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Monday, August 13, 2012
Saturday, August 11, 2012
Spending more on trauma care doesn't translate to higher survival rates, study suggests
ScienceDaily (Aug. 10, 2012) ? A large-scale review of national patient records reveals that although survival rates are the same, the cost of treating trauma patients in the western United States is 33 percent higher than the bill for treating similarly injured patients in the Northeast. Overall, treatment costs were lower in the Northeast than anywhere in the United States.
The findings by Johns Hopkins researchers, published in The Journal of Trauma and Acute Care Surgery, suggest that skyrocketing health care costs could be reined in if analysts focus on how caregivers in lower-cost regions manage their patients.
At least in the case of trauma care, "spending more doesn't always mean saving more lives," says study leader Adil H. Haider, M.D., M.P.H., an associate professor of surgery at the Johns Hopkins University School of Medicine and director of Hopkins' Center for Surgical Trials and Outcomes Research. "If doctors in the Northeast do things more economically and with good results, why can't doctors out West do the same thing? This study provides a potential road map for cutting unnecessary costs without hurting outcomes."
But researchers say they don't know exactly why costs vary by region. Haider says that it is possible that in one part of the country, it may be customary to do an expensive type of medical test prior to treatment, while in other parts, that test may not be done.
Haider notes that health care costs account for roughly 16 percent of the Gross Domestic Product (GDP) of the United States, and trauma-related disorders rank among the five most costly conditions.
For their study, Haider and his colleagues analyed three years of data from the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (NIS), the largest all-payer inpatient database publicly available in the United States. They identified 62,678 adult patients with a primary injury in one of five domains: blunt injury to the spleen, collapsed lung and bleeding in the chest, shinbone (tibia) fracture, mild traumatic brain injury and liver injury.
After controlling for a variety of factors that could bias the results -- including injury severity, the presence of chronic illnesses, variations in regional prices for goods -- the researchers estimated that the average per-person cost in the Northeast for trauma care for all five injury types combined was $14,022. The cost was 18 percent higher in the South, 22 percent more in the Midwest and 33 percent more in the West.
Of the injury types, the most expensive was for liver injury. For liver injury, the average cost of care in the Northeast was $16,213, while the cost was 18 percent more in the South, 22 percent more in the Midwest and 35 percent more in the West.
The Northeast also had the lowest costs for each of the five types of injury, while the West had the highest, even after accounting for known differences in the widely used consumer price index.
Haider, a trauma surgeon, cautions that when looking for ways to cut costs, researchers should look closely at outcomes beyond survival alone to make sure the more expensive care isn't better in some way. For example, it may be possible, he says, that higher-cost regions have patients with less pain and fewer disabilities after recovery.
"If surgeons are fixing tibia fractures in the West in a way that's more expensive but makes patients more comfortable, that would not be a trivial finding," Haider says. "We really need to drill down and figure out what parts of care improve outcomes and what parts drive up costs without improving any outcomes or aspects of care important to patients."
Financial support for this work was provided by: National Institutes of Health/ NIGMS K23GM093112-01; American College of Surgeons C. James Carrico Fellowship for the study of Trauma and Critical Care and Hopkins Center for Health Disparities Solutions.
Other Johns Hopkins researchers involved in the study include Darrell J. Gaskin, Ph.D.; Cassandra V. Villegas, M.D., M.P.H.; Stephen M. Bowman, Ph.D.; Eric B. Schneider, Ph.D.; Elliott R. Haut, M.D.; and David T. Efron, M.D.
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The above story is reprinted from materials provided by Johns Hopkins Medicine.
Note: Materials may be edited for content and length. For further information, please contact the source cited above.
Journal Reference:
- Augustine C. Obirieze, Darrell J. Gaskin, Cassandra V. Villegas, Stephen M. Bowman, Eric B. Schneider, Tolulope A. Oyetunji, Elliott R. Haut, David T. Efron, Edward E. Cornwell, Adil H. Haider. Regional variations in cost of trauma care in the United States. Journal of Trauma and Acute Care Surgery, 2012; 73 (2): 516 DOI: 10.1097/TA.0b013e31825132a0
Note: If no author is given, the source is cited instead.
Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.
Source: http://feeds.sciencedaily.com/~r/sciencedaily/top_news/top_health/~3/verY4NmH6as/120810133159.htm
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Wednesday, August 8, 2012
LeGarrette Blount Jersey Strategic Business Planning ? phpFox ...
