Source: http://www.thehollywoodgossip.com/2013/03/jim-carrey-fights-back-against-fox-news-vitriol/
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Sunday, March 31, 2013
Rubio: Reports of immigration deal 'premature'
FILE - In this March 12, 2013 file photo, Sen. Marco Rubio, R-Fla. is seen on Capitol Hill in Washington. The Republican Party?s search for a way back to presidential success in 2016 is drawing a striking array of personalities and policy options. It?s shaping up as a wide-open self-reassessment by the GOP. Some factions are trying to tug the party left or right. Others argue over pragmatism versus defiance. (AP Photo/Susan Walsh, File)
FILE - In this March 12, 2013 file photo, Sen. Marco Rubio, R-Fla. is seen on Capitol Hill in Washington. The Republican Party?s search for a way back to presidential success in 2016 is drawing a striking array of personalities and policy options. It?s shaping up as a wide-open self-reassessment by the GOP. Some factions are trying to tug the party left or right. Others argue over pragmatism versus defiance. (AP Photo/Susan Walsh, File)
Sen. Chuck Schumer, D-N.Y., makes a point as he is joined by Sen. John McCain, R-Ariz., Sen. Jeff Flake, R-Ariz., and Sen. Michael Bennett, D-CO, during a news conference after their tour of the Mexico border with the United States on Wednesday, March 27, 2013, in Nogales, Ariz. A group of influential U.S. senators shaping and negotiating details of an immigration reform package vowed Wednesday to make the legislation public when Congress reconvenes next month. (AP Photo/Ross D. Franklin)
WASHINGTON (AP) ? Even with one of the largest hurdles to an immigration overhaul overcome, optimistic lawmakers on Sunday cautioned they had not finished work on a bill that would provide a path to citizenship for 11 million illegal immigrants.
The AFL-CIO and the pro-business U.S. Chamber of Commerce reached a deal late Friday that would allow tens of thousands of low-skill workers into the country to fill jobs in construction, restaurants and hotels. Yet despite the unusual agreement between the two powerful lobbying groups, lawmakers from both parties conceded that the negotiations were not finished.
"With the agreement between business and labor, every major policy issue has been resolved," said Sen. Chuck Schumer, the New York Democrat who brokered the labor-business deal.
But it hasn't taken the form of a bill and the eight senators searching for a compromise haven't met about the potential breakthrough.
"We haven't signed off," said Sen. Lindsey Graham, R-S.C.
"There are a few details yet. But conceptually, we have an agreement between business and labor, between ourselves that has to be drafted," he added.
Yet just before lawmakers began appearing on Sunday shows, Sen. Marco Rubio warned he was not ready to lend his name ? and political clout ? to such a deal without hashing out the details.
"Reports that the bipartisan group of eight senators have agreed on a legislative proposal are premature," said Rubio, a Florida Republican who is among the lawmakers working on legislation.
Rubio, a Cuban-American who is weighing a presidential bid in 2016, is a leading figure inside his party. Lawmakers will be closely watching any deal for his approval and his skepticism about the process did little to encourage optimism.
Rubio, who is the group's emissary to conservatives, called the agreement "a starting point" but said 92 senators from 43 states haven't yet been involved in the process.
The detente between the nation's leading labor federation and the powerful business lobbying group still needs senators' approval, including a nod from Sen. John McCain, the Arizona Republican whose previous efforts came up short.
"I think we're on track. . But as Sen. Rubio correctly says, we have said we will not come to final agreement till we look at all of the legislative language and he's correctly pointing out that that language hasn't been fully drafted," Schumer said.
Sen. Jeff Flake, R-Ariz., also noted the significance of the truce between labor and business but added that this wasn't yet complete.
"That doesn't mean we've crossed every 'i' or dotted every 't,' or vice versa," said Flake, who is among the eight lawmakers working on the deal.
Schumer negotiated the deal between AFL-CIO president Richard Trumka and Chamber of Commerce head Tom Donohue during a late-Friday phone call. Under the compromise, the government would create a new "W'' visa for low-skill workers who would earn wages paid to Americans or the prevailing wages for the industry they're working in, whichever is higher. The Labor Department would determine prevailing wage based on customary rates in specific localities, so that it would vary from city to city.
The proposed measure would secure the border, crack down on employers, improve legal immigration and create a 13-year pathway to citizenship for the millions of illegal immigrants already here.
It's a major second-term priority of President Barack Obama's and would usher in the most dramatic changes to the faltering U.S. immigration system in more than two decades.
"This is a legacy item for him. There is no doubt in my mind that he wants to pass comprehensive immigration reform," said David Axelrod, a longtime political confidant of Obama.
During the last week, an immigration deal seemed doomed. But the breakthrough late Friday restarted the talks.
Ultimately the new "W'' visa program would be capped at 200,000 workers a year, but the number of visas would fluctuate, depending on unemployment rates, job openings, employer demand and data collected by a new federal bureau being pushed by labor groups as an objective monitor of the market, according to an official involved with the talks who also spoke on condition of anonymity ahead of a formal announcement.
A "safety valve" would allow employers to exceed the cap, the official said, if they could show need and pay premium wages, but any additional workers brought in would be subtracted from the next year's cap.
The workers could move from employer to employer and would be able to petition for permanent residency and ultimately seek U.S. citizenship. Neither is possible for temporary workers now.
"As to the 11 million (illegal immigrants), they'll have a pathway to citizenship, but it will be earned, it will be long, and it will be hard, and I think it is fair," Graham said.
The new program would fill needs employers say they have that are not currently met by U.S. immigration programs. Most industries don't have a good way to hire a steady supply of foreign workers because there's one temporary visa program for low-wage nonagricultural workers but it's capped at 66,000 visas per year and is only supposed to be used for seasonal or temporary jobs.
Separately, the new immigration bill also is expected to offer many more visas for high-tech workers, new visas for agriculture workers, and provisions allowing some agriculture workers already in the U.S. a speedier path to citizenship than that provided to other illegal immigrants, in an effort to create a stable agricultural workforce.
Schumer, Flake and Axelrod appeared on NBC's "Meet the Press." Graham was interviewed on CNN's "State of the Union."
___
Associated Press writer Erica Werner contributed to this report.
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North Korea: Nukes are our country's 'life'
North Korea said on Saturday it was entering a "state of war" with South Korea. NBC's Ian Williams reports.
By Alastair Jamieson, Staff writer, NBC News
One of North Korea's top decision-making bodies is setting guidelines that call nuclear weapons "the nation's life" that won't be traded even for "billions of dollars,? The Associated Press reported.
The statement Sunday came after a plenary meeting of the central committee of the ruling Workers' Party attended by leader Kim Jong Un and other officials, the AP said.
It also followed a declaration on Saturday that it was entering a "state of war" with South Korea, the latest in a string of increasingly belligerent outbursts from the isolated state.
Sunday?s statement says nuclear weapons aren't "goods for getting U.S. dollars" or a "political bargaining chip." Outside analysts have said Pyongyang raises worries over its nuclear ambitions to spur nuclear-disarmament-for-aid talks, the AP said.
