Do drunks have to go to the ER?

NEW YORK (Reuters Health) – With the help of a checklist, ambulance workers may be able to safely reroute drunk patients to detoxification centers instead of emergency rooms, according to a new study.

Researchers in Colorado found no serious medical problems were reported after 138 people were sent to a detox center to sleep it off, instead of to an ER.

In 2004, according to the researchers, it’s estimated that 0.6 percent of all U.S. ER visits were made by people without any problems other than being drunk. Those visits ended up costing about $ 900 million.

“Part of the issue has been – as it is in many busy ER departments – there’s a lot of chronic alcoholics that are brought in by ambulance, police or just come in. Often they are brought in because they have not committed a crime or there is limited space in our detoxification center. So the majority were brought to the ER department,” said Dr. David Ross, the study’s lead author from Penrose-St. Francis Health Services in Colorado Springs.

Ross said the ambulance company where he serves as medical director created the checklist with the help of the local detox center, which provided limited medical care by a nurse, and the local hospitals to reduce the number of drunks without medical needs being sent to the local ERs.

They created a checklist with 29 yes-or-no questions, such as whether the patient is cooperating with the ambulance worker’s examination and if the patient is willing to go to the detox center.

The patient was sent to the ER if the ambulance worker checked “no” on any question.

The researchers then went back to look at the patients they transported between December 2003 and December 2005 to see whether or not any of them ended up having serious medical problems at the detox center.

During that two year period, the ambulance workers transported 718 drunks. The detox center received 138 and the local ERs got 580.

Overall, 11 of the patients who were taken to detox were turned away because there was no room, their blood alcohol level exceeded the limit, their family came to pick them up or they were combative.

Another four patients at the detox center were taken to the ER because of minor complications, including chest and knee pain. However, there were no serious complications reported.

“We really believe that we did not miss anybody with a serious illness and injury that didn’t go to the ER as they should have,” said Ross.

But the researchers write in the Annals of Emergency Medicine that their study did have some limitations.

Specifically, the researchers did not plan in advance to do a study when they were creating the checklist, which means their findings are limited to whatever information was collected at the detox center and ERs.

Also, the number of people who were sent to the detox center in their study is relatively small, so it’s hard to tell how many serious complications they’d see among a larger group of people.

“We tried to estimate how likely we would have been to encounter a serious event… We estimated at most we’d encounter three serious adverse events (in 748 patients),” Ross told Reuters Health.

SOURCE: http://bit.ly/QgPCT5 Annals of Emergency Medicine, online November 9, 2012.

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Serious About Free Markets? Prove It

On Friday the Republican Study Committee, a policy shop for congressional Republicans, published a memo on how to fix copyright law. By Saturday afternoon the group’s executive director had pulled the memo, which had evidently failed to approach the subject with “all facts and viewpoints in hand.” This is Washington’s way of saying that an interest group hit the roof, and indeed, Ars Technica reports that lobbyists from the “content industry”—Hollywood and recording companies—pressured the group to renounce the memo.

Copyright being in fact broken, you can still read copies of the memo online. It lays out what copyright reform advocates have been saying for years. Copyright protections now extend 70 years past the life of the author; for a corporation, 95 years after publication. This, along with punitive laws on copyright violation, hinders creativity and innovation. These facts aren’t new. What’s new is the tone. Derek Khanna, the memo’s author, writes like an unashamed free marketeer, and in doing so manages to latch on to a larger point: Laws that help businesses often harm markets. From the memo:

Today’s legal regime of copyright law is seen by many as a form of corporate welfare that hurts innovation and hurts the consumer. It is a system that picks winners and losers, and the losers are new industries that could generate new wealth and added value. We frankly may have no idea how it actually hurts innovation, because we don’t know what isn’t able to be produced as a result of our current system. (Emphasis in the original.)

Radical stuff. There’s no one in Washington to lobby for industries that don’t exist yet, and ever so briefly, Khanna and the Republican Study Committee stepped into that breach. Then they stepped back, to gather more facts and viewpoints. Here’s one: Pro-business and pro-market are not the same thing. The most pleasant place for a business is not elbows-out in the middle of a free market, but sitting alone, atop a fat monopoly. Ask your local cable provider. The larger a business gets, the more it has to protect from the companies and industries that might follow it with something better or cheaper. And the best way to protect what you have is to have it written into law.

