Lift chairs are chairs that feature a powered lifting mechanism that pushes the entire chair up from its base and so assists the user to a standing position. In the United States, lift chairs qualify as Durable Medical Equipment under Medicare Part B. In a February 1989 report released by the Inspector General of the US Department of Health and Human Services, it was found that: lift chairs might not meet Medicare's requirements for Durable Medical Equipment and lift chair claims need to be re-regulated; the report was stimulated by an increase in lift chair claims between 1984 and 1985 from 200,000 to 700,000. A New York Times article stated that aggressive TV ads were pushing consumers to inquire about lift chairs and, once consumers called in, a form was sent to them for their physicians to sign; some companies would ship lift chairs before receiving a physician's signature. Medicare may only cover the cost of the lift-mechanism rather than the entire chair. Before Medicare can be considered for covering the cost, patients will need to have a visit with their physician to discuss the need for this particular equipment.
The DME provider will request a prescription and a certificate of medical necessity. The CMN typical involves 5 questions; the questions are Does the patient have severe arthritis, Does the patient have a neuromuscular disease, Is the patient incapable of getting up from a regular chair in their home, Can the patient walk once standing, Have all other therapeutic measures been taken? If any of the questions are answered "NO", it may result in a denial of the claim. DME providers require full payment for the lift chair and will offer reimbursement upon approval from Medicare. DME providers cannot bill Medicare without first providing the equipment. List of chairs Massage chair Mobility aid Recliner
Physical strength is the measure of an animal's exertion of force on physical objects. Increasing physical strength is the goal of strength training. An individual's physical strength is determined by two factors. Individuals with a high proportion of type I slow twitch muscle fibers will be weaker than a similar individual with a high proportion of type II fast twitch fibers, but would have a greater inherent capacity for physical endurance; the genetic inheritance of muscle fiber type sets the outermost boundaries of physical strength possible, though the unique position within this envelope is determined by training. Individual muscle fiber ratios can be determined through a muscle biopsy. Other considerations are the ability to recruit muscle fibers for a particular activity, joint angles, the length of each limb. For a given cross-section, shorter limbs are able to lift more weight; the ability to gain muscle varies person to person, based upon genes dictating the amounts of hormones secreted, but on sex, health of the person, adequate nutrients in the diet.
A one-repetition maximum test is the most accurate way to determine maximum muscular strength. There are various ways to measure physical strength of a population. Strength capability analysis is done in the field of ergonomics where a particular task and/or a posture is evaluated and compared to the capabilities of the section of the population that the task is intended towards; the external reactive moments and forces on the joints are used in such cases. The strength capability of the joint is denoted by the amount of moment that the muscle force can create at the joint to counter the external moment. Skeletal muscles produce reactive moments at the joints. To avoid injury or fatigue, when person is performing a task, such as pushing or lifting a load, the external moments created at the joints due to the load at the hand and the weight of the body segments must be ideally less than the muscular moment strengths at the joint. One of the first sagittal-plane models to predict strength was developed by Chaffin in 1969.
Based on this model, the external moments at each joint must not exceed the muscle strength moments at that joint. Mj/L < Sj Where, Sj is the muscle strength moment at joint, j, Mj/L is the external moment at the joint, j, due to load, L and the body segments preceding the joint in the top-down analysis. Top-down analysis is the method of calculating the reactive moments and forces at each joint starting at the hand, all the way till the ankle and foot. In a 6-segment model, the joints considered are elbow, shoulder, L5/S1 disc of the spine, hip and ankle, it is common to ignore the wrist joint in manual calculations. Software intended for such calculation use the wrist joint dividing the lower arm into hand and forearm segments. Static strength prediction is the method of predicting the strength capabilities of a person or a population for a particular task and/or posture. Manual calculations are performed using the top-down analysis on a six or seven-link model, based on available information about the case and compared to standard guidelines, such as the one provided by the National Institute for Occupational Safety and Health, to predict capability.