David Guttenfelder / AP
As chief Asia photographer for the Associated Press, David Guttenfelder has had unprecedented access to communist North Korea. Here's a rare look at daily life in the secretive country.
It said Pyongyang will also increase work to build up the economy. Kim has made fixing the moribund economy a focus.
On Thursday the U.S. sent two nuclear-capable bombers to South Korea, where they dropped inert munitions in a military exercise. The flight sparked an angry response from the North, which declared on Friday that it was preparing rockets aimed at American bases in South Korea and the Pacific.
Related:
Analysis: North Korea's threats predictable but Kim Jong Un is not
North Korea's Internet? For most, online access doesn't exist
PhotoBlog: Pyongyang marchers: 'Rip the puppet traitors to death!'
This story was originally published on Sun Mar 31, 2013 9:38 AM EDT
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WSJ: Facebook plans to clog up Android home screens with status updates
By Simon Evans March 28 (Reuters) - United States forward Landon Donovan, returning to soccer after a three-month break from the game, said on Thursday he hopes to be back with the national team for June's World Cup qualifiers. Donovan announced last December that he needed a break from the game, saying he had lost his passion and enjoyment for the sport, raising the question as to whether he would play at next year's World Cup finals in Brazil should the U.S. qualify. But after returning to training with his Major League Soccer club L.A. ...
Source: http://news.yahoo.com/wsj-facebook-plans-clog-android-home-screens-status-154442481.html
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Saturday, March 30, 2013
Obama to pitch investing in public works in Miami
WASHINGTON (AP) ? President Barack Obama will press Congress to pass new tax incentives and other flexibility measures aimed at attracting more private sector investment in infrastructure projects around the country, a senior administration official said.
The president will flesh out the details of his proposals during a speech Friday at a Miami port that is undergoing $2 billion in upgrades, funded by public and private money. In his quick trip to South Florida, Obama will try to show the public that the economy remains his top priority in the midst of high-profile campaigns on immigration reform and gun control.
Among the proposals Obama will call for Friday:
? Higher caps on "private activity bonds" to encourage the private sector to spend more on highway projects and other infrastructure needs. State and local governments use the bonds to attract investment.
? Giving foreign pension funds tax-exempt status when selling U.S. infrastructure, property or real estate assets. U.S. pension funds are generally tax exempt under such circumstances. The administration says some international pension funds cite the tax burden as a reason for not investing in American infrastructure.
? $4 billion in new spending on two infrastructure programs that award loans and grants.
? A renewed call for a $10 billion national "infrastructure bank" ? a proposal from his first term that gained little traction.
The administration official requested anonymity because the proposals were not being announced publicly until Friday's event.
The president made private sector infrastructure investment a key part of the economic agenda he rolled out in his State of the Union address last month. He also called in the national address for a "Fix-It-First" program that would spend $40 billion in taxpayer funds on urgent repairs.
Obama's focus on generating more private sector investment underscores the tough road new spending faces on Capitol Hill, where Republican lawmakers often threaten to block additional spending unless it is offset through tax cuts or other measures.
The official said any increased spending associated with the proposals Obama was outlining Friday would not add to the deficit. But the official did not detail how the costs would be offset, saying only that more information would be included in the president's budget.
Obama will release his budget April 10.
___
Follow Julie Pace on Twitter: http://twitter.com/jpaceDC
Source: http://news.yahoo.com/obama-pitch-investing-public-works-miami-111059473--finance.html
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Architectural Mailboxes are on Houzz.com | Architectural Mailboxes ...
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Source: http://www.architecturalmailboxes.com/blog/2013/03/architectural-mailboxes-are-on-houzz-com/
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AP NewsBreak: China jails Nobel winner's relative
BEIJING (AP) ? Police have arrested the brother-in-law of China's jailed Nobel Peace Prize winner Liu Xiaobo on fraud charges in what the family said is the latest act of official retaliation.
Beijing police detained Liu Hui on Jan. 31, just before the Lunar New Year and a planned family reunion, and formally charged him two weeks ago over a real estate dispute, lawyer Mo Shaoping said Thursday. He said the criminal charges were unwarranted in a business dispute that has since been resolved.
Liu Hui's arrest is the latest blow to the family and, Mo said, is particularly painful for his sister, Liu Xia, the wife of democracy campaigner Liu Xiaobo. He was imprisoned in late 2008, and ever since he was awarded the Nobel prize two-and-a-half years ago, Liu Xia has been under house arrest. Isolated in an apartment with no phone or Internet, she appears emotionally fragile, allowed only weekly visits with family members and a monthly visit to her husband in prison.
The latest arrest "affected the whole family, especially Liu Xia, who is worried about her brother," said Mo.
Calls to the prosecutor's office in the suburban Beijing district of Huairou where Liu Hui is to be tried rang unanswered. Family members publicly declined comment, but privately one said the stress on the family is taking its toll. They are under close surveillance and have been warned not to talk to the media about Liu Xiaobo or Liu Xia, said the family member, who asked not to be identified.
An associate of Mo's, who declined to be named, said Liu Xia skipped her February visit to Liu Xiaobo in Jinzhou Prison 450 kilometers (280 miles) east of Beijing out of anger at the arrest of her brother.
Chinese authorities commonly put pressure on relatives and friends of government critics and political and religious dissidents as a way to try to keep them in line. Even by those standards, the treatment of the Liu family is severe and underscores how the Nobel award embarrassed the Chinese government, which bridles at criticisms of its human rights record and its authoritarian political system.
"We used to interact with both Liu Xiaobo and Liu Xia's brothers and sisters, but now we have been completely cut off from them," said Pu Zhiqiang, an activist lawyer and family friend. "I think there is only one explanation about this: that the family has been the victim of repressive measures, which are cruel and cowardly."
Liu Xiaobo, once a literary critic and university lecturer, had campaigned for peaceful democratic change for 20 years and been imprisoned three times before his current stint, an 11-year sentence for drafting a programmatic call for political reform called Charter '08.
The recent arrest of the brother, Liu Hui, may be particular retaliation for two incidents that broke the security cordon around Liu Xia and her isolation in her fifth-floor apartment in central Beijing. Reporters from The Associated Press visited her briefly in December, getting into the building while the guards were apparently away at lunch. A few weeks later, five Chinese activist friends did the same thing. In both cases, Liu Xia appeared agitated and shaken.
Pu, the lawyer and Liu family friend, said arresting and prosecuting Liu Hui in an ordinary business dispute fits a pattern of selectively using the law to harass activists and their families. The artist and prominent government critic Ai Weiwei has faced tax charges, for example, rather than a direct attack against his activism. "State security is increasingly using selective enforcement of the law," Pu said.
Police previously arrested Liu Hui, in April last year for the same real estate dispute but then released him on bail in September, Mo said. According to the recent indictment, Liu represented a company from the southern city of Shenzhen in real estate development deals in Beijing, and he and a partner pocketed 3 million yuan ($500,000) that was claimed by another party to the transaction.
