Wednesday, August 26, 2009

News Clipping Archives

 

 

Maryland / Regional

Dementia indicated in fatal pummeling  (Baltimore Sun)

Board of Public Works approves $454 million in cuts (Baltimore Sun)

County to take $15M hit in state aid (Annapolis Capital)

Students in grades K-5 offered free flu vaccinations (Hagerstown Herald-Mail)

County juggles budget cuts, flu preparation (Salisbury Daily Times)

Allegany, Garrett budget cuts may total $8.3 million (Cumberland Times-News)

Streamlining at St. Joseph Medical Center (Daily Record)

D.C.'s Ex-Dealers Back On Streets -- Saving Lives (Washington Post)

 

National / International

Medical Workers Leery of Flu Vaccine (Associated Press)

CDC leery of estimates about swine flu's toll (Washington Post)

Agency Urges Caution on Estimates of Swine Flu (New York Times)

Half of health workers reject swine flu shot (Washington Post)

H1N1 has Del. pig farmers on guard (Salisbury Daily Times)

Proposal to Ease Aid for G.I.’s With Stress Disorder (New York Times)

Kennedy's cancer puts focus on quality of life (Washington Post)

Rare Side Effect Is Seen in Long-Term Use of a Breast Cancer Drug (New York Times)

Six companies recall blinds, shades after kids' deaths (Baltimore Sun)

New blood tests find heart attacks quicker, better (Washington Post)

An Environmentally Friendly Mosquito Repellent? (New York Times)

 

Opinion

More budget blues (Baltimore Sun  Editorial)

Some facts about vaccines weren’t mentioned (Cumberland Times-News Letter to the Editor )

 

 

Maryland / Regional

Dementia indicated in fatal pummeling

Man, 87, accused of hitting fellow patient was boxer in Army

 

By Larry Carson and Nick Madigan

Baltimore Sun

Wednesday, August 26, 2009

 

Retired Baltimore Transit Company worker Earl Lafayette Wilder, the 87-year-old accused of killing a 91-year-old fellow resident at their Columbia assisted-living home, is a one-time boxer who suffers from dementia, according to court records.

 

The eldest of Wilder's five children, who is his guardian, said Tuesday that she was still struggling to comprehend the Aug. 17 incident in which Wilder is alleged to have risen from his wheelchair and attacked James W. Brown with his fists as the victim sat on a metal bench outside Harmony Hall. Brown died five days later.

 

"Right now, I'm in total shock. That's not my dad," Frances Crist said of the murder and assault charges.

 

In May 2008, Crist won guardianship of her father in Howard County Circuit Court. Two doctors at Lorien Nursing Home, part of a senior living complex that includes Harmony Hall, told the court that Wilder was unable to manage his affairs or live independently.

 

Dr. Rebecca Elon wrote that he was "not capable of comprehending the meaning of the appointment of a guardian," according to court records, and therefore did not need to attend the hearing in his case.

 

Harmony Hall is part of the Howard County Health Park, developed by Mangione Family Enterprises.

 

In June, the Maryland Department of Health and Mental Hygiene found a number of deficiencies in staff training and operations at Harmony Hall during an unannounced inspection conducted as part of the state's relicensing process.

 

"These are deficiencies and problems that need to be fixed, but are unlikely to lead to harm to a resident," said David Paulson, a department spokesman.

 

Joseph LaVerghetta, general counsel for Mangione, said he had not discussed the report with his client but would do so today.

 

Brown had lived in the complex for about two years, and Wilder for about a year, company officials said. Police said the men were strangers to each other.

 

Margaret Bell, a resident at Harmony Hall, said she would see Brown in the hallway at times but didn't know him or any friends he had made there.

 

"He was an average type of man. Thin," she said. "He was always by himself."

 

Brown's niece, Nancy Koza, was settling his affairs this week and was unavailable for comment Tuesday.

 

During World War II, Wilder served in the infantry in Europe and left the Army as a sergeant major, according to Keith Wynn Sr., 80, of Stanardsville, Va., where Wilder lived at a rural ranch home on 10 acres until last year.

 

"I'd go over to see him, and he'd break out all his uniforms and his medals," Wynn said. Wilder told him that he had boxed in the Army while stationed in Hawaii before the war.

 

Wilder was diagnosed with "pugilistic dementia" and Alzheimer's disease by the nursing home doctor as part of the guardianship process.

 

According to initial police reports of the incident, two witnesses said Wilder attacked Brown without provocation. A police spokesman said Wilder was in a wheelchair but got up to approach Brown. Others intervened, but not quickly enough.

 

"Brown attempted to fend off the attack with his walking cane," the report said, but suffered a severe head injury. Wilder, charged with second-degree murder and assault on Monday, is being held at a private hospital and has not been arrested, according to authorities.

 

Patients with dementia can become paranoid and delusional, and convince themselves that a stranger is someone else or that someone has stolen their property, said Dr. Alan Jonas, a Baltimore geriatric psychiatrist.

 

"People who have a dementia have periods when they lose touch with reality," said Jonas, who was not personally familiar with Wilder's condition. "Most of the time, they just talk and don't act it out."

 

Warren A. Brown, a Baltimore defense attorney and no relation to James W. Brown, predicted that, pending an evaluation, Wilder would end up in a secure health facility rather than in prison.

 

"It sounds like a slam-dunk for 'not criminally responsible,' " he said.

 

Copyright © 2009, The Baltimore Sun.

 

Board of Public Works approves $454 million in cuts

O'Malley budget plan slashes $210 million for roads, colleges, health, police; about 200 to lose jobs

 

By Julie Bykowicz and Laura Smitherman

Baltimore Sun

Wednesday, August 26, 2009

 

The Board of Public Works approved Wednesday the latest round of Maryland budget cuts that will cost about 200 state employees their jobs and slash more than $210 million in funding for road maintenance, health care, community colleges and police funding in Baltimore and the 23 counties.

 

The vote from the three-member board, which includes Gov. Martin O'Malley, Treasurer Nancy Kopp and Comptroller Peter Franchot, was unanimous.

 

Under the plan that O'Malley, a Democrat, outlined Tuesday for $454 million in cuts, the state also would shut a minimum-security prison in Jessup by March and would close units at health facilities.

 

The layoffs would be twice as many as in all previous rounds of O'Malley administration budget-cutting.

 

As local governments and universities begin to absorb the cuts in state aid, they could decide to lay off workers or force them to take unpaid days off, officials said. Community colleges could increase tuition.

 

"These realities are awfully tough," said Michael Sanderson, executive director of the Maryland Association of Counties. "There's going to be a lot of county officials and budget officers sitting around tables trying to figure out what to do."

 

The Board of Public Works makes budget adjustments when the General Assembly is not in session. Since the budget year began last month, state officials have worked to avoid a deficit of more than $700 million and say they face a shortfall of more than $1 billion next year. Maryland's overall budget is $13 billion, and by law it must be balanced.

 

With a further $282 million in reductions approved weeks ago, the state budget should remain balanced unless the economy worsens and tax collections continue to fall, officials said.

 

The governor's proposal includes furloughs for most of the state's 70,000 employees, a shutdown of routine government operations on five days near holidays and other agency cutbacks. Details of the furlough plan emerged earlier in the week and drew criticism from the American Federation of State, County and Municipal Employees, the largest public-sector union.

 

The state workers who are losing their jobs began receiving pink slips Tuesday. Officials said they would release details on affected departments and which facilities would be closed after employees have been notified.

 

"This is not something we do easily," O'Malley said. "This is not something we do lightly. And I have a tremendous amount of concern for those employees who are going to be affected. They're all moms and dads."

 

Patrick Moran, Maryland director of AFSCME, said the layoffs would affect not only employees but residents who rely on state services. "This takes away from our priorities in Maryland," he said.

 

State workers remaining in their jobs would see their salaries reduced by the equivalent of three to 10 days' pay through the government shutdown and furloughs, with those earning more taking a progressively larger hit.

 

The plan would not apply to workers in the legislative and judicial branches, but they might be encouraged to follow suit.

 

House Speaker Michael E. Busch said he would take a 10-day cut in pay and that he expects other lawmakers to do the same. A spokesman for the Maryland judiciary said it is studying the governor's plan.

 

The state is "down to bone and gristle," Busch said, and Maryland officials must begin turning to local governments, many of which have avoided furloughs and some of which have been able to reduce property tax rates.

 

O'Malley's proposed cuts to counties and Baltimore include $159.5 million in gas tax, title fee and other transportation revenue that funds local road projects, $20 million in health department funding, $21 million in police aid and $10.5 million to support community colleges. Public universities and private colleges would see a $36 million hit to their budgets.

 

The governor decided against scaling back aid to poorer jurisdictions such as Baltimore City and Prince George's County -- a pot of $121 million known as disparity grants. Administration officials had said they would propose $470 million in cuts, but the reduction in local aid is about $40 million less than O'Malley had initially indicated.

 

Mayor Sheila Dixon said the impact of the $35 million cut on Baltimore's budget "will be painful but not as drastic" as she had expected. Nonetheless, Dixon said city employees probably would face layoffs and furloughs, though she did not provide details. She is examining a parking ticket amnesty period to raise money.

 

Sanderson said the proposed reduction in highway user funding would nearly wipe out state contributions for road projects in many counties. Baltimore is expected to retain a larger share of the money because, unlike other jurisdictions, it is responsible for maintaining all roads within its borders.

