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Expanding enrollment options may be most attractive at this early stage in the development of consumer choice tools medicine abuse purchase topiramate 100 mg, when no one knows which tools will turn out to be most helpful to consumers symptoms thyroid topiramate 100mg. Public Marketplaces will have strong appeal to certain types of consumers treatment of uti buy generic topiramate 100 mg line, but private web brokers will appeal to other consumers and may be able to experiment with consumer shopping enhancements in ways that public agencies find more difficult medications used for fibromyalgia order discount topiramate. The substantial value that public Marketplaces can offer web brokers suggests that, rather than "give away" that value, they bargain for significant marketing commitments in return. To leverage tax credits, brand awareness, and a wide range of participating issuers to make the Marketplace the primary destination for all individual buyers, whether subsidized or not. This objective suggests favoring web brokers that agree to place subsidized and non-subsidized individual business through the Marketplace. To target for special outreach efforts particular linguistic, professional, or demographic groups. This objective suggests favoring web brokers who have appointments from all the issuers or commit to equally promote those issuers that have not appointed the web broker by including them in its decision-support tools. Depending on the marginal cost of adding web brokers, this objective may suggest the open competition model or, if marginal costs are high, this objective may suggest limiting the number of web brokers with which the Marketplace contracts. For example, a Marketplace may initially want to learn from as many web brokers as possible or it may not have the resources to negotiate individual contracts. Over time, the same Marketplace may find a better return from selectively partnering only with those web brokers who make a major commitment to promoting the Marketplace and its priorities. To date, the agency has signed contracts with more than 30 web brokers, though various problems impeded the effective use of web brokers during the 2014 open enrollment period. Some leading web brokers have sought similar partnerships with states and, while there has been some state interest and a few alternative forms of collaboration between states and web brokers, no state has embraced the federal web broker policy. This may be changing now that the first open enrollment period has closed and states are beginning to look ahead to 2015. First, the brief describes web brokers, who come in different flavors, but share a common goal with the public Marketplaces: to use the internet as a distribution channel that makes it easier, cheaper, and faster to purchase health insurance in a consumer-oriented marketplace. Five leading web brokers are profiled, each with its own particular business model. The operational challenge for Marketplaces and web brokers is to integrate technology and functionality for an optimal customer experience. For purposes of this issue brief, "web brokers" are defined as a web-based channel, including its own or contracted brokers, to sell health insurance from multiple insurers to individual consumers. However, it is important to recognize that this distinction may well disappear over time as web brokers and private exchanges diversify and/or partner with each other to add complementary capabilities and focus. Having acquired ExtendHealth, Towers Watson also operates a private exchange serving Medicare enrollees. Web brokers function as private distribution channels in a fashion similar to Marketplaces, offering a choice of health plans primarily to individuals, and relying primarily on web sites and call centers for customer service. The standardization of covered services (Essential Health Benefits) and actuarial values (four metal levels) also mean that the choice of offerings on private and public Marketplaces may be fairly similar. Some differences exist as well, the most obvious of which are that only public Marketplaces can offer tax credits, and web brokers also sell their own selection of unsubsidized health plans outside the Marketplace. Carriers that appoint web brokers typically pay them on a commission schedule, and most issuers will also pay Marketplaces some kind of "user fee," typically based on business volume. As a result, the contractual and financial relationships among the three sets of entities-Marketplaces, web brokers, and carriers-can be overlapping, or mutually exclusive, or some complex combination of the two. Working in tandem, the Marketplace offers web brokers access to subsidized coverage to sell, and web brokers are organized to process many individual buyers efficiently. Public Marketplaces are projected to double the size of the individual market nationally, so web-based brokers have a powerful incentive to tap into that growth. For a public Marketplace, web brokers can provide technology tools, consumer-friendly innovations, and additional marketing and sales capacity. Direct sales is very expensive and, absent ongoing grant support, must be tightly managed to be cost-effective. Web brokers already have a customer base, and generally have an advertising budget and/or affiliations to reach customers for the Marketplace.
