**บทความนี้เป็นประสบการณ์ส่วนตัวของเจ้าของรถ 2021 MG5 (MG Pilot) และมาจากเว็บไซต์ประเทศจีน ไม่ได้เป็นความเห็นของ
MG Extender 2.0 Giant Cab D 6MT ราคา 619,000 บาท- MG Extender 2.0 Giant Cab GRAND D 6MT ราคา 659,000
MG (เอ็มจี) ได้รับรางวัลแบรนด์รถยนต์ที่ความคุ้มค่ายอดเยี่ยม (Best Value Brand 2020) จากการประกาศผลรางวัล
หลังจาก MG HS รถสไตล์รถครอบครัวจากแบรนด์จีนเปิดตัวก็ได้รับความสนใจล้นหลาม และก็กลายเป็น Compact SUV ที่มียอดขายดีในกลุ่มได้อย่างรวดเร็วด้วยชื่อ
MG Motor (เอ็มจี มอเตอร์) แห่งสหราชอาณาจักร เปิดตัวบริการรูปแบบใหม่เพื่อเอาใจลูกค้าผู้ใช้รถยนต์ไฟฟ้าในสหราชอาณาจักร
2021 MG 5 (2021 เอ็มจี 5) เจนเนอเรชั่นใหม่เตรียมเปิดตัวออกจำหน่ายในเร็ว ๆ นี้ หลังมีภาพหลุดจากกระทรวงอุตสาหกรรมของประเทศจีนออกมาให้แฟน
MG HS (เอ็มจี เอชเอส) ถือเป็นรถอเนกประสงค์อีกรุ่นที่ได้รับความนิยมไม่แพ้ MG ZS ของค่ายเอ็มจีเลย ด้วยความโดดเด่นในด้านเทคโนโลยี
ดีกว่ารถทั่วไปอย่างไรข้อดีหลัก ๆ คือ สมรรถนะที่แรงขึ้น จากการทำงานของมอเตอร์ไฟฟ้า ที่เสริมแรงให้กับเครื่องยนต์ MG
2020 MG HS PHEV (เอ็มจี เอชเอส พีเอชอีวี) เปิดตัวอย่างเป็นทางการแล้ว เคาะราคาที่ 1,359,000 บาท โดยจะเป็นรถปลั้กอินไฮบริดรุ่นแรกของ
ค่ายรถยนต์ MG สัญชาติจีนเริ่มต้นบุกเบิกตลาดรถเอสยูวีมาได้สักระยะ ล่าสุดก็เปิดตัว Compact SUV รุ่นล่าสุดอย่าง
MG (เอ็มจี) ประเทศไทย ขยับสายการผลิตเพิ่มการผลิต MG ZS (เอ็มจี แซดเอส) พวงมาลัยซ้าย เพื่อเริ่มการส่งออกไปยังตลาดเวียดนามภายในสิ้นปีนี้
ความพยายามในการเดินหน้าตลาดรถยนต์ไฟฟ้าในหลายประเทศยังดำเนินการไปอย่างเข้มข้น หนึ่งในนั้นคือเจ้าพ่อรถยนต์ไฟฟ้าอย่าง MG
และต้องบอกเลยว่า MG กล้าหาญชาญชัยมากที่นำรถกระบะ MG EXTENDER (เอ็มจี เอกซ์เทนเดอร์) เข้ามาขายในประเทศไทย
MG (เอ็มจี) แบรนด์รถยนต์น้องใหม่ประเทศไทย ประกาศขึ้นแท่นผู้นำตลาดเอสยูวีในครึ่งแรกของปี 2563 ด้วยยอดจำหน่ายรวม
2021 Haval H6 และ 2020 MG HS2021 Haval H6 (2021 ฮาวาล เอช6) จะเผยโฉมอย่างเป็นทางการในประเทศไทยในช่วงปลายเดือนมีนาคมนี้
ความสำเร็จของรถอเนกประสงค์ค่าย MG ทั้ง MG ZS (เอ็มจี แซดเอส) และ MG HS (เอ็มจี เอชเอส) แสดงให้เห็นว่าค่ายรถยนต์น้องใหม่สามารถโค่นแบรนด์ยักษ์อันเก่าแก่ลงได้หากเดินถูกทางยอดขายสะสมของรถอเนกประสงค์ขนาดซับคอมแพ็กต์อย่าง
2020 MG ZS (เอ็มจี แซดเอส) รถเอสยูวีโฉมใหม่ได้รับรองมาตรฐานความปลอดภัยระดับ 5 ดาวจาก Asean NCAP แต่คะแนนการทดสอบยังด้อยกว่า
2021 MG ZS EV (เอ็มจี แซดเอส อีวี) รถอเนกประสงค์พลังงานไฟฟ้าล้วนจาก MG (เอ็มจี) ที่ออกแบบเพื่อตอบโจทย์การใช้ชีวิตสไตล์คนเมือง
เอ็มจี เอชเอส ปลั๊กอินไฮบริด เปิดตัวในราคา 1,359,000 บาท2020 MG HS PHEV (เอ็มจี เอชเอส ปลั๊กอินไฮบริด
แบงค์บอกต่อ เรามาดูโปรโมชั่นรถยนต์น่าสนใจหลายขนาดจากทางฝั่ง MG (เอ็มจี) ที่มีทั้ง 2021 MG ZS (เอ็มจี
MG V801.ภายใน MG V80 กว้างขวางจุดเด่น MG V80 ก็คือด้านความกว้างขวาง เนื่องจากตัวถังที่ค่อนข้างใหญ่ ถ้าเทียบกับคู่แข่งก็จะเห็นว่าความกว้างความยาวความสูงล้วนแต่มากกว่าแทบทุกจุด2
2021 MG EP (เอ็มจี อีพี) รถไฟฟ้าตัวถังสเตชั่นวากอนรุ่นใหม่ ได้เป็นตัวอย่างเป็นทางการพร้อมเผยราคาในงาน
MG (เอ็มจี) ลอนดอน ได้ทำการเปิดคอนเซปท์รถสปอร์ตคันใหม่ในนาม MG Cyberster แบบเปิดประทุน ก่อนที่จะมีรายละเอียดออกมาในงาน
**บทความนี้เป็นประสบการณ์ส่วนตัวของเจ้าของรถ 2021 MG5 (MG Pilot) และมาจากเว็บไซต์ประเทศจีน ไม่ได้เป็นความเห็นของ
MG ZS X+ vs.
MG HS C ราคา 919,000 บาท, MG HS D ราคา 1.019 ล้านบาท และรุ่นตัวทํอป MG HS X ราคา 1.119 ล้านบาท2.MG HS
MG (เอ็มจี) ในปี 2021 วางแผนที่จะทำการเปิดตัวรถยนต์ไฟฟ้ารุ่นใหม่ปลายปีนี้ ในตัวถังแฮทช์แบ็ค 5 ประตู อาจคล้ายกับ
รถต้นแบบ MG E-Motionรถสปอร์ตพลังงานไฟฟ้ารุ่นแรกของ MG (เอ็มจี) ยุคใหม่เตรียมเปิดตัวครั้งแรกในโลกภายในช่วงปลายปีนี้
ในงาน BIG Motor Sale 2020 ค่ายรถยนต์ MG ได้จัดโปรโมชั่นน่าสนใจให้กับรถ SUV ZS และ HS มาแล้ว ล่าสุด MG
แต่ละบ้านคงออกจะมาทำการไหว้เจ้าและบรรพบุรุษ หลาย ๆ บ้านก็เป็นวันจ่าย และสำหรับบ้านไหนกำลังมองหารถยนต์สักคันจะใช้ เรามีโปรดี ๆ จาก MG
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Quais estados do Brasil você já foi?1. PR 2. SP3. SC4. BA5. RS6. GO7. MS8. DF9. MG10. TO11. ALsó falta ir na casa da danada, até quando hein @?
