Landfill on the Toronto Islands

Concrete slabs and rebar are regularly dumped along the Toronto Island beaches to curb erosion

I took this photo of Gibraltar Point Beach on a long walk around Toronto Islands during the citys most recent cold snap. Because parts of the Island are exceedingly untamed, especially in the isolated winter, I was surprised to see Leslie Street Spit-style slabs of concrete and twisted rebar landfill breaking the otherwise undomesticated landscape of the Islands south-west beach.

As past postshave explored, the Toronto Islands were formed when land from the dramatic erosion of the Scarborough Bluffs dropped into Lake Ontario and was pushed by the lakes current to form a peninsular sand bar. Though always referred to as The Islands, a powerful storm in 1858 pierced its thin connection to mainland Toronto, rendering them islands in the true sense.

Looking at a few historical Toronto maps (courtesy of the fantastic Historical Maps of Toronto blog), the shape of the sand bar changes dramatically. For its first hundreds of years, the form of the Toronto Islands changed every year and after every storm.

Toronto Island, 1818

Toronto Island, 1834

Toronto Island, 1860

When the Leslie Street Spit peninsula made its final extension into the lake in the 1970s, the flow of sand from the Scarborough Bluffs was effectively blocked. Consequently, the Islands have been eroding, their sand pushed away by the lapping waves of Lake Ontario without the replenishing effect of the Bluffs accumulative currents of land.

The citys response has been to dump landfill along the Islands south shore to curb erosion. In fact, the City has been doing this for more than a hundred years. In 1885, with the vision of Central Park style forests, lawns and meadows,the City decided to parkify the Islands and began dumping soil and infill to landscape and tame the wild, constantly changing landform (picture the French-style geometric gardens that lead from Centre Island to the pier, and the constantly mown fields just to their west). More recently, the City has embraced Michael Hough style natural processes, and native plants are reclaiming their habitats.

In both cases the historical parkification, and the current attempts to curb erosion I can vividly see how this wild place is slowly being taken over by the deep urbanity across the Bay. As the Toronto Islands remain untamed in many senses, I hope that a delicate balance is maintained between the urbanity and wildness that characterizes Torontos frontier shoreline as we continue to negotiate the Islands role in our cityscape.

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Landfill on the Toronto Islands

Islands to draw more tourists

20 January 2014| last updated at 10:38PM

MERSING: ISLANDS around here are set to be major crowd-pullers among locals and foreign tourists during the Visit Malaysia Year 2014 (VMY2014).

Mersing District Council (MDM) president Zainal Eran said among the favourite tourist destinations of island getaways are Pulau Rawa, Pulau Besar, Pulau Pemanggil, Pulau Aur, Pulau Tengah and Pulau Sibu which are accessible via the Sungai Mersing jetty.

"We are expecting an increase in the number of visitors compared with the 200,000 people recorded last year," he said.

"Throughout last year, there were 68,788 overseas visitors including those from Europe, Japan, Korea and China. The rest were local visitors," he said.

"We will woo the tourists with various promotions as carried out by the government in conjunction with VMY2014," he said.

"MDM has also beautified several places in the district including having a beach cleanup. We believe a pristine, litter-free beach will make tourists feel more welcome," he said.

Zainal said he hoped the locals will play their part in ensuring the cleanliness of tourist spots.

He said MDM has also placed several centralised waste containers for residents living in rural areas outside its jurisdiction.

"With the facilities, it is hoped that the locals will enjoy a better garbage disposal system. Previously, the locals will dispose of garbage by the roadside for the garbage collectors," he said.

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Islands to draw more tourists

Human genetics – An Introduction to Genetic Analysis – NCBI …

In the study of rare disorders, four general patterns of inheritance are distinguishable by pedigree analysis: autosomal recessive, autosomal dominant, X-linked recessive, and X-linked dominant.

