Health Law Implementation: Actuarial Value, Health Disparities Draw Attention
The Department of Health and Human Services offered a bulletin last week to provide guidance on how insurers should calculate actuarial value. Also, some health policy experts are beginning to question whether the health law's quality provisions might exacerbate the nation's health disparities.
Politico Pro: AV Guidance Leaves Room For States
A new HHS bulletin on how insurers should calculate actuarial value follows the pattern established by other recent health reform regulations: CMS will provide a national standard, but allow for state flexibility. Actuarial value is a measure of the share of health costs a plan covers for a standard population. The health reform law requires plans sold in the exchanges to be marketed in different tiers, based on their AV scores, so that consumers can compare benefits side by side. These range from "platinum" plans, with an actuarial value of 90 percent, to "bronze" plans, which would have an actuarial value of 60 percent. To make sure all insurers are calculating their AV scores the same way, CMS will develop its own standard population and create an "AV calculator" that will score plans based on key features of their benefit designs, the guidance explains (Feder, 2/24).
Modern Healthcare: Disparity Clarity
One of the central themes of the Patient Protection and Affordable Care Act, mentioned numerous times throughout the law, is the pressing need to eliminate health care disparities. But some health policy experts worry that provisions of the law designed to improve health care quality could exacerbate gaps in access and outcomes by penalizing the hospitals that minority and poor patients depend on the most (McKinney, 2/25).


The Miracle Child: The Lang Family Story
The year 2001 had already been an eventful one for our family. I was a stay at home to two beautiful daughters. My husband Mike and I decided to build a new house and sell the current one. The horrors of September 11th sent shock waves through our country and hit close to home.
In early November, we settled into our new home. Five days later, Mike was laid off and our youngest daughter was diagnosed with an eye disorder. We thought, “wow, that’s a lot to deal with;” little did we know the worst was yet to happen.
Three weeks later, my daughters and I were involved in a horrific car accident that left our 3-year-old daughter with a severe Traumatic Brain Injury and fighting for her life. We did not know if she would survive the ride to the hospital or her first night in the intensive care unit. There were so many questions, and the doctors did not have answers.
At each turn we had questions but did not receive many answers. The doctors said, “every brain injury is different so we really don’t know what to expect, she may never wake up.” Eventually, she did wake up and after two weeks, she was transferred to an in-patient rehabilitation center where she had to relearn how to walk, talk, eat, and play. The staff told us she was lucky because her injury occurred at such an early age and kids are resilient, however the first 2 years will be the most important for a full recovery.
Once she came home, a month after the accident, our new reality set in. There was the obvious transition to our home life and finding new ways of doing things. Locating therapists to assist in her healing proved to be an arduous task. It was hard enough to find providers experienced in brain injury, but they also needed skill working with the pediatric populations. It was a daunting task.
As we were finally settling into our new routine, I realized something was not right with me. I had trouble comprehending things I read and my fatigue was overwhelming. Not knowing where to turn I went to my primary care doctor who referred me to a neuropsychologist. I discovered that I, too, had a brain injury. I was devastated. How was I going to help my daughter and myself heal?
Olivia received a placement into our school system’s special education program and began attending two mornings a week where she also received speech, physical, and occupational therapy. She now had an opportunity to meet classmates who had been diagnosed with learning disabilities. Young children are accepting of each other. A mother in the class upon hearing our story expressed her empathy to me. She said, “I have had years to accept my son’s disability, but you were thrown an unexpected curve ball. That must be so difficult.” I cried. She was so empathetic to our position. She understood the grief. The positive aspect in my diagnosis is I can sometimes understand Olivia’s frustrations, word finding issues, and difficulty with multi-tasking.
We attended a support group at the hospital for parents of children who had brain injuries. We heard the stories of other families and felt hope. The group gave us resources and directed us to organizations that may be able to assist us along the way. We applied for case management services and Olivia was accepted into the newly developed pediatric program. This led me to join the Brain Injury Service’s Speakers Bureau where I was able to share our family’s story to help others. I spoke to local university students, therapists, attorneys, educators, first responders and others.
