In an attempt to improve safety and reduce the number of accidents on the world's curviest roads, Ford has developed an experimental brake light that lets vehicles behind you know there's slow traffic ahead, even if they can't see your lights.
The enhanced brake lights include a wireless transmitter that sends a signal to following vehicles which activates a light on their dashboard indicating there's slow traffic ahead. It's less useful on straight stretches of road where you can see an upcoming traffic jam well before you have to slow down, but when visibility's limited due to bad weather, or on twisty roads where there could be stopped traffic just around the next bend, it gives drivers ample time to ease off the accelerator instead of having to suddenly slam on the brakes.
Ford hasn't said if or when it plans to implement the new technology in upcoming models, but it's a step towards vehicle-to-vehicle communications which will assist in everything from improved traffic and weather reports, to new forms of anonymous road rage. Exciting times. [Ford via PSFK]
Gay rights advocate Vin Testa waves a rainbow flag in front of the Supreme Court at sun up in Washington, Wednesday, June 26, 2013. Justices are expected to hand down major rulings on two gay marriage cases that could impact same-sex couples across the country. One is a challenge to California's voter-enacted ban on same-sex marriage. The other is a challenge to a provision of federal law that prevents legally married gay couples from receiving a range of tax, health and pension benefits. (AP Photo/J. Scott Applewhite)
Gay rights advocate Vin Testa waves a rainbow flag in front of the Supreme Court at sun up in Washington, Wednesday, June 26, 2013. Justices are expected to hand down major rulings on two gay marriage cases that could impact same-sex couples across the country. One is a challenge to California's voter-enacted ban on same-sex marriage. The other is a challenge to a provision of federal law that prevents legally married gay couples from receiving a range of tax, health and pension benefits. (AP Photo/J. Scott Applewhite)
FILE - This Nov. 2, 2008 file photo shows supporters of Proposition 8, the state?s measure that banned same sex marriages, in front of city hall during a Yes on Prop. 8 rally in Los Angeles. The U.S. Supreme Court is expected to issue a ruling that will determine the fate of California's voter-approved ban on same-sex marriages on Wednesday morning, June 26, 2013. (AP Photo/Mark J. Terrill, File)
FILE - In this Nov. 5, 2008 file photo, Joni Boettcher, left, kisses her roommate Tika Shenghur during a protest march down Santa Monica Boulevard in West Hollywood , Calif. The U.S. Supreme Court is expected to issue a ruling that will determine the fate of California's voter-approved ban on same-sex marriages on Wednesday morning. (AP Photo/Kevork Djansezian, File)
WASHINGTON (AP) ? The Supreme Court is meeting to deliver opinions in two cases that could dramatically alter the rights of gay people across the United States.
The justices are expected to decide their first-ever cases about gay marriage Wednesday in their last session before the court's summer break.
The issues before the court are California's constitutional ban on same-sex marriage and the federal Defense of Marriage Act, which denies legally married gay Americans a range of tax, health and pension benefits otherwise available to married couples.
The broadest possible ruling would give gay Americans the same constitutional right to marry as heterosexuals. But several narrower paths also are available, including technical legal outcomes in which the court could end up saying very little about same-sex marriage.
If the court overturns California's Proposition 8 or allows lower court rulings that struck down the ban to stand, it will take about a month for same-sex weddings to resume for the first time since 2008, San Francisco officials have said.
The high court rulings are arriving amid rapid change regarding gay marriage. The number of states permitting same-sex partners to wed has doubled from six to 12 in less than a year, with voter approval in three states in November, followed by legislative endorsement in three others in the spring.
At the same time, an effort to legalize gay marriage in Illinois stalled before the state's legislative session ended last month. And 30 states have same-sex marriage bans enshrined in their constitutions.
Massachusetts was the first state to allow same-sex couples to marry, in 2004. Same-sex marriage also is legal, or soon will be, in Connecticut, Delaware, the District of Columbia, Iowa, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New York, Rhode Island, Vermont and Washington.
Roughly 18,000 same-sex couples got married in California in less than five months in 2008, after the California Supreme Court struck down a state code provision prohibiting gay unions.
California voters approved Proposition 8 in November of that year, writing the ban into the state's constitution.
Two same-sex couples challenged the provision as unconstitutional and federal courts in California agreed.
The federal marriage law, known by its acronym DOMA, defines marriage as between a man and a woman for the purpose of deciding who can receive a range of federal benefits. Another provision not being challenged for the time being allows states to withhold recognition of same-sex marriages from other states.
DOMA easily passed Congress and was signed into law by President Bill Clinton in 1996, the year of his re-election.
Several federal district and appeals courts struck down the provision. In 2011, the Obama administration abandoned its defense of the law but continued to enforce it. House Republicans are now defending DOMA in the courts. President Barack Obama subsequently endorsed gay marriage in 2012.
The justices chose for their review the case of 83-year-old Edith Windsor of New York, who sued to challenge a $363,000 federal estate tax bill after her partner of 44 years died in 2009.
Windsor, who goes by Edie, married Thea Spyer in 2007 after doctors told them Spyer would not live much longer. She suffered from multiple sclerosis for many years. Spyer left everything she had to Windsor.
Windsor would have paid nothing in inheritance taxes if she had been married to a man.
Policy issues plague hydropower as wind power backupPublic release date: 25-Jun-2013 [ | E-mail | Share ]
Contact: A'ndrea Elyse Messer aem1@psu.edu 814-865-9481 Penn State
Theoretically, hydropower can step in when wind turbines go still, but barriers to this non-polluting resource serving as a backup are largely policy- and regulation-based, according to Penn State researchers.
