Thursday, July 25, 2013

Sony names devices that will (eventually) see Android 4.3

Sony confirms Android 43 is coming to its flagship devices

With Android 4.3 being less than 24 hours old, it's nice to see manufacturers already addressing concerns about whether all those under-the-hood tweaks will reach their devices. On Sony Mobile's website, the company confirms that the Xperia Z, Xperia ZL, Xperia ZR, Xperia Tablet Z, Xperia SP and Xperia Z Ultra will get Android 4.3, though a concrete timetable hasn't been provided. Furthermore, if you own an Xperia ZR or Tablet Z, then consider yourself lucky, because you'll see Android 4.2 hit your device next month, making the wait for 4.3 that much more bearable. So yes, a Nexus might get its updates quicker, but can it receive them in the bath?

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Source: Sony Mobile

Source: http://www.engadget.com/2013/07/25/sony-android-4-3-plan/?utm_medium=feed&utm_source=Feed_Classic&utm_campaign=Engadget

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Monday, July 22, 2013

News in Brief: Dolphins name themselves with a whistle

The marine mammals respond only to their own handles

By Meghan Rosen

Web edition: July 22, 2013

Enlarge

Wild bottlenose dolphins (one shown) respond to hearing their "signature whistles," specific high-pitched tunes that may serve as the animals' names.

Credit: Courtesy of V. Janik, University of St. Andrews

To call a dolphin, just whistle a squeaky shout-out.

Bottlenose dolphins answer to high-pitched bursts of sound ? but each animal responds to only one specific trill, its ?signature whistle,? Stephanie King and Vincent Janik of the University of St. Andrews in Scotland report June 22 in the Proceedings of the National Academy of Sciences.?

The signature whistle, a distinct tune each dolphin develops for itself and broadcasts to others, may act as a sort of audible nametag.

Scientists knew dolphins exchanged signature whistles when meeting at sea, but no one knew if the animals responded to these ?names.? King and Janik recorded wild dolphins? chirps and squeaks and then played the signature whistles back for the animals.

When dolphins heard their own signature whistles, they whistled the tune back, the pair found. Aside from humans, dolphins may be the only other mammals to name individuals.

Source: http://www.sciencenews.org/view/generic/id/351785/title/News_in_Brief_Dolphins_name_themselves_with_a_whistle

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Wednesday, July 10, 2013

Mini-golf company threatens to sue Mojang after recreations of their courses appear in Minecraft

Once again another company has fundamentally misunderstood the nature of ?user-generated content?. Putt-Putt, a mini-golf company (who are very famous, according to their letter) are threatening to take Mojang to court over Google search results which show people have used Minecraft to recreate some of their ?iconic? mini-golf courses.

Putt-Putt, apparently confusing ?Minecraft players? with ?Mojang?, insist in their letter that ?Mojang AB has been using, without authorization, our famous Putt-Putt trademarks in connection with their business?, and worry that people might get confused that there is some commercial relationship between Minecraft and Putt-Putt mini-golf.

Naturally the first thing Mojang did was to publish the cease-and-desist letter online and roundly make fun of it, so we?re jumping on that bandwagon as well. Take a read of it here and join us in laughter.

Putt-Putt have not commented again on the issue, and chances are they will probably just walk quietly away. But let?s hope they don?t, because frivolous lawsuits are the best kind of lawsuits.

Source: Rock, Paper, Shotgun

Source: http://games.on.net/2013/07/mini-golf-company-threatens-to-sue-mojang-after-recreations-of-their-courses-appear-in-minecraft/

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Texas House passes abortion measure

(CNN) -

The Texas House of Representatives approved a measure Wednesday that would place broad new restrictions on abortions in the state.

A state Senate committee is scheduled to vote Thursday on whether to send its version of the bill to the full Senate.

The legislation would ban abortions past 20 weeks of gestation, require abortion clinics to become ambulatory surgical centers, tighten usage guidelines for the drug RU486 and require doctors who perform abortions to have admitting privileges at a hospital within 30 miles of the clinic at which they're providing abortion services.

The House's move comes two weeks after state Sen. Wendy Davis tried to block the bill with a filibuster, talking for more than 10 hours in an attempt to run out the clock on the legislative session.

Gov. Rick Perry called a special session so the legislature could take up the measure again.

The measure passed the House on Wednesday with a 98-49 vote after hours of debate over proposed amendments.

Critics said the measure would shut down most abortion clinics in Texas, denying access to many in rural communities, and force women to seek dangerous back alley abortions. Many Democrats, like Rep. Mary Gonzales, felt the motives for the legislation were less than pure.

"Is this bill more about women's health or political futures," she asked Tuesday.

But for Republicans like Rep. Jason Villalba, the bill's passage was intensely personal. Holding up a sonogram of his 13-week-old son, he voiced his support.

"I will fight, and I will fight, and I will fight to protect my baby," he said.

Proponents say that the bill is necessary to raise the standard of care for women in Texas and will protect 20-week-old babies at the point that they begin to have the ability to feel pain.

On Tuesday, Davis conceded to CNN the abortion legislation was likely to pass this time around.

"It will be very difficult because unfortunately the voices that have been here crying out against this bill are not going to be heard," Davis told CNN.

"But I don't think it's the end. It's the beginning of a battle line," she added.

Source: http://www.kjct8.com/Texas-House-passes-abortion-measure/-/163252/20920752/-/jkfilaz/-/index.html

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App Deals Of The Day: Android, iPhone, iPad, Windows Phone

Root Cleaner reduced to 99c on Android, How to Cook Everything now free (was $10.49) on iOS, Task Cards now free on iPad, Weight Story for 99c on Windows Phone, plus lots more. Deals end without warning, so be quick or miss out!

This is a hand-picked list of apps that we think are worth checking out, but we do not endorse them in any way, nor have we reviewed them.

Productivity and lifestyle apps are listed first. Games are stacked towards the bottom of each list. Otherwise, the apps are not listed in any particular order. Some apps may require in-app purchases for extra features or levels.

Android

? MoreQuicklyPanel reduced to $0.99 (normally $1.75)
? MoreQuicklyDock reduced to $0.99 (normally $1.75)
? Root Cleaner reduced to $0.99 (normally $1.99)

? Hive for free (new)
? Lamb For The Dragon (full version unlock) now free (normally $0.99)
? Reflections HD reduced to $1.47 (normally $2.60)
? Magician?s Handbook (Full) reduced to $0.99 (normally $2.99)
? Letters from Nowhere (Full) reduced to $0.99 (normally $4.99)
? Lost Souls (Full) reduced to $0.99 (normally $4.99)

iOS

? Barefoot World Atlas now free (normally $5.49)
? Day One (Journal / Diary) now free (normally $5.49)
? How to Cook Everything now free (normally $10.49)
? Over now free (normally $1.99)
? Traktor DJ for iPhone now free (normally $5.49)
? Debt Snowball+ now free (normally $1.99)
? Localscope now free (normally $1.99)

? Wide Sky now free (iTunes App of the Week)
? BADLAND now free (normally $4.49)
? Infinity Blade II now free (normally $7.49)
? Superbrothers: Sword & Sworcery EP now free (normally $5.49)
? Tiny Wings now free (normally $0.99)
? Where?s My Water? now free (normally $0.99)
? Iesabel for $1.99 (new)

iPad Only

? X is for X-Ray (iPad) reduced to $1.99 (normally $8.49)
? ShapeEffects reduced to $0.99 (normally $4.49)
? Task Cards now free (normally $0.99)

? Rum Run HD now free (normally $0.99)
? Go Home Dinosaurs reduced to $.99 (normally $5.49)

Windows Phone

? Weight Story for $0.99 (new)
? HD EPG Pro now free (normally $0.99)

? FIFA 13 for $5.49 (new ? exclusive to Nokia Lumia devices)
? That Frog Game for free (new)


App Deals is a daily roundup of notable new, updated and discounted apps. Know of any other awesome deals? Are you a developer and want your app listed here? Leave a comment or contact us.

