Frequently used biologic agents might cause acute liver injury

Apr. 29, 2013 ? A commonly used class of biologic response modifying drugs can cause acute liver injury with elevated liver enzymes, according to a new study in Clinical Gastroenterology and Hepatology, the official clinical practice journal of the American Gastroenterological Association. Patients with inflammatory diseases such as Chron's disease or ulcerative colitis often are prescribed tumor necrosis factor-alpha (TNF-?) antagonists, which modify the body's response to infection. Patients with inflammatory arthropathies and selected dermatological diseases are also candidates to receive such compounds.

"TNF-? antagonists are extremely beneficial as therapies for several bowel, joint and skin inflammatory conditions," said Maurizio Bonacini, MD, AGAF, study author and associate clinical professor, University of California, San Francisco. "However, gastroenterologists, internists, rheumatologists and dermatologists all need to be aware of this potential complication and know how to diagnose it. They should conduct tests for autoimmunity early upon diagnosis of abnormalities to determine the proper path of care."

Researchers searched the U.S. Drug-Induced Liver Injury Network database and identified six well-characterized cases of drug-induced liver injury (DILI) in the setting of TNF-? antagonist therapy. Additionally, they reviewed 28 additional cases identified in PubMed. The researchers found acute liver injury in all cases, most frequently autoimmunity and hepatocellular injury, but mixed non-autoimmune patterns and cholestasis (blocked flow of bile from the liver) also occurred. No deaths were attributed to the liver injury; one patient required a liver transplant, which was attributed to pre-existing cirrhosis with superimposed DILI.

Of the TNF-? antagonists, infliximab-associated liver injury has been the best documented, most likely because of its earlier approval and more wide-spread clinical use. Etanercept and adalimumab have also been linked to drug-induced liver injury. So far, there are no published cases found to be linked to natalizumab, golimumab or certolizumab.

The researchers found that liver damage was typically resolved following drug discontinuation, although some patients did benefit from a course of corticosteroids. Importantly, patients treated with an alternative TNF-? after resolution of their liver injury appeared to tolerate the drugs without recurrence.

"If patients who are taking these biologic agents experience symptoms such as abdominal pain, nausea and fatigue, physicians should check liver enzyme levels to determine if the symptoms are a result of these drugs," added Dr. Bonacini.

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Journal Reference:

1. Marwan Ghabril, Herbert L. Bonkovsky, Clarissa Kum, Tim Davern, Paul H. Hayashi, David E. Kleiner, Jose Serrano, Jim Rochon, Robert J. Fontana, Maurizio Bonacini. Liver Injury From Tumor Necrosis Factor-? Antagonists: Analysis of Thirty-four Cases. Clinical Gastroenterology and Hepatology, 2013; 11 (5): 558 DOI: 10.1016/j.cgh.2012.12.025

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Source: http://feeds.sciencedaily.com/~r/sciencedaily/top_news/top_health/~3/ZXJuWf8KuwY/130429164926.htm

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10 things you need to know today: April 28, 2013

Obama entertains at the White House Correspondents' Dinner, another ricin suspect is arrested, and more in our roundup of stories that are making news and driving opinion

1.?OBAMA CRACKS JOKES AT CORRESPONDENTS' DINNER
President Obama joked Saturday night about his plans for a radical second-term evolution from "strapping young Socialist" to retiree golfer at this year's annual White House Correspondents' Association dinner, hosted by Conan O'Brien. Before showing a montage of photos of him sporting bangs styled like first lady Michelle's, Obama joked about how re-election would allow him to unleash a radical agenda. But then he showed a picture of himself golfing on a mock magazine cover of Senior Leisure. Obama closed by noting the nation's recent tragedies in Massachusetts?and Texas, praising Americans of all stripes, from first responders to local journalists for serving the public good.?[Huffington Post]
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2. OWNER OF COLLAPSED BANGLADESH BUILDING IS ARRESTED
The owner of Rana Plaza, the building that collapsed last week near Dhaka, Bangladesh, was arrested on Sunday at a border crossing with India. After the owner, Mohammed Sohel Rana, was arrested, an announcement was made by loudspeaker at the site of the collapsed building, where people cheered and clapped. At least 362 people have died as a result of the Wednesday?collapse of the eight-story building that housed garment factories. It is already the deadliest tragedy to hit Bangladesh's garment industry, surpassing another deadly tragedy in November.?[New York Times]
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SEE MORE: Latest shots in the austerity debate: Krugman vs. Reinhart and Rogoff

3.?FURLOUGH ENDS, FAA RETURNS TO REGULAR STAFFING
Less than a week after furloughs began that idled air traffic controllers and delayed flights, the FAA will return to normal staffing levels by Sunday evening. The move comes after Congress voted to let the FAA move money around in its budget ? a quick response that came after several days of travel delays that were either caused by or worsened by the furloughs. The FAA is taking action despite the fact that the legislation has not yet been signed by President Obama. A?typo ? a missing "s" ? exists in the Senate version of the bill, but not the House version. The Senate is expected to correct the error Tuesday.?[NPR]
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4.?ANOTHER RICIN SUSPECT IS ARRESTED IN MISSISSIPPI
FBI agents arrested J. Everett Dutschke, a Mississippi man, Saturday in connection with sending?ricin-laced letters to government officials.?Dutschke, of Tupelo, Miss., was charged with possessing a toxin for use as a weapon, among other charges, the U.S. attorney's office said.?The arrest follows a tumultuous week in which the man initially charged, Paul Kevin Curtis, an Elvis impersonator who had quarreled with Dutschke, was released. Dutschke is a martial-arts instructor, rock musician and failed political candidate.?[Wall Street Journal]
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SEE MORE: 10 things you need to know today: April 27, 2013

5.?TWO SHOT OUTSIDE ITALIAN PM'S OFFICE
Two Italian police officers were wounded Sunday when a gunman shot at officers outside the prime minister's office in Rome. The gunman, a 49-year-old man from Calabria, Italy, fired five shots at police before being taken into custody. The officers didn't suffer life-threatening wounds, and the shooter was also hospitalized, though unwounded. Enrico Letta was being sworn in as prime minister at the time at the president's palace a short distance away. Police said the man's motive was unclear.?[CNN]
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6. CHERTOFF?DESCRIBES TRICKY SYRIAN CHEMICAL WEAPON?SITUATION
Former Homeland Security Secretary Michael Chertoff acknowledged Sunday that President Obama is in a difficult situation when it comes to Syrian President Bashar al-Assad's alleged use of chemical weapons on Syrian rebels. "Putting aside the question of exactly what we do, once we announce there's a red line, if we don't take it seriously, then we are discrediting ourselves not only in Syria, but in Iran, North Korea, and all around the world," Chertoff said on CNN's State of the Union. Former Undersecretary of State Nicholas Burns agreed and said the need for concrete evidence is necessary to avoid another situation like U.S. involvement in Iraq.?[Politico]
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SEE MORE: Are $100,000 cancer drugs unethical?