 

While the federal government has directed $610 million in stimulus money to Maryland transportation projects, only about $60 million has trickled down to local governments.

 

Howard County Executive Ken Ulman, who also said that layoffs and furloughs might be considered as his county absorbs an $8.3 million hit, said he was surprised at the size of the cut to highway user funding, which Howard uses for repaving as well as overtime during winter storms.

 

"The squeeze is becoming unbearable," said Ulman, a Democrat.

 

Anne Arundel County Executive John R. Leopold, a Republican, criticized cuts to vital services such as transportation and public safety. His county would see a $15 million reduction in aid. "Any cut is problematic at this stage," he said. "Our cupboard is bare."

 

Clay Whitlow, executive director of the Maryland Association of Community Colleges, said students probably will see a tuition increase in January. The $10.5 million cut represents about 5 percent of the state aid to Maryland's 15 locally run community colleges and comes at a time when community college enrollment is up 11 percent, he said. Baltimore City Community College is state-run and lost $1.5 million in earlier budget reductions.

 

Community colleges are in a "double bind," Whitlow said, because local governments could soon reduce their funding. "That essentially leaves no choice but to raise tuition," he said.

 

Prison officials say they would save about $4.7 million by closing a minimum-security prison and a unit in another building. The Herman L. Toulson Correctional Facility in Jessup, which houses 350 inmates, would be closed by March, said Rick Binetti, a spokesman for the Department of Public Safety and Correctional Services. The building's 88 employees would be moved to other Jessup facilities, he said.

 

Plans to close the minimum-security west wing of the Metropolitan Transition Center in Baltimore have been accelerated, Binetti said. About 350 short-term inmates would be displaced by that closure.

 

More state budget pain

·         $211 million in reduced aid to local governments

·         $75 million saved by state worker furloughs of three to 10 days

·         $36 million in cuts to higher education

·         $21 million less in Medicaid payments

·         $17 million saved by layoffs of 205 employees and elimination of 159 vacant positions

·         $12 million saved by closing health units and prison facilities

 

Baltimore Sun reporters Larry Carson, Nicole Fuller and Annie Linskey and the Associated Press contributed to this article.

 

Copyright © 2009, The Baltimore Sun.

 

County to take $15M hit in state aid

O'Malley proposes cuts in health, colleges, highways

 

By Liam Farrell and Erin Cox

Annapolis Capital

Wednesday, August 26, 2009

 

Anne Arundel County will receive almost $15 million less in state aid under a budget plan brought to the state Board of Public Works this morning in an effort to address Maryland's worsening financial woes.

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Gov. Martin O'Malley has proposed $454 million in reductions and transfers in a second round of steps needed to close a $700 million deficit for this year.

 

County governments and Baltimore city will lose $210.7 million in health, police, community college and highway project aid, and state employees will face from three to 10 furlough days to save another $75 million. More than 200 state workers also are going to be laid off.

 

"These are not things we decided upon lightly," O'Malley said during a briefing for reporters yesterday in Annapolis. "These are difficult times and we have to make the decisions necessary to protect our priorities."

 

Education funding for kindergarten through 12th grade will not be touched in this round of cuts, but other pots of money for local government have now collectively fallen almost 25 percent.

 

Anne Arundel will lose about $14.8 million, according to state budget documents: $1.7 million in local health spending, $2.3 million in police aid, $1.4 million for community colleges and $9.3 million in highway project money.

 

Also, Queen Anne's County will lose a total of $3 million.

 

When coupled with earlier cuts from the General Assembly, Anne Arundel is $28 million below fiscal 2009 state aid levels, and county officials see little to like in the numbers.

 

County Executive John R. Leopold said the highway fund and community college reductions are troublesome because those areas help spur economic development and drive job creation.

 

"You look in the cupboard and it gets barer all the time," he said.

 

John Hammond, county budget officer, said the government will have some flexibility in making sure areas like public safety don't take the full state hit, but that the cuts are "not good news." How to handle the reductions will be decided in coming weeks, he said.

 

Fearful that Anne Arundel's budget picture would worsen over the year, the County Council in May carved out $15 million from the 2010 budget and stashed it in something akin to a savings account.

 

"We did that for precisely circumstances like this," said Councilman Josh Cohen, D-Annapolis. "We were talking during the budget hearing: What if the state comes back and makes more cuts?"

 

County Council Chairwoman Cathy Vitale, R-Severna Park, agreed the council did that "obviously for circumstances like this."

 

"But I don't think we've seen the worst yet," she said. "I wouldn't be in favor of touching that until the worst comes, and I don't think we've seen it."

 

The economic triggers that caused trouble for the state government also might inflict separate financial pain on Anne Arundel, where officials expect income tax revenue to be less than they projected. One brighter part of the county's budget picture lies in property tax revenue, which is not expected to decline.

 

"We're fortunate enough that most of our budget is paid for through property taxes," Vitale said.

 

Nevertheless, carving the sum out of the $1.22 billion operating budget without touching the half dedicated to schools may lead to cuts that affect service to citizens.

 

"They're pretty serious cuts, and some of them are not going to be easy to swallow," Cohen said.

 

But state officials said they believe there are few choices left.

 

House Speaker Michael E. Busch, D-Annapolis, said the state made sure to look within itself to find savings before looking to the counties.

 

Local governments will now have to decide whether to ask for waivers to spend less on education than last year or undergo other adjustments such as furloughs, he said.

 

"You are down to bone and gristle now when it comes to state government," Busch said. "This is the residue of a national recession. … I don't believe this should be a surprise to any subdivision out there."

 

But Leopold pointed out that the state has consistently been putting counties in a difficult position by raiding funds that would otherwise help local governments, such as the transportation trust fund.

 

"This latest cut is just a continuance of what has been going on for years," he said.

 

The number of furlough days O'Malley proposed for nearly 70,000 state employees will vary depending on salary. The state government will be shut down on the days before Labor Day weekend, Thanksgiving, Christmas, New Year's Day and Memorial Day weekend.

 

Employees making less than $40,000 can cover two of those days with earned, personal or compensatory leave, but others in higher salary brackets will have to take additional furloughs of their choosing. Workers who earn up to $49,999 will take three more furlough days; those earning up to $99,999 will take four more furlough days; and anyone earning $100,000 or more will take five more furlough days.

 

O'Malley's aides said those furloughs will save 1,500 jobs.

 

Patrick Moran, the Maryland director of the American Federation of State, County and Municipal Employees, said the union was "disappointed" with the governor's furlough proposal. He urged O'Malley to look at closing corporate tax loopholes and decreasing the use of private contractors.

 

Busch said he would take the maximum of 10 furlough days and expects other legislators "to do the same," although elected officials can voluntarily give up only part of their salaries.

 

"It's important that while state employees take the furlough days, people who represent them in elected office take furlough days," he said.

 

Proposed state cuts

 

Here are some of the $454 million in spending cuts Gov. Martin O'Malley brought to the state Board of Public Works Wednesday:

 

• $210.7 million in local aid, including $14.8 million from Anne Arundel County and $3 million from Queen Anne's County.

• $75 million from furloughing almost 70,000 workers for three to 10 days, depending on salary.

• $21 million in reductions in Medicaid payments to hospitals, managed-care organizations, community and other health care providers.

• $17 million from abolishing 364 state positions, including 202 filled posts.

• $7.2 million from closing units at several state Department of Health and Mental Hygiene facilities.

• $4.7 million from consolidating correctional facilities.

• $3 million from denying Medicaid claims for 'unnecessary' emergency room care.

 

Copyright 2009 Annapolis Capital.

 

Students in grades K-5 offered free flu vaccinations

 

By Dan Dearth

Hagerstown Herald-Mail

Monday, August 24, 2009

 

HAGERSTOWN - Officials from Washington County Public Schools and the Washington County Health Department are offering free seasonal flu vaccinations to students in grades kindergarten through five.

 

The vaccinations will not protect children from swine flu.

 

John Davidson, director of student services for Washington County Public Schools, said vaccinations will be administered from Oct. 19 to 26.

 

He said the vaccinations would not be given without parental consent.

 

The vaccinations will be administered as a mist through both nostrils because most children are afraid of needles, said Susan Parks, director of community health nursing for the Washington County Health Department.

 

Parks said children who are younger than 9 and never have received a flu vaccination will require two doses. The second dose will be given in January, she said.

 

Children in grades kindergarten through five were chosen to receive the vaccinations because they are the ones most likely to get the flu and transmit it to others, Parks said.

 

“We want to keep them from giving it to older siblings and relatives,” she said.

 

The vaccinations could produce several side effects, including abdominal pain, diarrhea, fever, nasal congestion, wheezing, muscle aches and headaches, Parks said. Parents should take their children to the emergency room if the vaccination causes a high fever.

 

Davidson said school officials and health department officials are working together to provide the public with swine flu vaccinations when a vaccine becomes available.

 

The health department would supply the vaccine, and the school system would provide the space, Davidson said. The tentative dates for the vaccinations are Nov. 2-3, he said.

 

If an outbreak occurs, school officials would close schools on the advice of the health department, Davidson said.

 

How to prevent the flu

• Avoid close contact with people who are sick.

• When you are sick, keep your distance from others to protect them from getting sick, too.

• Cover your mouth and nose with a tissue when coughing or sneezing.

• Wash your hands often to help protect you from germs.

