WASHINGTON (AP) ? The Obama administration has levied financial sanctions against eight drug gang bosses accused of working for Mexico's powerful and violent Sinaloa Cartel.
The government accused the eight regional bosses of managing drug smuggling operations for Joaquin "El Chapo" Guzman, the purported head of the Sinaloa Cartel, the Treasury Department announced Tuesday. By declaring the men specially designated narcotics traffickers under the Kingpin Act, Washington has made it illegal for U.S. citizens to do business with them and freezes any assets they may have inside the U.S.
Seven of the men ? Armando Lopez Aispuro, Guillermo Nieblas Nava, Felipe de Jesus Sosa Canisales, Raul Sabori Cisneros, Ramon Ignacio Paez Soto, Jesus Alfredo Salazar Ramirez and Jose Javier Rascon Ramirez ? are believed to run smuggling operations in the Mexican state of Sonora, which borders Arizona. Cenobio Flores Pachecho is accused of being in charge of smuggling efforts in Mexicali, across the border from California.
"These eight individuals are the gate keepers. These are the last eight people to have control of (drugs and other contraband) before it hits the streets of our communities," said Carl Pike, the assistant special agent in charge of the Drug Enforcement Administration's special operations division. "This is a huge step forward."
Adam Szubin, the head of the Treasury Department's Office of Foreign Assets Control, said the government has taken 15 actions targeting 100 individuals and entities connected to the Sinaloa cartel since last year.
Guzman, one of Mexico's most wanted persons, was designated a drug kingpin by the U.S. more than a decade ago. Despite that, he has still managed to amass a fortune estimated at more than $1 billion. His cartel has also managed to remain largely intact despite years of fighting with the Mexican government and rival drug trafficking groups.
But Guzman's criminal group hasn't been unscathed. Several high-ranking members have been arrested or killed. Last month Guzman's father-in-law, Ines Coronel Barreras, was arrested by Mexican authorities in Agua Prieta, across the border from Douglas, Ariz. Coronel has also been the subject of U.S. government sanctions.
Pike described the Sinaloa Cartel Tuesday as "the oldest and probably right now the best established cartel."
"Others are suffering in-house fighting. As the others weaken, obviously the Sinaloa Cartel will grow stronger," Pike said.
__
Follow Alicia A. Caldwell on Twitter at www.twitter.com/acaldwellap
KC-135 Stratotanker planes have been refueling fighter craft in-flight for more than 60 years. While such longevity is commendable, the US military?s fleet of mid-air refuellers is in desperate need of an update. And that?s where this new flying gas station comes in.
CAIRO (Reuters) - A key Egyptian negotiator with the International Monetary Fund said on Sunday he has resigned as first deputy finance minister, in a potential blow to Cairo's prospects of an early IMF deal.
Hany Kadry Dimian has been the crucial point man in Egypt's protracted and so far fruitless negotiations to obtain a $4.8 billion loan needed to help combat a severe economic crisis.
"The only comment I can make for the time being is that yes, my term ends on April 30 according to my resignation, which I submitted in December," Kadry told Reuters by telephone.
"My next move is not decided."
A senior technocrat appointed in 2007, Kadry survived five finance ministers in office since the 2011 uprising that overthrew former autocratic President Hosni Mubarak.
Kadry gave no explanation for his decision to quit, first reported on the Egyptian dissident Rebel Economy blog, saying he would say more on Tuesday.
A senior European diplomat said his departure was not a good omen for Egypt's hopes of wrapping up a deal on the long delayed IMF loan next month, as the government has said it aims to do.
Kadry was the one expert in the ministry who fully understood the IMF program and was able to deal with the global lender professionally, the diplomat said.
The daily El-Watan said on its website that Kadry had been under increasing pressure from the ruling Muslim Brotherhood's Freedom and Justice Party, and in conflict with Abdallah Shehata, the FJP economic adviser to Finance Minister Al-Mursi Al-Sayed Hegazy.
Separately, the head of Egypt's bourse, Mohamed Omran, told Prime Minister Hisham Kandil he would like to leave his position at the end of his term on July 1, the state news agency MENA reported, citing an unnamed official stock exchange source.
The report did not give a reason for Omran's request, but said he had told the prime minister in August he wanted to leave the post. Kandil had asked him to stay until the end of his term, MENA said.
(Additional reporting by Alexander Dziadosz; Writing by Paul Taylor; Editing by Jon Hemming)
SEOUL, South Korea (AP) ? Australia's Brett Rumford eagled the first hole of a three-way playoff to win the Ballantine's Championship in South Korea on Sunday.
Rumford was leading by two shots when he double-bogeyed No. 17. He holed a 10-foot par putt at the last to finish at 11-under 277 and force a playoff with Marcus Fraser of Australia and Peter Whiteford of Scotland.