7.?JAPANESE AIRLINE RESUMES BOEING FLIGHTS
ANA, the Japanese launch customer for Boeing's 787, flew its first Dreamliner in more than three months on Sunday to test reinforced batteries installed by Boeing. The successful flight was the second by an airline since aviation regulators on Friday gave permission for 787 operations to restart after batteries on two of them overheated in mid-January. On Saturday,?Ethiopian Airlines became the world's first carrier to resume flying Dreamliner?jets since the global fleet was grounded.?[Reuters]
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8.?BLACK VOTER TURNOUT HIT HIGH IN 2012 ELECTION
America's blacks voted at a higher rate than other minority groups in 2012 and, by most measures, surpassed the white turnout for the first time, reflecting a deeply polarized presidential election in which blacks strongly supported Barack Obama while many whites stayed home. Had people voted last November at the same rates they did in 2004, when black turnout was below its current historic levels, Mitt Romney would have won narrowly, according to an analysis conducted for The Associated Press.?[Washington Post]
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SEE MORE: The week in words

9.?WWII IWO JIMA FLAG PROVIDER DIES
Alan Wood, a World War II veteran credited with providing the flag in the famous flag-raising on Iwo Jima, has died at the age of 90. Wood died April 18 of natural causes at his Sierra Madre home, his son Steven Wood said Saturday. Wood was a 22-year-old Navy officer when five Marines and a Navy Corpsman later raised his flag in a stirring moment captured by Associated Press photographer Joe Rosenthal.?[USA Today]
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10.?ZACH BRAFF RAISES $2 MILLION FOR NEW MOVIE
Another day, another celebrity-backed movie fundraiser on Kickstarter. Just three days after Zach Braff posted his Garden State follow-up on Kickstarter, Wish I Was Here has already hit its $2 million fundraising goal. One particularly deep-pocketed Braff supporter made a $10,000 donation, earning the most prized reward: Being a cast member in Wish I Was Here, which involves speaking a line of dialogue written by Braff.?[Entertainment Weekly]

SEE MORE: Is gun control primed for a huge comeback?

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Source: http://news.yahoo.com/10-things-know-today-april-28-2013-095500508.html

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International troops should prepare to go into Syria: U.S. senator

WASHINGTON (Reuters) - A group of nations should get troops ready to invade Syria in order to secure possible stocks of chemical weapons, a senior U.S. senator said on Sunday.

Senator John McCain, a Republican from Arizona, said U.S. troops should not go into Syria, but that an international force must "be ready operationally" to go in and prevent Islamic militants involved in Syria's civil war from getting their hands on chemical weapons.

"There are number of caches of these chemical weapons. They cannot fall into the hands of the jihadists," McCain, who was the 2008 Republican presidential candidate and is an influential voice on military issues in the U.S. Senate, told NBC's Meet The Press.

More than 70,000 people have died in Syria's two-year-old civil war, and the White House said on Thursday the Syrian government of President Bashar al-Assad had probably used chemical weapons on a small scale in the conflict.

Syria denies using chemical weapons in the war.

The U.S. fears anti-Assad Islamist rebels affiliated to al Qaeda could seize the chemical weapons, and Washington and its allies have discussed scenarios where tens of thousands of ground troops go into Syria if Assad's government falls.

(Reporting by Jason Lange; editing by Christopher Wilson)

Source: http://news.yahoo.com/international-troops-prepare-syria-u-senator-150852575.html

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Miss. man charged in suspicious letters case

BRANDON, Miss. (AP) ? An ex-martial arts instructor made ricin and put the poison in letters to President Barack Obama and others, the FBI charged Saturday, days after dropping similar charges against an Elvis impersonator who insisted he had been framed.

The arrest of 41-year-old James Everett Dutschke early Saturday capped a week in which investigators initially zeroed in on a rival of Dutschke's, then decided they had the wrong man. The hunt for a suspect revealed tie after small-town tie between the two men and the 80-year-old county judge who, along with Obama and U.S. Sen. Roger Wicker of Mississippi, was among the targets of the letters.

Dutschke's house, business and vehicles in Tupelo were searched earlier in the week often by crews in hazardous materials suits and he had been under surveillance.

Dutschke (pronounced DUHS'-kee) was charged with "knowingly developing, producing, stockpiling, transferring, acquiring, retaining and possessing a biological agent, toxin and delivery system, for use as a weapon, to wit: ricin." U.S. attorney Felicia Adams and Daniel McMullen, the FBI agent in charge in Mississippi, made the announcement in a news release Saturday.

Dutschke's attorney, Lori Nail Basham, said she had no comment. Earlier this week she said that Dutschke was cooperating fully with investigators and Dutschke has insisted he had nothing to do with the letters. He was arrested about 12:50 a.m. at his house in Tupelo and is expected in court Monday. He faces up to life in prison, if convicted.

He already had legal problems. Earlier this month, he pleaded not guilty in state court to two child molestation charges involving three girls younger than 16. He also was appealing a conviction on a different charge of indecent exposure. He told AP earlier this week that his lawyer told him not to comment on those cases.

The letters, which tests showed were tainted with ricin, were sent April 8 to Obama, Sen. Roger Wicker of Mississippi and Mississippi judge, Sadie Holland.

Wicker spokesman Ryan Taylor said since the investigation was ongoing, the senator couldn't comment.

The first suspect fingered by the FBI was Paul Kevin Curtis, 45, an Elvis impersonator. He was arrested on April 17 at his Corinth, Miss., home, but the charges were dropped six days later and Curtis, who says he was framed, was released from jail.

The focus then turned to Dutschke, who has ties to the former suspect, the judge and the senator. Earlier in the week, as investigators searched his primary residence in Tupelo, Dutschke told The Associated Press, "I don't know how much more of this I can take."

"I'm a patriotic American. I don't have any grudges against anybody. ... I did not send the letters," Dutschke said.

Curtis' attorney, Christi McCoy, said Saturday: "We are relieved but also saddened. This crime is nothing short of diabolical. I have seen a lot of meanness in the past two decades, but this stops me in my tracks."

Some of the language in the letters was similar to posts on Curtis' Facebook page and they were signed, "I am KC and I approve this message." Curtis' signoff online was often similar.

And Dutschke and Curtis were acquainted. Curtis said they had talked about possibly publishing a book on a conspiracy that Curtis insists he has uncovered to sell body parts on a black market. But he said they later had a feud.

Curtis' attorneys have said they believe their client was set up. An FBI agent testified that no evidence of ricin was found in searches of Curtis' home. Curtis attorney Hal Neilson said the defense gave authorities a list of people who may have had a reason to hurt Curtis and Dutschke came up.

Judge Holland also is a common link between the two men, and both know Wicker.

Holland was the presiding judge in a 2004 case in which Curtis was accused of assaulting a Tupelo attorney a year earlier. Holland sentenced him to six months in the county jail. He served only part of the sentence, according to his brother.

And Holland's family has had political skirmishes with Dutschke. Her son, Steve Holland, a Democratic state representative, said he thinks his mother's only other encounter with Dutschke was at a rally in the town of Verona in 2007, when Dutschke ran as a Republican against Steve Holland.