A low-floor bus is a bus or trolleybus that has no steps between the ground and the floor of the bus at one or more entrances, low floor for part or all of the passenger cabin. A bus with a partial low floor may be referred to as a low-entry bus in some locations. Low floor refers to a bus deck, accessible from the sidewalk with only a single step with a small height difference, caused by the difference between the bus deck and sidewalk; this is distinct from high-floor, a bus deck design that requires climbing one or more steps to access the interior floor, placed at a higher height. Being low-floor improves the accessibility of the bus for the public the elderly and people with disabilities, including those using wheelchairs and walkers. All are rear-engine, rear-wheel-drive layout with no drive shaft. Low-floor buses are divided into two major types: low-floor buses with a low floor throughout the length of the bus, low-entry buses with step-free access to only a part of the bus, most between the front door and the middle door.
In North America, both types are called low-floor, as the majority of the vehicle has a low floor, without steps at the doors. The main reason for choosing a low-entry configuration is to allow better placement for the powertrain and other technical equipment in the raised floor section, in addition to allowing a more comfortable ride on rough roads; some manufacturers use the initials LF or L in their model designations for low-floor models, in North America buses that are low-floor are also designated LF. In some countries, LE, short for Low Entry, is used by some manufacturers in their model designations for low-entry buses. Most bus manufacturers achieve a low floor height by making rear-engined rear-wheel drive buses with independent front suspension, so that no axle is needed to pass under the floor of the front part of passenger compartment, or a lowered front axle; some full low-floor buses have a lowered rear axle, while the rear axle is not an issue on a low-entry bus. Many low-floor buses, including the Irisbus Citelis, has the engine in a vertical cabinet at the rear of the bus.
Van Hool have a series of "side-engine mid-drive" buses that puts the engine off to one side of the cabin longitudinally between the first and the second axle, to maximize usable cabin space. The same concept was utilized by Volvo on their B9S articulated chassis. For smaller buses, such as midibuses, the low-floor capability is achieved by placing the front wheels ahead of the entrance. One of the last types of buses to gain low-floor accessibility as standard was the minibus, where a similar front-wheel arrangement allows around 12 seats and a wheelchair space to be accommodated in small low-floor minibuses, such as the Optare Alero and Hino Poncho. Accessibility was achieved in paratransit type applications, which use small vehicles with the fitment of special lifts; the inception of small low-floor buses has allowed the development of several accessible demand-responsive transport schemes using standard'off-the-shelf' buses. A disadvantage of the low floor is accommodating the bus's own wheels.
With the low floor, the wheels protrude into the passenger cabin, need to be contained in wheel pockets of waist height, this occupies space which would otherwise be used for seating. To allow space for technical equipment, many low-floor buses have the seats mounted on podiums, making a small step up from the floor, while others are able to mount the seats directly to the floor, avoiding the step. Seating layout for a low-floor bus therefore requires careful design. Low floor configuration is known to have poor side to side dead load distribution within the chassis due to the asymmetrical off-centre placement of driveline components - engine and transmission; as a result, many of such buses require electronically controlled air suspension to compensate the lopsided configuration. Low-floor buses include an area without seating next to at least one of the doors, where wheelchairs, strollers/prams, where allowed bicycles, can be parked; this is sometimes not the only purpose of this area, though, as many operators employ larger standee areas for high occupancy at peak times.
Despite the space existing, operators may insist that only one or two wheelchairs or pushchairs can be accommodated unfolded, due to space/safety concerns. Low floors can be complemented by a hydraulic or pneumatic'kneeling device', which can be used when the bus is not in motion, tilting it or lowering it at the front axle further down to normal curb height. Depending on how close to the curb the bus is parked and wheelchair design, this can allow wheelchair users to board unaided. Though such technology has been available and in use on high-floor buses since the 1970s, it is of significant utility on low-floor vehicles only where it enables less-mobile passengers to board and leave the vehicle without help from others. Many vehicles are equipped with wheel-chair lifts, or ramps which, when combined with a low floor, can provide a nearly level entry. An interesting implementation of the low floor design exists in Australia, where Custom Coaches makes a "Hybrid" variant of its CB60 bodywork.
