U.S. President Barack Obama, left, shakes hands with South African President Jacob Zuma at the Union Building on Saturday, June 29, 2013, in Pretoria, South Africa. The visit comes at a poignant time, with former South African president and anti-apartheid hero Nelson Mandela ailing in a Johannesburg hospital. The White House issued a statement Saturday that President Barack Obama plans to visit privately with relatives of former South African President Nelson Mandela, but doesn't intend to see the critically ill anti-apartheid activist he has called a "personal hero." (AP Photo/Evan Vucci)
U.S. President Barack Obama, left, shakes hands with South African President Jacob Zuma at the Union Building on Saturday, June 29, 2013, in Pretoria, South Africa. The visit comes at a poignant time, with former South African president and anti-apartheid hero Nelson Mandela ailing in a Johannesburg hospital. The White House issued a statement Saturday that President Barack Obama plans to visit privately with relatives of former South African President Nelson Mandela, but doesn't intend to see the critically ill anti-apartheid activist he has called a "personal hero." (AP Photo/Evan Vucci)
PRETORIA, South Africa (AP) ? President Barack Obama says he doesn't feel threatened by the fact that other countries, led by China, are investing in Africa. In fact, Obama says the more countries that come to Africa, the merrier.
Obama says he's touring three African nations this week because the United States needs to increase its engagement with a continent that's showing promise and possibility.
He says such interaction is good for the U.S. regardless of what other countries do.
But he cautions that Africa must be wary of outside investment and always ask how it will benefit when other countries come seeking its natural resources or to make other investments.
Obama spoke Saturday during a news conference in South Africa with President Jacob Zuma.
An interactive workshop on teaching of Chinese at UK Universities with the opportunity to share experience
Workshop 1: Teaching Chinese in the digital and mobile age (Dr. Kan Qian, Open University)
Workshop 2: Interaction in UK Higher Education Context (Dr. Minjie Xing, Manchester University)
Workshop 3: Corpus-based language education in Chinese context (Dr. Richard Xiao, Lancaster University)
Workshop 4: Pitfalls to avoid for new teachers of teaching Chinese as a second language (Ms Cheng Yao, Lancaster University Confucius Institute and South China University of Technology)
Photo courtesy of Reiner Bajo/Columbia Pictures Industries, Inc./Sony Pictures Entertainment Inc.
Should Roland Emmerich be put on some sort of government watch list? Nearly two decades after he first publicly fantasized about the destruction of Washington, D.C., in Independence Day (1996), he?s back with another massive imagined attack on our nation?s capital in White House Down?this time not via alien invasion, but a humanity-driven inside job. In the Mayan-calendar disaster epic 2012, Emmerich demolished not only the seat of U.S. government but a large portion of the Earth?s surface. And when not compulsively re-enacting the annihilation of all that America holds dear, the German-born director has been known to espouse radical-fringe ideology?namely, in his last film Anonymous, the belief that William Shakespeare of Stratford was not the author of the plays published under his name.
I?m glad, though, that the NSA hasn?t yet spirited Emmerich off to a remote location, because I rather enjoy his movies (the more self-serious Anonymous being a rare exception). Emmerich?s vision of civilization?s collapse is so loony, the scale of the damage he imagines so vast, that his best movies (that is to say his worst) achieve a strange tone of devil-may-care merriment. In White House Down, the spectacularly disturbing image of the Capitol rotunda exploding into flame?which dominates the film?s marketing campaign?isn?t some sort of action-climax dessert; it?s an amuse-bouche of excitement that occurs about 15 minutes in. Things only escalate from there, as the battleground quickly moves from Capitol Hill to 1600 Pennsylvania Ave. (as impressively replicated in the production design of Kirk M. Petruccelli).
Channing Tatum plays John Cale, who (having presumably time-traveled from his days as a founding member of the Velvet Underground) is an Iraq vet serving on the security detail of the speaker of the House, Congressman Eli Raphelson (Richard Jenkins). Cale?s dream is to move up to the Secret Service?in part because his 11-year-old daughter Emily (Joey King) is a politics nerd with a crush on the sitting president. You can see why given that, as played by Jamie Foxx, President James Sawyer is basically Barack Obama (complete with a secret addiction to cigarettes and a not-so-secret obsession with Abraham Lincoln) after an extra spin through the sexifying machine. In addition to being handsome and charmingly self-effacing, Sawyer is honest, idealistic, and righteous. ?The pen is mightier than the sword,? he announces in a speech on the eve of a major Middle East peace accord. It?s an adage that will come in handy later, when weapons around the Oval Office are in short supply.
Cale?s interview for the Secret Service job doesn?t go so well. His interviewer, Special Agent Carol Finnerty (Maggie Gyllenhaal) turns out to be an old college flame, which is not only socially awkward but professionally disadvantageous?she remembers her ex?s bad study habits and poor impulse control, and suggests he content himself with a less prestigious post. But as Cale and his daughter are about to leave the White House (in an attempt to win her reluctant tween affection, he?s wangled a day pass for them both), some heavy shit starts to go down. First there?s the aforementioned explosion at the Capitol, then a full-scale armed invasion of the White House by domestic terrorists. Cale and his little girl?not to mention the president, his staff, and a roomful of nervous tourists?become the hostages of a nasty crew of heavily armed malcontents, including a resentful war vet (Jason Clarke), a sadistic white supremacist (Kevin Rankin), and a traitorous presidential staffer whose identity I won?t disclose, but whose treachery is revealed early on.
Just what this ruthless bunch is after?and why it?s so important to them, in all the surrounding mayhem, to capture the president alive?won?t make sense until the last few minutes (and, unless you?re on mescaline, probably not even then). All Cale knows is that he must find and protect his daughter, who?s gotten separated from him in the chaos. But in his search for Emily, Cale happens upon President Sawyer being held at gunpoint?and suddenly, that Secret Service position he wanted is all his, along with the unenviable responsibility of saving the world from all-out war. You see, the bad guys have also brought along a computer hacker (Jimmi Simpson)?one of the evil kind who, in an apparent nod to Die Hard, enjoys blasting Beethoven symphonies as he cracks the NORAD missile launch codes, one by one.
Even as the story accrues preposterousness, the action moves along crisply, and Tatum and Foxx hit a nice buddy-movie vibe, especially in the scenes where the bookish, retiring president (again, shades of Obama) learns to enjoy the pleasures of putting on a pair of Jordans and firing a rocket launcher out the window of a limousine. In this season of solemnly manly blockbusters, I appreciated the boyish energy of White House Down, a movie that, for all its flamboyant destructiveness, has a playful innocence at its core. In essence, it?s 137 minutes of action figures being bashed together, and even if that?s about 20 minutes too long, there are plenty of laughs and thrills all through?many of them at the expense of plausibility, which, as the film?s last act makes clear, might be the one thing Emmerich enjoys destroying more than Air Force One.