Holland said his mother confronted Dutschke after he made a derogatory speech about the Holland family. She demanded that he apologize, which Holland says he did.

On Saturday, Steve Holland said he can't say for certain that Dutschke is the person who sent the letter to his mother but added, "I feel confident the FBI knows what they are doing."

"We're ready for this long nightmare to be over," Holland told The Associated Press.

He said he's not sure why someone would target his mother. Holland said he believes Dutschke would have more reason to target him than his mother.

"Maybe he thinks the best way to get to me is to get to the love of my life, which is my mother," Holland said.

___

Associated Press writer Jack Elliott Jr. in Jackson contributed to this report.

___

Follow Mohr at http://twitter.com/holbrookmohr.

Source: http://news.yahoo.com/miss-man-charged-suspicious-letters-case-195839113.html

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Racing car with electric drive

Apr. 26, 2013 ? Drive technology has an electric future -- of this Fraunhofer research scientists are in no doubt. At the Sensor + Test measurement fair in Nuremberg from May 14 -16, they will use an electric racing car to present novel solutions for battery management and electronic sensor systems together with an industry partner. The scientists are following a new trend, as even FIA, the governing body for world motor sport, federation of the world's leading motoring organizations and organizer of Formula 1, is planning a racing series for electric vehicles.

From 0 to 100 in 3.6 seconds -- we're not talking about the rapid acceleration of a Porsche Carrera or Ferrari Scaglietti, but of EVE, a racing car with a very quiet engine. EVE is powered by two electric motors, one for each rear wheel. With a maximum output of 60 kilowatts, they get the e-racer going at 4500 rotations per minute. The sprinter can reach a top speed of 140 km/h, and has a range of 22 km thanks to two lithium polymer batteries, with a combined capacity of 8 kWh. Electrical engineering students from the e-racing team at the Hochschule Esslingen University of Applied Sciences designed the 300 kg car as a voluntary project alongside their studies, and they have already competed in it at the international Formula Student Electric (FSE) race in Italy. From May 14-16, the racing car will be on show at the Sensor + Test measurement fair in Nuremberg at the joint Fraunhofer trade show booth (Hall 12, Booth 537). Scientists from the Fraunhofer Institute for Integrated Circuits IIS in Erlangen developed the entire electronic sensor system in close collaboration with Seuffer GmbH & Co.KG, an industry partner with whom the institute has been working for over 11 years. Seuffer GmbH & Co.KG is based in Calw in Baden-W?rttemberg, southern Germany, and sponsors the students of the E.Stall racing team.

"Electromobility as a topic is becoming ever more important. The racing car serves as a showcase for us to demonstrate novel sensor solutions as well as battery and energy management concepts," says Klaus-Dieter Taschka, an engineer at Fraunhofer IIS. Besides wheels, brakes, damper unit, batteries and electric motors, EVE is equipped with numerous sensors. These include braking pressure, crash, temperature and acce- leration sensors as well as sensors that monitor the accelerator and brake pedals, speed, steering angle, wheel speed and power. These last six functions could all be performed by HallinOne? sensors developed by Fraunhofer IIS, 3D magnetic-field sensors that are already a standard feature in washing machines, where they are used to determine the position and orientation of the drum.

Electronic sensors determine charge state of the battery

The two electronic sensors attached at the sides of the batteries use 3D magnetic-field sensor technology developed by Fraunhofer IIS to measure the magnetic field generated by the flow of electrical current and thus to determine the battery's level of charge. What's special about this is that the contactless sensors measure both the current that flows from the battery to the engine and the current that flows back again when the vehicle brakes. The integrated sensor system is able to eliminate disturbances and foreign magnetic fields, thus guaranteeing very precise measurements. A further advantage is that the system is also able to measure other aspects of the battery such as its voltage and temperature. The data is collected and sent to the power control unit (PCU) and the battery management system (BMS), which controls the charging and discharging processes.

Intelligent battery management system extends battery life

Battery running times and battery life are limiting factors for all electric vehicles. The BMS developed by Fraunhofer IIS in Nuremberg tackles this problem by determining the impedance spectrum of all battery cells and constantly testing whether the cells are functioning properly. This allows cells' condition, current capacity and potential service life to be ascertained and running times to be predicted more accurately.

As individual battery cells age, they are able to store less and less energy. The challenge lies in optimizing cell utilization. "Until now, a battery system was able to provide only as much energy as was available in its weakest cell. The energy stored in other cells remained unused. Our BMS has an active cell balancing system that moves energy between stronger and weaker cells. This means that all cells share the load equally, allowing the maximum capacity of the battery as a whole to be utilized," explains Dr.-Ing. Peter Spies, group manager at Fraunhofer IIS in Nuremberg. Actively balancing out the cells during the charging and discharging process extends the battery's service life and range. "EVE's current BMS is a system developed in house by E.Stall, but our solution could take its place," says Spies.

Polarization camera detects cracks in bodywork

EVE's compact design is built on a tubular steel space frame housed within a carbon fiber body. Racing around the track puts a great deal of stress on the plastic fibers, and this can lead to tiny cracks developing in the material. Fraunhofer IIS in Erlangen has developed POLKA, a polarization camera that can detect such damage at an early stage by measuring stresses within unpainted surfaces of the carbon structure. This compact camera makes any scratches visible by registering properties of light that are imperceptible to the human eye: polarization. Material stresses in the plastic cause changes in polarization. POLKA is able to collect all the polarization information for each pixel in a single shot at speeds of up to 250 frames per second. Using real-time color coding, the dedicated software translates the information collected about the intensity, angle and degree of polarization into a visual display that is accessible to the human eye. The system will also be presented at the joint Fraunhofer booth.

"We are convinced that EVE's innovative technology will allow the vehicle to perform very well while demonstrating excellent environmental awareness," says Rolf Kleiner, group manager of the battery technology department at Seuffer. And the students of team E.Stall will soon have a chance to prove it: This year EVE will be in the lineup for the Formula Student race in Italy, Spain and Czechia.

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38 die in psychiatric hospital fire outside Moscow

MOSCOW (AP) ? At least 38 people died in a fire in a psychiatric hospital outside Moscow late Thursday night.

Police said the fire, which broke out at about 2 a.m. local time (6 p.m. Eastern, 2200 GMT) in the one-story hospital in the Ramenskoye settlement, was caused by a short circuit, the RIA Novosti reported on Friday.

Officials from the Russian Investigative Committee later said they are looking at poor fire regulations and short circuit as possible causes.

By early Friday morning, investigators listed 38 people ? 36 patients and two doctors ? as dead. Only three nurses managed to escape. The emergency services also posted a list of the patients indicating they ranged in age from 20 to 76.

Health Ministry officials said that hospital housed patients with severe mental disorders. Vadim Belovoshin from the emergency situations ministry official told the Itar-TASS news agency that the windows in the hospital were barred but said there were two fire escapes.

Belovoshin also said that it took fire fighters an hour to get to the hospital following an emergency call because a local ferry across the river was closed and the fire fighters had to make a detour.

Deadly fires are common in Russia because of wide-spread violations of fire safety rules.

