>>>great britain needs the help of any
code breakers
out there, trying to learn a message sent by
carrier pigeon
during
world war ii
. it is a hand-written message, never making its way to a recipient. it was discovered all these years later in a chimney. they think that
carrier pigeon
was used during the war, including
behind enemy lines
.
british intelligence
agents say they can't figure it out. so if anyone is good at it, we put it on the website.
A few months after the Sept. 11 attacks, when crippled phone networks thwarted communications across New York City, Congress called for the creation of what could be called the nerd reserves.
Lawmakers tasked the federal government with establishing a volunteer force of IT experts -- the tech equivalent of a National Guard -- that could respond to disasters by fixing damaged computer or telecom equipment or providing high-tech assistance to relief workers.
But a decade later, the federal government has still not established the National Emergency Technology Guard, known as NET Guard.
Now, in the wake of Hurricane Sandy, proponents are renewing their call for a cyber reserve corps. A highly-organized network of tech volunteers, they say, could have quickly re-established wireless networks in New York and New Jersey, which were down for several days, or built online tools for tracking gasoline, water, medical supplies or even displaced nursing home residents, said Andrew Rasiej, chair of NY Tech Meetup.
"In the same way you need National Guardsmen to protect communities when the river is cresting, we need national tech guardsmen to protect our critical communications infrastructure," Rasiej said.
There was no shortage of tech-savvy volunteers after Sandy. More than 900 people from New York?s startup community signed up to help schools, nonprofits and small businesses get back online, Rasiej said. But their efforts were slowed down by a lack of organization.
?We had all these volunteers, but not everybody knew what they needed or knew they were available,? he said. "We lost precious time in advance of the storm and after the storm because we didn't have a set of protocols."
Despite the challenges, members of the New York's tech community built maps tracking instances of price gouging, helped small businesses with websites and data recovery, and participated in several ?hackathons? to build apps, platforms and tools to help with hurricane recovery.
In 2002, Congress approved NET Guard as part of a bill that created the Department of Homeland Security. NET Guard would have organized employees at the nation's tech companies -- software engineers, website designers and wireless communications specialists -- put them through periodic training, and ensured their jobs would be safe while they left to help with disaster recovery.
In 2008, DHS created a pilot program, and later created an online tutorial to show how communities could organize their own tech volunteers. But DHS never fully implemented the program.
A DHS spokesman declined to comment about why NET Guard was never established. But proponents say the program was never adequately funded and suffered from a lack of interest within the Department of Homeland Security, which was tasked with its creation.
Though NET Guard was never fully realized, similar ideas have surfaced elsewhere. Groups like Crisis Commons, Nethope.org, and Geeks Without Bounds organize volunteer tech experts to create online tools that help relief and recovery efforts around the world.
Yet Rasiej said there is still a need for a single organization -- a unified corps of cyber reservists -- to coordinate those efforts for the next crisis.
"It's not that there aren't enough volunteers," he said. "It's that they?re not trained and coordinated to be most efficient. You want to have this already organized. You don't want to re-invent the wheel every time there?s a new disaster."
In this Aug. 30, 2012 photo provided by Penguin Books, Australian best-selling author Bryce Courtenay poses with wife Christine Gee on a park bench in Canberra Australia Courtenay, author of "The Power Of One" and 20 other titles died Thursday Nov. 22, 2012 of stomach cancer. He was 79. (AP Photo/Penguin Books) EDITORIAL USE ONLY, NO SALES
In this Aug. 30, 2012 photo provided by Penguin Books, Australian best-selling author Bryce Courtenay poses with wife Christine Gee on a park bench in Canberra Australia Courtenay, author of "The Power Of One" and 20 other titles died Thursday Nov. 22, 2012 of stomach cancer. He was 79. (AP Photo/Penguin Books) EDITORIAL USE ONLY, NO SALES
In this Aug. 30, 2012 photo provided by Penguin Books, Australian best-selling author Bryce Courtenay walks his dog Timmy in Canberra Australia. Courtenay, author of "The Power Of One" and 20 other titles, died Thursday Nov. 22, 2012 of stomach cancer. He was 79. (AP Photo/Penguin Books) EDITORIAL USE ONLY, NO SALES
CANBERRA, Australia (AP) ? Best-selling Australian author Bryce Courtenay, whose first and final books drew on his tough early-life experiences in Africa, has died of stomach cancer. He was 79.
He started writing in midlife and called his first novels "practice books," but his debut was a success. "The Power of One" was published in 1989, translated into 12 languages and became a hit movie.
His publisher Penguin Group said Friday that Courtenay died at his family home in the Australian capital Canberra late Thursday surrounded by his family and pets.
His 21st novel, "Jack of Diamonds," was published on Nov. 12 and included a moving epilogue to his readers.
"It's been a privilege to write for you and to have you accept me as a storyteller in your lives," he wrote.
"Now, as my story draws to an end, may I say only, 'Thank you. You have been simply wonderful,'" he added.
Courtenay was born the illegitimate son of a dressmaker on Aug. 14, 1933, in the mountain town of Barberton in what is now the Limpopo province of South Africa.
By the age of 17, he was working in the dangerous mines of what is now Zimbabwe, which paid his way to Britain where he studied at the London School of Journalism. He met an Australian, Benita Solomon, whom he followed to her hometown of Sydney in 1958 and married.
He fell into a career in advertising with U.S. agency McCann Erikson at the age of 26 and rose to creative director. He had an epiphany at the age of 50 when he decided to fulfill a lifelong ambition to be a novelist.
"The Power of One" was to be the first of three "practice books" Courtenay planned to write over three years before taking two years to write a fourth book which he hoped would find a publisher.
"I was absolutely staggered when somebody wanted to publish it in the first place," Courtenay said in his official biography released by Penguin.
"Now its worldwide success and the fact that it's available in 12 languages still amazes me," he added. It became a movie starring Morgan Freeman.
Courtenay dedicated its sequel, "Tandia," to his third son, Damon, who died of medically-acquired AIDS at the age of 24 on April 1, 1991 ? two months before the book was published.
That tragedy inspired his third book, "April Fool's Day," that deals with the public fear of AIDS and was published in 1993.
In June, doctors told Courtenay that there was no hope of curing his stomach cancer.
Bob Sessions, Courtenay's longstanding publisher at Penguin, said the author would produce a 600-page book in only six months, sometimes writing for more than 12 hours a day.
"He was a born storyteller and I would tell him he was a latter-day Charles Dickens with his strong and complex plots, larger-than-life characters and his ability to appeal to a large number of readers," Sessions said.
BUDAPEST (Reuters) - Hungary's banks, smarting from an extension of Europe's highest bank tax, are counting on looser policy once the economy picks up, the interim chairman of the Hungarian Banking Association said.
The country's banks are looking for ways to work with the government, said Daniel Gyuris whose predecessor Mihaly Patai resigned as chairman last week in protest at new taxes on the financial sector.
The government of Prime Minister Viktor Orban has milked banks heavily as the indebted central European country of 10 million people struggled to keep its budget deficit within European Union limits to avoid financial sanctions.
Last week, Orban made permanent the bank levy, which at one stage was intended to be phased out by 2013, causing a shock among bankers and forcing a review of banks' lending strategies for the years ahead.