• Avoid touching your eyes, nose or mouth. Germs often are spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose or mouth.

• Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids and eat nutritious food.

 

Source: Centers for Disease Control and Prevention

 

Copyright 2009 Hagerstown Herald-Mail.

 

County juggles budget cuts, flu preparation

 

By Deborah Gates

Salisbury Daily Times

Wednesday, August 26, 2009

 

WESTOVER -- The Somerset County Health Department, facing another round of state budget cuts while bracing for what could escalate into a global health crisis, is counting on the medical community to help administer doses of vaccine arriving in October to fight the potentially deadly H1N1 virus.

 

"The biggest preparation now is H1N1 and preparing for the upcoming flu season; we are trying to prepare ahead," said Colleen Parrott, health officer in Somerset County. "Any cuts in public health are difficult. When it comes to giving injections, it requires medical people."

 

Parrott prepared for a financial blow before Gov. Martin O'Malley announced Tuesday that more state budget cuts would have a $20 million impact on local health services statewide. Overall, the governor proposes $454 million in cuts that include 205 layoffs and a reduction in aid to state agencies and local governments, a package that goes to the Maryland Board of Public Works today for approval.

 

"We've been told to expect more cuts and also to expect additional furlough days," Parrott said before the governor outlined cuts. "We're (already) short on resources."

 

The Somerset Health Department, already hit with a total of $629,448 in county or state cuts since spring and spanning parts of 2009 and 2010 budget years, has asked area medical facilities to roll up the sleeves of expectant recipients and administer the H1N1 vaccine.

 

McCready Memorial Hospital in Crisfield and TLC health services in Princess Anne are signed on to receive and administer doses of H1N1 vaccine, Parrott said. The department also is working with Somerset Emergency Medical Services to train the county's 11 paramedics to administer the vaccine, she said.

 

Parrott also delivered educational materials on H1N1 to the 4,000-student University of Maryland Eastern Shore and invited the campus medical official to administer the vaccine on campus.

 

"We're working closely with UMES to make sure the student population is informed about the virus," Parrott said. "They have a target group."

 

Targeted groups for the H1N1 vaccine are pregnant women, household members in contact with children less than 6 months old and people ages 6 months to 24.

 

Clinics start Oct. 1 for seasonal flu vaccinations, which are administered free of charge. If H1N1 is present in the region when clinics open, "we will give them together in one clinic," Parrott said. Otherwise, separate October vaccination schedules would be established, she said.

 

A flu mist for seasonal flu will be administered to grades kindergarten through five beginning in October, with guardian consent, Parrott said.

 

"We're very cautious this year; we're advocating that everybody receive the season flu shot, and there are target groups for the H1N1," she said.

 

To date, cutbacks have been mostly through attrition and the elimination of two contract positions involving outreach, Parrott said. Downsizing also lost five positions, she said, citing a receptionist, a program administrator and counselor and information technology and clerical personnel. Medical and other essential personnel likely would be spared, she said.

 

Copyright 2009 Salisbury Daily Times.

 

Allegany, Garrett budget cuts may total $8.3 million

 

By Kevin Spradlin

Cumberland Times-News

Wednesday, August 26, 2009

 

CUMBERLAND - Allegany and Garrett counties are facing a combined $8.36 million in budget cuts if the Maryland Board of Public Works approves a proposal presented Tuesday by Governor Martin O’Malley.

 

Total appropriations cuts to Allegany County, excluding kindergarten through 12th grade education and libraries, amount to $4,757,432. In Garrett County, the figure is $3,604,878. The proposals are expected to be approved today by the state board, comprised of members Treasurer Nancy Kopp, Comptroller Peter Franchot and O’Malley. Statewide, proposed cuts total $454 million.

 

The bulk of cuts to both counties take the form of reduced appropriations to the highway user revenue fund, in which O’Malley has proposed nearly an across-the-board cut of 90 percent through each Maryland county. Garrett County Administrator Monty Pagenhardt said the cuts pretty much eliminate any state funding in that category to the county and municipalities.

 

In fact, the state still has $351,601 - from an original $3.5 million - for Garrett County and towns and $412,698, down from $3.7 million, for Allegany County and municipalities.

 

“We knew this day was coming,” Pagenhardt said. “It’s not like it’s a surprise.”

 

The remainder of the cuts impact the budgets of the local health departments (a combined $724,835) and aid to community colleges (a combined $370,900). In addition, aid to local police agencies total $387,880, including $304,631 in Allegany County and $83,249 in Garrett County.

 

Pagenhardt said county workers have been notified that changes could be made in health care benefits. Already, the county has eliminated the practice of carrying over vacation days to a new fiscal year. Pagenhardt said it’s unfortunate that while the county has operated “efficiently and effectively,” services to local residents could be adversely impacted by state actions.

 

“The state got themselves in this mess,” Pagenhardt said. “We don’t mind being cut, but let’s be fair and equitable. We didn’t live beyond our projected revenue.”

 

Garrett County will likely carry out its current road improvement projects through mid-October, Pagenhardt said, including paving and tar-and-chip orders. Winter operations could prove costly and future budget cuts can’t be predicted until spring. With snow and ice, operations, fuel and overtime are costly and unpredictable, Pagenhardt said.

 

“We could have ice, which takes a lot more time” and is more costly “than 10 feet of snow, in some cases,” he said. “You really can’t predict that.”

 

Last year, there was less snow accumulation in Garrett County than in recent years but it fell on weekends and holidays, driving up overtime costs.

 

“You have to plow the snow,” he said.

 

Garrett County workers have a self-funded pension plan and vesting is up June 30, 2010. Pagenhardt said a number of roads department employees are predicted to retire and “we may not fill those positions. We’re going to have to take a look at all those possibilities.”

 

Kevin Spradlin can be reached at kspradlin@times-news.com.

 

Copyright © 1999-2008 cnhi, inc.

 

Streamlining at St. Joseph Medical Center

 

By Danielle Ulman

Daily Record

Wednesday, August 26, 2009

 

St. Joseph Medical Center has taken notice of the Toyota Way.

 

The Towson-based hospital has adopted the automobile maker’s innovative strategy for streamlining car production and applied it to its emergency department, reducing the length of time a patient waits there by 25 percent over the last year through more efficient communication systems.

 

Lean manufacturing techniques, pioneered by Toyota, cut waste by improving the pace of the production cycle, bringing more value to customers at a lower cost. In hospitals, lean techniques translate to cutting down patient wait times, improving patient flow and upgrading the patient experience.

 

Two years ago, St. Joseph brought in Dave Norton, a 37-year auto industry veteran who worked for Toyota and General Motors, to lead its lean efforts.

 

The hospital fully implemented the program in its emergency department last year after word came from management that the hospital needed to shrink the length of emergency department stays.

 

“If you’re coming into the emergency department, your main value is probably not to die first, and second is to get in and out of there quickly,” Norton said. “So coming in and doing a half an hour registration or waiting for an hour or two is a waste.”

 

St. Joseph cut the average emergency department visit down from 5 hours and 57 minutes to 4 hours and 30 minutes in fiscal 2009, which ended June 30, said Durenda Juergensen, assistant vice president of nursing.

 

Now, instead of waiting to take blood until a bed opens up, patients get their blood drawn immediately. A major emergency department obstacle is knowing when a patient can move to the next step of the process, whether that’s reviewing lab results or getting discharged. St. Joseph implemented a color-coded patient tracker system that gives doctors, nurses and technicians visual cues on patient status, for example, by changing the color in each letter of the word “lab” to show when blood has been taken, dropped off for testing or the full lab results are available.

 

The hospital achieved the reduction last November and has sustained the drop, Juergensen said.

 

“We’re constantly pursuing perfection,” Norton said. “It’s focused on what the Japanese call kaizen spirit. It’s developing that continuous improvement.”

 

Clogged emergency departments have become a major issue nationwide, and many hospitals say the problem is a lack of beds.

 

But St. Joseph found that streamlining the process of moving patients from the emergency department to inpatient beds freed up space in the emergency department. The hospital cut the average move to an inpatient bed to 50 minutes — down from 1 hour and 50 minutes — by creating a system that sends a page to hospital staff when a bed has been assigned, instead of requiring multiple calls between staff to see if the bed is available.

 

“You have built capacity of your emergency department without building anything with bricks and mortar,” Juergensen said.

 

St. Joseph is certainly not the first hospital to employ lean techniques. In the last decade, businesses have popped up worldwide offering job placements in hospitals and other fields for former Toyota employees and students of the lean philosophy.

 

Jason Stiles, president and chief operating officer of Stiles Associates LLC in New Hampshire, a lean-focused search firm founded in 1991, said his company started getting calls for placing lean experts in hospitals in 2006.

 

Stiles said the use of lean systems in hospitals is growing rapidly, a likely result of more transparency in hospital data.

 

“It can be very impactful if applied correctly,” he said. “If it’s not [applied correctly], people can view it as a headcount reduction program, so it’s really important for hospitals to have the right people guiding them.”

 

St. Joseph plans to implement lean processes in operating rooms next. While the process will save the hospital money, Norton said that is not the priority.

 

“I’d like to think we’re saving lives rather than focusing on saving dollars,” he said. “Obviously the monetary savings come later, but the point is saving lives.”

 

According to Press Ganey, a leading national provider of patient satisfaction data, the average stay in Maryland’s emergency departments was 4 hours and 23 minutes in 2008, from the time patients walk in the door until the time they leave. The national average was 4 hours, 3 minutes.

