Bill Thompson, former New York City comptroller and rising candidate for mayor, spoke out against the New York Police Department?s controversial?stop and frisk? policy, one of the few times he?s discussed race, invoking George Zimmerman.
?on Sunday, Mr. Thompson arrived before a mostly black congregation in a storefront church and issued a fierce denunciation of the policies of the New York Police Department, saying they are drawn from the same racial suspicions that drove George Zimmerman to hunt down Trayvon Martin.
?Here in New York City, we have institutionalized Mr. Zimmerman?s suspicion with a policy that all but requires our police officers to treat young black and Latino men with suspicion, to stop them and frisk them because of the color of their skin,? Mr. Thompson said at the Abundant Life Church in the Prospect Heights section of Brooklyn.
"Proteins run the body," explains Stephen Arnold. "When the immune system encounters virus, it pumps out huge quantities of antibody proteins, and all cancers generate protein markers. A test capable of detecting a single protein would be the most sensitive diagnostic test imaginable." (Credit: BASF - The Chemical Company/Flickr)
NYU (US) ? Scientists have used a special type of biosensor to detect a single cancer marker protein that is one-sixth the size of the smallest virus.
The achievement shatters the previous record, setting a new benchmark for the most sensitive limit of detection, and may significantly advance early disease diagnostics.
The team at the Polytechnic Institute of New York University (NYU-Poly) set a record recently using the same technique to detect in solution the smallest known RNA virus, MS2, with a mass of 6 attograms.
The researchers have now detected two proteins: a human cancer marker protein called thyroglobulin, with a mass of just 1 attogram, and the bovine form of a common plasma protein, serum albumin, with a far smaller mass of 0.11 attogram.
?An attogram is a millionth of a millionth of a millionth of a gram,? explains Stephen Arnold, a professor of applied physics, ?and we believe that our new limit of detection may be smaller than 0.01 attogram.?
This latest milestone builds on a technique pioneered by Arnold and collaborators from NYU-Poly and Fordham University. In 2012, the researchers set the first sizing record by treating a novel biosensor with plasmonic gold nano-receptors, enhancing the electric field of the sensor and allowing even the smallest shifts in resonant frequency to be detected.
Their plan was to design a medical diagnostic device capable of identifying a single virus particle in a point-of-care setting, without the use of special assay preparations.
At the time, the notion of detecting a single protein?phenomenally smaller than a virus?was set forth as the ultimate goal.
?Proteins run the body,? explains Arnold. ?When the immune system encounters virus, it pumps out huge quantities of antibody proteins, and all cancers generate protein markers. A test capable of detecting a single protein would be the most sensitive diagnostic test imaginable.?
To the surprise of the researchers, examination of their nanoreceptor under a transmission electron microscope revealed that its gold shell surface was covered with random bumps roughly the size of a protein.
Computer mapping and simulations created by Stephen Holler, once Arnold?s student and now assistant professor of physics at Fordham University, showed that these irregularities generate their own highly reactive local sensitivity field extending out several nanometers, amplifying the capabilities of the sensor far beyond original predictions.
?A virus is far too large to be aided in detection by this field,? Arnold says. ?Proteins are just a few nanometers across?exactly the right size to register in this space.?
The implications of single protein detection are significant and may lay the foundation for improved medical therapeutics.
Among other advances, Arnold and his colleagues posit that the ability to follow a signal in real time?to actually witness the detection of a single disease marker protein and track its movement?may yield new understanding of how proteins attach to antibodies.
Arnold named the novel method of label-free detection ?whispering gallery-mode biosensing? because light waves in the system reminded him of the way that voices bounce around the whispering gallery under the dome of St. Paul?s Cathedral in London.
A laser sends light through a glass fiber to a detector. When a microsphere is placed against the fiber, certain wavelengths of light detour into the sphere and bounce around inside, creating a dip in the light that the detector receives.
When a molecule like a cancer marker clings to a gold nanoshell attached to the microsphere, the microsphere?s resonant frequency shifts by a measureable amount.
The National Science Foundation supported the research, which is reported in the journal Nano Letters.
Believe it not my Pakistani friends, but the West think it otherwise. Look what they think of Pakistan
China Invades But Will Not Open Fire
July 30, 2013: Pakistan is still in political turmoil as the elected government strives, for the first time in Pakistan?s 66 year history, to bring the military fully under control of civilian leaders. The military is resisting, but is very much on the defensive. After decades of desperate moves (coups, anti-foreigner propaganda and lots of corruption) the generals have run out of options. Over the last decade the generals misjudged the degree of popular hatred for their years of bad behavior and for the military in general. While the current leadership of the military has an idea of why this is so, many retired generals and admirals are clueless and threatening some kind of retaliation. The generals currently in charge know better and understand the officers and troops are increasingly split over what to do. The old solutions no longer work. Since the 1950s the military has seized control of the government four times and each time ran the country for 5-10 years before popular anger forced them to allow elections again. This no longer works for the generals and the recent arrest of former general Musharraf (who took over in 1999 and was eased out by popular disgust with military rule in 2008) is the evidence none of the generals want to see. While the military insists that civilian courts cannot go after active duty personnel (under a 1952 law), those who have left or retired are another matter and the government can force officers to retire.
Perhaps the greatest damage the generals have done is to promote intense (and irrational) hatred of India for over half a century. A lot of Pakistanis never bought into this and many more are resisting the relentless military warnings that India was preparing to invade. But the hatred of India has become an entrenched ?tradition? that is proving hard to lose. The United States also became subject to ?they are out to destroy Pakistan? propaganda and that is supported by over three decades of official (military backed) support for Islamic terrorism (which sees the U.S. as the main threat to Islam and Pakistan.) Many Pakistanis realize that all this hate talk is nonsense and counterproductive, but to say so out loud in Pakistan can (and regularly does) get you killed. This is perhaps the greatest harm done by the military, persuading so many Pakistanis to wallow in paranoia and hate. This has helped perpetuate, and make worse, a dysfunctional society crippled by corruption and greed. As a result of all this, Pakistan is an unreliable ally in the struggle to deal with Islamic radicalism and terrorism.
In northwest Pakistan the army has managed to find and attack (and often permanently destroy) most Taliban bases this year. While hundreds of Taliban have been killed in these operations, most of the Islamic terrorists escape. Some have quit, fed up with the constant attacks and lack of success. Others have fled into Afghanistan where they establish bases, often with the help of kinsmen living on that side of the border. There are several Pushtun tribes with clans on both sides of the border, a situation which still annoys all Pushtuns. A growing number of defeated Taliban head for the largest city (Peshawar, population 3.6 million) in the tribal territories or Karachi (population 14 million) the largest city (and port) in Pakistan. In both these cities the Taliban can become gangsters for God, or just gangsters. Peshawar is almost entirely Pushtun (the tribes that dominate the northwest tribal territories) and contains several neighborhoods that are pro-Taliban. The existing gangs have been recruiting Taliban driven from their rural bases and put them to work expanding the gang?s criminal activities (mainly theft and extortion). Karachi has over two million Pushtun, many who have been there for generations. So have some major Pushtun gangs. So while the army and police are destroying the Taliban in the rural northwest, a side effect is providing more eager, and experienced, recruits for urban Pushtun gangs. Some of these criminal outfits now claim affiliation with the Taliban, partly out of conviction but mostly because it is often good for business.