It designated national laboratories as centers of excellence in special fields and imposed ceilings on the number of personnel treatment effect definition buy topiramate 200 mg overnight delivery. Oak Ridge was made the lead laboratory for coal technology and fuel reprocessing medicine 66 296 white round pill discount 200mg topiramate amex, and the Laboratory was told that its staff could not exceed 5165 personnel for 1979 symptoms pink eye buy topiramate with mastercard. The Carter administration proved more interested in energy conservation and "soft" energy than in nuclear energy medicine lake mn 200mg topiramate free shipping. The Environmental Sciences Division also initiated intensive study of wood and herbaceous biomass-fast-growing trees and grasses that could be converted to a renewable energy resource. This included research in the Chemistry Division on scaling and brine chemistry, in the Metals and Ceramics Division on corrosion, and in the Engineering Technology and Energy divisions on cold-vapor, low-temperature heat cycles. The collective goal of this technical re earch was to upgrade the efficiency of producing electricity with geothermal energy. Rather than burning the rock and burning the seas with nuclear energy-a dream of the 1960s-this research sought to extract low-level energy from the earth and ocean in kinder and gentler ways. Instead of using chemical doping methods, a silicon isotope in samples inserted in the Bulk Shielding Reactor was transmuted into phosphorus through interactions with neutrons. This process provided uniform distribution of phosphorus in the silicon, thereby improving the efficiency of solar cells fabricated from this material. In a related development, the Solid State Division in 1978 used lasers to prepare silicon for solar cell fabrication. To provide good di tribution within the silicon, ions of a dopant such as boron were deposited on a silicon surface or implanted among the atoms at the surface using an ion accelerator. Lasers were used for diffusing the boron throughout the silicon and for removing crystal imperfections introduced in the implantation process. This combination of ion implantation doping and laser annealing, which wa initiated primarily by Rosa Young and C. The Surface Modification and Characterization Research Center, started by Bill Appleton and later headed by White and David Poker, became the focal point for these studies. President Carter arrived at the Laboratory in a limousine about noon and walked to a packed Central Auditorium in Building 4500-North. There he sat at a table with managers and researchers for a roundtable discussion. Many were proud because this former governor of Georgia was the first president from the Southeast and because he had worked on a Navy submarine as a nuclear engineer under the supervision of Admiral Hyman Rickover. His stance was based on his concern that the plutonium produced in such devices might be diverted by terrorists and outlaw nations to make bombs. At the roundtable discussion, President Carter told employees, "I think the success that we will strive to achieve in the energy field is heavily on your shoulders. President Carter then listened to the Laboratory researchers at the roundtable: Bob Honea and Patricia Rice, on use of computers to study potential impacts of the 198 0 President Jimmy Carter (center), with U. After the discussion, the president was escorted to the East Lobby of Building 4500-North, where he was shown several exhibits. He heard about the development of fluidized-bed coal burners (from John Jones); tertiary recovery of oil (from Alicia Compere); use of bioreactors to degrade hazardous substances and produce desired chemicals (from Chuck Scott); and detection of single atoms of target elements using lasers (from Sam Hurst). Richard Wood, Rosa Young, and Jagdish Narayan test the efficiency of solar cells made at the Laboratory using laser technology. He used neutron activation analysis to determine the amount of uranium present to assess the extent of fuel melting. Quick Responses the March 1979 accident at Three Mile Island Unit 2 surprised nuclear experts at the Laboratory and elsewhere. Although nuclear safety research had concentrated on the risks of pipe rupture and the pos ibility of loss-of-coolant accidents in light-water reactor, the Three Mile Island accident in Penn ylvania resulted instead from a pressure valve that stuck and inaccurate instrumentation and human error that complicated the emergency. Having a national reputation in the safety field, Laboratory staff Jed by Fred Mynatt became immersed in the Three Mile Island emergency and subsequent analysis. When the company owning the disabled reactor called Floyd Culler at the Electric Power Research Institute for help, Culler (who had just left the Laboratory after 25 years of service, including one year as acting director) contacted Postma and other Laboratory officials, as did the staff of the Nuclear Regulatory Commission. During the emergency, Laboratory personnel erved as consultants and onsite analysts. Seventy-five staff members performed technical and analytical re earch during the emergency or subsequently provided information to the committee appointed by President Carter to investigate the accident.