25 motivos, 25 iniciales 1- AG 2- RB3- CG4- LT5- MG 6- DO7- WB8- AR9- MT10- AS11- AG 12- HN, MS13- RB14- AR15- LT, RH16- MG17- BO18- EP19- LT20- IR21- VR22- YG23- RH24- MG25- LSOLO PÍDELO SI LO VAS A HACER.
Barium chloride - Read in another language Barium chloride is the inorganic compound with the formula Ba Cl 2 . It is one of the most common water-soluble salts of barium . Like most other barium salts, it is white, toxic, and imparts a yellow-green coloration to a flame. It is also hygroscopic , converting first to the dihydrate BaCl 2 (H 2 O) 2 . It has limited use in the laboratory and industry. [ 5 ] Barium chloride Names Other names Barium muriate Muryate of Barytes  Barium dichloride Identifiers CAS Number 10361-37-2 10326-27-9 (dihydrate) 3D model (JSmol ) Interactive image ChemSpider 23540 ECHA InfoCard 100.030.704 EC Number 233-788-1 PubChem CID 25204 RTECS number CQ8750000 (anhydrous) CQ8751000 (dihydrate) UNII 0VK51DA1T2 CompTox Dashboard (EPA) DTXSID7044508 InChI InChI=1S/Ba.2ClH/h;2*1H/q+2;;/p-2 Key: WDIHJSXYQDMJHN-UHFFFAOYSA-L InChI=1/Ba.2ClH/h;2*1H/q+2;;/p-2Key: WDIHJSXYQDMJHN-NUQVWONBAL SMILES [Ba+2].[Cl-].[Cl-] Properties Chemical formula BaCl 2 Molar mass 208.23 g/mol (anhydrous) 244.26 g/mol (dihydrate) Appearance White solid Density 3.856 g/cm 3 (anhydrous) 3.0979 g/cm 3 (dihydrate) Melting point 962 °C (1,764 °F; 1,235 K) (960 °C, dihydrate) Boiling point 1,560 °C (2,840 °F; 1,830 K) Solubility in water 31.2 g/100 mL (0 °C) 35.8 g/100 mL (20 °C) 59.4 g/100 mL (100 °C) Solubility soluble in methanol , insoluble in ethanol , ethyl acetate  Magnetic susceptibility (χ) -72.6·10 −6 cm 3 /mol Structure Crystal structure orthogonal (anhydrous) monoclinic (dihydrate) Coordination geometry 7-9 Thermochemistry Std enthalpy of formation (ΔfH⦵298) −858.56 kJ/mol Hazards Safety data sheet See: data page EU classification (DSD) (outdated) Toxic (T) Harmful (Xn) R-phrases (outdated) R20 , R25 S-phrases (outdated) (S1/2) , S45 NFPA 704 0 3 0 Flash point Non-flammable Lethal dose or concentration (LD, LC): LD 50 (median dose ) 78 mg/kg (rat, oral) 50 mg/kg (guinea pig, oral)  LD Lo (lowest published ) 112 mg Ba/kg (rabbit, oral) 59 mg Ba/kg (dog, oral) 46 mg Ba/kg (mouse, oral)  US health exposure limits (NIOSH ): PEL (Permissible) TWA 0.5 mg/m 3  REL (Recommended) TWA 0.5 mg/m 3  IDLH (Immediate danger) 50 mg/m 3  Related compounds Other anions Barium fluoride Barium bromide Barium iodide Other cations Beryllium chloride Magnesium chloride Calcium chloride Strontium chloride Radium chloride Lead chloride Supplementary data page Structure and properties Refractive index (n), Dielectric constant (ε r ), etc. Thermodynamic data Phase behaviour solid–liquid–gas Spectral data UV , IR , NMR , MS Except where otherwise noted, data are given for materials in their standard state (at 25 °C [77 °F], 100 kPa). verify (what is ?) Infobox referenc e
Sounds like a case of brain inflammation from the Covid. Suzanne Gazda MD Integrative Neurologist, ISEAI Member Assume that in most/all neurological problems, there are one and or two things going on; BBB is leaking Neuro-inflammation from immune cell activation We address both with the same techniques: Turn off what is causing the leak--the Cell Danger Response (CDR), assaulting the brain. Improve brain homeostasis while up-regulating mitochondrial function and the body's way of cleaning out damaged cells, in order to regenerate newer, healthier cells (autophagy). The cells making up the BBB; glial cells & astrocytes are RICH in mitochondria. Some things that help boost mitochondrial function are; Intermittent fasting; Ketogenic diet promotes autophagy. In mice studies, 24 hours of fasting was best for the brain since in the brain in takes longer to turn on autophagy. Heal the Gut: the gut brain connection is a BIG deal Metabolic products produced by the microbiome, such as short-chain fatty acids, can cross the BBB to affect brain function. The role of gut microbiome and associated metabolome in the regulation of neuroinflammation in multiple sclerosis and its implications in attenuating chronic inflammation in other inflammatory and autoimmune disorders - PubMed Exercise Sleep The brain needs BOTH the BBB and the glymphatic for clearing mechanisms Disruption of these mechanisms can lead to protein accumulation and may initiate neurodegenerative disorders Interaction between blood-brain barrier and glymphatic system in solute clearance - PubMed Sunlight and Vit D: Vit D deficiency affects brain ‘scaffolding’ Low Vit D has been linked to neuropsychiatric diseases like schizophrenia Reduce stress There’s strong validity to the argument that it helps the brain relax, increases the blood flow to the brain, and reduces cortisol levels. A regular meditation practice has been shown to increase gray matter Loneliness increases inflammation Loneliness in healthy young adults predicts inflammatory responsiveness to a mild immune challenge in vivo The established link between loneliness and poor health outcomes may stem from aberrant inflammatory regulation. The present study tested whether lone… https://www.sciencedirect.com/science/article/pii/S0889159119303174?dgcid=raven_sd_aip_email Photo modulation with Red light therapy promotes mitochondrial function Heat Stress/IR sauna Support NAD: NAD is called the essence of life and has a key role in mitochondrial function Like Nadovim Nadovim 2 q am which is a mixture of a highly bioavailable form of NAD Cats claw Coenzyme Q 10 Mg Thiamine Other Mitochondrial function and autophagy supplements: Resveratrol 150 mg to 250 mg/day D-Ribose (Studies have looked at D-Ribose in neurodegenerative diseases such as early ALS and MS with promising results) High dose antioxidants (Vitamin’s C, D, E & A) Coenzyme Q 10 or Ubiquinone if older ALA (alpha lipoic acid) 200 mg bid N-acetyl cysteine-Human trials done after injury of active duty military NAC showed decreased brain inflammation and oxidative stress markers Metformin may help with autophagy/studies are mixed Isorhynchophylline, a natural alkaloid, promotes the degradation of alpha-synuclein in neuronal cells via inducing autophagy Autophagy, 8:1, 98-108, DOI: 10.4161/auto.8.1.18313 https://doi.org/10.4161/auto.8.1.18313 Control glucose and address insulin resistance: High blood sugar which Produces oxidative stress and inflammation and leads to… Insulin resistance in the brain Reduce obesity: Leads to inflammation August 20, 2019; 93 (8) ARTICLE Neurology July 24, 2019, In this study, Measures of obesity are associated with MRI markers of brain aging Reduced gray matter High-fat diet or Overeating Leads to leptin resistance Look to the Liver: Liver damage releases a signal called MMP9 into the bloodstream that increases BBB permeability Reduce overall toxic load: Chemical Heavy metals Up regulate detox mechanisms Avoid exposure Optimize oral microbiome Hormone balance: Studies have found that brain energy decreases up to 40% on average during peri- and early menopause, and Women in this group have more Alzheimer’s plaques than men of similar age or younger women. Progesterone and estradiol are steroid hormones that have neuroprotective effects on injured brain cells &… Progesterone potentiates the effect of vitamin D. Pregnenolone benefits the brain by helping regulate myelination. Make sure thyroid is optimized Reduce homocysteine Elevated Homocysteine damages the brain At Lewis Katz School of Medicine at Temple University, they show in mice that diet-induced increases in homocysteine levels directly contribute to the development of damaging neurofibrillary tangles, which result from the progressive accumulation of abnormal tau protein in the brain. Homocysteine should be 6-7 or less. Supplements to increase Brain-Derived Neurotrophic Factor (BDNF) Curcumin 750-1500 mg / day Cat's Claw please note that Nadovim has this in it Exercise Sleep Lion's Mane mushroom 500 mg once or twice a day Liposomal melatonin (given 2-3hr before bedtime) to reduce brain inflammation. I like to work up to 20 mg / day if tolerated for brain health/some say 100 mg is needed for optimal brain health but it’s tough to tolerate very high doses Cordycepin: Reduced pro-inflammatory cytokines and increased BDNF in mice w MS Int Immunopharmacol. 