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M. Darmok, MD

Deputy Director, University of Texas Southwestern Medical School at Dallas

Roe and Baker point out that if we knew the mean and standard deviation of f, denoted by and f respectively, and if f is small, f then the standard deviation of S would be proportional to f =(1 -)2. To illustrate the problem further, Roe and Baker assume that f is normally distributed (with mean and standard deviation f) and derive f the resulting distribution for S, climate sensitivity. In fact, in an accompanying article in the journal Science, Allen and Frame (2007) argued that climate sensitivity is in the realm of the "unknowable," and that the uncertainty will remain for decades to come. The Impact of Climate Change When assessing climate sensitivity, we at least have scientific results to rely on, and we can argue coherently about the probability distributions that are most consistent with those results. When it comes to predicting the impact of climate change, however, we have much less to go on, and the uncertainty is far greater. In fact, we know very little about the impact 24 Pindyck that higher temperatures and rising sea levels would have on the economy and on society more generally. In fact there have been some empirical studies that made use of weather data for a large panel of countries over 50 or more years. Finally, the observed changes in temperature used in these studies are relatively small-not the 47C or more of warming that many people worry about. A second problem is that there is little or nothing in the way of economic theory to help us understand the potential impact of higher temperatures. We have some sense of how higher temperatures might affect agriculture, and indeed, most of the empirical work that has been done is focused on agriculture. But we also know that losses of agricultural output in some regions of the world. Beyond agriculture, it is difficult to explain, even at a heuristic level, how higher temperatures will affect economic activity. A third problem is that climate change will occur slowly, which allows for adaptation. This is not to say that adaptation will eliminate the impact of climate change-it will only reduce the impact. As discussed earlier, some researchers have come to the conclusion that climate sensitivity is in this category of the "unknowable," and it may be that the impact of climate change is in that same category. On the other hand, we may start learning more about the impact of climate change, perhaps not in the next few years, but in the next few decades. With more time, and most important with more data related to higher temperatures, it is likely that we will be better able to estimate impacts. For now, however, we need to recognize that our ability to predict the impact of climate change is extremely limited. A Catastrophic Outcome It may turn out that over the coming decades climate change and its impact will be mild to moderate. And if we were certain that this will be case, it would imply that we can relax and stop worrying about climate change. There is a possibility of an extremely unfavorable outcome, one that we could call catastrophic. Such an outcome would entail a major decline in human welfare from whatever climate change occurs. This is not surprising; the damage functions in these models, which are ad hoc, are calibrated to give small damages for small temperature increases and cannot tell us very much about the kinds of damages we should expect for temperature increases of 57C or more. For climate scientists, a "catastrophic outcome" usually means a high temperature outcome. Putting aside the difficulty of estimating the probability of that outcome, what matters in the end is not the temperature increase itself but rather its impact. A mild to moderate outcome, on the other hand, is something to which society can respond, in part through adaptation, at a relatively low cost. This means that to a large extent climate policy has to be based on the (small) likelihood of an extreme outcome. So how likely is a catastrophic outcome, and how catastrophic might it turn out to be Furthermore, is difficult to see how answers to these questions will become clear in the next few years, despite all of the ongoing research on climate change. We may know much more in the next 20 years, but in the short term, the likelihood and impact of a catastrophic outcome may simply be in the realm of the "unknowable.

