This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription. Reuters reports on a “fresh look at past research” that finds several non-medical variables may be central to how some patients do once they are discharged from the hospital. Reuters: Are Social Factors Tied To Hospital ReadmissionsThere may be several non-medical factors outside of hospitals’ control that are linked to how heart and pneumonia patients fare once they’re discharged, according to a fresh look at past research. Beginning October 1, the Centers for Medicare and Medicaid Services (CMS) started using readmission rates and patient outcomes as a way to determine how much money hospitals should get paid (Seaman, 10/19).Meanwhile, news outlets take a look at how hospitals in certain states might fare once the readmission penalties kick in -Kaiser Health News: Capsules: Revised Medicare Penalties Hit Some States HardMedicare’s readmissions penalties are falling hardest on hospitals in New Jersey, New York, Arkansas, Mississippi and the District of Columbia, a Kaiser Health News analysis of updated government data shows (Rau, 10/22). The Atlanta Journal-Constitution: Too Many Readmissions To Cost Hospitals Georgia hospitals face the loss of hundreds of thousands of dollars in federal funding for having too many Medicare patients come back through their doors just weeks – or sometimes days – after being sent home….Statewide, one-third of hospitals ended 2011 in the red, said Kevin Bloye, a spokesman for the Georgia Hospital Association. Starting this fiscal year, hospitals face up to a 1 percent penalty of their total Medicare funding if readmission rates are too high, followed by 2 percent in fiscal 2014 and 3 percent the year after that (Williams, 10/21). Are Some Factors Related To Readmissions Beyond Hospitals’ Control?
This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription. Reuters reports on a “fresh look at past research” that finds several non-medical variables may be central to how some patients do once they are discharged from the hospital. Reuters: Are Social Factors Tied To Hospital ReadmissionsThere may be several non-medical factors outside of hospitals’ control that are linked to how heart and pneumonia patients fare once they’re discharged, according to a fresh look at past research. Beginning October 1, the Centers for Medicare and Medicaid Services (CMS) started using readmission rates and patient outcomes as a way to determine how much money hospitals should get paid (Seaman, 10/19).Meanwhile, news outlets take a look at how hospitals in certain states might fare once the readmission penalties kick in -Kaiser Health News: Capsules: Revised Medicare Penalties Hit Some States HardMedicare’s readmissions penalties are falling hardest on hospitals in New Jersey, New York, Arkansas, Mississippi and the District of Columbia, a Kaiser Health News analysis of updated government data shows (Rau, 10/22). The Atlanta Journal-Constitution: Too Many Readmissions To Cost Hospitals Georgia hospitals face the loss of hundreds of thousands of dollars in federal funding for having too many Medicare patients come back through their doors just weeks – or sometimes days – after being sent home….Statewide, one-third of hospitals ended 2011 in the red, said Kevin Bloye, a spokesman for the Georgia Hospital Association. Starting this fiscal year, hospitals face up to a 1 percent penalty of their total Medicare funding if readmission rates are too high, followed by 2 percent in fiscal 2014 and 3 percent the year after that (Williams, 10/21). Are Some Factors Related To Readmissions Beyond Hospitals’ Control?
Today’s headlines include an array of stories previewing today’s election possibilities and what the outcome might mean for the health law, Medicare and the health care industry. Kaiser Health News: Election Will Decide Health Law’s FutureKaiser Health News staff writer Jay Hancock reports: “The highest court in the country upheld most of the Affordable Care Act in June. But everybody knew it was only an overture. The law ‘will fall in November by a vote of the American people,’ Mississippi Gov. Phil Bryant pledged that day, speaking for many other Republicans. Democrats were more reluctant to paint the election as a referendum on what even they came to call ‘Obamacare.’ But privately they admitted the stakes” (Hancock, 11/5). Read the story.Kaiser Health News: Employers Expected To Keep Some Of Health Law’s Popular Provisions, Even If Obama LosesKaiser Health News staff writer Julie Appleby reports: “Employers will continue looking for ways to cap expenses, moving toward higher deductible policies, or placing limits on how much they pay toward their workers’ premiums — both trends that predate the federal health law, analysts say” (Appleby,11/5). Read the story.Kaiser Health News: Health Care Stakes Are High In CaliforniaKaiser Health News staff writer Sarah Varney reports: “More than any other state, California has wagered heavily on the Affordable Care Act: It has moved quickly to erect an insurance exchange and establish the high risk pool. It’s also codified federal consumer protections into state law. In 2010, the state signed a $10 billion Medicaid waiver with the Obama administration that has allowed counties here – from Democratic Los Angeles to Republican San Diego – to enroll as many as 500,000 low-income adults into a ‘Medicaid-lite’ program years ahead of the law’s expansion of the federal-state program for the poor. Similar to the high risk pool, ‘Medicaid-lite,’ which is officially called the Low Income Health Plan, is envisaged as a temporary measure until January 2014. That’s when California would open up its Medicaid program to millions of poor people, an expansion paid for largely by the federal government” (Varney, 11/5). Read the story.Kaiser Health News: Medicare Trying To Nudge Seniors Out Of Plans With Low RatingsReporting for Kaiser Health News in collaboration with USA Today, Susan Jaffe writes: “Medicare officials are trying a novel approach during this open enrollment season to gently nudge a half million beneficiaries out of 26 private drug and medical plans that have performed poorly over the past three years. It begins with letters informing seniors they are enrolled in a plan that received low ratings” (Jaffe, 11/5). Read the story or check out the related chart.Kaiser Health News: Insuring Your Health: Dispelling Some Rumors About Medicare And The Health Law Limiting CareKaiser Health News consumer columnist Michelle Andrews answers questions from readers about provisions in the Affordable Care Act related to drugs and medical-care coverage under Medicare and high-risk insurance plans (11/5). Read the column.Kaiser Health News: Capsules: Less Experienced Doctors Cost Health System More; Are ACOs Doomed To Fail?; Study: Depression A Leading Risk For Higher Health SpendingNow on Kaiser Health News’ blog, Jenny Gold reports on a commentary on the future of ACOs: “Accountable care organizations are widely touted as one of the most effective cost-containing measures of the 2010 federal health law. Yet they have a great deal in common with the integrated delivery networks of the 1990s, leaving some wondering whether the bold experiment might come to the same disappointing end” (Gold, 11/5).Also on Capsules, Jordan Rau writes about a new study finding that depression is a leading driver of health spending: “Depression was the most costly among 10 common risk factors linked to higher health spending for employees, according to a new study of seven companies. The study published in Health Affairs found that the 10 factors — which also included obesity, high blood sugar and high blood pressure — were associated with nearly a quarter of the money spent on the health care of the workers” (Rau, 11/6).In addition, Alvin Tran reports on a study about the physicians who may cost the health system more: A new study “found that doctors with less experience spend more money treating patients than their veteran colleagues” (Tran, 11/5). Check out what else is on the blog. The Associated Press/Washington Post: No More Days: Obama, Romney Fight On Into The Night At The End Of Long Presidential CampaignThe White House the prize, President Barack Obama and Mitt Romney raced through a final full day of campaigning on Monday through Ohio and other battleground states holding the keys to victory in a tight race. Both promised brighter days ahead for a nation still struggling with a sluggish economy and high joblessness (11/5).The Wall Street Journal: Obama And Romney Battle Down To WireAfter