"We have a very clear realization that we need to make energy systems more sustainable," said Seth A. Blumsack, assistant professor of energy policy. "We want to reduce the environmental footprint -- carbon dioxide and conventional pollutants."
Americans also expect to have the system continue to work exactly as it is without blackouts and with low cost electricity. While wind and solar power are emission-free once installed, they are also subject to the whims of nature. The wind can suddenly cease to blow and an area can have minimal sunlight for days.
"Wind is the fastest growing renewable energy source in the U.S.," said Alisha R. Fernandez, graduate student in energy and mineral engineering.
The U.S. Department of Energy recently examined the feasibility of producing 20 percent of U.S. electricity from wind by 2030.
"Texas is either there or close," said Blumsack. "During certain periods, as much as 30 percent of their energy is generated by wind."
Reliance on wind requires that there be some backup technology to fill in when the wind does not blow. The technology has to be capable of coming on line quickly. Two types of electrical generation that fit this bill are natural gas and hydropower, but natural gas is not carbon neutral.
The researchers looked at the Kerr Dam in North Carolina as a case study. They report their results in a recent issue of Environmental Research Letters. The power produced by the Kerr Dam goes into the PJM segment of the electric grid -- Pennsylvania through Virginia on the East Coast, west to Indiana and also includes the Chicago area -- but agreements made before establishment of the PJM market mean that the Kerr Dam also supplies other local outlets.
Hydroelectric dams cannot simply release water to meet some electricity demand or hold back water when electricity is in low demand. Plants operate using guide curves that consider not only electric production, but also drinking water needs, irrigation, fish and wildlife requirements, recreation and minimum levels for droughts. These guide curves are created by the government agencies regulating the particular dam -- in the case of Kerr, the U.S. Army Corps of Engineers -- but in other places it could be the U.S. Bureau of Reclamation, the Tennessee Valley Authority, the Colorado River Authority or other entities. In practice, the guide curves are currently based on one-week weather forecasts and their parameters take into account the requirements of a large variety of interested parties.
The researchers determined that the Kerr Dam could accommodate the unexpected variations in wind energy, but only if those operating the dam were allowed to meet the guide curve requirements over a two-week rather than one-week period of time.
"Changing guide curves is complex, time-consuming and may even require an act of Congress," said Blumsack. "Another problem is that two weeks is at the outer margin of weather prediction."
If hydro plants do not pledge to sell their electricity to make up for the variability of wind energy, they sell their excess on the spot market. The researchers found that changing the pricing of electricity so that backing up wind is more lucrative than the spot market would not make these multipurpose hydro facilities more prone to supply backup to wind power.
"Operational conflicts may be significantly reduced if the time length of the guide curve schedule was altered, yet such regulatory changes prove quite challenging given the institutional barriers surrounding water rights in the U.S.," said the researchers, who also include Patrick M. Reed, professor of civil engineering, Cornell University.
###
The National Science Foundation supported this research.
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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Policy issues plague hydropower as wind power backupPublic release date: 25-Jun-2013 [ | E-mail | Share ]
Contact: A'ndrea Elyse Messer aem1@psu.edu 814-865-9481 Penn State
Theoretically, hydropower can step in when wind turbines go still, but barriers to this non-polluting resource serving as a backup are largely policy- and regulation-based, according to Penn State researchers.
"We have a very clear realization that we need to make energy systems more sustainable," said Seth A. Blumsack, assistant professor of energy policy. "We want to reduce the environmental footprint -- carbon dioxide and conventional pollutants."
Americans also expect to have the system continue to work exactly as it is without blackouts and with low cost electricity. While wind and solar power are emission-free once installed, they are also subject to the whims of nature. The wind can suddenly cease to blow and an area can have minimal sunlight for days.
"Wind is the fastest growing renewable energy source in the U.S.," said Alisha R. Fernandez, graduate student in energy and mineral engineering.
The U.S. Department of Energy recently examined the feasibility of producing 20 percent of U.S. electricity from wind by 2030.
"Texas is either there or close," said Blumsack. "During certain periods, as much as 30 percent of their energy is generated by wind."
Reliance on wind requires that there be some backup technology to fill in when the wind does not blow. The technology has to be capable of coming on line quickly. Two types of electrical generation that fit this bill are natural gas and hydropower, but natural gas is not carbon neutral.
The researchers looked at the Kerr Dam in North Carolina as a case study. They report their results in a recent issue of Environmental Research Letters. The power produced by the Kerr Dam goes into the PJM segment of the electric grid -- Pennsylvania through Virginia on the East Coast, west to Indiana and also includes the Chicago area -- but agreements made before establishment of the PJM market mean that the Kerr Dam also supplies other local outlets.
Hydroelectric dams cannot simply release water to meet some electricity demand or hold back water when electricity is in low demand. Plants operate using guide curves that consider not only electric production, but also drinking water needs, irrigation, fish and wildlife requirements, recreation and minimum levels for droughts. These guide curves are created by the government agencies regulating the particular dam -- in the case of Kerr, the U.S. Army Corps of Engineers -- but in other places it could be the U.S. Bureau of Reclamation, the Tennessee Valley Authority, the Colorado River Authority or other entities. In practice, the guide curves are currently based on one-week weather forecasts and their parameters take into account the requirements of a large variety of interested parties.
The researchers determined that the Kerr Dam could accommodate the unexpected variations in wind energy, but only if those operating the dam were allowed to meet the guide curve requirements over a two-week rather than one-week period of time.
"Changing guide curves is complex, time-consuming and may even require an act of Congress," said Blumsack. "Another problem is that two weeks is at the outer margin of weather prediction."
If hydro plants do not pledge to sell their electricity to make up for the variability of wind energy, they sell their excess on the spot market. The researchers found that changing the pricing of electricity so that backing up wind is more lucrative than the spot market would not make these multipurpose hydro facilities more prone to supply backup to wind power.