JERUSALEM (AP) ? U.S. Secretary of State John Kerry held talks with Palestinian President Mahmoud Abbas on Saturday for the second time in two days, continuing his rushed round of shuttle diplomacy to restart talks between Israel and the Palestinians.
Kerry is shuttling between meetings in Jerusalem and Amman, Jordan, to find a way to coax both sides back into negotiations to craft a two-state solution to their long-running conflict.
U.S., Israeli and Palestinian officials have all declined to disclose details of the talks. "Working hard," is all Kerry would say when a reporter asked him, during a photo-op before the Abbas meeting, whether progress was being made.
For the past three days, Kerry, who is on a two-week swing through the Mideast and Asia, has been conducting meetings with Israeli and Palestinian officials at a frenetic pace. A few days ago, Kerry added a stop in Abu Dhabi to his itinerary, but it was later canceled because of his ongoing discussions on the Mideast peace process.
He had a four-hour dinner meeting with Israeli Prime Minister Benjamin Netanyahu Thursday night in Jerusalem followed by a more than two-hour lunch with Abbas on Friday in Amman at the home of the Palestinian ambassador to Jordan. Then it was back to Jerusalem for another meeting with Netanyahu and dinner with Israeli President Shimon Peres.
On Saturday morning, he boarded a helicopter to fly back to Amman to meet again with Abbas, this time at the Palestinian president's residence there. Later Saturday, he was to return to Jerusalem to meet with Tzipi Livni, Israel's chief negotiator with the Palestinians, and Isaac Molho, a Netanyahu envoy.
Kerry is scheduled to leave Jerusalem on Sunday to head to Brunei for a Southeast Asia security conference.
There is deep skepticism that Kerry can get the two sides to agree on a two-state solution, something that has eluded presidents and diplomats for years. But the flurry of meetings has heightened expectations that the two sides can be convinced to at least restart talks, which broke down in 2008.
So far, there have been no public signs that the two sides are narrowing their differences.
In the past, Abbas has said he won't negotiate unless Israel stops building settlements on war-won lands or accepts its 1967 lines ? before the capture of the West Bank, Gaza Strip and east Jerusalem in a Mideast war that year ? as a starting point for border talks. The Palestinians claim all three areas for their future state.
Netanyahu has rejected the Palestinian demands, saying there should be no pre-conditions for talks.
Abbas made significant progress with Netanyahu's predecessor, Ehud Olmert, in talks in 2007 and 2008, but believes there is little point in negotiating with the current Israeli leader.
Netanyahu has adopted much tougher starting positions than Olmert, refusing to recognize Israel's pre-1967 frontier as a baseline for border talks and saying east Jerusalem, the Palestinians' hoped-for capital, is off the table. Abbas and his aides suspect Netanyahu wants to resume talks for the sake of negotiating and creating a diplomatic shield for Israel, not in order to reach an agreement.
Abbas, in turn, has much to lose domestically if he drops his demands that Netanyahu either freeze settlement building or recognize the 1967 frontier as a starting point before talks can resume. Netanyahu has rejected both demands. A majority of Palestinians, disappointed after 20 years of fruitless negotiations with Israel, opposes a return to talks on Netanyahu's terms.
___
Associated Press writer Karin Laub in Ramallah, West Bank, contributed to this report.
According to a "top secret" National Security Agency (NSA) document, the US bugged the offices of European Union member state offices in Washington and at the UN and gained access to computer networks used at those locations. The latest report revealing spy activities by the NSA comes from German news magazine Der Spiegel, which says it saw parts of documents in whistleblower Edward Snowden's possession. Snowden was also behind leaks that revealed the NSA's massive PRISM program, designed to spy on internet users, as well as documents that shed light on the British government's involvement in the program.
Europeans called out as a "target"
Today's leak, according to the Der Spiegel report, reveals that NSA efforts to spy on European Union representatives in the US granted access to conversations as well as emails and other documents stored on computers used at locations in Washington and the United Nations. Europeans were apparently specifically mentioned as a target in the source document, which is dated from September of 2010. The spying methods resemble those reportedly used by the British at the 2009 G20 Summit in London, which saw the UK's Government Communications Headquarters (GCHQ) tap into phones and computers used by heads of state. That surveillance campaign was uncovered by a separate Snowden leak earlier this month.
In addition to NSA efforts to listen in on EU representatives in the US, the agency is said to have spied on telecommunications at the Justus Lipsius building in Brussels (pictured above), where the Council of the European Union sits. EU member states have offices at the building with internet connections and phone lines, and it's presumed that the NSA tapped into at least some of those communications. It's not clear if this information comes from the same document, but Der Spiegel reports that five years ago security officers at the Justus Lipsius building traced some missed calls to NSA offices at a NATO building in Brussels.
NEW YORK (Reuters) - Panic selling on fears of an early exit of the U.S. Federal Reserve's stimulus efforts may be over, but the stock market may still face wild intraday swings as investors scramble to position themselves for Friday's payrolls report.
Trading volume is likely to be thin, with a half-day session on Wednesday and markets closed for the Independence Day holiday on Thursday. Both the Labor Department's weekly jobless claims and employment report for June will be released at 8:30 a.m. (1230 GMT).
"Non-farm payrolls generally cause more volatility in the market, but how many times do you see weekly claims and payrolls coming out the same day on a shortened trading week? That will certainly cause a lot of volatility," said Randy Frederick, managing director of trading and derivatives at Charles Schwab & Co Austin, Texas.
In the options market, traders were active in the put weekly options on the S&P 500 <.spx>. These short-term options have a week-long life span and expire on July 5. Put options are generally viewed as bearish bets against the market.
"We've seen some buying pop up in the weeklies for next week. The most active ones are the 1,600 puts on the SPX," said JJ Kinahan, chief strategist at online brokerage firm TD Ameritrade in Chicago.
"We will probably see more hedging activity early next week and perhaps higher intraday swings as people try to figure out their option positions going into the holiday with the employment report due the next day."
June's employment report could offer clues on the timing of the Fed's eventual tapering of its bond purchases. Non-farm payrolls are expected at 170,000, below the 194,000 six-month moving average. The unemployment rate is seen dipping to 7.5 percent from 7.6 percent.
Manufacturing will also be in the spotlight next week. The Institute for Supply Management is expected to report on Monday that factory activity expanded in June after a surprise contraction in May.
While U.S. markets are closed on Thursday, the Bank of England monetary policy meets for the first time under the chairmanship Governor Mark Carney.
The European Central Bank, which also holds its monetary meeting on Thursday, is not expected to change rates, but President Mario Draghi may discuss just how much longer the ECB will stick with extraordinary policy settings.
