NASA Astronomy Picture of the Day:

In this evocative night scene a dusty central Milky Way rises over the ancient Andean archaeological site of Yacoraite in northwestern Argentina. The denizens of planet Earth reaching skyward are the large Argentine saguaro cactus currently native to the arid region. The unusual yellow-hued reflection nebula above is created by dust scattering starlight around red giant star Antares. Alpha star of the constellation Scorpius, Antares is over 500 light-years distant. Next to it bright blue Rho Ophiuchi is embedded in more typical dusty bluish reflection nebulae though. The deep night skyscape was created from a series of background exposures of the rising stars made while tracking the sky, and a foreground exposure of the landscape made with the camera and lens fixed on the tripod. In combination they produce the single stunning image and reveal a range of brightness and color that your eye can't quite perceive on its own.

Photo by Franco Meconi

It was a long trail, as I recall.
Well used by deer and man alike.
A slight incline, along the hillside,
only grass and shale with Sagebrush, a few.
Climbing higher, one encounters some trees.
There were many Pine trees and Fir.
Looking down the trail you climbed,
the view was grand; seeing the valley floor,
with majestic snow capped peaks on the horizon.
A scenic, Panoramas, words can't describe.
How small we are in this World sublime,
yet there I was on my first hill climb.

Tell me now.
Tell me true.
What am I
supposed to do,
when she says,
"I don't know you."

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NASA Astronomy Picture of the Day:

Sixty years ago, near the dawn of the space age, NASA controllers "lit the candle" and sent Mercury astronaut Alan Shepard arcing into space atop a Redstone rocket. His cramped space capsule was dubbed Freedom 7. Broadcast live to a global television audience, the historic Mercury-Redstone 3 (MR-3) spacecraft was launched from Cape Canaveral Florida at 9:34 a.m. Eastern Time on May 5, 1961. The flight of Freedom 7, the first space flight by an American, followed less than a month after the first human venture into space by Soviet Cosmonaut Yuri Gagarin. The 15 minute sub-orbital flight achieved an altitude of 116 miles and a maximum speed of 5,134 miles per hour. As Shepard looked back near the peak of Freedom 7's trajectory, he could see the outlines of the west coast of Florida, Lake Okeechobe in central Florida, the Gulf of Mexico, and the Bahamas. Shepard would later view planet Earth from a more distant perspective and walk on the Moon as commander of the Apollo 14 mission.

You said "I love you."
Is this another lie?
For when you left,
there was no goodbye.

I am a rabbit.
I'm not a hare.
You may see me
over here or there.
I'll eat your Tulips,
Daffodils aren't my fare.
I travel your yard
and do it with flair.
I visit your neighbors;
I am everywhere.

The sound of the morning,
I hear in my ear,
for a Rooster is crowing
and the noise is quite near.
This place is the Islands
where I hear this sound
of crowing and crowing,
near Old Kealoha Town.

The words smacked
of the Devil
planting the seed
of all the debauchery
accompanied by greed.
Throw out the evil
seed within you,
for there is little time
on this Earth

Think of the words.
The words I wrote.
They came from memory
not an election or vote,
for the words written
came when I learned by Rote.

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NASA Astronomy Picture of the Day:

NGC 3199 lies about 12,000 light-years away, a glowing cosmic cloud in the nautical southern constellation of Carina. The nebula is about 75 light-years across in this narrowband, false-color view. Though the deep image reveals a more or less complete bubble shape, it does look very lopsided with a much brighter edge along the top. Near the center is a Wolf-Rayet star, a massive, hot, short-lived star that generates an intense stellar wind. In fact, Wolf-Rayet stars are known to create nebulae with interesting shapes as their powerful winds sweep up surrounding interstellar material. In this case, the bright edge was thought to indicate a bow shock produced as the star plowed through a uniform medium, like a boat through water. But measurements have shown the star is not really moving directly toward the bright edge. So a more likely explanation is that the material surrounding the star is not uniform, but clumped and denser near the bright edge of windblown NGC 3199.

Photo by Mike Selby

Walk the path
after tomorrow is gone.
Speak not a word,
sing not a song.
Music will settle
the beast within,
unless, of course
it is not
a Mortal Sin.
Exhale it now.
Rid your lungs
of the musty air;
the ancient dust.

Throw back your head,
Eyes to the sky.
Let out a howl
To quiet your nerve.
Do you feel better
Or do you feel worse?
The words now written
are found in this verse.

My words
now written,
lay on the floor.
All were rejected;
won't be used anymore,
for my mind is vacant,
no thoughts grow there
is my latest recant.
Disappeared in the air.

I have searched the World over
trying to find
The person I lost who was
intelligent and kind.

I lost your memory,
in the vastness of space.
Were we connected, so long ago?
Worlds apart? I want to know.
I felt a tremble, when we first met
wasn't sure if we had yet,
the years and lives, from long ago,
are passed and will no longer show.
I feel strangely, if we've loved before.
Perhaps this is the feeling,
I spoke of before.
Do you believe in life after death?
I believe I do.
How about you?