2019 Jul 26;75:105777. doi: 10.1016/j.intimp.2019.105777. Brain neurotrophics; DHE/DHA has been shown to promote amyloid-ß plaque clearance from the brain DHA has been shown to decrease tau tangles Phosphatidylserine (PS) important role in cell signaling Desensitizes hypothalamic cortisol receptors, and Serine can be converted into glycine, an inhibitory NT given at 100–300 mg/d in divided doses. Bacopa used in ancient medicine practices for 1000’s of years for memory and cognitive 200–600 mg/d in divided doses Green tea/ polyphenols or Whole coffee fruit extract (WCFE), 100 mg once or twice per day for three months, then withdraw slowly over one month. Eat 1 to 2 servings of dark chocolate • Consider 100– 300 mg green tea extract Synapsin Selegiline: Acts as an antioxidant and protects against glutamate toxicity CAUTION; MAOI Type B PQQ, or pyrroloquinoline quinone. PQQ is an enzyme cofactor possessing Antioxidative Neuroprotective; protects neurons by preventing the long term over-activation of the NMDA receptor 10 to 20 mg/ day Scutellaria baicalensis: Antioxidant Attenuates microglial activation Reduces neuroinflammation 2 or 3 teaspoons or 2 capsules per day, to enhance branching of neurons in the hippocampus. Other mast cell stabilizers like Luteolin Quercetin Mirica Dr Ackerly uses: Miraca at 2 tid in worst pain patients plus Neuroprotek 2 qd plus working up to 4.5 mg LDN Taurine Taurine helps with neurogenesis Increases cerebral blood flow, and Activates neuronal stem cells. Also great for liver support Glycine Magnesium threonate blocks the NMDA receptor L-tyrosine: 500mg/ day improves memory and focus Citicoline; 250 mg twice per day Vit B 6 20 mg tid L Theanine Helps with Sleep Depression Anxiety Memory L-Theanine: 100–200 mg/d. up to 800 mg/day in dd/blocks glutamate receptors Rhodiola For mental fatigue & stress 200mg once or twice a day or Ashwagandha 500 mg, twice per day with meals Ashwagandha helps in The reduction of amyloid, as well as in Handling stress) Ginkgo biloba Neuroprotection Studies have found that it has -oxidant and Anti-amyloid properties Huperzine A Inhibits the breakdown of the neurotransmitter acetylcholine Grape seed extract Potent anti-inflammatory Antioxidant Helps mitochondria Gotu kola 500 mg twice per day with meals, to Increase focus and Alertness Avoid Calcium supplementation in patients with PANS and PANDAS It can fuel the NMDA receptor Boost immune function IVIG One of the many reasons I love IVIG is because it has Neuroprotective effects and studies have shown it can Improve BBB function Dose must be 2 gm/kg LDN Tinospora cordifolia (guduchi) is helpful to Boost immune support. It is taken at a dosage of 300 mg with meals, 2 or 3 times per day CBD has many neurological and immune benefits Neuro-Inflammation & TBI Therapy https://fullscript.com/patients ; 1. High dose Omega 3 1-gram capsules twice daily (slightly increased risk of bleeding if on anticoagulants) but so helpful for the brain! 2. Anti-oxidants a. α-Lipoic Acid 100 mg/d to twice/d b. Zinc c. N-acetyl cysteine-Human trials done after injury of active duty military NAC showed decreased brain inflammation and oxidative stress markers d. Luteolin (NeuroProtek or NeuroFlam) (NOT available from www.FullScript.com ) e. Liposomal Curcumin (increases BDNF and up regulates Nrf2 pathway reducing oxidative damage in brain) f. Any of the Flavonoids will help. g. Vitamin C to bowel tolerance, taken 2-4 times daily as high a dose as tolerated without diarrhea. 3. Palmitoylethanolamide (PEA); PEA is a fatty acid that is similar to the endocannabinoids anandamide and 2-arachidonoylglycerol, though is not considered an endocannabinoid since it does not bind to the CB1 and CB2 receptors. a. PEA indirectly has an effect on the endocannabinoid system by upregulating anandamide activity. b. Anandamide and THC from cannabis both act on the CB1 receptors, which is why PEA and THC have similar effects such as reducing brain inflammation and pain, although PEA is non-psychoactive. In a sense, PEA can be considered an anti-stress molecule. c. During times of stress, PEA stores can be used up quickly, which is why supplementing PEA can be helpful for many different conditions. d. When glial cells become too active, they can cause brain inflammation. PEA modulates and reduces glial cell activity e. PEA supplements are often combined with the plant pigment luteolin in a 10:1 ratio. Luteolin on its own is also used to calm mast cells, but the combination of PEA and luteolin has been shown to be more effective than either substance by itself. f. The most researched PEA supplement is i. Glialia, a micronized combination of PEA and luteolin. Another ii. PEA/luteolin combination product available is Mirica (Amazon). 4. Melatonin has shown benefits in TBI (2-5 mg before bedtime, I also like the QS liposomal version) up to 20mg/day with titration (the pineal gland post TBI shows up to 40 % reduction in melatonin production) when given within 1 day post‐injury, brain & serum had: a. Increased anti‐inflammatory & anti‐oxidant proteins: IL‐10, IL‐4, SOD, GSH, glutathione peroxidase, & anti‐ inflammatory gene expression b. Reduced inflammatory proteins: IL‐1β, TNFα, & malondialdehyde. 5. Reduce NMDA over-activation and up regulation of glutamate (neuro-excitatory) release a. Namenda 10 mg/day has been used as an NMDA antagonist b. Magnesium is definitely depleted in ALL brains but especially in brains on fire c. Magnesium Dosing; (Safe to try along with other cofactors & meds Adult doses): i. 125‐500 mg QD. Mainly glycinate or taurinate used. ii. 125‐300 mg QID (with meals and at bedtime) iii. Or higher doses 400‐500 QD. iv. Certain forms (citrate & hydrochloride) and higher amounts can cause diarrhea. v. L‐threonate form increased CSF levels. 6. Increase GABA/Gaba supplementation a. Taurine (an amino acid that increases GAD enzyme and therefore GABA ) 7. Using taurine and glycine together seems to really help with pushing bile (even more effective if you add choline) Taurine is good for heart and eyes and has been documented to increase hippocampal flow in the brain. 8 For excessive vigilance/hypersensitivity to sound etc; Theanine Taurine GABA Phosphatidyl serine and an adaptogen herbal formula 9. BBB Disruption; Intranasal Restore, oral NeuroProtek, Mirica, nutritional repletion (or IV Myers, GSH, PC), meditation, DNRS, BDNF. 910. Gut .... we know that within a few hours of TBI .... the patients show GUT dysregulation.