After hearing our story so many commented how unique our story was and illustrated the strength of family. Some even suggested we write a book.
Well, Mike and I agreed. We learned so much over the years about brain injury and advocacy and team building. The process of writing has been cathartic. It showed us how much our family has endured. During the years, we heard comments that he and I approach things differently.
For example, when we attended Individualized Education Plan meetings our differing styles was evident. I usually walked into the meeting with my heart on my sleeve and it was common for me to get emotional. He approached it as a business meeting; he was prepared with a strategic plan to assist Olivia in her educational goals. These approaches worked for us. Through it all we were a team. Our goal has always been to give our children a loving and supportive home.
We decided to use our different points of view in the execution of our book. Each section is our individual perspectives. Our alternating sections detail our perceptions of the events and the feelings they evoked. We hired a developmental editor in 2020 to help organize all the information and give the manuscript structure. There were rewrites as we narrowed it down from 115,000 words to approximately 90,000.
Our goal is to educate others about brain injury but also illustrate brain injury does not only affect one individual. A brain injury is a shocking event no matter the severity. Your whole life is knocked off balance and it takes a long time to regain equilibrium. Our story is one example of how a family rallies together to heal both the individual and the other relationships. It requires us to look at life differently with the knowledge that things can change when we least expect it. I am proud of Olivia and her continued recovery and the strength of our family to support her the best we can. We have had assistance along the way which illustrates it truly does take a village.
This blog post was submitted by BIAV member Kelly Lang. You can purchase her and her husband Michael's new book, The Miracle Child: Traumatic Brain Injury and me on Amazon, Barnes and Noble, and Indie Bound.
Want to support their book?
- Purchase the book and leave a review on Amazon and GoodReads
- Request the book from your local library
- Share the book on your social media pages
The Lang family is graciously donating a portion of proceeds from the book to the Brain Injury Association of Virginia.


Did you know that toxic mold may be responsible for: Fibromyalgia, Chronic Fatigue Syndrome, IBS, Multiple Chemical Sensitivities, And many other vague diagnoses! All too often, those who are dealing with a toxic mold illness get labeled with a diagnosis that only describes their symptoms. A diagnosis of … [Read more...]
Clear Focused Mind
Do you experience any of the following?
- Brain fog
- Difficulties concentrating or holding your focus
- Irritability over little things
- Low energy
- Intense food cravings
These are all early warning signs that your brain and mind are fatiguing. You cannot overcome fatigue without addressing your mind.
Brain fog and difficulties concentrating could be the cause of your fatigue. Or they could be the symptom.
The articles below tell you how to increase your focus, decrease your brain fog, and clear your mind of fatigue. For good.
Read on for a Clear Focused Mind!
You have adrenal fatigue. This much you're sure of. Before you head to your local health food store to pick up an assortment of supplements, read this post. I'll show you exactly which supplements will help your adrenal fatigue and which will make it worse! What's the first thing you do before starting a new workout routine? You get all … [Read more...]
More than 90% of New Year’s resolutions fail. (1) The problem may be that most people don't know how to set goals. I'll show you the best method to set goals below! I think you should set goals. People who set goals report they are happier with their lives. (2) If that's not enough motivation, I don't know what is! If goal setting is a good … [Read more...]
Your constant fatigue and strange array of symptoms could be caused by mold. But there's far more to mold illness than just mold. Your symptoms could actually be caused by a mysterious illness known as Chronic Inflammatory Response Syndrome. Regardless of who you are, if you are living or working in a moldy home or building, you're going to … [Read more...]