Gyuris told Reuters in an interview late on Wednesday that banks will review any cooperation on a project-by-project basis and keep looking for opportunities to cut risk and lend to viable businesses.
"I don't believe austerity will last forever," said Gyuris who also heads OTP Bank's mortgage unit. "We should not treat these matters on an emotional basis."
Gyuris added however there would be no new broad accord such as the one the sides brokered last year only for the government to renege on its pledge to ease the hefty bank levy.
Analysts expect austerity to further stifle recovery prospects after a recession this year, putting pressure on Orban's government to find ways to restore growth as it prepares for an election in 2014.
"Once the goal of growth becomes the top priority of this government instead of the singular goal of deficit containment, we believe that will necessitate a new attitude toward lenders," Gyuris said.
Despite several rounds of "shocking" measures that Orban's government slapped banks with over the past two years, Gyuris said lenders remained open to working with the government.
END OF AUSTERITY?
Gyuris said government austerity was probably close to an end as the budget-cutting measures, by most accounts, guarantee that Hungary would fulfill the European Commission's criteria and allow its exit from a deficit surveillance procedure next year.
"Most people believe managing the deficit... is complete," he said. "Growth is the most important and least painful way to make that structurally sustainable over the long term."
"We believe the government will find a way to cooperate with banks despite the higher bank tax. One way to do that would be to offset the bank tax with any measurable increase in business activity."
He said banks would be especially keen to participate in export pre-financing, agricultural financing or guarantee programs and co-financing for EU-funded projects.
With Hungary facing a potentially deep cut in EU subsidies as richer member states seek to cut back spending in the 2014-2020 period, Gyuris said it was paramount that every last cent of remaining funding is used.
"Nobody can afford the luxury of not using every last bit of our reduced share after the EU budget is finalized," he said.
EU leaders are due to thrash out a budget for the 2014-2020 period at a summit beginning on Thursday.
Retirement is a game changer when it comes to investing, as you will need a completely different investment strategy than you had when you were building your nest egg. Why is this? Well, most people can?t afford to take risks with their retirement money, because once the money is gone, it?s gone.
Where you were once willing to take risks with your money with the hopes of seeing huge capital gains, retirement forces you to minimise any risky investing moves so that you can maintain a meaningful level of income and avoid running out of money too early. Since there are endless options when it comes to retirement investing, the following tips will help you choose which strategy is best for you.
Immediate annuities
The major risk retirees face is the possibility they will outlive their money, and an immediate annuity is perhaps the simplest way to ensure this doesn?t happen. Immediate annuities offer an investment option that provides guaranteed income, whereby an insurance company must pay regular income over the lifetime of the policyholder.
Essentially, you pay an insurance company a lump sum and the insurer agrees to pay you a monthly income for as long as you live. If you die earlier than expected, the insurance company gets to keep the money, but if you continue to lead a long and healthy life, the company must keep paying you even if it?s substantially more than you paid initially.
Real estate investing
Property always has been and always will be a great way to diversify your portfolio, and it can benefit you in many different ways. For instance, if you have an investment property you are currently renting out, you will receive monthly income from the rents. When you eventually choose to sell your investment property, you will benefit from not being charged capital gains tax on the sale simply because you?re retired. Alternatively, you can invest in Real Estate Investment Trusts (REITs), which is like a mutual fund that owns real estate.
Fixed income investments
Fixed income investments cover a lot of different types of investments, such as bank certificates of deposit, individual bonds and unit investment trusts. The key characteristic of this group of investments is that the initial and renewal interest rates are fixed by the issuer over a certain period of time. This means you will receive interest income that will be steady and safe, with at least some measure of principle protection.
Asset allocation alternatives
This is by far the largest category of investment alternatives, as asset allocation strategies can range from single-product mutual fund purchases to individually tailored investment allocations that are provided by a professional. This type of investing provides a potential for higher gains and higher withdrawals during your retirement, but it comes with a slightly higher risk.
The benefit of this investment strategy is essentially to diversify your investment portfolio, as it includes investments such as brokerage accounts, mutual fund programs, deferred variable annuities, exchange traded funds and target and lifestyle mutual funds.
Investing throughout retirement is tricky business, as you don?t know how long you need your money to last and you only have a certain amount to work with. If you?re not sure of the best investment solution for your particular situation, you should always consult with a financial planner who can help you invest your money properly.
Nikki Hahn as Jenny Reynolds, Lily Rabe as Sister Mary Eunice.
Photo by Byron J. Cohen/FX.
Every week in?Slate?s?American Horror Story TV club, J. Bryan Lowder will have an IM conversation with a different?AHS fan. This week, he rehashes episode 2.6 with AHS superfan George Abbott.
J. Bryan Lowder: Happy Thanksgiving Eve Mr. Abbott, and welcome to the TV Club! After hearing all that talk of flesh tonight--touching it, missing it, cutting it--I wonder if you still have an appetite for your bird tomorrow...I have to say that was one doosy of an episode!
George Abbott: Honestly, I can eat anything if Thredson doesn't talk about wearing Clea DuVall's teeth again. I've been rabidly watching this show since the beginning, but last week was the only episode that actually gave me nightmares. And speaking of the upcoming holiday, how perfect was it that they sent us into decorative gourd season with maybe the show's best line ever: "Nutmeg makes all the difference?in the world." I'm going to find DOZENS of ways to use that in the next 5 days.
Lowder: Yes! I found this episode particularly scary--and well-crafted--myself (I believe Murphy was the writer), and also, despite the scariness, particularly campy? That nutmeg line you mention was divine, as was the new level of queen Quinto brought to our now unbuttoned Thredson. That, paired with his newly revealed infantilistic obsessions, just blew my mind. But I wonder, do you worry that two sites of horror--Thredson's basement and Briarcliff--will lessen the affect of both? I'm a little ambivalent about the world expanding outward too much.
Abbott: That's so funny, because I was thinking about how refreshing it was that this episode dealt with relatively few characters (even though, now that you mention it, they spent very little time at Briarcliff). My bigger concern is with the Bloodyface unhappy-childhood direction in general. I mean, next to some of the stuff Ryan Murphy's thrown at us (possession, rape, Nazis, etc.), I have to wonder if an orphanage and apparent lack of colostrum (which, yes, I had to look up after that scene) is enough to send someone down the serial killer track. Did it ring true for you?
Lowder: That's a great question (and you will have to tell me and our readers what colostrum is: The TV Club is all about sharing the knowledge)! I guess we have to expect some kind of gripping back-story for our serial killers, but I'm a little bummed they didn't just leave the "explanation" for his violent tendencies unclear. I find that inexplicable violence is more frightening than overly explained stuff. Though i do think that his self-theory was based on some real research--perhaps a commenter can tell us whether it still holds true?
Abbott: Oh - it's so gross. Colostrum = First Milk
Lowder: OMG, really? That's super gross. And I think we can assume that she wouldn't even be lactating, right? Unless she's secretly pregnant?
