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The second form of essential Omega-3 fatty acids is eicosapentaenoic acid (EPA or eicosapentaenoic acid). It is a 20 carbon atom molecule with 5 cis double bonds in the chain. Also referred to as Timnodonic acid, EPA is an important precursor of thromboxane-3, leukotriene 5 groups and prostaglandins in the body, namely prostaglandin-3.

Inflammation and Rheumatoid arthritis Diabetes Schizophrenia and Depression

EPA may inhibit some hepatic enzymes that are vital to drug metabolism in the liver.

Docosahexaenoic acid (DHA) is the longest n-3 fatty acid, with a 22 carbon chain and 6 double bonds. DHA is also known as cervonic acid and is an essential Omega 3 for proper brain function.

DHA is the most abundant fatty acid in the brain and the retina. It is an important component of these two, along with the cerebral cortex, skin, sperm and testicles. As mentioned before, it can be synthesized in small quantities by the body if it has an ample amount of ALA and EPA. However, the major chunk of it required by the body must be obtained from natural food sources rich in DHA.

Brain Health Colon Cancer Infertility

ALA, EPA and DHA can all be obtained from natural food sources, with only the latter two being produced by the body itself in minor quantities. However, as mentioned before, the amount produced inside the body is far less than the amount required for a normal metabolism, making the dietary consumption of each of these fatty acids a must.

ALA is mainly found in seed oils such as soybean oil and canola oil. Chia, perilla and kiwifruit seeds are also rich in ALA. Several nuts like peanuts, almonds and walnuts (both English and Persian) are another good plant source. The thylakoid membrane of the chloroplast of most leaves, especially pea leaves, contains a high quantity of ALA. Flaxseeds contain linseed oil which is probably the richest source of ALA, containing 2.5g of it in one teaspoon. A tablespoon of ground flaxseeds itself contains 1.6g of ALA. However, it is worth noting that solid flaxseeds pass undigested through the human gastrointestinal system and are of no use.

EPA is primarily found in microalgae, with almost no higher plants being a significant source of it. Algae are commercially farmed nowadays as a non-animal source of EPA. It is interesting to note that oily fish such as cod, herring, mackerel, herring, salmon and sardine, which constitute the major animal source of EPA, are themselves not rich in EPA as it was assumed in the past. These fish consume EPA (and DHA) via the algae they consume. Fish oils like cod liver oil are one of the richest sources of EPA. Human breast milk also contains this fatty acid.

Exhibit 9

Oregon’s Section 1115 Waiver: Using Medicaid to Provide “Health-Related” Services

Using a Section 1115 waiver, Oregon operates its Medicaid program through coordinated care organizations (CCOs), which are community-based partnerships of managed care plans and providers that manage physical, behavioral, and oral health services for a defined Medicaid population. Like managed care plans, CCOs take on risk and are paid rates developed in accordance with the Centers for Medicare and Medicaid Services’ rate-setting requirements for Medicaid managed care.

A major goal of Oregon’s initiative is to “address the social determinants of health and improve health equity across all low-income, vulnerable Oregonians.” To this end, Oregon encourages its CCOs to offer “health-related services,” which include “flexible services” (cost-effective services offered voluntarily to individuals as an adjunct to covered benefits) and “community benefit initiatives” (community-level interventions focused on improving population health and health care quality). They can include, for example, short-term housing assistance post-hospitalization or a public education campaign to increase vaccination rates.

Oregon secured clarification in its 1115 waiver that it can put the cost of such services in the numerator of the MLR if the services are related to a quality initiative (see Option 5 below). Moreover, Oregon incentivizes plans to offer health-related services by rewarding high-quality and relatively efficient plans with a higher profit margin. To date, CCOs have dedicated a relatively small share of their capitation funds to such services, but the state continues to encourage them to do so.

The process of negotiating a Medicaid 1115 waiver can be time-consuming and complex, requiring extensive discussions with CMS. Moreover, such demonstrations are intended to test out new ideas, not to serve as the permanent vehicle by which a state operates its Medicaid program. For example, delivery system reform waivers, such as the one secured by Oregon, are expected to phase out over time. Indeed, a number of the waivers already in place explicitly require that some of the innovation taking place will gradually be built into a state’s Medicaid managed care contracting strategy, creating a long-term, sustainable approach to financing that can outlive the waiver.

The Trump administration has suggested that under certain circumstances it will permit waivers to continue indefinitely. Still, it has restricted some of the tools used in the past to help finance waivers. 14 And, as with prior administrations, it does not appear willing to authorize Medicaid coverage of significant social interventions.

Value-based payments create an opportunity to address social issues when doing so would deliver value to Medicaid and improve health outcomes. Historically, Medicaid has been a program that pays for Medicaid-covered benefits — for the most part clinical services — delivered to Medicaid-eligible beneficiaries. It has not been in a position to cover social interventions, even when it would be cost-effective to do so, unless they could be squeezed into the Medicaid box. Because value-based payments — whether paid by the plan or the Medicaid agency — are not linked to providing specific medical services, they can be used by providers for social investments even beyond those included in the Medicaid benefit package. Of course, this assumes the provider is persuaded that investment in social interventions will have a positive impact on health outcomes and its performance under the value-based payment arrangement.

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Why the Weak Dollar Trend Is Good for the U.S.
Why the Weak Dollar Trend Is Good for the U.S.

Why the Weak Dollar Trend Is Good for the U.S.

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It’s been seven months since the dollar surged to the highest level since at least 2005 -- long enough for the prolonged bout of weakness in the world’s reference currency to reshape the trading landscape.

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at length . Here’s a look at how the softer greenback has forced investors in markets from equities to emerging assets and commodities to rewrite their trading theses.


A softer dollar boosts the purchasing power of overseas customers looking to pick up American-made goods and increases the value of profits that U.S. companies earn abroad.That’s shown up in the earnings and share prices of large, internationally focused companies.

A Goldman Sachs basket of stocks with international exposure has beaten its domestically oriented peer by about 11 percentage points in 2017. It’s on course for the best year of outperformance since 2009. Similarly, the SP 500 Index is beating the Russell 2000 Index of small caps by five percentage points.

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effects of bathing, fresh air, a good diet, and exercise. The ancient Romans also recognized the influence of these factors on health and even made significant advances in supplying and purifying water and in improving sanitation. Today, a balanced diet, clean air and water, and exercise continue to be emphasized as important factors for maintaining health. The ancient Greeks also introduced the notion that illness resulted from an imbalance between the four humours of the body: blood, phlegm, yellow , and black bile. They emphasized the value of observation, including bodily signs and excretions. However, the focus was more on predicting the outcome of an illness (i.e., prognosis ) and less on its diagnosis. A physician’s reputation depended on accurate prognostic skills, predicting who would recover and who would die or how long an illness would last.

Hippocrates is credited with establishing the ethical basis of the physician’s behaviour, and graduating physicians still recite the Hippocratic oath . His writings document the value of objectively evaluating all aspects of the patient’s symptoms, diet, sleep patterns, and habits. No finding was considered insignificant, and physicians were encouraged to employ all their senses—sight, hearing, smell, taste, and touch—in making a diagnosis. These principles hold just as true today.

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