Source: http://news.yahoo.com/38-die-mental-hospital-fire-outside-moscow-051615611.html

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Hands off "Game of Thrones", says U.S. ambassador to Australians

SYDNEY (Reuters) - Taking to Facebook, the U.S. ambassador to Australia is urging Australians to cease their illegal downloads of "Game of Thrones", saying that they are among the world's worst pirates of the wildly popular medieval television drama.

In a post titled "Stopping the Game of Clones", Jeffrey Bleich - himself a devotee of the HBO series - compared the rampant piracy of online thieves to the plotting and machinations of the noble houses in the show.

"Unfortunately, nearly as epic and devious as the drama is its unprecedented theft by online viewers around the world," he wrote on his official Facebook page.

"As the ambassador here in Australia, it was especially troubling to find out that Australian fans were some of the worst offenders with among the highest piracy rates of 'Game of Thrones' in the world".

TorrentFreak, a file-sharing news website, estimated that Game of Thrones was the most pirated TV series in 2012, with one episode notching 4.28 million pirated downloads, equal to the number of broadcast viewers for that episode, Bleich said.

When the second season began, Australian fans had to wait a week before being able to access new episodes by legitimate means, but the wait has come down to a few hours for the third season.

Neil Gane, managing director of the Australian Federation Against Copyright Theft (AFACT), said that surveys had found that unsurprisingly, most of the illegal downloaders said they did it because it was free.

Game of Thrones season 2 is priced at $38.99 in the Apple iTunes store in the United States and A$33.99 ($35.05) in the Australian store.

"The number of unauthorized downloads is staggering," he told Reuters in an email.

Based on the books by George R. R. Martin, the show follows a vast cast of characters fighting for control of the throne in the fictional world of Westeros.

"If the 4 million people who watched Game of Thrones legally had been illegal downloaders - the show would be off the air and there would never have been a season 3," Bleich said. ($1 = 0.9697 Australian dollars)

(Reporting By Thuy Ong; Editing by Elaine Lies and Robert Birsel)

Source: http://news.yahoo.com/hands-off-game-thrones-says-u-ambassador-australians-081628052.html

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Movement of pyrrole molecules defy 'classical' physics

Apr. 26, 2013 ? New research shows that movement of the ring-like molecule pyrrole over a metal surface runs counter to the centuries-old laws of 'classical' physics that govern our everyday world.

Using uniquely sensitive experimental techniques, scientists have found that laws of quantum physics -- believed primarily to influence at only sub-atomic levels -- can actually impact on a molecular level.

Researchers at Cambridge's Chemistry Department and Cavendish Laboratory say they have evidence that, in the case of pyrrole, quantum laws affecting the internal motions of the molecule change the "very nature of the energy landscape" -- making this 'quantum motion' essential to understanding the distribution of the whole molecule.

The study, a collaboration between scientists from Cambridge and Rutgers universities, appeared in the German chemistry journal Angewandte Chemie earlier this month.

A pyrrole molecule's centre consists of a "flat pentagram" of five atoms, four carbon and one nitrogen. Each of these atoms has an additional hydrogen atom attached, sticking out like spokes.

Following experiments performed by Barbara Lechner at the Cavendish Laboratory to determine the energy required for movement of pyrrole across a copper surface, the team discovered a discrepancy that led them down a 'quantum' road to an unusual discovery.

In previous work on simpler molecules, the scientists were able to accurately calculate the 'activation barrier' -- the energy required to loosen a molecule's bond to a surface, allowing movement -- using 'density functional theory', a method that treats the electrons which bind the atoms according to quantum mechanics but, crucially, deals with atomic nuclei using a 'classical' physics approach.

Surprisingly, with pyrrole the predicted 'activation barriers' were way out, with calculations "less than a third of the measured value." After much head scratching, puzzled scientists turned to a purely quantum phenomenon called 'zero-point energy'.

In classical physics, an object losing energy can continue to do so until it can be thought of as sitting perfectly still. In the quantum world, this is never the case: everything always retains some form of residual -- even undetectable -- energy, known as 'zero-point energy'.

While 'zero-point energy' is well known to be associated with motion of the atoms contained in molecules, it was previously believed that such tiny amounts of energy simply don't affect the molecule as a whole to any measurable extent, unless the molecule broke apart.

But now, the researchers have discovered that the "quantum nature" of the molecule's internal motion actually does affect the molecule as a whole as it moves across the surface, defying the 'classical' laws that it's simply too big to feel quantum effects.

'Zero-point energy' moving within a pyrrole molecule is unexpectedly sensitive to the exact site occupied by the molecule on the surface. In moving from one site to another, the 'activation energy' must include a sizeable contribution due to the change in the quantum 'zero-point energy'.

Scientists believe the effect is particularly noticeable in the case of pyrrole because the 'activation energy' needed for diffusion is particularly small, but that many other similar molecules ought to show the same kind of behavior.

"Understanding the nature of molecular diffusion on metal surfaces is of great current interest, due to efforts to manufacture two-dimensional networks of ring-like molecules for use in optical, electronic or spintronic devices," said Dr Stephen Jenkins, who heads up the Surface Science Group in Cambridge's Department of Chemistry.

"The balance between the activation energy and the energy barrier that sticks the molecules to the surface is critical in determining which networks are able to form under different conditions."

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Journal Reference:

1. Barbara A. J. Lechner, Holly Hedgeland, John Ellis, William Allison, Marco Sacchi, Stephen J. Jenkins, B. J. Hinch. Quantum Influences in the Diffusive Motion of Pyrrole on Cu(111). Angewandte Chemie International Edition, 2013; DOI: 10.1002/anie.201302289

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Source: http://feeds.sciencedaily.com/~r/sciencedaily/matter_energy/physics/~3/RDFpcgJ5_Os/130426115449.htm

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Boosting the powers of genomic science

Apr. 25, 2013 ? As scientists probe and parse the genetic bases of what makes a human a human (or one human different from another), and vigorously push for greater use of whole genome sequencing, they find themselves increasingly threatened by the unthinkable: Too much data to make full sense of.

In a pair of papers published in the April 25, 2013 issue of PLOS Genetics, two diverse teams of scientists, both headed by researchers at the University of California, San Diego School of Medicine, describe novel statistical models that more broadly and deeply identify associations between bits of sequenced DNA called single nucleotide polymorphisms or SNPs and say lead to a more complete and accurate understanding of the genetic underpinnings of many diseases and how best to treat them.

"It's increasingly evident that highly heritable diseases and traits are influenced by a large number of genetic variants in different parts of the genome, each with small effects," said Anders M. Dale, PhD, a professor in the departments of Radiology, Neurosciences and Psychiatry at the UC San Diego School of Medicine. "Unfortunately, it's also increasingly evident that existing statistical methods, like genome-wide association studies (GWAS) that look for associations between SNPs and diseases, are severely underpowered and can't adequately incorporate all of this new, exciting and exceedingly rich data."