Rumford then holed a 4-foot eagle to earn the victory.
"I battled today with my driver constantly as I was leaking a few drives right, including the whole back nine when I was feeling stuck, so I had a quick word to Pete (coach Peter Cowen) and then hit about five or six balls off the first tee, and that did the trick ... it's a funny game because it was an absolute roller-coaster ride of emotions out there this afternoon," said Rumford.
"Of course, what happened at 17 made my work a whole lot more difficult but I'm really pleased with my result."
Rumford is the first Australian to win on the European Tour in two years and he drew on the inspiration of Adam Scott who became the first Australian to win the Masters earlier this month.
"Scotty's win was a huge inspiration to all of us," he said. "It's just good on the European Tour side of things as we needed to make a shift and get a few runs on the board because the Aussie guys in the U.S. have been doing a great job."
Rumford started his final round in sizzling manner with six birdies in his opening nine holes including four in succession from the sixth hole.
Whiteford let slip a maiden European Tour win in his 142nd event when he missed a five-foot birdie putt on No. 18.
South African Louis Oosthuizen, the highest-ranked player in the field at No. 7, shot a final-round 69 to finish three strokes behind the leaders in a share of fifth place.
However, for a second day running the former Open champion came unstuck at the par-three No. 13, recording a double bogey and a day after walking off the same hole with a triple bogey.
Thailand's Thongchai Jaidee produced the lowest final-round score of 65 to finish among five players tied in sixth at 7 under.
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(Adds later picks) NEW YORK, April 25 (Reuters) - Selections in the first roundof the 2013 NFL Draft at Radio City Music Hall on Thursday (picknumber, NFL team, player, position, college): 1-Kansas City, Eric Fisher, offensive tackle, Central Michigan 2-Jacksonville, Luke Joeckel, offensive tackle, Texas A&M 3-Miami (from Oakland), Dion Jordan, defensive tackle, Oregon 4-Philadelphia, Lane Johnson, offensive tackle, Oklahoma 5-Detroit, Ezekiel Ansah, defensive end, Brigham Young 6-Cleveland, Barkevious Mingo, linebacker, LSU 7-Arizona, Jonathan Cooper, guard, North Carolina 8-St. ...
This issue in this thread is NOT about immigration...
I created it to show a double standard...
First, the poll...
Fox News poll: Majority says legal immigration should be reduced
Quote:
While most voters favor citizenship for illegal immigrants who meet certain requirements, there is widespread agreement that new border security should come first.
In addition, more than half say we should cut the number of legal immigrants allowed into the United States.
A just-released Fox News poll finds 55 percent of voters think fewer legal immigrants should be accepted into the U.S. That?s up from 43 percent in 2010.
Majorities of Republicans (67 percent) and independents (53 percent) as well as a plurality of Democrats (47 percent) want to decrease legal immigration.
Overall, 28 percent of voters say the U.S. should increase legal immigration.
The U.S. Senate took up immigration reform this month. The debate took a turn with the Boston Marathon Bombings. The suspected terrorist who was killed in a police shootout was a legal permanent resident, while his still-hospitalized younger brother became a naturalized U.S. citizen in 2011.
By a 78-21 percent margin, voters favor allowing immigrants in the U.S. illegally to become citizens after they meet requirements such as passing a background check. Support for a pathway to citizenship has increased slightly since February. At that time it was 72-25 percent.
Non-whites (88 percent), Democrats (87 percent) and those under age 35 (84 percent) are among those most likely to favor offering a pathway to citizenship.
Border security is another aspect of this issue, and opinions are changing. Nearly twice as many voters say border security is at the right level today (32 percent) as said so in 2010 (18 percent).
Still, the poll finds 60 percent of voters think it is not strict enough, and another 68 percent want new border security measures to be completed before changes to immigration policies.
The reason I bring this up is to show how polls don't mean crapola to people with partisan agendas...
Personally, I don't CARE if 1% or 99% agree with my position...It's still my position and it's not gonna change simply because the winds are blowing in another direction...
But what do we hear ALL OF THE TIME about gay marriage?...
"We should have it because more people in the polls SAY we should have it!!!!!"
And what do we hear ALL OF THE TIME about increased background checks for guns?...
"We should have it because more people in the polls SAY we should have it!!!!!"
And what do we hear ALL OF THE TIME about legal marijuana?...
"We should have it because more people in the polls SAY we should have it!!!!!"
But the SECOND a poll such as this says something against what the same people who put up polls on gay marriage and increased background checks for guns spew, then the argument becomes "It doesn't matter...We should just do what "I" want!"...