SECOND HALF OF THE YEAR
The S&P 500 on Friday posted the best first half of the year since 1998, rising more than 13 percent in the first six months of 2013, fueled by U.S. monetary stimulus.
"I think that the market's pretty fairly valued, so we would be surprised if you saw the same kind of rally like you saw in the first half of the year, but it doesn't seem to be a catastrophic environment, like you're going off the cliff either," said Steven Baffico, chief executive officer at Four Wood Capital Partners in New York.
For the quarter, the S&P 500 was up 2.3 percent but for the month, the S&P 500 fell 1.5 percent on concerns of an early exit by the Fed's supportive measures.
A Reuters survey of 53 investors across the United States, Europe and Japan released on Friday found that funds had already cut their average equity holdings in June to a nine-month low due to the recent volatility and had held more cash.
The equities market took a hit last week after Fed Chairman Ben Bernanke signaled the central bank would begin to slow the pace of its bond buying later this year if the economy improves as forecast. Since then, a number of Fed speakers have sought to calm markets, giving assurances the stimulus efforts are going to be in place for awhile.
Federal Reserve Bank of New York President William Dudley, who said markets are "quite out of sync" with the Fed, will speak on economic conditions on Tuesday.
"I think the panic selling from the Fed is pretty much over. Now they (Fed officials) are coming out and saying unanimously that 'we haven't changed at all, and we are possibly tapering in the fall depending on the data,'" Frederick said.
"I think the market is believing that now, and I don't expect anything surprisingly different from the Fed speaker next week."
(Additional reporting by Alison Griswold; Editing by Kenneth Barry)
MOSCOW (Reuters) - Russian state-controlled airline Aeroflot sees no benefits from its membership in the SkyTeam alliance, but a decision to leave the group is not for management to take, a source close to its board told Reuters.
Aeroflot is considering leaving the SkyTeam alliance because of unfavorable agreements with other members, in particular U.S. Delta Air Lines Inc , the Kommersant daily reported on Friday.
"There is no point in cooperating with them," a source close to the board told Reuters. He doubted, however, that Aeroflot would drop out of the alliance unless there is a political decision to do so.
The agreement to join SkyTeam in 2004 was signed in the Kremlin, a political stamp of approval largely due to close ties with France. Air France-KLM is a leading member of the group.
The newspaper cited sources close to Aeroflot's board of directors as saying the company was not happy with the development of its routes in the United States, where Delta Air Lines charges relatively high fares.
Dropping out of the alliance could cost Aeroflot $20 million and the airline may consider joining Star Alliance, the biggest airline marketing group, with 27 members.
As a member of SkyTeam, which brings together 19 global airlines, Aeroflot cannot undercut prices offered by other members and could become more competitive by joining the Star Alliance, Kommersant said.
Aeroflot declined to comment on the report.
(Reporting by Maya Dyakina and Gleb Stolyarov; Editing by Elizabeth Piper and Douglas Busvine)
FILE - This file photo provided Friday, April 19, 2013 by the Federal Bureau of Investigation shows Boston Marathon bombing suspect Dzhokhar Tsarnaev. A federal grand jury in Boston returned a 30-count indictment against Tsarnaev on Thursday, June 27, 2013, on charges including using a weapon of mass destruction and bombing a place of public use, resulting in death. (AP Photo/Federal Bureau of Investigation, File)
FILE - This file photo provided Friday, April 19, 2013 by the Federal Bureau of Investigation shows Boston Marathon bombing suspect Dzhokhar Tsarnaev. A federal grand jury in Boston returned a 30-count indictment against Tsarnaev on Thursday, June 27, 2013, on charges including using a weapon of mass destruction and bombing a place of public use, resulting in death. (AP Photo/Federal Bureau of Investigation, File)
U.S. Attorney Carmen M. Ortiz speaks during a news conference, announcing a 30-count indictment against Boston Marathon bombing suspect Dzhokhar Tsarnaev, Thursday, June 27, 2013, in Boston. Charges against Tsarnaev include using a weapon of mass destruction and bombing a place of public use, resulting in death near the marathon finish line on April 15. (AP Photo/Bill Sikes)
FILE - In this April 15, 2013 file photo, medical workers aid injured people at the finish line of the 2013 Boston Marathon following an explosion in Boston. A federal grand jury in Boston returned a 30-count indictment against bombing suspect Dzhokhar Tsarnaev on Thursday, June 27, 2013, on charges including using a weapon of mass destruction and bombing a place of public use, resulting in death. (AP Photo/Charles Krupa, File)
U.S. Attorney Carmen M. Ortiz pauses during a news conference, announcing a 30-count indictment against Boston Marathon bombing suspect Dzhokhar Tsarnaev, Thursday, June 27, 2013, in Boston. Charges against Tsarnaev include using a weapon of mass destruction and bombing a place of public use, resulting in death near the marathon finish line on April 15. Alongside are Richard DesLauriers, Special Agent in Charge for the Federal Bureau of Investigation, Boston Field Division, left, and Bruce Foucart, Special Agent in Charge for Homeland Security in Boston, right. (AP Photo/Bill Sikes)
FILE - In this April 15, 2013, file photo, blood from victims covers the sidewalk on Boylston Street, at the site of an explosion during the 2013 Boston Marathon in Boston. At right foreground is a folding chair with the design of an American flag on the cover. A federal grand jury in Boston returned a 30-count indictment against bombing suspect Dzhokhar Tsarnaev on Thursday, June 27, 2013, on charges including using a weapon of mass destruction and bombing a place of public use, resulting in death. (AP Photo/Charles Krupa, File)
BOSTON (AP) ? What Dzhokhar Tsarnaev needed to learn to make explosives with a pressure cooker was at his fingertips in jihadist files on the Internet, according to a federal indictment accusing him of carrying out the bombings at the Boston Marathon that killed three people and injured dozens more.
Investigators have been trying to determine whether Tsarnaev's older brother, Tamerlan, who was killed while the two were on the run after the bombings, was influenced or trained by Islamic militants during a trip overseas. But the indictment released Thursday against 19-year-old Dzhokhar makes no mention of any overseas influence.
Before the attack, according to the indictment, he downloaded the summer 2010 issue of Inspire, an online English-language magazine published by al-Qaida. The issue detailed how to make bombs from pressure cookers, explosive powder extracted from fireworks and lethal shrapnel.
He also downloaded extremist Muslim literature, including "Defense of the Muslim Lands, the First Obligation After Imam," which advocates "violence designed to terrorize the perceived enemies of Islam," the indictment said. The article was written by the late Abdullah Azzam, whose legacy has inspired terrorist attacks in the Middle East.
Another tract downloaded ? titled "The Slicing Sword, Against the One Who Forms Allegiances With the Disbelievers and Takes Them as Supporters Instead of Allah, His Messenger and the Believers" ? included a foreword by Anwar al-Awlaki, an American propagandist for al-Qaida who was killed in a U.S. drone strike in 2011.