Source: http://www.lifehacker.com.au/2013/07/app-deals-of-the-day-android-iphone-ipad-windows-phone-138/

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San Fran coroner reviews if vehicle ran over girl

Residents gather to mourn for the two victims of the Asiana airline plane crash in San Francisco at a park in Jiangshan city in eastern China's Zhejiang province on Monday, July 8 2013. Chinese state media and Asiana Airlines have identified the two victims of the Asiana Airlines crash at San Francisco International Airport girls as Ye Mengyuan and Wang Linjia, students in Zhejiang, an affluent coastal province in eastern China. (AP Photo) CHINA OUT

Residents gather to mourn for the two victims of the Asiana airline plane crash in San Francisco at a park in Jiangshan city in eastern China's Zhejiang province on Monday, July 8 2013. Chinese state media and Asiana Airlines have identified the two victims of the Asiana Airlines crash at San Francisco International Airport girls as Ye Mengyuan and Wang Linjia, students in Zhejiang, an affluent coastal province in eastern China. (AP Photo) CHINA OUT

People gather to mourn for the two victims of the Asiana airline plane crash in San Francisco at a park in Jiangshan city in eastern China's Zhejiang province on Monday, July 8, 2013. Chinese state media and Asiana Airlines have identified the two victims of the Asiana Airlines crash at San Francisco International Airport girls as Ye Mengyuan and Wang Linjia, students in Zhejiang, an affluent coastal province in eastern China. (AP Photo) CHINA OUT

Residents gather to mourn near a photo of the two victims of the Asiana airline plane crash in San Francisco at a park in Jiangshan city in eastern China's Zhejiang province on Monday, July 8 2013 . Chinese state media and Asiana Airlines have identified the two victims of the Asiana Airlines crash at San Francisco International Airport girls as Ye Mengyuan and Wang Linjia, students in Zhejiang, an affluent coastal province in eastern China. (AP Photo) CHINA OUT

Asiana Airlines President and CEO Yoon Young-doo, left, speaks with an unidentified family member of one of two Chinese students killed in an Asiana Airlines plane crash on Saturday at San Francisco International Airport, at the transit lounge of the Incheon International Airport in Incheon, west of Seoul, South Korea, Monday, July 8, 2013. (AP Photo/Korea Pool via Yonhap) KOREA OUT

Asiana Airlines President and CEO Yoon Young-doo, left, greets unidentified family members of two Chinese students killed in an Asiana Airlines plane crash on Saturday at San Francisco International Airport, at the transit lounge of the Incheon International Airport in Incheon, west of Seoul, South Korea, Monday, July 8, 2013. (AP Photo/Korea Pool via Yonhap) KOREA OUT

(AP) ? Amid the marvel of nearly all aboard Asiana Flight 214 surviving a crash landing, authorities here are investigating an unspeakable tragedy that may have unfolded during the frantic rescue ? whether a teenage girl made it out of the plane only to be run over by a rescue vehicle.

Federal and local officials on Monday addressed the possibility that the Chinese girl, who along with a classmate comprised the crash's two fatalities, might have been killed accidentally on the runway as the first firefighters raced to the scene of a wrecked, smoking airliner.

"One of our fire apparatus may have come into contact with one of our two victims," Fire Chief Joanne Hayes-White said during a news conference called to highlight the heroic efforts of first responders. "I assure you, we are looking closely at this."

Findings of what caused the 16-year-old's death ? the plane crash, the fire truck, or both ? may not come for several weeks.

A firefighter first reported to a superior on Saturday that a passenger who was on the ground roughly 30 feet from the wreckage and near the escape slide may have been run over as fire crews were shifting from dousing the flames to taking victims to hospitals, officials said.

Police, FBI agents, the coroner and other officials were notified after the firefighter at the scene reported his concerns, officials said. The drivers of the first five trucks to respond to the emergency were given drug and alcohol tests, which they passed.

It's not clear why the firefighters thought someone had been run over. Fire Department officials said they did not want to provide details because of the ongoing investigation by city police, the county coroner whose office received the body and the National Transportation Safety Board.

Airport video surveillance footage reviewed by federal accident investigators proved inconclusive, NTSB Chairwoman Deborah Hersman said.

"It is a very serious issue and we want to understand it," she said. "We want to make sure we have all the facts before we reach conclusions."

The job of gathering those facts ? including determining whether the evidence shows that the girl was hit by the truck and if she was still alive when it happened ? has fallen in large part to San Mateo County Coroner Robert Foucrault.

He said Monday the two Chinese girls have been identified through fingerprints. Their autopsies were completed and their bodies prepared to be claimed by their parents, who were expected to arrive in San Francisco on Monday.

Foucrault originally had planned to release a preliminary cause of death for each of them on Monday. But he decided to wait until he could do a broader inquiry that will include reviewing written information from the public safety agencies that responded to the crash, audio dispatch files and perhaps interviews.

"This is a very high-profile case and has obviously generated a lot of attention," Foucrault said at his office located a few miles south of San Francisco International Airport where the plane crashed Saturday. "I want to make absolutely sure my conclusions are correct."

He said he made the decision to hold off independently and that neither city officials nor federal accident investigators had asked him for a postponement.

Chinese state media and Asiana have identified the girls as Ye Mengyuan and Wang Linjia, students at Jiangshan Middle School in Zhejiang, an affluent coastal province in eastern China.

They were part of a group of 29 students and five teachers from the school who were heading to a summer camps in Southern California, according to education authorities in China.

Meanwhile, firefighters and police officers on Monday gave their first accounts of what they encountered in the first minutes after the Saturday's crash.

Most of the 307 people on board had exited the crippled craft before firefighters arrived, but four passengers were still trapped in the back.

Three firefighters and two police officers, who did not have safety gear, rushed onto the plane to help evacuate trapped passengers, including one who was trapped under a collapsed bulkhead. They had gotten everyone off the craft except one elderly man who was in his seat, moaning and unable to move.

"We were running out of time," San Francisco Fire Department Lt. Dave Monteverdi recalled. "The smoke was starting to get thicker and thicker. So we had no choice. We stood him up and amazingly, he started shuffling his feet. ... We were able to get him out and he was pretty much the last person off the plane."

Monteverdi and his two colleagues boarded the plane by charging up the front, left emergency chute that most of the passengers had already used to exit the burning craft.

"If he can do it, I can do it," Fire Department Lt. Chrissy Emmons said she told herself before clambering up the chute after Monteverdi.

As the firefighters made their way to the back of the plane, they saw San Francisco police officer Jim Cunningham racing up the aisle toward the cockpit without safety gear.

Cunningham said he was just finishing a patrol of an unoccupied airport building when he heard a fellow officer calmly report over the radio that a Boeing 777 had crashed. Cunningham said he screamed at the driver of an ambulance that happened to be nearby to follow him onto the runway where he could see the smoking wreckage.

When he arrived, he and another officer tossed their sheathed knives up to crew members yelling from the door that they needed to cut passengers from their seatbelts. Just then, the officers noticed jet fuel spewing from one of the wings "like it was coming out of a fire hose."

That's when Cunningham and police Lt. Gaetano Caltagirone made the decision to enter the burning plane through the back of the aircraft, which had a large opening since the tail had broken off.

The two helped clear debris out of the way and helped carry passengers off the burning plane. Cunningham even recovered two iPhones, figuring that "worried loved ones" would be trying to contact their owners.

Once everyone was off the plane, Cunningham required about 15 minutes of oxygen treatment. It was then that his wife, home with their 18-month-old daughter, called.

"I told the paramedic to answer and tell her I was all right," he said. But Cunningham said he could hear her voice rising when told that he was undergoing oxygen treatment, so he took the phone to tell her he was fine.

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/386c25518f464186bf7a2ac026580ce7/Article_2013-07-09-San%20Francisco%20Airline%20Crash-Victims/id-c4754393c86c499cbbe0cc26fda2dc04

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Laser-powered atomic clock fuels temporal pedants' ire

Image

If you thought that your regular atomic clock, which loses a second once every few years, is adequate for your needs, then Dr. Jerome Lodewyck wants a word. His team at the Paris Observatory claims to have invented an atomic clock which only loses a second every three centuries. Rather than measuring the oscillations of caesium atoms, the "Optical Lattice Clock" uses a laser to excite strontium atoms which vibrate much faster and are, therefore, more accurate. Of course, it's a cruel irony that just as soon as someone's plonked down $78,000 on a Hoptroff No. 10, a rogue gang of scientists find a way to make it obsolete.

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Via: BBC News

Source: Nature

Source: http://feeds.engadget.com/~r/weblogsinc/engadget/~3/FHyBVk_Vnso/

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GOP redistricting skills may hurt immigration push

FILE - In this April 16, 2013 file photo, House Majority Whip Kevin McCarthy of Calif. speaks during news conference on Capitol Hill in Washington. Republicans? knack for congressional redistricting helps them control the U.S. House. But it may be working against them on immigration and other issues important to presidential elections. House Republicans generally represent far fewer Hispanics than do Democrats, thanks in part to a politicized redistricting process that packs minorities into Democratic-leaning districts. That leaves GOP representatives with lots of white conservatives, many of whom oppose ?amnesty? for immigrants living here illegally, lawmakers say. (AP Photo/Jacquelyn Martin, File)

FILE - In this April 16, 2013 file photo, House Majority Whip Kevin McCarthy of Calif. speaks during news conference on Capitol Hill in Washington. Republicans? knack for congressional redistricting helps them control the U.S. House. But it may be working against them on immigration and other issues important to presidential elections. House Republicans generally represent far fewer Hispanics than do Democrats, thanks in part to a politicized redistricting process that packs minorities into Democratic-leaning districts. That leaves GOP representatives with lots of white conservatives, many of whom oppose ?amnesty? for immigrants living here illegally, lawmakers say. (AP Photo/Jacquelyn Martin, File)

(AP) ? Republicans' knack for congressional redistricting helps them control the U.S. House, but it may be working against them on immigration changes that national GOP leaders see as critical to the next presidential election.

House Republicans generally represent far fewer Hispanics than Democrats do. And that leaves many GOP members representing white conservatives, many of whom oppose a path to citizenship for immigrants living here illegally.

The combination poses a high hurdle for passage of a comprehensive immigration overhaul in the Republican-controlled House. The Senate has passed such a measure, which includes an eventual pathway to citizenship, accompanied by greater border security.