Abbott: Yeah, I'm pretty sure that was a... ahem... dry run. And I totally agree with you - once you've gotten into skin-lampshade territory, no background story is going to live up to the scariness of "skinning 33 year-olds alive is just his thing." But I have to get your take on one of the biggest questions of this episode: How... on earth... is this the first time that AHS has given us a super-creepy child WITHOUT some kind of mental illness/Down's? I can't believe that they held off on going into a "The Omen" space for so long!
Lowder: I hadn't even thought about that! Yes, the new affectless child was a welcome edition, and I'm glad you brought her up, because I thought her scene with Sister Mary Eunice was maybe my favorite of the episode. Their dry repartee was intoxicating. I'm kind of hoping Eunice will take her under her possessed wing and be an evil mentor--she will need a sidekick in the NEW ERA! Speaking of which, do you have any theories about her plans? She's clearly QBIC now that's she's got the dirt on Arden.
Abbott: I don't know about her plans, but if she wants to start her own church, I'm THERE. I actually wrote down "You were born with the gift of authentic impulse - don't ever let them kill it" like it was some Oprah-wisdom I needed to write on my mirror in lipstick every morning. MOVED. But I'm a little disappointed with her small moves so far. I mean, she's the devil, and all she's done so far is some gossip, some covering up, and some lingerie theft - I'm guessing she's trying to lead Arden to bring about some kind of zombie apocalypse, but I'd really rather she start a skanky Lesley Gore tribute band with Jude and take it on the road.
Lowder: I'm speechless. Your appraisal of Sister Mary is, like, Platonic. Are we soul mates? I don't have any concrete ideas, but I do tend to follow your logic (i.e. toward the drug-resistant zombie apocalypse). More machinations from her soon, please! Speaking of which, if I had to look like Shelly (bye bye Chloe Sevingy!) to survive the Russians' nuclear attack, I think I'll pass.
Ok, it's time to get back to cooking, so let's wrap it up with a final question--we were treated to another glimpse of the present day this evening, iPhones in severed limbs and all. What?s going on? Is Threadson still alive? Does he have acolytes? The voice on the phone sure sounded like him....
Abbott: Here's what I'm thinking: It's Threadson (it sounded A LOT like him on the phone), his plotline has dovetailed with Arden and he's some kind of age-resistant momma's boy zombie, and seriously NO ONE IN THE WORLD will care if he puts Megan Fox Lite out of her misery (how is that girl not dead yet???)
Lowder: Ha, totally. The colostrum mixed with the "immune boosting cocktail" and made him live forever, just so he could take out Channing Tatum's wife. Leaving him available?for me. Get into it. Alrighty, I'm going to get into some turkey stock real quick. Hope your holiday is as yummy as Thredson?s sandwich!
European finance ministers failed to agree on a debt-reduction package for Greece after battling with the International Monetary Fund over how to nurse the recession- wracked country back to fiscal health.
With creditors led by Germany refusing to put up fresh money or offer debt relief, the finance chiefs were unable to scrounge together enough funds from other sources to help alleviate Greece?s debt burden, set to hit 190 percent of gross domestic product in 2014.
Organization: The Edna McConnell Clark Foundation (EMCF) seeks to transform the life trajectories of vulnerable and economically disadvantaged youth, ages 9-24. We make large, long-terminvestments, frequently partnering with other funders, and promote effective public and private support of nonpro?ts with a?potential for growth?and?compelling evidence?that they can help more young people become successful, productive adults.
Foundation staff members work as a team to help youth-serving organizations build their organizational capacity and evidence of effectiveness so they can expand and sustain at greater scale programs that make a real and enduring difference in young people?s lives.? This work includes?actively searching?for prospective grantees; conducting rigorous due diligence assessments of organizations? strengths, weaknesses, and capacity for and commitment to growth; supporting the development and implementation of grantee business and evaluation plans, and performance measurement and management systems; managing highly engaged relationships with grantees and providing them with additional support; and reporting on our investments in organizations.
As they perform these and other tasks, the Foundation expects employees to uphold its?core values?of humility, belief in people, pragmatism, trust, and high standards.
Position Description: Reporting to the?Director of Communications, the Communications Associate is primarily responsible for managing department projects, such as managing the website, and managing production of quarterly reports to the board of trustees.? S/he will also support the work of the Director of Communications and the?Communications Advisor.
Manage the day-to-day operations of EMCF?s website, including special projects and the Communication Advisor?s regular updates.
Collaborate with the Communications Advisor to update and develop new web content on a regular basis; maintain grantee performance data on the website ensuring it is accurate and timely.
Oversee the work of design and programming consultants to update and/or create interactive web features.
Board Book Production and Grantee Performance Reporting (approximately 20%)
Manage the process for producing EMCF?s quarterly board books and grantee performance reports.
With input from key staff, set quarterly and yearly calendars to ensure deadlines are met.
Monitor and track the progress of the various components of the board book and performance report, and pro-actively engage other staff to troubleshoot and/or make adjustments as necessary to ensure accurate and timely completion.
Work with the Communications Advisor to ensure the contents of each book and report are high quality and accurate.
Oversee the Communications Assistant?s work in compiling board books and grantee performance reports.
Communications and Project Management (approximately 25%)
Manage the production of EMCF reports, external materials, guides and other content.? This may include managing the work of freelance writers, graphic designers and other consultants.
Develop and write content, as needed. This may include (but is not limited to) grant recommendations, talking points for staff, internal memos, collateral materials, reports and articles for EMCF?s website.
Ensure materials for external audiences are kept current, particularly information related to EMCF?s grantees and co-investors.
Provide support in the management and operation of a private online portal for co-investors and grantees in the Foundation?s True North Fund.
News Distribution (approximately 10%)
Manage the administration of EMCF?s news-clipping service.
Review daily media clippings featuring EMCF and Foundation grantees; select and distribute key articles to staff.? Post on EMCF?s website as requested.
Multimedia Assets (approximately 10%)
Ensure EMCF?s multimedia assets are well-maintained and up-to-date; oversee the results of the Communication Assistant?s day-to-day management of EMCF?s photo, video and audio databases.
Oversee efforts to produce new video and photo content, including managing the work of consultants, working with grantees on scheduling, and handing other project management-related details.
Coordinate sharing of multimedia resources with grantees.
Social Media (approximately 10%)
Track and manage EMCF social media accounts.
When necessary and with the approval of the Communications Director, respond to posts on social media.
Note: This description is a guide to the primary duties and functions of the job, not an all-inclusive list of responsibilities, qualifications, physical demands and working conditions.? Position descriptions are reviewed and may be revised to meet the changing needs of the Edna McConnell Clark Foundation at the sole discretion of management.
Qualifications:
Bachelor?s degree a must; Master?s degree a plus.
At least four to five years of hands-on project management and professional experience in the field of communications, including developing and implementing communications plans, maintaining websites, producing publications and reports, and/or managing social media business accounts.
Experience working with and overseeing the work of professional consultants, and holding them accountable for delivering high-quality products in a timely manner.
Excellent organizational skills, including very strong attention to detail and the ability to manage and prioritize multiple tasks in a fluid, dynamic environment while continuing to meet deadlines.
Strong oral and written communication skills.? Must be able to draft web content and copy for external communications materials, and have excellent proofreading skills.
A ?do-er? with a high energy level, collaborative leadership ability, and the aptitude for self-motivated team and independent work.