Today it cuts the county of Sussex (formed from Surry in 1754) into two almost equal parts symptoms 10 weeks pregnant purchase topiramate paypal. It was just between the Blackwater River and the Nottoway that the first Blows medicine youkai watch effective 200 mg topiramate, immigrants from England medicine vending machine discount topiramate 100 mg on line, patented land medications prescribed for depression discount 100mg topiramate overnight delivery. John Blow patented 150 acres and was called "an ancient planter," a term used to designate one of the men who felt that the people should be left to work out their own ideas of government. Richard Blow was one of the first vestrymen of Albemarle Parish, one of the earliest parishes in Virginia, created on November 1, 1738. The vestry made up the parish budget, apportioned the taxes, and elected the church wardens, who were, in many places, the tax collectors. They listed the "tithables," (Stiti Glossary: Tithables) laid the county levy, bound out poor children to trades, and represented orphans in probate and claims court. The importance of the vestry of the Episcopal Church in the early days is expressed by Bishop Meade as follows: "For nothing will the descendants of the old families of the State be more thankful than for the lists of vestrymen, magistrates, and others which liave been gathered from the earliest records, and by means of which the very localities of their ancestors may be traced. Thomas Jefferson referred to the system of justices of the peace and vestrymen of the parishes (all of them served without pay) to prove his belief in human nature and the people as a mass. By an act of the Assembly 1662, "Justices were to be of the most able, honest, and judicious persons of the county. According to family oral tradition, the original de Bollind family was Norman French and came to England with William the Conqueror in 1066. Perhaps in the family spirit of adventure, but for unknown reasons and details, Robert left England and arrived in Virginia on October 2, 1660, at tl1e age of fourteen. He began accumulating wealth by trading with Native Americans and growing tobacco. Prominent in both civic and church affairs, he was a lieutenant colonel in the Prince George County militia and a vestryman in the church parish. In 1675, at the age of twenty-nine, Robert married Jane Rolfe, the granddaughter of Pocahontas and John Rolfe, and though Jane died in childbirth, their son, John Bolling, born on January 26, 1676, survived, and, with l1iswife Mary Kennon, produced the only American descendants of Pocahontas. Six years later, in 1681, Colonel Bolling married his second wife, Anne Stith, with whom he had many children, including Robert Bolling, j-, who was born on January 25, 1682. Having served in the House of Burgesses from 1688 through 1706, Colonel Bolling died at the age of 62 on July 17, 1709 and was buried on his plantation, Kippax, in Prince George County, Virginia, where his tomb still stands. However, his remains were removed in 1858 from Kippax to the mausoleum erected by his great-grandson at Blandford Cemetery in Petersburg, Virginia. They had at least one child, Sarah, who was born around 1732, married Benjamin Howard on October 7, 1755, and died in 1763, at the age of thirtyone. There is evidence that the couple also had a son, Thomas, born in 1744, who married Catherine Fell, and died in 1800. He also served in the quorum simultaneously with his second term as justice of the peace. The manor house was large and comfortable, with furnishings of tlrn highest quality that could be afforded brought from England. There was probably a private chapel where the family attended services, along with all the servants on the estate. In addition to being self-governing, the manor was also self-sufficient, manufacturing nearly everything that was necessary for sustaining life. If there was a stream or river flowing tluougl1 the property, there would probably be a grist mill, where wheat and corn were ground into flour for use, not only by the families on the property, but perhaps served other customers as well. Manors also had a blacksmith shop, which produced the tools required for working the land, including wagon rims, barrel rings, perhaps even pewter spoons and other kitchenware. There might be a weaving house, where spinning wheels, spindles, and looms would be set up to manufacture the bulk of the fabric required for manor life. Preston s History of Hartford County, Maryland, publishedin Baltimore by an unknownpublisherin 1901. When he died, Roliert Booth left a library of not less than three hundred volumes valued at fourteen pounds sterling, and twenty-three thousand bricks valued at 184 shillings. A practicing physician, Robert Booth also served as clerk of York County from 16401657; justice of York County in 1652, and was a member of the House of Burgesses from 1653 through 1655.
