier adults being able to find employment rather than the work producing the improved health. In this circumstance, the health harms would outweigh uncertain health benefits for those who got jobs. They cited their own 2016 survey of 4000 Medicaid expansion enrollees. While nearly half were employed in some capacity, among the others who were either out of work or unable to work, the survey found that many were likely to be more than 50 years old and to report being in fair or poor health, having a mental health condition, or having health-related functional limitations. They emphasized that while a work requirement might serve to motivate younger recipients, it presents a serious risk of harm to older enrollees or those with chronic conditions if they were to lose their Medicaid coverage under the Obamacare expansion and be unable to afford effective medical care and services. Although some proposed providing for exemptions for "medically frail" persons, the standards and processes for determining such exemptions were undefined. This lack of specific governmental guidance on exemptions potentially placed physicians, especially primary care physicians, in a difficult ethical situation of choosing between doing harm to patients or providing inaccurate and thus dishonest assessments of their condition and functionality.
The New England Journal of Medicine authors provided further commentary on ways that work requirements might be handled to mitigate medical risks. In addition to narrative remarks, the article contains the following summary block:
Limit the initial implementation to adults under 50 years of age who are covered by Medicaid expansion, since they are less likely than older adults and those covered by traditional Medicaid to have chronic health conditions and functional limitations that will be adversely affected by loss of Medicaid coverage.
Provide clear guidance to physicians on health conditions, functional limitations, and caregiving responsibilities for household members with disabilities that will exempt enrollees from work requirements.
Provide job training, employment referrals, and support for work-related transportation and childcare for enrollees subject to work requirements.
Make the reporting of compliance with work requirements less frequent and more flexible to account for fluctuating work hours, seasonal employment, and temporary gaps in employment.
Tempering criticisms of the Medicaid work requirements, they conclude that the programs need to focus on enrollees who are healthy and functionally able to work and on whether effective work-related training and supports are implemented. "Without such tailoring and support, the health risks for enrollees who lose Medicaid coverage are likely to substantially outweigh the economic and health benefits of blunt incentives for enrollees to work." This would fail to promote the objectives of Medicaid and would be significantly contrary to the main purpose of Medicaid: to provide medical assistance to low-income adults under age 65.


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It can be used on any garden wood and over-coated with a Ronseal exterior wood oil. Ronseal Shed & Fence Preserver can be applied with a Ronseal Fence
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text: Mission: Impossible is a unique franchise. It has been around for 20 years, yet only produced 5 films. Each film has had a different director. Each installment, with a few small exceptions, stands more or less on its own. Most franchises suffer diminishing returns as they age. After a mixed first two films, MI produced two of the best spy/action-adventure films made in the last 25 years. Surely that was it. The fun was done. Director Christopher McQuarrie, Tom Cruise and company may not have turned in an installment as legendary as the previous two, but Holy Moses this is a fun film! If I could end this introduction by having my post self-destruct in five seconds, I am totally amped to do that…..however even if I figured it out, I'm fairly certain that would be international cybercrime…… Continue reading Movie Review: Mission Impossible Rogue Nation (2015) *Spy vs. Spy Fun*


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IBM appoints Katrina Troughton as managing director ANZ
IBM has appointed Katrina Troughton as its first female managing director of Australia and New Zealand. She will be replacing David La Rose who has been promoted to general manager at IBM partner ecosystem based in the US. Sign up for Which-50's Irregular Insights newsletter Troughton has spent 28 years
Pippa Leary appointed CEO at Swift Media
Swift Media has appointed Pippa Leary as its CEO effective from August, she was previously the commercial director of Nine's digital sales team. Current director Darren Smorgon has also been appointed non-executive chairman. Leary spent more than 20 years with Nine Entertainment Company and Fairfax Media, before moving to the
Cover story: Digital Savvy Boards Drive Profitability, But Few Make the Grade
Companies with enough digitally savvy board members make more money. That's the key finding from a recent study by MIT Sloan, which also revealed that few organisations measure up. The research found that only 24 per cent of the boards of companies listed in the US with over $1 billion
KPMG appoints ex-Datarati CEO as marketing director
KPMG Australia has appointed Jarther Taylor as its new marketing director. Taylor was previously the CEO of customer experience agency Datarati. He has been working at KPMG in a consulting capacity since December last year. Sign up for Which-50's Irregular Insights newsletter Nominate today for the Which-50 Digital Experience Awards.