The T-72B3 Image from . The T-90 Image from The bellow is all from http://www.kampfpanzer.de/vehicles/t-72 The T-72B3 is an upgrade for older T-72B developed for the Russian Army. It was developed due to the relatively high price of the Rogatka upgrade, which is rollout in limited number only. First part of the upgrade is the ballistic protection. If not already available, the tank is being equipped with Kontakt-5 ERA. For later T-72B using the packages already, the design is slightly changed at the turret front. The basic armour was not upgraded. Most significant change is the usage of the SOSNA-U based fire control system. It is replacing the old 1A40 FCS and the 1K13-49 night sight. SOSNA-U provides the gunner with day and thermal sight, as well as capabilities of using laser guided ATGM. The commander has not received any new sight and is stuck with the old TKN-3 sight without stabilization. But he is now equipped with a small screen to see the thermal image of the gunner. Armament of the tank was changed by adding the new 2A45M-5 main gun used by the T-90. The gun was added including upgraded stabilization system and auto loader. Final change is the usage of the new R-168-25UE-2 radio systems. These radios allow encrypted digital voice and data transfer, though the later one is not needed for the tank. The T-72B3 is a tank upgrade designed by controllers. It adds some new features to an old tank, but doesn’t go far enough. There is no massive upgrade of the armour, the propulsion was unchanged and the commander still lacks his own sight. The armour protection of the tank has to be called below expectation, as there are massive ballistic gaps at the turret front. Suspension is only protected by rubber skirts and not the metal skirts with ERA known from the T-90. The tank has been fielded with the Russian Army, but there is also an additional upgrade, going beyond the defined changes. It is called the T-72B3M, also know as T-72B4. T-72B4 First Appearance: 2014 Country: Russia The T-72B4, often called T-72B3M, has been presented in public during the 2014 tank biathlon in Russia. It is another combat improved version of the T-72B and will be slowly fielded by the Russian Army in the next years. The tank is based on the T-72B3 project, but goes slightly beyond that. The tank does not receive much of a protection upgrade. The turret is still insufficiently covered with Kontakt-5 modules. The side skirts are now T-90 style, including the large flat ERA modules. Most significant change is the usage of an independent sight for the commander, mounted at the turret top between the two hatches. It is the same B07K1 sight used for BMPT and T-72 Redut. The sight contains a day channel and a laser range finder, as well as an image intensifier. A thermal sight for the commander is not present. The sight is fully stabilized and allows the commander to observe the battlefield, assign targets to the gunner and direct the turret. TKN-3 sight is still present as a backup, as is the TPD-K1 for the gunner. Major improvements can be found in the hull. The tank received the propulsion system of the T-90MS. This includes the brand new V-92S2F engine, developing 1.130hp. It also covers the automated transmission control, often mixed up with a proper automatic gearbox, as well as electronic driver controls and steering wheel. The engine upgrade can be recognised by the T-90 style exhaust box on the left hull side. The T-72B4 definitively one of the most agile T-72 versions made in recent years. The power boost is significant and will improve overall mobility. Adding an independent sight for the commander is another big step ahead, lacking thermal sight makes it less powerful and not as helpful as it could have been. T-90A First Appearance: 2000 Country: Russia The T-90A is an upgraded version of the T-90, displayed for the first time in the year 2000. Additional funding available for the Russian Army allowed subsequend fielding. Until finalization of the production in 2011, 370 T-90A were handed over. The T-90 has been in use for 10 years and it was about time for an upgrade. The most visible change is the use of a new welded turret. It is very similar to the one developed for the object 187, but not the same. The T-90A turret does not hold the ABC filtration system, it is still placed in the hull rear. The new turret offers a much higher protection level than the older cast one. It is also covered by Kontakt-5 ERA. To further increase the protection, the tank can be equipped with the Nakidka camouflage system. It is placed over turret and hull, significantly reducing the radar and thermal signature of the tank. Changes inside the tank have been made to the fire control system of the gunner. The first one is the 1V216M switch block, used to store ammunition data. It can now contain up to 25 different types, including the latest Russian APFSDS rounds. the first batches of the T-90A were delivered using the latest Buran-M night sight. It is still only an image intensifyer, but more powerful than the older Buran-PA. Since 2006 the T-90A was being fielded in it's fnal configuration, which replaced Buran by ESSA. The sight is similar to SOSNA-U used for the T-72B2/3 upgrades, but it contains only a night sight based on the Catherine-FC thermal camera. ESSA is electrically stabilized in the vertical plane, which means independent from the movements of the main gun. Horizontal stabilization is done by the turret. The new sight is electronically linked to main gun and 1G46. This allows also the boresighting of all three devices to a common mark and thus the usage of the laser range finder when operating the thermal sight. The sight offers 3x and 9x magnification and can be used at ranges of up to 5km. This enables also the usage of the 9K119. A last improvement of the T-90A is the usage of the more powerful V-92S2 engine, developing 1.000hp. To ensure proper cooling, the tank is equipped with an improved cooling fan in the hull rear, replacing the one previous versions of the T-72 used ever since. The new fan has a much larger throughput and use a wider area of the hull to blow out air. One last change to mention ist the TVN-5 sight for the driver. It is a replacement for the older TVN-4. The sight is using a combined active/passive image intensifier, which means the driver does not have to switch between the two. T-90SM First Appearance: 2011 Country: Russia The T-90SM is currently the latest and most modern version of the T-90. The tank was presented back in 2011 for the first time and is constantly updated. The configuration of armour modules or searchlights changed over the years, but these modifications don't show different vehicles. The tank can be seen as a technology demonstrator for export customers. Main focus of the development was an overall combat improvement of the T-90, covering all functional areas. With other parallel developments for the Russian Army, it is currently unlikely that the T-90SM will be fielded in Russia. The first export customer to receive the moderniced version of the T-90S will be India. The tank was presented just about the same time the production of the T-90A was running out. As many people were expecting the new version to be fielded in Russia, other designations like T-90MS or T-90AM can be found. All are related to the same project. Design The tank is a typical member of the T-72 family of tanks, but with some important modifications. Most important is the massive usage of add-on armour for turret and hull. The turret is still mounted on top of the hull center, but it is much larger in size. Besides normal equipment, it is now also carrying an ammunition storage at the rear. Other new turret features are the large sight for the commander and the remotely controlled weapon station. The T-90SM shows the currently improvements available for the T-90. But they also show that it is getting more and more difficult to add systems or armour. Compared to the T-90A, the MS is already higher and also heavier. The tank is giving up two important features, which kept it separate from its western counterparts. For the future I would like to wish for a new concept and a more radical improvement. Propulsion The tank is using the new V-92S2F engine, developing a max power of 1.130hp. The additional power is needed to compensate the weight increase. Another new feature is the control of the transmissions. The driver is equipped with a proper handlebar and a new gearshift. The driver is selecting the highest gear to be used and the transmissions would be shifted automatically. Alternatively, the driver can also shift each gear manually. Shifting and steering signals are transferred electrically to the control unit in the hull rear. The control unit is then activating brakes and clutches in the two transmissions to enable steering and changing gears. The new system covers several requirements. First is the relief of the driver, as he is supported by the system and gearshifts are only done if multiple parameters are met. As braking is only done using a pedal, the risk of human errors is also reduced and wear is reduced. All together, the new transmission is a step ahead. But it does not replace a proper automatic transmission, used to modulate the torque flow to support driving and steering. Another propulsion related change is the usage of an engine control system. It is used to monitor various propulsion related parameters and inform the driver. It is also used to automatically perform certain actions, e.g. switch off the engine in case of a cooling system failure. A new system in the hull rear of the T-90MS is the auxiliary power unit. Finally, a diesel powered model is used, which run on the fuel provided by the tank. The system is mounted in the left rear hull, slightly extending it. The DGU5-P27.5-VM1 is controlled by the driver from inside the vehicle, the max power is given with 5kW. Suspension The