He is scheduled to go on trial in May, Mo said, even though the disputed funds have already been returned, and there's insufficient evidence of a crime. "This is irregular," Mo said.
Source: http://news.yahoo.com/ap-newsbreak-china-jails-nobel-winners-relative-115319919.html
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Friday, March 29, 2013
Jolie offers answer to latest wedding gossip
By Kurt Schlosser, TODAY
Did Angelina Jolie and Brad Pitt finally get married? It's an answer you've been waiting for since the last time there was a rumor that the two had secretly tied the knot.
Today's rock-solid proof that the A-lister and her betrothed are still just engaged comes from a new TMZ video and a truth-seeking paparazzo in Los Angeles.
"Is that a wedding ring, Angelina?" the voice shouts off camera. "No, it's not," Jolie says through the back of her head as she's ushered into a waiting SUV.
So there you have it. The gold band she was wearing on her left ring finger during a recent humanitarian trip to Africa is still nothing more than just a piece of jewelry. The fact that she actually deemed the question worth answering -- after being with Pitt for 8 years -- strikes us as a bigger deal at this point than her answer.
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What role do small dams play in pollution control?
Mar. 28, 2013 ? Sometimes, little things can add up to a lot. In short, that's the message of a research study on small dams, streams and pollution by Steve Powers, a postdoctoral researcher at the University of Notre Dame's Environmental Change Initiative (ECI).
"Small dams, reservoirs and ponds trap water pollution, which provides an important benefit to water resources," Powers said. "This is especially relevant in agricultural lands of the Midwest U.S., where there are lots of small, but aging dams."
Although small individually, the sum total of the small reservoirs and ponds have a global surface area comparable to that of all large reservoirs added together.
Powers and his fellow researchers showed in detail how a small aging dam, which was more than 100 years old and located in agricultural Wisconsin, trapped water pollutants associated with fertilizer and manure runoff. They also showed an increase in downstream transport of nutrient pollution after the dam was removed, which occurred because of concerns about the dam's safety.
"Many small dams are threatened by long-term structural decline and are also filling with sediment," Powers said. "If we don't better incorporate how small dams affect the movement of water and wastes through the environment, their benefit to downstream water quality could be lost. Meanwhile, legacy sediment and pollution currently trapped behind dams could release as dams lose their water storage capacity, fall apart, or are removed deliberately."
Powers notes that there is a crucial need to gain a better understanding of what small dams mean for our water quality before they crumble and disappear.
"I am continuing to work on the subject at a broader regional scale by looking at hundreds of stream and river monitoring stations throughout the Midwestern U.S. to detect signals of dams," he said. "One current goal is to try and figure out which regions are most vulnerable to water quality changes caused by accumulation of sediment and phosphorus behind dams."
The research paper appeared in the Journal of Geophysical Research-Biogeosciences.
Powers is conducting his research as part of the Notre Dame Environmental Change Initiative's Land Use Project. The Environmental Change Initiative conducts policy-oriented research designed to help policy-makers manage environmental changes.
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The above story is reprinted from materials provided by University of Notre Dame.
Note: Materials may be edited for content and length. For further information, please contact the source cited above.
Journal Reference:
- S. M. Powers, J. P. Julian, M. W. Doyle, E. H. Stanley. Retention and transport of nutrients in a mature agricultural impoundment. Journal of Geophysical Research: Biogeosciences, 2013; DOI: 10.1029/2012JG002148
Note: If no author is given, the source is cited instead.
Disclaimer: Views expressed in this article do not necessarily reflect those of ScienceDaily or its staff.
Source: http://feeds.sciencedaily.com/~r/sciencedaily/top_news/~3/YxvhKhIHuEg/130329090620.htm
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Teens' struggles with peers forecast long-term adult relationships
Mar. 28, 2013 ? Teenagers' struggles to connect with their peers in the early adolescent years while not getting swept along by negative peer influences predict their capacity to form strong friendships and avoid serious problems even ten years later. Those are the conclusions of a new longitudinal study by researchers at the University of Virginia that appears in the journal Child Development.
"Overall, we found that teens face a high-wire act with their peers," explains Joseph P. Allen, Hugh P. Kelly Distinguished Professor at the University of Virginia, who led the study. "They need to establish strong, positive connections with them while at the same time establishing independence in resisting deviant peer influences. Those who don't manage this have significant problems as much as a decade later."
Researchers followed about 150 teens over a 10-year period (starting at age 13 and continuing to 23) to learn about the long-term effects of their peer struggles early in adolescence. They gathered information from multiple sources -- the teens themselves, their parents and peers, and by observing teens' later interactions with romantic partners. The teens comprised a racially, ethnically, and socioeconomically diverse group.
Teens who had trouble connecting well with their peers in early adolescence had difficulty establishing close friendships in young adulthood. Teens who didn't connect well at 13 also had more difficulty managing disagreements in romantic relationships as adults.
Teens who had trouble establishing some autonomy and independence with peers (especially with respect to minor forms of deviance such as shoplifting and vandalism) were found to be at higher risk for problems with alcohol and substance use, and for illegal behavior, almost a decade later.
Conversely, teens who were seen as desirable companions -- those deemed empathetic, able to see things from different perspectives and control their impulses, and having a good sense of humor -- were more likely to have positive relationships in young adulthood.
Teens who were able to establish some autonomy vis a vis peers' influences were more likely to avoid problematic behavior in young adulthood, with teens who showed they were able to think for themselves in the face of negative peer influences using less alcohol as early adults and having fewer problems with alcohol and substance abuse as young adults. But teens who were seen as desirable companions were more likely to have higher levels of alcohol use in early adulthood and future problems associated with alcohol and substance use.
"The findings make it clear that establishing social competence in adolescence and early adulthood is not a straightforward process, but involves negotiating challenging and at times conflicting goals between peer acceptance and autonomy with regard to negative peer influences," Allen notes.
"Teaching teens how to stand up for themselves in ways that preserve and deepen relationships -- to become their own persons while still connecting to others -- is a core task of social development that parents, teachers, and others can all work to promote," adds Allen.
Teens who managed both of these goals simultaneously -- connecting with peers while retaining their autonomy -- were rated by their parents as being most competent overall by age 23. "There is a positive pathway through the peer jungle of early adolescence," says Allen, "but it is a tricky one for many teens to find and traverse."
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The above story is reprinted from materials provided by Society for Research in Child Development, via EurekAlert!, a service of AAAS.
Note: Materials may be edited for content and length. For further information, please contact the source cited above.
Journal Reference:
- Joseph P. Allen, Joanna Chango, David Szwedo. The Adolescent Relational Dialectic and the Peer Roots of Adult Social Functioning. Child Development, 2013; DOI: 10.1111/cdev.12106
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/~3/Shaf-2ktyMQ/130328080223.htm
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How does innovation take hold in a community? Math modeling can provide clues
Mar. 27, 2013 ? Mathematical models can be used to study the spread of technological innovations among individuals connected to each other by a network of peer-to-peer influences, such as in a physical community or neighborhood. One such model was introduced in a paper published yesterday in the SIAM Journal on Applied Dynamical Systems.