Did you know: A previous exposure to toxic mold could be the hidden cause of all your symptoms! Yes, even the strangest of symptoms - like those found in fibromyalgia and/or chronic fatigue syndrome - could be caused by toxic mold. What makes mold all the more challenging to diagnose is that the strange symptoms it creates could be caused by a … [Read more...]
One of the root causes of chronic fatigue (and all your other strange symptoms!) could be an infection you don't even know you have! The infectious agent in question is mold. Yes, the same stuff you see on your food. Mold is even present in a lot of food products that aren't rotting. Foods like coffee, corn, grains, and dehydrated fruits often … [Read more...]
After medication, what steps should you take to reclaim your energy for good? Note: this is the second article in a series. If you haven't already, please read the first article - The best ways to treat chronic fatigue through a conventional medical framework. After reading the first article of this series, you know how to best manage your … [Read more...]
According to the CDC, there is no cure nor approved treatment plan for chronic fatigue syndrome. (1) So what should you do to overcome this debilitating illness? Note: this is the first article in a series. Once you're finished this article, be sure to check out part II – The best ways to treat chronic fatigue through an alternative or holistic … [Read more...]


The immunoglobulin (Ig) variable region (V) genes expressed by IgM chronic lymphocytic leukemia (CLL) B cells display little or no somatic mutations. However, preliminary findings have shown that Ig V genes of IgA and IgG CLLs may be somatically mutated, suggesting that isotype-switched CLLs may represent a 'subtype' of the disease. To investigate the degree and nature of somatic mutations and the role of antigen (Ag) in the clonal selection and expansion of isotype-switched CLLs, and to determine whether specific oncogene or tumor suppressor gene mutations are associated with isotype-switched CLLs, we analyzed the expressed Ig V(H) gene, bcl-1 and bcl- 2 proto-oncogene, and p53 tumor suppressor gene configurations of 3 IgA-, 1 IgG-, and 1 IgA/IgG-expressing CLLs. These isotype-switched CLL B cells expressed surface HLA-DR, CD19, CD23, and CD5, and displayed no alterations of the bcl-1 and bcl-2 oncogenes and the p53 tumor-suppressor gene. The cDNA V(H)-D-J(H) gene sequence was joined with that of the Cα gene in the B cells of the three IgA CLLs, and with that of the Cγ gene in the IgG CLL g cells. In the IgA/IgG-coexpressing CLL B cells, identical V(H)-D-J(H) cDNA sequences were spliced to either Cα or Cγ genes. In all five CLLs, the pattern of Cμ DNA probe hybridization to the digested genomic DNAs was consistent with deletion of the Cμ exon from the rearranged Ig gene locus, suggesting that these CLL B cells had undergone DNA switch recombination. In one IgA CLL, the expressed V(H) gene was unmutated. In all other class-switched CLLs, the Ig V(H) segment gene was mutated, but the point mutations were not associated with intraclonal diversification. In one IgA and in the IgA/IgG-coexpressing CLL, the nature and distribution of the mutations were consistent with AG selection. These findings suggest that IgA- and/or IgG-expressing CLLs represent, in their V(H) gene structure, transformants of B cells at different stages of ontogeny. They also suggest that Ag may play a role in the clonal selection of some of these isotype-switched leukemic cells, but bcl-1 and bcl-2 oncogene rearrangements and p53 tumor suppressor gene mutation are not associated with the pathogenesis of isotype-switched CLLs.
|Original language||English (US)|
|Number of pages||8|
|State||Published - 1997|
ASJC Scopus subject areas
- Cell Biology


It is estimated that up to 20 million American men frequently suffer from impotence and that it strikes up to half of all men between the ages of 40 and 70. Doctors used to think that most cases of impotence were psychological in origin, but they now recognize that, at least in older men, physical causes may play a primary role in 60% or more of all cases. In men over the age of 60, the leading cause is atherosclerosis, or narrowing of the arteries, which can restrict the flow of blood to the penis. Injury or disease of the connective tissue, such as Peyronie's disease, may prevent the corpora cavernosa from completely expanding. Damage to the nerves of the penis, from certain types of surgery or neurological conditions, such as Parkinson's disease or multiple sclerosis, may also cause impotence. Men with diabetes are especially at risk for impotence because of their high risk of both atherosclerosis and a nerve disease called diabetic neuropathy.