These buses combine a smaller low floor area with a small underfloor bin for some luggage. Whilst these buses do not provide a full amount of luggage space, they can be used to house more luggage than what can be held inside the bus itself. Another drawback
A battery is a device consisting of one or more electrochemical cells with external connections provided to power electrical devices such as flashlights and electric cars. When a battery is supplying electric power, its positive terminal is the cathode and its negative terminal is the anode; the terminal marked negative is the source of electrons that will flow through an external electric circuit to the positive terminal. When a battery is connected to an external electric load, a redox reaction converts high-energy reactants to lower-energy products, the free-energy difference is delivered to the external circuit as electrical energy; the term "battery" referred to a device composed of multiple cells, however the usage has evolved to include devices composed of a single cell. Primary batteries are discarded. Common examples are the alkaline battery used for flashlights and a multitude of portable electronic devices. Secondary batteries can be discharged and recharged multiple times using an applied electric current.
Examples include the lead-acid batteries used in vehicles and lithium-ion batteries used for portable electronics such as laptops and smartphones. Batteries come in many shapes and sizes, from miniature cells used to power hearing aids and wristwatches to small, thin cells used in smartphones, to large lead acid batteries or lithium-ion batteries in vehicles, at the largest extreme, huge battery banks the size of rooms that provide standby or emergency power for telephone exchanges and computer data centers. According to a 2005 estimate, the worldwide battery industry generates US$48 billion in sales each year, with 6% annual growth. Batteries have much lower specific energy than common fuels such as gasoline. In automobiles, this is somewhat offset by the higher efficiency of electric motors in converting chemical energy to mechanical work, compared to combustion engines; the usage of "battery" to describe a group of electrical devices dates to Benjamin Franklin, who in 1748 described multiple Leyden jars by analogy to a battery of cannon.
Italian physicist Alessandro Volta built and described the first electrochemical battery, the voltaic pile, in 1800. This was a stack of copper and zinc plates, separated by brine-soaked paper disks, that could produce a steady current for a considerable length of time. Volta did not understand, he thought that his cells were an inexhaustible source of energy, that the associated corrosion effects at the electrodes were a mere nuisance, rather than an unavoidable consequence of their operation, as Michael Faraday showed in 1834. Although early batteries were of great value for experimental purposes, in practice their voltages fluctuated and they could not provide a large current for a sustained period; the Daniell cell, invented in 1836 by British chemist John Frederic Daniell, was the first practical source of electricity, becoming an industry standard and seeing widespread adoption as a power source for electrical telegraph networks. It consisted of a copper pot filled with a copper sulfate solution, in, immersed an unglazed earthenware container filled with sulfuric acid and a zinc electrode.
These wet cells used liquid electrolytes, which were prone to leakage and spillage if not handled correctly. Many used glass jars to hold their components, which made them fragile and dangerous; these characteristics made. Near the end of the nineteenth century, the invention of dry cell batteries, which replaced the liquid electrolyte with a paste, made portable electrical devices practical. Batteries convert chemical energy directly to electrical energy. In many cases, the electrical energy released is the difference in the cohesive or bond energies of the metals, oxides, or molecules undergoing the electrochemical reaction. For instance, energy can be stored in Zn or Li, which are high-energy metals because they are not stabilized by d-electron bonding, unlike transition metals. Batteries are designed such that the energetically favorable redox reaction can occur only if electrons move through the external part of the circuit. A battery consists of some number of voltaic cells; each cell consists of two half-cells connected in series by a conductive electrolyte containing metal cations.
One half-cell includes electrolyte and the negative electrode, the electrode to which anions migrate. Cations are reduced at the cathode; some cells use different electrolytes for each half-cell. Each half-cell has an electromotive force relative to a standard; the net emf of the cell is the difference between the emfs of its half-cells. Thus, if the electrodes have emfs E 1 and E 2 the net emf is E 2 − E 1.