more than one million television ads, countless appearances and three contentious debates, the 2012 presidential election remained on a knife’s edge with both candidates seeking to shore up support in states crucial to their chances Tuesday. … With the margin of victory for the winner expected to be narrow, a likely outcome is a political system as split as the country. It isn’t clear either party would be positioned to emerge Wednesday with a clear mandate for tackling some the nation’s biggest problems—including the looming tax increases and spending cuts known as the fiscal cliff (Meckler and Murray, 11/5).The Washington Post: On Election Eve, President Obama Has A Slim Edge In PollsPresident Obama held a slim advantage in national and battleground polls going into Election Day as the candidates made their last mad dashes across swing-state America and their campaigns braced for a day of intense battle — and the legal fights that may follow. A Washington Post-ABC News tracking poll showed Obama at 50 percent to Republican challenger Mitt Romney’s 47 percent. That is Obama’s best showing since July and a reversal of the three-percentage-point edge Romney held last month (Fahrenthold and Barnes, 11/5).Los Angeles Times: Wall Street May Rally Regardless Of Presidential Election WinnerIf nothing else, the end of the grueling presidential campaign will bring a long-awaited dose of certainty to the stock market. Given the divergent economic and fiscal policies of President Obama and Republican challenger Mitt Romney, investors have strained for months to divine who will win and how they should position their portfolios. … A second Obama term, for example, could boost shares of technology and alternative-energy companies. It also could help industries as varied as home builders, hospitals, fast-food chains and aluminum makers, analysts say. A Romney victory, by contrast, could lift financial-services firms, coal and other energy producers, high-end retailers and restaurants and dividend-paying companies. … Meanwhile, healthcare companies and their investors have been watching the campaign closely in light of Romney’s repeated vow to repeal Obama’s signature law, the Affordable Care Act. The federal healthcare overhaul imposes new rules on insurers and cuts reimbursements for many hospitals. But some experts think the net effect could be positive for many healthcare companies because the law expands coverage to an estimated 30 million Americans and requires most people to purchase health insurance (Hamilton, Terhune and Reckard, 11/6).The Wall Street Journal: Democrats Outraise GOP In Senate TossupsIn the battle for the Senate, which could determine the next president’s room for maneuver, Democrats have built a surprising advantage: They have outraised Republicans. In the 11 Senate races considered tossups, Democratic candidates outraised their Republican opponents by a combined $45 million, according to an analysis by The Wall Street Journal (Mullins and Bendavid, 11/5).The Wall Street Journal’s Washington Wire: Health Care Appears On Some BallotsWhen Florida voters cast their ballots, they will be asked to decide on a state constitutional amendment trying to block the federal health law’s requirement that people purchase insurance or pay a penalty. They may find the question surprising following the Supreme Court’s ruling in June that Congress had the authority to pass the individual mandate as part of its taxing power. … The question is appearing on the ballot because state legislators decided in 2011 to put it there. Florida lawmakers had tried to get a similar measure on the ballot for 2010 elections but state courts nixed it, saying the language was misleading. Similar questions are on ballots in Alabama, Montana and Wyoming, all placed there by state legislators before the Supreme Court’s ruling. Some 16 states already had provisions on the books that tried to block the health law (Radnofsky,11/5).The Wall Street Journal: Tough Calls On Deficit Await The WinnerIf the winner of the presidential election wants to tackle America’s groaning debt load, he will probably have to break a campaign promise or two. President Barack Obama and Republican challenger Mitt Romney have hammered at each other’s plan for tackling the nation’s growing debt. They are similar, though, in one key regard: Both offer prescriptions that largely exempt the vast middle class from the bitterest medicine (Paletta, 11/5).The Washington Post: Young Workers’ Retirement Hopes Grow Bleaker Amid Economic DownturnAs Washington turns in the coming weeks from the presidential election to the long-term debt issues facing the nation, the discussions will center on whether the country can afford programs such as Social Security and Medicare in their current form (Fletcher, 11/5).The New York Times: Michigan Judge Temporarily Blocks Health Law Mandate On Birth ControlA federal judge has issued an order shielding a Michigan business from a requirement of the new health care law to provide insurance coverage for contraceptives at no charge to female employees (Pear, 11/5).The Associated Press/Washington Post: Federal Appeals court Begins Hearing Arguments For And Against Arizona’s 20-Week Abortion BanA three-judge panel of the 9th U.S. Circuit Court of Appeal cast a skeptical eye Monday on the country’s most-restrictive abortion law, which prohibits the procedure after 20 weeks of pregnancy unless there’s a medical emergency. Even Judge Andrew Kleinfeld, a reliably conservative jurist appointed to the appeals court by former President George H.W. Bush, said Arizona’s law appears to wrongly prohibit abortions before “viability,” when the fetus can live outside the womb. Viability is generally considered to occur sometime after 23 weeks of pregnancy. The county’s seminal Supreme Court 1973 abortion ruling, Roe v. Wade, said states cannot prohibit abortions outright prior to viability (11/5).NPR: For Simple Care, Retail Clinics Are A Popular ChoiceIf you’ve got the sniffles or need a shot, do you go to the doctor or stop in at a clinic in a nearby drugstore? Lots of people are opting for the clinics, which are springing up inside grocery stores, big-box retailers and chain drugstores across the country. There are already 1,388 clinics like these in the U.S., according to data from Merchant Medicine, a consulting firm (Hensley, 11/5).The Washington Post: Previous Fungal Meningitis Outbreak A Decade Ago Resulted In No Oversight ChangesFirst, David Brannon couldn’t believe it. Then he couldn’t stand hearing about it. Hundreds of people were ill with fungal meningitis they had contracted after getting pain-killing injections made by a compounding pharmacy in Massachusetts. Dozens were dead, and the numbers were still rising (Brown, 11/5).Politico: Nationwide Drug Recall Likely To Deepen ShortagesThe recall of all drugs from a Massachusetts manufacturer — in the latest response to the meningitis outbreak — will most likely exacerbate a critical shortage of at least six drugs that were already in short supply. Hundreds of products were recalled Wednesday by Ameridose, a sister company to New England Compounding Center that is at the center of the Food and Drug Administration’s investigation into the fungal meningitis outbreak that has killed 29 and sickened more than 400. The FDA recommended the recall after saying that it “could not assure the sterility” of Ameridose products but has offered no other details (Norman, 11/6).Los Angeles Times: Kaiser Permanente Promotes Longtime Executive To Be Next CEOKaiser Permanente’s board said it would promote a veteran executive to be the next chairman and chief executive of the healthcare giant, effective next year. Bernard J. Tyson will replace George Halvorson, 65, who announced last month that he was retiring after a long tenure at the helm of the Oakland company. Halvorson was instrumental in building Kaiser into the nation’s largest nonprofit insurer and hospital system, with more than 9 million customers and nearly $50 million in annual revenue. It employs 17,000 physicians nationwide (Terhune, 11/6).Los Angeles Times: Health Net Posts Plunge In Profit, Strikes Deal With CaliforniaWoodland Hills insurer Health Net Inc. said third-quarter net income plunged 71%, but its shares rose as the company resolved a dispute with California officials over reimbursement for government health programs. Health Net disappointed investors in August when it slashed its full-year profit outlook and reported higher-than-expected medical costs. On Monday, Chief Executive Jay Gellert said the company