Dale cited, for example, a recent study published in Nature Genetics in which researchers used traditional GWAS to raise the number of SNPs associated with primary sclerosing cholangitis from four to 16. The scientists then applied the new statistical methods to identify 33 additional SNPs, more than tripling the number of genome locations associated with the life-threatening liver disease.

Generally speaking, the new methods boost researchers' analytical powers by incorporating a priori or prior knowledge about the function of SNPs with their pleiotrophic relationships to multiple phenotypes. Pleiotrophy occurs when one gene influences multiple sets of observed traits or phenotypes.

Dale and colleagues believe the new methods could lead to a paradigm shift in CWAS analysis, with profound implications across a broad range of complex traits and disorders.

"There is ever-greater emphasis being placed on expensive whole genome sequencing efforts," he said, "but as the science advances, the challenges become larger. The needle in the haystack of traditional GWAS involves searching through about one million SNPs. This will increase 10- to 100-fold, to about 3 billion positions. We think these new methodologies allow us to more completely exploit our resources, to extract the most information possible, which we think has important implications for gene discovery, drug development and more accurately assessing a person's overall genetic risk of developing a certain disease."

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The above story is reprinted from materials provided by University of California, San Diego Health Sciences, via Newswise.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

---

Journal References:

1. Andrew J. Schork, Wesley K. Thompson, Phillip Pham, Ali Torkamani, J. Cooper Roddey, Patrick F. Sullivan, John R. Kelsoe, Michael C. O'Donovan, Helena Furberg, Nicholas J. Schork, Ole A. Andreassen, Anders M. Dale. All SNPs Are Not Created Equal: Genome-Wide Association Studies Reveal a Consistent Pattern of Enrichment among Functionally Annotated SNPs. PLoS Genetics, 2013; 9 (4): e1003449 DOI: 10.1371/journal.pgen.1003449
2. Ole A. Andreassen, Wesley K. Thompson, Andrew J. Schork, Stephan Ripke, Morten Mattingsdal, John R. Kelsoe, Kenneth S. Kendler, Michael C. O'Donovan, Dan Rujescu, Thomas Werge, Pamela Sklar, J. Cooper Roddey, Chi-Hua Chen, Linda McEvoy, Rahul S. Desikan, Srdjan Djurovic, Anders M. Dale. Improved Detection of Common Variants Associated with Schizophrenia and Bipolar Disorder Using Pleiotropy-Informed Conditional False Discovery Rate. PLoS Genetics, 2013; 9 (4): e1003455 DOI: 10.1371/journal.pgen.1003455

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Source: http://feeds.sciencedaily.com/~r/sciencedaily/~3/W-16k4bufPw/130425213754.htm

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Young couple, sons, grandma ID'd in Ill. killings

MANCHESTER, Ill. (AP) ? The five people found shot to death in a small south-central Illinois town this week were two young brothers, their pregnant mother, their father and their great grandmother, authorities said Thursday.

Investigators were still trying to piece together the events that led to Scott County's first homicide in two decades, and why the suspect, Rick O. Smith allegedly walked into a home Wednesday and shot an entire family ? including a 6-year-old girl who survived ? before he was killed during a shootout with police.

The Illinois State Police said the victims were: 1-year-old Brantley Ralston, 5-year-old Nolan Ralston, 29-year-old James Ralston, 23-year-old Brittney Luark, and 67-year-old Jo Ann Sinclair. Sinclair was Luark's grandmother.

Authorities believe Smith and the victims were acquainted, but they didn't provide details of the relationships. Manchester Mayor Ronald Drake confirmed Wednesday that Smith was his nephew.

The state police said they believe Smith, 43, entered the home through the back door Wednesday and shot the victims at close range with a shotgun. Two people were found in a bedroom, two in a second bedroom and the man in the hallway. A sixth victim, a 6-year-old girl, was injured and taken to a hospital in Springfield.

"The offender took the 6-year-old out of the residence and put her in the hands of a neighbor," State Police Lt. Col. Todd Kilby said.

A bystander called police and told them that Smith fled in a white sedan. Smith led authorities on a chase to the nearby town of Winchester, where they exchanged gunfire. Officers shot Smith, and he later died at a hospital.

Police said they found a rifle, shotgun and large hunting knife in Smith's car.

Scott County State's Attorney Michael Hill said Smith, of rural Morgan County, had previous convictions for reckless homicide, drugs and bad checks.

Drake said he hadn't spoken to Smith in two years but that he believed his nephew was unemployed. Drake said the last time Smith contacted him was to borrow tools.

The preschool program that Nolan Ralston attended was closed Thursday, and Winchester Community School District Superintendent Dave Roberts said staff was meeting Thursday to decide how to broach the subject.

"I am trying to work with staff to get them prepared," he said. "They are very emotional at this point."

Roberts said he also wants to meet with parents Thursday night.

"I would say at least 40 kids knew him, and they're 3,4, 5 years old and that makes it even more difficult," he said.

He said a school psychologist will be at the school on Friday to talk with the children in the classrooms ? including the class of the 6-year-old girl who survived. He said that the girl is the older sister of the two dead boys.

___

Associated Press writers Don Babwin and Jason Keyser in Chicago and David Mercer in Champaign, Ill., contributed to this report.

Source: http://news.yahoo.com/police-identify-victims-illinois-killings-150032733.html

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Iran says it's ready to resume talks with world powers

GENEVA (Reuters) - Iran is ready to resume talks with world powers on its disputed nuclear program and awaits word from the European Union on timing and details, Iran's deputy nuclear negotiator said on Thursday.

Ali Bagheri, in an interview with Reuters in Geneva, said Iran needed 20 percent-enriched uranium for its Tehran research reactor and four others being built, and was continuing to convert some of its stockpile into reactor fuel.

"We are waiting for Lady Ashton to call Dr. Jalili, and Dr. Jalili is obviously ready to take the call," Bagheri said.

EU foreign policy chief Catherine Ashton oversees diplomatic contacts with Iran on behalf of the United States, Russia, China, France, Britain and Germany. Saeed Jalili is Iran's chief negotiator.

The world powers and Iran failed in talks in the Kazakh capital Almaty this month to end the deadlock in a decade-old dispute over Tehran's nuclear program, prolonging a standoff that could yet spiral into a new Middle East war.

Iran says its nuclear work is entirely peaceful and that it is only refining uranium to power a planned network of nuclear energy plants and for medical purposes. Critics accuse it of covertly seeking the means to produce nuclear weapons.

A report by the U.N. nuclear watchdog, the International Atomic Energy Agency (IAEA), in February said Iran had in December resumed converting to oxide powder some of the uranium it has enriched to 20 percent fissile concentration, for the production of reactor fuel.

That helped restrain the growth of Iran's higher-grade uranium stockpile, a development that could buy more time for diplomacy.

In a potentially encouraging sign for the powers, Bagheri said on Thursday this conversion continued.

"We produce 20 percent uranium to provide fuel for Tehran's research reactor, also four other reactors in four different parts of Iran which are under construction. With this in mind, plans have been drawn up to convert 20 percent uranium to 20 percent oxide," Bagheri said.

"This is very much going according to plan. This activity is ongoing," he added.