The 30-count indictment provides one of the most detailed public explanations to date of the brothers' alleged motive ? Islamic extremism ? and the role the Internet may have played in influencing them.
"Tamerlan Tsarnaev's justice will be in the next world, but for his brother, accountability will begin right here in the district of Massachusetts," Suffolk District Attorney Daniel Conley, whose jurisdiction includes Boston, said at a news conference with federal prosecutors on Thursday.
The indictment contains the bombing charges, punishable by the death penalty, that were brought in April against Tsarnaev, including use of a weapon of mass destruction to kill. It also contains many new charges covering the slaying of an MIT police officer and the carjacking of a motorist during the getaway attempt that left Tamerlan Tsarnaev dead.
U.S. Attorney Carmen Ortiz of Massachusetts said Attorney General Eric Holder will decide whether to pursue the death penalty against Tsarnaev, who will be arraigned on July 10.
Three people were killed and more than 260 wounded by the two pressure-cooker bombs that went off near the finish line of the marathon on April 15.
Dzhokhar Tsarnaev was captured four days later, hiding in a boat parked in a backyard in Watertown, Mass.
According to the indictment, he scrawled messages on the inside of the vessel that said, among other things, "The U.S. Government is killing our innocent civilians," ''I can't stand to see such evil go unpunished," and "We Muslims are one body, you hurt one you hurt us all."
The Tsarnaev brothers had roots in the turbulent Russian regions of Dagestan and Chechnya, which have become recruiting grounds for Muslim extremists. They had been living in the U.S. about a decade.
There was no mention in the indictment of any larger conspiracy beyond the brothers, and no reference to any direct overseas contacts with extremists. Instead, the indictment suggests the Internet played an important role in the suspects' radicalization.
Tamerlan Tsarnaev spent six months in Dagestan last year, and investigators traveled to the Russian province to talk to the men's parents and try to determine whether he was influenced or trained by local Islamic militants.
Christina DiIorio-Sterling, a spokeswoman for Ortiz, declined to comment on why the indictment did not mention whether authorities believe the elder Tsarnaev received any training during his stay in Russia.
The indictment assembled and confirmed details of the case that have been widely reported over the past two months, and added new pieces of information.
For example, it corroborated reports that Tamerlan Tsarnaev bought 48 mortar shells from a Seabrook, N.H., fireworks store. It also disclosed that he used the Internet to order electronic components that could be used in making bombs.
The papers detail how the brothers then allegedly placed knapsacks containing shrapnel-packed bombs near the finish line of the 26.2-mile race.
The court papers also corroborated reports by authorities that Dzhokhar Tsarnaev contributed to his brother's death by accidentally running him over with a stolen vehicle during a shootout and police chase.
The charges cover the slaying of Massachusetts Institute of Technology police officer Sean Collier, who authorities said was shot in the head at close range in his cruiser by the Tsarnaevs, who tried to take his gun.
In addition, prosecutors said that during the carjacking, the Tsarnaevs forced the motorist to turn over his ATM card and his password, and Dzhokhar withdrew $800 from the man's account.
At the same time the federal indictment was announced, Massachusetts authorities brought a 15-count state indictment against Dzhokhar over the MIT officer's slaying and the police shootout.
CHICAGO (Reuters) - An early stage study suggests an experimental vaccine may be able to tame bits of the immune system that go haywire in people with type 1 diabetes, offering hope for a new way to delay or prevent the autoimmune disease, researchers said on Wednesday.
For more than four decades, scientists have tried different ways of manipulating the immune system to stop the destruction of insulin-producing cells that is responsible for type 1 diabetes. The disease affects as many as 3 million Americans.
Some prior attempts suppressed desirable parts of the immune system, leaving individuals vulnerable to infections and cancer. Several teams are now attempting more targeted approaches in an effort to delay or reverse type 1 diabetes.
Those with this form of diabetes currently must monitor their blood sugar and take insulin several times a day, but the treatment is risky - it can cause coma or death at any time and can lead to heart disease, nerve damage, blindness and kidney failure over time.
"What one really wants to do is tame or regulate the specific aspects of the immune system that have gone awry and leave the rest of the immune system intact," said Dr. Richard Insel, chief scientific officer of JDRF, formerly known as the Juvenile Diabetes Research Foundation.
In the latest effort, published on Wednesday in the journal Science Translational Medicine, teams from Leiden University Medical Center in the Netherlands and Stanford University in California tested a vaccine genetically engineered to shut down only the immune system cells causing harm, while leaving the rest of the immune system intact.
"The idea here is to turn off just the rogue immune cells that are attacking the pancreas and killing the beta cells that secrete insulin," said Stanford Professor Dr. Lawrence Steinman, one of the study's senior authors and co-founder of a company called Tolerion recently formed to commercialize the vaccine.
The study, done in 80 people diagnosed with type 1 diabetes who were receiving insulin injections, was designed to test the safety of the vaccine known as TOL-3021. The so-called DNA vaccine is made up of a small round piece of DNA called a plasmid that is genetically engineered to tamp down the immune response to insulin and preserve insulin-producing beta cells.
The vaccine targets a precursor protein in the blood called proinsulin. "It's a complicated series of snips and cuts in the DNA that take away the capability to stimulate the immune system," Steinman said.
"This effectively triggers an off-switch," he said.
After 12 weeks of shots given once a week, patients who got the vaccine showed signs that they helped preserve some of the remaining insulin-producing beta cells in the pancreas without causing serious side effects.
The vaccine also reduced the number of killer immune cells known as T cells. And patients who got the active vaccine had higher levels of C-peptides - a remnant of insulin production in the blood that suggests the presence of more working beta cells.
Steinman admits the vaccine is far from commercial use, but the study is promising enough to do a bigger study.
"So far, it looks like it is doing what we want," he said.
Insel said it was too early to say much about the vaccine's promise. "It looks like it has some potential, but very small numbers," he said.
"This was done initially as a safety and dose-finding study. They were surprised to get these kinds of results," he said.
Stanford has licensed rights to the vaccine to California-based Tolerion, which is designing a longer study in as many as 200 patients to test whether the vaccine can slow or stop progression of the disease in younger patients, before too much damage has been done.
Insel said the work is one of several efforts aimed at developing a vaccine for type 1 diabetes. Such a vaccine could help people with active type 1 diabetes preserve residual beta cells, giving them better control of their disease and potentially getting them off insulin.
Ultimately, the hope is to develop an effective vaccine that could be given to individuals who are genetically predisposed to develop the condition, he said.
The World Health Organization estimates that about 10 percent of the 350 million people in the world with diabetes have the type 1 variety - most have type 2, which is associated with obesity and lack of exercise.