The affected phenotype of an autosomal recessive disorder is determined by a recessive allele, and the corresponding unaffected phenotype is determined by a dominant allele. For example, the human disease phenylketonuria is inherited in a simple Mendelian manner as a recessive phenotype, with PKU determined by the allele p and the normal condition by P . Therefore, sufferers from this disease are of genotype p /p , and people who do not have the disease are either P /P or P /p . What patterns in a pedigree would reveal such an inheritance? The two key points are that (1) generally the disease appears in the progeny of unaffected parents and (2) the affected progeny include both males and females. When we know that both male and female progeny are affected, we can assume that we are dealing with simple Mendelian inheritance, not sex-linked inheritance. The following typical pedigree illustrates the key point that affected children are born to unaffected parents:

From this pattern, we can immediately deduce simple Mendelian inheritance of the recessive allele responsible for the exceptional phenotype (indicated in black). Furthermore, we can deduce that the parents are both heterozygotes, say A /a ; both must have an a allele because each contributed an a allele to each affected child, and both must have an A allele because they are phenotypically normal. We can identify the genotypes of the children (in the order shown) as A /, a /a , a /a , and A /. Hence, the pedigree can be rewritten as follows:

Note that this pedigree does not support the hypothesis of X-linked recessive inheritance, because, under that hypothesis, an affected daughter must have a heterozygous mother (possible) and a hemizygous father, which is clearly impossible, because he would have expressed the phenotype of the disorder.

Notice another interesting feature of pedigree analysis: even though Mendelian rules are at work, Mendelian ratios are rarely observed in families, because the sample size is too small. In the preceding example, we see a 1:1 phenotypic ratio in the progeny of a monohybrid cross. If the couple were to have, say, 20 children, the ratio would be something like 15 unaffected children and 5 with PKU (a 3:1 ratio); but, in a sample of 4 children, any ratio is possible, and all ratios are commonly found.

The pedigrees of autosomal recessive disorders tend to look rather bare, with few black symbols. A recessive condition shows up in groups of affected siblings, and the people in earlier and later generations tend not to be affected. To understand why this is so, it is important to have some understanding of the genetic structure of populations underlying such rare conditions. By definition, if the condition is rare, most people do not carry the abnormal allele. Furthermore, most of those people who do carry the abnormal allele are heterozygous for it rather than homozygous. The basic reason that heterozygotes are much more common than recessive homozygotes is that, to be a recessive homozygote, both parents must have had the a allele, but, to be a heterozygote, only one parent must carry the a allele.

Geneticists have a quantitative way of connecting the rareness of an allele with the commonness or rarity of heterozygotes and homozygotes in a population. They obtain the relative frequencies of genotypes in a population by assuming that the population is in Hardy-Weinberg equilibrium, to be fully discussed in Chapter 24 . Under this simplifying assumption, if the relative proportions of two alleles A and a in a population are p and q , respectively, then the frequencies of the three possible genotypes are given by p 2 for A /A , 2pq for A /a , and q 2 for a /a . A numerical example illustrates this concept. If we assume that the frequency q of a recessive, disease-causing allele is 1/50, then p is 49/50, the frequency of homozygotes with the disease is q 2 =(1/50)2 =1/250, and the frequency of heterozygotes is 2pq =249/501/50 , or approximately 1/25. Hence, for this example, we see that heterozygotes are 100 times as frequent as disease sufferers, and, as this ratio increases, the rarer the allele becomes. The relation between heterozygotes and homozygotes recessive for a rare allele is shown in the following illustration. Note that the allele frequencies p and q can be used as the gamete frequencies in both sexes.

The formation of an affected person usually depends on the chance union of unrelated heterozygotes. However, inbreeding (mating between relatives) increases the chance that a mating will be between two heterozygotes. An example of a marriage between cousins is shown in . Individuals III-5 and III-6 are first cousins and produce two homozygotes for the rare allele. You can see from that an ancestor who is a heterozygote may produce many descendants who also are heterozygotes. Hence two cousins can carry the same rare recessive allele inherited from a common ancestor. For two unrelated persons to be heterozygous, they would have to inherit the rare allele from both their families. Thus matings between relatives generally run a higher risk of producing abnormal phenotypes caused by homozygosity for recessive alleles than do matings between nonrelatives. For this reason, first-cousin marriages contribute a large proportion of the sufferers of recessive diseases in the population.

Pedigree of a rare recessive phenotype determined by a recessive allele a . Gene symbols are normally not included in pedigree charts, but genotypes are inserted here for reference. Note that individuals II-1 and II-5 marry into the family; they are assumed (more...)

What are some examples of human recessive disorders? PKU has already served as an example of pedigree analysis, but what kind of phenotype is it? PKU is a disease of processing of the amino acid phenylalanine, a component of all proteins in the food that we eat. Phenylalanine is normally converted into tyrosine by the enzyme phenylalanine hydroxylase:

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Human genetics - An Introduction to Genetic Analysis - NCBI ...