Although India considers the tribal rebellions in the northeast suppressed, several small groups, often factions of groups that have made peace, continue to operate. Over the last two years, this violence has led to 78 deaths and 191 kidnappings in Assam, near the Nepal border. The rebels lost 135 killed and 2,749 arrested (some more than once). There has been ethnic and separatist violence in the seven states of northeast India (Assam, Arunachal Pradesh, Nagaland, Manipur, Mizoram, Tripura and Meghalaya) for over 60 years. The total population of this area is 39 million, with most of it (72 percent) in Assam. Despite peace breaking out in most of the region during the last decade, there are still outbreaks of violence. Some of it has been caused by Maoist rebels establishing themselves in the northeast. But the most violent actions are often between illegal migrants from Bangladesh (who are Moslem and illegal settlers) and legal Hindu and Moslem settlers from the rest of India. The tribes resent all these strangers coming in and claiming prime farmland. The immediate cause of most violence with migrants is economic issues. The most energetic of these tribal rebels are the Bodo. There are 1.2 million Bodo (who are ethnically related to the Tibetans and Chinese) in Assam and they are mostly Hindu. The many kidnappings in Assam are carried out by the rebels to raise money, and to persuade the outsiders to leave. But these people have no place to go and the violence continues.
July 29, 2013: In northwest Pakistan (near the Khyber Pass) some 150 Taliban attacked a prison and freed 253 prisoners, including 25 prominent Taliban inmates. The attackers used two suicide bombers and planted explosives along the walls of the prison and collapsed them. Some of the attackers were killed, but their bodies were taken by the retreating assault force. Six prison guards were killed, along with six Shia prisoners and two local civilians.
July 28, 2013: In northwest Pakistan (North Waziristan) an American UAV attack killed six people in a compound being used by a Taliban leader and some of his followers. This is the 17th such attack in Pakistan this year. These attacks have killed about 106 people.
In Indian Kashmir someone shot dead a policeman.
July 27, 2013: In southwest Pakistan (Baluchistan) gunmen attacked a checkpoint near the Iran border, killing seven coastguardsmen and wounding seven more. In northwest Pakistan (North Waziristan) a similar attack left two tribal police dead and 25 wounded. This incident left 18 of the attackers (apparently Taliban) dead.
Pakistani troops on the Indian border (Kashmir) opened fire on Indian troops. The return fire killed a Pakistani soldier and the Pakistani government blamed India of making an unprovoked attack. Incidents like this are up this year and Pakistan continues to deny responsibility for instigating nearly all of them. This exasperates the Indians, who despair of every reaching a lasting peace deal with Pakistan as long as the Pakistanis refuse to even admit what they are doing to break cease fire agreements.
July 26, 2013: In northwest Pakistan (Kurram) two Taliban suicide bombers (on motorcycles) killed 57 Shia (and wounded over 160) in crowded market places. The Taliban, like most Sunni Islamic radicals, consider Shia to be heretics and deserving of execution.
July 24, 2013: In southern Pakistan (Sukkur) four Taliban attacked a regional office of ISI (the Pakistani CIA) and killed five people. All four attackers were killed after a 30 minute gun battle. The attack began when a suicide car bomber detonated his explosives at the entrance checkpoint. Three gunmen then tried to get into the building, but were stopped by armed guards.
In eastern India (Jharkhand) two Maoist factions fought each other, leaving six rebels dead.
July 23, 2013: Chinese and Indian officials met in India to try and work out a way to prevent border incidents. India accuses Chinese troops of being caught on the Indian side of the LAC (Line of Actual Control) in Kashmir three times in the last week (July 16, 18, and 20). The first of these involved China sending a mounted (on horseback) patrol of 50 troops into Indian territory in Ladakh (northwest India) on July 16th and remaining across the line until the next day when confronted by Indian troops. China says all these incidents were misunderstandings, but in the GPS age this is not as convincing as it used to be. India is accusing China of violating a March agreement that was supposed to halt the Chinese practice of sending troops to follow each other?s infantry patrols along the LAC and sometimes sending troops into Indian territory. The LAC is also known as the MacCartney-MacDonald Line and is the unofficial border between India and China. The LAC is 4,057 kilometers long and is found in the Indian States of Ladakh, Kashmir, Uttarakhand, Himachal, and Arunachal. On the Chinese side it is mostly Tibet. China claims much territory that is now considered part of India. The practice of monitoring each other?s patrols has led to hundreds of armed confrontations over the last few years as one side or the other accuses ?foreign troops? of crossing the LAC. China has become less vocal about its claims on Indian territory recently but has not abandoned these assertions. The Chinese troops, when confronted by Indian soldiers or border guard will claim they are really in Chinese territory, but back off rather than open fire over the issue. This is a big relief to India, which has a defense budget one third that of China?s.
July 21, 2013: In Indian Kashmir the two day curfew was lifted because the separatist violence had abated.
July 20, 2013: India had accused China of using UAVs to patrol the northwest (Kashmir) border and entering Indian territory nearly 200 times since early 2012. Closer investigation of this revealed that most, or all, of these sightings (by Indian troops) were actually the planets Jupiter and Venus moving close to the horizon. Meanwhile Chinese incursions on the ground are less ambiguous and increasingly frequent.
In Karachi, Pakistan a policeman was killed by a bomb while three terrorists died while they were assembling a bomb. Elsewhere in Pakistan (near the Khyber Pass) air force warplanes and army troops killed 20 Taliban in a two day operation.
India-Pakistan: China Invades But Will Not Open Fire
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CLEVELAND (Reuters) - The son of the Ohio man who held three women captive for years said on Monday that he was happy his father pleaded guilty in a deal that spared him the death penalty and spared his victims from repeated court appearances.
"In death penalty cases, you end up in court a lot and so they come back a lot more often," Anthony Castro said on Monday on NBC News' "Today" program in his first television interview. "I think this way is a lot better because he's sent himself away and he will be away for the rest of his life."
Former school bus driver Ariel Castro, 53, pleaded guilty last week in Cleveland to 937 charges, including kidnapping and repeatedly raping three young women he abducted between 2002 and 2004. He also pleaded guilty to murder for impregnating one of the young woman and causing her to miscarry by assaulting her.
Castro is scheduled to be formally sentenced on August 1 after he agreed to serve life without parole, plus 1,000 years.
The women were chained and tied up for long periods and subjected to starvation, beatings and sexual assaults. On May 6, neighbors heard cries for help from Amanda Berry, 27, and helped her escape Castro's house along with her six-year-old daughter, fathered by Castro.
Berry then called 911 and police rescued Gina DeJesus, 23, and Michelle Knight, 32, from the second floor of the house.
Anthony Castro, 31, said he felt "overwhelming joy" when he first heard the women had been found and freed but was horrified when he learned from Berry's 911 call that it was his father who had held them.
Anthony Castro had been a journalism student at Bowling Green University in Ohio in 2004 when he wrote an article about the three missing women.
"I was shocked because of the magnitude of such a crime. I don't think I could imagine anyone doing that, let alone finding out it was my own flesh and blood, my father," Anthony Castro said.
Anthony Castro, who lives and works in Columbus, is the only son born to Ariel and Grimelda Figueroa. They had three daughters, including Emily Castro, who is in prison serving a 25-year sentence after being convicted of attempting to murder her baby daughter in 2007 by slashing her throat.
He said his father was violent, "incredibly strict" and regularly beat him and his mother, who died last year.
Figueroa accused Castro of abuse in 1989. Castro pleaded no contest and was given a year of probation. Figueroa was granted full custody of their children by 1997, according to Cuyahoga County court documents.
After a court hearing last week, Berry was seen on the stage of a Cleveland concert waving and shaking the hands of members of the cheering crowd. It was the first public appearance by any of the women since their rescue.