(Reporting by Julie Steenhuysen; Editing by Paul Simao)
WASHINGTON (Reuters) - The U.S. government slashed its estimate for first-quarter economic growth on Wednesday, offering a cautionary note on the recovery as the Federal Reserve ponders curtailing its massive monetary stimulus.
Gross domestic product expanded at a 1.8 percent annual rate in the quarter, the Commerce Department said. The economy was previously reported to have grown at a 2.4 percent pace after a gain of just 0.4 percent in the final three months of last year.
Almost all categories were revised lower, with the exception of home construction and government. Economists polled by Reuters had expected GDP growth would be unrevised.
The biggest surprise was consumer spending, which grew at a 2.6 percent pace, not the 3.4 percent rate previously estimated. The revision to consumer spending, which accounts for more than two-thirds of U.S. economic activity, sliced more than a half percentage point off the GDP growth rate.
Economists cautioned against reading too much into the data given its backward-looking nature, but said it could weigh on the Fed as it considers scaling back its bond buying.
"At the margin, it tilts them a little bit less strongly towards the tapering they were talking about a week ago," said Sam Coffin, an economist at UBS in New York.
Fed Chairman Ben Bernanke said last week that the central bank could trim the $85 billion in bonds it is buying each month sometime later this year and likely bring the program to a close by mid-2014.
Those comments led to a sharp selloff in stock markets and drove the yield on the benchmark 10-year Treasury note to a nearly two-year high.
However, a range of strong U.S. economic data on Tuesday - from business spending plans to home prices - bolstered investor sentiment.
After closing higher on Tuesday, stocks resumed their ascent on Wednesday. Bonds were also up on the day, with yields falling.
The GDP report showed that homebuilding grew at a 14.0 percent rate in the first quarter, but a big jump in mortgage rates on the back of Bernanke's remarks threatens to cool the sector.
Interest rates on fixed 30-year mortgages jumped more than a quarter point last week to an average 4.46 percent, the Mortgage Bankers Association said. That killed off refinance activity, although demand for loans to purchase a home edged higher.
PLUSES AND MINUSES
The revision to consumer spending largely reflected weak outlays that non-profits made on medical care services on behalf of consumers, which economists tied to lower government spending on health care.
Even given the revision, consumer spending picked up from the fourth quarter despite a rise in taxes, and recent gains in consumer sentiment suggest households are not pulling back.
Growth in the first quarter was also weighed down by weak exports, which contracted at a 1.1 percent pace in the first quarter in a likely reflection of a global economic slowdown. They had previously been reported to have expanded.
Business spending barely grew, with investment on nonresidential structures declining more sharply than previously reported. The drop in spending on nonresidential structures was the first in two years.
The pace of inventory accumulation was revised marginally lower, but it still contributed more than half a percentage point to GDP growth given that it was up sharply from the fourth quarter.
Excluding inventories, GDP grew at a 1.2 percent rate, the slowest in two years.
(Reporting by Lucia Mutikani; Editing by Andrea Ricci and Tim Ahmann)
Planet Labs, a space and analytics company formerly known as Cosmogia, is announcing $13 million in funding from DFJ, Capricorn, OATV, Founders Fund Angel, Innovation Endeavors (the investment arm of Jeff Skoll), Data Collective and First Round Capital. Planet Labs, which was founded by former NASA scientists, plans to launch the world's largest fleet of imaging satellites that will map the entire Earth to better understand the changing planet and ecosystems. The company successfully launched two imaging satellites in April 2013 for testing purposes.
When it comes to task managers and note-taking apps, iPhone users are spoiled with choices, as there are literally thousands of ideas out there on the App Store all crying for our attention and our credit cards. I?m a man of simple tastes, which is why I don?t really use my iPhone for note-taking ? I?ll probably use something like Drafts to scribble down something quickly when I?m on the move but I still rely on my trusty Moleskine for all my proper note taking. Yep, I?m old fashioned like that.
But when Elevatr was released back in May, my eye turned for two reasons. First, this looked like a nice, simple way to jot down my thoughts and ideas without having to waste an hour getting acquainted with the app. And secondly, the interface is so minimal and flat it?s positively infectious (and I?m a big fan of flat interfaces, which is why I?m looking forward to iOS 7 so much!). Read on after the break for my full thoughts about Elevatr and whether it is the de facto app for managing your ideas on the iPhone.
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First Thoughts
One of the first things I noticed about Elevatr was the fact it was free in the true sense of the word. There?s no in-app purchases to unlock extra features and no obtrusive advertising to speak of ? just a simple yet beautiful splash screen prompting you to create a new idea. Understand now that Elevatr is nothing fancy and doesn?t come with a lengthy App Store description or endless lists of features; it lets you jot down your business ideas and that?s about it, really.
The splash screen of Elevatr.
The main bulk of your idea is restricted to 140 characters, just like a tweet on Twitter, which I actually don?t mind at all. For me, an idea should just be a quick mental note of something that I want to work on later, not a lengthy description which takes me 10 minutes to type out, and I feel that this 140-character restriction allows me to be very selective with my ideas. I said that minimal was rife in Elevatr, and it?s certainly being mirrored here.
Entering a description for your idea. Keep it short, now.
Next, you need to give your idea a name. Just like the main body, this is restricted too ? it?s only 20 characters. Elevatr wants you to keep things short and snappy and it?s certainly working for me. The whole app is enshrined in that wonderful Avenir typeface, which first made an appearance on iOS with Apple Maps and I actually prefer it to Helvetica. It provides a refreshing change to the norm.
Once you?ve created your idea, it?ll pop up in a list showing you the title and the time since you last edited it. Anything you do in Elevatr is automatically saved to your iPhone?s memory, though there is a cloud sync function built into the app as well.
Working With Ideas
Elevatr is focused more towards business users and the default categories present when you tap on an idea certainly reflect this. Ideas are split down into five different sections: The Idea, The Market, The Product, Business Model and Execution. The description of the idea that we entered above when we created our idea appears in the Pitch section of the The Idea section, but of course we can add different notes to each individual section.
The main screen for your idea, showing all of the different sections.
Sections are displayed in beautiful coloured bars and all you need to do is tap on each one to bring up more options. In the The Idea section, for example, this is split down into the problem and the solution, each of which I can add notes to. Unlike the idea title, as we saw above, you aren?t restricted here and you can type away to your heart?s content. Elevatr will also allow you to attach photos to each individual section from your iPhone, making things easier to remember.
Entering some text for the Problem section. I think it?s relevant here.
The entire app is very well thought-out from a business point of view and it?s clear that the developers have put some real effort into making Elevatr as useful as possible for commercial ideas. In The Product section, for example, this is split down into Use Cases, Product Features and Brand Identity, making it really easy to pinpoint your ideas exactly. One thing I did notice, though, was that you can?t change the section headers ? something which I would liked to have seen and I hope that this feature is rectified in a future update.