A GOP-sanctioned study of Mitt Romney's November defeat concluded that the party must embrace immigration reform to stem its huge losses among Hispanic voters, a fast-growing group. But dozens of House Republicans have a far greater fear: inviting GOP primary challengers from the right by failing to appease their most conservative constituents.

"House members would clearly be taking a risk in supporting any kind of immigration reform that includes a path to citizenship," said Emory University political scientist Alan Abramowitz. "There's clearly a tension here between what would be in the interest of the Republican Party" ? particularly in presidential races ? "and what would be in the interest of individual Republicans, especially in the House."

Both Republicans and Democrats in many states have refined the art of congressional gerrymandering, in which they draw House districts to be as strongly conservative or liberal as possible. Adding to the partisan divide are decisions by millions of Americans to live among politically like-minded people. And partisan-tinged radio and TV programs shower lawmakers and constituents with ideological reinforcement.

While Democrats gerrymander districts too, GOP control of many state governments after the 2010 Census let Republicans draw an unusual number of House districts to their liking. Now, from a presidential election viewpoint, Republicans may be choking on their success.

Rep. Kevin McCarthy of California, the House's third-ranking Republican leader, notes the partisan disparity in Hispanic representation. The average Hispanic proportion of a Democrat's House district is 23 percent, he tells colleagues, while it's 11 percent for Republicans. Of the House's 234 Republicans, 106 have districts in which Hispanics make up less than 6 percent of all residents.

With conservative and liberal activists dominating Republican and Democratic primaries, respectively, lawmakers are being chosen by "very unrepresentative voters," said Mickey Edwards, a former Republican congressman from Oklahoma. If you're a lawmaker from a solidly partisan district, Edwards said, "you don't worry about the general election. You make sure you win the primary."

For many Republicans, he said, that means constantly veering right. On issues such as immigration, Edwards said, some Americans say, "'What's wrong with these people, they're irrational.'" In fact, he said, "the opposite is true. They are very rational."

At a meeting with constituents last week, GOP Rep. Justin Amash ? whose Michigan district is about 7 percent Hispanic ? heard sharp criticisms of the Senate immigration bill.

"Compromise is the crucifixion of conscience," said Terri Rogers, 66, of Cedar Springs, Mich.

She dismissed Amash's argument that the millions of immigrants living here illegally can't be rounded up and deported. "You break the law, you go to jail ? or at least go home," Rogers said. She suggested the U.S. military handle the task.

Even in districts with more Hispanics than Amash has, they "generally aren't the voters that Republicans are counting on" to win the all-important party primaries, Abramowitz said. That's because most Hispanics lean Democratic, as President Barack Obama proved by winning 71 percent of their vote last fall.

John Feehery, a GOP strategist and former House aide, said he once thought anti-immigrant sentiment would run lower in areas with relatively few Hispanics. Instead, he said, it seems "the fewer Hispanics you have in your district, the more you're against immigration reform."

House members will vote the interests of their districts and their primary-election needs, Feehery said. "Members are worried about a tea party challenge," he said. "They're not going to worry about presidential politics."

Rep. Tom Cole of Oklahoma is close to House Republican leaders, and he agrees that immigration reform would help the party's presidential prospects. However, he said, "people feel so strongly about this issue that it's extremely difficult to fashion a bill that will get a majority of the Republicans and a Democratic Senate and a Democratic president."

When House Republicans see their re-election efforts conflicting with the party's presidential goals, Cole said, "their own race almost certainly is going to come first, every time."

___

Associated Press writer David Eggert in Michigan contributed to this report. Follow Charles Babington on Twitter: https://twitter.com/cbabington.

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/89ae8247abe8493fae24405546e9a1aa/Article_2013-07-09-GOP%20Districts-Immigration/id-16fe90c59dd04961a03a4b81fa4b8cfe

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AstraZeneca signs up first Cambridge partners in cancer research

LONDON (Reuters) ? British pharmaceutical company AstraZeneca has agreed its first research partnerships in Cambridge for cancer treatments ahead of its relocation to the university city by 2016. The firm said it would work on three oncology proje?

Full Story Via Yahoo! Health News

Source: http://scooprocket.com/health/2013/07/09/astrazeneca-signs-up-first-cambridge-partners-in-cancer-research/

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Statins Have Few Side Effects, But Should More People Be Taking Them?

Statins lower cholesterol, reduce inflammation and may be responsible for saving thousands of lives. Should everyone be taking the wonder drug?

In the latest study investigating the side effects o statins, researchers report in the journal Circulation: Cardiovascular Quality and Outcomes, that the best-selling drugs are relatively safe. And as evidence builds that statins can lower inflammation, the process responsible for many chronic illnesses, from Alzheimer?s to cancer and heart disease, some experts are suggesting that more people should be taking advantage of the prescription medication to slow down aging.

The results of the Circulation paper may bolster that idea. The study?s lead author, Huseyin Naci, a research fellow at Harvard Medical School in the department of population medicine, pooled 135 studies involving 250,000 participants and all seven of the currently available statin medications and analyzed the risk of side effects. The studies were those that drug makers submitted to the Food and Drug Administration to demonstrate the safety of their medications for approval. Naci and his colleagues found a 9% increased risk of diabetes among those who used statins compared to those who were assigned placebo pills. The rates of other side effects, including muscle pain, cancer, and changes in liver enzymes were not statistically significant.

MORE: Who Should Take Statins? The Debate Continues

Such a relatively safe side effect profile could reignite the debate over whether more people should be taking statins ? or, as some researchers in the UK and US have suggested, whether everyone over age 40 or 50 should be on the medication.? Dr. David Agus, professor of medicine at the University of Southern California Keck School of Medicine, recommends that everyone over 40 should discuss statins with their doctor, even if they haven?t had heart problems or are at increased risk for heart disease or diabetes. He says that inflammation is driving a number of aging-related conditions, both in the body and brain, and since studies have shown that statins are a powerful way to dampen the inflammatory response, more people might be living longer if they take advantage of statins. Rory Collins, an epidemiologist at Oxford University, caused an uproar last year when he addressed the European Society of Cardiology with a talk entitled, ?The Case for Statins In a Wider Population,? and argued that more people should be availing themselves of the medications, just as they do aspirin.

Not everyone agrees with that view, however, despite the favorable side effect profile of the drugs. ?It?s a wonderful medication, but we shouldn?t be putting statins in the water supply,? says Dr. Steven Nissen, chair of cardiovascular medicine at Cleveland Clinic. Naci also says that although his analysis showed that the drugs were relatively safe, ?we don?t know the long term effects of statins. If we give it everyone, then after ten or 15 years we don?t know what the slight increased risk of diabetes will amount to.? Statin drugs have been linked to an increased risk of muscle weakness as well, which was severe enough for one medication to be pulled off the market.

MORE: Should You Take Statins? Study Says Heart Benefits Outweigh Diabetes Risk

There?s no argument that patients who have already had a heart attack or heart disease can lower their risk of further heart problems by taking a statin. What?s less clear is whether people who are otherwise healthy could lower their risk enough to justify their exposure to the side effects of the medications. And to answer that question, scientists are turning to statins? ability to reduce inflammation.

Currently, national guidelines recommend that patients start on statins based on their cholesterol levels. But doctors are investigating whether people with low cholesterol levels but high inflammation levels could benefit from statins. A recent trial showed that these patients, who under existing guidelines would not be advised to take statins, could lower their risk of a heart attack or stroke by 50% if they were taking the drug. To confirm the association between inflammation and a lower risk of heart events, Dr. Paul Ridker, director of the center for cardiovascular disease prevention at the Brigham and Women?s Hospital and a pioneer in understanding inflammation?s role in heart disease, is spearheading two trials involving heart patients on statins. Half will be randomly assigned to take another anti-inflammatory agent on top of their statin, while half will be assigned a placebo; if the group taking the anti-inflammatory agent ends up with a lower rate of heart problems, then that would support the idea that inflammation indeed plays a critical role in heart disease, and that controlling it with a statin might save more lives.

MORE:?Statins: Evidence of Broader Benefits

?We already know that the risk associated with elevated inflammation is as large as the elevated risk patients have from having either high cholesterol or high blood pressure,? he says. ?The question is, just as lowering blood pressure reduces risk, can we generate evidence that reducing inflammation reduces the risk of heart disease.?

Even if the results of those trials show that lowering inflammation also lowers risk of heart problems, that won?t mean that everyone should be taking a statin. ?One has to be cautious about for whom we recommend [statin] therapies,? says Dr. Sidney Smith, professor of medicine at the University of North Carolina Chapel Hill and past president of the American Heart Association. ?We are going to have to do a better job of identifying patients at risk who might benefit from medical therapies to reduce their risk of heart disease at a dosage that minimizes the side effects.?

That?s especially true for the youngest patients ? children ? who are increasingly being tested for high cholesterol levels and even prescribed the medications that most associate with middle-age. In 2008, I wrote about the American Academy of Pediatrics? recommendation to broaden cholesterol testing to include toddlers as young as two and to consider prescribing statins for youngsters with a history of abnormally high cholesterol levels:

While the guidelines target kids with a genetic risk of abnormally high cholesterol, called hyperlipidemia, they could lower the bar for prescriptions?not just for these children but for any overweight youngster whose cholesterol is not in check. Within hours of the AAP announcement on July 7, parents took to the blogs, expressing shock and unease over the aggressiveness of the guidelines. Statins are not without risks; in adults, in rare cases, they can cause muscle weakness and kidney problems, and there are limited data on how statins affect children.