What you need to know about STDs Sexually transmitted diseases (STDs) are infections that are passed on from one person to another through sexual contact. There are many STDs, including chlamydia, genital warts, syphilis, and trich. This article looks at some of the most common STDs, the symptoms, and how to avoid getting or passing an STD one on. Read now
ED usually has something physical behind it, particularly in older men. But psychological factors can be a factor in many cases of ED. Experts say stress, depression, poor self-esteem, and performance anxiety can short-circuit the process that leads to an erection. These factors can also make the problem worse in men whose ED stems from something physical.
Factors that mediate contraction in the penis include noradrenaline, endothelin-1, neuropeptide Y, prostanoids, angiotensin II, and others not yet identified. Factors that mediate relaxation include acetylcholine, nitric oxide (NO), vasoactive intestinal polypeptide, pituitary adenylyl cyclase–activating peptide, calcitonin gene–related peptide, adrenomedullin, adenosine triphosphate, and adenosine prostanoids.
Induction of erection occurs after stimulation of the cavernous and pelvic nerve plexus. Conversely, stimulation of the sympathetic trunk leads to detumescence. The reflex erectile response requires that the sacral reflex arc remain intact. Tactile and sensory signals are received by the somatic sensory pathways and integrate with parasympathetic nuclei within the sacral spinal cord (S2-4) leading to induction of erection via cholinergic signaling. These reflexogenic erections remain intact with upper motor neuron injuries. Psychogenic erections do not require that the sacral reflex arc remain intact. In a cat models, spinal cord removal below L4/L5 led to absence of a reflexogenic erection but stimulation of the medial preoptic area (MPOA) or placement near a female cat in heat led to erection (5,6). Psychogenic erections occur via induction of central pathways traveling from the brain through the sympathetic chain. Non-penile sensory pathways induced by sight, sound, touch and smell travel through the MPOA to the erection centers within the cord T11-L2, and S2-S4 to induce erections (7). When a sacral lower motor neuron injury is present in men, below T12 these types of erections are more likely to occur (8). Spinal cord lesions above T9 are not associated with psychogenic erections (9). Rigidity of erections is less with psychogenic erections because the thoracolumbar sympathetic outflow may contain a decreased concentration of neurons compared to the parasympathetic outflow from the sacral spinal cord.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
If you are taking medications (alpha-blockers) for problems with an enlarged prostate, you should discuss your prostate medications with your doctor. Alpha-blockers also can cause lowering of the blood pressure. Thus your doctor will need to carefully watch your blood pressure when you start the PDE5 inhibitor. Common alpha-blockers include doxazosin (Cardura), terazosin (Hytrin), and tamsulosin (Flomax).
While pills for ED are convenient, some men sustain stronger erections by injecting medication directly into the penis. Drugs approved for this purpose work by widening the blood vessels, causing the penis to become engorged with blood. Another option is inserting a medicated pellet into the urethra. The pellet can trigger an erection within 10 minutes.
The recommended starting dose of tadalafil for use as needed for most patients is 10 mg taken orally approximately one hour before sexual activity. A doctor may adjust the dose higher to 20 mg or lower to 5 mg depending on efficacy and side effects. Doctors recommended that patients take tadalafil no more frequently than once per day. Some patients can take tadalafil less frequently since the improvement in erectile function may last 36 hours. Patients may take tadalafil with or without food. Tadalafil is currently the only PDE5 inhibitor that is FDA-approved for daily use for erectile dysfunction and is available in 2.5 mg or 5 mg dosages for daily use.