Pegasystems appoints new VP to lead ANZ
Pegasystems has appointed Michael Evans as vice president for Australia and New Zealand. The company said this newly created role reflects its growth and investment in the market. According to Pegasystems its headcount locally has more than doubled in the last four years. Sign up for Which-50's Irregular Insights newsletter
Digital strategy and cyber security at the top of board agendas
Digital strategy and cyber security have climbed to the top of boardroom agendas, as the competitive and regulatory landscape continues to shift. That's a key finding from the Harvey Nash/Alumni Board Report 2018-2019, created in partnership with the London Business School's Leadership Institute. Leadership Webinar: Which-50's 2019 Outlook and Business
Google Appoints Mel Silva As Australian And New Zealand Managing Director
Google has appointed Mel Silva as its new Australian and New Zealand managing director. Silva has been working at Google for more than a decade and has held a number of senior leadership positions in Australia and the APAC. She was recently managing director, go to market strategy & operations
CEOs should stop saying this about tech
Here's something CEOs and other business leaders say — and seemingly without much forethought: "Of course, technology is the easy bit." It's one of those trite phrases that gets picked up and repeated in everyday corporate life, as if they were statements of obvious truth and wisdom, upon which we
Cover Story: CEO Priorities Highlight Focus on Growth and Innovation
We live in a disrupted age. For those already struggling, the situation is unlikely to improve. Indeed, listen to management consultants like McKinsey and Company, and they will tell you all value chains will be disrupted. But we are not so much accelerating towards entropy, as replacing an old order
Capgemini has its fourth Australian chief since 2013
It's not quite a revolving door but it is not far from it. Capgemini has appointed Olaf Pietschner as Head of Capgemini in Australia and New Zealand, effectively its fourth local leader since 2013, when Deepak Nangia took over the role from Paul Thorley. Nangia was replaced by Nicolas Aidoud in 2016


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Our experience in the Industrial Refrigeration and HVAC Industry stretches back more than 40 years. With Excel Industrial Services as our dedicated Industrial Refrigeration department, Excel Poultry Systems can offer a full suite of products and services.
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Pietersen plays dangerous game in quitting one dayers
Star batsman puts Test berth in peril by rocking England's boat again
KEVIN PIETERSEN will not extend his Twenty20 commitments beyond the IPL this winter after his sudden retirement from international limited-overs cricket. "That's not going to happen," his agent said yesterday.
Pietersen has already rejected inquiries from three Big Bash franchises in Australia, which came within hours of his decision being announced on Thursday.
Speculation is rife about the path Pietersen's career might now take and Adam Wheatley, his agent, conceded there were doubts over whether he would be offered, or accept, a new England contract. "He'll play all the Tests this year and we'll see what they offer him in September," Wheatley said. "I don't know what's going to happen, whether they'll offer him a new contract or not.
"Kevin is going to let the…


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The 2019 Lincoln Continental and the 2019 Lincoln MKZ are designed to provide refined power, a look of distinction, and strong confidence - everything you want in your next sedan. But if both of these Lincoln models have what you need, which suits you better? To help answer that question, our expert's at Sutton Lincoln created a 2019 Lincoln Continental vs. 2019 Lincoln MKZ comparison page, assessing the best features and specs of both models. For this comparison, we will be using the 2019 Lincoln Continental Select, starting at $49,945 MSRP, and the 2019 Lincoln MKZ Reserve I, starting at $38,995 MSRP.