"Operational conflicts may be significantly reduced if the time length of the guide curve schedule was altered, yet such regulatory changes prove quite challenging given the institutional barriers surrounding water rights in the U.S.," said the researchers, who also include Patrick M. Reed, professor of civil engineering, Cornell University.
###
The National Science Foundation supported this research.
[ | E-mail | Share ]
?
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
JEDDAH, Saudi Arabia (Reuters) - Saudi Arabia regards the involvement of Iran and Hezbollah in Syria's civil war as dangerous and believes the rebels must be offered military aid to defend themselves, the kingdom's foreign minister said on Tuesday.
Speaking at a news conference with U.S. Secretary John Kerry in Jeddah, Prince Saud al-Faisal added that Saudi Arabia "cannot be silent" about Iranian intervention and called for a resolution to ban arms flows to the Syrian government.
"The kingdom calls for issuing an unequivocal international resolution to halt the provision of arms to the Syrian regime and states the illegitimacy of the regime," Prince Saud said.
Kerry has returned to the Middle East after a two-day visit to India, and will continue efforts to strengthen the Syrian opposition and revive peace talks between Israel and the Palestinians.
In Jeddah, Kerry is holding discussions with Prince Saud and Saudi Arabian intelligence chief Prince Bandar bin Sultan, who coordinates the kingdom's efforts to topple Syrian President Bashar al-Assad.
The discussions include Washington's plans for providing direct military support to General Salim Idriss of the Supreme Military Council, the military wing of Syria's main civilian opposition group.
Prince Saud said the world's top oil exporter "cannot be silent" at the intervention of Iran and Hezbollah in the Syrian conflict and renewed calls to arm the opposition and bar weapons sales to President Bashar al-Assad.
"The most dangerous development is the foreign participation, represented by Hezbollah and other militias supported by the forces of the Iranian Revolutionary Guard," said.
"There is no logic that allows Russia to publicly arm the Syrian regime and the foreign forces that support it," he added.
U.S. President Barack Obama has said he will arm the rebels but has not disclosed what type of assistance he will provide. Kerry is trying to ensure that the aid to the rebels is properly coordinated among the allies, in part out of concern that weapons could end up in the hands of extremist groups.
A meeting between Kerry and European and Arab counterparts in Doha last week agreed to increase support for Syria's rebels although there was no consensus among the foreign ministers over providing arms, with Germany and Italy strongly opposed to the move.
More than 93,000 people have been killed in the Syrian conflict, which began as a popular protest movement against President Bashar al-Assad but has descended into a civil war with sectarian overtones.
Nearly 1.7 million refugees have fled into neighboring countries, including Lebanon, where clashes between armed groups supporting opposing sides in Syria have fuelled fears of a lapse back into sectarian civil war.
Saudi Arabia has become more actively involved in the Syrian crisis in recent months, expanding the flow of weapons to the rebels to include anti-aircraft missiles.
(Reporting By Mahmoud Habboush and Lesley Wroughton, Editing by Angus McDowall and William Maclean)
NEW YORK (AP) ? The funeral for James Gandolfini will be held Thursday at the Cathedral Church of Saint John the Divine in New York City.
An HBO spokeswoman speaking on behalf of Gandolfini's family says the funeral is scheduled for 10 a.m.
The 51-year-old star of "The Sopranos" died Wednesday in Rome. Family spokesmanMichael Kobold says Gandolfini died of a heart attack.
Port Authority of New York & New Jersey spokesman Steve Coleman tells the Star-Ledger of Newark that a Signature Airlines flight carrying Gandolfini's body arrived Sunday night at Newark Liberty International Airport from Rome. The body was taken from the airport around 11:20 p.m. but Coleman did not say where it went.
The actor had been headed to Sicily to appear at the Taormina Film Festival, which paid tribute to him Saturday.
For the beginning (or even experienced) cyclist, making your own bike repairs can seem like a daunting task. Most bike repair guides you'll find around the ol' internet can be complicated labyrinths of instruction that end up doing more harm than good. But taking your wheels to a pro can come with a major price tag. Bike Doctor wants to give you the knowledge you need to save a trip to the shop?but in an easy, digestible form that's useful to all walks of the bicycle world.
What does it do?
Gives you 42 guides for 42 common problems avid bike riders will come across. Everything from wheel punctures and squealing breaks to more advanced stuff like bleeding disk brakes gets the step-by-step treatment. There's also a set of preventative guides to make sure that you're giving your bike the necessary checkups and keeping it in tip-top shape.
Why do we like it?
The actual app was created by Andreas Kambanis, the founder of London bicycle blog londoncyclist.co.uk?so he knows what he's talking about. Plus, every instruction set has been explicitly tested on beginners to make sure that these repairs are approachable enough for anyone to handle. If you ride your bike with any frequency, this app is invaluable in the money it could potentially save you in costly bike repairs that you could just as easily do yourself. Plus, the app's newest incarnation runs on iPad, giving you an even clearer view every step along the way.
Bike Doctor, Download this app for: iOS, Android $5
Lowering costs for higher-cost medicare patients through better outpatient care may be limitedPublic release date: 24-Jun-2013 [ | E-mail | Share ]
Contact: Marge Dwyer mhdwyer@hsph.harvard.edu 617-432-8416 The JAMA Network Journals
In an analysis that included a sample of patients in the top portion of Medicare spending, only a small percentage of their costs appeared to be related to preventable emergency department visits and hospitalizations, limiting the ability to lower costs for these patients through better outpatient care, according to a study in the June 26 issue of JAMA. The study is being released early to coincide with its presentation at the AcademyHealth annual research meeting.