DeJesus also appeared in a short interview with a local Cleveland TV news station with her mother on Sunday. In the interview with WEWS, Nancy Ruiz, DeJesus' mother, told a reporter her daughter has been in contact with the other women and has visited each other.
Anthony Castro said he had visited his father's fortress-like home a few times in the last decade but had no idea the women were there and did not suspect anything was wrong. He stayed outside or entered through the back door and never went beyond the kitchen, he said.
Even when he lived there as a child, he said, the basement, attic and garage were locked, the windows were nailed shut and parts of the house were off-limits, he said.
His son said he will not visit his father in prison and has nothing to say to him.
According to jail logs, Castro has only been visited by his mother and sister during the nearly three months he has been incarcerated.
"He's been lying to his family for the past 10, 11 years at every possible turn," Anthony Castro said. "I have no trust in him. I can't see myself going to visit him and giving him the opportunity to face me and lie to me again."
(Reporting by Jane Sutton and Kim Palmer; Editing by Maureen Bavdek, Mary Wisniewski and Steve Orlofky)
2K Sports has now confirmed that NBA 2K14 will a launch title for both the PS4 and Xbox One consoles.
This give 2K Sports an edge over EA?s NBA Live 14 because this confirms that NBA 2K14 will be released at the end of 2013 sometime. NBA Live 14 on PS4 and Xbox One will be released in ?early 2014? instead.
If you are getting a PS4 and Xbox One on launch day, you can consider NBA 2K14 as one of the games you can get on the first day as well. The game will probably have the same features as the current-gen versions, but the graphics will look more realistic.
Kaliningrad Oblast is a unique part of Russia. Sandwiched between Poland, Lithuania, and the Baltic Sea, the exclave is isolated from the rest of the Russian mainland, both physically and culturally. As such, Moscow has launched several disparate policies over the years to address its unique geographic and economic concerns.
There was the plan to turn Kaliningrad into the "Russian Macao": one of a small number of special legal gambling zones in the Russian Federation. But the scheme has been scuttled and Kaliningrad?s casinos have moved to Minsk in Belarus.
Then there was the ambitious effort to promote investment in the oblast with special tax incentives for businesses that chose to make Kaliningrad home. However, this mandate ends in 2016 and will not be renewed, as the business community has shown little interest.
RECOMMENDED: Do you know anything about Russia? A quiz.
Now, one of the latest plans looks like it has indeed benefited Kaliningrad?s residents ? but to the detriment of the oblast?s business community, especially the retail sector.
A new agreement between the Russian Federation and European partners Poland and Lithuania, which took effect in 2012, allows residents of Kaliningrad to travel visa-free into the neighboring countries up to 50 kilometers (31 miles), for durations of a few days. Likewise Poles and Lithuanians can visit Kaliningrad with similar restrictions.
Travel to Poland has proven especially popular and the zone for visa-free visits has been expanded beyond its original limits by mutual agreement. Kaliningraders are enjoying brief holidays in Polish Baltic Sea resorts, weekends in the beautiful medieval city of Gdansk, and shopping sprees in Polish supermarkets and shops.
All of this great news for residents of Kaliningrad, who have been bottled up in their exclave 350 kilometers (about 220 miles) from contiguous Russia since the ascension of Poland and Lithuania to the European Union in 2004.
?I prefer to go to Gdansk or Sopot just to have fun, to eat, to walk, just to change the environment,? says Margarita Bochkova, a Kaliningrad native in her 20s. ?And if I go there I might also stop by at the supermarket to buy some food we don't have in Kaliningrad yet."
"But I know lots of people who go there to shop every weekend," she says. "They are mostly families, so it is much cheaper for them to stock up on food, clothes, and items for the home there.?
Illya Dementev, a professor at Immanuel Kant Baltic Federal University in Kaliningrad sees a similar pattern but notes that Poles are barely making reciprocal journeys ? instead just popping over the border for the cheaper gasoline. ?Usually, Polish people come to the petrol stations, and that is all. As for us, we prefer Polish shops and cultural centers such as Gdansk, so we go there often,? he says.
Professor Dementev notes that consumer rubles flowing out of the oblast is a concern to local businesses. ?As for the outflow of cash from the oblast, it is a problem. Retail businesses in Kaliningrad are very frightened by this regime because they are losing money," he says.
A Kaliningrad official put the situation succinctly. ?Frankly speaking, I'm very glad to spend my money in [large department stores] IKEA and Auchan in Gdansk, for instance," he said, before asking to remain anonymous. "That?s just between us.?
Michael Amundsen is co-editor at TallinnArts.com.
RECOMMENDED: Do you know anything about Russia? A quiz.
Over 17,000 people from 77 countries took on Anaheim, California this week as the SIGGRAPH, a?premier conference on computer graphics and interactive techniques celebrated its 40th anniversary. Numerous announcements, celebrations, exhibits and eye-popping demonstrations filled the event floor throughout the week. As a part of the accompanying Computer Animation Festival, SIGGRAPH 2013 hosted Production Sessions, where elite computer graphic experts and creative geniuses explained their process and techniques for creating compelling content.
Some highlights from the week included:
Pixar?celebrated?the 25th anniversary of its RenderMan software, which has been used in 19 of the last 21 Academy Award-winners for Visual Effects. fxguide has an?exclusive?on Pixar?s RenderMan and the software?s co-founder Ed Catmull.?This year, Pixar?s ?Monsters University? and ?The Blue Umbrella? are showcasing new levels of photorealism, including major advancements in lighting that are directly attributable to technological breakthroughs in RenderMan?s system for creating physically-based global illumination. Last month Pixar?announced?the release of RenderMan Pro Server 18, a?major version upgrade that presents core enhancements in lighting workflows.
NVIDIA (NVDA) unveiled its new flagship GPU ? the Quadro K6000. Delivering?five-times higher compute performance and nearly double the graphics capability of its predecessor, the K6000 GPU?enables leading organizations such as Pixar, Nissan, Apache Corporation and WSI, Professional Division of The Weather Company and Innovation Engine of The Weather Channel, to tackle visualization and analysis workloads of unprecedented size and scope. The K6000 features 12GB of ultra-fast GDDR5 graphics memory, 2,880 streaming multiprocessor cores and supports four simultaneous displays, up to 4k resolution with DisplayPort 1.2.
??The Kepler features are key to our next generation of real-time lighting and geometry handling. We were thrilled to get an early look at the K6000,? said Guido Quaroni, Pixar vice president of Software R&D.?The added memory and other features allow our artists to see much more of the final scene in a real-time, interactive form, and allow many more artistic iterations.?
Fusion-io (FIO) showcased a complete studio solution for visual effects acceleration. Its conference?demo illustrated a 12GB/s Fusion powered pipeline, with ioControl Hybrid storage, HP Z820 ioTurbine Cache, and HP Z820 Artist workstations with ioFX 1.6TB. ??Fusion-io products were a fundamental, core component of our pipeline for ?Star Trek Into Darkness,?? said Adam Watkins, Pixomondo Digital Effects Supervisor. ?If you have a facility equipped with Fusion-io with the ioFX for workstations or ioDrive in the server, you get an overall productivity gain that increases efficiency of the equipment you already have. Those cost savings and increased bandwidth help you take on more work to be more competitive in the visual effects market.?
AMD showcased?visual computing experiences it powered for Adobe, Autodesk, Christie, Dell and Optis. The AMD FirePro professional graphics demonstrations featured unique animation, display, simulation and other creative hardware and software collaborations for attendees from around the world.??At the AMD booth, artists will have the chance to check out Autodesk Maya and 3ds Max 3D animation and visual effects software running on workstations powered by AMD FirePro graphics,? said Rob Hoffmann, senior product marketing manager, Autodesk Media & Entertainment. ?The powerful combination of AMD hardware and Autodesk software can help increase productivity and creativity to complete tasks faster and give artists more time to try new ideas.?