Authors N. J. McCullen, A. M. Rucklidge, C. S. E. Bale, T. J. Foxon, and W. F. Gale focus on one main application: The adoption of energy-efficient technologies in a population, and consequently, a means to control energy consumption. By using a network model for adoption of energy technologies and behaviors, the model helps evaluate the potential for using networks in a physical community to shape energy policy.
The decision or motivation to adopt an energy-efficient technology is based on several factors, such as individual preferences, adoption by the individual's social circle, and current societal trends. Since innovation is often not directly visible to peers in a network, social interaction -- which communicates the benefits of an innovation -- plays an important role. Even though the properties of interpersonal networks are not accurately known and tend to change, mathematical models can provide insights into how certain triggers can affect a population's likelihood of embracing new technologies. The influence of social networks on behavior is well recognized in the literature outside of the energy policy domain: network intervention can be seen to accelerate behavior change.
"Our model builds on previous threshold diffusion models by incorporating sociologically realistic factors, yet remains simple enough for mathematical insights to be developed," says author Alastair Rucklidge. "For some classes of networks, we are able to quantify what strength of social network influence is necessary for a technology to be adopted across the network."
The model consists of a system of individuals (or households) who are represented as nodes in a network. The interactions that link these individuals -- represented by the edges of the network -- can determine probability or strength of social connections. In the paper, all influences are taken to be symmetric and of equal weight. Each node is assigned a current state, indicating whether or not the individual has adopted the innovation. The model equations describe the evolution of these states over time.
Households or individuals are modeled as decision makers connected by the network, for whom the uptake of technologies is influenced by two factors: the perceived usefulness (or utility) of the innovation to the individual, including subjective judgments, as well as barriers to adoption, such as cost. The total perceived utility is derived from a combination of personal and social benefits. Personal benefit is the perceived intrinsic benefit for the individual from the product. Social benefit depends on both the influence from an individual's peer group and influence from society, which could be triggered by the need to fit in. The individual adopts the innovation when the total perceived utility outweighs the barriers to adoption.
When the effect of each individual node is analyzed along with its influence over the entire network, the expected level of adoption is seen to depend on the number of initial adopters and the structure and properties of the network. Two factors in particular emerge as important to successful spread of the innovation: The number of connections of nodes with their neighbors, and the presence of a high degree of common connections in the network.
This study makes it possible to assess the variables that can increase the chances for success of an innovation in the real world. From a marketing standpoint, strategies could be designed to enhance the perceived utility of a product or item to consumers by modifying one or more of these factors. By varying different parameters, a government could help figure out the effect of different intervention strategies to expedite uptake of energy-efficient products, thus helping shape energy policy.
"We can use this model to explore interventions that a local authority could take to increase adoption of energy-efficiency technologies in the domestic sector, for example by running recommend-a-friend schemes, or giving money-off vouchers," author Catherine Bale explains. "The model enables us to assess the likely success of various schemes that harness both the householders' trust in local authorities and peer influence in the adoption process. At a time when local authorities are extremely resource-constrained, tools to identify the interventions that will provide the biggest impact in terms of reducing household energy bills and carbon emissions could be of immense value to cities, councils and communities."
One of the motivations behind the study -- modeling the effect of social networks in the adoption of energy technologies -- was to help reduce energy consumption by cities, which utilize over two-thirds of the world's energy, releasing more than 70% of global CO2 emissions. Local authorities can indirectly influence the provision and use of energy in urban areas, and hence help residents and businesses reduce energy demand through the services they deliver. "Decision-making tools are needed to support local authorities in achieving their potential contribution to national and international energy and climate change targets," says author William Gale.
Higher quantities of social data can help in making more accurate observations through such models. As author Nick McCullen notes,"To further refine these types of models, and make the results reliable enough to be used to guide the decisions of policy-makers, we need high quality data. Particularly, data on the social interactions between individuals communicating about energy innovations is needed, as well as the balance of factors affecting their decision to adopt."
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The above story is reprinted from materials provided by Society for Industrial and Applied Mathematics.
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Journal Reference:
- N. J. McCullen, A. M. Rucklidge, C. S. E. Bale, T. J. Foxon, W. F. Gale. Multiparameter Models of Innovation Diffusion on Complex Networks. SIAM Journal on Applied Dynamical Systems, 2013; 12 (1): 515 DOI: 10.1137/120885371
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Disclaimer: Views expressed in this article do not necessarily reflect those of ScienceDaily or its staff.
Source: http://feeds.sciencedaily.com/~r/sciencedaily/top_news/~3/hugYw5OyB2M/130327163559.htm
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Thursday, March 28, 2013
Rise in CF patient infections explained
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Public release date: 28-Mar-2013[ | E-mail |
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DNA sequencing reveals evidence for Mycobacterium abscessus transmission between Cystic Fibrosis patients
Researchers at Papworth Hospital, the University of Cambridge and the Wellcome Trust Sanger Institute have discovered why a new type of dangerous bacterial infection has become more common among people with Cystic Fibrosis around the world.
Through their ground-breaking research, the team has developed new measures to protect Cystic Fibrosis patients.
People with Cystic Fibrosis are prone to serious infection in part because they have sticky mucus that can clog up their lungs. In recent years doctors have seen a global increase in the number of infections caused by the antibiotic-resistant bacterial species Mycobacterium abscessus (M. abscessus). M. abscessus is distantly related to the bacterium that causes Tuberculosis and is usually found in water and soil. Until now, experts had thought it could not be passed from person to person.
"There has been worldwide concern about the rising number of M. abscessus infections in people with Cystic Fibrosis and anxiety that spread from person to person might be responsible," said Dr Andres Floto, Research Director of the Cystic Fibrosis Unit at Papworth Hospital, Principal Investigator at the Cambridge Institute for Medical Research, University of Cambridge and lead author of the research published in The Lancet. "Our work has allowed us to lead the world in changing hospital infection control: we used state-of-the-art DNA sequencing technology to understand how the infection is being spread, which conventional techniques would have missed."
"Our results will help to protect patients from this serious infection."
The team used the latest methods to sequence the genomes of almost 170 isolates of M. abscessus from Cystic Fibrosis patients collected over a five-year period. By looking at the fine detail of the relationships between the bacterial genomes, to produce a 'family tree', the research team could determine where it was likely that infection had passed from one patient to another. They showed that, even with nationally recommended infection control measures in place, M. abscessus can spread between patients.
"We are increasingly able to use DNA studies to improve patient care," says Professor Julian Parkhill, Head of Pathogen Genomics at the Wellcome trust Sanger Institute. "By sequencing the complete genomes of bacteria we can accurately describe where they have emerged from and how they pass from person to person.
"This knowledge means that the clinical teams can develop new health measures to safeguard their patients. Our aim is to develop the best methods to detect and control infection."
This new information has led to rapid changes in how people with Cystic Fibrosis are cared for in hospital to protect them from this emerging threat.