was making progress on its turnaround plans. He cited a wide-ranging agreement with California healthcare officials as a major step forward (Terhune, 11/6).The Associated Press/Washington Post: Humana Posts Lower 3Q Net, Hikes 2012 Earnings Forecast, Names CEO, Deal To Expand In FloridaHealth insurer Humana Inc. said Monday that its third-quarter net income fell 4 percent as more premium dollars from its members went to pay for medical claims, offsetting continued growth in its lucrative Medicare Advantage business. But its earnings still beat analysts’ expectations and the company raised its earnings forecast for the full year (11/5).The Wall Street Journal: Humana Brings Doctors In-HouseHumana Inc.is accelerating its move into directly providing health care, with new deals and planned investments that are expected to expand the number of physicians under its umbrella to more than 2,600 (Mathews and Kamp, 11/5).Los Angeles Times: Quiz: Test Your Healthcare KnowledgeHealthcare costs continue to climb, putting pressure on employers and consumers in a sputtering economy. In the past decade, U.S. health premiums have shot up 97%, three times as fast as wages and inflation nationwide, according to the Kaiser Family Foundation. Test your knowledge of healthcare costs and some of the changes under the federal healthcare law (Terhune, 11/5).Check out all of Kaiser Health News’ e-mail options including First Edition and Breaking News alerts on our Subscriptions page. This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription. First Edition: November 6, 2012
An annual survey shows that doctors, on average, still make at least three times the annual median household income. Media outlets also describe other trends, including the return of house calls, often as part of hospital palliative care programs, the use of scribes to help with digital records, rushed doctors’ visits and a study finding that free drug samples influence doctors’ prescribing practices.The Washington Post: Doctors Still Make Good Money In the United States, doctors on average still make at least three times the annual median household income. The lowest average income on the list of doctors for 2013 was $174,000 and in 2012, the median household income was about $51,000. Orthopedics had the highest average earnings at $413,000, and cardiologists and urologists were not far behind. Of the 25 medical specialties listed, three-quarters of them had an increase from 2012, according to the Medscape Physician Compensation Report, an annual survey of doctors around the country (Tobey, 4/18). The New York Times: House Calls Are Making A Comeback A relic from the medical past — the house call — is returning to favor as part of some hospitals’ palliative care programs, which are sending teams of physicians, nurses, social workers, chaplains and other workers to patients’ homes after they are discharged. The goal is twofold: to provide better treatment and to cut costs. … Confusion continues to exist over what palliative care is and whom it is for. Broadly, it is meant to ease symptoms and pain, and focus on quality of life for severely ill patients, who can choose between continuing or halting traditional medical treatment (Freudenheim, 4/19). Kaiser Health News: 15-Minute Visits Take A Toll On The Doctor-Patient RelationshipPatients — and physicians — say they feel the time crunch as never before as doctors rush through appointments as if on roller skates to see more patients and perform more procedures to make up for flat or declining reimbursements. It’s not unusual for primary care doctors’ appointments to be scheduled at 15-minute intervals. Some physicians who work for hospitals say they’ve been asked to see patients every 11 minutes. And the problem may worsen as millions of consumers who gained health coverage through the Affordable Care Act begin to seek care — some of whom may have seen doctors rarely, if at all, and have a slew of untreated problems (Rabin, 4/21).NPR: Scribes Are Back, Helping Doctors Tackle Electronic Medical Records Like many other doctors across the country, Dr. Devesh Ramnath, a Dallas orthopedic surgeon, recently made the switch from paper to electronic medical records. This meant he no longer had to just take notes when he was examining a patient — he also had to put those notes into the computer as a permanent record. … In fact, he found he was spending an extra two to three hours every clinic just on electronic records. So he hired medical scribe Connie Gaylan. Acting a bit like a court reporter, Gaylan shadows Ramnath at every appointment. As the doctor examines a patient, Gaylan sits quietly in the corner, typing notes and speaking into a hand held microphone. Once she’s finished with the records, she gives them to Ramnath to check and approve, saving him hours of administrative work and allowing him to concentrate on his patients (Silverman, 4/21). PBS NewsHour: Do Free Samples Influence The Way Doctors Prescribe Drugs?A new study from Stanford University’s School of Medicine found that doctors who are allowed to hand out free samples of expensive drugs prescribe those drugs more often than doctors who don’t have access to free samples. Dr. Alfred Lane, senior author of the report, talks with Hari Sreenivasan about the implications of the findings (Sreenivasan, 4/20). This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription. Doctors Still Make Good Money
State health officials have announced a new background check program for long-term care workers in West Virginia. On Wednesday, the Department of Health and Human Resources announced its West Virginia Clearance for Access: Registry and Employment Screening program. (8/6) The Associated Press: W.Va. Officials Announce Long-Term Care Background Checks Doctors and nurses made visit after visit to the elderly man’s home, even after watching him walk the dog, take a stroll down the street and repeatedly talk about visiting his grandkids. Yet the home visits were classified as treatment for the homebound, enabling a Chicago-based health care company to bill Medicare for thousands of dollars. The 71-year-old man, it turns out, was an undercover confidential source for federal agents who for months worked to gather evidence of alleged phony billing practices at Home Physician Services. (O’Connell, 8/6) The Elgin Courier-News: Agency For Developmentally Disabled Feels Impact Of Budget Gridlock This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription. The Associated Press: New Veterans Clinic In Pahrump Gets $12.1M Federal OK State Highlights: W.Va. Long-Term Care Workers To Have Background Checks; In Wash., 126 People Used Death-With-Dignity Law In 2014 Health care stories are reported from West Virginia, Washington, Delaware, Texas, Oregon, Illinois, Nevada and Maryland. The Washington Post: Rural Maryland Sees Jobs, Not Vice, In Medical Marijuana In January, Stuart Bowen took charge of a state office rocked by accusations of corruption, incompetence and inefficiency. Responsible for ferreting out fraud amid the programs and procedures of the sprawling Health and Human Services Commission, the office of Inspector General itself remains under a cloud. He hopes a new law kicking in Sept. 1 will help revive the office’s performance and perception. (Bollag, 8/6) NPR: Can A 32-Year-Old Doctor Cure Baltimore’s Ills? Cook County’s public health system is looking for a new company to process insurance claims after it canceled a contract with the firm it hired just a year ago. A spokeswoman at Cook County Health and Hospitals System confirmed Thursday that it plans to replace IlliniCare Health, a subsidiary of St. Louis-based Centene, as its third-party administrator. The county posted a request for bids on Tuesday.The role also is critical for Cook County because the health system has taken on the risk of insuring more of its patients. The health system started its own managed care plan in 2012 to enroll patients who gained insurance through the expansion of Medicaid under the Affordable Care Act. (Sachdev, 8/6) The Associated Press: Chicago To Allow Health Coverage For Gender Reassignment Surgery The Associated Press: Federal Lawsuit Targets Confinement Of Mentally Ill Patients Chicago Mayor Rahm Emanuel announced plans on Wednesday to allow reassignment surgery for the city’s employees as part of their health benefits package. “Chicago is known for being a city that is welcoming to all and inclusive of every resident, and this new policy is in line with our efforts to support the rights and well-being of transgender individuals,” Emanuel said in a statement. “With this change, Chicago will ensure that transgender city employees are able to receive the medical care that they need.” (8/6) The Associated Press: 126 Died In 2014 Using Death With Dignity 