The Tower of London is commonly considered to be a test of planning and 4 medications buy topiramate 100 mg mastercard, as such symptoms 4dp5dt fet order topiramate paypal, has been used on frontal patients to substantiate their planning deficit (Shallice symptoms 3 months pregnant purchase cheap topiramate line, 1982) symptoms of flu cheap 200 mg topiramate amex. The sticks are of different lengths, so that the first can accommodate the three rings on top of one another, the second two rings, and the third just one. From an initial position of the rings on the sticks (for example, red over green on the long stick, blue on the middle stick), the subject is asked to move one ring at a time from stick to stick and, in a prescribed number of moves, achieve a certain order (for example, green over blue over red on the long stick in five moves). The test requires planning a series of sub-goals in order to reach the ultimate goal; the subject must anticipate and visualize not only that goal but also the steps to it in the proper sequence. The Tower of London Test (see text frontal damage, especially if it is in the left hemisphere, were first found by McCarthy and Shallice to be severely impaired in the performance of the Tower of London (Shallice, 1982), though the results of subsequent experiments turned out to be somewhat inconsistent (Shallice and Burgess, 1991). However, left-frontal patients have been found to exhibit impaired performance in other tasks too that, like the Tower of London test, require self-initiated and self-ordered behavior (Messerli et al. Like working memory, planning and the execution of plans are dependent on attention and thus subject to interference. Especially disruptive may be the internal interference from competing action plans, notably routine plans. This kind of attention, which we call motor or executive attention or set, may be defective in the frontal patient in part because of poor inhibitory control of interference. Thus, it is difficult to ascertain to what extent the failure of frontal patients in formal tests of planning is due to a failure to suppress interference, internal or external (Karnath et al. In conclusion, the planning and execution of goal-directed schemes of action that are guided by internal cues are markedly vulnerable to frontal-lobe lesions, especially if these are in the left lateral prefrontal cortex. Both the planning and the execution are also vulnerable to defective control of interference, a disorder of attention to which the patient with prefrontal damage is particularly prone. Virtually all lesions of prefrontal cortex lead to a defect in temporal integration, although lesions elsewhere in associative cortex do not. As a rule, the prefrontal patient has no trouble whatsoever in executing old and well-rehearsed routines, even if they are temporally extended. The patient encounters trouble, however, when forced to develop a new temporal pattern of behavior, speech or reasoning, especially if it requires the mediation of cross-temporal contingencies. The reasons for the difficulty of the prefrontal patient in organizing new integrated sequences can be surmised from what we have already reviewed in this chapter. Indeed, the failure of what has come to be called "executive functioning" (Shallice, 1982; Lezak, 1983; Lhermitte et al. Trouble in any or all of them can lead, more or less directly, to inabilities in decisionmaking, and in initiating and organizing behavior. Temporal synthesis or integration, in the present context, is the ability to organize temporally separate items of perception and action into goal-directed thinking, speech, or behavior. In cognitive terms, this ability derives from the joint and temporally extended operation of attention, memory and planning. In neural terms, temporal synthesis derives from the cooperation of the prefrontal cortex with other brain structures, cortical and subcortical (to be discussed in Chapter 8), although the underlying mechanisms are still incompletely understood. That difficulty, which in cases of minor prefrontal damage may be subtle, remains concealed for as long as the cognitive functions that mediate sequential behavior remain unchallenged. To better understand under what circumstances those functions can be taxed, let us briefly examine further the phenomenology and behavioral manifestations of the deficit. Behavioral patterns that are not well-established routines appear to be anchored in the present and devoid of temporal perspective, for the past or for the future. Consequently, the behavior of the patient has an air of temporal immediacy, in the sense that it is dominated by present needs and stimuli, the here and now (Ackerly, 1964). Besides spontaneity, behavior seems to have lost its temporality, one action leading to another in more or less stereotyped sequence with little or no regard for either the origins of the sequence or its goal. In many patients, perhaps the majority, the disorder is fully compatible with ordinary life. Thus, by all appearances, the patient leads a normal life, albeit constrained by routine and without much display of imagination, let alone creativity.