Blue Cross Blue Shield premiums are somewhat competitive but are not at the low end despite developing more limited networks. Fidelis was able to contract with providers at relatively low rates but not always as low as contracts for their Medicaid products. All plans were required, if they had out of network coverage off the Marketplace, to offer at least one out-of-network product at the silver and platinum levels in the Marketplace as well. This led to commercial nongroup plans dropping their out-of-network options across the board; the result is that only in-network plans are offered both inside and outside the Marketplace in all but Western New York. There has been pressure for changes, including some call to require out-ofnetwork coverage. As a first response, the state passed legislation requiring more transparency and disclosure of networks; requiring carriers to make providers available at in network prices if a network provider is not available and requiring protection on pricing in emergency situations. There are nine carriers in Portland, nine in Salem and seven in the rural county rating region we examined. The premiums in Oregon for the lowest cost silver plans offered by Moda Health are below those in any other state we examined, ranging from $159. It established a narrow network of providers at relatively low payment rates and it has over 70 percent of all Marketplace enrollees in the state. There is some belief that Moda underpriced its plans and its premiums will come up. But premiums set by other carriers, including Health Net, Providence, Lifewise, Pacific Source and Kaiser, are also relatively low by national standards. Kaiser has always had a limited network, relying on its salaried physicians and system owned hospitals. Pacific Source established a tiered network in which one had to pay more depending upon the providers chosen. Bridgespan has a broader network than its competitors, and, in general, its rates are among the highest in the state. Some observers question the ability of carriers to maintain these networks and whether, in the case of the tiered approach, there will be sufficient low-cost tier providers to meet enrollee demand. There has been a great deal of provider consolidation in response to insurer competition. Hospitals have expanded capacity to provide a wide range of services, as have multispecialty groups. With provider consolidation, there will be more limited ability to negotiate provider payment rates when establishing limited networks. The state also has a number of one-hospital towns, which also constrains negotiations. Anthem has a large share of the individual and small group market, but alliances between other carriers, such as Aetna, and provider systems are becoming increasingly important. Anthem has a substantial amount of market power throughout the state, with the exception of Northern Virginia. This has allowed them to negotiate favorable contracts with hospitals and even more so with physicians. In the Richmond market, Anthem has developed a close relationship with the Hospital Corporation of America, and it is the second lowest cost plan in that market. Coventry offers a point of service product at an even lower premium, in part because of its close working relationship with the Bon Secours hospital system. In the Tidewater region, the Optima Health Plan has been established by the Sentara hospital system. In markets such as this one, where Optima can offer access to Sentara hospitals, its premiums are near the lowest. Optima is not only competitive in the Tidewater area but offers the lowest premiums in the Roanoke area as well. Aetna has a close working relationship with the Carillion system in Roanoke and the University of Virginia system in Charlottesville. Inova has combined with Aetna to offer an insurance product in the Marketplace: the Innovations Health Insurance Company.

The court, citing domestic and international legal principles, determined that "the delay and lethargy of the State in implementing the Framework offend the fundamental rights of the citizens. The commission further found that existing civil law in the Philippines provided grounds for action, and that it may be possible to hold companies criminally accountable where they have been clearly proved to have engaged in acts of obstruction and willful obfuscation. Insights the Peak in Climate Change Legislation Predates the Paris Agreement Practically all climate change laws have been passed over the last 30 years (fig. In 1990, there were only 35 laws with relevance to climate change worldwide (table 1). Because there was little awareness of the climate issue at that time, most of these laws had related objectives such as energy efficiency. Other early laws had wider environmental objectives that were later applied to climate change. Global Lessons from Climate Change Legislation and Litigation 57 By the mid-1990s, the number of climate laws began to rise. During this heyday, significant framework laws were passed, for example in the United Kingdom (2008), South Korea (2010), and Mexico (2012). In the United States, a law of similar standing, the American Clean Energy and Securities Act of 2009, known as the Waxman-Markey Bill after its sponsors, was approved by the House of Representatives but not tabled in the Senate. Many of these interventions concerned adaptation, which was a bigger legislative focus than in the industrialized world. Climate change litigation cases peaked at around the same time, although the rise was more sudden, with very few cases before the mid2000s (fig. It is difficult to discern an impact of external factors, such as the international climate negotiations, on national climate legislation or litigation. The peak in legislative activity clearly predates the agreement, which was signed in December 2015. Only about 230 climate-relevant laws were passed in the subsequent 4 years, which is less than half the annual rate than during the peak years. The more significant impact of the Paris Agreement was perhaps on the ambition of new laws (the intensive margin) rather than their number (the 58 Eskander, Fankhauser, and Setzer. Several countries, including Sweden (2017), France (2019), New Zealand (2019), and the United Kingdom (2019), have passed acts to put into law an economy-wide net-zero emissions target. The number of climate laws a country has passed tells us something about the interest of its lawmakers in climate change. However, it is Global Lessons from Climate Change Legislation and Litigation 59. What is covered in one overarching piece of legislation in one country may require several separate interventions in another. China, for example, has only eight climate change laws, but this includes powerful provisions incorporated in the 12th and 13th Five Year Plan. In comparison, Brazil has 28 recorded climate change laws, including 8 interventions trying to halt deforestation. In Europe, Sweden has 11 climate change laws, compared with 20 laws in the United Kingdom. The presumption is that laws passed by effective governments are more likely to be implemented, and therefore have a higher real-world impact, than those passed by ineffectual governments. Our effectiveness indicator is the Rule of Law variable from the Worldwide Governance Indicators by Kaufman, Kraay, and Mastruzzi (2010). The variable captures "perceptions of the extent to which agents have confidence in and abide by the rules of society, and in particular the quality of contract enforcement, property rights, the police, and the court" (Kaufman et al. The presumption is that laws that were passed early on have had a longer and therefore bigger impact on climate policy. Law-years are again weighted by the level of government effectiveness to account for differences in implementation.