Intel (INTC) was at SIGGRAPH highlighting high-fidelity ray-tracing from the upcoming 2.0 release of the Embree open source project, as well as giving a?demonstration of Autodesk Opticore Professional Studio running on Xeon Phi co-processors.
About John Rath
John Rath is a veteran IT professional and regular contributor at Data Center Knowledge. He has served many roles in the data center, including support, system administration, web development and facility management.
[unable to retrieve full-text content]Patients who receive a drug-eluting stent and demonstrate high platelet reactivity on clopidogrel are more likely to have blood clots form on the stent and to suffer a heart attack; however, these patients are less likely to develop bleeding complications.
WASHINGTON (Reuters) - A U.S. regulator on Thursday said it reached an $885 million settlement with UBS over allegations the bank misrepresented mortgage-backed bonds that were sold to Fannie Mae and Freddie Mac during the housing bubble.
Under the terms of the agreement with the Federal Housing Finance Agency, UBS must pay about $415 million to Fannie Mae and $470 million to Freddie Mac to resolve claims related to securities sold to the companies between 2004 and 2007. The Swiss banking giant did not admit to any liability or wrongdoing in settling the allegations. On Monday, it said it had reached an agreement in principle with the FHFA.
Fannie Mae and Freddie Mac were seized by the U.S. government in 2008 as the housing crisis threatened their solvency. They have received $187.5 billion in taxpayer funds to stay afloat.
UBS is just one of 18 banks the FHFA pursued in 2011 for allegedly misrepresenting the quality of the collateral backing securities during the run-up to the financial crisis. The regulator is seeking to recover losses on mortgage bonds sold to Fannie Mae and Freddie Mac, which could result in the recovery of billions of dollars.
Citigroup and General Electric have already settled with the FHFA for undisclosed sums.
(Reporting by Margaret Chadbourn; editing by Jackie Frank and Phil Berlowitz)
Supporters of Egypt's ousted President Mohammed Morsi attend the Friday prayer during a protest at Nasr City, where protesters have installed their camp and hold their daily rally, in Cairo, Egypt, Friday, July 26, 2013. Political allies of Egypt's military lined up behind its call for huge rallies Friday to show support for the country's top general, Abdel-Fattah el-Sissi, pushing toward a collision with Islamist opponents demanding the return of Mohammed Morsi, the nation's ousted president. (AP Photo/Khalil Hamra)
Supporters of Egypt's ousted President Mohammed Morsi attend the Friday prayer during a protest at Nasr City, where protesters have installed their camp and hold their daily rally, in Cairo, Egypt, Friday, July 26, 2013. Political allies of Egypt's military lined up behind its call for huge rallies Friday to show support for the country's top general, Abdel-Fattah el-Sissi, pushing toward a collision with Islamist opponents demanding the return of Mohammed Morsi, the nation's ousted president. (AP Photo/Khalil Hamra)
FILE -In this Saturday, Dec. 8, 2012 file photo, an Egyptian protester wears a Guy Fawkes mask while posing for a photo next to a mural painted overnight on the exterior wall of the presidential palace depicting president Mohammed Morsi, left, former military council ruler Hussein Tantawi, center and ousted President Mubarak with Arabic that reads "No, the brotherhood's constitution is not valid," in Cairo, Egypt. Egypt?s newly announced criminal investigation against Mohammed Morsi is likely just the start of wider legal moves against the ousted president and his Muslim Brotherhood _ ominous prospects for a country seething with violent divisions. During three weeks of secret detention, military intelligence has extensively questioned Morsi on the inner workings of his presidency and of the Brotherhood, seeking to prove he committed crimes including handing state secrets to the Islamist group. Military officials tell The Associated Press the interrogations could land Morsi in court in lead to a renewed ban for the Brotherhood. (AP Photo/Nasser Nasser, File)
FILE - In this Saturday, June 16, 2012 file photo, Egyptian presidential candidate Mohammed Morsi waves after he casts his vote at a polling station in Zagazig, 63 miles (100 kilometers) northeast of Cairo, Egypt. A statement on the Egyptian president's office's Twitter account has quoted Mohammed Morsi as calling military measures "a full coup." The denouncement was posted shortly after the Egyptian military announced it was ousting Morsi, who was Egypt's first freely elected leader but drew ire with his Islamist leanings. The military says it has replaced him with the chief justice of the Supreme constitutional Court, called for early presidential election and suspended the Islamist-backed constitution. (AP Photo/Amr Nabil, File)
FILE - In this Monday, Nov. 28, 2011 file photo, Saad el-Katatni, left, and Mohamed Morsi, center, of the Muslim Brotherhood's Freedom and Justice Party track voter turnout on the first day of parliamentary elections in Cairo, Egypt. Egypt?s newly announced criminal investigation against Mohammed Morsi is likely just the start of wider legal moves against the ousted president and his Muslim Brotherhood _ ominous prospects for a country seething with violent divisions. During three weeks of secret detention, military intelligence has extensively questioned Morsi on the inner workings of his presidency and of the Brotherhood, seeking to prove he committed crimes including handing state secrets to the Islamist group. Military officials tell The Associated Press the interrogations could land Morsi in court in lead to a renewed ban for the Brotherhood. (AP Photo/Mohammed Abu Zaid, File)
FILE - In this Saturday, Dec. 8, 2012 file photo, protesters opposed to Egyptian President Mohammed Morsi hang a banner outside the palace in Cairo, Egypt. Egypt?s newly announced criminal investigation against Mohammed Morsi is likely just the start of wider legal moves against the ousted president and his Muslim Brotherhood _ ominous prospects for a country seething with violent divisions. During three weeks of secret detention, military intelligence has extensively questioned Morsi on the inner workings of his presidency and of the Brotherhood, seeking to prove he committed crimes including handing state secrets to the Islamist group. Military officials tell The Associated Press the interrogations could land Morsi in court in lead to a renewed ban for the Brotherhood.(AP Photo/Maya Alleruzzo, File)
CAIRO (AP) ? Egypt's criminal investigation against the ousted president, announced Friday, is likely just the start of wider legal moves against Mohammed Morsi and his Muslim Brotherhood ? ominous prospects for a country seething with violent divisions.
During Morsi's three weeks in secret detention, military intelligence agents have extensively questioned him on the inner workings of his presidency and of the Brotherhood, seeking to prove he committed crimes including handing state secrets to the Islamist group, military officials told The Associated Press.
Military intelligence has had sole access to him and has questioned him at least once a day, sometimes for up to five hours, the officials said. At times they have presented him voice recordings of his conversations to question him on them, they said.
Throughout, Morsi has been denied access to television and newspapers, they said. He has been moved at least three times between Defense Ministry facilities in armored vehicles under heavy guard. He is currently in a facility outside Cairo, they said, without elaborating.
The military appears not to have decided yet what to do with the information it is gathering. But the officials said it could be used to fuel the civilian prosecution already underway, indict other Brotherhood figures or to justify a more dramatic move: renewing the ban on the Muslim Brotherhood itself.
The group was banned for decades, but became legal after Mubarak's fall and was widely seen as the real power and decision-maker behind Morsi during his year in office. Morsi and the group denied it played any role.
"We allowed Hosni Mubarak to be put on trial and he is one of our own, so there is nothing to stop us from doing this," said one military official familiar with the thinking of the military leadership. Mubarak was a career air force officer touted as a war hero before he became president in 1981. After his 2011 ouster, he was put on trial for complicity in killing protesters.