###
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Kate Lancaster, Papworth Hospital
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Publication details
Josephine M. Bryant, Dorothy M. Grogono, Daniel Greaves, Juliet Foweraker, Iain Roddick, Thomas Inns, Mark Reacher, Charles S. Haworth, Martin D. Curran, Simon R. Harris1, Sharon J. Peacock, Julian Parkhill1and R. Andres Floto. (2013) 'Evidence for transmission of Mycobacterium abscessus between Cystic Fibrosis patients from whole-genome sequencing.
Published in the Lancet online 29 March 2013. doi: 10.1016/S0140-6736(13)60632-7, http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60632-7/abstract
Funding
This work was supported by The Wellcome Trust, Papworth Hospital, NIHR Cambridge Biomedical Research Centre, The UK Health Protection Agency, Medical Research Council, and the UKCRC Translational Infection Research Initiative.
Participating centres
1. Wellcome Trust Sanger Institute, Hinxton, UK
2. Cambridge Institute for Medical Research, University of Cambridge, UK
3. Cambridge Centre for Lung Infection, Papworth Hospital, Cambridge, UK
4. Department of Medicine, University of Cambridge, UK
5. Health Protection Agency, Addenbrooke's Hospital, Cambridge, UK
6. HPA Health Protection Agency East of England Regional Epidemiology Unit, UK
7. HPA, Norfolk, Suffolk & Cambridgeshire Health Protection Unit, UK
8. Field Epidemiology Training Programme (FETP), Health Protection Agency, London, UK
The mission of the University of Cambridge is to contribute to society through the pursuit of education, learning and research at the highest international levels of excellence. It admits the very best and brightest students, regardless of background, and offers one of the UK's most generous bursary schemes. The University of Cambridge's reputation for excellence is known internationally and reflects the scholastic achievements of its academics and students, as well as the world-class original research carried out by its staff. Some of the most significant scientific breakthroughs occurred at the University, including the splitting of the atom, invention of the jet engine and the discoveries of stem cells, plate tectonics, pulsars and the structure of DNA. From Isaac Newton to Stephen Hawking, the University has nurtured some of history's greatest minds and has produced more Nobel Prize winners than any other UK institution with over 80 laureates. http://www.cam.ac.uk
The Wellcome Trust Sanger Institute is one of the world's leading genome centres. Through its ability to conduct research at scale, it is able to engage in bold and long-term exploratory projects that are designed to influence and empower medical science globally. Institute research findings, generated through its own research programmes and through its leading role in international consortia, are being used to develop new diagnostics and treatments for human disease. http://www.sanger.ac.uk
The Wellcome Trust is a global charitable foundation dedicated to achieving extraordinary improvements in human and animal health. We support the brightest minds in biomedical research and the medical humanities. Our breadth of support includes public engagement, education and the application of research to improve health. We are independent of both political and commercial interests. http://www.wellcome.ac.uk
Papworth Hospital is an international centre of excellence for the treatment of heart and lung disease. Since carrying out the UK's first successful heart transplant in 1979, Papworth has established a reputation for leading edge research and innovation in cardiopulmonary medicine and surgery. As part of the Cambridge Centre for Lung Infection (CCLI), the Adult Cystic Fibrosis Centre at Papworth Hospital was established in 1994 and now looks after over 280 adults with CF from throughout the Eastern Region. The service is supported by a multidisciplinary team including: four CF specialist consultants, three CF specialist nurses, a dedicated team of ward nurses, research nurses, specialist physiotherapists, dieticians, pharmacists, social workers, psychologist, psychiatrist, secretaries and managers. Research within the CCLI has focused on understanding how bacteria, particularly nontuberculous mycobacteria (NTM) cause infection and inflammatory lung damage. http://www.papworthhospital.nhs.uk/ccli.
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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Public release date: 28-Mar-2013[ | E-mail |
Share ] Contact: Aileen Sheehy
press.office@sanger.ac.uk
0044-012-234-96928
Wellcome Trust Sanger Institute
DNA sequencing reveals evidence for Mycobacterium abscessus transmission between Cystic Fibrosis patients
Researchers at Papworth Hospital, the University of Cambridge and the Wellcome Trust Sanger Institute have discovered why a new type of dangerous bacterial infection has become more common among people with Cystic Fibrosis around the world.
Through their ground-breaking research, the team has developed new measures to protect Cystic Fibrosis patients.
People with Cystic Fibrosis are prone to serious infection in part because they have sticky mucus that can clog up their lungs. In recent years doctors have seen a global increase in the number of infections caused by the antibiotic-resistant bacterial species Mycobacterium abscessus (M. abscessus). M. abscessus is distantly related to the bacterium that causes Tuberculosis and is usually found in water and soil. Until now, experts had thought it could not be passed from person to person.
"There has been worldwide concern about the rising number of M. abscessus infections in people with Cystic Fibrosis and anxiety that spread from person to person might be responsible," said Dr Andres Floto, Research Director of the Cystic Fibrosis Unit at Papworth Hospital, Principal Investigator at the Cambridge Institute for Medical Research, University of Cambridge and lead author of the research published in The Lancet. "Our work has allowed us to lead the world in changing hospital infection control: we used state-of-the-art DNA sequencing technology to understand how the infection is being spread, which conventional techniques would have missed."
"Our results will help to protect patients from this serious infection."
The team used the latest methods to sequence the genomes of almost 170 isolates of M. abscessus from Cystic Fibrosis patients collected over a five-year period. By looking at the fine detail of the relationships between the bacterial genomes, to produce a 'family tree', the research team could determine where it was likely that infection had passed from one patient to another. They showed that, even with nationally recommended infection control measures in place, M. abscessus can spread between patients.
"We are increasingly able to use DNA studies to improve patient care," says Professor Julian Parkhill, Head of Pathogen Genomics at the Wellcome trust Sanger Institute. "By sequencing the complete genomes of bacteria we can accurately describe where they have emerged from and how they pass from person to person.
"This knowledge means that the clinical teams can develop new health measures to safeguard their patients. Our aim is to develop the best methods to detect and control infection."
This new information has led to rapid changes in how people with Cystic Fibrosis are cared for in hospital to protect them from this emerging threat.
###
For further information please contact:
Kate Lancaster, Papworth Hospital
Tel +44 (0)1480 364148
Mobile +44 (0) 07850 918627
Email Kate.lancaster@papworth.nhs.uk
Don Powell, Media Manager, Wellcome Trust Sanger Institute
Hinxton, Cambridge, CB10 1SA, UK
Tel +44 (0)1223 496 928
Mobile +44 (0)7753 7753 97
Email press.office@sanger.ac.uk
Publication details
Josephine M. Bryant, Dorothy M. Grogono, Daniel Greaves, Juliet Foweraker, Iain Roddick, Thomas Inns, Mark Reacher, Charles S. Haworth, Martin D. Curran, Simon R. Harris1, Sharon J. Peacock, Julian Parkhill1and R. Andres Floto. (2013) 'Evidence for transmission of Mycobacterium abscessus between Cystic Fibrosis patients from whole-genome sequencing.