(Reporting by Stephanie Nebehay; additional reporting by Fredrik Dahl in Vienna; editing by Andrew Roche)

Source: http://news.yahoo.com/iran-ready-resume-talks-world-powers-awaits-call-144538391.html

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How To Build Your Own Muscle-Controlled Iron Man Repulsor

Iron Man 3 is just around the corner, and if you intend to show up on opening night decked out in your own home-made armor, you'll want to check out this slick Instructable by Advancer Technologies. More »

Source: http://feeds.gawker.com/~r/gizmodo/full/~3/lt_u-LeH3Wc/how-to-build-your-own-muscle+controlled-iron-man-repulsor

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SEO and keyword density ? Little Big Voice ? Blog ? Search Engine ...

For internet marketing professionals of all kinds, these three letters are a large part of their daily work routine. In fact, there isn?t really such a thing as internet marketing without SEO.

Here at Little Big Voice, our London SEO services force us to measure keywords every single day.

What is SEO?

When you browse on the internet, you are most likely searching through a search engine like Google.

Well, those words which you search with are the keywords that websites use to be discovered by you. Using keywords within content gets a business found in search engines, hence the term Search Engine Optimisation (SEO) keywords.

SEO isn?t just for the pretty content that you go to read on a website; it is also an important component of HTML on the website?s pages. This includes the page titles, alternative (Alt) text, the page description, Meta tags, and comments.

Why is SEO important?

Every person browsing through internet search engines is a potential customer. This is why, with the ever-increasing masses of information on the interest, SEO has become an essential marketing tool that will make a business stand out; a tool that must be mastered.

Without correct search engine optimisation, your business will not get the attention you want and most likely need. Doing it properly (i.e. using the right keywords) will also help your website content to reach the appropriate audience; search engines use keywords to index your website in the correct and relevant place on the internet.

This all might sound simple enough however; there is a trap which many SEO first-timers fall straight into and this is because of keyword density.

What is keyword density?

This term refers to the amount of keywords and their frequency which is measured as a percentage. For example:

If 300 words of content on a page (including the HTML text which we mentioned earlier) has an SEO keyword phrase 3 times, the keyword density percentage is 1%.

Although 1% may seem a small figure, this is actually an acceptable keyword density. Many SEO experts believe that 1-2% is the best amount whilst others argue that up to 5% is suitable.

Ultimately, the search engines indexing the content will dictate the density of keywords to use. For instance Google is believed to prefer under 2%.

Why is keyword density so important?

Too many SEO keywords (more commonly known as keyword stuffing) are lethal for websites and content. This is because a high density of keywords and phrases will be deemed as spam by search engines and pushed far back to the extremely poor positions on their search results. It will not matter how high-quality, interesting or entertaining the content is; too many keywords will ensure that the website or content do not get seen.

?

London SEO agency, Little Big Voice offer SEO services that will help you to ensure that your business will not be discarded from Google?s top search results.

Tags: keyword density, Search Engine Optimisation, SEO

Source: http://www.littlebigvoice.com/wordpress/seo-and-keyword-density/

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Happy 29th Birthday, Mandy Moore!

Source: http://www.thehollywoodgossip.com/2013/04/happy-29th-birthday-mandy-moore/

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4 Ga. firefighters held hostage; SWAT on scene

Locator map shows where firefighters are being held hostage.

Locator map shows where firefighters are being held hostage.

SUWANEE, Ga. (AP) ? Four firefighters who responded to what seemed like a routine medical call were being held hostage Wednesday by a gunman who has barricaded himself in a home in suburban Atlanta, authorities said.

Five firefighters responded to the call in Suwanee and were eventually taken hostage by an unidentified suspect inside the house, Gwinnett County Police Cpl. Edwin Ritter said. The gunman released one of the firefighters to move a fire truck.

Authorities were not releasing information on what happened inside the home, but did say it doesn't appear any of the firefighters has been hurt.

The gunman's motive was unclear to police and fire officials, and a SWAT team and negotiator have made contact with the suspect.

Fire department Capt. Tommy Rutledge said the medical call seemed routine and firefighters did not believe there was any danger. One engine and one ambulance responded.

"Right now we just want our firefighters to be released. We want them to be able to go home safe to their families," Rutledge told WSB-TV.

Television helicopter footage showed police and fire trucks surrounding the neighborhood of mostly two-story homes and well-kept lawns about 35 miles northeast of downtown Atlanta. Residents were not being allowed in to their neighborhood. About 50 bystanders gathered outside the subdivision while police and SWAT officials surrounded the house. According to public records, the home is in foreclosure and has been bank-owned since mid-November.

The firefighters are cross-trained as emergency medical technicians, said Rutledge, who would not speculate on whether there was a real emergency at the home.

"Our firefighters responded to a call they respond to hundreds of times, and that's a medical emergency," he said.

---

Lucas reported from Atlanta.

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/386c25518f464186bf7a2ac026580ce7/Article_2013-04-10-US-Firefighters-Hostage-Georgia/id-d8bb92d023e1410b831cd3348ef94bd5

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Video: HBT: Is Halladay done?? |? CSN: Phils top Mets

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

Source: http://nbcsports.msnbc.com/id/21134540/vp/51497718#51497718

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Red Sox sellout streak ends at 820 games

Two P-51's flyover Fenway Park during opening ceremonies before a baseball game between the Boston Red Sox and the Baltimore Orioles at Fenway Park in Boston Monday, April 8, 2013. (AP Photo/Winslow Townson)

Two P-51's flyover Fenway Park during opening ceremonies before a baseball game between the Boston Red Sox and the Baltimore Orioles at Fenway Park in Boston Monday, April 8, 2013. (AP Photo/Winslow Townson)

Boston Red Sox manager John Farrell, right, watches batting practice with pitchers John Lackey, center, and Jon Lester prior to their baseball game against the Baltimore Orioles at Fenway Park in Boston Monday, April 8, 2013. (AP Photo/Winslow Townson)

BOSTON (AP) ? The longest home sellout streak in major pro sports history ended Wednesday night at 820 games for the Boston Red Sox.

The official attendance for an 8-5 loss to the Baltimore Orioles was 30,862. The capacity for night games at Fenway Park is 37,493.

The streak began in May 2003 and includes the postseason. The string broke the record of 814 set by the NBA's Portland Trail Blazers from 1977-95.

Boston's streak of 794 regular-season sellouts also is the longest in major pro sports history. The previous mark in Major League Baseball history was 455 set by the Cleveland Indians from 1995-2001.

"The streak is a reflection of a phenomenal period of baseball in Boston and of America's greatest ballpark," Red Sox owner John W. Henry said in a statement. "But more than that, it is a testament to the baseball passion of New England fans. As we close the book on this incredible era, we look forward to another with a renewed certainty that the next couple of generations of Red Sox fans will also be enjoying baseball at the ever magical Fenway Park."

The sellout streak began on May 15, 2003, when the Red Sox beat the Texas Rangers 12-3 as Pedro Martinez pitched six scoreless innings before 32,485 fans. Seating capacity was expanded after that and the streak continued through Monday's home opener, a 3-1 win over the Orioles with an official attendance of 37,008.