The Chicago Tribune: Cook County Health System To Replace Claims Administrator The Chicago Tribune: CEO Of Health Care Company Charged In Undercover Fraud Probe The Register-Guard: Health Care Company Sues Eugene Paper Over Records Release Washington County is a proudly conservative place. Voters here haven’t backed a Democrat for president since 1964, and same-sex marriage lost by a landslide in a referendum three years ago. But when Chicago-based Green Thumb Industries pitched a proposal to put a medical-marijuana production plant here, the county’s five county commissioners — Republicans all — passed a resolution unanimously supporting the plan. (Dresser, 8/6) Jill Nomellini does not understand the concept of money. Her mom, Barb, has tried to teach her. But the 37-year-old has the mind of a young child and does not comprehend, her mother said. Nor does Jill understand exactly what is happening at the Association of Individual Development (AID), where she heads every day to do the job that she takes so much pride in doing. Jill is afraid AID will close, Barb Nomellini said. AID, with headquarters in Aurora and an office in Elgin along with smaller offices in Batavia and Yorkville, is in the crosshairs of Illinois legislators’ battle over the fiscal year 2016 budget that has caused an impasse in Springfield. (Casas, 8/6) Veterans in Pahrump, Nevada are getting a long-sought larger outpatient clinic now that a federal construction contract has been awarded. The news quickly turned political Wednesday when Nevada’s freshman Republican Congressman Cresent Hardy took credit saying in a statement that longtime Democratic Sen. Harry Reid and the Democratic representative unseated by Hardy couldn’t cut through “red tape” to make it happen. (Pierceall, 8/6) Several shareholders in the Eugene company that manages services to about 95,000 Lane County Oregon Health Plan patients have sued the state and Guard Publishing Co., publisher of The Register-Guard, to try to stop the state from releasing public records. Shareholders of Agate Resources Inc., the parent company of Trillium Community Health Plan — the coordinated care organization in Lane County — allege that disclosing the names and ownership interest of Agate shareholders would invade their personal privacy and threaten their professional reputations without serving any public interest. (McDonald, 8/6) Neighborhoods in Baltimore are still struggling to recover from the riots that broke out following the funeral of Freddie Gray, who suffered a fatal injury to his spine while in police custody. In the aftermath of the unrest, we here at NPR spent many hours trying to understand the raw anger on display. We looked at police brutality, economic disparities and housing segregation in Baltimore. Our conversations eventually led us to Leana Wen. (Cornish, 8/6) The Texas Tribune: New Law Helps Tackle Health Agency Woes State treasurers from across the country are meeting in Chicago Thursday and Friday to discuss how to implement a tax-exempt plan to help families cover the expenses of people with disabilities. The new ABLE accounts, which stands for Achieving a Better Life Experience, will operate much like 529 college savings plans in that the growth is federal tax-free and families are allowed to withdraw money for qualified expenses tax-free. (Rodriguez, 8/6) Legal advocacy groups filed a federal lawsuit against Delaware’s prison commissioner Thursday, alleging that the Department of Correction is unconstitutionally subjecting mentally ill prisoners to solitary confinement without proper evaluation, monitoring and treatment. In the complaint, the American Civil Liberties Union and Community Legal Aid Society argue that solitary confinement can exacerbate symptoms of mentally ill inmates’ disorders and violates their constitutional rights, amounting to cruel and unusual punishment. (Chase, 8/6) State health officials say 126 people died in Washington state last year after requesting and using a lethal prescription through Washington’s Death with Dignity law. The Washington Health Department reported Thursday 176 people requested and received lethal doses of medication in 2014, a slight increase from the year before. Of those people, 170 died, but some died without ingesting the medication and the state does not know whether some of them took the medicine or not. (8/6) The Chicago Tribune: Illinois To Implement New ‘ABLE’ Accounts For People With Disabilities 
Modern Healthcare: Mandatory Participation Killed The Part B Demo The Associated Press: Medicare Outpatients Risk Higher Bills For Some Procedures You pay less for outpatient treatment than for a hospital admission, right? Not necessarily in the topsy-turvy world of Medicare billing, according to a government report. People entitled to benefits under Medicare who had heart stents inserted as outpatients faced hospital bills that were $645 higher on average than those who had the same kind of procedure as inpatients, the Health and Human Services inspector general has found. (Alonso-Zaldivar, 12/19) Medicare Auditor Finds Some Treatments Cost More For Outpatients Than Inpatients The inspector general’s report shows that beneficiaries getting heart stents in the hospital pay on average $645 less than those getting them in outpatient facilities. It says Medicare needs to review how its billing rules distinguish between inpatient and outpatient hospital stays. Also, an analysis of Medicare’s decision to kill a controversial test to lower the payments for drugs administered by doctors in outpatient settings and one senator hears from constituents about concerns over Medicare funding. Experts say the cancellation of a pilot program whose goal was to drop drug prices doesn’t mean the fight is over, and future efforts should simply take lessons from the experience. The Obama administration Thursday evening announced it was killing a five-year Medicare initiative that would test new ways of paying for outpatient drugs in an effort to bring those prices down. … the mandatory program has served as an example for opponents of what’s wrong with the Center for Medicare and Medicaid Innovation, which was created by the Affordable Care Act to find ways to reform how healthcare is delivered and paid for. The center itself is in the crosshairs of some Republicans, who say the pilot programs created by the Innovation Center overstep its authority because they require physicians and patients to participate without creating legislation to support the efforts. Providers also said they weren’t consulted or asked for input before the model was unveiled. (Dickson, 12/16) 
This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription. Sen. Jon Tester met with senior health care representatives across the state on Thursday to hear concerns on Medicare, Medicaid and the Affordable Care Act. … “Medicare is a bedrock program for seniors and to do away with that would be criminal. To voucher it would be very very bad,” Tester said. Representatives from AARP Montana, The Montana Health Coop and Montana’s Area Agencies on Aging echoed Tester’s concerns, and called on him to protect Montanans with Medicare and Medicaid. They also came with suggestions for improvements to existing services and areas where Montanans need additional benefits. (Loranger, 12/17) Billings (Mont.) Gazette: Tester Gets Feedback On Medicare, Medicaid At Seniors Town Hall Meeting 
There are also rumors that a second battery plant is considered in Poland or maybe in another country. Construction of the second LG Chem plant in Europe is expected to begin in mid-2019.Interesting (google translate) | Jong Hyun Kim, president of LG Chem Energy Solutions, ensures that within 2-3 years the Korean company will increase the production potential of the factory from around 10 GWh to 70 GWh | me… Energy and mix is cheap and coal in Poland or? https://t.co/BEZQauNmVA— Matthias Schmidt (@auto_schmidt) November 24, 2018 Poland Will Become Home To Europe’s Largest Battery Factory Next Year – Courtesy Of LG Chem LG Chem to produce in Europe batteries for a million EVs annuallyAccording to Polish media, LG Chem has so many orders for electric car batteries that the recently constructed plant in Poland will be not big enough.A year ago, we assumed that the LG Chem Wroclaw Energy will produce at least several GWh of lithium-ion batteries annually, as the company announced a goal to power 100,000 cars. First production lines are already up and running, while new ones are under construction. Orders come from Daimler, Jaguar, Renault, Volkswagen Group and Volvo, to name just a few.Now, Jong Hyun Kim, president of LG Chem Energy Solutions is cited saying that within 2-3 years, production capacity will increase from 10 GWh to 70 GWh (for some 1 million electric cars annually). It would truly solidify the position of the market leader in Europe in terms of production capacity.See Also Panasonic’s Only Profitable Electric Car Battery Deal Is With Tesla Tesla Battery Cells Are Best Value In Class: 20% Cheaper Than LG Chem
