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Wednesday, October 15, 2008

At least 10% of the increase in Medicare expenditures since the mid-1990s is due to increased rates of one type of elective surgery, according to a recent study, and many of the patients may not need it. University of California, San Francisco found that only 44% of patients who undergo an elective cardiac surgery called angioplasty get the recommended test to determine whether the procedure is appropriate.

As a result, patients may be receiving a procedure that they either do not need or for which the risk outweighs the benefit. The operation opens partially clogged arteries in patients with heart disease and the annual rate of elective angioplasties has tripled in the United States during the last decade.

Angioplasties are currently being performed at a rate of over 800,000 per year in the U.S. The average cost was $44,110 per procedure in 2004. Since the operation tends to be performed on older Americans, Medicare covers most patients and compensates US$10,000 to $15,000 for each case.

Reuters reporter Julie Steenhuysen writes that angioplasty is “big business for medical device makers including Boston Scientific Corp, Medtronic Inc, Abbott Laboratories Inc and Johnson & Johnson”. Dr. Raymond Gibbons, a professor of medicine who specializes in cardiology at the Mayo Clinic in Rochester, Minnesota, criticizes the current U.S. health care system for compensating doctors based upon procedures performed rather than for following recommended practices.

A stress test in which the patient walks on a treadmill is recommended to determine whether a partial obstruction impairs heart function. Although not all patients who need angioplasty are strong enough to undergo the stress test, UC San Francisco researchers were surprised that testing preceded so few of the surgeries.

Professor of medicine Dr. Rita F. Redberg told U.S. News and World Report, “We didn’t expect to find 100 percent, but we expected a much higher percentage than 44”. Dr. Redberg co-authored a report on the findings for the Journal of the American Medical Association this month.

Dr. Grace Lin, another co-author of the study, noted: “What really matters is whether or not that blockage is affecting blood flow to the heart. That is why the stress test is important.” Their research analyzed over 23,000 Medicare cases and over 1,600 commercial insurance cases.

American Heart Association president Timothy Gardner called the study “a good wake-up call” to remind medical doctors to make sure they do not perform unnecessary procedures. Dr. Gardner regards the study as evidence that many unnecessary angioplasties are being performed.

The study found great variation in the rate of stress testing. Geographic areas ranged from 22% to 76% with the highest rate of testing in the Northeastern and Midwestern states. Testing rates also varied by gender, with men more likely to receive a stress test than women, and by other factors including the age of the physician. Dr. Gibbons points to some of these variances as indications that some physicians may be performing angioplasties indiscriminately.

Not all physicians agree. Although the various types of stress testing usually cost a few hundred dollars instead of tens of thousands, the chief cardiologist at University of Wisconsin Hospital and Clinics Dr. Matthew Wolff notes that stress tests yield false negative results in about 10% of cases. In his opinion, doctors who rely on stress tests “are going to be missing people with severe disease.” Although he agrees that some angioplasties are unnecessary, he contends that the new study does not offer a solution to the dilemma.

The American College of Cardiology plans to release new guidelines soon to help doctors determine when a stress test is appropriate, yet the payment system lacks a financial incentive to abide by testing guidelines. Dr. Eric Topol of Scripps Translational Science Institute in La Jolla, California noted the underuse of stress tests in a study of private insurance records 14 years ago. Dr. Topol agrees that testing guidelines “should be much more clear-cut”, and adds that stress tests ought to be performed annually. “You can do a stress test every year to be sure things are normal. That is an important baseline that is being ignored all too frequently.”

Cardiologist, Dr. Anthony DeFranco of Aurora St. Luke’s Medical Center, considers stress testing to be appropriate in at most 65% of cases, since a substantial minority of patients have other health problems that prevent them from undergoing the test.

Sunday, June 5, 2005

Irene Khan, Secretary General of Amnesty International, compared the United States detention facility at Guantanamo Bay to a Soviet-era gulag in that it is “entrenching the practice of arbitrary and indefinite detention in violation of international law,” she said.

The group’s Executive Director William Schulz, on Fox News Sunday, said in response to questioning that they do not “know for sure” whether or not testimonies it has published describing torture and abuse of prisoners by sections of the U.S. military are valid because the U.S. will not give access to the camp to investigate them. [1]

He also said he has no conclusive evidence that U.S. Secretary of Defense, Donald Rumsfeld, ordered torture of detainees at the facility. Schulz had previously referred to “apparent high-level architects of torture,”, and included Donald Rumsfeld in that group. [2]

Director Schulz stated that comparing the installation to a gulag was perhaps not the best choice of words. “…they (detainees) are not in forced labor, they are not being denied food. But,” he continued,” there are some analogies between the gulags and our detention facilities.” Schulz alleged that U.S. officials are “running an archipelago of detention facilities,” some secret. The report also describes “ghost” detainees who “disappear” and the export of prisoners to countries that are known to practice torture.