The Left is ADAMANTLY against securing the border before any pathway to citizenship is conducted...
Example...
Sen. Leahy: If Border Security Is A Must Before We Move Forward, That's Not Going To Happen
The whole point is this...
Polls are considered ONLY when the poll advances the cause of the people who were already for what the poll discusses...
But they'll NEVER consider it when the poll shows them on the small side...
LONDON (AP) ? A group of independent experts has slammed Britain's cosmetic surgery industry for not protecting patients adequately and is calling for stricter controls in the aftermath of a breast implant scandal in Europe last year that left tens of thousands of women with cheap silicone implants prone to ruptures. A top British health official, meanwhile, signaled support for their recommendations.
In a review of how cosmetic procedures are regulated, the group said all skin fillers should be available by prescription only and that all practitioners ? from surgeons to aestheticians who inject Botox ? must be properly qualified. The expert group, commissioned by the U.K. Department of Health, also called for the creation of a registry of implants and other medical devices and an ombudsman for private health care, among other suggestions.
The recommendations were released in a report on Wednesday.
The British government has previously rejected calls to oversee cosmetic procedures and the industry is largely self-regulated. There are few rules on who is allowed to perform a non-surgical cosmetic intervention.
"Anyone can give you a (skin) filler anytime, anywhere," said Bruce Keogh, medical director of the National Health Service, who led the review. "This is a bizarre situation."
During an embargoed press briefing on Monday, Keogh said the commercialization of the industry has led to some questionable claims about the efficacy of certain procedures.
"This is a pretty data-free zone," Keogh said.
In the report, Keogh and others wrote that a person having a non-surgical procedure such as a Botox injection "has no more protection and redress than someone buying a ballpoint pen."
They noted that the cosmetic interventions sector has grown by 300 percent in the last five years and that the use of procedures such as injecting substances to smooth out the skin make up 75 percent of the market. "It is our view that dermal fillers are a crisis waiting to happen," the report concluded. Side effects from skin fillers can include scarring, infection and even blindness.
Catherine Kydd, a Briton who received faulty breast implants, said stricter ethical policies should be in place for those who perform cosmetic surgeries and procedures.
"When you see a surgeon, you shouldn't be seeing a salesman," she said.
Regulations on cosmetic interventions in the U.K. are more lax than elsewhere. In Denmark, anyone carrying out cosmetic interventions must be registered with a national health board. When standards are breached, the board can suspend a clinic's operations, impose fines, strike professionals off the register and refer cases to the police. There is no such system in the U.K.
Keogh noted there are about 190 different types of skin fillers available in Europe versus only 14 approved by the U.S. Food and Drug Administration.
In a statement, Dr. Dan Poulter, a senior minister in the Department of Health, said it was time for the government to step in. "There is a significant risk of people falling into the hands of cowboy firms or individuals or individuals whose only aim is to make a quick profit," he said.
Poulter said the government would respond to the report in detail in the summer.
Kon-Tiki hits American theaters this week, months after it was nominated for the Best Foreign Film Oscar. It?s a narrative retelling of Kon-Tiki, the 1951 Academy-Award winning documentary directed by Thor Heyerdahl about his voyage across the South Seas in a raft of his own creation. Here are some other compelling real-life stories caught on film?that were then scripted and remade.
Rescue Dawn (2006)
In 1997, Werner Herzog made Little Dieter Needs to Fly for German television, a documentary about a German-born American pilot named Dieter Dengler who was shot down and captured in the Vietnamese War but later successfully escaped. About a decade later, Herzog wrote and directed Rescue Dawn, based on the events of Dieter.
Party Monster (2003)
Fenton Bailey and Randy Barbato produced and directed Party Monster: The Shockumentary in 1998, based on Disco Bloodbath by NYC club kid James St. James, which focuses on the life and murders of fellow club kid and horrifying sociopath Michael Alig. The duo remade it as a narrative film in 2003, with Seth Green and Macauley Culkin as St. James and Alig respectively, in Oscar-worthy performances.
Milk (2008)
Major Hollywood types had been trying for years to make a biographical film about Harvey Milk, the San Francisco city supervisor who was the first major openly gay politician in America ? and ultimately murdered by a colleague who was acquitted in a kangaroo court. SFO native Robin Williams tried for years, but Sean Penn got the title role and won the Oscar for 2008?s Milk. Until then, the only other film about Milk was The Times of Harvey Milk, directed in 1984 by Rob Epstein. (It won the Oscar for Best Documentary.)
Grey Gardens (2009)
The made-for-HBO drama about Jacqueline Kennedy?s cousins who fall into mental illness and hoarding in their crumbling beachside mansion demanded and required remarkable performances from Drew Barrymore and Jessica Lange (as Little Edie and Big Edie, respectively). But it?s not nearly as shocking or fascinating as the classic 1973 documentary of the same name.