Earliest Human DNA Shows Unforeseen Mixing with Mystery Population

Analysis of oldest sequence from a human ancestor reveals close link with Denisovans

Image: Javier Trueba/Madrid Scientific Films

Another ancient genome, another mystery. DNA gleaned from a 400,000-year-old femur from Spain has revealed an unexpected link between Europes hominin inhabitants of the time and a cryptic population, the Denisovans, who are known to have lived much more recently in southwestern Siberia.

The DNA, which represents the oldest hominin sequence yet published, has left researchers baffled because most of them believed that the bones would be more closely linked to Neanderthals than to Denisovans. Thats not what I would have expected; thats not what anyone would have expected, says Chris Stringer, a paleoanthropologist at Londons Natural History Museum who was not involved in sequencing the femur DNA.

The fossil was excavated in the 1990s from a deep cave in a well-studied site in northern Spain called Sima de los Huesos (pit of bones). This femur and the remains of more than two dozen other hominins found at the site have previously been attributed either to early forms of Neanderthals, who lived in Europe until about 30,000 years ago, or to Homo heidelbergensis, a loosely defined hominin population that gave rise to Neanderthals in Europe and possibly humans in Africa.

But a closer link to Neanderthals than to Denisovans was not what was discovered by the team led by Svante Pbo, a molecular geneticist at the Max Planck Institute for Evolutionary Anthropology in Leipzig, Germany.

The team sequenced most of the femurs mitochondrial genome, which is made up of DNA from the cells energy-producing structures and passed down the maternal line. The resulting phylogenetic analysis which shows branches in evolutionary history placed the DNA closer to that of Denisovans than to Neanderthals or modern humans. This really raises more questions than it answers, Pbo says.

The teams finding, published online in Nature this week (M. Meyer et al. Nature http://dx.doi.org/10.1038/nature12788; 2013), does not necessarily mean that the Sima de los Huesos hominins are more closely related to the Denisovans, a population that lived thousands of kilometres away and hundreds of thousands of years later, than to nearby Neanderthals. This is because the mitochondrial genome tells the history of just an individuals mother, and her mother, and so on.

Courtesy of Nature Magazine

Nuclear DNA, by contrast, contains material from both parents (and all of their ancestors) and typically provides a more accurate overview of a populations history. But this was not available from the femur.

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Earliest Human DNA Shows Unforeseen Mixing with Mystery Population

Breast cancer in Australia: Breast cancer genetics

Angelina Jolie: I feel great, I feel wonderful, and I'm very, very grateful for all the support, it's meant a lot to me. I've been very happy just to see the discussion about women's health expanded and that means the world to me, and after losing my mom to these issues I'm very grateful for it, and I've been very moved by the kind support from people, really very grateful for it.

Joel Werner: Hi, and welcome to the Health Report. I'm Joel Werner. And that was Angelina Jolie. It's been almost a month since she announced via a New York Times op-ed that she'd chosen to have a preventative double mastectomy, a decision reached after learning she carried a mutation on the BRCA1, or Braca-one gene. It was a revelation that resonated around the globe.

Clara Gaff: I thought it was very courageous of her to make public what for many people is a very private decision, and to let people know what was possible and to encourage people in similar situations to her to find out what their situation is and make their own choices.

Joel Werner: Associate Professor Clara Gaff is a genetic counsellor. She's also manager of genomic medicine at the Walter and Eliza Hall Institute for Medical Research. While Clara's reaction to Jolie's Times article epitomised that of many, her colleague Professor Geoff Lindeman wasn't quite so absolute in his praise.

Geoff Lindeman: I think it was somewhat of a mixed blessing. It's always good to have appropriate publicity in this area so that people can be aware, but similarly I think many women must have felt that they had the sword of Damocles hanging over their heads, and that's not necessarily the case for the vast majority of women and even for women who have mutations in the BRCA1 or 2 genes.

Joel Werner: Today on the Health Report it's part two in our special on breast cancer in Australia, and this week we're examining the role genetics plays in the diagnosis and treatment of the disease.

Over the past month, BRCA1 and 2 have been the most heavily publicised genes in the world; celebrity alleles of the human genome. But have you stopped to ask yourself what they actually are? Or how they influence the development of cancer?

Geoff Lindeman is head of the familial cancer centre at Melbourne Hospital, and joint head of breast cancer research at the Walter and Eliza Hall Institute.