During his appearance, Schulz argued that his and other human rights groups should be given broader access to the facility. “We don’t know for sure what all is happening at Guantanamo,” he said, “and our whole point is that the United States ought to allow independent human rights organizations to investigate.” The treatment of prisoners at the facility has been in hot dispute recently, with Amnesty International comparing the facility to a “gulag” in its annual human rights report. Bush administration officials condemned the comparison.

On Friday, the U.S. government released documents indicating that both guards and detainees at the facility had on a few occasions abused the Qur’an, the Muslim holy book.

Prisoners and ex-prisoners at Guantanamo Bay have testified that they have been tortured. David Hicks, still being held, filed an affidavit on August 5, 2004 [3] declaring that he had been tortured, abused and ill-treated during his detention by US military authorities, and that he saw and heard similar treatment inflicted on other detainees. Mamdouh Habib, now free, says about his time at Guantanamo Bay that he was told by interrogators that his family had been killed, and that he was tied to the ground while a prostitute menstruated on him. Professor Christopher Tennant of Sydney University also stated he saw an unsigned medical report from Guantanamo Bay that backed up Habib’s claim to have been beaten while in US custody;

“Well, the main feature of the medical report from Guantanamo was that he had had repeatedly blood in his urine, which is a very significant symptom and a worrying symptom, and that was consistent with his reports both to me and to the specialist physician who also examined him, and was consistent with the fact that, on examination, he had evidence of discolouration to his skin on his right loin, just over his kidney, which in turn was consistent with old bruising and possibly due to being beaten.”

Thursday, March 2, 2006

Buffalo, New York — In an unanimous vote, the City of Buffalo‘s Planning Board voted to table the Elmwood Village hotel Proposal, postponing voting on legislation for up to 30 days.

The Board said its decision was due to the lack of public involvement, saying that there have not been enough meetings.

The Elmwood Village Hotel is a proposed project by Savarino Construction Services Corporation and was designed by Karl Frizlen of The Frizlen Group. The hotel would be placed on Elmwood and Forest Avenues in Buffalo, New York. In order for the hotel to be built, at least five buildings, that include both businesses and residents, must be demolished.

The Forever Elmwood Corp. is a Buffalo-based non-profit organization founded in 1994. Justin Azzarella, the Executive Director for the organization voiced support for the proposal, stating: “I am here today to lend Forever Elmwood’s support the hotel project. Particularly, Forever Elmwood is encouraged by the fact that this building follows the more stringent Elmwood Village Design Guidelines. We have been speaking with Savarino Construction, and they have promised us [Forever Elmwood] that they will engage the community further, including the surrounding Block Clubs and businesses. For that reason, while Forever Elmwood is in support of this project and the type of project that it is, we are asking also that the project be tabled so that the community can be further engaged. Specifically the surrounding Block clubs which include the Granger, Claremont, Asland and The Lincoln Parkway Block Clubs.”

“Because of the excellent work that Karl does and the game plan that they have, I think its an ideal use of this particular location. I think that this particular type of development needs to be encouraged and promoted as opposed to roadblocked,” said a man who owns five properties near the proposal site.

However, Evelyn Bencinich, a resident of Granger Place and whose house would be located directly behind the hotel said, “My property value will be depreciated or non-existent because no one is going to want to live behind a multi-story hotel. We are facing up to a year of noisy and dangerous demolition and construction. Children, pets and even drunk rebellers could wander on site and get hurt. Traffic tie-ups caused by large machinery and garbage bins is inevitable. Where will pedestrians walk? We could experience increased unsanitary flooding in our yards and basements due to the digging and cementing for the underground parking garage. Rats will be displaced into the immediate neighborhoods and be in great abundance. Once we get past the year of nightmare construction, what if you build it and they don’t come? We could ultimately have a seven million dollar rooming house on our corner.”

Patty Morris, co-owner of Don Apparel with Nancy Pollina at 1119 Elmwood also asked that the project be tabled saying, “this has only been public knowledge for less than two weeks and the public never saw the redesign. How can you vote on anything that no one has seen yet? The Board cut off Morris saying, “so specifically you don’t have any problem with it [the design] you just…” Morris then said, “Oh I am totally against this project, but thats besides the point isn’t it.”

The planning board is also concerned that the current design may still be too big.