Source: orpa.pl Author Liberty Access TechnologiesPosted on November 29, 2018Categories Electric Vehicle News Source: Electric Vehicle News
That’s precisely what the team at CarWow has done here, but is the result what you’d expect?A big ol’ family-hauling Tesla SUV should be blown away by the Lamborghini Aventador, right? Well, without spoiling the excitement, we’ll just say the matchup is closer than one might expect.And we should point out there have been several other Tesla versus Aventador races in the past and most had the opposite result.Grab a look at the 360-degree video above to see how the racing action plays out.Video description:It’s petrol vs electric for our latest drag race! The Model X P100D has left all other competitors in its wake when it’s taken part in previous drag races, but how will it fare when it goes up against a 740hp Aventador S? There’s only one way to find out… Let’s race! Author Liberty Access TechnologiesPosted on December 31, 2018Categories Electric Vehicle News Watch Tesla Model S 75D Race Kia Stinger GT S It’s a battle between an electric SUV and a gas supercar.This most unlikely of matchups is only because the Tesla Model X P100D has crushed everything else thrown its way, so why not pit it against a vehicle that shouldn’t be beaten?More Tesla Racing Action Source: Electric Vehicle News Watch Tesla Model 3 Performance Race Chevy Corvette With Slicks Watch A Tesla Race A Superbike, Formula 1 Car, Jet, Airplane & More
When Fenske first got his Model 3 Mid Range rear-wheel-drive he seemed pretty happy with it. It was the most affordable version available, yet still boasted a reassuring 264 miles of EPA-rated range. Sure, there were some issues with it upon delivery that weren’t really acceptable, but those could be dealt with. Still, it didn’t quite seem to spark joy like he had thought it would. The problem, it seems, had to do with the acceleration.The mid-size Tesla sedan uses a unique type of permanent magnet motor. According to Fenske, it is a permanent magnet switched reluctance motor (PMSRM), which has a higher efficiency while costing less. With no AC induction motor on the front axle — used in the all-wheel-drive versions of the car — the Mid Range rear-wheel-drive version lacked that instant torque that is generally the hallmark of electric vehicles.Fenske tells us this is because a PMSRM has to deal with a unique phenomenon called torque ripple. In order to this from making acceleration feel uneven, power is meted out in a slightly limited fashion. While still capable of a 5.6-second sprint from 0-to-60 miles per hour, the performance edge felt blunted.The obvious fix to this situation was the one the affable host took. He traded in his car for a Performance variant. As you can see in the video, he is extremely happy with the new car. Besides having much better panel alignment and only a couple very minor paint issues, it gives him that deeply satisfying instant acceleration response he felt was missing. With 310 EPA-rated miles, it also gives his range a significant boost. Then there are the extra features like “track mode.”Besides the info in the video, Fenske also answered a couple questions in the text of the video description dealing with the price of everything and how he knows he didn’t get special treatment. We’ve added that just below. Enjoy!Video description:I Sold My Tesla Model 3 Mid-Range & Bought A Model 3 Performance! After driving the Tesla Model 3 mid-range, I regretted not opting to upgrade to the Performance AWD Model 3. The Model 3 mid-range features a unique permanent magnet rear motor, which gives it different driving characteristics versus many other electric cars, including the Model S and Model X, which both use induction motors. This video will cover what the differences in the motors are (front and rear), how this affects the driving characteristics of the car, the mechanical differences between the mid-range and Performance, as well as the overall condition that my Tesla Model 3 Performance arrived in. How Do I Know I Didn’t Get Special Treatment From Tesla With Paint Repair/Car Exchange? First off, this seems strange to me, but many have asked if I somehow received special treatment with regards to getting paint fixed, ordering the Tesla, delivery, etc. That’s not how Tesla works, nor myself, but here’s how I know that no special treatment was provided: 1. Both previous videos were filmed before either video was released. I took delivery of the Model 3 Performance BEFORE the video about paint scratches went live. Hence, Tesla had not seen that I had publicly posted paint issues until I already had my new vehicle. The paint video was filmed before I had decided I was going to trade-in the Mid-Range. 2. I specifically selected the vehicle which I bought. I called Tesla to find out what was in inventory, and I selected a red M3P from that inventory, with VIN. Tesla did not choose the new car for me. 3. When I received the Mid-Range with paint scratches, I called Tesla SLC for the fix. I had heard horror stories from friends about the process required to get the paint repaired (multiple body shop visits, coming back worse than before, loss in value from repaint, etc) so I decided against getting the repair and asked Tesla if they could compensate me at all for the damaged paint instead of dealing with the hassle of repair shops. I felt $2,500 was an unjustified payment for the red paint if it arrives defective/scratched. Tesla said they would get back to me about this. They never did before trading in the car. 4. I only put 49 miles on the car before calling Tesla to inform them I wanted to exchange it for the Performance. This was outside of the 3-day return window (we had a bunch of snow after I took delivery, so I waited until snow had melted before driving for the video review, thus no 3-day window). Tesla said they might be able to switch the car due to the special circumstances (71 miles on the odometer, typical 3-day window needs mileage under 500). Then, they told me they could not. How Much Did All Of This Cost? – I bought the Model 3 Mid-Range in November 2018. $46,000 base price. – $2,500 red paint option, $1,500 19” wheel option, and $1,200 delivery. Total: $51,200 – $7,500 tax credit. Actual Total: $43,700 – The trade-in value of the Mid-Range was $43,200. A $500 loss. The $7,500 tax credit can only be applied to the first buyer, so it instantly loses this much in value. Essentially, buying used means getting the tax credit up front. – I bought the Model 3 Performance in December 2018. $64,000 base price. – $2,500 red paint option, and $1,200 for delivery. Total: $67,700 – $7,500 tax credit. Actual Total: $60,200 – Total Cost To Upgrade To Model 3 Performance: $17,000Source: YouTube Author Liberty Access TechnologiesPosted on January 21, 2019Categories Electric Vehicle News Living With An Electric Car Long Term Will Convert You Source: Electric Vehicle News Explains how the Model 3 rear motor might work.Jason Fenske, of the popular Engineering Explained Youtube channel, has traded in his Tesla Model 3. His new car, which he says is a huge improvement, is also a Tesla Model 3. The video above doesn’t just fill us in on why he made the switch. It also gets into the inner workings of the Model 3 rear motor and how that played a part in his decision. We’ll give you a quick synopsis here, though, in case you don’t have the time to watch. (We do recommend it though)More with Engineering Explained Video: Everything That’s Wrong With This New Tesla Model 3 Engineering Explained Buys Tesla Model 3 Mid Range
Source: Charge Forward Ford’s “Go Electric” event in Amsterdam today revealed the automaker’s electrified vehicle lineup in Europe, but all of the new production models introduced at the event were hybrid variants. more…The post Ford’s ‘Go Electric’ event in Europe goes mostly hybrid appeared first on Electrek.