Extensive knowledge of Microsoft Word, Excel and PowerPoint, and the ability to master new software and applications quickly, including the TYPO3 content management system.
Ability to adapt to the changing needs of a fast-paced organization while effectively managing goals and deadlines; able to anticipate needs and proactively solve problems.
Sound judgment, including the abilities to make decisions in a collaborative manner with other colleagues, to listen well, and to seek and find creative, alternative solutions to challenges and disagreements that arise.
Outstanding interpersonal skills, including the ability to work with a diverse group of peers, trustees, consultants, advisors and grantees with different backgrounds and experiences.
Experience overseeing the work of colleagues or peers who are not subordinates and holding higher-ups accountable for deliverables is a plus.
Salary & Benefits: Salary is commensurate with knowledge, skills and experience, ranging from the mid- to high $60s.? The Foundation offers an excellent benefits package that includes medical, dental, 403b and generous vacation time.
How to Apply: Applicants should send their resumes and cover letters with salary requirements to?EMCFcareers@emcf.org.? Highlight project management, website experience, and include ?Communications Associate? in the subject line.
I don't know about Corian. Our home came with a Corian look alike (GE if I remember correctly). Bleach will lighten the color our's enough to be noticeable---like a water spot. It would not look bad at all, if the entire counter were that way. DAMHIKT. Now, a few years later, I can't see the "bleached" area.
While the counter was still under warranty something in the house settled slightly and a crack developed on the inside corner of a right angle turn in the counter. The man came and repaired it so you could not even find it---until 8 or 10 years later. It still does not show unless you are standing right by it and the sunlight through the kitchen window is at the right angle.
I was not here to watch. Sounds like he drilled a small hole at the end of the crack. Then he routed it out 3/8" wide by the length. It did not take him long. However, the poor guy was on the freeway for over three hours (round trip) to get here to do it.
Good luck with it and/or the butcher block top you make.
Enjoy,
JimB
You certainly are having your little ole adventure aren't you!
Oh yes! If you polish the top with an electric polisher with a lamb's wool pad--DO NOT accidently go to high speed. DAMHIKT either.
ST. PAUL, Minn. (WCCO) ? A holiday tradition that benefits local charities gets underway Tuesday night in St. Paul.
It?s the fifth year for drive through light display ?Holiday Lights in the Park? at Phalen Park. It?s great entertainment to look at, but more importantly it provides assistance to local charities.
Organizers with the project said a majority of the displays are new this year, including a finale with an under sea adventure that includes a sunken pirate ship, scuba divers and Santa Claus scuba diving.
It?s also a Minnesota-themed display with the parks and recreation, featuring the biggest display they?ve ever had with all the options people have when they visit the state?s parks. That includes displays for fishing, rock climbing, skiing.
The display costs $10 on weekends and $8 on weekdays to see, and the proceeds go towards four local charities. Those include the Union Gospel Mission, Second Harvest Heartland, a youth program called ?Under Construction? and the St. Paul Parks Conservancy. Entry fees go to those charities, which have partnered with event organizers for the last five years.
The display features hundreds of thousands of LED light bulbs which are energy efficient, running at about one-third the power of a normal light bulb. There are more than 60 light displays for people to take in, and the display goes through Jan. 1, 2013.
There?s a CD soundtrack for sale at Kowalski?s Markets around the Twin Cities, and that purchase gets people a free pass to the display.
TEHRAN, Iran (AP) ? Iran has started construction on a $10 billion natural gas pipeline to key ally Syria, a news agency reported Monday, in an apparent nod of support to President Bashar Assad's embattled regime and a further attempt by Tehran to boost energy exports battered by international sanctions.
The 1,500-kilometer (750-mile) project was first announced in July 2011 as Syrian rebels began stepping up the fight to topple Assad. Many analysts predicted the pipeline would remain in the planning stages because of the countless risks involved, but Iran's decision to start work ? even just the beginning sections ? is seen a public show of confidence in Assad's ability to ride out the uprising.
It also reflects Iran's wider efforts to expand natural gas and oil pipeline to Middle East and Asian markets as Western sanctions over Tehran's nuclear program cut into sales. The United States and its allies accuse Tehran of seeking to develop atomic weapons, an allegation the Iranians deny.
The semiofficial Fars news agency said Iran has already begun construction of the first phase of the project involving a 225-kilometer (140-mile) stretch at an estimated cost of $3 billion. The pipeline will carry gas from the giant South Pars field in the Persian Gulf to Syria via Iraq, whose government has close ties with Iran.
Fars said the entire project is to be completed in the second half of 2013.
Economist Saeed Leilaz, however, described it as more showmanship than a serious plan at this stage.
"Given the ongoing civil war in Syria, such a project can't be implemented now. Lack of security and political instability in Iraq and Syria doesn't allow this project to be enforced at least at this point," Leilaz said. "This is a symbolic gesture by Iran to show that it can bypass Western sanctions."
Iran already supplies gas to several other countries, including Armenia and Turkey, and has plans to build a pipeline to Pakistan. Iran has the world's second-largest natural gas reserves after Russia.
INDIANAPOLIS (AP) ? The search for what caused a massive, deadly explosion that rocked an Indianapolis neighborhood turned to natural gas Monday, with officials checking gas lines and a homeowner saying a problem furnace could be to blame.
The National Transportation Safety Board sent investigators to check gas main and other lines serving the neighborhood where two people were killed and seven injured in the weekend blast. Local gas supplier Citizens Energy said it also was checking gas lines and a meter at the home that exploded.
But officials cautioned that it was too soon to rule out other causes, saying only that they do not believe a meth lab was to blame for the explosion that obliterated two homes and severely damaged dozens of others.
"It's too early to speculate that this might have been caused by a gas leak," Citizens Energy spokeswoman Sarah Holsapple said at an afternoon news briefing.
The owner of one of the homes that was destroyed said there was a problem with the furnace in the last few weeks.
John Shirley, 50, of Noblesville told The Associated Press that he received a text message within the last week and a half from his daughter, who complained that the furnace in the home where she lived with her mother and her mother's boyfriend had broken. The malfunction had forced them to stay in a hotel, the girl said.
When Shirley asked if the furnace had been fixed, his daughter said yes. He said he wasn't aware of any additional problems until he heard from his daughter again Sunday morning.
"I get a text from my daughter saying 'Dad, our home is gone.' Then I called my ex-wife and she said what happened," he said.
His ex-wife, Monserrate Shirley, declined to comment Monday.
Scott Davis, president and principal engineer of GexCon US, an explosion investigation firm, questioned whether a furnace could cause the type of damage seen in the neighborhood. Furnaces have multiple safety triggers that prevent them from releasing that much natural gas.
"For a furnace to allow that much gas through, you'd have to defeat many of the safety features," he said.
Investigators said it could be some time before they determine a cause for the blast that sparked a massive fire, blew out windows, collapsed ceilings and shook homes up to three miles away.
"It's a methodical investigation. You have to move one step at a time," said Gary Coons, the city's homeland security director.
Public Safety Director Troy Riggs said investigators will treat the area as a crime scene until they rule out foul play.