Published in the Lancet online 29 March 2013. doi: 10.1016/S0140-6736(13)60632-7, http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60632-7/abstract
Funding
This work was supported by The Wellcome Trust, Papworth Hospital, NIHR Cambridge Biomedical Research Centre, The UK Health Protection Agency, Medical Research Council, and the UKCRC Translational Infection Research Initiative.
Participating centres
1. Wellcome Trust Sanger Institute, Hinxton, UK
2. Cambridge Institute for Medical Research, University of Cambridge, UK
3. Cambridge Centre for Lung Infection, Papworth Hospital, Cambridge, UK
4. Department of Medicine, University of Cambridge, UK
5. Health Protection Agency, Addenbrooke's Hospital, Cambridge, UK
6. HPA Health Protection Agency East of England Regional Epidemiology Unit, UK
7. HPA, Norfolk, Suffolk & Cambridgeshire Health Protection Unit, UK
8. Field Epidemiology Training Programme (FETP), Health Protection Agency, London, UK
The mission of the University of Cambridge is to contribute to society through the pursuit of education, learning and research at the highest international levels of excellence. It admits the very best and brightest students, regardless of background, and offers one of the UK's most generous bursary schemes. The University of Cambridge's reputation for excellence is known internationally and reflects the scholastic achievements of its academics and students, as well as the world-class original research carried out by its staff. Some of the most significant scientific breakthroughs occurred at the University, including the splitting of the atom, invention of the jet engine and the discoveries of stem cells, plate tectonics, pulsars and the structure of DNA. From Isaac Newton to Stephen Hawking, the University has nurtured some of history's greatest minds and has produced more Nobel Prize winners than any other UK institution with over 80 laureates. http://www.cam.ac.uk
The Wellcome Trust Sanger Institute is one of the world's leading genome centres. Through its ability to conduct research at scale, it is able to engage in bold and long-term exploratory projects that are designed to influence and empower medical science globally. Institute research findings, generated through its own research programmes and through its leading role in international consortia, are being used to develop new diagnostics and treatments for human disease. http://www.sanger.ac.uk
The Wellcome Trust is a global charitable foundation dedicated to achieving extraordinary improvements in human and animal health. We support the brightest minds in biomedical research and the medical humanities. Our breadth of support includes public engagement, education and the application of research to improve health. We are independent of both political and commercial interests. http://www.wellcome.ac.uk
Papworth Hospital is an international centre of excellence for the treatment of heart and lung disease. Since carrying out the UK's first successful heart transplant in 1979, Papworth has established a reputation for leading edge research and innovation in cardiopulmonary medicine and surgery. As part of the Cambridge Centre for Lung Infection (CCLI), the Adult Cystic Fibrosis Centre at Papworth Hospital was established in 1994 and now looks after over 280 adults with CF from throughout the Eastern Region. The service is supported by a multidisciplinary team including: four CF specialist consultants, three CF specialist nurses, a dedicated team of ward nurses, research nurses, specialist physiotherapists, dieticians, pharmacists, social workers, psychologist, psychiatrist, secretaries and managers. Research within the CCLI has focused on understanding how bacteria, particularly nontuberculous mycobacteria (NTM) cause infection and inflammatory lung damage. http://www.papworthhospital.nhs.uk/ccli.
[ | E-mail | Share ] ?
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Source: http://www.eurekalert.org/pub_releases/2013-03/wtsi-ric032713.php
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Congressman criticizes Obama girls for vacation
Sasha and Malia Obama at the Inaugural parade (AP/Gerald Herbert)
While speaking on a radio program, Rep. Steve King (R-IA) criticized Sasha and Malia Obama for taking a vacation while the federal government is being squeezed by the so-called sequester -- the deep automatic spending cuts that went into effect earlier this month when Congress and President Obama failed to reach a budget agreement.
ThinkProgress, a progressive blog, reports that King was speaking on the Mickelson in the Morning program. A listener named Carla called in to discuss the sequester's effects on her son, a Marine. She complained that Michelle Obama was vacationing in the Bahamas with her two daughters while others are being squeezed by the government cuts.
"It's hard to stomach. When we're tightening our belts, we should either all do it or none of us do it," she said.
Earlier this week, conservative news outlet Breitbart.com reported that the girls were on spring break and named the resort where they were staying.
King agreed with the caller, saying, "Carla, you're on point and on the mark all the way through." King then went on to mention that the girls vacationed in Mexico the year before.
"He sent the daughters to spring break in Mexico a year ago," King said, referring to President Obama. "That was at our expense, too. And now to the Bahamas at one of the most expensive places there. That is the wrong image to be coming out of the White House."
The Obamas pay for family vacations themselves. However critics complain that those costs do not include security measures.
King, who is mulling a Senate bid in 2014, has been an outspoken critic of President Obama for years. During the 2008 presidential campaign, King predicted that should Obama beat John McCain, "then the radical Islamists, the al-Qaida, the radical Islamists and their supporters, will be dancing in the streets in greater numbers than they did on September 11."
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BlackBerry makes $94 million on revenue of $2.7 billion, ships 1 million BB10 devices in 2013 Q4
This isn't quite the BlackBerry earnings story you're waiting for -- after all, the US figures covering the success (or otherwise) of the Z10 won't arrive until the next quarter. Instead, we're looking at the company's results from the end of the fiscal year to March 2nd, which shows that the smartphone maker made $94 million in GAAP income on revenues of $2.7 billion -- in contrast with the $125 million net loss it made in the same quarter last year. More importantly, however, it shipped out almost one million BlackBerry 10 devices during the three weeks of the quarter that they were available. In addition, it managed to push five million of its older smartphones and 370,000 PlayBook tablets out of the door, but saw user numbers fall from 79 million last quarter to 76 million now.
As revenue has remained relatively flat, the surge in profits can only be attributed to Thorstein Heins' aggressive cost-cutting measures, with the CEO remarking that the "numerous changes" he has implemented at the company have "resulted in [BlackBerry] returning to profitability." At the same time, Mike Lazaridis has announced that he'll retire from his position as vice-chair and director of the outfit he founded the better part of three decades ago. He'll exit the business on May 1st so that he can concentrate on his new enterprise, Quantum Valley Investments.
Update: During the conference call, Thorsten Heins has revealed that around two-thirds or three-quarters of the one million BB10 devices shipped have been sold.
Filed under: Cellphones, Mobile, Blackberry
Source: ADVFN
Source: http://www.engadget.com/2013/03/28/blackberry-2013-q4/
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Wednesday, March 27, 2013
Tuesday, March 26, 2013
Afghanistan car bomb injures British troops, underscores transition hurdles
? A round up of latest global reports.
As Secretary of State John Kerry met with President Hamid Karzai and oversaw the symbolic handoff of a major military prison on a surprise visit to Afghanistan this week, a suicide bombing killed five police officers in the eastern city of Jalalabad Tuesday.
The Taliban quickly claimed responsibility for today?s attack, which also injured at least five Afghans at the police headquarters in the provincial capital, according to the Associated Press. In a separate incident today a car bomb blast injured at least 10 British troops on a patrol base in Helmand Province, according to the Guardian.