Real markets, with real competition, are most helpful to newcomers. Small businesses and new industries create new value. Once created, they, too, move to Washington to protect it. Witness the growth of Google (GOOG) and Facebook’s (FB) lobbying operations in the Capitol. Khanna describes extended copyright protection as rent-seeking—in his words, “non-productive behavior that sucks economic productivity and potential from the overall economy.” What’s true of Hollywood and the recording industry could be said of any established industry.

Luigi Zingales, a professor at the University of Chicago Booth School of Business and a regular contributor to Bloomberg View, points out that larger companies can lobby for special exemptions in the tax code. This creates complexity in the tax code, which punishes smaller businesses that can’t pay for tax lawyers and don’t have anyone’s buttonhole on Capitol Hill. Zingales prefers simple regulations and simple taxes, which are harder for lobbyists to game and easier for democracies to understand. He sees this as a bipartisan problem. The left is inclined toward more regulation, and the right is pro-business, rather than pro-markets.

The direction Khanna was headed—a defense of open, competitive markets at the expense of existing businesses—is still wide open space, claimed by no party. This summer, conservatives such as Timothy Carney at the Examiner and Yuval Levin at National Review urged Mitt Romney to back markets, not businesses. But he chose not to, even though he, in his day, disrupted existing markets of his own. Some enterprising Republican can still do it. Derek Khanna in 2016! He’s young. Maybe VP.

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Greek PM presses for deal on loan

ATHENS, Greece (AP) — Greece has reacted with dismay to the European Union‘s failure to agree to release vital rescue loan funds for the debt-ridden country, with the prime minister warning it was not just Greece’s future that hangs in the balance.

The delay prolongs uncertainty over the future of Greece, which faces a messy default that would threaten the entire euro currency used by 17 EU nations.

Prime Minister Antonis Samaras stressed that Greece has done what its creditors from the EU and International Monetary Fund required. “Our partners, along with the IMF, also must do what they have committed to doing,” he said.

He said that “it is not just the future of our country, but the stability of the entire eurozone” that depend on the success of negotiations in coming days.

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Elmo left behind on ‘Sesame Street’ as actor exits

NEW YORK (AP) — Even on “Sesame Street,” where everything is famously A-OK, problems can arise for its residents.

And that includes the Muppets. Cookie Monster grapples with an eating disorder. Oscar the Grouch gets cranky. Mr. Snuffleupagus gets the blues.

But Elmo seemed immune to any of that. Since enjoying his breakout success more than two decades ago, the 3 1/2-year-old red monster has radiated good cheer, love and trilling giggles. No wonder everyone — adults as well as children — adores him.

The key to Elmo is “his innocence, his positiveness and his sweetness,” according to Kevin Clash, the man who created him and once told The Associated Press, “I would love to be totally like Elmo.”

Now Clash has been scandalously separated from Elmo and from “Sesame Street,” the TV series where he reigned behind the scenes for 28 years.

Clash spoke of “personal matters” as the cause of his resignation Tuesday after an unthinkable nine-day stretch that began with an unnamed man in his 20s claiming he had sex with Clash at age 16. That allegation was quickly recanted. But then came another accusation of sexual abuse, and a lawsuit.

That second accuser, a 24-year-old college student named Cecil Singleton, said the actor had engaged in sexual behavior with him when he was 15. He is suing Clash for $ 5 million.

“I am deeply sorry to be leaving,” said Clash in his parting statement, “and am looking forward to resolving these personal matters privately.”

But privacy may no longer be possible for Clash, the 52-year-old divorced father of a grown daughter who acknowledged last week that he is gay. Singleton’s lawyer, Jeff Herman, said he has been contacted by two other potential victims of Clash and expects additional legal action.

At a news conference Tuesday, Singleton said he and Clash met on a gay chat line and then, for a two-week period, they engaged in sexual contact, though not intercourse. Sex with a person under 17 is a felony in New York if the perpetrator is 21 or older.

Singleton said he didn’t know Clash’s profession until years later, when he Googled the man’s name.

“I was shocked when I found out what he did for a living,” said Singleton.