The blast forced about 200 people out of their homes in the once-tidy neighborhood of one- and two-story single-family houses. Some have been allowed to reoccupy their homes, and others have been escorted in to retrieve valuables and other belongings. Adam Collins, the city's deputy code enforcement director, said 29 remained uninhabitable Monday.
Mark Karnes, whose house is four doors down from the blast site and suffered severe structural damage, hoped to retrieve clothes and look for his cat. But he also questioned the wisdom of going back inside the house given the extent of the damage.
"Because the walls bowed out and separated from the ceiling, I don't think it's safe," he said.
The blast flattened the house Shirley co-owns with his ex-wife and one next door that belonged to second-grade teacher Jennifer Longworth and her husband, John. Indianapolis police said Monday the bodies of the pair were found in the basement of their home, which was leveled in the blast.
A candlelight vigil was held Sunday night at the school where Jennifer Longworth teaches. Her husband's employer, consumer electronics company Indy Audio Labs, issued a statement Monday saying it was "saddened by the loss."
Greenwood Community Schools Superintendent David Edds said Jennifer Longworth had taught at Southwest Elementary School for 12 years. Her husband had worked at Indy Audio Labs for 10 years and was director of product development and technology, according to the company.
John Shirley said Jennifer Longworth was quiet but funny and her husband was a huge Indianapolis Colts fan who maintained a garden of beautiful wildflowers along the side of the house.
"They were just very sweet people," he said.
Indiana real estate records show Shirley's house had been for sale for a year until it was taken off the market in March.
___
Associated Press researchers Lynn Dombek and Rhonda Shafner in New York contributed to this report.
November/December 2012 Annals of Family Medicine tip sheetPublic release date: 12-Nov-2012 [ | E-mail | Share ]
Contact: Angela Sharma asharma@aafp.org 913-269-2269 American Academy of Family Physicians
52,000 More Primary Care Physicians Needed by 2025 to Meet Anticipated Demand
Researchers project the United States will need 52,000 additional primary care physicians by 2025 a 25 percent increase in the current workforce to address the expected increases in demand due to population growth, aging, and insurance expansion following passage of the Affordable Care Act. Analyzing nationally representative data, the researchers conclude population growth will be the single greatest driver of increased primary care utilization, requiring approximately 33,000 additional primary care physicians by 2025, while 10,000 additional physicians will be needed to accommodate population aging. Insurance expansion, they estimate, will require approximately 8,000 additional primary care physicians, a 3 percent increase in the current workforce.
Projecting US Primary Care Physician Workforce Needs: 2010-2025
By Stephen M. Petterson, PhD, et al
The Robert Graham Center, Policy Studies in Family Medicine and Primary Care, Washington, D.C.
Which Guidelines Belong in Primary Care Practice? The Case of Prostate Cancer Screening
Using the example of prostate cancer screening, researchers tackle the question of whether overextended primary care clinicians should adopt guidelines developed primarily by specialists when there is limited direct evidence of benefit. The authors argue there is no direct evidence that the benefits of starting PSA screening at age 40, as recently recommended by two specialty organizations, instead of the previously recommended age of 50. Although well-meaning, the specialty guidelines, they assert, distract primary care physicians from providing services with proven benefit and value for patients. They note the US Preventive Services Task Force currently recommends delivering 35 adult preventive services, for which it found high certainty of moderate or high net benefit services that investigators estimate require 7.4 hours a day to deliver. Given the limited time in a typically rushed primary care visit, the authors conclude there is insufficient evidence that the benefits of starting PSA screening at age 40 justifies the additional counseling time. The researchers call on primary care professional societies to vet specialty guidelines using evidence-based processes to determine which belong in primary care, thus enabling physicians to focus on providing patients services with proven effectiveness and value. Moreover, they call for primary care physicians and experts in evidence synthesis to participate on guideline review panels to ensure guidelines are based on systematic review of evidence and not solely on expert opinion.
Reconciling Primary Care and Specialist Perspectives on Prostate Cancer Screening
By Richard M. Hoffman, MD, MPH, et al
University of New Mexico School of Medicine, Albuquerque
How Unrealistic Expectations are Contributing to the Health Care Crisis and the Challenge of Confronting False Beliefs
In an accompanying editorial, Steven H. Woolf at Virginia Commonwealth University contends a major contributor to the alarming rise in health care costs is patients' unrealistic expectations about the benefits of health services. Confronting these beliefs, he asserts, is a potentially more effective way to bend the cost curve than many current reforms. He writes, "If patients and clinicians widely hold that a procedure is life-saving and harmless, any reform is unlikely to curb demand until those misconceptions are addressed." Yet, he points out, such beliefs and behaviors are difficult to change with facts alone because they are shaped by affective influences: beliefs and fears; vulnerability; faith and trust; longstanding routines; personal experiences; messages conveyed by advertising and medicine; and the advice, testimonials and transmitted knowledge imparted by trusted sources. He points to encouraging hints of a shift in societal attitudes about the overutilization of medical services, overdiagnosis and profligate use of screening tests, and he calls on the medical profession to act as a change agent in bringing more realistic expectations to patient care.
The Price of False Beliefs: Unrealistic Expectations as a Contributor to the Health Care Crisis
By Steven H. Woolf, MD, MPH
Virginia Commonwealth University, Richmond
Patients in New Zealand Overestimate Benefits of Screening and Preventive Treatments
Many patients appear willing to undergo preventive care on the basis of overly optimistic expectations of the benefits of preventive interventions and screening. Analyzing data from 354 patient questionnaires on the perceived benefit of screening for breast and bowel cancer, and medication to prevent hip fracture and cardiovascular disease, researchers in New Zealand found participants overestimated the degree of benefit conferred by all interventions. A lower level of education was associated with higher estimates of minimum acceptable benefit for all interventions. Increasing age was associated with higher levels of minimum acceptable benefit for all interventions other than hip fracture prevention. The authors conclude physicians should consider these misperceptions, which may impair informed decision making about the use of such interventions, when counseling patients. Clinicians should also consider using decision aids when discussing these interventions, especially with older patients and those with a lower level of education, as they may reduce patients' tendency to overestimate intervention benefits.
Patients' Expectations of Screening and Preventive Treatments
By Ben Hudson, MRCGP, FRNZCGP, et al
University of Otago, Christchurch, New Zealand
Low Cesarean, High VBAC Rates and Good Perinatal Outcomes at Amish Birthing Center
In light of U.S. policymakers' efforts to lower the rapidly increasing primary cesarean delivery rate and recent national guidelines encouraging trial of labor after cesarean, researchers find encouraging outcomes at a Wisconsin Amish birthing center. Analyzing data on 927 deliveries in this nonhospital setting, the authors found a cesarean rate of 3.8 percent (compared with the cesarean rate of 33 percent in the United States in 2009), a TOLAC rate of 100 percent, and a vaginal birth after cesarean rate of 95 percent (compared with the VBAC rate of 8 percent in the United States in 2006). There were no cases of uterine rupture or maternal death, and the neonatal mortality rate of 5.4 of 1,000 was comparable to that of Wisconsin (4.6 of 1,000 in 2008) and the United States (4.5 of 1,000). The authors conclude these findings demonstrate that in the right circumstances and practice environment, cesarean rates can be decreased and VBAC rates increased in a safe and evidence-based manner. These results, they assert, support a low-tech approach to delivery.