Lords of Dogtown (2005)
Long-haired skater boys attract a certain element to the box office (teens of both genders), but there was really no reason to remake the joyous Dogtown and Z Boys, about the birth of skateboarding in California in the ?60s and ?70s.
Munich (2005)
Steven Spielberg?s stark, minimal thriller about the terrorist attacks on Israeli athletes at the 1972 Summer Olympics and the elite special-ops team that tracks them down almost feels like a documentary, and it owes a heavy debt to Kevin Macdonald?s Oscar-winning 1999 doc One Day in September.
American Heart (1992)
This is an intimate movie about a dad who gets out of jail and tries, heartbreakingly hard, to connect with his streetwise son and kick the bottle. It?s deliberate, personal, and feels like it?s based on a play, but it?s actually a reworking of some of the stories told in Streetwise, a 1984 documentary about homeless Seattle teenagers.
RKO 281 (1999)
In 1999, HBO dramatized the legendary battle faced by Orson Welles in trying to get his masterpiece Citizen Kane completed, facing adversity from his studio (and the person his film was very obviously attacking, newspaper publisher William Randolph Hearst). Citizen Kane?s story had been told before, though, in the 1996 American Experience episode The Battle Over Citizen Kane.
The King of Kong (2014?)
In a truly mind-bendingly meta film experience, plans are underway to remake the humorous documentary The King of Kong, which concerns two grown men fighting for the world record in Donkey Kong 30 years after that game came out, with a script and actors?as a mockumentary. Huh.
Quantum Hoops (2014?)
And here?s another upcoming remake of a documentary. Ben Stiller is producing a movie based on the 2007 documentary movie Quantum Hoops, about the brilliant but not-so-athletically-gifted team at Caltech, aiming to win a single game and break a 240-game, 21-year losing streak. Sounds like that would make an excellent movie. Again.
Apr. 23, 2013 ? Maternal use of valproate (a drug used for the treatment of epilepsy and other neuropsychological disorders) during pregnancy was associated with a significantly increased risk of autism in offspring, according to a study in the April 24 issue of JAMA. The authors caution that these findings must be balanced against the treatment benefits for women who require valproate for epilepsy control.
"Anti-epileptic drug exposure during pregnancy has been associated with an increased risk for congenital malformations and delayed cognitive development in the offspring, but little is known about the risk of other serious neuropsychiatric disorders," according to background information in the article.
Jakob Christensen, Ph.D., of Aarhus University Hospital, Aarhus, Denmark, and colleagues evaluated the association between maternal use of valproate during pregnancy and the risk of autism spectrum disorder and childhood autism in offspring. The population-based study included all children born alive in Denmark from 1996 to 2006. National registers were used to identify children exposed to valproate during pregnancy and diagnosed with autism spectrum disorders (childhood autism [autistic disorder], Asperger syndrome, atypical autism, and other or unspecified pervasive developmental disorders). Data were analyzed and adjusted for potential confounders (factors that can influence outcomes) such as maternal age at conception, paternal age at conception, parental psychiatric history, gestational age, birth weight, sex, congenital malformations, and parity. Children were followed up from birth until the day of autism spectrum disorder diagnosis, death, emigration, or December 31, 2010, whichever came first.
The analysis included 655,615 children born from 1996 through 2006. The average age of the children at end of follow-up was 8.8 years. During the study period, 5,437 children were diagnosed with autism spectrum disorder, including 2,067 with childhood autism. The researchers identified 2,644 children exposed to antiepileptic drugs during pregnancy, including 508 exposed to valproate. The authors found that use of valproate during pregnancy was associated with an absolute risk of 4.42 percent for autism spectrum disorder and an absolute risk of 2.50 percent for childhood autism.
"In this population-based cohort study, children of women who used valproate during pregnancy had a higher risk of autism spectrum disorder and childhood autism compared with children of women who did not use valproate. Their risks were also higher than those for children of women who were previous users of valproate but who stopped before their pregnancy," the researchers write.
"Because autism spectrum disorders are serious conditions with lifelong implications for affected children and their families, even a moderate increase in risk may have major health importance. Still, the absolute risk of autism spectrum disorder was less than 5 percent, which is important to take into account when counseling women about the use of valproate in pregnancy."
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The above story is reprinted from materials provided by The JAMA Network Journals.
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Journal Reference:
Jakob Christensen et al. Anti-Epileptic Drug During Pregnancy Associated With Increased Risk of Autism. JAMA, April 23, 2013
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Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.