Now that career has ended for Clash, who, in his dream job as a puppeteer for “Sesame Street,” was assigned a little-used puppet now known as Elmo, then turned him into a star. In the process, Clash won 23 daytime Emmy awards and one prime-time Emmy. He published his 2006 autobiography, “My Life as a Furry Red Monster,” and was the subject of the 2011 documentary “Being Elmo: A Puppeteer’s Journey.”

Elmo overshadowed Big Bird and other “Sesame” Muppets in popularity and screen time, while marginalizing the cast of live actors. Since 1998, he has had his own show-within-a-show on “Sesame Street” in addition to appearances elsewhere in the hour.

He is also a major moneymaker for Sesame Workshop, the New York-based company that produces the show, and for licensees. At his merchandising height in 1996, he inspired the Tickle Me Elmo doll, which became a cultural phenomenon and that Christmas season’s hottest toy.

This year’s Elmo dolls, “LOL Elmo,” which giggles, and “Let’s Rock! Elmo,” which sings and comes with a microphone and drum set, haven’t made any of this year’s hot toy lists. Even so, Elmo toys probably account for one-half to two-thirds of the $ 75 million in annual sales the “Sesame Street” toy line generates for toy maker Hasbro, estimates BMO Capital Markets analyst Gerrick Johnson.

Johnson said he wasn’t sure how this week’s news might affect sales of Elmo toys this holiday.

“How many people are going to want to explain to their kid why they’re not getting an Elmo?” he asked.

On Tuesday, Hasbro issued a statement saying “We are confident that Elmo will remain an integral part of Sesame Street and that Sesame Street toys will continue to delight children for years to come.”

Despite his resignation, Clash will remain an integral part of “Sesame Street” for the foreseeable future. Taping of season No. 44 will wrap by mid-December and will begin airing next September, according to someone close to the show who spoke on condition of anonymity because the person was not authorized to publicly discuss details of its production. That means new episodes with Clash performing as Elmo will presumably continue well into 2014.

As for who might take over as Elmo, other “Sesame Street” puppeteers were already being trained to serve as Clash’s stand-in, Sesame Workshop said. It’s part of an understudy policy being adopted for all the major Muppet characters.

But no one knows how Elmo will fare going forward. Will the jokes spurred by Clash’s downfall leave a lasting mark on Elmo’s image? Will there be parents who see him tainted by association with the man who brought him to life?

In the wake of a personal tragedy that may still be unfolding, Elmo’s innocence, positiveness and sweetness will be put to the test.

___

AP Television Writer David Bauder and AP Retail Writer Mae Anderson contributed to this report.

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En los pacientes de Medicare es común que se repitan los tests

NUEVA YORK (Reuters Health) – La mitad o más de los

beneficiarios de Medicare repiten los tests cardíacos,

pulmonares, estomacales o vesical en tres años, señala un

estudio.

Esas pruebas no deberían repetirse. Es más, en algunos

casos, como el ecocardiograma o la prueba de esfuerzo cardíaco,

existen recomendaciones en contra de su uso rutinario.

“Nos sorprendió la frecuencia con la que se repiten estas

pruebas”, dijo el autor principal, doctor H. Gilbert Welch, del

Instituto para las Políticas de Salud y la Práctica Clínica de

Dartmouth, New Hampshire. “O esos pacientes desarrollan nuevas

enfermedades continuamente o hay médicos que repiten los

estudios como rutina”.

Con su equipo analizó el uso de seis tests en 743.478

beneficiarios de Medicare: ecocardiograma (ultrasonido

cardíaco), prueba de esfuerzo cardíaco, test de función

pulmonar, tomografía de tórax, cistoscopía (exploración de la

vejiga con una sonda) y endoscopía superior (examen el tracto

gastrointestinal superior).

Todas las pruebas eran diagnósticas, es decir que se

realizan en personas con síntomas para que los médicos puedan

realizar un diagnóstico. Cuestan entre 200 y más de 1000

dólares.

En el período 2004-2006, entre el 7 por ciento (cistoscopía)

y el 29 por ciento (ecocardiograma) de los adultos mayores se

habían realizado esos tests por lo menos una vez.

A menudo, esos exámenes se repetían: el 35 por ciento de los

pacientes a quienes se le había indicado una endoscopía del

tracto superior volvió a hacerse la prueba en tres años. Lo

mismo ocurrió con el 55 por ciento que se había realizado un

ecocardiograma. Para el resto de los exámenes, los resultados

estuvieron dentro de ese rango.