Medicare (United States)
Medicare is a national health insurance program in the United States, begun in 1966 under the Social Security Administration and now administered by the Centers for Medicare and Medicaid Services. It provides health insurance for Americans aged 65 and older, younger people with some disability status as determined by the Social Security Administration, as well as people with end stage renal disease and amyotrophic lateral sclerosis. Medicare is funded by a combination of a payroll tax, beneficiary premiums and surtaxes from beneficiaries, general U. S. Treasury revenue. In 2017, Medicare provided health insurance for over 58 million individuals—more than 49 million people aged 65 and older and about 9 million younger people. On average, Medicare covers about half of healthcare expenses of those enrolled. According to annual Medicare Trustees reports and research by the government's MedPAC group, the enrollees almost always cover their remaining costs either with additional insurance, or by joining a Medicare health plan.
No one uses United States Medicare only. No matter which of those two options the beneficiaries choose or if they choose to do nothing extra, beneficiaries have out of pocket costs. OOP costs can include co-pays. Medicare is divided into four Parts. Medicare Part A covers hospital, skilled nursing, hospice services. Part B covers outpatient services including some providers' services while inpatient at a hospital, outpatient hospital charges, most provider office visits if the office is "in a hospital," and most professionally administered prescription drugs. Part D covers self-administered prescription drugs. Part C is an alternative called Managed Medicare by the Trustees that allows patients to choose health plans with at least the same service coverage as Parts A and B the benefits of Part D, always an annual OOP spend limit which A and B lack; the beneficiary must enroll in Parts A and B first before signing up for Part C. The name "Medicare" was given to a program providing medical care for families of people serving in the military as part of the Dependents' Medical Care Act, passed in 1956.
President Dwight D. Eisenhower held the first White House Conference on Aging in January 1961, in which creating a health care program for social security beneficiaries was proposed. In July 1965, under the leadership of President Lyndon Johnson, Congress enacted Medicare under Title XVIII of the Social Security Act to provide health insurance to people age 65 and older, regardless of income or medical history. Johnson signed the bill into law on July 30, 1965 at the Harry S. Truman Presidential Library in Independence, Missouri. Former President Harry S. Truman and his wife, former First Lady Bess Truman became the first recipients of the program. Before Medicare was created 60% of people over the age of 65 had health insurance, with coverage unavailable or unaffordable to many others, as older adults paid more than three times as much for health insurance as younger people. Many of this latter group became "dual eligible" for both Medicare and Medicaid with passing the law. In 1966, Medicare spurred the racial integration of thousands of waiting rooms, hospital floors, physician practices by making payments to health care providers conditional on desegregation.
Medicare has been operated for a half century and, during that time, has undergone several changes. Since 1965, the program's provisions have expanded to include benefits for speech and chiropractic therapy in 1972. Medicare added the option of payments to health maintenance organizations in the 1970s; as the years progressed, Congress expanded Medicare eligibility to younger people with permanent disabilities and receive Social Security Disability Insurance payments and to those with end-stage renal disease. The association with HMOs begun in the 1970s was formalized under President Bill Clinton in 1997 as Medicare Part C. In 2003, under President George W. Bush, a Medicare program for covering all self-administered prescription drugs was passed as Medicare Part D; the government added hospice benefits to aid elderly people on a temporary basis in 1982, made this permanent in 1984. Congress further expanded Medicare in 2001 to cover younger people with amyotrophic lateral sclerosis; the Centers for Medicare and Medicaid Services, a component of the U.
S. Department of Health and Human Services, administers Medicare, the Children's Health Insurance Program, the Clinical Laboratory Improvement Amendments, parts of the Affordable Care Act. Along with the Departments of Labor and Treasury, the CMS implements the insurance reform provisions of the Health Insurance Portability and Accountability Act of 1996 and most aspects of the Affordable Care Act of 2010 as amended; the Social Security Administration is responsible for determining Medicare eligibili
Gasoline, gas or petrol is a colorless petroleum-derived flammable liquid, used as a fuel in spark-ignited internal combustion engines. It consists of organic compounds obtained by the fractional distillation of petroleum, enhanced with a variety of additives. On average, a 42-U. S.-gallon barrel of crude oil yields about 19 U. S. gallons of gasoline after processing in an oil refinery, though this varies based on the crude oil assay. The characteristic of a particular gasoline blend to resist igniting too early is measured by its octane rating. Gasoline is produced in several grades of octane rating. Tetraethyl lead and other lead compounds are no longer used in most areas to increase octane rating. Other chemicals are added to gasoline to improve chemical stability and performance characteristics, control corrosiveness and provide fuel system cleaning. Gasoline may contain oxygen-containing chemicals such as ethanol, MTBE or ETBE to improve combustion. Gasoline used in internal combustion engines can have significant effects on the local environment, is a contributor to global human carbon dioxide emissions.