Because without Tesla in the headline, the mainstream media doesn’t care.Source: Electric Vehicle News
The FCPA Flash podcast provides in an audio format the same fresh, candid, and informed commentary about the Foreign Corrupt Practices Act and related topics as readers have come to expect from written posts on FCPA Professor.This FCPA Flash episode is a conversation with Joseph Moreno (a former federal prosecutor and currently a partner in Cadwalader’s White Collar Defense and Investigations Group). Moreno, along with other Cadwalader attorneys, recently authored this article “When Realities Test the Limits of Your FCPA Program” that caught my eye. During the podcast, Moreno discusses: the origins of the article; how excessive risk aversion regarding corporate hospitality can have negative consequences; what Congressional leaders in the mid-1970’s who led the FCPA movement might think about certain current enforcement theories; and what might happen if certain enforcement theories were actually subjected to judicial scrutiny.FCPA Flash is sponsored by Kreller Group.For the past 30 years, Kreller has distinguished itself as a best-in-class enhanced due diligence provider. It’s investigative network leverages the talent and integrity of some of the best law-enforcement, military specialists, business correspondents, and government contacts worldwide. With firsthand knowledge of the language, laws, regulations, political and economic climates and data availability in each country, Kreller provides reliable, compliant, and accurate information. A licensed private investigations firm, Kreller’s competitive advantage is experience, quality, commitment, and customer service.
Interesting, from the DOJ’s perspective, pay them more, sanctioned, scrutiny update, exit, and for the reading stack. It’s all here in the Friday roundup.InterestingAs highlighted here, in December 2016 Odebrecht S.A. (a Brazilian holding company) and Braskem S.A. (a Brazil-based petrochemical company in which Odebrecht owns a majority of voting shares) resolved a large FCPA and related enforcement action largely concerning conduct in Brazil including the companies relationships with Petrobras as well as allegations of improper payments in Angola, Argentina, Brazil, Colombia, Dominican Republic, Ecuador, Guatemala, Mexico, Mozambique, Panama, Peru, and Venezuela.As highlighted here, in late December 2018 Brazil-based Eletrobras resolved an FCPA enforcement action centered on allegations that “several Brazilian government officials, the former Eletronuclear president, and other Eletronuclear officers received bribes from Brazilian construction company executives engaged in a bid-rigging and bribery scheme involving” a specific project.Recently Eletrobras announced that Odebrecht “will pay it and three affiliates a combined sum of nearly 161.9 million Brazilian reals ($42.7 million) as part of a corruption-related leniency agreement between the Brazilian engineering conglomerate and the nation’s government.” As noted here: “Eletrobras said that adhering to the agreement “is an opportunity for Eletrobras to recover part of the funds to which it is entitled, as a result of the losses caused by Odebrecht, as part of the corruption scheme unveiled by [Operation Car Wash].”From the DOJ’s PerspectiveThe Fraud Section of the Department of Justice recently released this annual report. It contains several references to the FCPA including what the DOJ views as its most notable FCPA cases in 2018.Pay Them MoreThere are two parties in a bribery scheme. The giver and the recipient. Often times, the recipient “foreign official” with discretion has a low government salary and is looking to supplement their income by making a request for something of value.Does this mean that if the “foreign official’s” salary is increased that the “foreign official” will stop demanding things of value?I doubt it, but as highlighted in this article“[Guyana] Head of the Environmental Protection Agency (EPA), Dr. Vincent Adams, has said that he will petition the Government for more funds in an effort to boost the paltry pay of his officers. His reason for doing so is premised on concerns from local and international transparency advocates that the poor salaries of EPA officers make them more susceptible to the influence of corrupt oil companies. Dr. Adams noted, yesterday, that this is a serious concern of his. He said, too, that he notes the importance of the issue especially since the EPA will be one of the key regulators of the oil and gas sector.”SanctionedAs highlighted here, in November 2018 the DOJ criminally charged Venezuelan billionaire Raul Gorrin with FCPA and related offenses. According to the DOJ, Gorrin “offered and agreed to pay bribes to Foreign Official 1 [described as a high-level official with decision-making authority and influence within the Oficina Nacional del Tesoro (ONT), the Venezuelan National Treasury] for purposes of obtaining and retaining business; specifically, influencing and inducing Foreign Official 1 to permit Gorrin to conduct foreign currency exchanges for the Venezuelan government and securing an improper advantage in acquiring the right to conduct such exchange transactions.”Recently, the Treasury Department announced:“[T]he U.S. Department of the Treasury’s Office of Foreign Assets Control (OFAC) sanctioned Venezuelan individuals and companies involved in a significant corruption scheme designed to take advantage of the Government of Venezuela’s currency exchange practices, generating more than $2.4 billion in corrupt proceeds. This designation, pursuant to Executive Order (E.O.) 13850, targets seven individuals, including former Venezuelan National Treasurer Claudia Patricia Diaz Guillen (Diaz) and Raul Antonio Gorrin Belisario (Gorrin), who bribed the Venezuelan Office of the National Treasury (ONT, or Oficina Nacional del Tesoro) in order to conduct illicit foreign exchange operations in Venezuela.”Scrutiny UpdateAs highlighted in this previous post in late December 2017, Ciena Corp., Maryland-based technology company, disclosed:“During fiscal 2017, one of Ciena’s third-party vendors raised allegations about certain questionable payments to one or more individuals employed by a customer in a country in the ASEAN region. Ciena promptly initiated an internal investigation into the matter, with the assistance of outside counsel, which investigation corroborated direct and indirect payments to one such individual and sought to determine whether the payments may have violated applicable laws and regulations, including the U.S. Foreign Corrupt Practices Act (“FCPA”). In September 2017, Ciena voluntarily contacted the Securities and Exchange Commission (“SEC”) and the U.S. Department of Justice (“DOJ”) to advise them of the relevant events and the findings of Ciena’s internal investigation. With the direct oversight of the Board, Ciena continues to cooperate fully with the SEC and DOJ in their review of the investigation.Ciena’s operations in the relevant country have constituted less than 1.5% of consolidated revenues as reported by Ciena in each fiscal year since 2012. Ciena does not currently anticipate that this matter will have a material adverse effect on its business, financial condition or results of operations. However, as discussions with the SEC and DOJ are ongoing, the ultimate outcome of this matter cannot be predicted at this time.Recently the company disclosed:“On December 10, 2018, the DOJ advised that it has declined to prosecute this matter and that its investigation into the matter is now closed. Ciena continues to cooperate fully with the SEC in its investigation into this matter.”ExitAs highlighted here, Sandra Moser (Acting Chief of the DOJ’s Fraud Section) is leaving the government to join Quinn Emanuel Urquhart & Sullivan. See here for an example of one of Moser’s FCPA speeches.Reading StackThe New York Times goes in-depth to explore possible links between Dmitry Firtash (criminally charged for FCPA and related offenses in 2014 see here) and McKinsey and Boeing. The article also explores circumstances surrounding the U.S.’s extradition efforts against Firtash (see here for a prior post).An informative and comprehensive read here from Gibson Dunn attorneys titled “FCPA Liability for Third Party Conduct.” Also from Gibson Dunn, its annual FCPA Update. The following caught my eye.“In 2018, the SEC resolved 10 corporate FCPA enforcement actions that did not have a corresponding DOJ resolution. In several of these SEC-only resolutions, the SEC leveraged the accounting provisions to bring cases predicated upon aggressive theories of FCPA liability that, at least on the face of the charging documents, bore a tenuous (or non-existent) connection to foreign bribery. In another case, the SEC seemed to stretch (if not break) the boundaries of the anti-bribery provision. Thus continues a trend we have observed periodically over the years, including most recently in our 2017 Year-End FCPA Update. Although settlements are clearly non-binding in the legal sense, any FCPA practitioner knows that they are frequently bandied about as precedent in settlement discussions and thus become a very real part of the body of FCPA enforcement that must be contended with.”I agree with the general observations and have been writing about the facade of FCPA enforcement for nearly a decade. (See here for my 2010 article “The Facade of FCPA Enforcement”).But what is ever going to be done about this?As long as issuer risk aversion is the name of the game, the SEC is going to push the envelope. Will any issuer ever push back? It has never happened in FCPA history, but it should and if it would I am confident that the FCPA landscape would look different.However, so long as the roll-over-and-play dead mentality exists, issuers (and other business organizations subject to the FCPA) are part of the problem.Gibson Dunn also released its annual “Year-End Update on Corporate Non-Prosecution Agreements and Deferred Prosecution Agreements.” Learn More & Register FCPA Institute – Boston (Oct. 3-4) A unique two-day learning experience ideal for a diverse group of professionals seeking to elevate their FCPA knowledge and practical skills through active learning. Learn more, spend less. CLE credit is available.