KANSAS CITY, Mo. (AP) ? The running joke around Kansas City at the end of last season went something like this: "The Chiefs are so bad" ? pause for effect ? "they can't even stink in the right year."
After going 2-14 to match the worst finish in franchise history, the Chiefs will have the top pick in the NFL draft for the first time. But there's no clear-cut No. 1 choice this year, and certainly no must-have franchise quarterback such as Andrew Luck on the board.
The Chiefs were in need of a QB, too, hence the joke. But they solved that problem for the time being when they shipped their second-round pick and a conditional choice in next year's draft to the San Francisco 49ers to land a former No. 1 overall pick, Alex Smith.
Now, the Chiefs are left to choose the best available on Thursday night.
"We're exploring our options," said general manager John Dorsey, adding that there's four players who the Chiefs were trying to nitpick in their final days of preparation.
"You still have to give yourself some options and kind of see how these four guys play, and watch the games as they're played," Dorsey said. "You understand they're people. Now, let's watch them play their respective position."
Dorsey wouldn't divulge which four players the Chiefs are considering, but common sense says at least two play the same position: Luke Joeckel of Texas A&M and Eric Fisher of Central Michigan, who are widely considered the best two offensive tackles available.
The Chiefs are almost certain to choose a blindside protector for Smith with their lone first-round pick, in part because of an uncertain situation surrounding incumbent Branden Albert.
Kansas City franchised the big left tackle after failing to reach a long-term contract with him, and Albert has made it clear that he wants stability. So the Chiefs have granted the Dolphins permission to speak with Albert's representatives, and the assumption is that a trade could be in place for a draft pick at some point before the weekend.
Even if a deal isn't worked out, the franchise tender that Albert signed only locks him up for next season, so the Chiefs could still be looking at a long-term solution at the position.
"Branden Albert is a good football player. We wouldn't have stuck the franchise tag on him if he wasn't," Dorsey said. "It's my job to explore all options, and that's kind of what's going on."
Joeckel has been considered the top available player, regardless of position, for months after protecting Heisman Trophy winner Johnny Manziel last season at Texas A&M. The 6-foot-6, 306-pound tackle has excellent footwork and is technically sound, and that's what has made him stand out among a deep class of offensive tackles.
There has also been a late groundswell of support for the 6-foot-7, 306-pound Fisher. He didn't go up against the same kind of competition that Joeckel played in the Southeastern Conference, but he has exhibited the kind of mean streak on the football field that is coveted in a lineman.
"They're both really fine football players," said Dorsey, who wouldn't speak in detail on any specific players. "I think this year the offensive line position has some true prospects in it."
The Chiefs could also use help along the defensive line, at middle linebacker and even at running back, but the consensus among most draft experts is that those needs can wait.
Their priority is to upgrade along the offensive line.
"They've been fairly safe picks over the years," Chiefs coach Andy Reid added. "You evaluate the success rate with all the positions, and you'll come back to the offensive line and say, 'Yeah, that's a fairly safe pick, offensive tackle.'"
It's not the eye-catching pick that's going to energize fans, though, even if the reality is that no such player appears available. Luck and Robert Griffin III provided that kind of appeal in last year's draft, but there is a dearth of high-end quarterback prospects this season.
Otherwise, the Chiefs wouldn't have such a decision on their hands.
Kansas City was also listening to trade offers in the final days before the draft, and Dorsey made it clear that he would consider moving out of the top pick for the right deal.
"You have to weigh so many variables and options for the betterment of this organization," he said. "When you sit in this seat, you're not only responsible for yourself, but you're responsible for numerous other things within this organization. So, you have to weigh those factors in. At the end of the day, you have to do what's best for this organization."
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WASHINGTON (AP) ? An analysis of more than 33,000 cases of foodborne illness shows that ground beef and chicken have caused more hospitalizations than other meats.
The report by the Center for Science in Public Interest says chicken nuggets, ham and sausage pose the lowest risk of foodborne illness.
The group used government data on 1,700 outbreaks over 12 years to analyze salmonella, E. coli, listeria and other pathogens that were definitively linked to a certain meat.
To calculate which meats were riskiest, CSPI ranked the foods in which contamination was most likely to cause hospitalizations. Some meats may have had more illnesses but were less likely to cause severe illness.
After ground beef and chicken, CSPI categorized turkey and steak as "high risk" and deli meat, pork, roast beef and beef or pork barbeque as "medium risk."
Salmonella and E. coli, pathogens that contaminate meat and poultry during slaughter and processing, accounted for a third of the illnesses surveyed. Clostridium perfringens, a lesser-known pathogen that usually grows after processing when foods are left at improper temperatures for too long by consumers or food establishments, accounted for another third.
