Aca

The Piedmont Zone of the Indo-Gangetic Plain contains numerous, laterally coalescing small alluvial fans. The Latest Pleistocene–Holocene 30 km long Gaula Fan can be divided into gravelly proximal fan (0–14 km down-stream), gravel-sand rich mid fan (14–22 km) and sand–mud dominated distal fan (22–30 km). The fan succession is composed of two fan expansion cycles A and B. Separated by an undulatory erosional contact of regional extent, cycle A is characterized by river borne clast-supported gravelly deposits, and the overlying fan expansion cycle B by matrix-supported gravely debris flows. The main process behind fan development has been lateral migration of channels over the fan surface probably due to rapid sedimentation caused by increased sediment supply, and the fluctuating water budget in response to changing climate. The water laid expansion cycle A represents a humid phase. The debris flow deposits of expansion cycle B suggest a dry phase. Approximately between 8 and 3 Ka, cycle B also indicates a phase of tectonic instability in the Siwalik Hills forming the mountain front. The tectonic activity caused incision of rivers into the fan surface, and in turn resulted in reduced fan-building activity. At present the fan surface is accreting by sheet flow processes.

SINGLE PAYER SYSTEM There are about 44 million people who are 65 and over, who receive Medicare. (Medicare and Medicaid are both socialized medicine for groups of individuals.) The costs of services are reduced based upon negotiations by the government and by individual providers. This is a single payer system where the government is the one group that collects money and although not as efficient as we would like, it has been very successful for millions of seniors who otherwise would not receive benefits. Veterans also get a single payer system where medical services are paid for by Government agencies (the Veterans Administration.) In a sense, the VA is better because there is no co-insurance required. Not only do vets get socialized medicine but also a pension based upon disabilities that show up years after the tour of duty (think Agent Orange).

The U.S. health care system is expensive, fragmented, poorly organized, and fails too often to deliver high quality care that is both accessible and cost efficient. In 2014, Americans spent an estimated $3.1 trillion on health care, averaging $9695 per capita and accounting for 17.8% of gross domestic product (" GDP "). Over the course of the next decade, these figures are projected to increase by an average of 5.8% per year, reaching an estimated $5.4 trillion and 19.8% of GDP by 2024. In an effort to curb this unsustainable trend of rising health care costs, Congress enacted the Medicare Shared Savings Program (" MSSP ") in conjunction with the Affordable Care Act (" ACA ") in 2010. The MSSP created a Medicare framework for Accountable Care Organizations (" ACOs "), a new health care delivery model that promotes health care provider accountability, cost efficiency, and higher quality care. At the same time, the program raises serious antitrust concerns in that it facilitates horizontal integration between competitors, thus perpetuating increased concentrations of provider market power that allow providers to drive up health care prices. This Note argues that there is a need for increased vigilance on the part of Centers for Medicare and Medicaid Services in regulating ACOs participating in the MSSP to prevent the acquisition and exercise of pricing power. Antitrust enforcement alone remains an inadequate solution to the problem of provider market power and, accordingly, additional regulatory efforts are necessary to promote competition and, at the very least, mitigate and contain the anticompetitive effects of health care market consolidation under the MSSP.

Apart from genetic and environmental factors, activation of autoreactive mechanisms has been proposed to play a role in the pathogenesis of schizophrenia. In recent years, considerable work has been carried out to understand the role and contribution of the immune system in this disease. To investigate the T cell response to phytohaemagglutinin (PHA) and determine the serum levels of anti-nuclear antibody (ANA), anti-cytoplasmic antibody (ACA), and circulating immune complexes (CIC) in schizophrenic patients. A total of 30 drug-free schizophrenic patients and 42 healthy controls were enrolled in this study. T cell proliferation in response to PHA was measured using Methyl Thiazol Tetrazolium test. ANA and ACA were measured by indirect immunofluorescence. CIC concentration was determined using poly ethylene glycol precipitation assay. Mean PHA response was 1.96 +/- 0.83 in patients and 3.72 +/- 1.39 in healthy controls (p< 0.001). ANA and CIC concentrations were not significantly ...