 

Copyright 2009 Daily Record.

 

D.C.'s Ex-Dealers Back On Streets -- Saving Lives

Group Takes HIV Prevention to Old Haunts

 

By Darryl Fears

Washington Post

Wednesday, August 26, 2009

 

At a busy corner in the heart of Ward 7, Jamal Hawkins, a former drug dealer, embarked on a new career: getting residents hooked on HIV/AIDS prevention. His boss, Terrence Young, also a former dealer, said the path to success is simple.

 

"The same rapport you had with people you were selling drugs to, that's the same skill set you use to sell HIV and AIDS prevention," Young said recently. "The people skills you developed from that apply here."

 

Young demonstrated his technique in the parking lot of a 24-hour convenience store, beckoning to a woman who was passing by. "Hey," he called out. "I got something for you. I got some condoms here if you need them." She walked away with a fistful.

 

In wards 7 and 8 -- where the HIV infection rates are among the highest in the District, where many of the city's ex-convicts live and where many of its arrests occur -- former drug dealers are being recruited as HIV counselors.

 

"We don't say in our job description that only drug dealers need apply, but the reality is that men and women who soldiered illegally on the streets have the skills for what we do," said A. Toni Young, executive director of the nonprofit Community Education Group. Young runs the 11-month-old program and helped conceive it.

 

With his smooth boyish face, Hawkins looks the part of the choirboy he once was, growing up in suburban Maryland. But he was drawn to the streets.

 

"It was just the lifestyle. I always wanted to live life in the fast lane," he said, standing beside one of the program's vans, dressed in an oversized T-shirt and droopy jeans that bunched over snow-white sneakers. "I was always affiliated with people who did dirt in D.C."

 

The District has the highest HIV infection rate of any major city in the country. Ward 8 has the city's highest infection rate, 2.8 percent, and Ward 7 is not far behind at 2.4 percent. The two wards have what HIV/AIDS workers call hard-to-reach populations, the people least likely to be tested for and informed about HIV/AIDS and most likely to spread it. They are the kind of people drug dealers come face to face with every day.

 

Young said she knows what critics will say: A former drug dealer is bound to slide back into criminal behavior. "I think that's the problem," she said. "We have to provide an opportunity for them to do something different from what we've known them to do. . . . We're not just trying to give people a job. We're trying to change them, and change a community's dynamic."

 

In the past year, at least two workers have stumbled, contributing to doubts about whether the program can succeed. Last month, a counselor was arrested for narcotics possession; earlier this year, a second worker failed a D.C. Corrections drug test, Young said.

 

"I had some hard choices to make," she said. "Do I say, 'You're fired'? Or do I let the justice system run its course? I'm trying to change people, but if you're being charged with a crime, that's a problem."

 

About 20 men and women, most of whom have criminal records, have completed the program's training courses since it began in October, Young said. "If I've managed to hold onto 18 out of those 20, I'll live with that. You have to consider that these workers have distributed more than 100,000 condoms east of the Anacostia River, they have tested more than 2,000 residents of wards 7 and 8, and they have referred more than 100 people to substance abuse care and treatment, and this area needs that."

 

The idea for the program started with a family member's fall from grace. Young's nephew Terrence was jailed for a drug conviction.

 

When he returned home in 2003, he was tired of a criminal life where rival dealers and police were gunning for him. With a new fianceé and a baby on the way, the 37-year-old broke down: "I don't know what I'm going to do."

 

Several years later, his aunt was planning to start a condom distribution campaign east of the Anacostia River and had an idea. "I saw something in him that he didn't see," she said. "I said I need someone who knows the streets."

 

As it turned out, Terrence Young was a sharp student, completing courses on HIV transmission and prevention and on how to help people change behaviors that lead to infection. He also learned how to give a rapid HIV test. Now he returns to his old haunts -- jails, halfway houses and probation offices -- to talk about HIV. He leaves fliers that offer jobs in HIV prevention for ex-convicts.

 

He tells them that he can't promise them the same money they made on the streets, but he can give them respect, decency and a positive role in their community.

 

Kehinde Hall was more than interested. After serving a prison sentence for armed robbery, Hall, 30, wanted a new life.

 

A return to drug dealing was out of the question, he said. "I got tired of looking over my shoulder, wondering who was comin' up behind me," he said. "I wanted to do right. I wanted to give back to the community, give my family a reason to look up to me, so that when I give my child a dollar for ice cream, it's a clean dollar."

 

For the first time, thug life had an advantage. "It's hard to get a Harvard student to come out here and do what we do because he couldn't relate," Hall said from the backseat of a Chevy Mark III van as it bounded down Minnesota Avenue, past blighted corners with check-cashing centers and dollar stores.

 

Last month, the old life caught up with Hall. He was arrested for narcotics possession after police officers searched him near his house. He is charged with two counts of possession of a controlled substance.

 

Hall said police searched him -- without cause -- and found nothing. But one of the officers said he saw Hall toss something near a trash bin. A search turned up drugs.

 

A. Toni Young said that's not the full story. Police came to Hall's house in response to a noise complaint. He and some friends were grilling in the back yard and blasting music. When the officers ordered him to turn the music down, Hall yelled at them. Had Hall been polite to the neighbor or the police, there would have been no incident, she said.

 

"That's what we're trying to teach here," Young said. "I blame Kehinde. The police were just doing their job."

 

Hall and Hawkins entered the program together and underwent three months of training for certification in HIV prevention. The entry-level outreach position, handing out condoms and referring people to support services such as job placement, pays about $28,000 a year.

 

Hawkins, 25, a fast learner, now earns about $34,000 a year.

 

Hawkins recalled a woman he met at a public housing complex in May, his first month of giving HIV tests. She paced nervously outside the van, he said, and when she stepped inside, "she was panicking." Hawkins went through the routine, checking off her behaviors as part of a risk assessment. "She was shootin' dope," he said. "Sharing needles. Having sex without condoms while high. She was saying yes to everything."

 

Hawkins looked the woman in the eye, the way he had been trained. "I told her I was worried," he said. "I said, 'I can't tell you to stop what you're doing, but I can tell you that if you're going to do it, at least be careful.' "

 

He swabbed her mouth. The result was negative. "She said, 'I'm going to take a rack of condoms and nobody is going to have sex with me without a condom anymore.' "

 

Five years ago, Hawkins was arrested after selling crack cocaine to an undercover officer in Virginia. He served three years, mostly at a federal prison in West Virginia, watching men engage in sex, worrying about AIDS, about being attacked. He said he decided to change his life.

 

"It was the guidance I got in prison," Hawkins said. "Guys who had longer stints told me, 'This isn't where you want to be.' "

 

As an outreach worker, Hawkins offers similar advice, and it's not always welcome. During one outing in Southeast, he said, he crossed paths with young drug dealers he knew. "They were like, 'Damn, what's this?' " He described his new life as an HIV counselor, a job with a paycheck. "Some of them tried to recruit me back."

 

One day late last month, the program vans rolled to a stop along a curb outside the Benning Terrace public housing complex. Hawkins stepped out with Kamau Hall, 33, Kehinde Hall's older brother. There wasn't a soul in the courtyard.

 

Kamau Hall, who was convicted of destruction of public property in connection with a 2001 drug arrest, wasn't worried. He knows how things go down at Benning Terrace.

 

"This is a word-of-mouth spot," he said. "Somebody will call somebody. Once that call goes out, they'll be coming from everywhere, all different directions."

 

Staff researcher Meg Smith contributed to this report.

 

Copyright 2009 Washington Post.

 

National / International

Medical Workers Leery of Flu Vaccine

 

Associated Press

Wednesday, August 26, 2009

 

New research suggests that half of all health-care workers around the world would refuse the swine flu vaccine, a British scientific journal reported Wednesday.

 

The conclusion is taken from a study of more than 2,200 health workers this year in Hong Kong, during the height of global H1N1 flu panic in May. Experts said the trend would likely apply worldwide.

 

Most of those polled said they would pass on the flu shot because they were afraid of side effects and doubted how safe and effective it would be.

 

The World Health Organization recommends countries vaccinate their health workers. Many Western countries, including Britain, Spain and the United States, have said that doctors and nurses would be among the first to get swine flu shots this fall because their absence from work could cripple health systems.

 

The study results, published online in BMJ ( http://www.bmj.com/ ), formerly known as the British Medical Journal, suggest that carrying out those plans may be tricky.

 

"A good argument can be made that health workers have an ethical obligation to be vaccinated, not to protect themselves, but to protect their patients," said George Annas, a bioethics expert at Boston University. "But if they don't believe that vaccine to be safe and effective, it will be a hard sell."

 

Fewer than 60 percent of health workers in most countries get vaccinated against regular flu, thought to be a reliable indicator of whether they might get a swine flu shot. In the United States, about 35 percent of health workers get a regular flu shot.

 

Annas said health workers were ultimately like everyone else when it comes to getting vaccines. "Like the lay population, they assume they won't need the shot because they don't think they will get the flu," he said.

 

Several drugmakers are testing their swine flu vaccines. So far, officials say that no one who has gotten the injections has reported anything more serious than a sore or swollen arm.

 

Copyright 2009 Associated Press.

 

CDC leery of estimates about swine flu's toll

 

Associated Press

By Lauran Neergaard

Washington Post

Wednesday, August 26, 2009

 

WASHINGTON -- Government health officials are urging people not to panic over estimates of 90,000 people dying from swine flu this fall.