"High and increasing health care costs are arguably the single biggest threat to the long-term fiscal solvency of federal and state governments in the United States. One compelling strategy for cost containment is focusing on the small proportion of patients in the Medicare programs who account for the vast majority of health care spending. We know from prior work that Medicare spending is highly concentrated: 10 percent of the Medicare population accounts for more than half of the costs to the program," according to background information in the article.
The biggest sources of spending among high-cost beneficiaries are those related to acute care: emergency department (ED) visits and inpatient hospitalizations. "As a result, many interventions targeting high-cost patients have focused on case management and care coordination, aiming to prevent ED visits and hospitalizations for conditions thought amenable to improvement through high-quality outpatient management programs. The premise behind these and related interventions is that high-quality outpatient care should reduce unnecessary hospitalizations for high-cost patients. However, there are few data on the proportion of inpatient hospitalizations among high-cost patients that are potentially preventable," the authors write.
Karen E. Joynt, M.D., M.P.H., of the Harvard School of Public Health, Boston, and colleagues conducted a study to quantify the preventability of high-cost Medicare patients' acute care spending. The researchers summed standardized costs for each inpatient and outpatient service contained in standard 5 percent Medicare files from 2009 and 2010 across the year for each patient in their sample, and defined those in the top decile (one of ten groups) of spending in 2010 as high-cost patients and those in the top decile in both 2009 and 2010 as persistently high-cost patients. Standard algorithms were used to identify potentially preventable emergency department visits and acute care inpatient hospitalizations. A total of 1,114,469 Medicare fee-for-service beneficiaries 65 years of age or older were included.
The high-cost patient group, which included 10 percent of the patients in this sample, were older, more often male and more often black. This group was responsible for 32.9 percent of ED costs and 79.0 percent of inpatient costs. Within the high-cost group, 42.6 percent of ED visits were deemed to be preventable. These visits were associated with 41 percent of the ED costs within this group. The most common reasons for preventable hospitalization in high-cost patients were congestive heart failure, bacterial pneumonia, and chronic obstructive pulmonary disease.
Within the high-cost group, 9.6 percent of hospital costs were attributable to preventable hospitalization. Within the non-high-cost group, though overall spending was significantly lower, a higher proportion of inpatient costs were potentially preventable (16.8 percent).
"Comparable proportions of ED spending (43.3 percent) and inpatient spending (13.5 percent) were preventable among persistently high-cost patients. Regions with high primary care physician supply had higher preventable spending for high-cost patients," the authors write.
"The biggest drivers of inpatient spending for high-cost patients were catastrophic events such as sepsis, stroke, and myocardial infarction, as well as cancer and expensive orthopedic procedures such as spine surgery and hip replacement. These findings suggest that strategies focused on enhanced outpatient management of chronic disease, while critically important, may not be focused on the biggest and most expensive problems plaguing Medicare's high-cost patients."
The researchers add that their "findings suggest that a complementary approach to saving money on acute care services for high-cost patients may be to additionally focus on reducing per-episode costs for high-cost disease entities through clinical innovation and care delivery redesign."
(JAMA. 2013;309(24):2572-2578; Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: This study was funded by the Rx Foundation and the West Wireless Foundation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.
Editorial: New Evidence Supports, Challenges, and Informs the Ambitions of Health Reform
Aaron E. Carroll, M.D., M.S., of the Indiana University School of Medicine, Indianapolis, and Austin B. Frakt, Ph.D., of the VA Boston Healthcare System, Boston University Schools of Medicine and Public Health, Boston, comment on the findings of this study in an accompanying editorial.
"These findings certainly do not suggest abandoning efforts to reduce preventable emergency department use and hospitalizations. Joynt et al do not consider the social cost of this utilization. Even though avoiding some emergency department use and hospital admissions might not save much moneyand certainly not enough to declare victory in controlling health spendingpreventing such use when possible would be of substantial benefit to patients, both those who would otherwise use these services and those who have their care delayed because of overburdened emergency department and hospital resources. Even with no cost savings, reducing preventable use of high-intensity and capacity-constrained care would enhance efficiency. Improvements to quality are not always substantial cost savers but still may be worthwhile."
(JAMA. 2013;309(24):2600-2601; Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
###
[ | E-mail | Share ]
?
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Lowering costs for higher-cost medicare patients through better outpatient care may be limitedPublic release date: 24-Jun-2013 [ | E-mail | Share ]
Contact: Marge Dwyer mhdwyer@hsph.harvard.edu 617-432-8416 The JAMA Network Journals
In an analysis that included a sample of patients in the top portion of Medicare spending, only a small percentage of their costs appeared to be related to preventable emergency department visits and hospitalizations, limiting the ability to lower costs for these patients through better outpatient care, according to a study in the June 26 issue of JAMA. The study is being released early to coincide with its presentation at the AcademyHealth annual research meeting.
"High and increasing health care costs are arguably the single biggest threat to the long-term fiscal solvency of federal and state governments in the United States. One compelling strategy for cost containment is focusing on the small proportion of patients in the Medicare programs who account for the vast majority of health care spending. We know from prior work that Medicare spending is highly concentrated: 10 percent of the Medicare population accounts for more than half of the costs to the program," according to background information in the article.
The biggest sources of spending among high-cost beneficiaries are those related to acute care: emergency department (ED) visits and inpatient hospitalizations. "As a result, many interventions targeting high-cost patients have focused on case management and care coordination, aiming to prevent ED visits and hospitalizations for conditions thought amenable to improvement through high-quality outpatient management programs. The premise behind these and related interventions is that high-quality outpatient care should reduce unnecessary hospitalizations for high-cost patients. However, there are few data on the proportion of inpatient hospitalizations among high-cost patients that are potentially preventable," the authors write.