Geoff Lindeman: So these were genes that were discovered in the mid-1990s that were identified through women who had a very high risk of breast or ovarian cancer running in their families. The discovery of these genes really helped us to understand their role in helping keep cancer in check. They are basically suppressor genes which help repair DNA in our genome that has become damaged. And for reasons that we still don't fully understand, breast and ovarian cancer are quite prominent amongst the things that can go wrong when there is a fault in these genes.

Joel Werner: And that's the thing, it's when you have mutations in these genes that things go wrong.

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Breast cancer in Australia: Breast cancer genetics

Myriad Genetics and Sividon Diagnostics Announce Exclusiv.

EndoPredict is a second-generation, multigene prognostic test kit for patientsdiagnosed with breast cancer. Under the agreement, Myriad will receive comprehensive marketing rights todistribute and sell EndoPredict, including in high-growth markets in Europe.The agreement will leverage Myriad's 45-person international commercial teamand will significantly increase the number of medical specialists and salesprofessionals supporting EndoPredict. Specific terms of the deal were notdisclosed. EndoPredict provides physicians with information to devise personalizedtreatment plans for their breast cancer patients. The EndoPredict test kitformat is an ideal platform for use by clinical pathologists, who desire toconduct testing within their own laboratories. In contrast to older multi-genetests, EndoPredict detects the likelihood of late metastases (i.e., metastasisformation after more than five years) and can thus guide treatment decisionsfor chemotherapy as well as extended anti-hormonal therapy. Accordingly,therapy decisions backed by EndoPredict confer a high level of diagnosticsafety. EndoPredict was shown to accurately predict cancer-specific diseaseprogression and metastasis in multiple clinical outcome studies with more than2,200 patients. 'Myriad has a significant opportunity to leverage our international presence,and we are pleased to be partnering with Sividon to make EndoPredict even morewidely available to patients in Europe and worldwide,' said Gary King,Executive Vice President, International Operations, Myriad Genetics. 'We arecommitted to contributing to the health of people in Europe through a strongsales and marketing organization that provides enhanced access to life-savingproducts for patients and cost effective solutions for healthcare providers.Myriad's team of field specialists will support EndoPredict's current customersin liaison with Sividon's medical expert team, thus providing additional levelsof support and contact.' 'Sividon's EndoPredict, backed by compelling evidence from clinical studieswith thousands of patients combined with Myriad's strong commercial capabilityand coverage in many key countries creates an outstanding partnership,' saidDr. Christoph Petry, CEO of Sividon Diagnostics. 'Breast cancer affects thelife of more than 388,000 women per year in Europe, and EndoPredict will helpto significantly improve their cancer treatment. We are delighted to partnerwith Myriad to help save and improve the lives of more women with breastcancer.' About Myriad Genetics GmbHMyriad Genetics GmbH is based in Zurich, Switzerland and is the internationalsubsidiary of Myriad Genetics Inc., a leading molecular diagnostic companydedicated to making a difference in patients' lives through the discovery andcommercialization of transformative tests to assess a person's risk ofdeveloping disease, guide treatment decisions and assess risk of diseaseprogression and recurrence. Myriad's molecular diagnostic tests are based on anunderstanding of the role genes play in human disease and were developed with acommitment to improving an individual's decision making process for monitoringand treating disease. Myriad is focused on strategic directives to introducenew products, including companion diagnostics, as well as expandinginternationally. For more information on how Myriad Genetics GmbH is making adifference, please visit the Company's website: http://www.myriad.ch. Myriad and theMyriad logo are trademarks or registered trademarks of Myriad Genetics, Inc. inthe United States and worldwide. MYGN-F, MYGN-G About SividonSividon Diagnostics GmbH was founded in 2010 as a management buyout fromSiemens Healthcare Diagnostics in Cologne, Germany. Sividon is dedicated todevelop modern methods for the molecular pathology laboratory to help