suspension has been taken unchanged from the T-90A. It uses six road wheel pairs on each hull side, connected by torsion bars. The frontal bars were strengthened to compensate the weight increase and movement of the center of gravity towards the hull front. The tracks are also similar to the T-90A ones and can be equipped with removable rubber pads. Fire Control System The most exciting improvement rolled out with the T-90SM is the Kalina fire control system. It is basically the most powerful FCS every installed in a Russian MBT. It is fully digitalized and uses several modules to provide the different functionalities. Data is being exchanged using a powerful bus system. It allows access to data from different stations and subsystems. Only the day channel of the gunner’s sight is setup as a purely optical device. All other sights are using cameras and optical pre-processing. Most important sight of the tank is the SOSNA-U, which is used as main sight for the gunner. It contains a day channel, a thermal camera and a laser range finder. The sight is also capable of transmitting guidance signals for laser guided anti tank missiles fired thru the main gun. SOSNA-U is mounted infront of the gunner and the large housing can be identified on top of the left turret side. Unlike other Russian tanks using the same sight, the sight mirror head is protected by armoured doors, which can be operated from inside the tank. The gunner does not need to step outside the vehicle to open the sight and get the MS combat ready. The T-90SM is also equipped with a proper secondary sight for the gunner. It is setup as a day sight and is placed in a small housing in front of the main sight. The housing is armoured as well and equipped with a small door at the front. As the housing is fixed to the turret roof, the contained camera has been mounted in a way, that it can be moved vertically. The sight is mechanically connected to the main gun and follows its movements. The image generated by the sight can be shown on small displays mounted at the stations of gunner and commander. During an outage of the fire control system or the main power supply of the tank, the auxiliary sight can still operate for about one hour, as it is equipped with a separate battery. The third sight available with the tank is the commander’s sight, called Hawkeye (Соколиный глаз). It is completely independent from the turret and contains thermal sight, day channel and laser range finder. The sight can be rotated independently from the turret. It is mounted behind the commander’s hatch and electrically powered. It is also used to mount the commander’s weapon station. The sight is stabilized independently from turret and main gun in both planes. The commander is able to detect targets, assign them to the gunner or take over control of the main gun. The fire control system is again using a brought range of sensors, which are automatically capturing data. Most visible sensor is once again the cross wind sensor, mounted at the turret top. Other sensors deliver values for cant, turret position, vehicle speed, temperatures and atmospheric pressure. On top come correction values for the different ammunition types, data from the muzzle reference system, range to target and turret speed, which are all fed into the 1V528-2 ballistic computer. Based on the values, the aiming point of the main gun is being calculated and the main gun unblocked. The system works fully automated, all the gunner needs to do is aim and lase at the target. By connecting many turret and hull systems, the T-90SM is able to provide several new functionalities. The first is the usage of an automatic target tracking system. Using the thermal sight, the system is able to detect the target and follow it automatically. The system can be activated using both thermal sights. The commander can track targets using his panoramic sight or the turret, the gunner only with the turret. The autotracker also provides an inertial mode. Here the system is following the path rather than the image of the target. This is useful if the target is shortly covered by an obstacle and not visible anymore. The tank would simply continue tracking at the same speed. A similar system is also available with the Leclerc. Other modes, e.g. the automatic observation of a given area and automated detection of targets are not possible yet. A second function is the IFF, enabling the tank to identify friendly troops. The system does not use active sensors, but tactical data provided by the information system. Last but not least, the commander of the T-90SM is able to fire and direct ATGMs using the laser guiding system installed in the gunner’s sight. Kalina has to be seen as big step in the development of Russian Fire Control Systems. The nearly complete integration of digital systems enables new functionalities and allows further improvements in the future simply by upgrading the software. Armament The T-90SM is using the 2A46M-5 main gun. The smoothbore gun is the latest version of the D-81 family of guns. It allows increased accuracy at lower wear of the system. It can be used to attack a wide range of targets at ranges up to 6.000m. Direction of the gun is done using an electro-hydraulic stabilization device. As usually, the horizontal turret drive is fully electric, while the vertical gun drive is electrohydraulic. The gun is equipped with an automatic boresighting device. It measures the gun barrel displacement and provides the fire control system with the relevant correction values. The system can be identified by the mirror on top of the muzzle and the optical device on top of the gun mantlet. Loading of the main gun is done using a carousel autoloader. It is electrically powered and as usually mounted below the turret. It is now using a special liner to minimize the splitter damage in case of a penetration. It has also been upgraded to be able to handle longer grenades. This small but significant change enables the development of new and more powerful tank rounds in the near future, as well as the usage of a different main gun. The T-90SM can use the same rounds available for previous versions of the tank, covering APFSDS, HEAT, HE-FRAG and ATGM. A total of 22 rounds and charges are stored in the autoloader, another 10 in the fighting compartment. For the first time in Russian tank design, the T-90MS is using an external ammunition storage at the turret rear. It contains three chambers and can be accessed from the top only. The two outer chambers contain found rounds, while the center chamber holds 8 charges. Removing ammunition from the fighting compartment is often explained with the separation of fighting compartment and ammunition. But it is most likely also done to free space inside the tank needed to store the turret electronics. Secondary armament of the T-90SM consist of two 7.62mm PKTM machine guns. One is mounted to the right of the main gun. It has to be noted that the gun is firing thru a relatively small opening in the turret frontal armour. A second PKTM is placed in the T05BW-1 weapon station, mounted on top of the commander’s sight. It is replacing the normal 12.7mm MG. The weapon station is directed from inside the tank using the Hawkeye sight of the commander. It is stabilized in two planes and can be rotated with the sight by 360deg. By incorporating the weapon station into the fire control system of the tank, targets can be tracked automatically. And the system is blocking the gun in case it would hit parts of the tank, like main gun or turret sensors. The PKTM is used against soft and aerial targets at ranges up to 1.500m. The elevation of the weapon is -10 to +45deg. This is slightly less than the +66deg a 1ETs29-4S mount is delivering to the T-90. Using the relatively small PKTM has a positive impact on the gun mount size and the complexity of the stabilization unit. It also allows the placement of 800 ready rounds directly at the gun. Additional 2.000 rounds are carried inside the tank, but they are shared by the two machine guns. Crew The crew of the T-90SM consists of three soldiers, driver, commander and gunner. The individual stations were massively improved and are not comparable to previous versions of the tank anymore. The driver is placed centered in the hull front. The seat is mounted on the hull ceiling, which improves the protection in case of a mine detonation under the vehicle. The controls of the driver are complete replaced by new ones. He is now using a steering handle, replacing the usual steering levers right and left of the driver’s seat. Steering itself is now done similar to a normal car. Same goes for the pedals. Driver only has a pedal for acceleration and braking, there is no clutch. The gearshift is mounted to the right of the driver. It allows the automatic or manual selection of the forward and the manual selection of the reverse gear. In the automatic mode, the driver selects the highest possible gear and the automatic picks the one that fits to the current driving situation. Signals for steering, braking, accelerating and gearshift are transferred electrically to the hull rear control boxes. This is the first step to enable automatic gear changes at all and thus reduce the impact of driving errors. Shifting gears is based on the position of accelerator and brake, selected gear, steering signal, current gear and vehicle speed. The transmissions have not changed. They are still providing the 7 forward and 1 reverse gear. Steering is enabled by brakes and gear changes too. Another new feature is the usage of the digital control and information system BIUS. It is constantly controlling vital functions of the tank and displays them at the driver’s station. One display is used to show the current driving data, e.g. vehicle speed, distance and current gear. The second display is used to show the status of systems and errors in case of issues. It is also used to start certain