Once you've finished reading, head to our Matteson, IL, dealership inventory and offers pages to see how you can secure a great deal for a new Lincoln sedan. Get in touch with a Sutton Lincoln representative online or at (708) 720-8000 for your next steps.
Features & Technology
Keep ahead of the tech curve with the innovative features included on the Continental and the MKZ. Whether you want the best in infotainment or the latest smartphone software, these Lincoln sedans have what you want! Check the lists below for key tech specs of each model:
2019 Continental
- Voice-Activated Touchscreen Navigation System with pinch-to-zoom capability, and integrated SiriusXM® Traffic and Travel Link®
- Autolamp Automatic On/Off Headlamps
- Apple CarPlay® and Android Auto™
- Lincoln Premium Sound System with 10 speakers
- Lincoln Connect™ 4G LTE Wi-Fi
- Remote Start System
- SiriusXM®
- Voice-Activated Touchscreen Navigation System with pinch-to-zoom capability, HD Radio™ Technology, and integrated SiriusXM Traffic and Travel Link®
- 10.1-in. configurable LCD instrument cluster screen
- Lincoln Connect™ 4G LTE
- Remote Start System
- SmartGauge® with EcoGuide instrument cluster with 2 configurable 4.2-in. LCD screens
- Lincoln Premium Sound System with 11 speakers
- SiriusXM®
Price Overview
Both the Continental and the MKZ offer three trim levels, catering to various tastes and design needs. See the breakdown below for price and trim specifics for each model:
2019 Continental
- Continental Standard - Starting at $46,145 MSRP
- Continental Select - Starting at $49,945 MSRP
- Continental Reserve - Starting at $59,710 MSRP
- MKZ Standard - Starting at $35,995 MSRP
- MKZ Reserve I - Starting at $38,995 MSRP
- MKZ Reserve II - Starting at $44,995 MSRP
Performance Specs
For those who prize power over gas mileage, the V6 equipped Continental is likely the better choice. If you want strong fuel efficiency, then the turbocharged I4 of the MKZ has what you need. Look through the following list for performance figures of each engine:
2019 Continental
- 3.7L Ti-VCT V6
- 280 lb.-ft. of torque
- 17 MPG city/26 MPG hwy
- 2.0L Turbo I4
- 275 lb.-ft. of torque
- 20 MPG city/29 MPG hwy
Size & Trunk Space
Both of these Lincoln sedans sport ample space for passengers and cargo alike, ensuring you stay comfortable even with a full load. See below for model-specific measurements:
2019 Continental
- Passenger space: 5 passengers
- Rear cargo space: 16.7 cu.-ft.
- Passenger space: 5 passengers
- Rear cargo space: 15.4 cu.-ft.