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Strategy can be seen as an on going 'positioning' process for an organization and strategic planning can be seen as a separate activity reviewed at periodic well defined intervals.? Strategy involves achieving a competitive advantage for an organization in meeting the needs of customers and fulfilling the expectations of stakeholders. A strategic plan may be 'an intended method' or a 'scheme for accomplishing a purpose' as the dictionary states,Ryan Kerrigan Jersey, rather than "a representation projected on a flat surface".
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Planning approach?????????????????????????????Incremental approach
-?Control?????????????????????????????????????????????? ?? Interpretation problem by problem
-?Commitment????????????????????????????????????????mud dling through
-?Long term????????????????????????????????????????????short term
-?Grand plan??????????????????????????????????????????? step by step
-?Forecasting?????????????????????????????????????????? ?innovation and change
-?Organization of activities in advance??????fire fighting?
- Top down control????????????????????????????????? flexibility
-?Co-ordination of initiatives???????????????????? encourages initiatives.??????
A plan is an intended course of action and it can be argued that without a plan of one kind or another, an organization does not have a sense of direction and will simply drift,Tim Lincecum Jersey, pushed this way or that way by the latest influence.?
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Source: http://www.wirtualnamapa.com/authojersey/blog/legarrette-blount-jersey-strategic-business-planning/
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Tuesday, August 7, 2012
Stephen Lendman ? Cybersecurity Bills Threaten Freedom ...
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Various cybersecurity acts threaten constitutional freedoms.
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On March 27, HR 4263: SECURE IT Act of 2012 was introduced. Now in committee, no further action was taken.
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On April 26, the House passed HR 3523: Cyber Intelligence Sharing and Protection Act (CISPA) of 2011.
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On June 27, S. 3342: SECURE IT Act was introduced. Now in committee, no further action was taken.
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On July 19, S. 3414: Cybersecurity Act of 2012 was introduced in the Senate. On August 2, a Senate cloture vote failed. Voting 52 ? 46, the bill fell eight votes short.
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Prior and current cybersecurity bills represent draconian threats to Internet and constitutional freedoms. Unless stopped, they?ll be lost en route to destroying other legal protections.
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Pending legislation lets government bypass existing laws. Alleged cyber threats smooth the process. New bills emerged after earlier ones were defeated. Washington won?t quit until all legal restraints are removed.
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Senators were flooded with emails, calls, letters, and tweets against S 3414. Civil liberty groups petitioned them. For now, the measure is defeated. Score one for privacy advocates. Declaring victory remains premature. More battles remain.
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Congress and Obama officials prioritize cybersecurity. Doing so compromises civil liberties. Privacy is threatened.
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Following the vote, a White House statement expressed ?profound disappointment.? Obstructionist politics were blamed ?driven by special interest groups seeking to avoid accountability?.?
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Since taking office, Obama and those around him waged relentless war on constitutional freedoms. Police state laws passed. Domestic spying exceeds the worst Bush administration practices.
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Destroying Net Neutrality and other freedoms is planned. Full-blown tyranny approaches unless ordinary people and supportive organizations stop it. Cybersecurity battles continue.
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The Electronic Frontier Foundation (EFF) says other pending legislation is ?dangerously vague.? If enacted, they?ll add a ?cybersecurity exemption to virtually all existing privacy laws.?
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An earlier SECURE ACT version drew harsh criticism. Dozens of organizations opposed it. They included EFF, The Center for Media and Democracy, Center for Democracy & Technology, the ACLU, Defending Dissent Foundation, and the American Library Association.
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In a May Senate letter, they said it lacked ?sufficient privacy safeguards, oversight or accountability.? They called it a ?threat to privacy and civil liberties.? They enumerated over a dozen serious flaws.
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Amended legislation followed. Modest improvements only were made. Definitions were tightened. Government contractor obligations to share information were clarified. Required Inspector General reports were added.
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According to the Center for Democracy & Technology (CDT), ?changes made merely nibble around the edges of more substantial flaws.? SECURE It remains ?a back-door wiretap bill.?
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It requires private companies to share information with government agencies. They include NSA, DOD?s Cyber Command, DHS, and the Justice Department. Passage will grievously harm civil liberties.
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The measure circumvents existing privacy law protections. ?All cyber threat information shared with any cybersecurity center would be shared immediately with the NSA? and other above named centers.