improvethe quality of care for cancer patients. Sividon's first product, EndoPredict,has been introduced into the market in 2011 and allows for a moreindividualized therapy management in breast cancer. For more information onSividon please visit the Sividon's website at http://www.sividon.com. Sividon, theSividon logo and EndoPredict are registered trademarks of Sividon DiagnosticsGmbH in Germany and other countries. Safe Harbor StatementThis press release contains 'forward-looking statements' within the meaning ofthe Private Securities Litigation Reform Act of 1995, including statementsrelating to the EndoPredict test and Myriad's partnering with Sividon to marketthe EndoPredict test in Europe and worldwide; and the Company's strategicdirectives under the caption 'About Myriad Genetics.' These 'forward-lookingstatements' are management's present expectations of future events and aresubject to a number of risks and uncertainties that could cause actual resultsto differ materially and adversely from those described in the forward-lookingstatements. These risks include, but are not limited to: the risk that salesand profit margins of our existing molecular diagnostic tests and companiondiagnostic services may decline or will not continue to increase at historicalrates; risks related to changes in the governmental or private insurersreimbursement levels for our tests; the risk that we may be unable to developor achieve commercial success for additional molecular diagnostic tests andcompanion diagnostic services in a timely manner, or at all; the risk that wemay not successfully develop new markets for our molecular diagnostic tests andcompanion diagnostic services, including our ability to successfully generaterevenue outside the United States; the risk that licenses to the technologyunderlying our molecular diagnostic tests and companion diagnostic servicestests and any future tests are terminated or cannot be maintained onsatisfactory terms; risks related to delays or other problems with opeRatingour laboratory testing facilities; risks related to public concern over ourgenetic testing in general or our tests in particular; risks related toregulatory requirements or enforcement in the United States and foreigncountries and changes in the structure of the healthcare system or healthcarepayment systems; risks related to our ability to obtain new corporatecollaborations or licenses and acquire new technologies or businesses onsatisfactory terms, if at all; risks related to our ability to successfullyintegrate and derive benefits from any technologies or businesses that welicense or acquire; risks related to increased competition and the developmentof new competing tests and services; the risk that we or our licensors may beunable to protect or that third parties will infringe the proprietarytechnologies underlying our tests; the risk of patent-infringement claims orchallenges to the validity of our patents; risks related to changes inintellectual property laws covering our molecular diagnostic tests andcompanion diagnostic services and patents or enforcement in the United Statesand foreign countries, such as the Supreme Court decision in the lawsuitbrought against us by the Association for Molecular Pathology et al; risks ofnew, changing and competitive technologies and regulations in the United Statesand internationally; and other factors discussed under the heading 'RiskFactors' contained in Item 1A of our most recent Annual Report on Form 10-Kfiled with the Securities and Exchange Commission, as well as any updates tothose risk factors filed from time to time in our Quarterly Reports on Form10-Q or Current Reports on Form 8-K. All information in this press release isas of the date of the release, and Myriad undertakes no duty to update thisinformation unless required by law. CONTACT: Media Contacts:Ron Rogers(801) 584-3065rrogers@myriad.comEstherLinnenberg+49-221-66956170linnenberg@sividon.comInvestor Contact:ScottGleason(801) 584-1143sgleason@myriad.comNews Source: NASDAQ OMXEnd of Corporate News---------------------------------20.01.2014 Dissemination of a Corporate News, transmitted by DGAP - acompany of EQS Group AG.The issuer is solely responsible for the content of this announcement.DGAP's Distribution Services include Regulatory Announcements,Financial/Corporate News and Press Releases.Media archive at http://www.dgap-medientreff.de and http://www.dgap.de---------------------------------Language: English Company: Myriad Genetics, Inc. United States ISIN: US62855J1043 End of News DGAP News-Service --------------------------------- 248572 20.01.2014