Sharing Your Ideas
As I mentioned before, Elevatr features a built-in cloud service which allows you to share your ideas with other users and you?ll have to create an account first (don?t worry, this is completely free ? there?s no in-app purchase to enable sharing). Once created, you can choose to share either the whole idea (with all the different sections) or you can select individual sections to share.
Sharing your ideas via the built-in cloud service.
Ideas can either be shared publicly (with a built-in link which can be viewed on any platform, not just on the Elevatr app) or privately, for which you can create a password.
Final Thoughts
Elevatr is one of those rarities in the App Store ? it?s something that manages to be everything all at once. It?s beautifully designed, extremely easy to use and manages to be fun as well. I was extremely impressed by the flat design and the simplicity of the entire app; although Elevatr is business orientated, this doesn?t mean the developers have to bloat it up with a load of features that no one wants. It?s simple and it works damn well.
I would have liked to been able to edit the individual section headers (sometimes they don?t just cut it for me) but I can see this issue being addressed in a future app. For such a young app, the results are extremely impressive, and for a free one even more so. I can see Elevatr finding a warm and snug home on the iPhones of almost any business user, and I do hope that this great little app sticks around for a while because the results?do?impress.
Summer's here! And while many favorite and critically acclaimed shows have ended their seasons (see you next year, Don Draper!), summer blockbusters are starting to show up in theaters and many popular television programs are returning to the airwaves.
Warner Bros. / HBO / FOX / Paramount
"Casablanca," "The Sopranos," "The Simpsons" and "The Godfather Part 2" all made Entertainment Weekly's list of top movies and TV shows ever.
And as the summer entertainment season kicks into gear, Entertainment Weekly has unveiled its list of All Time Greatest TV Shows and Movies.
On Wednesday morning, the top five results for each category were revealed on TODAY.
Gangsters, outlaws, star-crossed lovers and creepy shower killers are among those viewers meet in the magazine's films list -- and not one of the movies that made the top five came along after America?s bicentennial.
The No. 1 pick is "Citizen Kane," the 1942 saga of old-school journalism.
The gritty and engrossing tales of mob life in "The Godfather" (1972) and "The Godfather Part 2" (1974) tie for second place in the roundup. In third is 1967's murder and mayhem-filled "Bonnie and Clyde." The classic tale of war-torn love, "Casablanca" (1942), takes the fourth spot. And 1960?s legendary ?Psycho,? dubbed the ?granddaddy of all slasher films,? rounds out the list.
(Before the EW results were revealed, we put the contenders to a vote and our readers put "The Godfather" films way ahead of the others, with "Casablanca" a distant second and "Citizen Kane," "Psycho," and "Bonnie and Clyde" trailing at the end of the list.)
On the small screen, only one of the magazine's top five picks for All Time Greatest TV Shows is still on the air. (Seriously, "Breaking Bad," "Walking Dead" and "Game of Thrones" didn't crack the summit of the list!)
Topping the list is complex crime drama "The Wire," which wrapped up its run in 2008.
The still-on-the-air show in second place is Fox's very long-running "The Simpsons." "Seinfeld," which aired its last episode in 1998, comes in at third place, followed by "The Mary Tyler Moore Show" (1977) in fourth. "The Sopranos," the HBO antihero drama that ended in 2007, takes fifth.
(In our vote, readers picked "Seinfeld" as No. 1, followed by "The Sopranos," "The Mary Tyler Moore Show" and "The Simpsons." As for EW's top choice? "The Wire" landed in last place.)
See the full Top 100 lists in the new issue of Entertainment Weekly.
Which movies and TV shows would put in your top 5? Click on "Talk about it" below and give us your list!
MIAMI (AP) ? The last piece of confetti had landed, the Miami Heat championship celebration was officially over and many in the crowd of revelers were starting to make their way to the exits.
Players and coaches remained on the stage.
They were in no hurry to leave. Every member of the NBA champions stood and watched a giant video board play highlights of Miami's march through the playoffs, from LeBron James' MVP-caliber plays on both ends to Ray Allen's season-saving 3-pointer in Game 6 of the NBA Finals and countless moments in between.
"It's a special group," Heat coach Erik Spoelstra said. "You know what? This season started over nine months ago with that trip to China and we were able to experience so many cool things together in the regular season. But at times, it just seems to be going by so fast."
So maybe that's why the Heat aren't ready to stop celebrating this title just yet.
With an estimated 400,000 people lining the downtown Miami streets, the Heat held their parade and an in-arena rally afterward Monday. James stood atop a double-decker bus with a cigar in his mouth for the parade. Shane Battier blew kisses to the crowd, Dwyane Wade raised three fingers aloft and Chris Andersen flapped his arms in a nod to his "Birdman" moniker.
"It's the ultimate," James told Sun Sports, the Heat broadcast partner. "It's the ultimate. This is what I came down here, to be able to have a parade at the end of the year. I'm extremely blessed, man. It doesn't get any better than this."
Several players held super-soaker squirt guns and sprayed water on fans, confetti dotted the streets, and horns honked from all directions. Heat managing general partner Micky Arison and team president Pat Riley stood in the front of one bus, while Spoelstra ? his championship cap turned backward ? waved and clapped at fans.
"Miami parties better than any city in the world," Spoelstra said. "But it took nine months, nine months of incredible sacrifice, not only by these men right here but everybody in our organization, grinding it out every single day, ups and downs, highs and lows. And to have a culmination like Game 7 in front of all of you here is incredible."
Wade said that without the fans, Miami wouldn't have found a way to win the title.
"It's humbling. It's very humbling to be here," Wade said, gazing out at the enormous crowd. "I envision a lot of things. I can't say I envisioned this. This parade down Biscayne Boulevard was once a vision by Coach Riley and now we've taken this ride three times. It's special."
When Riley got hired by the Heat, he talked at his introductory news conference about his vision of a parade down Biscayne Boulevard. It took Riley until 2006 to deliver on that hope, but now with three parades in eight seasons, the Heat are getting used to these celebrations.
"Their names are going to be respected and honored," Riley said. "And that's all we have. All we have is the name on the front of the shirt, which is the Heat, and the name on the back of the shirt. And that's why we play."
Miami became the sixth franchise in NBA history to win consecutive championships, after topping the San Antonio Spurs in this year's finals for the third title overall for the Heat franchise, needing a Game 7 to get it done. Wade and Udonis Haslem ? a Miami native who said "this is what it's all about" ? are the only players to be part of all three titles, and Wade insisted Monday that the city is going to be his home now for good.
"This is my home. They've treated me well since Day One," Wade said. "I'll be here for probably the rest of my life in this amazing city. I thank the Miamians for accepting me as one of their own."