 

"Everything we've seen in the U.S. and everything we've seen around the world suggests we won't see that kind of number if the virus doesn't change," Dr. Thomas Frieden, head of the Centers for Disease Control and Prevention, said in a C-SPAN interview taped Wednesday.

 

While the swine flu seems quite easy to catch, it so far hasn't been more deadly than the flu strains seen every fall and winter - many people have only mild illness. And close genetic tracking of the new virus as it circled the globe over the last five months so far has shown no sign that it's mutating to become more virulent.

 

Still, the CDC has been preparing for a worst-case flu season as a precaution - in July working from an estimate slightly more grim than one that made headlines this week - to make sure that if the virus suddenly worsened or vaccination plans fell through, health authorities would know how to react.

 

On Monday the White House released a report from a group of presidential advisers that included a scenario where anywhere from 30 percent to half of the population could catch what doctors call the "2009 H1N1" flu, and death possibilities ranged from 30,000 to 90,000. In a regular flu season, up to 20 percent of the population is infected and 36,000 die.

 

"We don't think that's the most likely scenario," CDC flu specialist Dr. Anne Schuchat said of the presidential advisers' high-end tally.

 

What's really expected this year? CDC won't speculate, finding a numbers game pointless as it tries to balance getting a largely complacent public to listen to its flu instructions without hyping the threat.

 

Along with how the virus itself continues to act, the ultimate toll depends on such things as vaccinations beginning as planned - currently set for mid-October - and whether the people who need them most get them. CDC also is working to help hospitals keep the not-so-sick from crowding emergency rooms and to properly target anti-flu drugs to the most vulnerable.

 

What is likely: A busy flu season that starts earlier than usual, Schuchat told The Associated Press. This new H1N1 strain never went away over the summer, infecting children at summer camps in particular. Already clusters of illnesses are being reported at some schools and colleges around the country.

 

Copyright 2009 Washington Post.

 

Agency Urges Caution on Estimates of Swine Flu

 

By Donald G. McNeil Jr.

New York Times

Wednesday, August 26, 2009

 

ATLANTA — Up to 90,000 deaths from swine flu in the United States, mostly among children and young people?

 

Up to 1.8 million people hospitalized, with 50 percent to 100 percent of the intensive-care beds in some cities filled with swine flu patients?

 

Up to half the population infected by this winter?

 

On Monday, a White House advisory panel issued a report with these estimates, calling them “a plausible scenario” for a second wave of infections by the new H1N1 flu. The grim numbers by the panel, the President’s Council of Advisers on Science and Technology, got considerable play in the news media.

 

On Tuesday, however, officials at the Centers for Disease Control and Prevention, the agency with the most expertise on influenza pandemics, suggested that the projections should be regarded with caution.

 

“We don’t necessarily see this as a likely scenario,” said Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases.

 

A press officer for the disease centers, speaking carefully to avoid a feud with the White House press office, said, “Look, if the virus keeps behaving the way it is now, I don’t think anyone here expects anything like 90,000 deaths.”

 

Even one of the experts who helped prepare the report said Tuesday that the numbers were probably on the high side, given that some weeks had passed since the calculations were finished in early August.

 

“As more data has come out of the Southern Hemisphere, where it seems to be fading, it looks as if it’s going to be somewhat milder,” said the expert, Marc Lipsitch, an epidemiologist at the Harvard School of Public Health. “If we were betting on the most likely number, I’d say it’s not 90,000 deaths; it’s lower.”

 

Dr. Harold Varmus, president of the Memorial Sloan-Kettering Cancer Center and one of the panel’s chairmen, defended the report.

 

“A lot of people think the flu is over,” Dr. Varmus said. “We think it’s important that there be a dose of reality. It’s certainly not an outlandish proposal. A lot of people are going to be infected.”

 

For a report with such striking figures, it was released with little fanfare and less coordination than might have been expected among public health officials.

 

The report was posted on the White House Web site on Monday, two weeks late, since it was dated Aug. 7. With President Obama on vacation in Martha’s Vineyard, no news conference with the White House or with the report’s authors was scheduled.

 

Kathleen Sebelius, secretary of health and human services, was at the disease centers’ headquarters in Atlanta, addressing a special symposium on swine flu.

 

A summary of the report was handed out by the centers’ press staff to medical reporters as she spoke, but Ms. Sebelius did not dwell on it or mention its forecast of 30,000 to 90,000 deaths, more than twice the 36,000 deaths usually caused by seasonal flu.

 

With the centers’ director, Dr. Thomas Frieden, by her side, she said fall would be a challenge when flu returned, and acknowledged a recent Washington Post poll showing that few Americans were worried. She even joked that it might bring handkerchiefs back into fashion.

 

Both she and Dr. Frieden acknowledged that “some people” would die, but neither gave an estimate.

 

Dr. Varmus said he was not happy with the way the report had been released “but that’s above my pay grade.”

 

A debate over alarming predictions for flu would recall September 2005, when Dr. David Nabarro, then in charge of the United Nations response to H5N1 avian flu, estimated that a human outbreak could kill 5 million to 150 million people.

 

Headlines focused on the larger number, and arguments over the wisdom of such estimates went on for months. But the flu never mutated to transmit easily between people and thus far only 262 deaths have been attributed to it by the World Health Organization.

 

Since the epidemic began, the centers have been reluctant to issue projections about probable swine flu cases, and the agency has even stopped estimating how many Americans have already had the flu. The official estimate has been stuck at “more than one million” for months.

 

At the Atlanta symposium, Lyn Finelli, head of surveillance for the influenza division, was asked when that would be updated. “Sometime in the next few weeks,” Dr. Finelli said. “We’re working on the model.”

 

Officials at the centers said they had known that the panel’s report was in the works, but had focused on the recommendations it would make.

 

They included these:

 

¶Releasing some vaccine for high-risk people in September, even before clinical trials are finished.

 

¶Speeding plans for intravenous flu drugs and clarifying guidelines for using drugs like Tamiflu.

 

¶Using social media that appeal to youth to urge them to get shots.

 

¶Changing federal rules and programs that discourage school closings.

 

Agency officials said they had already adopted some measures. For example, vaccine makers have been asked to prepare early batches of vaccine, and the disease control centers are already on Facebook and Twitter.

 

Even while distancing themselves from the grim forecasts presented in the White House advisers’ report, officials at the centers saw a possible benefit.

 

“Anything that breaks the complacency is a useful tool,” said Glen Nowak, the director of media relations at the centers.

 

Copyright 2009 New York Times.

 

Half of health workers reject swine flu shot

 

Associated Press

By Maria Cheng

Washington Post

Tuesday, August 25, 2009

 

LONDON -- About half of Hong Kong's health workers would refuse the swine flu vaccine, new research says, a trend that experts say would likely apply worldwide. In a study that polled 2,255 Hong Kong health workers this year, researchers found even during the height of global swine flu panic in May, less than half were willing to get vaccinated.

 

Most said they would pass on the swine flu shot, which is not yet available, because they were afraid of side effects and doubted how safe and effective it would be.

 

Doctors and nurses are on the swine flu front lines - and if they become infected, they may not only spread the disease to patients, but their absence from work could cripple health systems.

 

The World Health Organization recommends countries vaccinate their health workers. Many Western countries including Britain, Spain, and the U.S. have said doctors and nurses will be among the first to get swine flu shots.

 

The study results, published online in BMJ, formerly known as the British Medical Journal on Wednesday, suggest that carrying out those plans may be tricky.

 

"A good argument can be made that health workers have an ethical obligation to be vaccinated, not to protect themselves, but to protect their patients," said George Annas, a bioethics expert at Boston University. "But if they don't believe that vaccine to be safe and effective, it will be a hard sell."

 

Several drug makers are testing their swine flu vaccines. So far, officials say that among the few thousand people who got the injections no one has reported anything more serious than a sore or swollen arm.

 

It is unlikely any rare side effects will pop up until the vaccine is given to millions. That might include things like Guillain-Barre syndrome, a temporary paralyzing disorder, which was seen after the 1976 swine flu vaccination campaign, and happens fewer than once every 1 million vaccinations.

 

Researchers at the University of Hong Kong surveyed doctors and nurses in public hospitals this year from January to May, asking them if they would get a pandemic vaccine based either on bird flu or swine flu. About 35 percent of health workers were willing to get a bird flu vaccine, versus 48 percent for swine flu.

 

Experts were surprised so few of Hong Kong's health workers were willing to be vaccinated, since the city was hit hard during the 2003 outbreak of SARS, or Severe Acute Respiratory Syndrome.

 

Paul Chan of the Chinese University of Hong Kong, one of the study authors, thought the results would be similar elsewhere. Fewer than 60 percent of health workers in most countries get vaccinated against regular flu, thought to be a reliable indicator of whether they might get a swine flu shot. In the U.S., about 35 percent of health workers get a regular flu shot, while in Britain, only about 17 percent do.

 

Annas said health workers were ultimately like everyone else when it comes to getting vaccines. "Like the lay population, they assume they won't need the shot because they don't think they will get the flu."

 

On the Net:

http://www.bmj.com

 

Copyright 2009 Washington Post.

 

H1N1 has Del. pig farmers on guard

 

The News Journal

By Dan Shortridge

Salisbury Daily Times

Wednesday, August 26, 2009

 

HARTLY, Del. -- Farmer John Tigner worries about someone sneezing on his sows.