Since army chief Gen. Abdel-Fattah el-Sissi removed Morsi on July 3, Egypt's first freely elected president has been held incommunicado by the military. Six well placed military and security officials, including two in military intelligence, spoke to AP on condition of anonymity because they were not authorized to discuss the closed-door questioning.
On Friday, civilian prosecutors announced they had launched an investigation into Morsi on charges of murder and conspiring with the Palestinian militant group Hamas. At the heart of the case are allegations that Morsi and the Brotherhood worked with Hamas to carry out an attack on a prison that broke Morsi and around 30 other members of the group out of detention during the 2011 uprising against Mubarak. The attack killed 14 inmates.
The investigation is the first step toward an indictment and possible trial on the charges, which are punishable by death. Prosecutors ordered Morsi detained for 15 days pending the completion of the investigation and security officials late Friday said he was likely to be moved shortly to a civilian, high-security prison south of Cairo.
The officials spoke on condition of anonymity because they were not authorized to speak to the media.
The Brotherhood and Hamas deny the charges, calling them politically motivated. Morsi and the Brotherhood figures freed with him have said local residents attacked the Wadi el-Natroun prison to free their own relatives and that they escaped amid the chaos.
The move to prosecute Morsi shows the "bankruptcy of the leaders of the bloody coup," Brotherhood spokesman Ahmed Aref said in a statement. Egyptians, he added, will reject "the return of the dictatorial police state and all the repression, tyranny and theft it entails."
But the accounts of Morsi's interrogations suggest the military has a more ambitious aim to cripple the 85-year-old Brotherhood.
A move to ban the group again would likely bring a backlash from Islamists.
One senior Brotherhood official, Mohammed el-Beltagy, sought to belittle the significance of such a move.
"They can dissolve it if they want. They are dissolving the whole country now," he told the AP at the site of the group's main protest sit-in at an eastern Cairo district.
Another Brotherhood figure told AP that the group is fully aware that a new ban "cannot be ruled out." But he warned that the result would be "a tragic phase" that would "end with el-Sissi's fall." He spoke on condition of anonymity because the group had not authorized him to discuss the implications of a ban.
The Brotherhood has contended that the military is aiming to crush the Islamist movement after the military coup, which the group and its allies say aims to destroy Egyptian democracy. El-Sissi removed Morsi after four days of massive protests against him by millions of Egyptians.
The military's lines of questioning appear aimed at proving the secretive Brotherhood went far beyond its legal status as a non-government organization involved solely in religious work and put itself above the law.
Military intelligence agents have interrogated Morsi extensively on his actions as president, the officials said. Among the topics are his discussions with foreign leaders during his trips abroad and his ties with Turkey and top Brotherhood ally Qatar, and with Gaza's Hamas rulers, the officials said.
One main avenue is to determine if he gave sensitive state information to Islamist allies abroad or to the Brotherhood, they said.
Another line of questioning focuses on the deeply secretive finances of the Brotherhood and its funding channels abroad, they said.
As a sign of how enmeshed the Brotherhood was with the president, one senior military official noted an incident soon after Morsi took office on June 30, 2012. Morsi brought 19 members of the Brotherhood's top leadership body with him for his first briefing by the then-head of the General Intelligence Agency, Maj. Gen. Murad Muwafi.
When Muwafi objected to their presence because they had no security clearance, Morsi casually told him, "Come on, general, there are no strangers here." Muwafi went on to give the briefing but avoided sharing sensitive material, said the official, who was directly involved in contacts between the Morsi administration and the military and intelligence agencies.
Several weeks later, Morsi fired Muwafi.
The 61-year-old Morsi initially refused to answer investigators' questions but eventually cautiously cooperated, according to a military official with access to records of the questioning.
Throughout, however, he repeatedly declared that he remains Egypt's legitimate president, the official said. He often insisted he tirelessly served Egypt's best interests but was thwarted by the "deep state," the phrase used by Egyptians to refer to Mubarak loyalists and other entrenched powers in the army, security forces and state institutions.
Morsi is observing the dawn-to-sunset fast of the holy month of Ramadan and when not being questioned, he has spent his time praying and reading the Quran, Islam's holy book. He was making a point of praying loudly, seeking God's assistance against his "oppressors," several officials said.
When confronted with audio recordings and documents, Morsi bristled and said his investigators should treat him with the respect a president is entitled to, said the official with access to the questioning records.
At another point, Morsi sarcastically told his interrogators that he did not see the point of them asking him questions since they had video and sound recordings of everything he did while in office, the official said.
Another area that Morsi was being interrogated about is his pardon for dozens of jailed militants who once embraced violence. The officials said the military believes many of them move to Sinai and formed jihadi cells that include foreign extremists.
In the same vein, the military investigators are questioning Morsi on his perceived attempt to stop the military from pursuing militants behind the killing nearly a year ago of 16 army troops at a remote post near the Israel and Gaza borders in Sinai.
During his presidency, Morsi's aides said he was trying to move away from the approach of security crackdowns in Sinai to negotiations to ease discontent among the population there. Opponents accused him of protecting jihadis.
Besides Morsi, five other senior Brotherhood figures have been detained and face investigations by prosecutors on a variety of charges, including inciting violence. More than a dozen others have arrest warrants against them but have not been detained.
HOUSTON?Galveston-born businessman, billionaire developer and philanthropist George P. Mitchell died Friday morning at the age of 94, a family spokesman confirmed.
His legacy is unmatched in Texas, extending from Galveston to Houston to The Woodlands and beyond.
Mitchell, the son of Greek immigrants, grew up on the island and was "raised as a child of meager means," his family said in a statement Friday.
He graduated first in his class at Texas A&M University.
Mitchell was a young lieutenant in the Army when he met his future wife on Thanksgiving 1941 on a train from College Station to Houston. It was the beginning of a beautiful and enduring love story.
At the height of World War II in 1943, Captain George Mitchell and Cynthia Woods were married by an Army chaplain in a double wedding with her twin sister and brother-in-law.?
Their marriage and partnership spanned six decades with 10 children, 23 grandchildren and several great-grandchildren.?
The Mitchell partnership was equally as prolific outside the home. The power couple shared a common vision that led to the development of the first master-planned community in The Woodlands. They later added the popular outdoor performance arts venue, the Cynthia Woods Mitchell Pavilion.
But Mitchell never forgot his roots.
In 1976, the couple?set out on a mission?to preserve and revitalize their beloved Galveston Island, beginning with the Strand Historic District.?
They? transformed the old Blum building?into the charming, European-style Tremont House. They bought and restored the historic beachfront Galvez Hotel, then added another iconic destination to the Seawall in 1984 with The San Luis Hotel.
In 1985, the Mitchells turned their attention to Galveston?s renaissance and brought back the? Mardi Gras celebration that draws 500,000 visitors to the island each winter.
In 2002, Cynthia was diagnosed with Alzheimer?s disease. She died in 2009 at 87 years old, leaving her husband heartbroken and determined to help find a cure for Alzheimer?s.
He contributed millions to Alzheimer?s research at the George and Cynthia Mitchell Center for Neurodegenerative Diseases at UTMB in Galveston. He also helped establish the George P. and Cynthia Mitchell Center for Research on Alzheimer?s Disease and Related Brain Disorders at The University of Texas Health Science Center.
Mitchell?was also a generous donor to his alma mater A&M.
The Mitchells were generous benefactors of the Houston Symphony, Houston Grand Opera, Houston Ballet and United Way. They established the Global Children?s Foundation that provides safe havens to children affected by war.