Safety & Comfort
Regardless of which Lincoln you choose, you can be confident that you'll be pampered to no end. Outfitted with custom tailored leather, luxurious design elements, and a long list of safety features, the Continental and the MKZ ensure you remain safe and comfortable at all times. The full list of comfort and safety features can be found below:
2019 Continental
- Bridge of Weir Deepsoft™ leather-trimmed seats
- Hands-free, foot-activated trunk lid
- Illuminated front door-sill scuff plates
- Leather-wrapped steering wheel with genuine wood accent
- Power-cinch door closing
- Dual-zone electronic automatic temperature control
- Heated front seats
- Ambient lighting
- Power windows with one-touch-down front, one-touch-up/-down rear, and global open/close for all windows
- Universal garage door opener
- Lincoln Co-Pilot360™
- Adaptive Cruise Control with Stop-and-Go
- Forward and Reverse Sensing Systems
- Hill Start Assist
- Personal Safety System™
- AdvanceTrac®
- SecuriCode™ and SecuriLock® Passive Anti-Theft System
- Bridge of Weir™ leather-trimmed seats
- Fade-up ambient lighting
- Comfort front seats with 10-way power adjustability and driver's side memory feature
- Heated front seats
- Power windows with one-touch-up/-down and global open/close
- Sonata Spin aluminum accents on the instrument panel and door-trim panels
- Wollsdorf leather-wrapped steering wheel and airbag cover
- Lincoln Drive Control featuring Adaptive Suspension, Electric Power-Assisted Steering (EPAS), and Active Noise Control
- Lincoln Co-Pilot360™
- Reverse Sensing System
- Personal Safety System™
- AdvanceTrac®
- Intelligent Access with push-button start
- MyKey®


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Turn Off The World! This Remarkably Large Two Story Acreage is surrounded by over 50 mature palms. With a total of 6 Bedrooms, 5 full Bathrooms, Guest House (registered vacation rental), Work-Out Room (equipment included), Gym/Office, Private well water system, 24 Solar Panels, Manicured Lawn, Numerous fruit trees, it's own 'Power and Water' system all you need is to figure out where you want to put your pool. Located close to the Ocean it was purpose built by the owner to catch the trade winds. With so many extras upon extras this is a must see property. This house was built for family, privacy and location. There are no next door neighbors in front, back or side. Spectrum High-Speed Internet is being installed (October 11th, 2019) and Road is in the process of being paved (October 2019) *** Includes COOL PALMS an established, legal and licensed Vacation Rental *** 3 Bedroom 2 Bathroom House upstairs with large Master Ensuite, and large Master Study & Wardrobe Gas Stove, Electric Convection Oven, New Fridge Freezer (5 year warranty), New Washer and Dryer and Tiled Lanai. *** 2 Bedroom 1 Bathroom Unit downstairs, Fridge Freezer, Washer/Dryer, Wet Bar, Dining, Lounge and Private Enclosed Lanai. *** 1 Bedroom 1 Bathroom "COOL PALMS" Guest House, registered as a Vacation Rental and transferable to new owner. *** 24 Solar Panels (Owned & not leased) *** Well for an endless supply of FREE water *** Choose your anywhere in you private back yard to spend the day relaxing in the sun to the sound of the Ocean. *** Workout Room, Gym/Office with a separate private full bathroom *** Quiet and Private - NO next door neighbors. *** Palm Tree Paradise creates road front privacy *** Walking distance to the Ocean to see the whales and close to the Shipman trail to swim at the white sand beach/lagoon with the turtles.
Convection Oven, Dishwasher, Microwave, Refrigerator, Range/Oven
KW Kauai.
IDX is deemed reliable but is not guaranteed accurate by the Hawaii Information Service, Inc. Listing Service. © 2019 Hawaii Information Service. All Rights Reserved.
Listing information last updated on October 22nd, 2019 at 2:10pm HST.


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EP 21: The New Filipino Kitchen in Toronto
When "The New Filipino Kitchen" book launch happens on the first weekend of the first nationally declared Filipino Heritage Month in Canada...you bet I'm doing a whole episode on it!
This month I share some clips from the book launch in Toronto - including a short excerpt from my recipe in the cookbook, plus an incredibly fun panel chat with some local restaurateurs and community leaders.
I asked questions like:
What Filipino dish or food have you most "connected" to and why?
What are you most curious about in the world of Filipino food?
In your dream Filipino kitchen, what would be there and why?
What 3 words or phrases best describe your relationship with Filipino food today?
Pull up a chair, get settled, listen in...THIS is what it's like to peek into our kitchens in Toronto. Let's get to it!
Show notes
01:25 What place do my stories have?
05:30 "Every Sunset"
10:00 What The New Filipino Kitchen has to offer
11:05 Meet the panel
12:30 What does your Filipino kitchen look like?
13:25 Gelaine and heritage
15:45 Dolly and merienda
16:30 Dolly's favourite dishes
17:55 Diverse patrons
18:40 The power of referral
19:05 How Diona brought Filipino street food to downtown Toronto
20:10 Defying the norm
21:10 Diona and sinigang
22:20 Diona's childhood...and lechon
24:35 Gelaine's revelation
26:00 What's in your dream kitchen?