At one point Board member Susan Curran Hoyt said, “we know you’ve cut down your number of rooms on this project, but we still see it doesn’t seem to fit the description of a ‘botique’ hotel,” and asked Eva Hassett, Vice President of Savarino Construction, “we wonder if you could reduce the rooms further.”

“One thing I didn’t talk about was the price levels of these rooms and that will be important to know. The room rate will be somewhere between US$120 and $160 a night, which is about the same price of the Hampton Inn down town and the smaller you make the hotel, the more expensive the rooms will get. We believe that we’ve made a good compromise in terms of the size of the hotel and perhaps botique means different things to different people,” said Hassett.

The board was also concerned that there is not enough parking asking, “are there alternative plans for valet parking off-site, in the event that you have a full hotel or a large event going on?”

“We are exploring several possibilities with respect to additional parking for valet and parking near-by,” replied Hassett. “We are also exploring the possibility of using the rear of 1105 Elmwood for additional parking, which would give us an additional ten or eleven spaces.”

The new design has a total of 55 parking spaces for 72 rooms, with 39 of them underground and the rest on ground level.

Hassett also said that a “parking study” will be done on the area.

Concerns that the second floor of the hotel will be too close to the property of 605 Forest were also brought up. The board asked how far the hotel would be from the property and Karl Frizlen replied saying it would “be approximately five feet from the property line,” but he also admitted that, “I do not know exactly how close the house next door” will be from the hotel, but did say “I think the house is about four or five feet away from the property line and we [the hotel] sit right on the property line.”

The board is concerned the setback from the property is not enough saying the space between the building and the hotel is “pretty narrow.”

The City’s Common Council also agreed to table the proposal also citing the need for more public engagement and the need for more organizations to respond including the Buffalo Preservation Board and the Office of Historic Preservation.

During that meeting, Hassett also said the proposal to try and get a variance to obtain the properties of 605 and 607 Forest were “now off the agenda.”

The Common Council is expected to meet and hold a public hearing about the project and the rezoning of the properties to be demolished (1119-1121 Elmwood) on Tuesday March 7, 2006 at 2:00 p.m. in Council Chambers at City Hall. At the moment the properties are not zoned for a hotel.

Tuesday, December 5, 2006

NASA has unveiled plans to set up a self-sustaining settlement at the South Pole of the Moon by 2020.

The plan calls for four-person crews to begin the construction on a rotating basis with week-long stays, advancing toward a permanent presence by 2024. Initial infrastructure would be brought to the Moon from Earth; as work progressed, the settlement would provide hydrogen and oxygen mined from the lunar surface to make water and rocket fuel.

While NASA plans to use American astronauts in the construction and maintenance of the base, plans are underway for a multinational effort. Canada has been asked to provide astronauts for assistance, and NASA has since entered talks with the European Space Agency, Australia, China, France, Germany, England, India, Italy, Russia, South Korea, and Ukraine to see how those nations and space agencies may be able to contribute to costs, logistics and other efforts. NASA did not release figures on how much the settlement will cost to build and maintain, but have been searching for both public and private funding from around the globe.

NASA says that the base will serve as part of a mission to learn about the Moon and places beyond. It is also seen as part of a long-range plan to send astronauts to Mars.

This will be the first manned mission to the moon since 1972.

Wednesday, February 2, 2011

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The BBC have announced they are to axe annual music festival Electric Proms from their schedule for financial reasons. The festival first took place in October 2006. The 2011 event will not go ahead, with last year’s festival being the last.

Bob Shennan, controller of BBC Radio 2, said he was “disappointed” with the decision to cancel the festival. He said “In the current climate, we are faced with making difficult decisions, including how best to deliver high-quality live music programming throughout the year in light of continuing efficiency savings. I feel that Radio 2 can achieve the same impact of the Electric Proms in an alternative, more cost-effective way. I’m disappointed that the lifetime of Electric Proms has come to an end, but very proud of its fantastically rewarding run of creating new moments in music for the past five years.”

During the festival’s five year run it has featured performances from stars such as Elton John, Neil Diamond, and Shirley Bassey.

The decision to axe the festival comes at a time when the BBC are planning a 20% savings cut. Last week BBC director general Mark Thompson announced 650 job losses after dropping five languages from the BBC World Service.

Tuesday, July 17, 2007

Pittsburgh, Pennsylvania — Local caterers get ready for big business, as almost three thousand fans converge on the David L. Lawrence Convention Center over the Independence Day weekend for the world’s largest ever furry convention, Anthrocon 2007.

Many hope to renew acquaintances, or meet new friends. Others look to buy from dealers and artists, or show off new artwork or costumes. Some attend to make money, or even learn a thing or two. But one thing unites them: They’re all there to have fun.