While a large number of chicken illnesses were due to clostridium perfringens, chicken led to many hospitalizations partly because of the high incidence of salmonella in chicken that isn't properly cooked.
Most of the ground beef illnesses were from E. coli, which is found in the intestinal tracts of cattle and can transfer to the carcass if the meat isn't handled properly during slaughter. Ground beef can be riskier than steak and other beef products because pathogens are spread during the grinding process.
According to the report, listeria, salmonella and E. coli required the most hospitalizations.
The group noted that the data is incomplete because so many foodborne illnesses are not reported or tracked. The CDC estimates that as many as 48 million Americans get sick from food poisoning each year.
To reduce foodborne illnesses from meat, CSPI recommends what they call "defensive eating" ? assuming that meat can be unsafe. Safe handling includes not letting meat juices drip onto other food or counters, cleaning cutting boards and plates that have held raw meat, wearing gloves when preparing meat and washing hands often. Cooks should also make sure meat is heated to the proper temperature before eating it.
BEIJING (Reuters) - An elderly man in eastern China died of bird flu on Tuesday, bringing the death toll from a strain that recently emerged in humans to 22, a provincial health agency reported.
The 86-year-old man died after having been diagnosed with the H7N9 virus on April 17, the Zhejiang Health Bureau said on its website.
Two others in Zhejiang have been diagnosed with the disease, including an 84-year-old man and a 62-year-old man, both of Hangzhou who fell ill on April 15, the health bureau said.
In neighboring Anhui province, another case was diagnosed on Tuesday, a 91-year-old man, the state-run Xinhua news agency said.
The man became sick on April 14, Xinhua said.
So far 108 people have contracted the disease since the first deaths were reported in China last month. Authorities say many of those who became sick worked with poultry.
Investigators have yet to determine human-to-human transmission of the virus.
"Investigations into the possible sources of infection and reservoirs of the virus are ongoing," the World Health Organization said on Monday. "Until the source of infection has been identified, it is expected that there will be further cases of human infection with the virus in China.
The WHO's China representative, Michael O'Leary, issued data on Friday showing that half of the patients analyzed had no known contact with poultry, but he said it appeared human-to-human transmission was rare.
Some bird samples have tested positive and China has culled thousands of birds and shut down some live poultry markets.
(Reporting by Terril Yue Jones and Beijng newsroom; Editing by Nick Macfie)
(This story was refiled to correct paragraph six to say 108 people, not 109 people)
Apr. 22, 2013 ? In reviewing 25 years of U.S. malpractice claim payouts, Johns Hopkins researchers found that diagnostic errors -- not surgical mistakes or medication overdoses -- accounted for the largest fraction of claims, the most severe patient harm, and the highest total of penalty payouts. Diagnosis-related payments amounted to $38.8 billion between 1986 and 2010, they found.
"This is more evidence that diagnostic errors could easily be the biggest patient safety and medical malpractice problem in the United States," says David E. Newman-Toker, M.D., Ph.D., an associate professor of neurology at the Johns Hopkins University School of Medicine and leader of the study published online in BMJ Quality and Safety. "There's a lot more harm associated with diagnostic errors than we imagined."
While the new study looked only at a subset of claims -- those that rose to the level of a malpractice payout -- researchers estimate the number of patients suffering misdiagnosis-related, potentially preventable, significant permanent injury or death annually in the United States ranges from 80,000 to 160,000.
Diagnostic error can be defined as a diagnosis that is missed, wrong or delayed, as detected by some subsequent definitive test or finding. The ensuing harm results from the delay or failure to treat a condition present when the working diagnosis was wrong or unknown, or from treatment provided for a condition not actually present. "Overall, diagnostic errors have been underappreciated and under-recognized because they're difficult to measure and keep track of owing to the frequent gap between the time the error occurs and when it's detected," Newman-Toker says. "These are frequent problems that have played second fiddle to medical and surgical errors, which are evident more immediately."
He says experts have often downplayed the scope of diagnostic errors not because they were unaware of the problem, but "because they were afraid to open up a can of worms they couldn't close." He adds: "Progress has been made confronting other types of patient harm, but there's probably not going to be a magic-bullet solution for diagnostic errors because they are more complex and diverse than other patient safety issues. We're going to need a lot more people focusing their efforts on this issue if we're going to successfully tackle it."
For their review, Newman-Toker and his colleagues analyzed medical malpractice payments data from the National Practitioner Data Bank, an electronic repository of all payments made on behalf of practitioners in the United States for malpractice settlements or judgments since 1986.
They found that of the 350,706 paid claims, diagnostic errors were the leading type (28.6 percent) and accounted for the highest proportion of total payments (35.2 percent). Diagnostic errors resulted in death or disability almost twice as often as other error categories.