Karen E. Joynt, M.D., M.P.H., of the Harvard School of Public Health, Boston, and colleagues conducted a study to quantify the preventability of high-cost Medicare patients' acute care spending. The researchers summed standardized costs for each inpatient and outpatient service contained in standard 5 percent Medicare files from 2009 and 2010 across the year for each patient in their sample, and defined those in the top decile (one of ten groups) of spending in 2010 as high-cost patients and those in the top decile in both 2009 and 2010 as persistently high-cost patients. Standard algorithms were used to identify potentially preventable emergency department visits and acute care inpatient hospitalizations. A total of 1,114,469 Medicare fee-for-service beneficiaries 65 years of age or older were included.
The high-cost patient group, which included 10 percent of the patients in this sample, were older, more often male and more often black. This group was responsible for 32.9 percent of ED costs and 79.0 percent of inpatient costs. Within the high-cost group, 42.6 percent of ED visits were deemed to be preventable. These visits were associated with 41 percent of the ED costs within this group. The most common reasons for preventable hospitalization in high-cost patients were congestive heart failure, bacterial pneumonia, and chronic obstructive pulmonary disease.
Within the high-cost group, 9.6 percent of hospital costs were attributable to preventable hospitalization. Within the non-high-cost group, though overall spending was significantly lower, a higher proportion of inpatient costs were potentially preventable (16.8 percent).
"Comparable proportions of ED spending (43.3 percent) and inpatient spending (13.5 percent) were preventable among persistently high-cost patients. Regions with high primary care physician supply had higher preventable spending for high-cost patients," the authors write.
"The biggest drivers of inpatient spending for high-cost patients were catastrophic events such as sepsis, stroke, and myocardial infarction, as well as cancer and expensive orthopedic procedures such as spine surgery and hip replacement. These findings suggest that strategies focused on enhanced outpatient management of chronic disease, while critically important, may not be focused on the biggest and most expensive problems plaguing Medicare's high-cost patients."
The researchers add that their "findings suggest that a complementary approach to saving money on acute care services for high-cost patients may be to additionally focus on reducing per-episode costs for high-cost disease entities through clinical innovation and care delivery redesign."
(JAMA. 2013;309(24):2572-2578; Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: This study was funded by the Rx Foundation and the West Wireless Foundation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.
Editorial: New Evidence Supports, Challenges, and Informs the Ambitions of Health Reform
Aaron E. Carroll, M.D., M.S., of the Indiana University School of Medicine, Indianapolis, and Austin B. Frakt, Ph.D., of the VA Boston Healthcare System, Boston University Schools of Medicine and Public Health, Boston, comment on the findings of this study in an accompanying editorial.
"These findings certainly do not suggest abandoning efforts to reduce preventable emergency department use and hospitalizations. Joynt et al do not consider the social cost of this utilization. Even though avoiding some emergency department use and hospital admissions might not save much moneyand certainly not enough to declare victory in controlling health spendingpreventing such use when possible would be of substantial benefit to patients, both those who would otherwise use these services and those who have their care delayed because of overburdened emergency department and hospital resources. Even with no cost savings, reducing preventable use of high-intensity and capacity-constrained care would enhance efficiency. Improvements to quality are not always substantial cost savers but still may be worthwhile."
(JAMA. 2013;309(24):2600-2601; Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
###
[ | E-mail | Share ]
?
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Zhejiang Medicine Co. (SHA: 600216, ZHEXY.PK) formed a collaboration with Ambrx of San Diego to develop an Ambrx molecule that targets Her2-positive breast cancer (see story). Ambrx genetically engineers proteins that contain new amino acids with different properties than those of the 20 natural-occurring amino acids. In return for China rights, Zhejiang will underwrite the costs of development, which will be carried out by WuXi PharmaTech (NYSE: WX).
Suzhou Ribo Life Sciences and Life Technologies (LIFE) of California have stuck a deal giving Ribo exclusive China rights to develop and manufacture siRNA therapeutics using Life's Invivofectamine? Rx delivery technology (see story). Life Technologies will receive milestones and royalties for each drug that Ribo develops. Ribo's first product will be a treatment for hepatitis B.
Shanxi CY Pharmaceutical (SHE: 300254) will purchase a stake of at least 80% in Hangzhou Baoling Group Co., Ltd. (see story). Baoling Group's main asset is a 75% ownership of Zhejiang Baoling Pharmaceutical Co., which produces healthcare and drug products for pregnant women. The purchase price was not disclosed.
BioClinica?, a clinical trial services company headquartered in the US, has formed a strategic partnership with TEDA International Cardiovascular Hospital (TICH) in Tianjin, China. The partnership will offer the company's cardiac safety monitoring services in Asia. BioClinica recently completed the first CFDA-requested Thorough QT (TQT) cardiac safety study in China for a domestic China company at the hospital.
Sichuan BoXin LaiTe Biotechnology and its major shareholder, Heracles International Investment Inc., have signed a memorandum of understanding to form a partnership with the Center for Blood Research (CBR) at the University of British Columbia. BoXin LaiTe and Heracles use their ability to validate the commercial and clinical of novel discoveries made at the CBR and accelerate their development for the China market.
Government and Regulatory
China's chief drug safety regulator, the CFDA, recently felt compelled to have a meeting with Johnson & Johnson (NYSE: JNJ) about product recalls. The problem was an article in a China newsletter alleging that J&J has recalled 51 products globally since 2005. But 48 of those products were not recalled in China, according to the publication. The apparent double standard required an explanation.
CINCINNATI (AP) ? A budget analyst with a daredevil streak, Jane Wicker knew she was taking a risk when she signed up to entertain thousands of spectators at the Vectren Air Show near Dayton.