The Academy defended its position, maintaining that the benefits of addressing cholesterol in children, which can lower their risk of diabetes and heart disease, outweighed the risks of the medications. Making such risk-benefit calculations about statin use for non-heart patients continues to be a work-in-progress, says Smith, but new national guidelines may help doctors to make those calculations in the coming year. ?We still need to carefully define the groups that will benefit,? he says. ?I think we will do a better job of that based on studies like this and others that have come out in the past few years. Hopefully within the next year we will be able to pull some things together that will allow us to move forward and do good things for our patients.?

Source: http://news.yahoo.com/statins-few-side-effects-more-people-taking-them-094544365.html

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Washington Beat: Partisan Gridlock Could Halt Congress' Summer Assignments

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Tuesday, July 9, 2013

Pilot in SF crash had little experience with 777s

Parents of Wang Linjia, center, are comforted by parents of some other students who were on the Asiana Airlines Flight 214 when it crashed at San Francisco International Airport, while they gather and wait for news of their children at Jiangshan Middle School in Jiangshan city, in eastern China's Zhejiang province, Sunday July 7, 2013. Chinese state media have identified the two people who died in the plane crash at San Francisco International Airport on Saturday as Ye Mengyuan and Wang Linjia, 16-year-old students at Jiangshan Middle School in China's eastern Zhejiang province. (AP Photo) CHINA OUT

Parents of Wang Linjia, center, are comforted by parents of some other students who were on the Asiana Airlines Flight 214 when it crashed at San Francisco International Airport, while they gather and wait for news of their children at Jiangshan Middle School in Jiangshan city, in eastern China's Zhejiang province, Sunday July 7, 2013. Chinese state media have identified the two people who died in the plane crash at San Francisco International Airport on Saturday as Ye Mengyuan and Wang Linjia, 16-year-old students at Jiangshan Middle School in China's eastern Zhejiang province. (AP Photo) CHINA OUT

This frame grab from video provided by KTVU shows the scene after an Asiana Airlines flight crashed while landing at San Francisco Airport on Saturday, July 6, 2013, in San Francisco. (AP Photo/KTVU) MANDATORY CREDIT

A fire truck sprays water on Asiana Flight 214 after it crashed at San Francisco International Airport on Saturday, July 6, 2013, in San Francisco. (AP Photo/Noah Berger)

This photo provided by Antonette Edwards shows what a federal aviation official says was an Asiana Airlines flight crashing while landing at San Francisco airport on Saturday, July 6, 2013. It was not immediately known whether there were any injuries. (AP Photo/Antonette Edwards )

This photo provided by Wei Yeh shows what a federal aviation official says was an Asiana Airlines flight crashing while landing at San Francisco airport on Saturday, July 6, 2013. It was not immediately known whether there were any injuries. (AP Photo/Wei Yeh)

(AP) ? The pilot at the controls of an Asiana plane that crashed landed was guiding a Boeing 777 into the San Francisco airport for the first time, and tried but failed to abort the landing after coming in too slow to set down safely, aviation and airline officials said Sunday.

It was unclear if the pilot's inexperience with the aircraft and airport played a role in Saturday's crash. Officials were investigating whether the airport or plane's equipment could have also malfunctioned.

Also Sunday, San Mateo County Coroner Robert Foucrault said he was investigating whether t one of the two teenage passengers killed Saturday actually survived the crash but was run over by a rescue vehicle rushing to aid victims fleeing the burning aircraft. Remarkably, 305 of 307 passengers survived the crash and more than a third didn't even require hospitalization. Only a small number were critically injured.

Deborah Hersman, head of the National Transportation Safety Board, said the slow speed of Flight 214 in the final approach triggered a warning that the jetliner could stall, and an effort was made to abort the landing but the plane crashed barely a second later.

At a news conference, Hersman disclosed the aircraft was traveling at speeds well below the target landing speed of 137 knots per hour, or 157 mph.

"We're not talking about a few knots," she said.

Hersman described the frantic final seconds of the flight as the pilots struggled to avoid crashing.

Seven seconds before the crash, pilots recognized the need to increase speed, she said, basing her comments on an evaluation of the cockpit voice and flight data recorders that contain hundreds of different types of information on what happened to the plane. Three seconds later, the aircraft's stick shaker ? a piece of safety equipment that warns pilots of an impending stall ? went off. The normal response to a stall warning is to boost speed and Hersman said the throttles were fired and the engines appeared to respond normally.

At 1.5 seconds before impact, there was a call from the crew to abort the landing.

The details confirmed what survivors and other witnesses said they saw: an aircraft that seemed to be flying too slowly just before its tail apparently clipped a seawall at the end of the runway and the nose slammed down.

Pilots normally try to land at the target speed, in this case 137 knots, plus an additional five more knots, said Bob Coffman, an American Airlines captain who has flown 777s. He said the briefing raises an important question: "Why was the plane going so slow?"

The plane's Pratt & Whitney engines were on idle and the pilots were flying under visual flight rules, Hersman said. Under visual flight procedures in the Boeing 777, a wide-body jet, the autopilot would typically have been turned off while the automatic throttle, which regulates speed, would been on until the plane had descended to 500 feet in altitude, Coffman said. At that point, pilots would normally check their airspeed before switching off the autothrottle to continue a "hand fly" approach, he said.

There was no indication in the discussions between the pilots and the air traffic controllers that there were problems with the aircraft.

The airline said Monday in Seoul that the pilot at the controls had little experience flying that type of plane and was landing one for the first time at that airport.

Asiana spokeswoman Lee Hyomin said that Lee Gang-guk, who was at the controls, had nearly 10,000 hours flying other planes but only 43 in the 777, a plane she said he still was getting used to flying. Another pilot on the flight, Lee Jeong-min, had about 12,390 hours of flying experience, including 3,220 hours on the 777, according to the Ministry of Land, Infrastructure and Transport in South Korea. Lee was the deputy pilot, tasked with helping Lee Gang-guk get accustomed to the 777, according to Asiana Airlines.

Asiana spokeswoman Lee Hyomin said that Lee Gang-guk was trying to get used to the 777 during Saturday's crash landing. She says the pilot had nearly 10,000 hours flying other planes but had only 43 hours on the 777.

Among the questions investigators are trying to answer was what, if any, role the deactivation of a ground-based landing guidance system due to airport construction played in the crash. Such systems help pilots land, especially at airports like San Francisco where fog can make landing challenging. The conditions Saturday were nearly perfect, with sunny skies and light winds.

The flight originated in Shanghai, China, stopped over in Seoul, South Korea, before making the nearly 11-hour trip to San Francisco. The South Korea-based airline said four South Korean pilots were on board, three of whom were described as "skilled."

Among the travelers were citizens of China, South Korean, the United States, Canada, India, Japan, Vietnam and France. There were at least 70 Chinese students and teachers heading to summer camps, according to Chinese authorities.

Fei Xiong, a Chinese passenger , was traveling to California so she could take her 8-year-old son to Disneyland. The pair was sitting in the back half of the plane. Xiong said her son sensed something was wrong.

"My son told me: 'The plane will fall down, it's too close to the sea,'" she said. "I told him: 'Baby, it's OK, we'll be fine.'"

When the plane hit the ground, oxygen masks dropped down, said Xu Da, a product manager at an Internet company in Hangzhou, China, who was sitting with his wife and teenage son near the back of the plane. When he stood up, he said he could see sparking ? perhaps from exposed electrical wires.

He turned and could see the tail where the galley was torn away, leaving a gaping hole through which they could see the runway. Once on the tarmac, they watched the plane catch fire, and firefighters hose it down.

"I just feel lucky," said Xu, whose family suffered some cuts and have neck and back pain.

In the chaotic moments after the landing, when baggage was tumbling from the overhead bins onto passengers and people all around her were screaming, Wen Zhang grabbed her 4-year-old son, who hit the seat in front of him and broke his leg.

Spotting a hole at the back of the jumbo jet where the bathroom had been, she carried her boy to safety.

"I had no time to be scared," she said.

Authorities immediately closed the airport and rescuers rushed to the scene. A United Airlines pilot radioed the control tower, saying: "We see people ... that need immediate attention. They are alive and walking around."

"Think you said people are just walking outside the airplane right now?" the controller replied.

"Yes," answered the pilot of United Flight 885. "Some people, it looks like, are struggling."

At the crash scene, police officers knives up to crew members inside the burning wreckage so they could cut away passengers' seat belts. Passengers jumped down emergency slides, escaping from billowing smoke that rose high above the bay. Some passengers who escaped doused themselves with water from the bay, presumably to cool burns, authorities said.

By the time the flames were out, much of the top of the fuselage had burned away. The tail section was gone, with pieces of it scattered across the beginning of the runway.

Foucrault, the coroner, said senior San Francisco Fire Department officials notified him and his staff at the crash site on Saturday that one of the 16-year-olds who was kilkled may have been struck on the runaway. Foucrault said an autopsy he expects to be completed by Monday will involve determining whether the girl's death was caused by injuries suffered in the crash or "a secondary incident."