El intervalo promedio para la repetición de los tests fue de

entre cuatro y 14 meses, según publica el equipo en Archives of

Internal Medicine.

Welch aclaró que la única excepción médica para repetir

estas pruebas es cuando los pacientes desarrollan un nuevo

conjunto de síntomas que los médicos controlan después de la

primera prueba. Pero los incentivos económicos suelen lograr que

se pidan más exámenes, sin importar la finalidad.

En el caso de un ecocardiograma, por ejemplo, “si es un

cardiólogo quien lo solicita y lo va a interpretar (…) quizás

exista un incentivo económico para sobreutilizar la prueba”,

dijo la doctora Rachel Werner, de University of Pennsylvania,

Filadelfia. “El hecho es que cobramos más por hacer más”,

agregó. Y no siempre es lo mejor.

“Los pacientes comprendieron la importancia de no usar

medicamentos innecesarios. Pero pienso que la noción

generalizada es que un test diagnóstico nunca hará daño”, dijo

Welch. Pero agregó: “Cuando lo realizamos, podríamos distraernos

con un resultado circunstancial”. Son esos resultados los que

exigen nuevas pruebas y, quizás, un tratamiento innecesario.

Su equipo halló también que las ciudades donde se realizaba

la mayor cantidad de pruebas diagnósticas iniciales también

registraban los porcentajes más altos de repetición de esos

tests.

FUENTE: Archives of Internal Medicine, online 19 de

noviembre del 2012.

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UK public sector borrowing rises

21 November 2012 Last updated at 06:39 ET

The government borrowed much more than expected in October, reducing the chances that the UK will hit its deficit reduction target in 2012-13.

UK public sector net borrowing, excluding financial interventions, hit £8.6bn in October, the Office for National Statistics (ONS) said.

That marked a sharp rise from the £5.9bn borrowed in October 2011.

This is the last set of borrowing figures before the chancellor’s Autumn Statement on 5 December.

The headline figure was worse than expected – analysts had forecast borrowing of £6bn.

Corporation tax receipts fell nearly 10% in October, a month when there is usually a heavy inflow to boost the public coffers.

A rise in day-to-day departmental spending also contributed to the higher borrowing.

For the seven months of the financial year so far, borrowing has reached £73.3bn, excluding the one-off effects from the transfer of Royal Mail pension assets.

That is £5bn higher than the same time last year.

A spokesperson for the Treasury said: “The economy is healing, but it still faces many challenges.

“These numbers illustrate that, but also show the government’s plans to bring spending under control are on track for the year.”

But Labour’s shadow chief secretary to the Treasury, Rachel Reeves, said the chancellor was borrowing billions more to pay for the cost of his economic failure.

“Having failed on jobs and growth, the government is now failing on the deficit too,” she said.

‘Wrong direction’ Continue reading the main story

AAA-rating

The best credit rating that can be given to a borrower’s debts, indicating that the risk of borrowing defaulting is minuscule.

Chris Williamson, chief economist at Markit, said the low tax receipts reflected the disappointing performance of the economy, which is experiencing weak growth and weak consumer spending.

He told the BBC that he could see no chance of the government now hitting its deficit target of £120bn for 2012-13. Current projections suggest this year’s deficit would come in closer to £130bn.

“So it’s moving totally in the wrong direction,” he said.

“The longer-term prospects are looking much more disappointing than the Office for Budget Responsibility and the government were hoping when they first set these targets out back in March.”

He added that Chancellor George Osborne was likely to announce increases in taxes, further cuts in spending, or a combination of the two, when he delivers his Autumn Statement.

Chris Williamson, Chief Economist at Markit

However, analysts at Credit Suisse said the figures were disappointing but not disastrous.

“To some extent, this poor reading was mitigated by improvements in last month’s figure, which was around £0.8bn lower (less borrowing) than previously thought.

“In addition, the good news is that the poor figure appears to have been driven by expenditure rather than receipts data. This suggests that the weakness in the numbers may not be due to weaker GDP performance feeding into weaker tax receipts.”

They also pointed out that, overall, central government receipts were up 1.8% on the year to October, while expenditure was up 7.4%.