Throughout his life, Mitchell "believed in giving back to the community that made his success possible and lending a hand to the less fortunate struggling to reach their potential," the Mitchell family said Friday. "He will be fondly remembered for flying in the face of convention?focusing on ?what could be,? with boundless determination?many times fighting through waves of skepticism and opposition to achieve his vision."
When asked about his legacy in 2008, Mitchell was characteristically modest.
"So I think I?ll have enough things people can point to, ?He did this, he did that,?" Mitchell told KHOU 11 News anchor Len Cannon. "That?s all, that?s all? That?s enough."
FILE - In this May 11, 2010 file photo, Immigration Services Director (USCIS) Alejandro Mayorkas listens to a question on Capitol Hill in Washington. Mayorkas, President Barack Obama's choice to be the No. 2 official at the Homeland Security Department is under investigation for his role in helping a company secure an international investor visa for a Chinese executive, The Associated Press has learned. (AP Photo/Harry Hamburg)
FILE - In this May 11, 2010 file photo, Immigration Services Director (USCIS) Alejandro Mayorkas listens to a question on Capitol Hill in Washington. Mayorkas, President Barack Obama's choice to be the No. 2 official at the Homeland Security Department is under investigation for his role in helping a company secure an international investor visa for a Chinese executive, The Associated Press has learned. (AP Photo/Harry Hamburg)
WASHINGTON (AP) ? President Barack Obama's choice to be the No. 2 official at the Department of Homeland Security on Thursday strongly denied allegations that he had helped a politically connected company obtain a foreign investor visa, as his nomination got a White House vote of confidence. Republican senators boycotted the hearing on Alejandro Mayorkas' nomination.
Mayorkas, director of U.S. Citizenship and Immigration Services, told the Senate Homeland Security and Government Affairs Committee that suggestions of impropriety on the visa matter were "unequivocally false" and that he had overseen the program "based on the law and the facts and nothing else."
"I have never, ever in my career exercised undue influence to influence the outcome of a case," he said. "I have never based my decisions on who brings a case but rather on the facts and the law."
The Associated Press obtained a letter from White House counsel Kathryn Ruemmler to the committee stating that the administration has no concerns about Mayorkas' "suitability" for the post. She said the White House followed standard procedures in checking out Mayorkas for the job and urged the Senate to swiftly confirm him.
Mayorkas' nomination hit a snag this week when the AP reported that the Homeland Security Inspector General's Office was investigating his role in helping secure a foreign investor visa for Gulf Coast Funds Management, a company run by former Secretary of State Hillary Rodham Clinton's brother Tony Rodham. The efforts on behalf of Gulf Coast allegedly occurred even after the application had been denied and an appeal rejected.
The hearing played out with an empty bank of chairs for the committee's Republicans. Sen. Tom Coburn of Oklahoma, the ranking Republican on the panel, released a statement saying he wouldn't participate because it would be unfair to do so until the allegations are resolved and there is no pending investigation.
"We believe the committee must wait until these allegations against Mr. Mayorkas are resolved before deciding whether to move forward with his nomination," Coburn said.
Other Republicans stayed away as well.
The committee's chairman, Sen. Thomas Carper, D-Del., acknowledged questions surrounding Mayorkas' qualifications but said it was important to move forward with the hearing to ensure the department has "strong and stable leadership."
"At this point in time, we do not have all the facts," Carper said of the investigation. He also said it was his understanding that Mayorkas had not yet been interviewed by the inspector general's office.
Despite the controversy surrounding Mayorkas, Carper expressed confidence in his nomination.
"I have also taken the opportunity to review Mr. Mayorkas' FBI file, not once, but twice. Nothing in my conversations with Mr. Mayorkas or in my review of his FBI file has convinced me that we should not be holding this hearing today," Carper said.
The nomination took on new importance earlier this month when Homeland Security Secretary Janet Napolitano announced she would be leaving the massive department in September to take over as president of the University of California. Should Mayorkas be approved by the Senate, he almost certainly would lead the department until a permanent replacement for Napolitano is named.
With Napolitano's departure, 15 of the department's 45 top positions will either be filled with an acting official or vacant altogether.
Congressional officials briefed on the Mayorkas investigation, who spoke on the condition of anonymity because they were not authorized to release details of the case publicly, said the visa was for a Chinese executive. Homeland Security and Citizenship and Immigration Services have not commented on the investigation.
In an email to lawmakers Monday, the inspector general's office said that "at this point in our investigation, we do not have any findings of criminal misconduct."
Rodham's company said Tuesday it was not aware of the investigation or of any investor visa application being denied.
According to the inspector general's office email to lawmakers, the FBI's Washington Field Office was told about the Mayorkas investigation in June after it inquired about Mayorkas as part of the White House background investigation for his nomination.
The investigation does not appear to have any direct ties to Clinton's tenure as secretary of state. Nonetheless, any hint of scandal or even the most tangential connection to Clinton, who is a possible 2016 Democratic presidential candidate, is likely to become fodder for Republican super PACs, which have sought to discredit her record while she maintains a lower profile with private speeches and work on a new book.
The international investor visa program run by USCIS, known as EB-5, allows foreigners to get visas if they invest $500,000 to $1 million in projects or businesses that create jobs for U.S. citizens. The amount of the investment required depends on the type of project. Investors who are approved for the program can become legal permanent residents after two years and can later be eligible to become citizens.
Even before the inspector general's investigation became public, two other congressional officials said several Republican members on the committee had planned to ask Mayorkas for more details about his role in the 2001 commutation by President Bill Clinton of the prison sentence of the son of Horacio Vignali, a Democratic Party donor in Los Angeles.
Another of Hillary Rodham Clinton's brothers, Hugh Rodham, had been hired by Horacio Vignali to lobby for the commutation for his son, Carlos, who was serving a 15-year sentence for his conviction on three federal drug charges.
Mayorkas, who was a U.S. attorney in California at the time, told lawmakers during his 2009 confirmation hearing to head USCIS that "it was a mistake" to have talked to the White House about the request. The congressional officials said Mayorkas acknowledged in recent answers to his questionnaire that he also had telephoned a U.S. attorney in Minnesota at the time to check on the Vignali commutation matter.
___
Associated Press writers Julie Pace and Stephen Braun contributed to this report.
___
Follow Alicia A. Caldwell on Twitter at www.twitter.com/acaldwellap
The textbooks I've read emphasize how politically inconsequential minorities in Iran are. Azeris are well integrated; Kurds are co-opted; religious minority communities are even guaranteed symbolic representation in the majlis. Only one of the texts, in my recollection, mentions the Sunnis, and the authors note that there's not even a Sunni mosque in Tehran.
As usual, there's more to this than meets the casual eye.
Iran mobile company indicted for ''insulting Sunnis''
Authorities in Iran have indicted the main mobile network operator, Irancell, on charges of insulting Sunni Muslims in an SMS competition.
Irancell was strongly criticised by Iran's Sunni community over the contest, which allegedly insulted the Sunni's revered Calipha, Omar.
The indictment was made by the Prosecutor General of the predominantly Sunni Province of Sistan-Baluchestan.
Iranian Sunnis have long accused the government of discrimination.
Irancell has blamed the company which provided it with questions for the competition.
The company, a religious cultural organisation [i.e., a bonyad], has since apologised for the ''unintentional" mistake?
Sunnis are believed to comprise about 10% to 20% of Iran's population, but estimates vary because there are no official figures?
Iranian authorities are wary of sectarianism in the country. Their rhetoric stresses the theme of Muslim unity, accusing Sunni radicals and foreign powers ''sowing sectarian discord''.