They also found that more diagnostic error claims were rooted in outpatient care than inpatient care, (68.8 percent vs. 31.2 percent) but inpatient diagnostic errors were more likely to be lethal (48.4 percent vs. 36.9 percent). The majority of diagnostic errors were missed diagnoses, rather than delayed or wrong ones. Per-claim payments were highest in cases of serious neurologic harm, including quadriplegia and brain damage resulting in the need for lifelong care. Those payments, the researchers found, were higher even than for errors resulting in death.
Newman-Toker noted that among malpractice claims, the number of lethal diagnostic errors was roughly the same as the number that resulted in permanent, severe harm to patients. This suggests that the public health impact of these types of mistakes is probably much greater than previously believed because prior estimates are based on autopsy data, so they only count deaths and not disability, Newman-Toker says.
The human toll of mistaken diagnoses is likely much greater than his team's review showed, Newman-Toker says, because the data they used covers only cases with the most severe consequences of diagnostic error. There are many others that occur daily that result in costly patient inconvenience and suffering, he says. One estimate suggests that when patients see a doctor for a new problem, the average diagnostic error rate may be as high as 15 percent.
The financial costs are difficult to unravel, Newman-Toker says, noting that tens of billions are spent every year on "defensive medicine," marked by unnecessary tests ordered to protect doctors from the possibility of a lawsuit for missing something. "Yet diagnoses are still missed, with grave consequences," he says.
As with other kinds of medical errors, diagnostic mistakes won't succumb to a one-size-fits-all solution, Newman-Toker says. For example, patients with severe dizziness are misdiagnosed with benign inner ear conditions instead of stroke for a different set of reasons than an infection is missed due to misreading laboratory tests. Checklists may prevent misdiagnosis of some conditions, but not others.
More research money needs to be devoted to finding answers, he says.
"There just hasn't been enough attention paid to this," he says.
Other Johns Hopkins researchers involved in the study include Ali Shabahang Saber Tehrani, M.D.; HeeWon Lee, M.D.; Simon C. Mathews, M.D.; Andrew Shore, Ph.D.; Martin A. Makary, M.D., M.P.H.; and Peter J. Pronovost, M.D., Ph.D.
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The above story is reprinted from materials provided by Johns Hopkins Medicine, via Newswise.
Note: Materials may be edited for content and length. For further information, please contact the source cited above.
Journal Reference:
Ali S Saber Tehrani, HeeWon Lee, Simon C Mathews, Andrew Shore, Martin A Makary, Peter J Pronovost, David E Newman-Toker. 25-Year summary of US malpractice claims for diagnostic errors 1986?2010: an analysis from the National Practitioner Data Bank. BMJ Qual Saf, 22 April 2013 DOI: 10.1136/bmjqs-2012-001550
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Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.
Epigenetic changes shed light on biological mechanism of autismPublic release date: 23-Apr-2013 [ | E-mail | Share ]
Contact: Seil Collins seil.collins@kcl.ac.uk 44-207-848-5377 King's College London
Scientists from King's College London have identified patterns of epigenetic changes involved in autism spectrum disorder (ASD) by studying genetically identical twins who differ in autism traits. The study, published in Molecular Psychiatry, is the largest of its kind and may shed light on the biological mechanism by which environmental influences regulate the activity of certain genes and in turn contribute to the development of ASD and related behaviour traits.
ASD affects approximately 1 in 100 people in the UK and involves a spectrum of disorders which manifest themselves differently in different people. People with ASD have varying levels of impairment across three common areas: deficits in social interactions and understanding, repetitive behaviour and interests, and impairments in language and communication development.
Evidence from twin studies shows there is a strong genetic component to ASD and previous studies suggest that genes that direct brain development may be involved in the disorder. In approximately 70% of cases, when one identical twin has ASD, so does the other. However, in 30% of cases, identical twins differ for ASD. Because identical twins share the same genetic code, this suggests non-genetic, or epigenetic, factors may be involved.
Epigenetic changes affect the expression or activity of genes without changing the underlying DNA sequence they are believed to be one mechanism by which the environment can interact with the genome. Importantly, epigenetic changes are potentially reversible and may therefore provide targets for the development of new therapies.
The researchers studied an epigenetic mechanism called DNA methylation. DNA methylation acts to block the genetic sequences that drive gene expression, silencing gene activity. They examined DNA methylation at over 27,000 sites across the genome using samples taken from 50 identical twin pairs (100 individuals) from the UK Medical Research Council (MRC) funded Twins Early Development Study (TEDS): 34 pairs who differed for ASD or autism related behaviour traits, 5 pairs where both twins have ASD, and 11 healthy twin pairs.