Gasoline can enter the environment uncombusted, both as liquid and as vapor, from leakage and handling during production and delivery. As an example of efforts to control such leakage, many underground storage tanks are required to have extensive measures in place to detect and prevent such leaks. Gasoline contains other known carcinogens. "Gasoline" is a North American word. The Oxford English Dictionary dates its first recorded use to 1863 when it was spelled "gasolene"; the term "gasoline" was first used in North America in 1864. The word is a derivation from the word "gas" and the chemical suffixes "-ol" and "-ine" or "-ene". However, the term may have been influenced by the trademark "Cazeline" or "Gazeline". On 27 November 1862, the British publisher, coffee merchant and social campaigner John Cassell placed an advertisement in The Times of London: The Patent Cazeline Oil, safe and brilliant … possesses all the requisites which have so long been desired as a means of powerful artificial light.
This is the earliest occurrence of the word to have been found. Cassell discovered that a shopkeeper in Dublin named Samuel Boyd was selling counterfeit cazeline and wrote to him to ask him to stop. Boyd did not reply and changed every ‘C’ into a ‘G’, thus coining the word "gazeline"; the name "petrol" is used in place of "gasoline" in most Commonwealth countries. "Petrol" was first used as the name of a refined petroleum product around 1870 by British wholesaler Carless, Capel & Leonard, who marketed it as a solvent. When the product found a new use as a motor fuel, Frederick Simms, an associate of Gottlieb Daimler, suggested to Carless that they register the trademark "petrol", but by this time the word was in general use inspired by the French pétrole, the registration was not allowed. Carless registered a number of alternative names for the product, but "petrol" nonetheless became the common term for the fuel in the British Commonwealth. British refiners used "motor spirit" as a generic name for the automotive fuel and "aviation spirit" for aviation gasoline.
When Carless was denied a trademark on "petrol" in the 1930s, its competitors switched to the more popular name "petrol". However, "motor spirit" had made its way into laws and regulations, so the term remains in use as a formal name for petrol; the term is used most in Nigeria, where the largest petroleum companies call their product "premium motor spirit". Although "petrol" has made inroads into Nigerian English, "premium motor spirit" remains the formal name, used in scientific publications, government reports, newspapers; the use of the word gasoline instead of petrol outside North America can be confusing. Shortening gasoline to gas, which happens causes confusion with various forms of gaseous products used as automotive fuel like compressed natural gas, liquefied natural gas and liquefied petroleum gas ). In many languages, the name is derived from benzene, such as Benzin in benzina in Italian. Argentina and Paraguay use the colloquial name nafta derived from that of the chemical naphtha.
The first internal combustion engines suitable for use in transportation applications, so-called Otto engines, were developed in Germany during the last quarter of the 19th century. The fuel for these early engines was a volatile hydrocarbon obtained from coal gas. With a boiling point near 85 °C, it was well-suited for early carburetors; the development of a "spray nozzle" carburetor enabled the use of less volatile fuels. Further improvements in engine efficiency were attempted at higher compression ratios, but early attempts were blocked by the premature explosion of fuel, known as knocking. In 1891, the Shukhov cracking process became the world's first commercial method to break down heavier hydrocarbons in crude oil to increase the percentage of lighter products compared to simple distillation; the evolution of gasoline followed the evolution of oil as the dominant source of energy in the industrializing world. Prior to World War One, Britain was the world's greatest industrial power and depended on its navy to protect the shipping of raw materials from its colonies.
Germany was industrializing and, like Britain, lacked many natural resources which had to be shipped to the home country. By the 1890s, Germany