Source:https://www.hopkinsmedicine.org/news/media/releases/surgeons_discuss_options_when_the_risks_of_surgery_may_be_too_high Jul 27 2018In an essay published July 26 in The New England Journal of Medicine, Ira Leeds, M.D., research fellow, and David Efron, M.D., professor of surgery, both of the Johns Hopkins University School of Medicine, along with their collaborator, Lisa Lehmann, M.D., Ph.D., M.Sc., from the U.S. Department of Veterans Affairs, call for shared decision making when a patient’s risks for surgical complications may outweigh the potential benefits of an operation.”Ethical use of health care resources, surgeon ability and experience, and patient wishes all come into play when risk factors known to predict poorer surgical outcomes are present, including obesity, smoking, diabetes and age,” says Leeds. “Our essay highlights the realities for both surgeons and patients at a time of increasing focus on transparency, high value care, public reporting of clinical outcomes, and accountability, along with patient suffering in making decisions to operate or not operate.”In the essay, the authors acknowledge that surgeons now not only must consider how poor outcomes might affect the patient, but also how those outcomes may affect their personal and institutional quality rankings, which are not only increasingly available for public scrutiny but also are tied to payments by insurance companies and Medicare/Medicaid.Inherently, Leeds says, there is an ethical concern with cherry-picking one’s way to better surgical outcomes. By current quality measures, selecting the healthiest patients for operation is an easy way to improve one’s outcomes. However, surgeons are ethically obligated to center their decision-making on the patient. For sick and debilitated patients, deferring surgery may be help them in the long run, but for others, deferring surgery may be ethically unbalanced, favoring the institution or society as a whole over the suffering of the individual.Related StoriesPorvair Sciences develops new fluid collection vent for surgical suction cannistersCommon cold virus strain could be a breakthrough in bladder cancer treatmentFight for Sight poll: Brits put their eyesight at risk through unsafe contact lens habitsAmong the options and decision points that require consideration from surgeons and patients, says Efron, are when and for how long to delay surgery until risk factors can be modified, and when risk factor modification should be abandoned in the interest of alleviating a patient’s surgically correctable conditions -; even when risky.In the essay, Leeds and Efron also consider the fair allocation of limited health care resources as a factor in risk assessment. For example, is it wiser to perform one high-risk surgery or two average-risk surgeries that use the same level of health care resources? A recent analysis, the authors note, showed that obesity increased the cost of a hospitalization for a person undergoing cardiac surgery by 17.2 percent on average, or $426 for each unit of body mass index. Should such cost analyses be part of the decision to operate or not operate? And importantly, who should make these assessments? The authors argue that the proximity of operating surgeons and patients to the decision’s consequences requires more involvement from professional societies and other impartial third parties.The root of conflict in the surgical selection process, Leeds and Efron argue, lies in a misalignment of goals of patients, surgeons and society. More effective shared decision making, with clear communication to patients about surgical risks and responsibilities, concrete guidelines for operating from professional societies, and consistent support from insurance companies would help align the goals.