 

Just as people can catch the H1N1 virus from infected pigs, pigs can catch it from people -- and that's one fear among pork producers in Delaware, who are keeping most visitors off their farms to guard against someone passing the virus to their herds.

 

The so-called swine flu already has put farmers on the economic margins as prices for pork have plunged, and an outbreak on the farm would hurt them even further, according to leaders of the Delaware Pork Producers Association.

 

"Farmers are losing money on every hog that they're sending to market right now," said Tigner, the group's president, who has about 25 purebred sows and 250 hogs in Hartly.

 

There has been only one suspected case of human-to-pig influenza spread -- in Canada in May, believed to have been spread by a man who had recently traveled to Mexico -- but farmers and the pork industry are still on guard.

 

The simplest and most effective biosecurity measure is to minimize access to the pigs, said Roxana-area farmer Henry C. Johnson IV.

 

"You just need to be more conscious of that," he said. "If a person would sneeze on the animal or spit some mucus or something, they might cough in the animal's area -- that's how they would catch it."

 

Tigner said that, generally speaking, farmers should not allow people onto their farms who are not regular employees or family members who work with hogs. Visitors to his farm also don suits of protective clothes and boots.

 

"Biosecurity is No. 1," he said. "We worry about diseases all the time -- the H1N1 wasn't something that just popped up."

 

Other biosecurity measures include not loaning or borrowing farm equipment or vehicles; keeping swine from outside sources off the farm; disinfecting workers' shoes, clothes and hands and equipment and vehicles; and reporting sick animals immediately, according to the U.S. Department of Agriculture.

 

The virus' spread could cost pork producers up to $1.25 billion by the end of the year, according to the National Pork Producers Council.

 

While swine farming isn't a huge business in Delaware -- there are 8,000 to 9,000 pigs in the state -- an outbreak would severely hurt smaller family farms, Tigner said.

 

"They're not big corporations. They don't have a lot of excess money, their working capital is going to be a lot tighter," he said.

 

Development of an H1N1 vaccine for pigs won't be finished until later this year, according to the Wall Street Journal.

 

Copyright 2009 Salisbury Daily Times.

 

Proposal to Ease Aid for G.I.’s With Stress Disorder

 

By James Dao

New York Times

Wednesday, August 26, 2009

 

Under fire from veterans groups and Congress for its handling of disability claims, the Department of Veterans Affairs is proposing new regulations that it says will make it easier for veterans to seek compensation for post-traumatic stress disorder.

 

The proposal is intended to lower the burden on noncombat veterans who claim they developed PTSD in the service and to speed processing of those claims, which represent a significant part of the 82,000 disability claims the department receives each month.

 

Current rules require veterans who have received diagnoses of PTSD to document that they experienced traumatic events during service that triggered the disorder. For veterans who did not serve in combat units, such proof can be difficult to find given the unevenness of military record keeping.

 

But veterans’ advocates have argued that many noncombat troops, including truck drivers and supply clerks, have experienced such events, which include roadside bombs, firefights, mortar attacks or the deaths of friends. Despite receiving diagnoses of PTSD, many of those troops struggle to receive disability compensation.

 

The proposed rule would eliminate the requirement to document triggering events, provided veterans with PTSD could show that they were in places and performed duties where such events might have occurred. Their symptoms must also be consistent with the trauma they claim to have experienced.

 

By some estimates, 20 percent of troops returning from Iraq and Afghanistan have PTSD.

 

In a news release on Monday, the secretary of veterans affairs, Eric K. Shinseki, said, “The hidden wounds of war are being addressed vigorously and comprehensively by this administration as we move V.A. forward in its transformation to the 21st century.”

 

Dennis M. Cullinan, national legislative director for Veterans of Foreign Wars, called the proposed change “a big plus” for veterans. Mr. Cullinan cited the example of a truck driver in Iraq who might have experienced repeated roadside bomb attacks but whose military record would not have shown combat duty.

 

Mr. Cullinan also said that changing the policy administratively was faster than waiting for legislation. A bill in Congress that would make similar changes, sponsored by Representative John Hall, Democrat of New York, faces opposition because of the projected cost, nearly $5 billion.

 

But some veterans’ advocates responded skeptically to the proposed regulation, which now must undergo a 60-day review period.

 

“Whenever the V.A. touts a proposed compensation rule change that it says will ‘make it easier for a veteran to claim service connection,’ red flags go up all over the place,” a veterans’ advocate, Larry Scott, wrote on his Web site, vawatchdog.org.

 

Critics said the proposed rule would still require veterans to prove a connection between a traumatizing event and their PTSD, even when that connection was not clear cut. Strict application of that requirement could lead to many rejected claims, they say.

 

Katrina J. Eagle, a veterans’ lawyer in California, said the proposed rule would also require veterans to receive diagnoses from department-employed or approved psychiatrists and psychologists. Currently, veterans can receive diagnoses from their own psychiatrists.

 

“This is their way of being able to control the diagnosis,” Ms. Eagle said. “I don’t see how this is going to make it easier.”

 

But other veterans’ advocates said the proposed requirement on using department psychiatrists seemed like a reasonable means to reduce fraud and standardize diagnoses.

 

Meaghan Smith, a spokeswoman for Mr. Hall, said that he thought the proposed rule change was “pretty significant” but that he would study it closer to make sure it was “as inclusive” as his bill.

 

Copyright 2009 New York Times.

 

Kennedy's cancer puts focus on quality of life

 

Associated Press

By Marilynn Marchione

Washington Post

Wednesday, August 26, 2009

 

He lived 15 months with an incurable brain tumor, a little longer than usual for a patient in his late 70s. Perhaps equally important is that Sen. Edward M. Kennedy lived those months well - able to work almost to the end, to sail the choppy New England waters he adored, to help elect a president he supported, and even to give him a dog.

 

Time is important to any cancer patient. Quality of life, not just how much life they can squeeze out, is increasingly the focus for people with a terminal illness, cancer specialists say. It also is one of the chief goals of treatments for brain tumors, since these therapies typically do not buy much time.

 

"The advances that we've made in prolonging survival aren't as big as we've liked them to be, but people have stayed at a good quality of life right up to the end," said Dr. Matthew Ewend, neurosurgery chief at the University of North Carolina, Chapel Hill.

 

Even after treatments can no longer control tumor growth for patients, "we can usually keep their quality of life pretty good with medicines for brain swelling, and then the end is usually pretty graceful," Ewend said.

 

There is much to be admired in how Kennedy spent his final months, said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society.

 

"This is a man who had a serious and fatal illness and he knew that. Despite his illness, he carried on as best he could," Lichtenfeld said.

 

He noted that celebrities "are public representatives of millions of people who deal with these issues on a daily basis." When one gets recommended treatments and is able to live life to its fullest, it gives hope to other patients, Lichtenfeld said.

 

Kennedy was diagnosed with a malignant glioma, a cancerous brain tumor, after suffering a seizure at his home in May 2008. He had surgery two weeks later, followed by chemotherapy with the drug Temodar during and after radiation, his family has said.

 

Cancer specialists say he also likely received Avastin, a newer drug aimed at depriving the tumor of its blood supply. Avastin recently won federal approval for treating brain tumors that recur after standard treatment. It is made by Genentech, which recently was acquired by Swiss-based Roche.

 

Kennedy's doctors have declined to comment on specifics and did not respond to interview requests Wednesday.

 

Median survival for the type of tumor Kennedy is believed to have had is 12 to 15 months, but the range is wide, said Dr. Mark Gilbert, a brain tumor expert at the University of Texas M.D. Anderson Cancer Center in Houston.

 

Gilbert is leading an international study of 1,200 patients testing intensive Temodar therapy to see if that can improve survival. Results are expected next year. Temodar is made by Schering-Plough Corp.

 

"Treatments are keeping the cancer under control for a longer time," Gilbert said. Without the tumor continuing to grow, patients "maintain their function and with that, their quality of life," he said.

 

Even though survival time remains grim, it has improved, said Dr. Steve Brem, neurosurgery chief at Moffitt Cancer Center in Tampa, Fla.

 

"Only a few years ago, it used to be about nine months," Brem said. Gliomas are so invasive - spreading tentacles into the brain in a way that all cannot be removed with surgery - that they usually cannot be cured, he explained.

 

Treatments besides Temodar that might improve the odds are in testing now: several experimental drugs, an experimental vaccine that prods the immune system to fight the cancer, and a radioactive "homing device" that helps a cancer drug reach tumors deep in the brain.

 

However, much more research is needed to make meaningful gains, said a statement from the International Brain Tumour Alliance, a British-based international support and advocacy group.

 

Each year 200,000 people worldwide develop a malignant brain tumor "and there has been only a minimal improvement in new therapies in the past 30 years," the statement says.

 

Cancer research is a cause Kennedy championed long before his illness, the cancer society's chief executive, John Seffrin, said in a statement.

 

Kennedy helped overhaul the 1971 National Cancer Act, "rein in the tobacco industry" with a bill giving the federal Food and Drug Administration authority to regulate tobacco products, and backed expansion of the Children's Health Insurance Program with an increase in the tobacco tax, the statement said.

 

For these and other achievements, he was given the Society's Medal of Honor and National Distinguished Advocacy Award.

 

Copyright 2009 Washington Post.