Low Primary Cesarean Rate and High VBAC Rate With Good Outcomes in an Amish Birthing Center
By James Deline, MD, et al
La Farge Medical Clinic-VMH, Wisconsin
Vitamin D Supplementation May Provide Pain Relief for Vitamin D-deficient Patients
High-dose vitamin D supplementation may have a positive effect on persistent musculoskeletal pain among vitamin D-deficient patients. A small study of 84 non-Western immigrants in Western Europe, a population prone to vitamin D deficiency and musculoskeletal problems, revealed a small positive effect on pain six weeks after supplementation with 150,000 IU of Vitamin D3 on vitamin D-deficient patients. Specifically, patients randomized to receive vitamin D supplementation were significantly more likely than those in a control group to report pain relief six weeks after treatment (35 percent vs. 20 percent). The former were also more likely to report an improved ability to walk stairs (21 percent vs. 8 percent). In a nonsignificant trend, patients receiving vitamin D over 12 weeks were more likely to report an improvement than patients receiving it over six weeks. The authors call for future investigation involving greater numbers of participants with longer follow-up and higher doses.
Vitamin D Supplementation for Nonspecific Musculoskeletal Pain in Non-Western Immigrants: A Randomized Controlled Trial
By Ferdinand Schreuder, et al
Erasmus MC, Rotterdam, The Netherlands
Which Interventions Improve Influenza and Pneumococcal Vaccination Rates? A Review of the Research
With influenza and pneumococcal immunization rates below national targets, researchers review the evidence for the effectiveness of different quality improvement interventions aimed at increasing vaccination rates. The analysis of 106 studies involving more than 470,000 patients revealed the best chance for improving vaccination rates may be achieved by 1) shifting vaccine administration from physicians to members of the primary care team with clear responsibilities for chronic and preventive care and 2) activating patients through personal contact. The authors note the impact of these interventions is modest, and they call on policy makers to temper their expectations of such interventions. They call for further research to develop and evaluate more potent approaches and better understand how and why they work.
Interventions to Improve Influenza and Pneumococcal Vaccination Rates Among Community-Dwelling Adults: A Systematic Review and Meta-Analysis
By Darren Lau, BMSc, et al
University of Alberta, Edmonton, Canada
Adding a Contraceptive Vital Sign to Avoid Potentially Harmful Prescriptions and Increase Preconception Counseling in Primary Care
Evaluating the feasibility and efficacy of adding a "contraceptive vital sign" to help spur preconception counseling and safe prescribing of teratogenic medications (drugs known to cause congenital malformations) in primary care, researchers found a contraceptive vital sign improves documentation of pregnancy intentions and contraception in a manner that is acceptable to patients, but had little effect on the rate of family planning counseling and prescribing of potentially teratogenic medications. Specifically, the randomized controlled trial that included data on more than 2,304 women found documentation of contraception increased from 23 percent to 57 percent in the intervention group but remained 28 percent in the control group. For visits involving a teratogenic prescription, documentation increased from 14 percent to 48 percent in the intervention group and decreased from 29 percent to 26 percent in the control group. Provision of new family planning services increased only minimally, however, including among visits with potentially teratogenic prescriptions. When women with documented nonuse of contraception were prescribed potential teratogens, family planning services were provided to only 7 percent. The authors conclude that because the majority of potentially teratogenic medications are prescribed by primary care physicians, ongoing efforts are needed to ensure these patients receive preconception counseling and family planning services. They note that although the intervention was designed to limit primary care physicians' liability when a potential teratogen was prescribed, it may have inadvertently increased liability when contraceptive nonuse was explicitly documented alongside a potential teratogenic prescription.
Promoting Safe Prescribing in Primary Care With a Contraceptive Vital Sign: A Cluster-Randomized Controlled Trial
By Eleanor Bimla Schwarz, MD, MS, et al
University of Pittsburgh, Penn.
High Risk of Undiagnosed Asthma and COPD in Patients with Acute Cough
In a 12-country study, approximately one-fifth of adult patients without an established diagnosis of asthma or chronic obstructive pulmonary disease consulting their family physician for acute cough showed subsequent airway obstruction or bronchodilator responsiveness, both of which are suggestive of undiagnosed asthma or COPD. Analyzing data on 3,105 adult patients with acute cough in primary care practices in 12 European countries, researchers found 240 patients (12 percent) showed bronchodilator responsiveness and 193 patients (10 percent) had obstructive spirometry according to the Global Initiative for Chronic Obstructive Lung Disease grading system. The authors conclude that because both asthma and COPD benefit from appropriate and timely interventions, including pharmacological and lifestyle modifications, such as quitting smoking, clinicians should be aware and responsive to potential underdiagnosis. Additionally, they note that detection of asthma and COPD may help reduce unnecessary use of antibiotics in patients with acute cough.
Airway Obstruction and Bronchodilator Responsiveness in Adults with Acute Cough
By Saskia van Vugt MD, MSc, et al
University Medical Centre Utrecht, the Netherlands
Clinically Relevant Incidental Findings on Chest Radiographs Uncommon
Recognizing that imaging can sometimes produce unexpected or incidental findings that have consequences for patients and lead to further expensive and potentially harmful investigations, researchers find that clinically relevant incidental findings on chest radiographs in primary care adult patients with acute cough are uncommon. In this companion article, researchers in the Netherlands analyze 2,823 chest radiographs from patients complaining of acute cough in 16 different European primary care networks and find that although incidental findings were reported in 19 percent of patients, only 3 percent of these patients had clinically relevant incidental findings, including lung nodules and shadows. Notably, the frequency of the reporting of incidental findings varied dramatically between the different primary care networks, ranging from 0 percent to 36 percent. The authors assert these findings should inform decisions about the appropriate threshold for ordering chest radiographs in primary care, as well as guide clinicians in informing patients about the possibility of incidental findings.
Incidental Chest Radiographic Findings in Adults With Acute Cough
By Saskia van Vugt, MD, MSc, et al
University Medical Centre Utrecht, the Netherlands
Modified Surgical Approach to Treating Ingrown Toenail With Excellent Results
Researchers in Turkey describe a method for treating ingrown toenails that prevents recurrences. Reviewing outcomes from a series of 348 proximolateral partial matricetomies and phenol ablations in 225 patients with stage 2 or 3 ingrown toenail, they found only one recurrence during the 24-month follow-up period, no severe complications and excellent cosmetic results. The authors assert the surgical technique, which is more invasive than simple partial nail avulsion and easier to perform than wide wedge excision, is the most important determinant of the success rate.
Treatment of Ingrown Toenail With Proximolateral Matrix Partial Excision and Matrix Phenolization
By Nezih Karaca, MD and Tugrul Dereli
Okmeydani Education and Research Hospital, Istanbul, Turkey
Proposed Model for the Electronic Support of Practice-Based Research
Researchers propose a model for the electronic support of practice-based translational research, including the information architecture, processes, and software requirements needed to support practice-based research networks. The model, which identifies seven independent applications that interact over the Internet using standard Web services, scales to a size large enough to support every PBRN and primary care practice in the United States and supports local customization and enhancement.