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They operate secretly. Companies sharing information won?t know how it?s used. These agencies have a deplorable record of operating extrajudicially.
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NSA recently admitted it couldn?t estimate how many Americans were included in intelligence surveillance activities. The 2008 FISA Amendments Act (FISAAA) authorized targeting only non-US citizens abroad.
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SECURE It lets NSA use alleged cyber threat information for national security purposes unrelated to cybersecurity. CDT calls doing so inappropriate and dangerous.
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Numerous flaws remain. They include using information unrelated to law enforcement. Provisions are broad and vague. Warrants aren?t required. Fourth Amendment and other rights are jeopardized.
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EFF ?remain(s) unpersuaded that any?.cybersecurity measures are necessary?.? All proposed bills contain constitutionally lawless provisions. Warrantless wiretaps are especially egregious. EFF challenged their legitimacy for years.
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Since at least 2001, major telecom companies agreed to participate in massive domestic spying. Ordinary Americans are targeted.
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NSA routinely intercepts phone calls and Internet communications. Doing so violates Fourth Amendment and other constitutional freedoms. EFF sued to stop it.
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In Hepting v. AT&T (January 2006), EFF charged the company with lawlessly monitoring private customer communications. Without their knowledge or approval, it supplies NSA with information they contain.
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Whistleblower help provided documented proof. Nonetheless, right-wing courts are incorrigible. In June 2009, a federal judge dismissed Hepting and dozens other suits against telecoms.
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The ruling claimed these companies have immunity from liability under FISAAA. Enacted in 2008, it lets the Attorney General order dismissal of lawsuits if Washington claims surveillance didn?t occur, was lawful, or had presidential approval.
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EFF plans to appeal. It calls FISAAA unconstitutional. It grants presidents extrajudicial discretion. It blocks courts from administering the law fairly. In Hepting and pending cybersecurity legislation, privacy issues are at stake.
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EFF has help fighting lawlessness. The Center for Constitutional Rights, ACLU, other groups, and individuals are involved.
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Pending cybersecurity bills provide sham cover for destroying personal freedoms. Obama serves as lead attack dog. Institutionalized tyranny is planned. It?s dangerously close to full-blown.
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Cybersecurity legislation is one of many worrisome threats. Thomas Jefferson called eternal vigilance the price of freedom. It?s needed more than ever now.
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A Final Comment
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The National Security Agency (NSA) threatens personal freedom. Since 1952, it conducted secret foreign communications and intelligence gathering. For decades it operated extrajudicially. Its dark history is disturbing.
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In the 1960s, Senator Frank Church warned:
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NSA?s ?capability at any time could be turned around on the American people, and no American would have any privacy left, such is the capability to monitor everything: telephone conversations, telegrams, it doesn?t matter.?
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?There would be no place to hide.? Presidents could ?impose total tyranny, and there would be no way to fight back.?
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Church died in 1984. If alive, he?d say he warned us, but we didn?t listen.
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Church learned that the NSA engaged in lawless domestic spying. It was widespread against US citizens. In 1978, the Foreign Intelligence Surveillance Act (FISA) included privacy protections for American communications.
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The USA Patriot Act and other police state laws destroyed them. More than ever, NSA operates extrajudicially. It menaces freedom. It?s Big Brother writ large.
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Post-9/11, it established a massive warrantless wiretapping program. It violates constitutional and statute laws with impunity. Congressional investigations and lawsuits haven?t stopped it.
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The FISA Amendments Act (FISAAA) granted telecom companies retroactive immunity. They spy freely on US citizens. NSA intercepts millions of online, phone, and other communications. Everyone is vulnerable globally.
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Everything NSA does is classified and secret. It menaces freedom. It?s unaccountable. It?s shielded from prosecution.
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Given today?s technological capabilities, it?s more dangerous than Church imagined. Big Brother expanded exponentially.
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Stephen Lendman lives in Chicago and can be reached at lendmanstephen@sbcglobal.net.
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His new book is titled ?How Wall Street Fleeces America: Privatized Banking, Government Collusion and Class War?
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http://www.claritypress.com/Lendman.html
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Visit his blog site at sjlendman.blogspot.com and listen to cutting-edge discussions with distinguished guests on the Progressive Radio News Hour on the Progressive Radio Network Thursdays at 10AM US Central time and Saturdays and Sundays at noon. All programs are archived for easy listening.