 

Rare Side Effect Is Seen in Long-Term Use of a Breast Cancer Drug

 

By Roni Caryn Rabin

New York Times

Wednesday, August 26, 2009

 

A new report suggests that a drug widely used to prevent the recurrence of breast cancer may have a rare but dangerous side effect: increasing the odds that long-term users may develop an uncommon but aggressive new tumor.

 

But medical experts were quick to question the significance and methodology of the study, saying clinical trials had repeatedly found that the drug, tamoxifen, reduced the recurrence and spread of common breast cancers and that its benefits exceeded any possible risks.

 

Even the author of the report, which is based on an observational study and not the kind of randomized, controlled clinical trial considered the gold standard in medicine, said the findings should not affect practice because the drug’s benefits were well established.

 

“All treatments have risks associated with them,” said Dr. Christopher I. Li, an associate member of the Fred Hutchinson Cancer Research Center in Seattle and the first author of the study, which appeared Tuesday in Cancer Research. “Here we’re adding another potential risk to the risk side of the equation for tamoxifen. But the broader context is that tamoxifen lowers a patient’s risk of dying of the disease.”

 

Tamoxifen, which blocks the effects of estrogen, significantly reduces the recurrence and spread of estrogen-sensitive cancers, which are the most prevalent.

 

The new study, which assessed the likelihood of developing a new cancer in the second breast, found that women who took tamoxifen for five years or more were 60 percent less likely than nonusers to develop a new estrogen-sensitive tumor in the second breast, and 40 percent less likely to develop a new tumor of any kind in the second breast.

 

But the study also found that the long-term tamoxifen users were possibly four times as likely as nonusers to develop a new tumor that was not estrogen-sensitive. Those tumors are harder to treat, but also relatively rare; only 1 in 7 of the women studied who developed a cancer in the second breast had the kind of tumor that falls into this category.

 

The finding of a four-fold increase was questionable both because the number of women who developed the unusual tumor was small, and because women who took tamoxifen for one to four years were not affected, statisticians said.

 

Dan Berry, a biostatistician with the M. D. Anderson Cancer Center in Houston, said the findings might well be “a statistical fluke.”

 

“This is what we call a case control study, and we all know the problems associated with these studies,” Dr. Berry said. “Case control studies showed conclusively that hormone replacement therapy protected women from cardiovascular disease, which turned out to be not only wrong but in the wrong direction.”

 

The study assessed the history of tamoxifen use among more than 1,000 breast cancer survivors from the Seattle-Puget Sound region who learned they had an estrogen-sensitive breast cancer when they were 40 to 79 years old. It compared the histories of 358 women who developed a new cancer in the second breast with 674 women who did not develop a second cancer. Most of the women who took hormonal therapy used tamoxifen.

 

Several breast cancer experts said they were concerned that breast cancer patients who heard about the new study might stop taking their tamoxifen, even though the main reason to take the drug is to prevent the cancer they already have from recurring and spreading, which can lead to death.

 

“You have to keep in mind, this drug isn’t being given to women to prevent cancer in the other breast — it’s to prevent cancer from spreading to the bones and the liver and the lungs,” said Dr. Eric Winer, director of the breast oncology center at the Dana-Farber Cancer Institute in Boston. “We know from other studies that in this setting, tamoxifen is able to lower the chance the cancer will spread to other parts of the body and improve overall survival.”

 

Copyright 2009 New York Times.

 

Six companies recall blinds, shades after kids' deaths

 

Associated Press

By Jennifer C. Kerr

Baltimore Sun

Wednesday, August 26, 2009

 

WASHINGTON - Six companies are recalling millions of window blinds and shades, following the deaths of three children who got caught in cords that help the coverings move up and down.

 

The recalls, announced Wednesday by the Consumer Product Safety Commission, involve some big-name companies, including Pottery Barn Kids and IKEA as well as smaller companies that sold their window covers at retailers such as Target.

 

No deaths were associated with the blinds and shades from Pottery Barn Kids and IKEA, but CPSC says there have been six reports of children becoming entangled in the inner cord of the Pottery Barn Kids shades.

 

CPSC says the three deaths, which date back to 2006, involved blinds or shades made or imported by Vertical Land Inc., of Panama City Beach, Fla., and Lewis Hyman Inc., in Carson., Calif.

 

A one-year-old was killed in 2007 when he became entangled and strangled in the lift cord loop of a roll-up blind from Lewis Hyman that had fallen into his portable crib, CPSC said. The company is recalling about 4.2 million of the blinds.

 

It's also recalling more than a half-million roman shades following the strangulation death of a 13-month-old boy last year. The child was found with his head caught between the exposed inner cords and cloth on the backside of the shade, the agency said.

 

Vertical Land is recalling more than 32,000 blinds and shades following the death of a four-year-old girl. Her death was first reported to CPSC in 2006. The girl was strangled in the loop of a vertical blind cord that was not attached to the wall or floor.

 

The commission's new chairman, Inez Tenenbaum, says the blinds and shades pose a hidden hazard.

 

"I urge all parents to inspect their blinds and shades immediately and obtain the free repair or refund that the companies are offering to consumers," she said.

 

The Vertical Land blinds and shades were sold in Florida from 1992 through 2006. Customers can contact the company for a free retrofit kit.

 

The Lewis Hyman oval roll-up blinds were sold at retail stores from 1999 through 2003, and the Woolrich roman shades were sold exclusively at Target stores from between 2006 and 2008. Customers can contact the company for a repair kit if the blinds don't have release clips, and for a free repair kit for the roman shades.

 

The other recalls involve:

 

• Pottery Barn Kids/Williams-Sonoma., Inc of San Francisco. About 85,000 roman shades with exposed inner cords on the backside are being recalled. Four kids were found with cords entangled around their necks. Two children had red marks around their necks after having freed themselves. CPSC says there were no permanent injuries.

 

Pottery Barn Kids customers should stop using the shades and can get a merchandise card for the purchase value.

 

• IKEA Home Furnishings, of Conshohocken, Pa. About 120,000 MELINA roman blinds are being recalled after a report of a 2-year-old boy who suffered a near strangulation. His mother found him hanging from the looped bead chain on the blind, said CPSC.

 

The blinds were sold at IKEA stores between 2006 and 2008. Consumers should return them to IKEA for a full refund.

 

• About 163,000 Thermal Sailcloth and Matchstick Bamboo roman shades sold at Target stores between 2008 and 2009. They were imported by Victoria Classics of Edison, N.J., and the agency says they have exposed inner cords that could be dangerous. Consumers can contact the company for a repair kit.

 

• About 245,000 roller shades distributed by Lutron Electronics Co. Inc., of Coopersburg, Pa., and sold at specialty dealers and Expo Design Centers from 2000 through April of this year. The shades, the CPSC says, have a looped bead chain that should be attached to the floor or wall. If it is not, customers can contact Lutron for a repair kit.

 

Copyright 2009 Associated Press. All rights reserved.

 

New blood tests find heart attacks quicker, better

 

Associated Press

By Alicia Chang

Washington Post

Wednesday, August 26, 2009

 

LOS ANGELES -- A new generation of blood tests can quickly and reliably show if a person is having a heart attack soon after chest pains start - a time when current tests are not definitive, two studies found.

 

The newer, sensitive tests give a much better way to tell who needs help fast. Each year, 15 million people in the United States and Europe go to emergency rooms with symptoms of a heart attack, but most are not truly suffering one.

 

Those having a heart attack need to have blocked arteries opened quickly to limit damage to the heart muscle from lack of blood.

 

Doctors currently have two main ways of diagnosing a heart attack. They can use an electrocardiogram, or EKG, to measure the electrical activity of the heartbeat for abnormalities. But that test is not always conclusive.

 

Doctors also use blood tests to detect elevated levels of a heart muscle protein known as troponin - a sign of heart muscle injury. A drawback with the older troponin tests is they take longer to detect increased troponin levels and by that time, heart damage may have already occurred.

 

Two European studies published in Thursday's New England Journal of Medicine found that the newer blood tests can improve early diagnosis of a heart attack soon after a person feels chest pain. The studies looked at four tests made by Abbott Laboratories, Roche and Siemens AG. The Abbott and Siemens tests are approved for use in the United States.

 

"Until this point, we really did not have direct evidence that they improved overall diagnostic accuracy," said cardiologist Dr. David Morrow of Brigham and Women's Hospital in Boston. Morrow wrote an accompanying editorial in the journal and has consulted for Siemens.

 

In one study, doctors led by the University Hospital in Basel, Switzerland, took blood samples from 718 patients who came into the emergency room with heart attack symptoms such as chest discomfort and shortness of breath. Doctors compared the accuracy of four of the new blood tests with an older test.

 

In the second study, researchers led by Johannes Gutenberg University in Mainz, Germany, studied 1,818 people who came in with chest pain. Their troponin level was detected by a sensitive Siemens test and a conventional test.

 

In both cases, the accuracy of the newer tests was 94 to 96 percent compared with 85 to 90 percent for the older tests.

 

Mayo Clinic cardiologist Dr. Allan Jaffe advocates using the newer tests. Several doctors said the new tests do not cost more than the older versions they are replacing, and are usually covered by insurance.

 

"You diagnose heart attacks faster and you detect more people who are having heart attacks," said Jaffe, who had no role in the studies.

 

Further studies are needed to determine if earlier detection of heart injury results in more lives saved, the researchers said.