systems like the APU. A final improvement to the driver’s station has been done regarding the sight. The tank is now using the modern TWN-10 sight, containing day channel, thermal sight and image intensifier. The sight is still mounted in front of the driver in the hull front. The day channel does not provide any magnification and is setup as a direct view. It is used by the driver to observe the field in front of the tank during daytime. Thermal sight and image intensifier are used during bad visual conditions or night. Both images are shown on a small display. It is also possible to overlay both images, creating a high contrast display. The two small TNPO-168V sights placed in the hatch are also available, extending the field of view to the sides. The gunner is still placed in the left side of the turret. Compared to previous versions of the T-72, the station has been heavily reworked and modernized. The usage of new sights and controls allow a much clearer presentation of the station. Unfortunately, a bad habit has sneaked into the ergonomic setup of the gunner’s controls. It can be historically explained, but seems to be a fixed part of Russian tank development by now. Directly in front of the gunner is the control handle for turret and main gun. It is placed at the same position as it was with the TPD-K1 before. The large optic itself was removed and the space taken by the ammunition select panel. To the left of the control handle is the SOSNA-U sight with its monocular eyepiece of the day channel. To use the sight, the gunner will have to constantly lean to the left side. Even more to the left is the screen to display the image of the thermal sight and the auxiliary sight. Below is the gunner’s control panel. A quite similar configuration can be found in modernized T-72 tanks like the T-72B3. To easy the daily work of the gunner, a central eyepiece just above the handle would be certainly much more appreciated. For the first time, the gunner is equipped with his own direct view periscope, mounted at the left turret side. Access to the gunner’s station is done thru a small hatch in the turret top, opening to the front. The commander is placed in the right site of the turret. As his station was completely digitalized, it is not comparable to other Russian tanks anymore. The changes start already with the new cupola. It is now only used to allow access to the commander’s station, but not anymore to direct sight or armament. It is fixed with the turret and can not be revolved anymore. Eight periscopes allow the commander to observe the direct surroundings of the tank. The hatch itself is also new and not at all similar to the ones used before. Using a small mechanic mounted on the front of the cupola, the hatch can be set to several positions. It can be flapped open or closed, but also set to a so called umbrella position. Here the hatch is in a position similar to closed, but it in a certain distance above the cupola. This gives the commandeer some protection, but at the same time allows observation from inside the cupola. Similar is available with the Leopard 2 until version A4. When the hatch is fully closed, the commander is using the periscopes for observation. Each periscope is equipped with an index switch, which allows turning the commanders sight into the direction of the individual periscope. Additional near field observation devices for the commander are small cameras mounted around the turret. They allow a nearly 360deg field of view around the tank. The sensors used are quite sensitive and can also be used in bad visual conditions. The commander’s station is now covered by several clearly structured controls and panels. Directly in front of the commander is the control handle. It is used to direct the commander’s sight, but also turret and main gun. Above the handle is a large colour display. It is used for navigation and digital data communication with other units. The screen can display tactical information on a map and allow the commander to gather an overview on the current situation. It is also used to display vehicle information or setup the configuration of the turret systems. To the left of the main display is a second smaller one. It can only display grey colours and is used to present the images delivered by the different sight systems of the tank. Unfortunately, the commander will have to switch between different sights and cannot simply display their images in parallel or even overlaid. The commander’s station is also equipped with several control panels, enabling control over the fire control system, the sights and the automatic loader. Protection system Besides the fire control system, the improvement of the active and passive protection was one major requirement in the development of the T-90SM. Most visible change is the usage of Relikt ERA. Compared to the previously used Kontakt-5, Relikt offers a significantly higher level of protection against incoming HEAT and kinetic rounds. The new armour consists mainly of 4S23 modules, which are placed on hull and turret front, as well as the turret top. The new armament can be recognized by the much closer coverage of the basic armour. As the T-90SM is not using any IR jammers, the reactive armour is added on the turret until close to the main gun. Another advantage of Relict is the possibility to replace modules easier, as they are not build into the hull front anymore. The hull sides are covered over the full length by heavy side skirts. The lower part of the skirts is additionally covered by metal-enforced rubber skirts. These light skirts are flexibly mounted, so they don’t get damaged when driving through rough terrain. Beside increasing the passive protection, the large scale usage of skirts is also reducing the IR signature of the suspension and suppressing the dust clouds. If needed, 4S24 ERA modules can be mounted on top of the side skirts. As they are quite heavy, the modules are not mounted during normal operation. The rear sides of the hull are also equipped with slat armour, meant to detonate incoming rounds before they hit the vehicle. The turret front is also heavily armoured with the new Relikt modules. The same goes for the area of the turret top in front of the two hatches. Turret sides are not covered with ERA, but storage boxes and add on armour plates. The later ones are similar to the heavy side skirts and simply detonate impacting rounds earlier. The turret rear is again protected by slat armour, which also acts as storage basket. All together, the T-90MS has a much smoother surface compared to previous T-72 versions. This significantly reduces the radar cross section of the tank, a fact especially important in times of air born anti tank threats. As the T-90A, the T-90SM can also be equipped with the Nakidka camouflage system, which allows a further reduction of IR signature and RCS. The passive protection inside the fighting compartment has been improved by a massive use of spell liners. It is added to the vehicle walls and protects the crew in case of penetrating hits. The tank has also been equipped with fire suppression and NBC protection systems. The T-90SM is using the Shtora-1 active protection system, but without the IR jammers usually mounted at the turret front. The system has been improved in a way, that the sensors covering a wider area and reacting in a broader spectrum to potential threats. Shtora has been connected to the commander’s sight and will turn it into the direction of a detected laser signal, but not the full turret anymore. The system also comes with a total of six smoke grenade dischargers mounted on each side of the turret. The special placement of the launchers allows laying of smoke is a more complex way, depending on the current need. If switched to automatic, Shtora-1 can fire smoke grenades automatically in the direction of a detected laser signal and block it by a rapidly setup aerosol curtain. Communication The T-90SM is equipped with two different radio sets. The first one is the R-168-25UE-2, used for voice communication. Communication is being secured by using encryption, as well as very fast frequency hopping. The system can communicate in parallel in two different radio channels and has a max range of up to 40km. The second radio set is the R-168MRAE, which serves for data communication only. It allows the setup of encrypted subscriber networks using multiple stations. Today, R-168MRAE is used to exchange tactical information between different vehicles. Other functionalities like assigning targets to different vehicles, control the FCS of several vehicles or coordinate fire might be possible. These functionalities are not present yet, but maybe one day. The technology would support them. The range is the data communication depends very much from the area, as well as the speed of the vehicles. Static vehicles can communication at ranges of up to 20km, while moving ones have to be as close as 6km. Special Equipment The T-90SM is equipped with an electrically powered air conditioning system. It is mounted in a metal box on the rear part of the right turret side. Cooled air is being transferred into the vehicle and released at the different stations. Each crew member has a control panel to regulate the air flow. Performance The T-90SM is the most powerful version of the T-72 ever made, but also the largest and heaviest. It is packed with modern technology and allows optimized control of vehicle and armament. Powerful sights enable commander and gunner to attack targets fast. There is no western tank that the T-90SM would not be at least equal in performance. Automatic target tracking is a feature which is not found in other tanks very often. The future of the T-90SM will be most likely the combat improvement. There is a large number of older T-72 and T-90, which are desperately waiting for improvements. For Russia, I would hope development will do one more step.