NASA Astronomy Picture of the Day:

What creates STEVEs? Strong Thermal Emission Velocity Enhancements (STEVEs) have likely been seen since antiquity, but only in the past five years has it been realized that their colors and shapes make them different from auroras. Seen as single bright streaks of pink and purple, the origin of STEVEs remain an active topic of research. STEVEs may be related to subauroral ion drifts (SAIDs), a supersonic river of hot atmospheric ions. For reasons currently unknown, STEVEs are frequently accompanied by green "picket-fence" auroras. The featured STEVE image is a combination of foreground and background exposures taken consecutively in mid-March from Copper Harbor, Michigan, USA. This bright STEVE lasted several minutes, spanned from horizon to horizon, and appeared in between times of normal auroras.

Photo by MaryBeth Kiczenski

The federal government must aggressively bolster primary
care and connect more Americans with a dedicated source of care, the National
Academies of Sciences, Engineering and Medicine warn in a major report that
sounds the alarm about an endangered foundation of the U.S. health system.

The urgently worded report, which comes as internists,
family doctors and pediatricians nationwide struggle with the economic fallout
of the coronavirus pandemic, calls for a broad recognition that primary care is
a “common good” akin to public education.

The authors recommend that all Americans select a primary
care provider or be assigned one, a landmark step that could reorient how care
is delivered in the nation’s fragmented medical system.

And the report calls on major government health plans such
as Medicare and Medicaid to shift money to primary care and away from the
medical specialties that have long commanded the biggest fees in the U.S. system.

“High-quality primary care is the foundation of a robust
health care system, and perhaps more importantly, it is the essential element
for improving the health of the U.S. population,” the report concludes. “Yet,
in large part because of chronic underinvestment, primary care in the United
States is slowly dying.”

The report, which is advisory, does not guarantee federal
action. But reports from the national academies have helped support major
health initiatives over the years, such as curbing tobacco use among children
and protecting patients from medical errors.

Strengthening primary care has long been seen as a critical
public health need. And research dating back more than half a century shows
that robust primary care systems save money, improve people’s health and even
save lives.

“We know that better access to primary care leads to more
timely identification of problems, better management of chronic disease and
better coordination of care,” said Melinda Abrams, executive vice president of
the Commonwealth Fund, a New York-based foundation that studies health systems
around the world.

Recognizing the value of this kind of care, many nations —
from wealthy democracies like the United Kingdom and the Netherlands to
middle-income countries such as Costa Rica and Thailand — have deliberately
constructed health systems around primary care.

And many have reaped significant rewards. Europeans with
chronic illnesses such as diabetes, high blood pressure, cancer and depression
reported significantly better health if they lived in a country with a robust
primary care system, a group of researchers found.

For decades, experts here have called for this country to
make a similar commitment.

But only about 5% of U.S. health care spending goes to
primary care, versus an average of 14% in other wealthy nations, according to
data collected by the Organization for Economic Co-operation and Development.

Other research shows that primary spending has declined in
many U.S. states in recent years.

The situation grew even more dire as the pandemic forced
thousands of primary care physicians — who didn’t receive the government
largesse showered on major medical systems — to lay off staff members or even
close their doors.

Reversing this slide will require new investment, the
authors of the new report conclude. But, they argue, that should yield big
dividends.

“If we increase the supply of primary care, more people and
more communities will be healthier, and no other part of health care can make
this claim,” said Dr. Robert Phillips, a family physician who co-chaired the
committee that produced the report. Phillips also directs the Center for
Professionalism and Value in Health Care at the American Board of Family
Medicine.

The report urges new initiatives to build more health
centers, especially in underserved areas that are frequently home to minority
communities, and to expand primary care teams, including nurse practitioners,
pharmacists and mental health specialists.

And it advocates new efforts to shift away from paying
physicians for every patient visit, a system that critics have long argued
doesn’t incentivize doctors to keep patients healthy.

Potentially most controversial, however, is the report’s
recommendation that Medicare and Medicaid, as well as commercial insurers and
employers that provide their workers with health benefits, ask their members to
declare a primary care provider. Anyone who does not, the report notes, should
be assigned a provider.

“Successfully implementing high-quality primary care means
everyone should have access to the ‘sustained relationships’ primary care
offers,” the report notes.

This idea of formally linking patients with a primary care
office — often called empanelment — isn’t new. Kaiser Permanente, consistently
among the nation’s best-performing health systems, has long made primary care
central. (KHN is not affiliated with Kaiser Permanente.)

But the model, which was at the heart of managed-care health
plans, suffered in the backlash against HMOs in the 1990s, when some health
plans forced primary care providers to act as “gatekeepers” to keep patients
away from costlier specialty care.

More recently, however, a growing number of experts and
primary care advocates have shown that linking patients with a primary care
provider need not limit access to care.

Indeed, a new generation of medical systems that rely on
primary care to look after elderly Americans on Medicare with chronic medical
conditions has demonstrated great success in keeping patients healthier and
costs down. These “advanced primary care” systems include ChenMed, Iora Health
and Oak Street Health.

“If you don’t have empanelment, you don’t really have
continuity of care,” said Dr. Tom Bodenheimer, an internist who founded the
Center for Excellence in Primary Care at the University of California-San
Francisco and has called for stronger primary care systems for decades.

Bodenheimer added: “We know that continuity of care is
linked to everything good: better preventive care, higher patient satisfaction,
better chronic care and lower costs. It is really fundamental.”

Source: KHN (Kaiser Health News) is a national newsroom that
produces in-depth journalism about health issues. Together with Policy Analysis
and Polling, KHN is one of the three major operating programs at KFF (Kaiser
Family Foundation). KFF is an endowed nonprofit organization providing
information on health issues to the nation.