Miami needed to win Games 6 and 7 of the finals to capture the title, and needed a huge late comeback in Game 6 just to force the ultimate game. Down by five with less than a half-minute left in regulation, James and Ray Allen made 3-pointers ? Allen's coming with 5.2 seconds left ? to force overtime, and the Heat ultimately prevailed to get into Game 7.
"I have to say that is the biggest shot I ever hit in my career," Allen said.
Along the parade route, one vehicle carried a number of uniformed military personnel. The Heat have honored military members before every home game in Miami for the past several seasons.
Police reported no major problems, and bomb- and drug-sniffing dogs were spotted working their way through the crowd. City officials banned fans from carrying backpacks, though several were spotted along the route and some people were searched randomly for security reasons. The huge crowds and parking difficulty did not seem to take away from the fans' celebratory mood.
"It's the excitement of something that doesn't come around too often, even though we've been lucky to experience it two years in a row," said Heat fan Blake Thames, who made the trip down from Palm Beach County.
Some fans began arriving before sunrise Monday, and traffic into downtown was extremely heavy as people hoped to get close enough for a glimpse of the celebration.
"It hasn't hit me yet," James said. "This is unbelievable to be a part of such a great franchise and to be able to go back-to-back."
Players spent the weekend celebrating. Some are planning to start vacations later this week, while others will remain in South Florida for at least a few more days.
"All the fans that we're seeing here is who supported us throughout the whole season, man," James said. "This is the least we could do is ride through the city and show our appreciation."
___
Associated Press Writers Jennifer Kay and Kelli Kennedy in Miami contributed to this report.
Didier Esteyne and EADS turned heads at the 2011 Paris Air Show when they debuted the the world's first all-electric airplane, the single-seat Cri-Cri. Fast forward two years, and the miniscule Cri-Cri has grown into a sleek tandem-seat training craft that's as green as it is acrobatic.
Dubbed the E-Fan, this Light Sport Aircraft prototype is 21 feet long, has a 31-foot wingspan, and weighs about 1,212 pounds. Esteyne and EADS (the parent company of Airbus) have spent more than eight months developing the platform with funding from French civil aviation authority, among others.
It's powered by 250 volt, 40 amp-hour Li-ion battery packs in the bases of the wings that drive a pair of 1.5kN electrical engines that spin the ducted fans, rather than the conventional propellers, to provide thrust. This offers significant energy savings, less noise and danger, according to Esteyne, albeit at the cost of some power. "This plane, with these dimensions, can fly with 20 kilowatts [per side], easy,? he told Wired. That should be enough for an hour's flight at 110 mph.
To further improve its energy efficiency, the E-Fan is outfitted with a powered main landing gear that allows the plane to taxi without running the fans as well as help get the plane up to takeoff speed with a 35MPH boost.
Like it's tiny predecessor, the E-Fan can handle a bit of aerial acrobatics. Sure, barrel rolling and loop-de-looping through the wild blue yonder is way fun, it also cuts the flight time in half to just 30 minutes.
While the plane hasn't actually ever "flown" yet, it has successfully completed taxi and ground testing with flight testing to commence later this year. If it's successful, "we believe that the E-Fan demonstrator is an ideal platform that could be eventually matured, certified to and marketed as an aircraft for pilot training,? explained Jean Botti, CTO of EADS. Of course that'd require the FAA and civil air authorities the world over to enact new regulations for electric aircraft first, though it's got to be easier than writing the new rules for UAVs. [Cleantechnica - EV World - AV Web - Gas 2 - Image: EADS]
LogicBUY’s Deal for Monday is the?32GB HTC One smartphone for AT&T for $99.99. ?Features: 1.7GHz quad-core processor 2GB RAM, 32GB memory 4.7″ 1080p display Android 4.1 Jelly Bean Ultra Pixel low-light efficient camera with Zoe Built-in IR blaster HTC Sense 5.0 Aluminum body in Glacial Silver or Stealth Black $199.99 – 50% savings = $99.99 [...]
Lowering costs for higher-cost medicare patients through better outpatient care may be limitedPublic release date: 24-Jun-2013 [ | E-mail | Share ]
Contact: Marge Dwyer mhdwyer@hsph.harvard.edu 617-432-8416 The JAMA Network Journals
In an analysis that included a sample of patients in the top portion of Medicare spending, only a small percentage of their costs appeared to be related to preventable emergency department visits and hospitalizations, limiting the ability to lower costs for these patients through better outpatient care, according to a study in the June 26 issue of JAMA. The study is being released early to coincide with its presentation at the AcademyHealth annual research meeting.
"High and increasing health care costs are arguably the single biggest threat to the long-term fiscal solvency of federal and state governments in the United States. One compelling strategy for cost containment is focusing on the small proportion of patients in the Medicare programs who account for the vast majority of health care spending. We know from prior work that Medicare spending is highly concentrated: 10 percent of the Medicare population accounts for more than half of the costs to the program," according to background information in the article.
The biggest sources of spending among high-cost beneficiaries are those related to acute care: emergency department (ED) visits and inpatient hospitalizations. "As a result, many interventions targeting high-cost patients have focused on case management and care coordination, aiming to prevent ED visits and hospitalizations for conditions thought amenable to improvement through high-quality outpatient management programs. The premise behind these and related interventions is that high-quality outpatient care should reduce unnecessary hospitalizations for high-cost patients. However, there are few data on the proportion of inpatient hospitalizations among high-cost patients that are potentially preventable," the authors write.
Karen E. Joynt, M.D., M.P.H., of the Harvard School of Public Health, Boston, and colleagues conducted a study to quantify the preventability of high-cost Medicare patients' acute care spending. The researchers summed standardized costs for each inpatient and outpatient service contained in standard 5 percent Medicare files from 2009 and 2010 across the year for each patient in their sample, and defined those in the top decile (one of ten groups) of spending in 2010 as high-cost patients and those in the top decile in both 2009 and 2010 as persistently high-cost patients. Standard algorithms were used to identify potentially preventable emergency department visits and acute care inpatient hospitalizations. A total of 1,114,469 Medicare fee-for-service beneficiaries 65 years of age or older were included.
The high-cost patient group, which included 10 percent of the patients in this sample, were older, more often male and more often black. This group was responsible for 32.9 percent of ED costs and 79.0 percent of inpatient costs. Within the high-cost group, 42.6 percent of ED visits were deemed to be preventable. These visits were associated with 41 percent of the ED costs within this group. The most common reasons for preventable hospitalization in high-cost patients were congestive heart failure, bacterial pneumonia, and chronic obstructive pulmonary disease.
Within the high-cost group, 9.6 percent of hospital costs were attributable to preventable hospitalization. Within the non-high-cost group, though overall spending was significantly lower, a higher proportion of inpatient costs were potentially preventable (16.8 percent).