He said he did not get a close enough look at the victims on Saturday to know whether they had external injuries.

Foucrault said one of the bodies was found on the tarmac near where the plane's tail broke off when it slammed into the runway. The other was found on the left side of the plane about 30 feet away from where the jetliner came to rest after it skidded down the runway.

___

Lowy reported from Washington, D.C. Associated Press writers Terry Collins, Terry Chea and Sudhin Thanawala in San Francisco, David Koenig in Dallas and Louise Watt in Beijing contributed to this report.

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/cae69a7523db45408eeb2b3a98c0c9c5/Article_2013-07-08-San%20Francisco%20Airliner%20Crash/id-833793a3e4544224aa7334b6e40fe315

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Fire department adds 15 jobs

After five years without a new class of city firefighters, city officials and the Fort Wayne Fire Department Monday announced a $1.2 million plan to get more firefighters beginning next year.

The department will add 15 firefighters using taxpayer dollars collected through a local option income tax approved by the City Council, officials said.

?After five years of having to do more with less and not being able to staff a class, the city of Fort Wayne?s fire department is now hiring again,? Fort Wayne Mayor Tom Henry announced Monday, surrounded at Station 1 by city firefighters and several City Council members.

Fire Chief Amy Biggs said the department?s goal is to hire 15 well-rounded, qualified firefighters from diverse cultural backgrounds.

?We want people who represent our community,? she said. ? ? The path is not easy, but the reward is gratifying.?

The fire department is currently staffed with 340 firefighters, Biggs said.

The 15 new candidates will bring the department closer to the 375 mark, the maximum number of firefighters the department is allowed to have, Biggs said.

The last time the Fort Wayne Fire Department hired a new class of firefighters was in 2008.

In recent years, the fire department has reduced the number of fire investigators from seven to five, building inspectors from 10 to 7, and public education officials from three to two, Biggs said earlier this year.

In doing so, the department has increased the workload for others in those positions and has had to sacrifice some of the programs related to fire prevention and awareness.

The hiring of new firefighters begins with an application process that began Monday and will continue through July 26.

The applicants will then be given a written exam and an orientation for the candidate physical ability test, or CPAT. Candidates will have up to eight weeks to prepare for the CPAT.

After the orientation, candidates will perform the CPAT, a panel interview, background investigation, fire chief interview and state agility testing including tests for acrophobia and claustrophobia.

If candidates remain eligible, they will then undergo a psychological and medical exam and seek approval from the pension board and merit commission before being appointed to the 17-week firefighter academy.

The entire process is expected to take between nine and 10 months, with a graduation date of May 2014, Biggs said.

A new local option income tax approved in June by the Fort Wayne City Council will pay for most of the $1.2 million needed for a class of 15 firefighters, she said.

The $1.2 million includes funding for the academy class, administrators for exams and other components of the hiring process ? as well as money to pay current firefighters overtime until the seats are filled, Biggs said.

Marty Bender, a city councilman and deputy police chief, said the council spent more than a year examining the city?s finances to find the best way to provide the funding the fire department needed for a new class.

?That?s where we came up with the idea to use the (local option income tax) that the state legislature made available to us,? he said.

?Some of the other ideas that were put forth would have got us to about the same spot, but they wouldn?t have been sustainable.

?In about two or three years, we would have to go through this again and figure out where ? we were going to get that money.?

jcrothers@jg.net

Source: http://www.journalgazette.net/article/20130709/LOCAL07/307099969/-1/LOCAL11

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Five dead in Quebec derailment; PBF Energy hauling same oil

Sorry, Readability was unable to parse this page for content.

Source: http://www.delawareonline.com/article/20130707/NEWS/307070066/1008/RSS0903

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Video: Global Markets: Europe Shares 'Firmer'

Sorry, Readability was unable to parse this page for content.

Source: http://www.nbcnews.com/video/cnbc/52427910/

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July/August 2013 Annals of Family Medicine tip sheet

July/August 2013 Annals of Family Medicine tip sheet [ Back to EurekAlert! ] Public release date: 8-Jul-2013
[ | E-mail | Share Share ]

Contact: Angela Sharma
asharma@aafp.org
913-269-2269
American Academy of Family Physicians

The Need for Discussion About Prostate Cancer Screening Choices, Optimizing Shared Decision Making

Three research studies and an accompanying editorial address the importance of shared decision making around prostate cancer screening. Although prostate cancer is among the most common cancers among men in the United States, the value of screening for prostate cancer by measuring prostate-specific antigen levels remains highly controversial because screening can lead to invasive procedures and treatments that in turn can cause substantial harm. Because such harms may outweigh any population-level benefit, the U.S. Preventive Services Task Force in 2012 downgraded its PSA screening recommendation to recommend against screening for average-risk men and recommended clinicians inform patients of the pros, cons and uncertainties of PSA screening before offering the test. Shared decision making, in which clinicians collaboratively help patients understand medical information to reach value-congruent medical decisions, can be effective, especially in cases of such medical uncertainty. This cluster of articles explores the prevalence, mediators, mutability and meaning of shared decision making around prostate cancer screening.

Shared Decision Making Is an Uncommon Occurrence in PSA Screening, Especially in Men Who Do Not Receive Screening

Most U.S. men report little shared decision making in PSA screening, and a lack of shared decision making is more prevalent in nonscreened than in screened men. Analyzing data from a nationally representative survey of 3,427 men aged 50 to 74 years, researchers examined the prevalence of three key elements of shared decision making: physician-patient discussion of the advantages, disadvantages, and scientific uncertainty of PSA screening. Nearly two-thirds (64 percent) of men reported no past physician-patient discussion of any of the three elements (no shared decision making); 28 percent reported discussion of one to two elements only (partial shared decision making); and 8 percent reported discussion of all three elements (full shared decision making). Forty-four percent of participants reported no PSA screening, 28 percent reported less-than-annual screening and 25 percent reported nearly annual screening. Notably, the absence of shared decision making was more prevalent in men who were not screened 88 percent of nonscreened men reported no shared decision making compared with 39 percent of men undergoing nearly annual screening. These findings, the authors assert, provide justification for a broader focus in the current policy debate about PSA screening. While much of this debate has historically focused on PSA screening in the absence of shared decision making and the potential harm of undesired and unnecessary treatment, these findings suggest the more prevalent problem is nonscreening in the absence of shared decision making the harm of which is the failure to allow individuals to decide for themselves if screening is beneficial. The authors also found the extent of shared decision making was associated with black race, Hispanic ethnicity, higher education, health insurance and physician recommendation. Screening intensity was associated with older age, higher education, usual source of medical care and physician recommendation, as well as with partial shared decision making.

National Evidence on the Use of Shared Decision Making in Prostate-Specific Antigen Screening
By Paul K. J. Han, MD, MA, MPH, et al
Maine Medical Center Research Institute, Portland

Pairing Physician Education with Patient Activation Improves Rates of Shared Decision Making and Affects Physician Attitudes About Prostate Cancer Screening

Pairing a brief 20- to 30-minute Web-based educational intervention for physicians with a companion intervention for patients about counseling for prostate cancer screening appears to improve shared decision making rates and influence physicians' attitudes about screening. Analyzing data on 120 physicians and 712 male patients aged 50 to 75 years, researchers compared usual education (control) with physician education alone (MD-Ed) and paired physician education and patient activation (MD-Ed+A). They found MD-Ed+A patients had higher prostate cancer screening discussion rates (65 percent) than MD-Ed (41 percent) or control (38 percent). Standardized patients actors trained to simulate real patient cases and later report on the encounter also reported that physicians seeing MD-Ed+A patients were more likely to be neutral in their final recommendations about whether the patient should obtain a PSA blood test (MD-Ed+A=50 percent, MD-Ed=33 percent, control=33 percent). (Further reporting on this secondary measure can be found in an accompanying study by Feng and colleagues. Please see the full summary below.) The shift in the physicians' attitudes toward screening from a pro screening bias toward neutral counseling persisted three months after participating in the intervention. Notably, the researchers found no difference in patients' ratings of shared decision making between the groups. Coupling physician education with patient activation, the authors conclude, has the potential to improve the appropriate utilization of medical services by encouraging shared decision making around issues of medical uncertainty such as prostate cancer screening.

Pairing Physician Education With Patient Activation to Improve Shared Decisions in Prostate Cancer Screening: A Cluster-Randomized Controlled Trial
By Michael S. Wilkes, MD, PhD, et al
University of California, Davis

Analysis of Unannounced Standardized Patient Visits Shows Educational Intervention Can Improve Shared Decision Making and Change Physician Attitudes About Prostate Cancer Screening

In a more detailed discussion and analysis of the standardized patient visit data reported as a secondary measure in the previous study by Wilkes, et al, researchers discuss how the Web-based educational intervention appears to improve shared decision making, encourage neutrality in recommendation and reduce PSA test ordering. Analyzing transcripts from unannounced standardized patient encounters with the 118 participating primary care physicians in which trained actors prompted physicians to address prostate cancer screening, researchers found intervention physicians showed more shared decision making behaviors (intervention 14 items vs. control 11 items), were more likely to mention no screening as an option (intervention 63 percent vs. control 26 percent), to encourage patients to consider different screening options (intervention 62 percent vs. control 39 percent) and seek input from others (intervention 25 percent vs. control 7 percent). The authors conclude that by analyzing standardized patient transcripts of the actual conversations between physicians and patients, this study offers unique and important insights into how physicians actually behaved when prompted to discuss the risk and uncertainty of prostate cancer screening. They assert that in light of the USPSTF's recent recommendation against screening, interventions such as this one may be important adjuvants to help influence physicians' behaviors regarding controversial medical topics with public health implications and may potentially decrease utilization of tests with uncertain value.