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U.S. fiscal impact of great concern to Canada: Canada’s Harper

TORONTO (Reuters) – Any fiscal problems that would significantly slow the U.S. economy would be of great concern to Canada, Canadian Prime Minister Stephen Harper said on Monday.

The United States needed a credible medium-term fiscal plan, Harper said at a business forum in Ottawa, adding that he was following the U.S. fiscal debate with “great interest.”

(Reporting by Solarina Ho)

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Interpublic exits Facebook

(Reuters) – Interpublic Group of Cos said it sold its remaining investment in Facebook Inc for $ 95 million in cash.

Interpublic said it expects to record a pre-tax gain of $ 94 million. It had recorded a pre-tax gain of $ 132.2 million for the third quarter of last year from the sale of half of its 0.4 percent stake in Facebook.

Interpublic paid less than $ 5 million for the stake in 2006.

Shares of Facebook, which debuted with a market value of more than $ 100 billion in May, have lost nearly half their value since then on concerns about money-making prospects.

“We decided to sell our remaining shares in Facebook as our investment was no longer strategic in nature,” Chief Executive Michael Roth said in a statement.

Interpublic also authorized an increase in its existing share repurchase program to $ 400 million from $ 300 million. The company repurchased shares worth $ 151 million, as of September 30.

Shares of the company were up 1 percent at $ 10 on the New York Stock Exchange on Tuesday.

Facebook shares were marginally up at $ 23.00 on the Nasdaq.

(Reporting by Sruthi Ramakrishnan in Bangalore; Editing by Joyjeet Das)

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Phillip Phillips looks at life beyond “American Idol”

LOS ANGELES (Reuters) – Like the 10 winners before him, Phillip Phillips faces the uneven road from “American Idol” victor to pop-chart mainstay.

After the success of his Top 10 hit, “Home,” the Georgia native is facing a new challenge – to replicate the mainstream successes of past “Idol” winners Carrie Underwood and Kelly Clarkson on his debut album, “The World from the Side of the Moon,” released on Monday by Interscope Records.

Phillips, 22, spoke to Reuters about making his first proper studio album, what he might do differently on a second one, and whether he could have won “Idol” with this season’s panel of judges.

Q: How do you plan to transition from “American Idol” winner to a mainstream music career?

A: “It’s pretty funny that you mention that because the majority of the people I meet don’t even know that I was on ‘Idol.’ It’s really cool to hear that. When I go home, people ask, ‘What’ve you been doing? I’ve heard your song,’ but they don’t even know that I’ve been on ‘Idol.’”

Q: Your first single “Home” has gone twice platinum. You’ve said that it isn’t a song you would have written yourself. What’s your relationship now with your first hit?

A: “It’s amazing how well it has done, and I look at all the stories that I hear like how it has helped families out with their situation, or something’s happened with their kid, mom or dad, or if their child’s overseas in the war. Something like that’s pretty amazing how many different stories come out of it.”

Q: Did you have any ideas on how you wanted to develop your sound finally getting into a big-time studio?

A: “I already had the songs written, and it was just a matter of throwing in ideas and then just trimming it down to what felt right, because we only had three weeks to do this album. So it was kind of pressured, but that kind of helped out as well. It didn’t make us overthink anything.”

Q: Was there anything in particular you wanted to achieve?

A: “I wanted to make it similar to what I did on the show – a horn section and some rock. I tried to be a little artistic. I just wrote what came from my heart and what felt right.”

Q: Unlike many of the other contestants, you went into “Idol” as a songwriter, how many of the album’s songs did you write?

A: “I think five. Some of the co-writes, (the writers) really just kind of pushed me, so I kind of wrote most of those myself. But it was a lot of fun; it was a great experience.”

Q: Would you do anything differently next time?

A: “It’s still early, but I’d definitely want a little more time to do it. But that’s really about it, because three weeks is just really quick, and also I have just so many other things going on. … It was very kind of stressful and hopefully for the next record I’ll have a little more time.”

Q: What would that time allow you to do in the studio?

A: “Just being able to listen to it a little more. We all knew that it sounded really good but also having to listen to, like 17 songs in a row. You say, ‘Yeah that sounds great’ but you listen to it more and more and (say) ‘Maybe I would’ve brought this instrument down a little bit or brought it up a little bit more.’”