 

The Swiss study was funded by the Swiss National Science Foundation, Swiss Heart Foundation and the three makers of the tests. One of the authors reported receiving fees from the three companies. The German study was funded by diagnostic company Brahms Aktiengesellschaft. Two of the authors reported receiving fees from test makers.

 

On the Net:

New England Journal:http://www.nejm.org

 

Copyright 2009 Washington Post.

 

An Environmentally Friendly Mosquito Repellent?

 

By Cornelia Dean

New York Times

Wednesday, August 26, 2009

 

A report this week in the journal Nature is taking me back to my childhood summers in New Jersey, where evenings were often marked by the appearance of a slow-moving Jeep towing a battered cart. A machine, about the size of a lawn mower, sat on the cart, spewing a whitish mist — DDT.

 

The town did the spraying in recognition of the fact that New Jersey was the mosquito core of the universe, a place, it was said, where an only-average sized insect could bring down a deer. Some of us called the mosquito the state bird.

 

My friends and I would dash along behind the jeep, running in and out of the gassy cloud, breathing in the strong odor of the insecticide as droplets condensed on our clothes and skin. As far as I know, this experience left no ill effects, except a persistent skepticism about claims that exposure to this, that or the other chemical is inevitably a health disaster.

 

Still, I accept the idea that widespread use of DDT caused environmental problems. The chemical persists in the flesh of animals that come into contact with it, and it concentrates in creatures at the top of the food web, like the fish-hunting ospreys I see often when I am at the coast. Because DDT can thin the shells of their eggs to the cracking point, widespread use of the chemical almost led ospreys and other raptors to extinction. When I see ospreys now I am reminded of how good it is that little jeep and its cart are long retired.

 

Unless, of course, the bugs are biting. Then, if it were up to me, I would crank up the sprayer and let loose a chemical blast. And for me mosquitoes are just an annoyance. In many parts of the world they are a deadly menace, spreading diseases like malaria.

 

That’s where the Nature paper comes in.

 

It is a description of work led by Anandasankar Ray, an entomologist at the University of California, Riverside, on fruit flies and their sensitivity to carbon dioxide. The researchers report that they have identified a compound that blocks the ability of the insects to detect it.

 

Clouds Hill Imaging Culex mosquitoes are vectors for many diseases.

 

The finding is interesting because it is the carbon dioxide we exhale that draws mosquitoes to us. A chemical that blocked that attraction would, in a sense, make us invisible to the insects. That is what seems to have happened when the researchers tested it on a class of mosquitoes — the genus Culex, which spreads West Nile Disease and other ailments.

 

It is too soon to say whether researchers will ever be able to turn the compounds, 2,3-butanedione and 1-hexanol, into an economical and environmentally benign insect repellent that works on mosquitoes generally.

 

But if they can, it would be a boon whose benefits might spread far beyond New Jersey, to the regions of the world where malaria is common, and where researchers and health workers argue about whether and how they can use DDT to combat it.

 

According to the World Health Organization, about 250 million people contract malaria each year, and about 900,000 of them die of it. Almost all of them are children.

 

Here’s a YouTube video that explains how the compounds work:

 

Copyright 2009 New York Times.

 

Opinion

More budget blues

Our view: The latest state budget cuts may be the most difficult yet, but the economic outlook is gloomy enough to wonder: Is it enough?

 

Baltimore Sun Editorial

Wednesday, August 26, 2009

 

Perhaps the most troubling aspect of the $454 million in state budget cuts expected to be approved today by the Board of Public Works is the strong possibility that a similar situation will arise again in a matter of months as tax revenue estimates continue to drop. While the impact of the economic recession on Maryland's state government may not be quite as overwhelming as it's been in Sacramento and Albany, the worst may not yet have hit Annapolis.

 

Gov. Martin O'Malley said yesterday that the budget reductions are designed to preserve his administration's priorities as best as possible until a recovery takes hold. Most of the savings will come out of the hides of state agencies and by lopping off nearly one-quarter of aid to local governments.

 

That may be a sound approach. Certainly, preserving K-12 public education funding ought to be the highest priority, and Mr. O'Malley appears to have accomplished this - at least for now and assuming local aid cuts don't lead to reductions at the county level.

 

But it's also clear that the current administration is doing little more than putting fingers in the dike. The governor's own budget secretary acknowledges that next fiscal year's budget is at least another $1 billion in the red. Some of the cuts to be approved today will probably help that situation; many will not.

 

More than 200 people will lose their jobs thanks to these reductions, and all state employees will see smaller paychecks. Some may lose as many as 15 days of pay this calendar year. That's a lot, considering many counties have yet to issue a single furlough to their civil servants.

 

Average Maryland residents may not notice much of this, at least not immediately. Road projects are likely to be delayed and pot holes not fixed. Health programs will be scaled back, and fewer police will be on the payroll. Considering the state's general fund spending is about to fall to three-year-old levels for the first time in more than three decades, that's a remarkably modest impact.

 

How is this possible? Obviously, part of it is that Maryland was better positioned than most states for the economic downturn, and President Barack Obama's stimulus aid has been helpful in reducing the shock of falling tax revenue on governments generally.

 

But it's also because Mr. O'Malley has chosen to defer some of the hard choices. Is he minimizing the pain because it's in the interests of the state or because he fears what deeper cuts or raising taxes could lead to - voter unrest and a return face-off with former Gov. Robert L. Ehrlich Jr. next fall?

 

We cannot forecast the future. But we have learned enough hard economic lessons to know that facing budget realities sooner rather than later is almost always preferable. If there is a problem with these budget cuts - as painful as they may be - it's that they don't go far enough toward solving the long-term imbalance.

 

Mr. O'Malley didn't cause his budget problems. His willingness to raise taxes, chiefly the state's sales tax, is one of the factors that's kept the situation from being far worse than it already is. If he truly believes, as we do, that voters support elected leaders willing to make the hard decisions, then it's time more of them were made.

 

Copyright © 2009, The Baltimore Sun.

 

Some facts about vaccines weren’t mentioned

 

Cumberland Times-News Letter to the Editor

Wednesday, August 26, 2009

 

To the Editor:

 

In response to the Aug. 16 letter (“Childhood immunizations may not be the ‘silver bullet’ ”): While I agree that as concerned parents we should be educated about vaccine safety, I wanted to present some facts about vaccines the author failed to mention.

 

Vaccines are inarguably one of the most successful medical advance. They transformed the face of medicine during the 20th century. Before vaccines, parents in the United States could expect that each year:

 

Polio would paralyze 10,000 children.

 

Rubella (German Measles) would cause defects and mental retardation in a many as 20,000 newborns.

 

Measles would infect about 4 million children, killing 3,000.

 

Diphtheria would be one of the most common causes of death in school aged children

 

A bacterium called Haemophilus influenzae (Hib) would cause meningitis in 15,000 children, leaving many with permanent brain damage.

 

Pertussis (whooping cough) would kill thousands of infants.

 

Vaccines have reduced, and in some cases even eradicated, many diseases that killed or severely disabled people a few generations before. Because of vaccines, many diseases that once caused suffering and devastation in children are now only seen by pediatricians of this generation in textbooks.

 

For example, polio has been eradicated from most countries and the worldwide incidence has decreased from an estimated 350,000 cases in 1988 to 1652 cases in 2007. Another good example is smallpox. Once a disfiguring and sometimes fatal disease, smallpox was considered eradicated in 1979, due to successful vaccination campaigns.

 

Because more parents chose not to vaccinate, certain diseases are on the rise. After the pertussis vaccine was introduced, the incidence of “whooping cough” decreased from 157 per 100,000 to less than 1 per 100,000 in 1970.

 

However, now pertussis is the only vaccine-preventable disease associated with increasing deaths in the U.S., with the number of deaths increasing from 4 in 1996 to 17 in 2001, all infants under the age of 1.

 

In January, my 6-month old son had to be prophylactically treated with antibiotics after being exposed to an unvaccinated child who tested positive for pertussis.

 

Because parents withhold the controversial MMR (measles, mumps, and rubella) vaccine, measles are also on the rise. From January through July 2008, the Center for Disease Control reported 131 cases of measles from 15 states, the highest year-to-date number since 1996. Many were children whose parents chose not to have them vaccinated.

 

There has been no credible scientific evidence that supports the link between MMR vaccine and autism. The controversial study that raised the question of a link was later proven to be inaccurate because the study’s lead author received major funding from British trial lawyers seeking evidence against vaccine manufacturers. Perhaps those lawyers should have received the “greed” vaccine Mr. And Ms. Cozatt refer to.

 

Although I understand that vaccine reactions can be devastating, they are rare and in most cases the benefit of vaccinating far outweighs the risk. Am I suggesting someone with a true medical contraindication receive a vaccine? Absolutely not, and I don’t think any reasonable person would deny a “medical exemption” based on such a reaction either.

 

The objective of this letter is not to spark a bitter debate over vaccine safety, but rather to urge parents to do their own research based on credible information.

 

An excellent resource that I have encountered is www.vaccine.chop.edu, the Children’s Hospital Of Philadelphia Vaccine Education Center, which is funded by grants and endowments and does not receive any funding from vaccine manufacturers.

 

Discuss this topic with your pediatrician at your child’s next well check-up and I’m sure he/she will agree with the old adage, “An ounce of prevention is worth a pound of cure.”

 

Daniell Shertzer

Frostburg

 

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