She said in a TV interview she felt confident of her ability and said on her website that lots of practice makes her signature stunt a "managed risk." She planned to hang underneath the plane's wing by her feet and sit on the bottom of the airplane while it was upside-down.
It wasn't clear Saturday what went so wrong. The biplane glided through the sky, rolled over, then crashed and exploded into flames, killing the wing walker and the pilot, authorities said. No one else was hurt.
A video posted on WHIO-TV shows the small plane turn upside-down as the performer sits on top of the wing. The plane then tilts and crashes to the ground, erupting into flames as spectators screamed.
Ian Hoyt, an aviation photographer and licensed pilot from Findlay, was at the show with his girlfriend. He told The Associated Press he was taking photos as the plane passed by and had just raised his camera to take another shot.
"Then I realized they were too low and too slow. And before I knew it, they hit the ground," he said.
He couldn't tell exactly what happened, but it appeared that the plane stalled and didn't have enough air speed, he said. He credited the pilot for steering clear of spectators and potentially saving lives.
"Had he drifted more, I don't know what would have happened," Hoyt said. He said he had been excited to see the show because he'd never seen the scheduled performer ? wing walker Jane Wicker ? in action.
The show was canceled for the rest of the day, but organizers said events would resume Sunday and follow the previous schedule and normal operations. The National Transportation Safety Board said it is investigating the crash.
On the video, the announcer narrates as the plane glides through the sky and rolls over while the stuntwoman perches on a wing.
"Now she's still on that far side. Keep an eye on Jane. Keep an eye on Charlie. Watch this! Jane Wicker, sitting on top of the world," the announcer said, right before the plane makes a quick turn and nosedive.
Federal records show the 450 HP Stearmans was registered to Wicker, who lived in Loudon, Va. A man who answered the phone at a number listed for Wicker on her website said he had no comment and hung up.
One of the pilots listed on Wicker's website was named Charlie Schwenker. A post on Jane Wicker Airshows' Facebook page announced the deaths of Wicker and Schwenker, and asked for prayers for their families.
A message left at a phone listing for Charles Schwenker in Oakton, Va., wasn't immediately returned.
Dayton International Airport spokeswoman Linda Hughes and Ohio State Highway Patrol Lt. Anne Ralston confirmed that a pilot and stunt walker had died but declined to give their names. The air show also declined to release their identities.
Another spectator, Shawn Warwick of New Knoxville, told the Dayton Daily News that he was watching the flight through binoculars.
"I noticed it was upside-down really close to the ground. She was sitting on the bottom of the plane," he said. "I saw it just go right into the ground and explode."
Thanh Tran of Fairfield said he could see a look of concern on the wing walker's face just before the plane went down.
"She looked very scared," he said. "Then the airplane crashed on the ground. After that, it was terrible, man ... very terrible."
Wicker's website says she responded to a classified ad from the Flying Circus Airshow in Bealeton, Va., in 1990, for a wing-walking position, thinking it would be fun. She was a contract employee who worked as a Federal Aviation Administration budget analyst, the FAA said.
She talked to WDTN-TV in an interview this week about her signature stunt.
"I'm never nervous or scared because I know if I do everything as I usually do, everything's going to be just fine," she told the station.
Wicker wrote on her website that she had never had any close calls.
"What you see us do out there is after an enormous amount of practice and fine tuning, not to mention the airplane goes through microscopic care. It is a managed risk and that is what keeps us alive," she wrote.
In 2011, wing walker Todd Green fell 200 feet to his death at an air show in Michigan while performing a stunt in which he grabbed the skid of a helicopter.
In 2007, veteran stunt pilot Jim LeRoy was killed at the Dayton show when his biplane slammed into the runway while performing loop-to-loops and caught fire.
Organizers were presenting a trimmed-down show and expected smaller crowds at Dayton after the Air Force Thunderbirds and other military participants pulled out this year because of federal budget cuts.
The air show, one of the country's oldest, usually draws around 70,000 people and has a $3.2 million impact on the local economy. Without military aircraft and support, the show expected attendance to be off 30 percent or more.
___
Thomas reported from Philadelphia. Associated Press writers Kerry Lester in Chicago and Randy Pennell in Philadelphia contributed to this report.
HAILEY, Idaho (AP) ? The tearful mother of the only known U.S. prisoner of war said Saturday she's feeling "very optimistic" about his eventual release after his Taliban captors offered last week to exchange him for prisoners at Guantanamo Bay.
U.S. Army Sgt. Bowe Bergdahl's mother, Jani Bergdahl, spoke to about 2,000 people gathered in Hailey, his hometown, in a city park where he played as a toddler and little boy.
About 400 in the crowd arrived astride motorcycles, adorned in leather and patches commemorating America's military missing in action.
Bowe Bergdahl, 27, was taken prisoner in Afghanistan on June 30, 2009. First Jani Bergdahl, then his father, Bob Bergdahl, who accompanied the motorcycle procession on his son's 1978 dirt bike, spoke for a combined 15 minutes about rejuvenated hopes that their son's now-four-year ordeal will soon come to a joyful close.
"We are feeling very optimistic this week," his mother, before addressing her son directly. "Bowe, we love you, we support you, and are eagerly awaiting your return home. I love you my son, as I have, from the first moment I heard of you, the never-ending, unconditional love a mother has for her child."
Buses also brought POW-MIA activists to the event from as far as Elko, Nev., some 230 miles to the south.
Though yellow ribbons on Main Street trees and "Bring Bowe Home" placards in Hailey shop windows are a constant reminder of the 27-year-old Bergdahl's captivity, organizers of the event said the Taliban offer has lent an addition element of urgency ? and hope ? to Saturday's gathering.