A Model for the Electronic Support of Practice-Based Research Networks
By Kevin Peterson, MD, MPH, et al
University of Minnesota, Minneapolis
###
Annals of Family Medicine is a peer-reviewed, indexed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care disciplines. Launched in May 2003, Annals is sponsored by seven family medical organizations, including the American Academy of Family Physicians, the American Board of Family Medicine, the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group, and the College of Family Physicians of Canada. Annals is published six times each year and contains original research from the clinical, biomedical, social and health services areas, as well as contributions on methodology and theory, selected reviews, essays and editorials. Complete editorial content and interactive discussion groups for each published article can be accessed free of charge on the journal's Web site, www.annfammed.org.
[ | 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.
November/December 2012 Annals of Family Medicine tip sheetPublic release date: 12-Nov-2012 [ | E-mail | Share ]
Contact: Angela Sharma asharma@aafp.org 913-269-2269 American Academy of Family Physicians
52,000 More Primary Care Physicians Needed by 2025 to Meet Anticipated Demand
Researchers project the United States will need 52,000 additional primary care physicians by 2025 a 25 percent increase in the current workforce to address the expected increases in demand due to population growth, aging, and insurance expansion following passage of the Affordable Care Act. Analyzing nationally representative data, the researchers conclude population growth will be the single greatest driver of increased primary care utilization, requiring approximately 33,000 additional primary care physicians by 2025, while 10,000 additional physicians will be needed to accommodate population aging. Insurance expansion, they estimate, will require approximately 8,000 additional primary care physicians, a 3 percent increase in the current workforce.
Projecting US Primary Care Physician Workforce Needs: 2010-2025
By Stephen M. Petterson, PhD, et al
The Robert Graham Center, Policy Studies in Family Medicine and Primary Care, Washington, D.C.
Which Guidelines Belong in Primary Care Practice? The Case of Prostate Cancer Screening
Using the example of prostate cancer screening, researchers tackle the question of whether overextended primary care clinicians should adopt guidelines developed primarily by specialists when there is limited direct evidence of benefit. The authors argue there is no direct evidence that the benefits of starting PSA screening at age 40, as recently recommended by two specialty organizations, instead of the previously recommended age of 50. Although well-meaning, the specialty guidelines, they assert, distract primary care physicians from providing services with proven benefit and value for patients. They note the US Preventive Services Task Force currently recommends delivering 35 adult preventive services, for which it found high certainty of moderate or high net benefit services that investigators estimate require 7.4 hours a day to deliver. Given the limited time in a typically rushed primary care visit, the authors conclude there is insufficient evidence that the benefits of starting PSA screening at age 40 justifies the additional counseling time. The researchers call on primary care professional societies to vet specialty guidelines using evidence-based processes to determine which belong in primary care, thus enabling physicians to focus on providing patients services with proven effectiveness and value. Moreover, they call for primary care physicians and experts in evidence synthesis to participate on guideline review panels to ensure guidelines are based on systematic review of evidence and not solely on expert opinion.
Reconciling Primary Care and Specialist Perspectives on Prostate Cancer Screening
By Richard M. Hoffman, MD, MPH, et al
University of New Mexico School of Medicine, Albuquerque
How Unrealistic Expectations are Contributing to the Health Care Crisis and the Challenge of Confronting False Beliefs
In an accompanying editorial, Steven H. Woolf at Virginia Commonwealth University contends a major contributor to the alarming rise in health care costs is patients' unrealistic expectations about the benefits of health services. Confronting these beliefs, he asserts, is a potentially more effective way to bend the cost curve than many current reforms. He writes, "If patients and clinicians widely hold that a procedure is life-saving and harmless, any reform is unlikely to curb demand until those misconceptions are addressed." Yet, he points out, such beliefs and behaviors are difficult to change with facts alone because they are shaped by affective influences: beliefs and fears; vulnerability; faith and trust; longstanding routines; personal experiences; messages conveyed by advertising and medicine; and the advice, testimonials and transmitted knowledge imparted by trusted sources. He points to encouraging hints of a shift in societal attitudes about the overutilization of medical services, overdiagnosis and profligate use of screening tests, and he calls on the medical profession to act as a change agent in bringing more realistic expectations to patient care.
The Price of False Beliefs: Unrealistic Expectations as a Contributor to the Health Care Crisis
By Steven H. Woolf, MD, MPH
Virginia Commonwealth University, Richmond
Patients in New Zealand Overestimate Benefits of Screening and Preventive Treatments
Many patients appear willing to undergo preventive care on the basis of overly optimistic expectations of the benefits of preventive interventions and screening. Analyzing data from 354 patient questionnaires on the perceived benefit of screening for breast and bowel cancer, and medication to prevent hip fracture and cardiovascular disease, researchers in New Zealand found participants overestimated the degree of benefit conferred by all interventions. A lower level of education was associated with higher estimates of minimum acceptable benefit for all interventions. Increasing age was associated with higher levels of minimum acceptable benefit for all interventions other than hip fracture prevention. The authors conclude physicians should consider these misperceptions, which may impair informed decision making about the use of such interventions, when counseling patients. Clinicians should also consider using decision aids when discussing these interventions, especially with older patients and those with a lower level of education, as they may reduce patients' tendency to overestimate intervention benefits.
Patients' Expectations of Screening and Preventive Treatments
By Ben Hudson, MRCGP, FRNZCGP, et al
University of Otago, Christchurch, New Zealand
Low Cesarean, High VBAC Rates and Good Perinatal Outcomes at Amish Birthing Center
In light of U.S. policymakers' efforts to lower the rapidly increasing primary cesarean delivery rate and recent national guidelines encouraging trial of labor after cesarean, researchers find encouraging outcomes at a Wisconsin Amish birthing center. Analyzing data on 927 deliveries in this nonhospital setting, the authors found a cesarean rate of 3.8 percent (compared with the cesarean rate of 33 percent in the United States in 2009), a TOLAC rate of 100 percent, and a vaginal birth after cesarean rate of 95 percent (compared with the VBAC rate of 8 percent in the United States in 2006). There were no cases of uterine rupture or maternal death, and the neonatal mortality rate of 5.4 of 1,000 was comparable to that of Wisconsin (4.6 of 1,000 in 2008) and the United States (4.5 of 1,000). The authors conclude these findings demonstrate that in the right circumstances and practice environment, cesarean rates can be decreased and VBAC rates increased in a safe and evidence-based manner. These results, they assert, support a low-tech approach to delivery.
Low Primary Cesarean Rate and High VBAC Rate With Good Outcomes in an Amish Birthing Center
By James Deline, MD, et al
La Farge Medical Clinic-VMH, Wisconsin
Vitamin D Supplementation May Provide Pain Relief for Vitamin D-deficient Patients
High-dose vitamin D supplementation may have a positive effect on persistent musculoskeletal pain among vitamin D-deficient patients. A small study of 84 non-Western immigrants in Western Europe, a population prone to vitamin D deficiency and musculoskeletal problems, revealed a small positive effect on pain six weeks after supplementation with 150,000 IU of Vitamin D3 on vitamin D-deficient patients. Specifically, patients randomized to receive vitamin D supplementation were significantly more likely than those in a control group to report pain relief six weeks after treatment (35 percent vs. 20 percent). The former were also more likely to report an improved ability to walk stairs (21 percent vs. 8 percent). In a nonsignificant trend, patients receiving vitamin D over 12 weeks were more likely to report an improvement than patients receiving it over six weeks. The authors call for future investigation involving greater numbers of participants with longer follow-up and higher doses.