The questionnaires were emailed to all the respondents allowing three days in which to complete the survey. The total number o f respondents were 153 (7% response rate) indiv iduals across the different locations. Of the 153 respondents, 115 individuals co mpleted the survey; the individuals who did not complete the survey were removed fro m the survey results. This resulted in, a sample size of 115 part icipants, which equates to a total participation of 5% of the entire group who received the email to participate in the questionnaire survey. The questionnaire requested the participants to select which group they belonged to in order to assess the differences between these two population groups and to ascertain if call takers have higher levels of burnout than the back office staff. A question around meditation training is also asked to identify if the participants have in fact received any mindfulness training interventions, which could account for higher than average mindfulness scores. Two research instruments utilised in the form of a survey were used in this study, along with a demographic questionnaire. Both these tools have been widely published and have been used within a South African context to assess validity. The questions are rated using a Likert scale which ranges fro m 0, as never and scales up to 6 which is an indication of everyday occurrence. Individuals rate themselves on how present they are during day-to-day activities using a six point Likert scale which ranges fro m the bottom of the scale (one) being "almost always" to the top of the scale (six) "almost always". In addition, this has been tested across different countries to assess its validity cross nationally. In this study, the highest an individual scored was 6; the lowest score recorded on the engagement version of the questionnaire was 0. The higher the score, the more engaged an individual is, and the lower the score the less engaged an individual is. In this study, the highest an individual scored was 6 on the 9-question burnout version of the questionnaire. The lowest score recorded on the burnout version (with the absorption questions removed) of the questionnaire was 0. The higher the score, the mo re engaged and less burnout an individual is, and the lo wer the score the less engaged and more burnout an individual is. The reason this method was utilised was to determine the number of part icipants that displayed inherent mindful behaviour through a self-assessment questionnaire and to what extent mindfulness is present in the sample group. In this study, the highest an individual scored was 6 and the lowest score recorded was 1. The higher the score, the more mindful an individual is and the lo wer the score the lower the individuals Mindfulness. The Back Office / Support Staff made up 29% (n = 33) of the total sample group and the Call Taking Staff made up the balance of 71% (n = 82) of the total sample group. These scores reveal that the Call Taking Staff have lower levels of mindfulness, higher levels of burnout and lower levels of engagement. This provides strong evidence to support the theory that a Contact Centre environ ment is a more challenging environment to work in and as per the paper written by Visser (2007) where it was stated that the call centre environment is often seen as a stressful one and creates burnout for the individuals who work in it. Looking at the prevalence of Mindfulness in the Call Centre, the average across the entire sample was a mean of 4. A consideration is that as the percentage of the sample gets smaller the results could be less reliable as any anomalies in the individual data could be perceived. The above statists show a strong correlation between lower levels of inherent mindfulness and higher levels of burnout and lower levels of engagement. Which correlates to the research conducted by Ismail (2010) where he stated that individuals with higher levels of mindfulness, be it as a result of meditation or a predisposition to mindfulness, are less likely to experience burnout. In the research conducted by Ismail (2010) he found a strong correlation of individuals who were mindful and reported lower cases of burnout within a corporate co mpany in South Africa. The research in this report has also identified that higher levels of mindfulness, which has been reported can be achieved through meditation, does appear to benefit Contact Centre Agents in a South African teleco mmunicat ions Call Centre, despite their environment. When the results of the population were split into Back Office / Support Staff and Call Taking staff levels of burnout levels are far mo re evident fro m the Call Taking staff.