Q: Would you have fared any differently on ‘Idol’ with the current judges Nicky Minaj and Mariah Carey?

A: “I don’t know. I’m curious to see how they’re going to judge. It’s a completely different panel this year. … I don’t really know how I would’ve turned out. Maybe I’ll have to go out and audition again (laughs).”

Q: Would you have had to change your roots-y style?

A: “Naw, I would’ve still been the same dude. If they wouldn’t have sent me through, they wouldn’t have sent me through. And if they did, that’d be awesome.”

(Reporting By Eric Kelsey, editing by Jill Serjeant and Gunna Dickson)

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No increase in heart disease after food poisoning

NEW YORK (Reuters Health) – Despite earlier evidence tying an outbreak of E. coli infections in Canada to later heart disease, an expanded follow up study finds no link between the two.

“Although we definitely want to avoid anyone getting infected in the first place, this new information is reassuring for those who develop an infection from E. coli O157:H7,” Dr. Amit Garg, one of the authors of the study, said in a press release issued by the Canadian Medical Association Journal (CMAJ), which published the study.

This strain of E. coli bacteria polluted the drinking water supply of Walkerton, Ontario in May of 2000, sickening more than 2,300 people and resulting in seven deaths.

Food-borne E. coli infections – which affect about 265,000 people each year in the U.S., according to the Centers for Disease Control and Prevention – can damage the kidneys and lead to high blood pressure. That has raised concerns that they might also contribute to heart disease and stroke.

“There’s anecdotal evidence that certain infections immediately predate heart attack or stroke,” said Dr. Deepak Bhatt, the chief of Cardiology at VA Boston Healthcare System, who was not involved in the study.

“It’s not been clear whether it’s the infection or inflammation (from the infection) or coincidence,” Bhatt, also a professor at Harvard Medical School, told Reuters Health.

To see whether an E. coli outbreak could increase the risk of heart disease and stroke, Garg, a professor at Western University, Lawson Health Research Institute in London, Ontario, and his colleagues collected data on affected individuals from the 2000 event at a health clinic where they had annual visits.

Initially, the group seemed to have a higher risk for heart disease and stroke compared to people who had not suffered an E. coli infection. The researchers point out, however, that nearly half of the participants dropped out of the study, making those findings difficult to interpret.

In the current study, the group included 153 people who experienced severe illness during the outbreak, 414 people with mild illness, 331 people from Walkerton who did not get sick and more than 11,000 people who lived in neighboring towns that were spared from the E. coli outbreak.

In the decade following the outbreak, people who became severely sick were no more likely to later suffer a heart attack or stroke than people who lived outside of Walkerton.

In contrast, people who suffered a mild illness were actually 36 percent less likely to die from heart disease or stroke than residents of the surrounding communities.

Among people with a mild reaction to the infection, about 6 percent died during the study period, compared to about 10 percent of people who lived outside of the outbreak.

The reason is not totally clear. The authors write in their study that perhaps people in the mild-illness group didn’t get that sick from the infection – and also had a lower risk of cardiovascular death – because they were healthier than average.

(Garg would not agree to an interview with Reuters Health unless he was able to review major portions of this article in advance, a practice that violates Reuters’ policy to protect journalistic independence.)

STILL UNCLEAR?

The results from the study don’t necessarily mean infections don’t increase the risk of cardiovascular disease, said Dr. Liam Smeeth, a professor at the London School of Hygiene and Tropical Medicine, who was not part of the study.

Smeeth told Reuters Health that research has shown that any impact on the coronary arteries from infection and subsequent inflammation is short-lived, and perhaps the numbers in the Walkerton study were not big enough, or the increased risk not large enough, to be detected.

“It’s not crystal clear because it was a relatively small study,” he said.

Bhatt agreed that the findings don’t prove or disprove the idea that infections could be involved in heart disease, and it’s also possible that the type of infection might matter.

He said that it’s important to rule out the types that don’t contribute.

“I think the study’s important because it makes it very, very much less likely that gastrointestinal infections in some way are linked to atherosclerosis, and I think that finding is useful because probably investigators in the future shouldn’t focus on this area as far as causes of atherosclerosis and heart attack and stroke,” he said.

SOURCE: http://bit.ly/Te450j CMAJ, online November 19, 2012.

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