Vitamin D Supplementation for Nonspecific Musculoskeletal Pain in Non-Western Immigrants: A Randomized Controlled Trial
By Ferdinand Schreuder, et al
Erasmus MC, Rotterdam, The Netherlands
Which Interventions Improve Influenza and Pneumococcal Vaccination Rates? A Review of the Research
With influenza and pneumococcal immunization rates below national targets, researchers review the evidence for the effectiveness of different quality improvement interventions aimed at increasing vaccination rates. The analysis of 106 studies involving more than 470,000 patients revealed the best chance for improving vaccination rates may be achieved by 1) shifting vaccine administration from physicians to members of the primary care team with clear responsibilities for chronic and preventive care and 2) activating patients through personal contact. The authors note the impact of these interventions is modest, and they call on policy makers to temper their expectations of such interventions. They call for further research to develop and evaluate more potent approaches and better understand how and why they work.
Interventions to Improve Influenza and Pneumococcal Vaccination Rates Among Community-Dwelling Adults: A Systematic Review and Meta-Analysis
By Darren Lau, BMSc, et al
University of Alberta, Edmonton, Canada
Adding a Contraceptive Vital Sign to Avoid Potentially Harmful Prescriptions and Increase Preconception Counseling in Primary Care
Evaluating the feasibility and efficacy of adding a "contraceptive vital sign" to help spur preconception counseling and safe prescribing of teratogenic medications (drugs known to cause congenital malformations) in primary care, researchers found a contraceptive vital sign improves documentation of pregnancy intentions and contraception in a manner that is acceptable to patients, but had little effect on the rate of family planning counseling and prescribing of potentially teratogenic medications. Specifically, the randomized controlled trial that included data on more than 2,304 women found documentation of contraception increased from 23 percent to 57 percent in the intervention group but remained 28 percent in the control group. For visits involving a teratogenic prescription, documentation increased from 14 percent to 48 percent in the intervention group and decreased from 29 percent to 26 percent in the control group. Provision of new family planning services increased only minimally, however, including among visits with potentially teratogenic prescriptions. When women with documented nonuse of contraception were prescribed potential teratogens, family planning services were provided to only 7 percent. The authors conclude that because the majority of potentially teratogenic medications are prescribed by primary care physicians, ongoing efforts are needed to ensure these patients receive preconception counseling and family planning services. They note that although the intervention was designed to limit primary care physicians' liability when a potential teratogen was prescribed, it may have inadvertently increased liability when contraceptive nonuse was explicitly documented alongside a potential teratogenic prescription.
Promoting Safe Prescribing in Primary Care With a Contraceptive Vital Sign: A Cluster-Randomized Controlled Trial
By Eleanor Bimla Schwarz, MD, MS, et al
University of Pittsburgh, Penn.
High Risk of Undiagnosed Asthma and COPD in Patients with Acute Cough
In a 12-country study, approximately one-fifth of adult patients without an established diagnosis of asthma or chronic obstructive pulmonary disease consulting their family physician for acute cough showed subsequent airway obstruction or bronchodilator responsiveness, both of which are suggestive of undiagnosed asthma or COPD. Analyzing data on 3,105 adult patients with acute cough in primary care practices in 12 European countries, researchers found 240 patients (12 percent) showed bronchodilator responsiveness and 193 patients (10 percent) had obstructive spirometry according to the Global Initiative for Chronic Obstructive Lung Disease grading system. The authors conclude that because both asthma and COPD benefit from appropriate and timely interventions, including pharmacological and lifestyle modifications, such as quitting smoking, clinicians should be aware and responsive to potential underdiagnosis. Additionally, they note that detection of asthma and COPD may help reduce unnecessary use of antibiotics in patients with acute cough.
Airway Obstruction and Bronchodilator Responsiveness in Adults with Acute Cough
By Saskia van Vugt MD, MSc, et al
University Medical Centre Utrecht, the Netherlands
Clinically Relevant Incidental Findings on Chest Radiographs Uncommon
Recognizing that imaging can sometimes produce unexpected or incidental findings that have consequences for patients and lead to further expensive and potentially harmful investigations, researchers find that clinically relevant incidental findings on chest radiographs in primary care adult patients with acute cough are uncommon. In this companion article, researchers in the Netherlands analyze 2,823 chest radiographs from patients complaining of acute cough in 16 different European primary care networks and find that although incidental findings were reported in 19 percent of patients, only 3 percent of these patients had clinically relevant incidental findings, including lung nodules and shadows. Notably, the frequency of the reporting of incidental findings varied dramatically between the different primary care networks, ranging from 0 percent to 36 percent. The authors assert these findings should inform decisions about the appropriate threshold for ordering chest radiographs in primary care, as well as guide clinicians in informing patients about the possibility of incidental findings.
Incidental Chest Radiographic Findings in Adults With Acute Cough
By Saskia van Vugt, MD, MSc, et al
University Medical Centre Utrecht, the Netherlands
Modified Surgical Approach to Treating Ingrown Toenail With Excellent Results
Researchers in Turkey describe a method for treating ingrown toenails that prevents recurrences. Reviewing outcomes from a series of 348 proximolateral partial matricetomies and phenol ablations in 225 patients with stage 2 or 3 ingrown toenail, they found only one recurrence during the 24-month follow-up period, no severe complications and excellent cosmetic results. The authors assert the surgical technique, which is more invasive than simple partial nail avulsion and easier to perform than wide wedge excision, is the most important determinant of the success rate.
Treatment of Ingrown Toenail With Proximolateral Matrix Partial Excision and Matrix Phenolization
By Nezih Karaca, MD and Tugrul Dereli
Okmeydani Education and Research Hospital, Istanbul, Turkey
Proposed Model for the Electronic Support of Practice-Based Research
Researchers propose a model for the electronic support of practice-based translational research, including the information architecture, processes, and software requirements needed to support practice-based research networks. The model, which identifies seven independent applications that interact over the Internet using standard Web services, scales to a size large enough to support every PBRN and primary care practice in the United States and supports local customization and enhancement.
A Model for the Electronic Support of Practice-Based Research Networks
By Kevin Peterson, MD, MPH, et al
University of Minnesota, Minneapolis
###
Annals of Family Medicine is a peer-reviewed, indexed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care disciplines. Launched in May 2003, Annals is sponsored by seven family medical organizations, including the American Academy of Family Physicians, the American Board of Family Medicine, the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group, and the College of Family Physicians of Canada. Annals is published six times each year and contains original research from the clinical, biomedical, social and health services areas, as well as contributions on methodology and theory, selected reviews, essays and editorials. Complete editorial content and interactive discussion groups for each published article can be accessed free of charge on the journal's Web site, www.annfammed.org.
[ | E-mail | Share ]
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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
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Public release date: 12-Nov-2012
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