"Comparable proportions of ED spending (43.3 percent) and inpatient spending (13.5 percent) were preventable among persistently high-cost patients. Regions with high primary care physician supply had higher preventable spending for high-cost patients," the authors write.
"The biggest drivers of inpatient spending for high-cost patients were catastrophic events such as sepsis, stroke, and myocardial infarction, as well as cancer and expensive orthopedic procedures such as spine surgery and hip replacement. These findings suggest that strategies focused on enhanced outpatient management of chronic disease, while critically important, may not be focused on the biggest and most expensive problems plaguing Medicare's high-cost patients."
The researchers add that their "findings suggest that a complementary approach to saving money on acute care services for high-cost patients may be to additionally focus on reducing per-episode costs for high-cost disease entities through clinical innovation and care delivery redesign."
(JAMA. 2013;309(24):2572-2578; Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: This study was funded by the Rx Foundation and the West Wireless Foundation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.
Editorial: New Evidence Supports, Challenges, and Informs the Ambitions of Health Reform
Aaron E. Carroll, M.D., M.S., of the Indiana University School of Medicine, Indianapolis, and Austin B. Frakt, Ph.D., of the VA Boston Healthcare System, Boston University Schools of Medicine and Public Health, Boston, comment on the findings of this study in an accompanying editorial.
"These findings certainly do not suggest abandoning efforts to reduce preventable emergency department use and hospitalizations. Joynt et al do not consider the social cost of this utilization. Even though avoiding some emergency department use and hospital admissions might not save much moneyand certainly not enough to declare victory in controlling health spendingpreventing such use when possible would be of substantial benefit to patients, both those who would otherwise use these services and those who have their care delayed because of overburdened emergency department and hospital resources. Even with no cost savings, reducing preventable use of high-intensity and capacity-constrained care would enhance efficiency. Improvements to quality are not always substantial cost savers but still may be worthwhile."
(JAMA. 2013;309(24):2600-2601; Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
###
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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.
Lowering costs for higher-cost medicare patients through better outpatient care may be limitedPublic release date: 24-Jun-2013 [ | E-mail | Share ]
Contact: Marge Dwyer mhdwyer@hsph.harvard.edu 617-432-8416 The JAMA Network Journals
In an analysis that included a sample of patients in the top portion of Medicare spending, only a small percentage of their costs appeared to be related to preventable emergency department visits and hospitalizations, limiting the ability to lower costs for these patients through better outpatient care, according to a study in the June 26 issue of JAMA. The study is being released early to coincide with its presentation at the AcademyHealth annual research meeting.
"High and increasing health care costs are arguably the single biggest threat to the long-term fiscal solvency of federal and state governments in the United States. One compelling strategy for cost containment is focusing on the small proportion of patients in the Medicare programs who account for the vast majority of health care spending. We know from prior work that Medicare spending is highly concentrated: 10 percent of the Medicare population accounts for more than half of the costs to the program," according to background information in the article.
The biggest sources of spending among high-cost beneficiaries are those related to acute care: emergency department (ED) visits and inpatient hospitalizations. "As a result, many interventions targeting high-cost patients have focused on case management and care coordination, aiming to prevent ED visits and hospitalizations for conditions thought amenable to improvement through high-quality outpatient management programs. The premise behind these and related interventions is that high-quality outpatient care should reduce unnecessary hospitalizations for high-cost patients. However, there are few data on the proportion of inpatient hospitalizations among high-cost patients that are potentially preventable," the authors write.
Karen E. Joynt, M.D., M.P.H., of the Harvard School of Public Health, Boston, and colleagues conducted a study to quantify the preventability of high-cost Medicare patients' acute care spending. The researchers summed standardized costs for each inpatient and outpatient service contained in standard 5 percent Medicare files from 2009 and 2010 across the year for each patient in their sample, and defined those in the top decile (one of ten groups) of spending in 2010 as high-cost patients and those in the top decile in both 2009 and 2010 as persistently high-cost patients. Standard algorithms were used to identify potentially preventable emergency department visits and acute care inpatient hospitalizations. A total of 1,114,469 Medicare fee-for-service beneficiaries 65 years of age or older were included.
The high-cost patient group, which included 10 percent of the patients in this sample, were older, more often male and more often black. This group was responsible for 32.9 percent of ED costs and 79.0 percent of inpatient costs. Within the high-cost group, 42.6 percent of ED visits were deemed to be preventable. These visits were associated with 41 percent of the ED costs within this group. The most common reasons for preventable hospitalization in high-cost patients were congestive heart failure, bacterial pneumonia, and chronic obstructive pulmonary disease.
Within the high-cost group, 9.6 percent of hospital costs were attributable to preventable hospitalization. Within the non-high-cost group, though overall spending was significantly lower, a higher proportion of inpatient costs were potentially preventable (16.8 percent).
"Comparable proportions of ED spending (43.3 percent) and inpatient spending (13.5 percent) were preventable among persistently high-cost patients. Regions with high primary care physician supply had higher preventable spending for high-cost patients," the authors write.
"The biggest drivers of inpatient spending for high-cost patients were catastrophic events such as sepsis, stroke, and myocardial infarction, as well as cancer and expensive orthopedic procedures such as spine surgery and hip replacement. These findings suggest that strategies focused on enhanced outpatient management of chronic disease, while critically important, may not be focused on the biggest and most expensive problems plaguing Medicare's high-cost patients."
The researchers add that their "findings suggest that a complementary approach to saving money on acute care services for high-cost patients may be to additionally focus on reducing per-episode costs for high-cost disease entities through clinical innovation and care delivery redesign."
(JAMA. 2013;309(24):2572-2578; Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: This study was funded by the Rx Foundation and the West Wireless Foundation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.
Editorial: New Evidence Supports, Challenges, and Informs the Ambitions of Health Reform
Aaron E. Carroll, M.D., M.S., of the Indiana University School of Medicine, Indianapolis, and Austin B. Frakt, Ph.D., of the VA Boston Healthcare System, Boston University Schools of Medicine and Public Health, Boston, comment on the findings of this study in an accompanying editorial.
"These findings certainly do not suggest abandoning efforts to reduce preventable emergency department use and hospitalizations. Joynt et al do not consider the social cost of this utilization. Even though avoiding some emergency department use and hospital admissions might not save much moneyand certainly not enough to declare victory in controlling health spendingpreventing such use when possible would be of substantial benefit to patients, both those who would otherwise use these services and those who have their care delayed because of overburdened emergency department and hospital resources. Even with no cost savings, reducing preventable use of high-intensity and capacity-constrained care would enhance efficiency. Improvements to quality are not always substantial cost savers but still may be worthwhile."
(JAMA. 2013;309(24):2600-2601; Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
###
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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.
Jamie Foxx and Channing Tatum in White House Down 
Planet Labs, a space and analytics company formerly known as 
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Public release date: 24-Jun-2013
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