Patients should continue testosterone therapy only if there is improvement in the symptoms of hypogonadism and should be monitored regularly. You will need periodic blood tests for testosterone levels and blood tests to monitor your blood count and PSA. Testosterone therapy has health risks, and thus doctors should closely monitor its use. Testosterone therapy can worsen sleep apnea and congestive heart failure.
The Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) study, designed to determine whether an individual man’s sexual outcomes after most common treatments for early-stage prostate cancer could be accurately predicted on the basis of baseline characteristics and treatment plans, found that 2 years after treatment, 177 (35%) of 511 men who underwent prostatectomy reported the ability to attain functional erections suitable for intercourse.
So here’s something that’s really fascinating. Healthy eating is a way to reduce anxiety and stress. Now how, you may be asking, right? Well, think about it. We live in a world where there are so many variables and where we don’t have control over our lives. But now, with healthy eating, we have control over what goes into our body. And now having that control empowers us to be even healthier, to be more directive in what we do. And certainly, that begins then to reduce the anxiety and the stress. So all in one, you have a healthier body, but certainly a healthier mind.
Everything you need to know about chlamydia Chlamydia is the most common STI in the United States, yet most people do not experience obvious symptoms. Chlamydia affects men and women and can harm the reproductive systems, sometimes permanently. Find out about the causes and symptoms of chlamydia, as well as what the best treatments are and how to get screened. Read now
The medications are extremely effective, which is very good. And the medications are, for the most part, extremely well-tolerated. But there are, like with any medications, a potential downside. The one absolute downside to the use of any of these erection what we call PDE5 medications is if a patient is using a nitroglycerin medication. And nitroglycerins are used for heart disease and for angina, for the most part, although there are some recreational uses of nitrites. And that’s important because your blood vessels will dilate and your blood pressure will drop. And that is an absolute contraindication.
VED involved placing the penis in a clear plastic tube where negative pressure created by the vacuum pump leads to penile engorgement and tumescence. Usually a constriction ring can be placed on the base of penis following penile engorgement. Some men complain of bruising, a “cold” penis and pain associated with the constriction ring; however, in some men with NED sensation may not be intact mitigating the side effects of VEDs. VEDs have reported effectiveness up to 90% in certain ED populations and it remains a non-invasive means to achieve and erection.
However, a review of a United Kingdom medical record database found no evidence that the use of 5-alpha reductase inhibitors independently increase the risk for ED. In 71,849 men with benign prostatic hyperplasia (BPH), the risk of ED was not increased with the use of finasteride or dutasteride only (odds ratio [OR] 0.94), or a 5-alpha reductase inhibitor plus an alpha blocker (OR 0.92) compared with an alpha blocker only. In addition, the risk of ED was not increase in 12 346 men prescribed finasteride 1 mg for alopecia, compared with unexposed men with alopecia (OR 0.95). The risk of ED did increase with longer duration of BPH, regardless of drug exposure.
One study by Palmer and colleagues evaluated sildenafil use in SB males with thoracic lesions (76). A prospective, blinded, randomized, placebo-controlled, dose-escalation, crossover study in 17 patients with SB and ED was performed. All study participates took sets of tablet in groups, two sets of placebo, one of 25 mg, and the last 50 mg. Overall response to the tablet sets was measured by IIEF response and self-report of erectile rigidity. Patients reported that taking 50 mg of sildenafil led to improved erections, duration of erections, frequency of erections and level of confidence compared to sildenafil 25 mg and more significantly compared to placebo. Of the five patients who reported side effects, two experienced mild hematological changes that reverted to baseline after study completion.