Reviewed by James Ives, M.Psych. (Editor)Aug 29 2018A new study appearing online today from the American Journal of Psychiatry finds that ketamine’s acute antidepressant effect requires opioid system activation, the first time that a receptor site has been shown in humans to be necessary for any antidepressant’s mechanism of action. While opioids have been used historically to treat depression, they are known to carry a high risk of dependence. Alan F. Schatzberg, M.D., who led this research at Stanford, cautions against widespread and repeated use of ketamine for depression treatment until more research can be done on both the mechanism of action and the risk of tolerance, abuse and dependence.Previous research has found ketamine to have rapid-onset antidepressant effects. While the specific mechanism of action for these effects was unknown, it had been generally thought to be due to NMDA receptor antagonism. Since many efforts to develop NMDA antagonists as antidepressants have been unsuccessful, this new study aimed at determining the role of the opioid system in ketamine’s antidepressant and dissociative effects in adults with treatment-resistant depression.Related StoriesSchwann cells capable of generating protective myelin over nerves finds researchPesticide exposure may increase risk of depression in adolescentsSome children are at greater risk of ongoing depression long after being bulliedNolan R. Williams, M.D., and Boris D. Heifets, M.D., Ph.D., from Stanford University, co-first authors of the article, hypothesized that ketamine’s antidepressant effects may be related to intrinsic opioid receptor properties of ketamine. The study looked at whether use of naltrexone, an opioid blocker, prior to ketamine treatment would reduce the acute antidepressant effects of the ketamine or its dissociative effects. The researchers conducted a randomized double-blind crossover trial involving individuals with treatment resistant depression. Participants received the opioid blocker or a placebo prior to ketamine infusion treatment. Twelve participants completed both conditions in randomized order.Use of naltrexone dramatically blocked the antidepressant effects of the ketamine but not the dissociative effects, so the trial was halted at the interim analysis. Participants receiving the ketamine plus naltrexone experienced much less reduction in depression symptoms than participants receiving ketamine plus placebo. There were no differences in ketamine-induced dissociation between those receiving naltrexone or a placebo.In an accompanying editorial in the American Journal of Psychiatry, Mark S. George, M.D., with the Medical University of South Carolina and the VA Medical Center in Charleston, S.C., notes, “We would hate to treat the depression and suicide epidemics by overusing ketamine, which might perhaps unintentionally grow the third head of opioid dependence.” George cautions that “with these new findings, we should be cautious about widespread and repeated use of ketamine before further mechanistic testing has been performed to determine whether ketamine is merely another opioid in a novel form.”George also suggests more attention to other underused treatments for depression and suicidality, including electroconvulsive therapy, transcranial magnetic stimulation and cervical vagus nerve stimulation. Source:https://www.psychiatry.org/
Ozone shields our planet from the sun’s harmful ultraviolet rays, but it may be also be keeping bees away from their favorite flowers, according to a new study. Ozone doesn’t just live high in Earth’s atmosphere; near the ground, it contributes to smog, and ground-level ozone has gradually increased in most places because of industrial pollution from vehicles and fossil-fuel burning. Ozone is known to react with and break down molecules called volatile organic compounds. That’s a concern because flowers emit certain kinds of these compounds that, like a natural perfume, entice bees and other pollinators to visit the flowers. In the new study, researchers grew and collected black mustard (Brassica nigra, pictured), flowering plants that commonly appear around the world. In the laboratory, the scientists exposed groups of them to ozone levels ranging from 0 parts per billion (ppb) of ozone to 120 ppb, which is found in some urban areas. A machine called a mass spectrometer measured levels of scent molecules as far as 4.5 meters away from the flowers. At 4.5 m away, levels of most of the scent’s component molecules ranged from 17% to 31% lower at 120 ppb than at 0 ppb ozone, the researchers report online before print in New Phytologist. Little to no decrease occurred at 0 m away, showing that ozone’s effect increases with distance. Additional lab tests showed that unaltered scent is attractive to a common type of bumblebee (Bombus terrestris); bees preferred spending time in scent-laced air over scent-free air, the researchers say. Because some molecules’ levels decreased more than others in the lab tests, the scent’s strength isn’t all that’s at stake: The scent itself may change a bit, too. The findings suggest pollinators could struggle more over time to locate flowers, as ozone pollution in most parts of the world will keep rising as a result of industrialization and climate change.
A new species of praying mantis has been identified based on female genitals for the first time, a break from the traditional use of male genitalia for insect species classification. Insects with a hook-shaped penis might be classified as one species, whereas those with slightly curved genitalia might be classified as another. Male genitalia have long been preferred because of their seemingly wider—and more easily observed—variety of shapes and sizes. Ilomantis ginsburgae is a leaf-dwelling mantis from Madagascar, according to a new study in Insect Systematics & Evolution. It was named in honor of U.S. Supreme Court Justice Ruth Bader Ginsburg, a strong supporter of gender equality and a regular wearer of jabot collars, which resemble the neck plate of the insect. The scientists hope that this new identification will help make species classification easier by increasing the number of possible ways to differentiate bugs.
Stories on a lichen threesome, tremors caused by tides, and a theoretical way to inspect nuclear warheads without looking too closely at them, with Catherine Matacic. Despite concerns about antibiotic resistance, it seems like antimicrobials have crept into everything—from hand soap to toothpaste, and even fabrics. What does the ubiquitous presence of these compounds mean for our microbiomes? Alyson Yee talks with host Sarah Crespi about one antimicrobial in particular—triclosan—which has been partially banned in the European Union. [Image: T. Wheeler/Music: Jeffrey Cook]
BOSTON—Less is better. That much is clear about arsenic, the naturally occurring metal in soil and rock that sneaks into well water and infiltrates food crops. High levels in drinking water are linked to multiple cancers, lung and cardiovascular disease, and neurodevelopmental delays in children. But it’s not so clear exactly what levels are acceptable in food, and how best to limit our exposure. And concern is growing—particularly when it comes to rice, which is known to accumulate arsenic more readily than many other plants. At a session yesterday here at the annual meeting of AAAS, which publishes Science, researchers described efforts to keep the toxin out of our crops and off our plates. Develop arsenic-averse cropsArsenic gets into plants through a “case of mistaken identity,” plant biologist David Salt of the University of Nottingham in the United Kingdom explained yesterday. It offers no benefit to a plant, but enters its roots thanks to mechanisms meant to bring in nutrients such as silicon. Several labs are working to describe the mechanisms of these cellular transporters, and eventually to render them more selective. That could happen through genetic engineering with a system such as CRISPR, he says. But it might also be possible through traditional breeding of plant varieties with a natural tendency to keep arsenic out. Salt and others are now testing the arsenic uptake in hundreds of rice varieties to identify relevant regions of their genome. “We’re closing in on genes,” he says, but “we don’t have genes yet.”Tweak the irrigation equationIn parts of Asia, dangerous arsenic levels can arise when rice and other crops are irrigated with well water drawn from deep within arsenic-rich rock. And growing rice in flooded fields has been shown to increase its levels in the grain 10-fold by converting arsenic to a form that the roots take up more readily. Some researchers are exploring the effect of water-conserving strategies that allow fields to dry partially before reflooding. But plant biologist Mary Lou Guerinot of Dartmouth College, who organized the session, notes that those strategies will have to balance arsenic risk against another risk—higher uptake of the toxin cadmium in unflooded fields.Promote careful eatingFor U.S. policymakers, even the scale of the arsenic problem is hard to estimate, explained panelist Keeve Nachman, an environmental health scientist with the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. Since 2013, the U.S. Food and Drug Administration has proposed limits on allowable arsenic levels in apple juice and infant rice cereal. But there’s still heated debate about what levels of exposure actually increase risk of cancer or other illnesses. Nachman, who is part of a 2-year effort known as the Collaborative on Food with Arsenic and Associated Risk and Regulation, aims to inventory the foods that can contain arsenic and prioritize those that may contribute most to our overall intake. Pressure on regulators and farmers to keep levels low will likely come from consumers, he says. “They’re the ones that drive change in the first place.” Three ways scientists are trying to keep arsenic out of our diets A bowl of rice 4kodiak/iStockphoto 
By Kelly ServickFeb. 18, 2017 , 12:30 PM Check out our full coverage of AAAS 2017.
By Roni DenglerNov. 10, 2017 , 2:00 PM Poohz Trinkajee/Aurora Photos Why do some bridges wobble? Blame the way pedestrians walk on them
In the summer of 2000, a couple thousand people walked over the brand-new Millennium Bridge in London (pictured) at once, causing it to sway dangerously from side to side. The structure wobbled not because so many people were on it, but because they fell into lock step with each other and the motions of the bridge itself. In a new study that used multiple modeling approaches to capture pedestrian-bridge interactions, researchers found that pedestrian bridges don’t become more unstable as more people walk over them. Rather, things break down when the crowd exceeds a certain limit, the team reports today in Science Advances. When the number of people walking on a bridge passes this threshold, the force of their collective footfalls pushes the bridge from side to side in sync with the bridge’s minute oscillations and exacerbates the swaying. But, there’s a simple fix: Change the bridge design to make it heavier, longer, or stiffer, the researchers say. That will put the bridge’s natural motion outside of pedestrian influence. The team hopes the work will inform new bridge design, potentially saving lives and millions of dollars.