Physician Communication Regarding Prostate Cancer Screening: Analysis of Unannounced Standardized Patient Visits
By Bo Feng, PhD, et al
University of California, Davis

Editorial: Shared Decision Making Should be Approached as a Learned Skill Cultivated Within the Context of an Ongoing Relationship

An accompanying editorial explores the importance of viewing shared decision making not as an episodic event but as a learned skill and ongoing process that is cultivated through repeated application within the context of meaningful physician-patient relationships. The authors assert the research in the current issue is consistent with previously published literature that shared decision making remains poorly integrated into primary care practices largely because it is considered in isolation. They encourage clinicians to reframe their approach to shared decision making, viewing it in a broader context and giving attention to unanswered questions, conflicting demands and systems implications.

Shared Decision Making, Contextualized
By Robert L. Ferrer, MD, MPH, and James M. Gill, MD, MPH
Annals of Family Medicine

Patients with Chronic Illnesses More Likely to Receive Recommended Preventive Services

In contrast to the oft-expressed concerns that increasing patient complexity impedes the delivery of preventive services because of competing demands, researchers find the presence of chronic illness is positively associated with receipt of recommended preventive services. In a study of 667,379 adult patients from 148 primary care practices across the United States, researchers found strong positive associations between the receipt of clinical preventive services and the presence of chronic illnesses. For each preventive service examined, they found a curvilinear relationship with the number of chronic conditions, with an increased likelihood of being up-to-date with preventive services as the number of chronic conditions increases from zero to four or five. At this point, they note, the association largely plateaus with no further increases in the proportion of patients up-to-date with the preventive service as the number of chronic conditions increases above five. The associations between the odds of being up-to-date and the presences of chronic illness persisted even after adjustment for age and encounter frequency. The authors conclude these findings suggest that it is something about the nature of the care provided to these patients that accounts for the finding of increased attention to prevention. They assert primary care practices, facilitated by tools like electronic health records, can overcome competing demands and effectively deliver preventive services to the growing number of patients with multiple chronic illnesses.

Preventive Services Delivery in Patients With Chronic Illnesses: Parallel Opportunities Rather Than Competing Obligations
By Steven M. Ornstein, MD, et al
Medical University of South Carolina, Charleston

Study Shows the Potential for Health Plans to Implement Interventions to Improve Colon Cancer Screening Rates

A previously proven telephone outreach intervention delivered by research-based staff to increase colorectal cancer (CRC) screening was successfully translated to the health plan arena with staff of a Medicaid managed care organization (MMCO) increasing (CRC) screening rates by one-third to nearly double among publicly insured urban women in this study. The trial involving 2,240 women overdue for screening and insured by one of three New York City MMCOs found intervention women were significantly more likely than usual care women to become up-to-date on CRC screening during the study period with screening rates 6 percent higher in the intervention arm. The authors note, however, that the increases varied from 1 percent to 14 percent across the participating MMCOs, with the overall increase being driven by increases at one particular MMCO. At this MMCO, telephone outreach focused solely on CRC screening, while at the other two MMCOs, telephone outreach included support for cervical and breast cancer screening as well as CRC screening. Comparing eligible intervention women reached by telephone with eligible usual care women with whom no contact was attempted, they found intervention arm screening rates were between 12 percent and 26 percent higher than usual care at the three MMCOs, with an overall increase of 15 percent (again, primarily due to screening increases at one of the MMCOs). The authors conclude these findings show that MMCOs, key players in the delivery of health care to publicly insured and underserved populations, can successfully implement interventions to increase CRC screening, reducing health care disparities among a difficult to reach population.

Telephone Outreach to Increase Colon Cancer Screening in Medicaid Managed Care Organizations: A Randomized Controlled Trial
By Allen J. Dietrich, MD, et al
The Geisel School of Medicine at Dartmouth and the Norris Cotton Cancer Center, Lebanon, New Hampshire

Primary Care Physicians Examine the Causes of Potentially Avoidable Hospitalizations

Exploring the causality hospitalizations for illnesses that can typically be managed effectively on an outpatient basis, researchers found primary care physicians deemed most to be potentially avoidable, attributing the causes to five possible categories: system-related, physician-related, medical, patient-related and/or social. Interviews with 12 German primary care physicians regarding 104 hospitalizations of 81 patients with ambulatory care-sensitive conditions revealed participating physicians rated 41 percent of the hospitalizations as potentially avoidable. During the interviews, the cause of hospitalization fell into one or more of five principal categories: system-related (e.g., unavailability of outpatient services), physician related (e.g., suboptimal monitoring), medical (e.g., medication side effects), patient-related (e.g., delayed help-seeking) and social (e.g., lack of social support). System-related causes were attributed to 30 hospitalizations (29 percent), physician-related causes to 32 (31 percent), medical causes to 101 (97 percent), patient-related causes to 83 (80 percent) and social causes to 20 (19 percent). Based on these findings, the authors posit strategies to avoid such hospitalizations, including after-hours care, optimal use of outpatient services, intensified monitoring of high-risk patients and initiatives to improve patients' willingness and ability to seek timely help as well as patients' medication adherence.

Strategies for Reducing Potentially Avoidable Hospitalizations for Ambulatory Care-Sensitive Conditions
By Tobias Freund, MD, et al
University Hospital Heidelberg, Germany

Intervention to Improve Primary Care Practices' Fitness Culture Did Not Translate Into Differential Improvements in Physical Activity and Healthy Eating

Evaluating the effect of the American Academy of Family Physician's Americans in Motion Healthy Interventions public health initiative to promote physical activity, healthy eating, and emotional well-being as part of routine patient care, researchers found impressive before-after improvements in patient outcomes but no differences between two different implementation approaches. The authors assessed the outcomes of 610 enrolled patients at 24 family medicine practices randomized to either an enhanced practice (asked to use AIM-HI tools to help office staff make personal changes and create a healthy practice environment) or a traditional practice (trained and asked to use the tools directly with patients). They hypothesized that practices which used the AIM-HI tools as a group to improve physician and office staff lifestyle behaviors and actively advertised their commitment to AIM-HI principles to their patients would be more successful in improving patient-level outcomes; however, they found no significant differences in the patient-outcomes between the two practice groups. Regardless of practice group, 16 percent of patients who completed a 10-month visit (378 patients) and 10 percent of all patients enrolled lost 5 percent or more of their body weight. Moreover, of the patients who completed a 10-month visit, 17 percent had a 2-point or greater increase in their fitness level, and 29 percent lost 5 percent or more of their body weight and/or increased their fitness level by 2 or more points. The authors posit several reasons for the lack of a between-group difference, including study design, patient selection, the nonprescriptive approach to AIM-HI, and already established physician workplace wellness activities that motivated the clinicians to intervene with patients.

Effectiveness of 2 Methods of Implementing the Americans in Motion: Healthy Interventions (AIM-HI) Approach to Promoting Physical Activity, Healthy Eating, and Emotional Well-being
By Wilson D. Pace, MD, et al
University of Colorado, Aurora

Most Pregnant Women in the United States Receive Care from Multiple Types of Clinicians, Number Seeing Family Physicians Remains Stable Over Past Decade

Approximately one-third of pregnant women report having seen or talked to a family physician for medical care during the prior year, a percentage that has remained stable over the past decade. Analyzing nationally representative data on 3,204 women from 2000 to 2009, researchers found a substantial and steady proportion of pregnant women (36 percent) received some care from family physicians, with most reporting receiving care from multiple types of clinicians, including family physicians, obstetrician-gynecologists, midwives, nurse practitioners and physicians assistants. The authors conclude these findings underscore the importance of care coordination for this patient population. The researchers also identify regional differences in trends in family physician care, with pregnant women in the North Central United States increasingly reporting care from family physicians and women in the South reporting a decline (7 percent annual increase vs. 5 percent annual decrease).

Care From Family Physicians Reported By Pregnant Women in the United States
By Katy Backes Kozhimannil, PhD, MPA, and Patricia Fontaine, MD, MS
University of Minnesota School of Public Health, Minneapolis-St. Paul and Health Partners Institute for Education and Research, Minnesota

Safety Climate in German Family Practices Generally Positive

Evaluating the impact of different individual and practice features on perceptions of the safety climate the shared employee perceptions of the priority of safety at an organization in German primary care practices, researchers find though the safety culture is positive overall, health care professionals' use of incident reporting and a systems approach to errors was fairly rare. The researchers' analysis of more than 2,100 questionnaires revealed the safety climate as perceived by doctors and health care assistants was not significantly influenced by individual and practice team characteristics. They also found participation of the whole practice team in the survey had a positive influence on safety climate, and doctors had more positive perceptions of four of the seven climate factors evaluated than health care assistants. Because measurement of a safety climate aims to detect areas of deficiencies to improve patient safety, the authors assert these findings should prompt German primary care doctors and health care assistants to learn more about error causation and adopt a systems approach toward patient safety incidents as a method to develop a memory for past errors and to learn from them. They call for health care assistants, in particular, to contribute more to incident reporting and participate in an open and fair safety culture.