What should I know about Bernie Sanders’ Medicare for All bill? just a few things Bernie does not have Medicare What we should be looking at is they do not want it for themselves In fact Medicare does not not appeal to Bernie or Ms Warren Both are eligible, and have been for a decade. Neither took it. Neither did they put the family members on it Neither did Uncle Joe Aside form all the other arguments - and there are many, that they choose not to take it for themselves and the “loved ones” is the best single argument against it. What do they know we the public are not being told? Actions always speak loader than words. - In a nutshell - It is grossly incomplete, and not really serious as a proposal there are 4 key aspects to consider - here is the only active proposal: https://www.congress.gov/115/bills/s1804/BILLS-115s1804is.pdf studied as written, with 3 ultimate outcomes: https://www.mercatus.org/system/files/blahous-costs-medicare-mercatus-working-paper-v1_1.pdf So far the quibbling is not about the actual numbers in the study - just about details in the weeds, like did the private sector being phased out get fully counted into the proposal and the focus os only on the perfect enactment situation, and it possibly saving 2 trillion over 10 years compared to an old (outdated btw) national health care cost projection. The other two situations, with less than perfect outcomes - will cost more - 1) It does not address - The major undisclosed flaw in Medicare payment system of Medicare for All is that Medicare only pays for the actual treatment - there is no payment or percentage added to cover the costs of the building, staff, equipment or facility. Once it is Medicare for all - the payments MUST go up to replace the costs that are now shifted to private insurers. 2) The existing Dr shortage - AND If doctors choose to retire rather than accept the reduction in payment that is Medicare - 20% of the doctors are at and over retirement age, the shortage will expand at the same time the number of patients are expanded - 3) to go to a single payer system, the initial one-time cost will be high. - very high as in Trillions, since the only proposed model is Medicare for all Here is a partial list of all that will need to be addressed to put in and maintain a Medicare for All system NONE OF WHICH IS ADDRESSED FULLY in Bernie’s Program We will need a NATIONAL ID number / I D card system, and the Social Security number is ILLEGAL for that purpose - which is why we have new Medicare Cards to everyone - but the cards are not designed for high and lifetime use The Federal Government is barred from paying for Abortions - we will need to redo the abortion debate The Single Payer debate will require a decision of how much care will be covered in end of life, as well as what medications and what treatments will be covered at a national level - EVERY OTHER NATION RATIONS MEDICAL CARE to get those lower per capita costs The Single Payer issue requires a solution to the immigration situation FIRST we have 60,000 trying to enter the U S EVERY MONTH that we ACTUALLY CATCH over the U S / Mexico border. Since we know we do not catch 100% - we need a plan to add those illegals to the system, or a decision on immigration we need a policy - do we treat those who have no ID, or do we turn them away? we have 20 to 30 million in the U S that today can not buy coverage, because they have no legal status to be able to do so we need to manage the enrollment of all of the homeless in the U S we need to manage the 30 million who have chosen to not get coverage - and get them enrolled All 57 sets of Insurance laws will have to be redone All 57 sets of IRS laws will have to be redone Medicare 4 All requires NEW contracts and terms with EACH doctor - best guess - 40,000 + of them Medicare 4 All requires NEW contracts and terms with EACH doctor - all 1.1 million of them Medicare mandates use of ICD-10 Medicare will have to be revised to add all it does not cover, and payment rates and structures will have to be established U S Governments tax medical care, devices and drugs - which adds 20% (low estimate) to the cost of care. Those taxes need to be relocated to other parts of the economy, or built into the NEW system. U S Governments mandate extra reporting on medical care - which adds 20% (low estimate) to the cost of care. Those costs need to be built into the NEW system. U S purchasing of drugs requires use of FAR system The FAR system is not staffed for Medication purchasing, Medical supply and equipment purchasing at a national level. This will need to be staffed up. FAR requires product descriptions to be in place for each purchased item - these need to be written and revised to stat semi-current (this is why the VA is about 10 years behind in technology) FAR requires master contracts with each provider - and there are 1000 drug makers. (this and the following is why the VA is about 10 years behind in medication technology) FAR requires sub contracts for each medication dose - so a drug in 5 mg, 10 mg, 20 mg, 100 mg and 250 mg = 5 sub contracts. FAR Purchasing contracts require quantity per shipment / contract. FAR requires contracts to be revised regularly. the U S will have to revise how Government purchased drugs get into the PUBLIC distribution system that is in place, or set up a new PUBLIC distribution system Medicare is not set up to manage the daily Rx claims that private insurers now manage Medicare is not set up to manage the claims volume of 330 insured people - it is already failing to manage the claims for onl20 million on Original Medicare google “Medicare denies more claims” for more details staff would need to be hired, certified, background checked, and put in OPM retirement system IT systems would need to be built - Medicare IT is 20 years out of date and behind the doctor’s systems new claims pathways and processes would need to be set up for issues not covered by current Medicare (outpatient Rx, dental & vision processes do not exist) - 4) the end results would be a lower per capita cost with universal coverage. Maybe. In how many years / decades ? Just to remind you - the U S medical condition is worse than EVERY other nation with Universal Health Care Worse medical condition = higher lifestyle induced illnesses, chronic health issues , prescribed medication use, addiction rates, obesity issues and it’s medical effects, and higher demand for advanced diagnostics and end of life deterrence medical issues Since we are not going to kill all of those people off, and we are not going to deny them medical care - In how many years / decades will we have a lower per capita cost? Bernie says we need between 30 and 40 T for his 2017 proposal The adjusted gross U S income total is about 10.8 T so 10.8 T less 3 T for M4A, less another 3 T for other federal govt, less 1 T for state and 1 T for local government fast napkin math - leaves each of us about 8K for life
Q: “What else should I be doing? I am borderline diabetic, but I am not on medication. My doctor agreed that I have been consistent by managing it through diet and exercise.” To start… as already noted by Ms. Barber, the concept of “borderline diabetes” (aka, “Pre-diabetes”) is an ABSURDITY. The diagnostic criteria are set INTENTIONALLY HIGH, to “…AVOID over-diagnosing the disease.” Those are the words of the diagnositicians that set the criteria. Let’s review the two primary criteria. FBG, or FPG (Fasting Blood or Plasma Glucose) in non-diabetics is ALWAYS BELOW 100 mg/dl… usually in the low 90s mg/dl, or upper 80’s mg/dl. That’s below 5.55 mmol/L for non-U.S. readers. BUT… from 100 to 125 mg/dl (5.55 to 6,99 mmol/L) is called “pre-diabetes”, or “borderline diabetes”. It’s simply too high… but not “official” yet. From 126 mg/dl (7.00 mmol/L) and up is diabetes. The HbA1c test, which is NOT any kind of blood glucose test, but rather, a glycated haemoglobin test, is often used as a diagnostic tool. It is a measure of the percentage of your haemoglobin that has glycated, which means bound chemically to the glucose in your bloodstream. In non-diabetics, this ranges from 3.5% to 5.5%; from 5.7% to 6.4% is called “pre-diabetes”, while 6.5% and up is diabetes. Unfortunately, MOST newly-diagnosed diabetes mellitus patients are ALREADY suffering from “complications” caused by elevated BG (Blood Glucose) levels. If the clinicians would stop putting off the diagnosis, and stress the importance of early treatment, fewer people would experience that unnecessary damage. Here’s a worthwhile article on the subject: Prediabetes Equals Diabetes -- Complications Begin Before Type 2 Okay… enough of that rant. On to your query. “Diet” and “exercise” are rather vague terms; it’s good, and important to do those things - but