…have traditionally been classified as impotence (inability of a man to achieve or maintain penile erection) and frigidity (inability of a woman to achieve arousal or orgasm during sexual intercourse). Because these terms—impotence and frigidity—have developed pejorative and misleading connotations, they are no longer used as scientific classifications, having been…
2 inability of the adult male to achieve or sustain a penile erection or, less commonly, to ejaculate after achieving an erection. Several forms are recognized. Functional impotence has a psychological basis. Organic impotence includes vasculogenic, neurogenic, endocrinic, and anatomical factors. Anatomical impotence results from physically defective genitalia. Atonic impotence involves disturbed neuromuscular function. Poor health, old or advancing age, drugs, smoking, trauma, and fatigue can induce impotence. Also called erectile dysfunction, impotency. impotent, adj.
Patients with both ED and cardiovascular disease who receive treatment with an oral PDE5 inhibitor require education regarding what to do if anginal episodes develop while the drug is in their system. Such education includes stressing the importance of alerting emergency care providers to the presence of the drug so that nitrate treatment is avoided.
Years ago, the standard treatment for impotence was an implantable penile prosthesis or long-term psychotherapy. Although physical causes are now more readily diagnosed and treated, individual or marital counseling is still an effective treatment for impotence when emotional factors play a role. Fortunately, other approaches are now available to treat the physical causes of impotence.
You’ve probably heard of Viagra, but it’s not the only pill for ED. This class of drugs also includes Cialis, Levitra, Staxyn, and Stendra. All work by improving blood flow to the penis during arousal. They're generally taken 30-60 minutes before sexual activity and should not be used more than once a day. Cialis can be taken up to 36 hours before sexual activity and also comes in a lower, daily dose. Staxyn dissolves in the mouth. All require an OK from your doctor first for safety.


What We Provide
Male and Female Outpatient with Lodging
This service offers 16 male beds and 32 female beds in a sober environment and includes 28 hours weekly of programming. Clients are provided with lunch daily and transportation to and from programming. We are MAT friendly and mental health services are offered on site.
Adult Co-Ed Intensive Outpatient Treatment
Our adult treatment is focused on healing trauma and mental health issues in conjunction with addressing substance use issues. We prefer a nurturing approach, with an emphasis on education and empowerment to move forward. We are here to help clients put this phase of their life behind and start anew. Both day and evening outpatient hours are offered.
Your personal history and circumstances make your issues unique to you. This service is tailored for you and is designed to get a clear picture of what services are needed to help you meet your individual goals. We are able to do Rule 25 assessments, comprehensive assessments, and mental health diagnostic assessments. In some cases, we may be able to do mobile assessments and come to you.
Mental health therapy
We offer mental health therapy to any adult or adolescent interested in attending. You do not have to be enrolled in our outpatient treatment to attend mental health therapy. We treat a variety of issues including trauma, depression, anxiety, personality disorders, grief, as well as family and marital issues. We have mental health professionals that are trained in EMDR in addition to a variety of other therapeutic interventions.


Clariness congratulates Micah Stanbridge on completing his ride across America!! Micah, you did a great job raising awareness and funds for patients with blood cancer. Since starting his ride, 25 people have signed up to be stem cell donors. It took Micah 6 weeks to finish his 4,100 mile trek from the Pacific Ocean to the Atlantic Ocean. I am sure he will be happy not to ride his bike for a few days. Clariness is very proud to have been one of Micah’s sponsors and we enjoyed riding along with him through his frequent posts and vlogs.
Micah talks about reaching the end of the road in his current video.
Clariness has partnered with Micah Stanbridge to support his bicycle ride across the US. Micah is riding to raise awareness about blood cancers and blood disorders and the need for life saving stem cell transplants. Micah is raising money for Anthony Nolan, the world’s first bone marrow registry. The charity provides life saving support to people with blood cancer and blood disorders across the UK and beyond. Currently, there are 680,000 people on their registry of volunteer donors.
Micah’s goal is to raise £15,000 for the Anthony Nolan blood cancer charity. He has reached 52% of his goal! It’s not too late to donate. You can support Micah and Anthony Nolan, by making an online donation here: https://www.justgiving.com/fundraising/supermarrowman
Team Clariness is behind you all the way Micah.