The average attendance during the streak was 36,605, the Red Sox said.

In recent seasons, there were hundreds, sometimes thousands, of empty seats at Fenway Park, which opened in 1912. The Red Sox said last season that attendance is based on tickets distributed, such as those given to charities, and not on the actual number of fans who attend games.

The Red Sox won the World Series in 2004, the second season of the streak, and again in 2007. But they missed the playoffs the past two years and finished 69-93 last season in Bobby Valentine's only season as their manager.

During last season, they traded pitcher Josh Beckett, first baseman Adrian Gonzalez and left fielder Carl Crawford, who were due $261 million from 2013-18, to the Los Angeles Dodgers.

In the offseason, the Red Sox hired John Farrell as manager and overhauled their roster, avoiding star free agents and long-term deals.

"We are proud of this historic achievement," Red Sox President Larry Lucchino said of the streak. "Over the past 10 years, more than 30 million, many among the most sophisticated baseball fans in America, have purchased tickets to see games at Fenway Park. Never in that period was there a crowd less than 32,000. No other club in Major League Baseball can make that statement."

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/347875155d53465d95cec892aeb06419/Article_2013-04-11-Red%20Sox-Sellout%20Streak/id-4a417f5aa0aa4f51b7e032d59b42be71

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UnitedHealth units hit with $500 million verdict in hepatitis case

(Reuters) - A Nevada jury awarded $500 million in punitive damages in a closely watched case against two affiliates of UnitedHealth Group stemming from a hepatitis C outbreak in the state, according to a spokeswoman for a law firm in the case.

The case involves two patients who claimed they became infected with hepatitis C, a disease that attacks the liver, because their gastroenterologist used allegedly unsafe injection practices for an endoscopy.

The plaintiffs argued that UnitedHealth should be held responsible because the accused gastroenterologist was part of the company's network and that the insurer should have known about allegedly unsafe practices.

The case could set a far-reaching precedent requiring health insurance companies to police practices of member hospitals and doctors, according to experts.

Last week, the same jury in Clark County District Court in Las Vegas awarded $24 million in compensatory damages in favor of the patients and one of their spouses. In the jury's punitive award on Tuesday, it assessed $270 million to Health Plan of Nevada and $230 million to Sierra Health Services, according to Sharon Christal, a spokeswoman for the law firm representing the plaintiffs.

The plaintiffs had sought over $1 billion in punitive damages.

Health Plan of Nevada said the damages were unreasonable and evidence and testimony kept from the jury would help in an appeal.

"The number announced today has no grounding in reality -- it represents fantasy damages, not punitive damages," the company said in a statement.

The cases are Helen Meyer v. Health Plan of Nevada Inc, Eighth Judicial District Court (Clark County), No. 09A583799; and Bonnie Brunson v. Health Plan of Nevada Inc, Eighth Judicial District Court (Clark County), No. A-10-608344-C.

(Reporting by Andrew Longstreth; additional reporting by Jacob Hale Russell and Caroline Humer; Editing by Stephen Coates)

Source: http://news.yahoo.com/unitedhealth-units-hit-500-million-verdict-hepatitis-case-024252060--finance.html

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International Law Reporter: Nouwen: Legal Equality on Trial ...

Sarah Nouwen (Univ. of Cambridge - Law) has posted Legal Equality on Trial: Sovereigns and Individuals before the International Criminal Court (Netherlands Yearbook of International Law, forthcoming). Here's the abstract:

Writing in 1964, Pieter Kooijmans challenged the principle of legal equality of states: it would have to prove its value or be discarded. He also predicted the relevance of the principle for a new subject of international law: the individual. Almost fifty years later, this article reviews how the principle has fared in international criminal law, a field of international law relevant both to states and to the individual. The review shows how the emergence of a more vertical international legal order has weakened the position of the principle of equality between states. The weakening of the principle in the relation between states has in turn affected the equality between individuals, which has contributed to further actual inequality between states.

Contrary to one of Kooijmans?s scenarios, the emerging international legal order has not diminished the role of the ?factual conditions of power politics?. Legal questions on permitted differentiations always involve inherently political assessments. For instance, Kooijmans?s concept of ?juridically relevant? differences requires a determination of which differences are ?of intrinsic value for the existence of legal order?, and thus a decision on what that order should look like and how it is to be pursued. Moreover, factual conditions of power politics continue to encroach upon the principle of legal equality. Perhaps the principle of legal equality, like the fight against impunity, is more of an ideal than a reality. But the pursuit of the fight against impunity has thus far undermined the fight for more equality.

Source: http://ilreports.blogspot.com/2013/04/nouwen-legal-equality-on-trial.html

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Pitino leads class of 7 into Naismith Hall of Fame

ATLANTA (AP) ? Rick Pitino, who will coach Louisville in the NCAA championship game Monday night, is among seven people elected to the Naismith Memorial Basketball Hall of Fame.

Joining Pitino in the class of 2013, announced Monday, are former NBA stars Bernard King and Gary Payton, former UNLV coach Jerry Tarkanian, North Carolina women's coach Sylvia Hatchell, former University of Houston coach Guy Lewis, former University of Virginia star Dawn Staley.

The inductions will take place in Springfield, Mass. in September.

Inductees announced previously were Edwin E.B. Henderson, a direct elect by the Early African Pioneer Committee, longtime Indiana Pacers guard Roger Brown, Oscar Schmidt of Brazil, the leading scorer in Olympic history, Richie Guerin, a star for the New York Knicks in the 1950s, and Russ Granik, the longtime assistant commissioner of the NBA.

Source: http://news.yahoo.com/pitino-leads-class-7-naismith-hall-fame-155348063--spt.html

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Walgreen clinics expand care into chronic illness

Walgreen Co. has stretched the reach of its drugstore clinics beyond treating ankle sprains and sinus infections to handling chronic diseases such as diabetes, asthma and high blood pressure.

The company, based in Deerfield, Ill., said Thursday that most of its roughly 370 in-store Take Care Clinics now will diagnose, treat and monitor patients with some chronic conditions that are typically handled by doctors.

Drugstore clinics, which are run by nurse practitioners or physician assistants, have grown popular in recent years as a convenient and less expensive way to treat relatively minor illnesses when a patient doesn't have a doctor or if their physician isn't available. But the clinics have been broadening their scope of care: Walgreen's decision follows a move by competitor CVS Caremark Corp. a few years ago to start monitoring chronic conditions at most of its 640 MinuteClinics.

Drugstores say they don't aim to replace doctors, but rather to provide more people with access to health care and to work with physicians as part of a team treating patients. But the move to provide more complex care draws concern from doctors who say that can disrupt their relationships with patients and lead to fragmented care.

Dr. Jeffrey J. Cain, president of the American Academy of Family Physicians, one of the nation's largest medical organizations, compares the clinics to fast-food restaurants. He said they're good for the occasional meal but not something a person wants to rely on for too much of their diet.