27:25 What Chef Marc wants
28:30 On Dolly and Diona's wish list
29:40 Jennilee's dream kitchen
30:30 Gelaine on fruit, halo-halo and cacao
32:30 Spaces like iSLAS
33:00 Why Marc and Mariel built their restaurant
34:00 Marc's favourite dish
35:25 Jennilee and champorado
36:45 About "Filipino Talks"
37:30 What led Gelaine to Cambio & Co.
38:55 Cuisine in flux
39:45 "Our expressions make us nuanced and interesting"
40:25 What's your relationship with Filipino food today?
40:45 Jennilee's wishes
41:40 Some words from restaurateurs
42:35 What keeps Gelaine going
42:50 A beacon for me, and maybe for you
Links for this episode
Check out Filipino TV's coverage of our first seating for "The New Filipino Kitchen" book launch. On the panel we had Rechie Valdez and Susan Graham from Filipino Fusion Desserts; Jaisa Sulit from the Pluma Writing Collective; and one of my lovely co-authors from the book, Vanessa Lorenzo, who blogs as Amusing Maria and came up to visit from Richmond, VA. It was such a pleasure to hear your stories!
My ode to the first Filipino heritage month in Canada: How to Make Halo-Halo on the CBC! Many thanks to Althea who I met through the Filipino-Canadian Writers and Journalists Network for inviting me to prep one of my favourite things on earth for curious Canadians.
Pulutan night was tons of fun to wrap up June, with lots of San Miguel. You'll always be in my life 😄
Marc and Mariel Buenaventura from iSLAS Filipino BBQ & Bar showed incredible inspiration and support for the book from the moment we met. Maraming, maraming salamat! The space you've created is more than just a restaurant - it's a centre for our community.
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|in an endemic area of somalia both humoral and cell mediated immunity against leishmania donovani was demonstrated in 246 inhabitants. in a study of 14 patients with active visceral leishmaniasis, we found that antibodies appear early in infection and that they are then demonstrable for a limited period only. leishmanin positivity develops later and persists longer, but does not seem to be lifelong. the majority of the immunoreactive individuals were either sero- or leishmanin positive. this fin ...
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Have the Dems given up on white working class midwesteners?
Joined: 9 Dec 2009
Gender: Male
Posts: 336
Democrats are so Hollywood and out of touch with with hard working working class Americans. Working class Americans do not care about climate change or social media fads the Hollywood elites push. Working class only care about keeping their jobs or finding jobs and living for today. Trump appeals more to the working class Americans than the Democrats pushing issues like climate change and social media fads.
Joined: 1 Jan 2018
Gender: Female
Posts: 437
Clones like to push and pull each other to media perfection whereas the elite just bide their time waiting for the pony trap that has Bill Clinton back in office with a T train expresso cart in his favourite vice attorneys renaissance period chair..without the novice description backing state attorney General coffee drinkers at this time in a green house office cesspit of hybrid green tea plantations from the word Green.
Joined: 12 Apr 2010
Age: 53
Gender: Male
Posts: 40,216
Location: Spokane area, Washington state.
Really? I do know working class people who, while worried about being able to pay the bills, are also concerned about the larger world around them, such as global warming, etc. My late dad was a blue collar guy and union man who was also a deep thinker, and who cared about more than just where his next meal was coming from.
It also has to be remembered, Trump's own business practices show he's no friend of working people. And it's the Republicans who have been responsible for declining wages, outsourcing of jobs, and breaking unions. They know how to sound like populists, but are in fact hypocritical elitists.
-Bill, otherwise known as Kraichgauer
|Similar Topics
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25 Oct 2011, 2:07 pm
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26 May 2016, 8:19 pm
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21 Apr 2008, 2:36 pm


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