He has both private and government background, as well as, non-profit and community work that enhances the necessary skills that he will be able to utilize to lead this government entity forward. His leadership skills to involve community members who have a vested interest in the outcome of any project has been exemplified in the many prior positions that he has held. As a leader, you need someone who understands how to build consensus and relationships with people from many walks of life. He made sure that the companies followed the various laws, and did not do anything to jeopardize the reputations of the companies that he worked for. This is the kind of person and the type of character that Carleton Ching possesses. Thielen, Chair Senator Brickwood Galuteria, Vice Chair Members of the Committee on Water and Land Page 2 Although he has been very busy with his various work responsibilities, he has always maintained a level of community service and commitment to making Hawaii a better place for our future generations. I unequivocally support and believe that Carleton Ching will represent the people of Hawaii well in this position and that the values and background that he brings to the job is important for those who represent us, the people, to give him the opportunity to do this job. Respectfully, Teri Yamashige Kailua, Hawaii March 9, 2015 Senator Laura Thielen Chair, Senate Committee on Water and Land 415 S. Carleton provided guidance on community-relations to our ad agency and worked with us to understand the importance of the culture, history and significance of the areas in which plans for development were being considered. Carleton is smart, experienced, dedicated and knows how to work with people of diverse interests and opinions with respect and fairness. As a Kailua resident and your supporter, I appreciate the opportunity to provide this testimony in support of Carleton Ching. Sincerely, Teri Yamashige 322 Aoloa Street, #1405 Kailua, Hawaii 96734 March 9, 2015 Senator Laura Thielen Chair, Senate Committee on Water and Land 415 S. Thank you for the opportunity to support Carleton Ching as the Chairperson of the Department of Land and Natural Resources. Ching brings a management background, a willingness to collaborate with stakeholders, and develop a strategy for efficiencies, I Support this nomination. Aloha, Tom Lodge Please note that testimony submitted less than 24 hours prior to the hearing, improperly identified, or directed to the incorrect office, may not be posted online or distributed to the committee prior to the convening of the public hearing. Like Carleton, I have had the unique opportunity to work in both the public and private sectors in positions that involve land stewardship on the one hand and land development on the other. Finite resources and the need for balance require the committed stewardship that Carleton has displayed. Thank you, Tom Shigemoto Lihue, Hawaii From: To: Cc: Subject: Date: mailinglist@capitol. It also takes experience, foresight, a willingness to get the job done and managing the "overall picture". I do not believe Carleton Ching possesses these things in the capacities required for the tasks this job entails. I oppose the confirmation of Carleton Ching as Director of the Department of Land and Natural Resources. Ching is a capable man who has done a fine good job advancing the interests of landowners and developers. But his past career hardly qualifies him to suddenly become the chief protector of our fragile natural resources - a job very much in opposition to the interests of his previous employers. From my observations and conversations, I believe that I am not alone in my feelings. This nomination, which fuels the cynicism of an already alienated electorate, is neither in the public interest nor in the interest of a healthy and functioning democracy. Organization Individual Testifier Position Support Present at Hearing No Comments: Please note that testimony submitted less than 24 hours prior to the hearing, improperly identified, or directed to the incorrect office, may not be posted online or distributed to the committee prior to the convening of the public hearing. Our Vision Statement includes: the People of South Kohala are united by our love and reverence for the beauty and peace of our lands and waters and by our respect for the richness of our various cultures and traditions. We are blessed to live in one of the most unique, exquisite places on the planet, and we know it.