Physicians know their patients, and that makes them better suited for doing things like helping someone with diabetes develop an exercise plan, stick with their treatment or learn how to eat better, Cain said. And different computer systems can make transferring records between clinics and health care providers a problem, leading to test duplications and gaps in a doctor's knowledge of a patient's care, he said.

"It's not about telling somebody what they have to do, it's helping them make choices in their life to move toward a healthier lifestyle," he said.

Walgreen said its expansion into chronic care is based on need. Cases of diseases such as diabetes are growing and the U.S. population is aging.

In addition, the health care overhaul will increase coverage to millions of uninsured people next year. That coverage expansion will arrive as the country struggles with a doctor shortage, Walgreen noted. In fact, some studies have predicted a shortfall of roughly 40,000 primary care doctors over the next several years.

"If there wasn't a primary care access crisis ... I don't think we'd be expanding our services quite like this," said Dr. Alan E. London, chief medical officer for the Take Care Clinics.

He said nearly half of the patients who receive treatment at Walgreen clinics don't have a primary care doctor or have trouble finding one who accepts the government-funded Medicare or Medicaid coverage.

"We're filling a niche for patients who need access," London said. "When we uncover gaps in care and we're capable of closing those gaps, it's the right thing to do."

He added that the clinics also can play a big role for patients with doctors. If a patient already has a treatment plan for a condition such as high cholesterol, he or she can use the clinics for blood tests and then have the results sent back to the doctor.

The clinics also can help monitor blood sugar or blood pressure levels when the regular doctor's office is closed or the patient can't get there.

In cases where patients don't have a primary care doctor, care providers at the clinics will diagnose a chronic illness, get the patient started on medication, educate them about their treatment and then help them connect with a doctor.

Convenient care clinics started in 2000, and there are now more than 1,400 in the United States, according to the trade group Convenient Care Association. That growth is expected to continue.

CVS Caremark says it will have nearly 800 clinics by the end of this year, and it aims to operate about 1,500 clinics nationwide by 2017.

Walgreen had 51 clinics in 2007 and runs 372 now. A spokesman said the company expects "double digit percentage growth" in the number of clinics this fiscal year, which ends in August. He declined to be more specific.

Aside from drugstores, patients also can find clinics in grocery stores, malls and some Wal-Mart and Target stores. Proponents say they can be more convenient than a doctor's office because they are open on weekends and for longer hours.

They also are a less-expensive option than a doctor's office, urgent care center or emergency room, which is important for people with no insurance or coverage that makes them pay more upfront for care.

The clinics initially handled mostly minor medical conditions and immunizations but have expanded over the years to add things like school and camp physicals to their menu of services.

A few years ago, CVS Caremark started offering lab tests and education for people who generally have already been diagnosed by a doctor with a chronic condition. Earlier this year, its clinics expanded into acne consultations, with the company advertising that service on its website under the slogan, "We treat it so you can beat it."

CEO Larry Merlo also told analysts in February his company is testing clinic programs that help customers quit smoking or manage their weight.

Rite Aid Corp., the nation's third-largest drugstore chain, doesn't offer chronic illness care at its small chain of clinics. But the company said last month it would start offering 10-minute online doctor consultations for $45 to store customers in several big cities.

Source: http://news.yahoo.com/walgreen-clinics-expand-care-chronic-illness-040834929--finance.html

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Study: Dementia tops cancer, heart disease in cost

Cancer and heart disease are bigger killers, but Alzheimer's is the most expensive malady in the U.S., costing families and society $157 billion to $215 billion a year, according to a new study that looked at this in unprecedented detail.

The biggest cost of Alzheimer's and other types of dementia isn't drugs or other medical treatments, but the care that's needed just to get mentally impaired people through daily life, the nonprofit RAND Corp.'s study found.

It also gives what experts say is the most reliable estimate for how many Americans have dementia ? around 4.1 million. That's less than the widely cited 5.2 million estimate from the Alzheimer's Association, which comes from a study that included people with less severe impairment.

"The bottom line here is the same: Dementia is among the most costly diseases to society, and we need to address this if we're going to come to terms with the cost to the Medicare and Medicaid system," said Matthew Baumgart, senior director of public policy at the Alzheimer's Association.

Dementia's direct costs, from medicines to nursing homes, are $109 billion a year in 2010 dollars, the new RAND report found. That compares to $102 billion for heart disease and $77 billion for cancer. Informal care by family members and others pushes dementia's total even higher, depending on how that care and lost wages are valued.

"The informal care costs are substantially higher for dementia than for cancer or heart conditions," said Michael Hurd, a RAND economist who led the study. It was sponsored by the government's National Institute on Aging and will be published in Thursday's New England Journal of Medicine.

Alzheimer's is the most common form of dementia and the sixth leading cause of death in the United States. Dementia also can result from a stroke or other diseases. It is rapidly growing in prevalence as the population ages. Current treatments only temporarily ease symptoms and don't slow the disease. Patients live four to eight years on average after an Alzheimer's diagnosis, but some live 20 years. By age 80, about 75 percent of people with Alzheimer's will be in a nursing home compared with only 4 percent of the general population, the Alzheimer's group says.

"Most people have understood the enormous toll in terms of human suffering and cost," but the new comparisons to heart disease and cancer may surprise some, said Dr. Richard Hodes, director of the Institute on Aging.

"Alzheimer's disease has a burden that exceeds many of these other illnesses," especially because of how long people live with it and need care, he said.

For the new study, researchers started with about 11,000 people in a long-running government health survey of a nationally representative sample of the population. They gave 856 of these people extensive tests to determine how many had dementia, and projected that to the larger group to determine a prevalence rate ? nearly 15 percent of people over age 70.

Using Medicare and other records, they tallied the cost of purchased care ? nursing homes, medicines, other treatments ? including out-of-pocket expenses for dementia in 2010. Next, they subtracted spending for other health conditions such as high blood pressure, diabetes or depression so they could isolate the true cost of dementia alone.

"This is an important difference" from other studies that could not determine how much health care cost was attributable just to dementia, said Dr. Kenneth Langa, a University of Michigan researcher who helped lead the work.

Even with that adjustment, dementia topped heart disease and cancer in cost, according to data on spending for those conditions from the federal Agency for Healthcare Research and Quality.

Finally, researchers factored in unpaid care using two different ways to estimate its value ? foregone wages for caregivers and what the care would have cost if bought from a provider such as a home health aide. That gave a total annual cost of $41,000 to $56,000 per year for each dementia case, depending on which valuation method was used.

"They did a very careful job," and the new estimate that dementia affects about 4.1 million Americans seems the most solidly based than any before, Hodes said. The government doesn't have an official estimate but more recently has been saying "up to 5 million" cases, he said.

The most worrisome part of the report is the trend it portends, with an aging population and fewer younger people "able to take on the informal caregiving role," Hodes said. "The best hope to change this apparent future is to find a way to intervene" and prevent Alzheimer's or change its course once it develops, he said.

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/386c25518f464186bf7a2ac026580ce7/Article_2013-04-03-US-MED-Alzheimer's-Toll/id-6d05c45596474a4c8b420a33e34653a3

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