it’s important to KNOW that it’s working, day to day. You learn that by TESTING YOUR BG regularly. Following is a T2 Primer I wrote for another query, which I’ll quote here since it’s on point to your query. It contains a lot of links to reliable information on managing T2 - and “pre-diabetes” (a condition akin to being “a little bit pregnant”). Use it as much or little as you like… but from this, you can take control of your T2 and keep yourself from developing those nasty “complications”. These sources provide more specific guidance on how to achieve that. “T2 is an hereditary disease (meaning it's not only genetic, but often transferred from one generation to the next - though that's not a "requirement") caused by a certain combination of genetic alleles that cause a biochemical problem called IR - Insulin Resistance. In short - although your pancreas produces all the insulin you should need - your body's cells don't respond to it efficiently. Insulin's job is to transfer glucose (a simple form of sugar, and the only kind your body can use to fuel its cells) from the bloodstream (your body's "delivery system") into those cells. When the cells resist insulin's action - they don't get the fuel they need, and too much sugar gets "left behind" in your bloodstream - leading to the first and primary symptom, elevated BG (Blood Glucose). Elevated BG leads to the typical early symptoms of polydipsia (excessive thirst), polyurea (frequent urination), fatigue, blurry vision, and easy weight gain. Most T2s have elevated BG for a while before the symptoms are severe enough to go to the doc and get it dx'd (diagnosed). In response to the cellular IR - your pancreas starts overproducing insulin. At first - this works, and your BG stays in "normal" range (about 90 to 120 mg/dl all day long, with 80% of the day spent below 100 mg/dl). BUT... in time, your pancreas can no longer make enough "extra" insulin, and BG levels climb - and that's when folks get dx'd. But in all likelihood - your pancreas is still producing "more than normal" amounts of insulin - but the cellular resistance to it is too much, and that's why your BG is still too high. This is where the "lifestyle changes" come in. For a long time, docs have been blaming T2s for giving themselves the disease by overeating and not getting enough exercise. THAT is a LIE. You don't get the disease without the genetic markers....and there are lots of overweight lazy people that do NOT have T2. There are over 80 genetic anomalies associated with T2, but there are so far THREE that are absolutely confirmed as causative. All three are located near IRS1 (Insulin Receptor Substrate 1) on chromosome 2 of the human genome; these are SNPs (Single Nucleotide Polymorphisms) rs2943650, rs2943634, and rs2972146. These all cause the underlying biochemical issue of IR… but also, they pre-dispose the carrier to a tendency to gain weight easily, and fatigue readily. By eating a proper diet and getting regular physical activity, you CAN improve (for some, even "normalise") your BG levels. Here's why. The glucose in your bloodstream comes primarily from the carbohydrates you eat. When talking about a "proper" diet - we're talking about limiting carbs to a level your body can handle. The less glucose there is in your bloodstream, the better your body can transfer it to the cells. HOW MUCH to limit carbs is DIFFERENT FOR EVERYONE - which is why there are so many different approaches to meal planning for T2s. The "trick" is to learn what works for you. A gentleman named Alan Shanley has an excellent website that covers everything you need to know about this... and the primary thing you need to start is learning to count carbs, and testing your BG regularly to learn how many carbs your system can tolerate at each meal. So I'm going to give you some links to pages you should read on these subjects: Carb counting for beginners: https://www.bd.com/resource.aspx?IDX=9850 Carbs by foods: http://www.med.umich.edu/1libr/MEND/CarbList.pdf If your doc hasn't suggested a meter - ask for a script so you can get one through your insurance, or just go to any major pharmacy and get one of their own brand; Walmart has them for about $10 (the meter will last for several years, with a few battery changes), with strips (you need a new strip for each test) for 18 cents apiece. Docs often don't think T2's need meters - but you DO. Without testing, you have no idea what your meals and exercise are doing to your BG levels. From Alan's site: Getting Started: Getting Started Testing with purpose (use your meter to control BG): Test, Review, Adjust Target BG levels: Blood Glucose Targets So... that covers most of the dietary issues - on to 'exercise". The reason exercise - by which we mean ANY form of regular physical activity - is important is that active cells are insulin-receptive cells. Meaning when you get regular physical activity (running, walking, swimming, bicycling - ANYTHING you enjoy and can stick to) at least 4 or 5 days a week for at least 35 or 30 minutes each day, you are improving your body's cellular response to insulin - making the insulin your body is already making more effective. If you aren't accustomed to regular activity - start with something you like for short durations, and work up over time. It's very beneficial. You'll also read about exercise lowering BG by "burning off" the glucose - which it does... BUT... that's only for as long as you're exercising. The REAL benefit is from the improvement in your cellular response to insulin, which, once you're getting in regular activity, remains all the time - NOT just when you're being active. Here’s a useful page from the endocrinology website (endocrinologists are the docs that specialize in treating diabetics): Type 2 Diabetes and Exercise Another excellent site on all types of DM – here’s the page on T2: Type 2 Diabetes :: Diabetes Education Online On T2 medications - KNOW THIS - all T2 oral meds REQUIRE the use of "diet and exercise" to be effective (read the fine print in the paperwork that comes with it). The standard starting T2 med is met, or metformin. This med does NOT actually lower BG - what it does is inhibit your body from raising your BG, which is a normal part of the glucose balance system that keeps non-D's (non-Diabetic's) BG in the 90 to 120 mg/dl range. By dulling this side of the body's response - the met is keeping your BG from getting too high too often. It's the "diet and exercise" that control the glucose you get from eating. Also - for many people, met needs to be taken for a couple of weeks before it starts having an effect on BG. Why is keeping BG as close to "normal" as possible important? Because elevated BG levels are what cause all the nasty complications of D - vascular damage leading to CVD and atherosclerosis, and retinopathy leading to blindness, and nephropathy leading to kidney failure, nerve damage leading to neuropathy and loss of limbs, and so on. BUT... it's not the high BG alone that does this - high BG leads to high HbA1c levels - you may have had a test referred to as an A1c test; this is a measure of the percentage of your haemoglobin that has glycated, which means bound chemically to the sugar in your blood (glucose). When that chemical binding happens - AGES are created (Advanced Glycation End productS), and it's ultimately these AGES that do the damage - they're a sticky-sweet "gunk" that adheres to, covers and smothers the tissue of the vasculature and organs, slowly killing them off (leading to the various "complications" along the way). A non-diabetic's HbA1c level ranges from 3.5% to 5.5%; the most extensive study of complications in diabetics (DCCT/EDIC studies) found that those that maintain an HbA1c level of NO MORE than 6.5% suffer the least amount of these "complications". For every point above 5.5%, the risk for those complications goes up about 30% (NIH ADVANCE collaborative group). Besides AGES, there is also a chemical reaction to elevated BG in the endothelial cells; this also contributes to the malfunctioning of those cells, and the damage that leads to complications… especially vascular degradation. Finally, for those with “pre-diabetes”… here’s a good intro from NIH on how to prevent the onset of full-blown T2, geared to those with high risk factors for it - and those with “pre-diabetes” (a condition akin to being “a little bit pregnant”): Preventing Type 2 Diabetes | NIDDK Another site on prevention, from the ADA: Risk Test | ADA Another from Mayo Clinic: Diabetes prevention: 5 tips for taking control A final one from the endocrinologists: Type 2 Diabetes Prevention: Here's What You Can Do So… that’s a brief outline of T2 and “pre-diabetes”, aka “borderline diabetes”; I hope you find it helpful. Good Luck!!”