Impact of Individual and Team Features of Patient Safety Climate: A Survey in Family Practices
By Barbara Hoffmann, MD, MPH, et al
Goethe University, Frankfurt, Germany

The Consequences of Postponing Motherhood in the Pursuit of a Career in Medicine

Two female physicians reflect on the consequences of postponing motherhood in the pursuit of successful medical careers. They share their personal stories of difficulty conceiving, miscarriages and stillbirth, reflecting on how their intense career focus led them to gamble away their fertility. Because delayed childbearing can result in unintended childlessness, the need for assisted reproductive techniques, adoption and having smaller than desired family size, the authors call for training programs and employers to provide more information and support to women in medicine, and adopt policies that are consistent with today's trainees' and physicians' complex lives. They caution men and women in medicine to carefully consider how medical school, residencies and fellowships can impinge on family planning.Annals of Family Medicine

Women in Medicine and the Ticking Clock
By Lisa N. Miura, MD and Rebecca S. Boxer, MD, MS
Legacy Emanuel Medical Center, Portland, Oregon

###

Annals of Family Medicine is a peer-reviewed, indexed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care disciplines. Launched in May 2003, Annals is sponsored by seven family medical organizations, including the American Academy of Family Physicians, the American Board of Family Medicine, the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group, and the College of Family Physicians of Canada. Annals is published six times each year and contains original research from the clinical, biomedical, social and health services areas, as well as contributions on methodology and theory, selected reviews, essays and editorials. Complete editorial content and interactive discussion groups for each published article can be accessed free of charge on the journal's website, http://www.annfammed.org.


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July/August 2013 Annals of Family Medicine tip sheet [ Back to EurekAlert! ] Public release date: 8-Jul-2013
[ | E-mail | Share Share ]

Contact: Angela Sharma
asharma@aafp.org
913-269-2269
American Academy of Family Physicians

The Need for Discussion About Prostate Cancer Screening Choices, Optimizing Shared Decision Making

Three research studies and an accompanying editorial address the importance of shared decision making around prostate cancer screening. Although prostate cancer is among the most common cancers among men in the United States, the value of screening for prostate cancer by measuring prostate-specific antigen levels remains highly controversial because screening can lead to invasive procedures and treatments that in turn can cause substantial harm. Because such harms may outweigh any population-level benefit, the U.S. Preventive Services Task Force in 2012 downgraded its PSA screening recommendation to recommend against screening for average-risk men and recommended clinicians inform patients of the pros, cons and uncertainties of PSA screening before offering the test. Shared decision making, in which clinicians collaboratively help patients understand medical information to reach value-congruent medical decisions, can be effective, especially in cases of such medical uncertainty. This cluster of articles explores the prevalence, mediators, mutability and meaning of shared decision making around prostate cancer screening.

Shared Decision Making Is an Uncommon Occurrence in PSA Screening, Especially in Men Who Do Not Receive Screening

Most U.S. men report little shared decision making in PSA screening, and a lack of shared decision making is more prevalent in nonscreened than in screened men. Analyzing data from a nationally representative survey of 3,427 men aged 50 to 74 years, researchers examined the prevalence of three key elements of shared decision making: physician-patient discussion of the advantages, disadvantages, and scientific uncertainty of PSA screening. Nearly two-thirds (64 percent) of men reported no past physician-patient discussion of any of the three elements (no shared decision making); 28 percent reported discussion of one to two elements only (partial shared decision making); and 8 percent reported discussion of all three elements (full shared decision making). Forty-four percent of participants reported no PSA screening, 28 percent reported less-than-annual screening and 25 percent reported nearly annual screening. Notably, the absence of shared decision making was more prevalent in men who were not screened 88 percent of nonscreened men reported no shared decision making compared with 39 percent of men undergoing nearly annual screening. These findings, the authors assert, provide justification for a broader focus in the current policy debate about PSA screening. While much of this debate has historically focused on PSA screening in the absence of shared decision making and the potential harm of undesired and unnecessary treatment, these findings suggest the more prevalent problem is nonscreening in the absence of shared decision making the harm of which is the failure to allow individuals to decide for themselves if screening is beneficial. The authors also found the extent of shared decision making was associated with black race, Hispanic ethnicity, higher education, health insurance and physician recommendation. Screening intensity was associated with older age, higher education, usual source of medical care and physician recommendation, as well as with partial shared decision making.

National Evidence on the Use of Shared Decision Making in Prostate-Specific Antigen Screening
By Paul K. J. Han, MD, MA, MPH, et al
Maine Medical Center Research Institute, Portland

Pairing Physician Education with Patient Activation Improves Rates of Shared Decision Making and Affects Physician Attitudes About Prostate Cancer Screening

Pairing a brief 20- to 30-minute Web-based educational intervention for physicians with a companion intervention for patients about counseling for prostate cancer screening appears to improve shared decision making rates and influence physicians' attitudes about screening. Analyzing data on 120 physicians and 712 male patients aged 50 to 75 years, researchers compared usual education (control) with physician education alone (MD-Ed) and paired physician education and patient activation (MD-Ed+A). They found MD-Ed+A patients had higher prostate cancer screening discussion rates (65 percent) than MD-Ed (41 percent) or control (38 percent). Standardized patients actors trained to simulate real patient cases and later report on the encounter also reported that physicians seeing MD-Ed+A patients were more likely to be neutral in their final recommendations about whether the patient should obtain a PSA blood test (MD-Ed+A=50 percent, MD-Ed=33 percent, control=33 percent). (Further reporting on this secondary measure can be found in an accompanying study by Feng and colleagues. Please see the full summary below.) The shift in the physicians' attitudes toward screening from a pro screening bias toward neutral counseling persisted three months after participating in the intervention. Notably, the researchers found no difference in patients' ratings of shared decision making between the groups. Coupling physician education with patient activation, the authors conclude, has the potential to improve the appropriate utilization of medical services by encouraging shared decision making around issues of medical uncertainty such as prostate cancer screening.

Pairing Physician Education With Patient Activation to Improve Shared Decisions in Prostate Cancer Screening: A Cluster-Randomized Controlled Trial
By Michael S. Wilkes, MD, PhD, et al
University of California, Davis

Analysis of Unannounced Standardized Patient Visits Shows Educational Intervention Can Improve Shared Decision Making and Change Physician Attitudes About Prostate Cancer Screening

In a more detailed discussion and analysis of the standardized patient visit data reported as a secondary measure in the previous study by Wilkes, et al, researchers discuss how the Web-based educational intervention appears to improve shared decision making, encourage neutrality in recommendation and reduce PSA test ordering. Analyzing transcripts from unannounced standardized patient encounters with the 118 participating primary care physicians in which trained actors prompted physicians to address prostate cancer screening, researchers found intervention physicians showed more shared decision making behaviors (intervention 14 items vs. control 11 items), were more likely to mention no screening as an option (intervention 63 percent vs. control 26 percent), to encourage patients to consider different screening options (intervention 62 percent vs. control 39 percent) and seek input from others (intervention 25 percent vs. control 7 percent). The authors conclude that by analyzing standardized patient transcripts of the actual conversations between physicians and patients, this study offers unique and important insights into how physicians actually behaved when prompted to discuss the risk and uncertainty of prostate cancer screening. They assert that in light of the USPSTF's recent recommendation against screening, interventions such as this one may be important adjuvants to help influence physicians' behaviors regarding controversial medical topics with public health implications and may potentially decrease utilization of tests with uncertain value.

Physician Communication Regarding Prostate Cancer Screening: Analysis of Unannounced Standardized Patient Visits
By Bo Feng, PhD, et al
University of California, Davis

Editorial: Shared Decision Making Should be Approached as a Learned Skill Cultivated Within the Context of an Ongoing Relationship

An accompanying editorial explores the importance of viewing shared decision making not as an episodic event but as a learned skill and ongoing process that is cultivated through repeated application within the context of meaningful physician-patient relationships. The authors assert the research in the current issue is consistent with previously published literature that shared decision making remains poorly integrated into primary care practices largely because it is considered in isolation. They encourage clinicians to reframe their approach to shared decision making, viewing it in a broader context and giving attention to unanswered questions, conflicting demands and systems implications.

Shared Decision Making, Contextualized
By Robert L. Ferrer, MD, MPH, and James M. Gill, MD, MPH
Annals of Family Medicine

Patients with Chronic Illnesses More Likely to Receive Recommended Preventive Services

In contrast to the oft-expressed concerns that increasing patient complexity impedes the delivery of preventive services because of competing demands, researchers find the presence of chronic illness is positively associated with receipt of recommended preventive services. In a study of 667,379 adult patients from 148 primary care practices across the United States, researchers found strong positive associations between the receipt of clinical preventive services and the presence of chronic illnesses. For each preventive service examined, they found a curvilinear relationship with the number of chronic conditions, with an increased likelihood of being up-to-date with preventive services as the number of chronic conditions increases from zero to four or five. At this point, they note, the association largely plateaus with no further increases in the proportion of patients up-to-date with the preventive service as the number of chronic conditions increases above five. The associations between the odds of being up-to-date and the presences of chronic illness persisted even after adjustment for age and encounter frequency. The authors conclude these findings suggest that it is something about the nature of the care provided to these patients that accounts for the finding of increased attention to prevention. They assert primary care practices, facilitated by tools like electronic health records, can overcome competing demands and effectively deliver preventive services to the growing number of patients with multiple chronic illnesses.