Many in the crowd said they were Vietnam veterans; some of them supported the proposed prisoner exchange without reservation.
"Give them their guys and get our guy home," said David Blunt, of Elko, Nev., who said he served in the U.S. Army in Vietnam as a medic. "Bring our guy home. He's suffered enough."
Bergdahl is believed held somewhere in Pakistan, but the Taliban said they would free him in exchange for five of their most senior operatives at Guantanamo Bay, the American installation on the southeastern tip of Cuba that's housed suspected terrorists following the Sept. 11 attacks.
The militant group's exchange proposition came just days ahead of possible talks between a U.S. delegation and Taliban members.
Bergdahl's father, Bob Bergdahl, urged those gathered at Hailey's Hop Porter Park to remember everyone, regardless of nationality, who had suffered during the 12-year conflict in Afghanistan that began following the Sept. 11 attacks.
He described his son as "part of the peace process."
"I wish she was the only mother that was suffering in that way," Bob Bergdahl said of his wife. "Mothers all over the world are suffering because of this war, and I don't forget that for even one day."
He addressed his son's captors in Pashto, the Afghan language he's learned since Bowe Bergdahl went missing.
Bob Bergdahl, who has grown a beard and wore all black at Saturday's event, said that while he is physically in Idaho, he's living vicariously through his son, having set his cell phone to Afghan time, in a bid to share as much as he can his son's experience in exile.
Both mother and father talked of Bergdahl as an adventurer, a young man who once helped crew a sailboat through the Panama Canal, disembarked in San Francisco and then rode a bicycle south along the Pacific Ocean to meet family in Santa Barbara, Calif., 350 miles away.
He joined the military at 22 because "he honestly thought he could help the people of Afghanistan," Bob Bergdahl said.
On June 6, the family said it received its first letter from their son in his handwriting in four years, ferried through the International Committee of the Red Cross.
The circumstances of his capture aren't completely clear, though U.S. officials on July 2, 2009, told The Associated Press a soldier had been taken after walking off his base following his duty shift. For some of the motorcycle riders who participated Saturday, those details are something to be sifted through later, after Bergdahl is safely in the arms of his family.
"He didn't go over there on his own," said Randy Danner, a former U.S. Air Force member from Mountain Home, who rode his motorbike to Hailey with a group called the Green Knights. "No matter the circumstances, for our men and women over there who have put themselves in harm's way, we have a duty to support them in any way we can."
BRUSSELS (Reuters) - Depositors and senior debt holders would be shielded from losses in any bank restructurings ordered by the European Commission, a senior Commission official said on Friday, the latest attempt to reassure savers that they would not be hit by bank problems.
Gert-Jan Koopman, deputy director-general for state aid at the EU executive body, said shareholders and junior debt holders would bear the burden under updated state aid rules that are set to come into force in August.
"If necessary, equity will be fully written down. The same goes for junior debt. But senior debt holders or depositors will not be required to be bailed in," Koopman told Reuters.
Concerns arose about whether depositors would be hit in bank rescues after Cyprus controversially forced savers to foot part of the bill for bailing out its banks.
Koopman said rescued banks, which need EU regulatory approval for their bailouts, would have to exploit their capital-raising ability to the maximum extent possible.
"Often banks have other means of contribution. One is to reduce their risk-weighted assets," Koopman said.
The European Commission is updating its rules governing when countries are allowed to assist banks in trouble. As regulator in such state-aid cases across the European Union, it has the power to set conditions, including the restructuring of a bank, or freezing dividend and coupon payments.
(Reporting by Foo Yun Chee; Editing by John O'Donnell and Greg Mahlich)
KARACHI, Pakistan (AP) ? Two young men received death sentences Friday over a fatal shooting that exposed class divisions in Pakistan and led to an unusual social media campaign demanding that the country's rich and powerful be held accountable.
The suspects, Shahrukh Jatoi and Nawab Siraj Talpur, come from two of the wealthiest families in Karachi, a violent metropolis of 18 million people on Pakistan's southern coast. They were convicted of killing 20-year-old Shahzeb Khan one late night in December after the university student had an argument with one of Talpur's servants.
Khan's family would likely have had little chance of getting justice in the past, though his father is a mid-ranking police officer. Pakistan's police and judges are notoriously corrupt and are often swayed by pressure from the country's elite.
After Khan's death, his father called his wife's brother-in-law, Nabeel Gabool, a member of the National Assembly, who said he had difficulty getting the police to register a case against the accused ? an allegation denied by the police.
But powerful Pakistanis and their offspring are now faced with a growing cadre of citizens ? often middle class or upper middle class ? who are increasingly fighting them with the help of the Internet, an activist Supreme Court and prominent political figures seeking to harness their anger.
Activists in Karachi sprang into action over Khan's death, holding protests, using Twitter and setting up a Facebook page, "In memory of Shahzeb Khan," to get word out about the case. Some of the protests were organized by the party of politician Imran Khan, a former cricket star.
Eventually, the Supreme Court demanded that police arrest the suspected killers in 24 hours, seize their property and freeze their bank accounts. Police detained Jatoi, Talpur, his brother Sajjad Talpur and his servant Mustafa Lashari. Jatoi was nabbed in Dubai, where he had tried to escape.
After the court announced its verdict and sentence Friday, Pakistani TV channels aired video showing Jatoi making a victory sign and smiling as police pushed him toward a prison van.
Defense lawyer Hummol Zubedi confirmed the court's decision but said that the defendants would appeal it. He added that the other two suspects were sentenced to life in prison.
Although Pakistan has many people on death row, the sentences are rarely carried out. Also, a life term usually translates to around 14 years in prison.