She probably does this to hide her connection with Africa due to her lo westeem for her African origin medicine yeast infection order topiramate american express. In the public life of A merican society treatment degenerative disc disease 200mg topiramate visa, in order to be accepted symptoms diarrhea proven 200 mg topiramate, many Africans thought that adopting American ways of life is the right way of integration medicine in french generic topiramate 200 mg on line. According to Belton (2013): " racis m has played some pretty horrible tricks on black people but the worst is the one that teaches you that if you modify your behaviour, the doors will be open and the prejudices will melt away"(P. Adichie also points out, through the example of Aunt Uju, how some African immigrants could be plunged into assimilat ion practices mainly African wo men when they arrive in America. The transformation of their (African wo men) hair so as to comply with A merican hairstyle is explicit in Americanah. Contrary to aunt Uju, Ifemelu is an illustration of what Belton has said about the assimilat ion of African immigrants. For instance, when she was about to sit for a job interview, a friend told her to change her braids: "when she told Ruth about the interview in Baltimore, Ruth said, `my only advice In other words, this way of imitating American ways of liv ing by African immigrants becomes an efficient strategy of negotiating around the different operating racist networks at play in the American society. In order to become a fully integrated and accepted American cit izen without any major prejudices, most African immigrants eventually prefer assimilat ion wh ich results in losing their African identity and values as seen through the character of aunt Uju. She hence becomes an alienated African wo man who neither sees and comprehends things through an African eye nor behaves like an African lady on a foreign soil. The racis m and the identity loss that African immigrants are subjected to are the results of racial stig matizat ion and prejudices. They actually undergo all sorts of experiences in their relationships with African A mericans, white A mericans and within their o wn black co mmun ities. They are thus trapped between three fires: stig matization, racism and assimilation. The latter although a strategy adopted by some African immigrants to be accepted or to integrate the American society, the two others refer to the delicate and difficult relationship that they have with some black and white A mericans. This pushes and influences many of them into psychological and behavioral changes leading to assimilation in such a racially problematized American society. But it is pertinent to point out that some also do assimilation out of necessity because in their mind this is actually the right thing for them to succeed in a hostile American society. The second one is a sensitization about race wh ich may imp ly different things in the A merican society of today where race still matters as exemplified in the novel. She does this for a change of behavior and in the way the A merican society perceives race and confines colored people in a space of their own, especially when they want to integrate or look for a job. At the same time, she criticizes those Africans who unconsciously become assimilated and stopped being African by behavior and identity. However, she also calls for a Homi Bhabharian Third Space of Enunciation wherein cultural and racial differences therefore become an asset of comp lementarity, of reinfo rcement and acceptance instead of stigmatization, racis m and assimilation. The Interesting Narrtive of the Life o f Olaudah Equiano or Gustavus Vassa, the African. Referencing is a way of life in all communities, things and people are named in a certain manner. People are given references that communicate certain messages to those who hold the reference and the community at l arge. Analysing the Gikuyu female references reveals that the references are discriminative of women and to some extent deny them power by skillfully communicating an oppressive message to the female person among the Agikuyu. This study aims at identifying and analyzing these references to show how they portray skewed power relations. The data consisted of the Agikuyu female references which were collected purposefully. The results show that many Gikuyu references on women are discriminative, and portray power and dominance over women. The references also reveal the traditional ideologies that stereotype women, reflecting the culture and belief system of the community. Those interested in power relations, identity, ideology and culture will find this paper useful. This applies well to this study since it is interested in the symbolic forms that are used to refer to women in the Gikuyu Language as micro features and how they bring out macro structures of ideology. Van Djik reports that a cognitive component should be included in the theory of ideology. The second aspect of social cognition is the attitudes, which refers to socially shared opinions of a group of people while the third aspect is ideology.
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