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http://www.progressiveradionetwork.com/the-progressive-news-hour
?
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Monday, August 6, 2012
Markets stay buoyed by US jobs figures
LONDON (AP) ? Financial markets remained in a buoyant mood Monday by figures showing the U.S. economy generated a greater than expected amount of jobs in July and by a growing belief that the European Central Bank could do more in the months ahead to contain the continent's debt crisis.
With little scheduled economic news due, Friday's figures showing the U.S. economy adding 163,000 jobs in July continued to drive sentiment. Though the figures eased concerns over the world's largest economy, the rise in the unemployment rate to 8.3 percent provided more evidence, if any were needed, that the recovery is patchy.
All things considered though, the figures were welcomed after three months when payrolls failed to meet expectations. The data also helped markets clamber off lows registered on Thursday when investors were disappointed by comments from European Central Bank president Mario Draghi.
"Those bumper non-farm payroll figures on Friday seem to be providing markets with a lasting distraction from the ongoing woes of the eurozone," said Fawad Razaqzada, market strategist at GFT Markets.
In Europe, Germany's DAX was up 1 percent at 6,938 while the CAC-40 in France rose 1.2 percent to 3,415. The FTSE 100 index of leading British shares was 0.6 percent higher at 5,821.
In the U.S., the Dow Jones industrial average was up 0.6 percent at 13,168 while the broader S&P 500 index rose 0.5 percent to 1,398.
Also helping to shore up markets has been a bit of a reassessment of Draghi's comments last Thursday. Though Draghi failed to meet market expectations at the time, investors have turned a little more positive.
"Despite last week's disappointment, Draghi's comments did suggest assistance in the near future and this is likely to increase risk appetite," said James Hughes, chief market analyst at Alpari.
That reassessment has helped ease the pressure on Spain and the country's 10-year yield dipped further below the 7 percent threshold that is widely-considered unsustainable in the long-run. It's down a further 0.10 percentage points to 6.73 percent, having spiked up above 7 percent in the aftermath of Draghi's comments.
It's been an eventful day on Madrid's main stock exchange. After a five-hour blackout blamed on a technical glitch, the IBEX 35 was up 2.5 percent when trading restarted.
Spain remains the epicenter of Europe's debt crisis especially as concerns over whether Greece will get its next batch of bailout cash have diminished. Weekend comments from the country's debt inspectors suggest that progress has been made.
Last Friday, Spain's Prime Minister Mariano Rajoy came close to acknowledging that he has considered a sovereign bailout for the country. He told reporters he would consider asking for financial aid only once the ECB had fleshed out its crisis-fighting plans for buying government bonds.
And the euro was steady having recovered the losses it posted following Draghi's comments on Friday. It was up a further 0.1 percent at $1.2397 on Monday.
A weekend statement by the People's Bank of China indicating it would intensify policy fine-tuning also helped investment sentiment in Asia earlier.
That was among factors helping to lead Asian stock markets sharply higher.
Japan's Nikkei 225 index rose 2 percent to finish at 8,726.29 and Hong Kong's Hang Seng climbed 1.7 percent to 19,998.72. South Korea's Kospi added 2 percent to 1,885.88.
Oil markets were steady having pushed above $90 a barrel on Friday. Benchmark crude was down 50 cents at $90.90 a barrel in electronic trading on the New York Mercantile Exchange.
Source: http://news.yahoo.com/markets-stay-buoyed-us-jobs-figures-142114593--finance.html
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Thursday, August 2, 2012
Uber Spins Its Latest Variation On Car Rides: DJs On Party Buses In Chicago
Uber is still growing its business as a disruptive (sometimes controversial) car service app, but in the meantime it continues to push the envelope on what else it might eventually do with the logistics infrastructure it is also creating. The latest development comes by way of Chicago, where Uber is now laying on busses with DJs and drinks. Yes, it's bus bumping from Uber. Uberpalooza will feature DJs Dante, Bobbylite, Megan Taylor and Andrew Hayden, and is being run to coincide with the Lollapalooza music festival taking place in the Windy City this weekend. Those requesting the service will be charged $50 for 25 minutes or 5 miles -- whichever comes first (so pick your traffic-clogged streets of Chicago carefully). Up to 10 other people can join in on the party bus -- as long as all are over 21.Source: http://feedproxy.google.com/~r/Techcrunch/~3/C4z8nvhKF_A/
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