In a tearful interview broadcast on Pakistani TV channels, Khan's mother, Ambreen Aurangzeb, said she was satisfied with the court ruling, but added, "I miss my son day and night, and this court order cannot bring him back."
___
Associated Press Writer Munir Ahmed contributed to this report from Islamabad.
The quantity and quality of mobile games have exploded over the past few years. Game developers have been blessed with rapidly improving hardware and an ever-growing customer base that's becoming more comfortable with the idea of spending money for mobile entertainment. Mobile development studios like Rovio and Glu along with independent, one-man developers like Loren Brichter of Letterpress and Andreas Illiger of Tiny Wings are playing on the same field for the same dollars as long-time game studios like Electronic Arts and Rockstar.
But while the customers and dollars might be directed towards any one of those warriors, the battlefield itself is segmented. Is it better for a developer to target the expansive iOS or Android ecosystems and risk all of their work being lost in the fog of app storefront warfare, or should they go for less-populated venues like BlackBerry and Windows Phone, where they can be the big fish in the small digital pond? Do they try and support those features unique to specific platforms, like BBM or Game Center, or do they hit only the most common features across all platforms? And how do those answers change if they?re small indie developers, or powerhouse studios?
Iraq is less violent than it was and the press frequently wonders if the country could descend into war again. What if the war never ended?
By Dan Murphy,?Staff writer / June 6, 2013
May was the most violent month in Iraq since June 2008, with 1,045 people killed. The next most violent month since 2008? This April, with 712 people killed.
Skip to next paragraph Dan Murphy
Staff writer
Dan Murphy is a staff writer for the Monitor's international desk, focused on the Middle East.?Murphy, who has reported from Iraq, Afghanistan, Egypt, and more than a dozen other countries, writes and edits Backchannels. The focus? War and international relations, leaning toward things Middle East.
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Death has stalked Iraqis in the form of car bombs on mosques and markets, assassinations of political figures, and organized massacres of security forces, prompting many to wonder if Iraq could plunge back into another sectarian civil war like the one that raged in the middle of the last decade, and claimed over 3,000 lives a month at its height.
"Systemic violence is ready to explode at any moment if all Iraqi leaders do not engage immediately to pull the country out of this mayhem," UN special representative to Iraq, Martin Kobler, said earlier this month.
While I think that Iraqis are sufficiently horrified at the prospect that it has restrained a surge in the conflict, looked at from a broader perspective than its own recent tragic history. Iraq is currently one of the deadliest conflicts in the world - probably in the top five. Syria at the moment is certainly bloodier. The drug war in Mexico (which some would not consider a war) probably claimed more than 10,000 lives last year. Good numbers on deaths from conflict in Somalia, Sudan, the Democratic Republic of Congo, and Mali are currently hard to come by, but after that it's hard to think of a conflict that would be as or more bloody than Iraq currently is.?
Jay Ulfelder, a political scientist who focuses on civil conflict and instability (and runs an excellent blog), reckons that Iraq is almost certainly currently among the top 10 deadliest conflicts and "very likely top 5"? and estimates it could be near the top with Syria if per capita deaths are taken into account.?
Collecting statistics from war zones is far from an exact science, and combatants have incentives to minimize their own casualties, maximize those of their opponents, and point the finger of blame elsewhere for civilian debts, adding more uncertainty.
Total deaths in the Afghanistan war, for instance, aren't compiled on a regular basis by anyone. Though the United Nations Mission in Afghanistan estimated 2,754 civilian deaths in Afghanistan in 2012 and the well respected Icasualties.org recorded 74 deaths that year for the US-led NATO coalition, deaths among anti-government insurgents and within the Afghan security forces don't appear to be tracked regularly by any outside body. However, an analysis of 2011 deaths by the Congressional Research Service estimated 1,080 deaths that year among Afghan soldiers and police and 3,021 among civilians. That year, 402 members of the US-led coalition were killed.?
In the absence of decent data on deaths within the Taliban and other insurgent groups, let's just make a number up (thoroughly scientific, I know). Let's assume that the 2011 death toll among Afghan civilians and security forces and among the foreign coalition were matched by deaths among insurgents (which is almost certainly an over-count. That would yield a total of 9,000 killed in Afghanistan that year.)
How does Iraq stack up? If the average monthly rate of deaths from conflict there over the past two months held up for a year, that would yield over 10,000 dead. That's of course not likely - violence typically ebbs and flows month to month, and picking the worst two month period over the past five years to extrapolate from almost certainly will end up producing an overestimate. Adding in the death tolls for March (271) and February (220) yields an artificial annual death toll of 6,744.?
The point is that the Iraq of right now could reasonably be considered to be in a type of war, albeit a low-level one with little chance that the current Shiite-led government of Nouri al-Maliki being ousted. Is what's happening now a civil war? I guess it depends on how you define the terms.
In August 2005, I wrote that Iraq was probably already a civil war (a politically unpopular conclusion at the time, with the US eager to portray itself in the mopping up phase after dismantling the Baathist regime of Saddam Hussein):
The academic thumbnail definition of a civil war is a conflict with at least 1,000 battlefield casualties, involving a national government and one or more nonstate actors fighting for power.
While the US has lost 1,862 soldiers, getting an accurate casualty count beyond that is difficult. The Iraqi government and US military say they don't keep figures on Iraqi troops or civilians killed. According to www.iraqbodycount.net, a website run by academics and peace activists, 24,865 Iraqi civilians were killed between March 2003 and March 2005. The report said that US-led forces killed 37 percent of the total.
Obviously things are currently better than that ? but not by much. The horrors that Iraqis continue to confront, in a war that the US has largely put out of its mind, continue and remain the country's deepest challenge.
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Public release date: 25-Jun-2013
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