The timing of the violence highlights the major security challenges that remain as the United States attempts to wind down a decade of intensive military presence in the country and hand control to the Afghans.
RECOMMENDED: How well do you know Afghanistan? Take our quiz.
The attacks came just hours after Secretary Kerry and President Karzai held a rosy news conference in Kabul on the state of US-Afghan relations, which have undergone particular strain in recent weeks after Karzai accused the US of working with the Taliban to deliberately keep the country weak.
(For more on the costs of the US war effort, read about the $610 million late fee Washington is currently paying on shipping containers it rented to ship home military equipment.)
But during his trip, Kerry was glowing in his appraisal of Karzai, declaring that he and the president were ?on the same page? when it came to Afghan security and reconciliation.
"I am confident the president [Karzai] does not believe the US has any interest except to see the Taliban come to the table to make peace and that we are completely cooperative with the government of Afghanistan with respect to the protection of their efforts and their people," Kerry told reporters.
Monday?s meeting was a pivot from the prickly interaction between Karzai and Defense Secretary Chuck Hagel on Mr. Hagel?s own trip to the country earlier this month. During that visit, Hagel and Karzai abruptly called off a joint press conference after tense closed-door negotiations failed to yield progress on key diplomatic questions, including the transfer of a key US-controlled prison to Afghan hands.
The American military formally ceded control of all but a ?small number? of prisoners in that facility, known as Bagram Prison, to the Afghans during Kerry?s visit Monday.
This marks the formal completion of a transfer of 4,000 Bagram prisoners that began a year ago, but hit several snags over perceived security threats. The US military, however, will continue to hold in its custody around 50 high-level foreign prisoners considered ?enduring security threats,? along with hundreds of Afghans arrested since the initial transfer deal was authorized last March, reports Russia Today.
Despite its limitations, however, the transfer has potent symbolic value for Afghanistan, writes The New York Times.
Bagram Prison was the most flagrant symbol of Mr. Karzai?s lack of control. Americans detained several thousand Afghans there, and Mr. Karzai had no power to release them. His effort to wrest the prison from the Americans began in earnest more than year ago, and nearly succeeded at least twice, most recently two weeks ago, a day before Mr. Hagel?s first visit.
Each time, American military commanders backed out because of worries that the Afghans might release Taliban prisoners, who would return to the battlefield and endanger American soldiers. This time, despite those concerns, the transfer went forward.
?It?s about a shift that?s going on in how the U.S. is looking at what?s important,? said one American official knowledgeable about detention issues. ?We have to look at the larger picture: What?s the U.S. strategic interest here??
Kerry rounded out his visit Tuesday by meeting with democracy activists and female entrepreneurs at the American Embassy in Kabul. There, he traded headers with the captain of the Afghan women?s national soccer team and lauded civic leaders preparing for the 2014 elections, according to the Associated Press.
"You're engaged in a remarkable effort and the whole world is watching," Kerry said.
RECOMMENDED: How well do you know Afghanistan? Take our quiz.
Related stories
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A paradox for young docs: New work-hour restrictions may increase, not decrease, errors
Public release date: 25-Mar-2013[ | E-mail |
Share ] Contact: Kara Gavin
kegavin@umich.edu
734-764-2220
University of Michigan Health System
U-M-led study of 2,300 1st-year residents questions impact of 2011 duty rules
ANN ARBOR, Mich. At hospitals around the country, young doctors fresh out of medical school help care for patients of all kinds and work intense, long hours as part of their residency training.
Traditionally, residents were allowed to work more than 24 hours without a break. In 2011, new rules cut back the number of hours they can work consecutively to 16, in the name of protecting patients from errors by sleepy physicians.
But a new study of more than 2,300 doctors in their first year of residency at over a dozen hospital systems across the country raises questions about how well the rules are protecting both patients and new doctors.
While work hours went down after new rules took effect in 2011, sleep hours didn't go up significantly and risk of depression symptoms in the doctors stayed the same, according to a new paper published online in JAMA Internal Medicine by a team led by University of Michigan Medical School researchers.
Most concerning: the percentage of residents reporting that they had committed medical errors that harmed patients went up after the new rules took effect.
The results, especially the increase in errors, surprised Srijan Sen, M.D., Ph.D., the U-M psychiatrist who is the report's first author.
"In the year before the new duty hour rules took effect, 19.9 percent of the interns reported committing an error that harmed a patient, but this percentage went up to 23.3 percent after the new rules went into effect," he says. "That's a 15 to 20 percent increase in errors -- a pretty dramatic uptick, especially when you consider that part of the reason these work-hour rules were put into place was to reduce errors."
The findings echo anecdotal reports about the impact of the 2011 duty hour rules.
Co-author Sudha Amarnath, M.D., a resident in the radiation oncology program at the University of Washington, says, "Many interns entering after the new work hour restrictions took effect felt that they were expected to do the same amount of work as in previous years, but in a more limited amount of time, leading to more harried and tiring work schedules despite working fewer hours. Overall, they felt that there was less 'down time' during the work day compared to pre-2011 work schedules, which may partially explain some of the unexpected findings."
Breck Nichols, M.D., MPH, the program director of the combined Internal Medicine and Pediatrics residency program at the University of Southern California, and another co-author on the paper, concurs.
"In 2000 a typical call day lasted 36 hours. We have very specifically reduced that for interns from 36 hours to 30 hours in 2003, and now with the latest 2011 work hours change it has been reduced even further to 16 hours," he says. "For most programs the significant reduction in work hours has not been accompanied by any increase in funding to offload the work. As a result, though many programs have made some attempts to account for this lost work in other ways, the end result is that current interns have about 20 less hours each week to complete the same or only slightly less work. If we know that timed tests result in more errors than untimed ones, we should not be surprised that giving interns less time to complete the same amount of work would increase their errors as well."
All the interns assessed in this study were working under the duty hour restrictions that went into effect in 2003 limiting residents to no more than 80 hours of work in a week, and other restrictions. Some studies have suggested that these rule changes, recommended by the Accreditation Council for Graduate Medical Education, did result in better safety for patients cared for by residents. But in an effort to achieve even greater safety, the ACGME recommended further changes that were implemented in 2011.
Each year, Sen and colleagues send out surveys to students entering residency programs around the U.S. The research team then surveys these interns every three months throughout that first year, asking questions that gauge mental health, overall well-being, sleep habits, work hours and performance on the job.
By comparing the interns serving before the new ACGME rules (called the 2009 and 2010 cohorts) with the interns serving after the new rules were implemented (the 2011 cohort), the research team assessed the effects of the new duty hour rules.
In addition to the increase in self-reported medical errors, 20 percent of the residents screened positive for depression.
Sen was an intern in 2006, and in the years since has studied depression among medical students and residents, said he had been in favor of the adjusting duty hour rules in principle. "It was obvious that after working for 24 hours, we were not functioning at our best, and this was not optimal for us or the patients we were treating," he explains. But in practice, he says, the new rules may have had unintended consequences that ran counter to the goals of new guidelines.