Sunni communities in Iran are mainly concentrated along Iran's border provinces of Sistan-Baluchestan and Kurdistan.
In recent years, these areas have seen unrest fuelled by sectarianism, ethnic tensions and drug related criminal activity.
More autonomy and equal opportunities for Sunnis has been a campaign theme of reformists and moderates within the Shia establishment.
However, Iranian Shia clerics close to government circles deny that there is discrimination against Sunnis.
Teaching Comparative blog entries are indexed. The Second Edition ofWhat You Need to Know: Teaching Toolsis now available from the publisher
If the Washington Wizards have their way, star guard John Wall will not be going anywhere anytime soon.
Citing ?sources close to the process,? ESPN.com?s Marc Stein reported that the Wizards are in ?advanced talks? to sign Wall to a five-year, $80 million contract extension. The same report claimed both the team and Wall hope to have an agreement completed and signed by August 1.
Wall, 22, must sign an extension by Oct. 31 declaring him a designated franchise player. Otherwise, he?d become a restricted free agent on July 1, 2014.
Medicare spending rates based on regional cost variations unlikely to improve health carePublic release date: 24-Jul-2013 [ | E-mail | Share ]
Contact: Jennifer Walsh news@nas.edu 202-334-2138 National Academy of Sciences
WASHINGTON -- A "geographic value index" that would tie Medicare payment rates to the health benefits and costs of health services in particular regions of the country should not be adopted by Congress, says a new congressionally mandated report from the Institute of Medicine. The committee that wrote the report concluded that decisions about health care generally are made at the level of the physician or organization, such as a hospital, not at the regional level. Because individual physician performance varies, sometimes even within a single practice group, an index based on regions is unlikely to encourage more efficient behavior among individual providers, and therefore, is unlikely to improve the overall value of health care. The new report reiterates the findings of the committee's interim report released in March 2013.
Variation in Medicare spending across geographic areas is driven largely by differences in the use of post-acute care, which includes home health services, skilled nursing facilities, rehabilitation facilities, long-term care hospitals, and hospices, the committee said. If regional variation in post-acute care spending did not exist, Medicare spending variation would fall by 73 percent, and it would fall by 89 percent if there was no variation in both acute and post-acute care. However, an overall explanation for geographic variation in spending remains elusive. The statistical analyses that the committee examined accounted for factors such as beneficiary health status and demographics, insurance plans, and factors related to health care markets, but much of the variation could not be explained by such factors.
The committee also examined the differences in spending at a variety of levels progressively smaller than geographic regions, such as hospital referral regions, hospital service areas, hospitals, and individual providers. Spending varies greatly across all these levels, and providers even at a small level do not practice the same way or perform similarly. Consequently, a geographic value index would reward low-value providers for practicing in areas that are on average high-value and punish high-value providers in low-value regions. As a result, area-level performance calculations would likely mischaracterize the actual value of services delivered by many providers and hospitals, resulting in unfair payments and inappropriate incentives.
The committee found that in contrast to Medicare, variations in spending in the commercial insurance market are due mainly to differences in price markups by providers rather than differences in the use of health care services. Medicare spending is weakly correlated with commercial insurance across regions, and total spending by all payers in a region is not strongly correlated with either Medicare spending or spending by commercial insurers.
To improve care, payment reforms need to create incentives for behavioral change by decision makers, whether they are at the level of individual providers, hospitals, health care systems, or stakeholder collaboratives. The committee recommended that the Centers for Medicare & Medicaid Services (CMS) continue to test Medicare payment reforms that incentivize the clinical and financial integration of health care delivery systems to encourage coordination of care among individual providers, real-time sharing of data and tracking of service use and health outcomes, receipt and distribution of provider payments, and assumption of risk managing their populations' care continuum. CMS should also evaluate the effects of test payment reforms on health care quality by measuring Medicare spending and beneficiaries' clinical health outcomes and use the results to improve the payment models. If these evaluations demonstrate increased quality, Congress should give CMS the flexibility to accelerate the adoption of the new Medicare payment models.
###
Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies. A committee roster follows.
Contacts:
Jennifer Walsh, Senior Media Relations Officer
Rachel Brody, Media Relations Assistant
Office of News and Public Information
202-334-2138; e-mail news@nas.edu
http://national-academies.com/newsroom
Twitter: @NAS_news and @NASciences
RSS feed: http://www.nationalacademies.org/rss/index.html
Flickr: http://www.flickr.com/photos/nationalacademyofsciences/sets
Pre-publication copies of Variation in Health Care Spending: Target Decision Making, Not Geography are available from the National Academies Press on the Internet at http://www.nap.edu or by calling 202-334-3313 or 1-800-624-6242. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).
INSTITUTE OF MEDICINE
Board on Health Care Services
Committee on Geographic Variation in Health Care Spending and Promotion of High-Value Care
Joseph P. Newhouse, Ph.D. (chair)
John D. MacArthur Professor of Health Policy and Management
Harvard School of Public Health and Harvard Kennedy School
Boston
Alan M. Garber, M.D., Ph.D. (vice chair)
Provost
Harvard University, and
Mallinckrodt Professor of Health Care Policy
Harvard Medical School
Boston
Peter B. Bach, M.D.
Director, Center for Health Policy and Outcomes
Department of Epidemiology and Biostatistics
Memorial Sloan-Kettering Cancer Center
New York City
Joseph R. Baker, J.D.
President
Medicare Rights Center
New York City
Amber E. Barnato, M.D., M.P.H., M.S.
Associate Professor of Medicine, and of Clinical and Translational Science, Health Policy, and Management, and
Director, Clinical Scientist Training Program and Doris Duke Clinical Research Fellowship
University of Pittsburgh
Pittsburgh
Robert M. Bell, M.S., Ph.D.
Lead Member, Technical Staff
Statistics Research Department
AT&T Labs Research
Florham Park, N.J.
Karen Davis, Ph.D.
Eugene and Mildred Lipitz Professor and Director
Roger C. Lipitz Center for Integrated Health Care
Department of Public Health Policy and Management
Johns Hopkins Bloomberg School of Public Health
Baltimore
A. Mark Fendrick, M.D.
Professor
Departments of Internal Medicine and Health Management and Policy, and
Director, Center for Value-Based Insurance Design
University of Michigan
Ann Arbor
Paul B. Ginsburg, Ph.D.
President
Center for Studying Health System Change
Washington, D.C.
Douglas A. Hastings, J.D.
Chair of the Board of Directors
Epstein Becker & Green, P.C.
Washington, D.C.
Brent C. James, M.D.
Chief Quality Officer and Executive Director
Institute for Health Care Delivery Research
Intermountain Healthcare Inc.
Salt Lake City
Kimberly Johnson, M.D.
Assistant Professor of Medicine
Division of Geriatrics and Center for Palliative
Duke University Medical Center
Durham, N.C.
Emmett B. Keeler, Ph.D.
Senior Mathematician
RAND Corp.
Santa Monica, Calif.
Thomas H. Lee, M.D.
Professor of Medicine
Harvard Medical School and Harvard School of Public Health, and
CEO and Medical Director
Partners Community Healthcare Inc.
Boston
Mark B. McClellan, Ph.D., M.D.
Director, Engelberg Center for Health Care Reform, and
Leonard D. Schaeffer Director's Chair in Health Policy Studies
The Brookings Institution
Washington, D.C.
Sally C. Morton, Ph.D., M.S.
Professor and Chair
Department of Biostatistics
Graduate School of Public Health
University of Pittsburgh
Pittsburgh
Robert D. Reischauer, Ph.D.