Preventive Services Delivery in Patients With Chronic Illnesses: Parallel Opportunities Rather Than Competing Obligations
By Steven M. Ornstein, MD, et al
Medical University of South Carolina, Charleston

Study Shows the Potential for Health Plans to Implement Interventions to Improve Colon Cancer Screening Rates

A previously proven telephone outreach intervention delivered by research-based staff to increase colorectal cancer (CRC) screening was successfully translated to the health plan arena with staff of a Medicaid managed care organization (MMCO) increasing (CRC) screening rates by one-third to nearly double among publicly insured urban women in this study. The trial involving 2,240 women overdue for screening and insured by one of three New York City MMCOs found intervention women were significantly more likely than usual care women to become up-to-date on CRC screening during the study period with screening rates 6 percent higher in the intervention arm. The authors note, however, that the increases varied from 1 percent to 14 percent across the participating MMCOs, with the overall increase being driven by increases at one particular MMCO. At this MMCO, telephone outreach focused solely on CRC screening, while at the other two MMCOs, telephone outreach included support for cervical and breast cancer screening as well as CRC screening. Comparing eligible intervention women reached by telephone with eligible usual care women with whom no contact was attempted, they found intervention arm screening rates were between 12 percent and 26 percent higher than usual care at the three MMCOs, with an overall increase of 15 percent (again, primarily due to screening increases at one of the MMCOs). The authors conclude these findings show that MMCOs, key players in the delivery of health care to publicly insured and underserved populations, can successfully implement interventions to increase CRC screening, reducing health care disparities among a difficult to reach population.

Telephone Outreach to Increase Colon Cancer Screening in Medicaid Managed Care Organizations: A Randomized Controlled Trial
By Allen J. Dietrich, MD, et al
The Geisel School of Medicine at Dartmouth and the Norris Cotton Cancer Center, Lebanon, New Hampshire

Primary Care Physicians Examine the Causes of Potentially Avoidable Hospitalizations

Exploring the causality hospitalizations for illnesses that can typically be managed effectively on an outpatient basis, researchers found primary care physicians deemed most to be potentially avoidable, attributing the causes to five possible categories: system-related, physician-related, medical, patient-related and/or social. Interviews with 12 German primary care physicians regarding 104 hospitalizations of 81 patients with ambulatory care-sensitive conditions revealed participating physicians rated 41 percent of the hospitalizations as potentially avoidable. During the interviews, the cause of hospitalization fell into one or more of five principal categories: system-related (e.g., unavailability of outpatient services), physician related (e.g., suboptimal monitoring), medical (e.g., medication side effects), patient-related (e.g., delayed help-seeking) and social (e.g., lack of social support). System-related causes were attributed to 30 hospitalizations (29 percent), physician-related causes to 32 (31 percent), medical causes to 101 (97 percent), patient-related causes to 83 (80 percent) and social causes to 20 (19 percent). Based on these findings, the authors posit strategies to avoid such hospitalizations, including after-hours care, optimal use of outpatient services, intensified monitoring of high-risk patients and initiatives to improve patients' willingness and ability to seek timely help as well as patients' medication adherence.

Strategies for Reducing Potentially Avoidable Hospitalizations for Ambulatory Care-Sensitive Conditions
By Tobias Freund, MD, et al
University Hospital Heidelberg, Germany

Intervention to Improve Primary Care Practices' Fitness Culture Did Not Translate Into Differential Improvements in Physical Activity and Healthy Eating

Evaluating the effect of the American Academy of Family Physician's Americans in Motion Healthy Interventions public health initiative to promote physical activity, healthy eating, and emotional well-being as part of routine patient care, researchers found impressive before-after improvements in patient outcomes but no differences between two different implementation approaches. The authors assessed the outcomes of 610 enrolled patients at 24 family medicine practices randomized to either an enhanced practice (asked to use AIM-HI tools to help office staff make personal changes and create a healthy practice environment) or a traditional practice (trained and asked to use the tools directly with patients). They hypothesized that practices which used the AIM-HI tools as a group to improve physician and office staff lifestyle behaviors and actively advertised their commitment to AIM-HI principles to their patients would be more successful in improving patient-level outcomes; however, they found no significant differences in the patient-outcomes between the two practice groups. Regardless of practice group, 16 percent of patients who completed a 10-month visit (378 patients) and 10 percent of all patients enrolled lost 5 percent or more of their body weight. Moreover, of the patients who completed a 10-month visit, 17 percent had a 2-point or greater increase in their fitness level, and 29 percent lost 5 percent or more of their body weight and/or increased their fitness level by 2 or more points. The authors posit several reasons for the lack of a between-group difference, including study design, patient selection, the nonprescriptive approach to AIM-HI, and already established physician workplace wellness activities that motivated the clinicians to intervene with patients.

Effectiveness of 2 Methods of Implementing the Americans in Motion: Healthy Interventions (AIM-HI) Approach to Promoting Physical Activity, Healthy Eating, and Emotional Well-being
By Wilson D. Pace, MD, et al
University of Colorado, Aurora

Most Pregnant Women in the United States Receive Care from Multiple Types of Clinicians, Number Seeing Family Physicians Remains Stable Over Past Decade

Approximately one-third of pregnant women report having seen or talked to a family physician for medical care during the prior year, a percentage that has remained stable over the past decade. Analyzing nationally representative data on 3,204 women from 2000 to 2009, researchers found a substantial and steady proportion of pregnant women (36 percent) received some care from family physicians, with most reporting receiving care from multiple types of clinicians, including family physicians, obstetrician-gynecologists, midwives, nurse practitioners and physicians assistants. The authors conclude these findings underscore the importance of care coordination for this patient population. The researchers also identify regional differences in trends in family physician care, with pregnant women in the North Central United States increasingly reporting care from family physicians and women in the South reporting a decline (7 percent annual increase vs. 5 percent annual decrease).

Care From Family Physicians Reported By Pregnant Women in the United States
By Katy Backes Kozhimannil, PhD, MPA, and Patricia Fontaine, MD, MS
University of Minnesota School of Public Health, Minneapolis-St. Paul and Health Partners Institute for Education and Research, Minnesota

Safety Climate in German Family Practices Generally Positive

Evaluating the impact of different individual and practice features on perceptions of the safety climate the shared employee perceptions of the priority of safety at an organization in German primary care practices, researchers find though the safety culture is positive overall, health care professionals' use of incident reporting and a systems approach to errors was fairly rare. The researchers' analysis of more than 2,100 questionnaires revealed the safety climate as perceived by doctors and health care assistants was not significantly influenced by individual and practice team characteristics. They also found participation of the whole practice team in the survey had a positive influence on safety climate, and doctors had more positive perceptions of four of the seven climate factors evaluated than health care assistants. Because measurement of a safety climate aims to detect areas of deficiencies to improve patient safety, the authors assert these findings should prompt German primary care doctors and health care assistants to learn more about error causation and adopt a systems approach toward patient safety incidents as a method to develop a memory for past errors and to learn from them. They call for health care assistants, in particular, to contribute more to incident reporting and participate in an open and fair safety culture.

Impact of Individual and Team Features of Patient Safety Climate: A Survey in Family Practices
By Barbara Hoffmann, MD, MPH, et al
Goethe University, Frankfurt, Germany

The Consequences of Postponing Motherhood in the Pursuit of a Career in Medicine

Two female physicians reflect on the consequences of postponing motherhood in the pursuit of successful medical careers. They share their personal stories of difficulty conceiving, miscarriages and stillbirth, reflecting on how their intense career focus led them to gamble away their fertility. Because delayed childbearing can result in unintended childlessness, the need for assisted reproductive techniques, adoption and having smaller than desired family size, the authors call for training programs and employers to provide more information and support to women in medicine, and adopt policies that are consistent with today's trainees' and physicians' complex lives. They caution men and women in medicine to carefully consider how medical school, residencies and fellowships can impinge on family planning.Annals of Family Medicine

Women in Medicine and the Ticking Clock
By Lisa N. Miura, MD and Rebecca S. Boxer, MD, MS
Legacy Emanuel Medical Center, Portland, Oregon

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Annals of Family Medicine is a peer-reviewed, indexed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care disciplines. Launched in May 2003, Annals is sponsored by seven family medical organizations, including the American Academy of Family Physicians, the American Board of Family Medicine, the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group, and the College of Family Physicians of Canada. Annals is published six times each year and contains original research from the clinical, biomedical, social and health services areas, as well as contributions on methodology and theory, selected reviews, essays and editorials. Complete editorial content and interactive discussion groups for each published article can be accessed free of charge on the journal's website, http://www.annfammed.org.


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