In addition to "work compression", he says, residents now hand off responsibility for a long list of patients more frequently than in the past. Communication between the intern who is ending a shift, and the one beginning a shift, may not cover all patients in detail, he suggests, and this gap in communication may not become apparent until an urgent situation arises with one of the patients.
He also said the increase in errors may come back down with time. "The 2011 changes were a pretty radical shift," he notes. "Doctors have worked 30-hour shifts for decades, and it may just take time for all parts of the health care system to get used to the new rules and adjust."
But, he cautions, the new data don't definitively support any one of these theories as the culprit in the rise in error rates or the lack of progress in sleep hours and well-being among young doctors. Further study is needed to assess what's happening and determine how to better support young doctors in during their stressful training and keep the patients that they treat as safe as possible.
###
The Intern Health Study, from which the new results are drawn, is funded by the National Institutes of Health (grants UL1RR024986, MH095109 and AA013736) with additional support from the American Foundation for Suicide Prevention. In addition to Sen, Amarnath and Nichols, the paper's authors include Joseph Kolars, M.D., senior associate dean for education and global at the U-M Medical School, Gregory Dalack, M.D., chair of the U-M Department of Psychiatry, Henry R. Kranzler, M.D., from the University of Pennsylvania; Aashish K. Didwania, M.D., from Northwestern University; Ann C. Schwartz, M.D., from Emory University; and Constance Guille, M.D. from the Medical University of South Carolina. REFERENCE: JAMA Internal Medicine, March 25, 2013
[ | E-mail | Share ] ?
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Public release date: 25-Mar-2013[ | E-mail |
Share ] Contact: Kara Gavin
kegavin@umich.edu
734-764-2220
University of Michigan Health System
U-M-led study of 2,300 1st-year residents questions impact of 2011 duty rules
ANN ARBOR, Mich. At hospitals around the country, young doctors fresh out of medical school help care for patients of all kinds and work intense, long hours as part of their residency training.
Traditionally, residents were allowed to work more than 24 hours without a break. In 2011, new rules cut back the number of hours they can work consecutively to 16, in the name of protecting patients from errors by sleepy physicians.
But a new study of more than 2,300 doctors in their first year of residency at over a dozen hospital systems across the country raises questions about how well the rules are protecting both patients and new doctors.
While work hours went down after new rules took effect in 2011, sleep hours didn't go up significantly and risk of depression symptoms in the doctors stayed the same, according to a new paper published online in JAMA Internal Medicine by a team led by University of Michigan Medical School researchers.
Most concerning: the percentage of residents reporting that they had committed medical errors that harmed patients went up after the new rules took effect.
The results, especially the increase in errors, surprised Srijan Sen, M.D., Ph.D., the U-M psychiatrist who is the report's first author.
"In the year before the new duty hour rules took effect, 19.9 percent of the interns reported committing an error that harmed a patient, but this percentage went up to 23.3 percent after the new rules went into effect," he says. "That's a 15 to 20 percent increase in errors -- a pretty dramatic uptick, especially when you consider that part of the reason these work-hour rules were put into place was to reduce errors."
The findings echo anecdotal reports about the impact of the 2011 duty hour rules.
Co-author Sudha Amarnath, M.D., a resident in the radiation oncology program at the University of Washington, says, "Many interns entering after the new work hour restrictions took effect felt that they were expected to do the same amount of work as in previous years, but in a more limited amount of time, leading to more harried and tiring work schedules despite working fewer hours. Overall, they felt that there was less 'down time' during the work day compared to pre-2011 work schedules, which may partially explain some of the unexpected findings."
Breck Nichols, M.D., MPH, the program director of the combined Internal Medicine and Pediatrics residency program at the University of Southern California, and another co-author on the paper, concurs.
"In 2000 a typical call day lasted 36 hours. We have very specifically reduced that for interns from 36 hours to 30 hours in 2003, and now with the latest 2011 work hours change it has been reduced even further to 16 hours," he says. "For most programs the significant reduction in work hours has not been accompanied by any increase in funding to offload the work. As a result, though many programs have made some attempts to account for this lost work in other ways, the end result is that current interns have about 20 less hours each week to complete the same or only slightly less work. If we know that timed tests result in more errors than untimed ones, we should not be surprised that giving interns less time to complete the same amount of work would increase their errors as well."
All the interns assessed in this study were working under the duty hour restrictions that went into effect in 2003 limiting residents to no more than 80 hours of work in a week, and other restrictions. Some studies have suggested that these rule changes, recommended by the Accreditation Council for Graduate Medical Education, did result in better safety for patients cared for by residents. But in an effort to achieve even greater safety, the ACGME recommended further changes that were implemented in 2011.
Each year, Sen and colleagues send out surveys to students entering residency programs around the U.S. The research team then surveys these interns every three months throughout that first year, asking questions that gauge mental health, overall well-being, sleep habits, work hours and performance on the job.
By comparing the interns serving before the new ACGME rules (called the 2009 and 2010 cohorts) with the interns serving after the new rules were implemented (the 2011 cohort), the research team assessed the effects of the new duty hour rules.
In addition to the increase in self-reported medical errors, 20 percent of the residents screened positive for depression.
Sen was an intern in 2006, and in the years since has studied depression among medical students and residents, said he had been in favor of the adjusting duty hour rules in principle. "It was obvious that after working for 24 hours, we were not functioning at our best, and this was not optimal for us or the patients we were treating," he explains. But in practice, he says, the new rules may have had unintended consequences that ran counter to the goals of new guidelines.
In addition to "work compression", he says, residents now hand off responsibility for a long list of patients more frequently than in the past. Communication between the intern who is ending a shift, and the one beginning a shift, may not cover all patients in detail, he suggests, and this gap in communication may not become apparent until an urgent situation arises with one of the patients.
He also said the increase in errors may come back down with time. "The 2011 changes were a pretty radical shift," he notes. "Doctors have worked 30-hour shifts for decades, and it may just take time for all parts of the health care system to get used to the new rules and adjust."
But, he cautions, the new data don't definitively support any one of these theories as the culprit in the rise in error rates or the lack of progress in sleep hours and well-being among young doctors. Further study is needed to assess what's happening and determine how to better support young doctors in during their stressful training and keep the patients that they treat as safe as possible.
###
The Intern Health Study, from which the new results are drawn, is funded by the National Institutes of Health (grants UL1RR024986, MH095109 and AA013736) with additional support from the American Foundation for Suicide Prevention. In addition to Sen, Amarnath and Nichols, the paper's authors include Joseph Kolars, M.D., senior associate dean for education and global at the U-M Medical School, Gregory Dalack, M.D., chair of the U-M Department of Psychiatry, Henry R. Kranzler, M.D., from the University of Pennsylvania; Aashish K. Didwania, M.D., from Northwestern University; Ann C. Schwartz, M.D., from Emory University; and Constance Guille, M.D. from the Medical University of South Carolina. REFERENCE: JAMA Internal Medicine, March 25, 2013
[ | E-mail | Share ] ?
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Source: http://www.eurekalert.org/pub_releases/2013-03/uomh-apf032113.php
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