Myriad Genetics

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Myriad Genetics and Sividon Diagnostics Announce Exclusiv.

Community Health Program Interview w/Canadian Wait-list Practitioner Dr. Krista Ryan Google Hangout – Video


Community Health Program Interview w/Canadian Wait-list Practitioner Dr. Krista Ryan Google Hangout
Community health program http://communitywellnessday.com/google-hangout-special.html In this video Community Health Program expert Dr. Randi Ross interviews ...

By: Dr Randi Ross

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Community Health Program Interview w/Canadian Wait-list Practitioner Dr. Krista Ryan Google Hangout - Video

Yonsei University Health System: Patient Confidentiality in a Mobile World – Video


Yonsei University Health System: Patient Confidentiality in a Mobile World
For Yonsei University Severance Health System, like most health care providers, patient confidentiality is paramount, with four hospitals and an increasing n...

By: VMware

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Yonsei University Health System: Patient Confidentiality in a Mobile World - Video

Former health care CEO argues America’s medical system rewards bad outcomes – Video


Former health care CEO argues America #39;s medical system rewards bad outcomes
Judy Woodruff talks to George Halvorson, former CEO of Kaiser Permanente and author of "Don #39;t Let Health Care Bankrupt America," who argues we spend too much...

By: PBS NewsHour

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Former health care CEO argues America's medical system rewards bad outcomes - Video

Health Care REIT Kept at Neutral – Analyst Blog

On Jan 16, 2014, we reinstated our long-term recommendation on Health Care REIT Inc. ( HCN ) at Neutral. The decision reflects the company's strong third-quarter 2013 results, ongoing accretive strategic investments and promising healthcare industry fundamentals. However, intense competition in the industry is a headwind and continuous acquisition on the company's part is expected to raise upfront operating expenses.

Why Neutral?

Health Care REIT's diversified portfolio allows it to explore opportunities in different markets based on individual market dynamics. The company is focused on capitalizing on growth opportunities in high-barrier-to-entry affluent markets around the world. In relation to that, completion of the Sunrise Senior Living facility acquisition and the Avery Healthcare investments in the U.K. in the third quarter are expected to further enhance the company's high-quality senior housing portfolio.

Health Care REIT's third-quarter 2013 normalized funds from operations (FFO) of 97 cents per share came a cent ahead of the Zacks Consensus Estimate and 6 cents above the year-over-year figure. The improved results were primarily attributable to better-than-expected revenues and decent same-store net operating income growth.

In addition, rise in senior citizen spending for healthcare reasons bodes well for the company's growth going forward. Also, the introduction of the Affordable Act is expected to brighten growth prospects for Health Care REIT as it will widen the insured people bracket. This will further boost the demand for new outpatient facilities.

Despite these positives, the company faces stiff competition from national and local healthcare operators and its dependency on few tenants for revenue generation exposes it to concentration risks. Moreover, though acquisitions are a strategic fit, such moves involve considerable upfront costs. This remains a drag as new properties usually take time to generate revenues.

Over the last 60 days, the Zacks Consensus Estimate for 2013 FFO per share dipped by a cent to $3.78. Also, the Zacks Consensus Estimate for 2014 FFO per share moved south by 3 cents to $4.01. Health Care REIT currently carries a Zacks Rank #3 (Hold).

Health Care REIT is scheduled to release its fourth-quarter 2013 earnings results on Feb 19, before the market opens. The Zacks Consensus Estimate for FFO per share for the upcoming quarter is pegged at 97 cents per share, representing year-over-year growth of 14.66%.

Other Stocks to Consider

Some better ranked stocks in the REIT-Equity Trust - Other industry include PS Business Parks Inc. ( PSB ), Ventas, Inc. ( VTR ) and Public Storage ( PSA ). All the three stocks carry a Zacks Rank #2 (Buy).

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Health Care REIT Kept at Neutral - Analyst Blog

In Mass., website woes frustrate health care push

BOSTON Massachusetts has long held a special status in the debate about President Obama's health care law. It was a 2006 Massachusetts law that provided the inspiration for the 2010 national law, and Massachusetts already had near-universal coverage before the federal law took effect.

Now the state that gave birth to a sweeping expansion of health coverage nationally is trying to knit the two laws together and struggling to make sure no resident falls through the insurance net.

At the center of their frustration is a glitchy website that has forced the state to rely on workarounds to ensure access to coverage.

About 5,400 shoppers were able to enroll in health care plans through the Massachusetts Health Connector by the end of December, according to a report by the federal Health and Human Services Department. Of those, 31 percent were between the ages of 18 and 34.

But state health officials say that the number of new people were able access to subsidized coverage through the Connector and MassHealth programs despite the website problems was higher about 28,000.

Even so, 26,000 other people ran into technical roadblocks and had to be enrolled in temporary subsidized coverage through MassHealth, the state's Medicaid program.

Officials say they're focused on improving those numbers before March 31, when the federal health care law's first open enrollment season ends.

Jean Yang, executive director of the Health Connector, said the agency had to come up with creative ways to work around the website failures.

That included increasing call center capacity to help people who were unable to use the website. On Dec. 31, there were about 200 call center staff on hand three times the original capacity on Oct. 1.

Massachusetts Secretary of Administration and Finance Glen Shor said the state is determined to protect the gains made since 2006. Massachusetts has the highest percentage of insured residents of any state.

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In Mass., website woes frustrate health care push