Distinguished Institute Fellow and President Emeritus
The Urban Institute
Washington, D.C.
Alan Weil, J.D.
Executive Director
National Academy for State Health Policy
Washington, D.C.
Gail R. Wilensky, Ph.D.
Senior Fellow
Project HOPE
Bethesda, Md.
STAFF
Robin Graham, Ph.D., M.P.H.
Study Director
[ | E-mail | Share ]
?
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Medicare spending rates based on regional cost variations unlikely to improve health carePublic release date: 24-Jul-2013 [ | E-mail | Share ]
Contact: Jennifer Walsh news@nas.edu 202-334-2138 National Academy of Sciences
WASHINGTON -- A "geographic value index" that would tie Medicare payment rates to the health benefits and costs of health services in particular regions of the country should not be adopted by Congress, says a new congressionally mandated report from the Institute of Medicine. The committee that wrote the report concluded that decisions about health care generally are made at the level of the physician or organization, such as a hospital, not at the regional level. Because individual physician performance varies, sometimes even within a single practice group, an index based on regions is unlikely to encourage more efficient behavior among individual providers, and therefore, is unlikely to improve the overall value of health care. The new report reiterates the findings of the committee's interim report released in March 2013.
Variation in Medicare spending across geographic areas is driven largely by differences in the use of post-acute care, which includes home health services, skilled nursing facilities, rehabilitation facilities, long-term care hospitals, and hospices, the committee said. If regional variation in post-acute care spending did not exist, Medicare spending variation would fall by 73 percent, and it would fall by 89 percent if there was no variation in both acute and post-acute care. However, an overall explanation for geographic variation in spending remains elusive. The statistical analyses that the committee examined accounted for factors such as beneficiary health status and demographics, insurance plans, and factors related to health care markets, but much of the variation could not be explained by such factors.
The committee also examined the differences in spending at a variety of levels progressively smaller than geographic regions, such as hospital referral regions, hospital service areas, hospitals, and individual providers. Spending varies greatly across all these levels, and providers even at a small level do not practice the same way or perform similarly. Consequently, a geographic value index would reward low-value providers for practicing in areas that are on average high-value and punish high-value providers in low-value regions. As a result, area-level performance calculations would likely mischaracterize the actual value of services delivered by many providers and hospitals, resulting in unfair payments and inappropriate incentives.
The committee found that in contrast to Medicare, variations in spending in the commercial insurance market are due mainly to differences in price markups by providers rather than differences in the use of health care services. Medicare spending is weakly correlated with commercial insurance across regions, and total spending by all payers in a region is not strongly correlated with either Medicare spending or spending by commercial insurers.
To improve care, payment reforms need to create incentives for behavioral change by decision makers, whether they are at the level of individual providers, hospitals, health care systems, or stakeholder collaboratives. The committee recommended that the Centers for Medicare & Medicaid Services (CMS) continue to test Medicare payment reforms that incentivize the clinical and financial integration of health care delivery systems to encourage coordination of care among individual providers, real-time sharing of data and tracking of service use and health outcomes, receipt and distribution of provider payments, and assumption of risk managing their populations' care continuum. CMS should also evaluate the effects of test payment reforms on health care quality by measuring Medicare spending and beneficiaries' clinical health outcomes and use the results to improve the payment models. If these evaluations demonstrate increased quality, Congress should give CMS the flexibility to accelerate the adoption of the new Medicare payment models.
###
Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies. A committee roster follows.
Contacts:
Jennifer Walsh, Senior Media Relations Officer
Rachel Brody, Media Relations Assistant
Office of News and Public Information
202-334-2138; e-mail news@nas.edu
http://national-academies.com/newsroom
Twitter: @NAS_news and @NASciences
RSS feed: http://www.nationalacademies.org/rss/index.html
Flickr: http://www.flickr.com/photos/nationalacademyofsciences/sets
Pre-publication copies of Variation in Health Care Spending: Target Decision Making, Not Geography are available from the National Academies Press on the Internet at http://www.nap.edu or by calling 202-334-3313 or 1-800-624-6242. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).
INSTITUTE OF MEDICINE
Board on Health Care Services
Committee on Geographic Variation in Health Care Spending and Promotion of High-Value Care
Joseph P. Newhouse, Ph.D. (chair)
John D. MacArthur Professor of Health Policy and Management
Harvard School of Public Health and Harvard Kennedy School
Boston
Alan M. Garber, M.D., Ph.D. (vice chair)
Provost
Harvard University, and
Mallinckrodt Professor of Health Care Policy
Harvard Medical School
Boston
Peter B. Bach, M.D.
Director, Center for Health Policy and Outcomes
Department of Epidemiology and Biostatistics
Memorial Sloan-Kettering Cancer Center
New York City
Joseph R. Baker, J.D.
President
Medicare Rights Center
New York City
Amber E. Barnato, M.D., M.P.H., M.S.
Associate Professor of Medicine, and of Clinical and Translational Science, Health Policy, and Management, and
Director, Clinical Scientist Training Program and Doris Duke Clinical Research Fellowship
University of Pittsburgh
Pittsburgh
Robert M. Bell, M.S., Ph.D.
Lead Member, Technical Staff
Statistics Research Department
AT&T Labs Research
Florham Park, N.J.
Karen Davis, Ph.D.
Eugene and Mildred Lipitz Professor and Director
Roger C. Lipitz Center for Integrated Health Care
Department of Public Health Policy and Management
Johns Hopkins Bloomberg School of Public Health
Baltimore
A. Mark Fendrick, M.D.
Professor
Departments of Internal Medicine and Health Management and Policy, and
Director, Center for Value-Based Insurance Design
University of Michigan
Ann Arbor
Paul B. Ginsburg, Ph.D.
President
Center for Studying Health System Change
Washington, D.C.
Douglas A. Hastings, J.D.
Chair of the Board of Directors
Epstein Becker & Green, P.C.
Washington, D.C.
Brent C. James, M.D.
Chief Quality Officer and Executive Director
Institute for Health Care Delivery Research
Intermountain Healthcare Inc.
Salt Lake City
Kimberly Johnson, M.D.
Assistant Professor of Medicine
Division of Geriatrics and Center for Palliative
Duke University Medical Center
Durham, N.C.
Emmett B. Keeler, Ph.D.
Senior Mathematician
RAND Corp.
Santa Monica, Calif.
Thomas H. Lee, M.D.
Professor of Medicine
Harvard Medical School and Harvard School of Public Health, and
CEO and Medical Director
Partners Community Healthcare Inc.
Boston
Mark B. McClellan, Ph.D., M.D.
Director, Engelberg Center for Health Care Reform, and
Leonard D. Schaeffer Director's Chair in Health Policy Studies
The Brookings Institution
Washington, D.C.
Sally C. Morton, Ph.D., M.S.
Professor and Chair
Department of Biostatistics
Graduate School of Public Health
University of Pittsburgh
Pittsburgh
Robert D. Reischauer, Ph.D.
Distinguished Institute Fellow and President Emeritus
The Urban Institute
Washington, D.C.
Alan Weil, J.D.
Executive Director
National Academy for State Health Policy
Washington, D.C.
Gail R. Wilensky, Ph.D.
Senior Fellow
Project HOPE
Bethesda, Md.
STAFF
Robin Graham, Ph.D., M.P.H.
Study Director
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Bill Thompson, former New York City comptroller and rising candidate for mayor, spoke out against the New York Police Department?s controversial?stop and frisk? policy, one of the few times he?s discussed race, invoking George Zimmerman.
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Public release date: 24-Jul-2013
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