Dr Chloe Wong, first author of the study from King's College London's Institute of Psychiatry, says: "We've identified distinctive patterns of DNA methylation associated with both autism diagnosis and related behaviour traits, and increasing severity of symptoms. Our findings give us an insight into the biological mechanism mediating the interaction between gene and environment in autism spectrum disorder."
DNA methylation at some genetic sites was consistently altered for all individuals with ASD, and differences at other sites were specific to certain symptom groups. The number of DNA methylation sites across the genome was also linked to the severity of autism symptoms suggesting a quantitative relationship between the two. Additionally, some of the differences in DNA methylation markers were located in genetic regions that previous research has associated with early brain development and ASD.
Professor Jonathan Mill, lead author of the paper from King's College London's Institute of Psychiatry and the University of Exeter, says: "Research into the intersection between genetic and environmental influences is crucial because risky environmental conditions can sometimes be avoided or changed. Epigenetic changes are potentially reversible, so our next step is to embark on larger studies to see whether we can identify key epigenetic changes common to the majority of people with autism to help us develop possible therapeutic interventions."
Dr Alycia Halladay, Senior Director of Environmental and Clinical Sciences from Autism Speaks who funded the research, says: "This is the first large-scale study to take a whole genome approach to studying epigenetic influences in twins who are genetically identical but have different symptoms. These findings open the door to future discoveries in the role of epigenetics in addition to genetics in the development of autism symptoms."
###
The study was funded by Autism Speaks, Medical Research Council UK (MRC) and the Brain and Behavior Research Foundation (NARSAD). The twins were selected from the Twins Early Development Study (TEDS) which is funded by the MRC with additional support from the US National Institutes of Health.
Paper reference: Wong, C.C.Y et al. 'Methylomic analysis of monozygotic twins discordant for autism spectrum disorder and related behavioural traits' Molecular Psychiatry (2013) doi: 10.1038/mp.2013.41
For a copy of the paper or interviews with the authors, please contact Seil Collins, Press Officer, King's College London, Institute of Psychiatry. Email: seil.collins@kcl.ac.uk or tel: (+44) 0207 848 3577/(+44) 07718 697 176
About King's College London:
King's College London is one of the top 30 universities in the world (2012/13 QS international world rankings), and was The Sunday Times 'University of the Year 2010/11', and the fourth oldest in England. A research-led university based in the heart of London, King's has more than 25,000 students (of whom more than 10,000 are graduate students) from nearly 140 countries, and more than 6,500 employees. King's is in the second phase of a 1 billion redevelopment programme which is transforming its estate.
King's has an outstanding reputation for providing world-class teaching and cutting-edge research. In the 2008 Research Assessment Exercise for British universities, 23 departments were ranked in the top quartile of British universities; over half of our academic staff work in departments that are in the top 10 per cent in the UK in their field and can thus be classed as world leading. The College is in the top seven UK universities for research earnings and has an overall annual income of nearly 525 million (year ending 31 July 2011).
King's has a particularly distinguished reputation in the humanities, law, the sciences (including a wide range of health areas such as psychiatry, medicine, nursing and dentistry) and social sciences including international affairs. It has played a major role in many of the advances that have shaped modern life, such as the discovery of the structure of DNA and research that led to the development of radio, television, mobile phones and radar.
King's College London and Guy's and St Thomas', King's College Hospital and South London and Maudsley NHS Foundation Trusts are part of King's Health Partners. King's Health Partners Academic Health Sciences Centre (AHSC) is a pioneering global collaboration between one of the world's leading research-led universities and three of London's most successful NHS Foundation Trusts, including leading teaching hospitals and comprehensive mental health services. For more information, visit: http://www.kingshealthpartners.org.
The College is in the midst of a five-year, 500 million fundraising campaign World questions|King's answers created to address some of the most pressing challenges facing humanity as quickly as feasible. The campaign's five priority areas are neuroscience and mental health, leadership and society, cancer, global power and children's health. More information about the campaign is available at http://www.kcl.ac.uk/kingsanswers.
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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.
Epigenetic changes shed light on biological mechanism of autismPublic release date: 23-Apr-2013 [ | E-mail | Share ]
Contact: Seil Collins seil.collins@kcl.ac.uk 44-207-848-5377 King's College London
Scientists from King's College London have identified patterns of epigenetic changes involved in autism spectrum disorder (ASD) by studying genetically identical twins who differ in autism traits. The study, published in Molecular Psychiatry, is the largest of its kind and may shed light on the biological mechanism by which environmental influences regulate the activity of certain genes and in turn contribute to the development of ASD and related behaviour traits.
ASD affects approximately 1 in 100 people in the UK and involves a spectrum of disorders which manifest themselves differently in different people. People with ASD have varying levels of impairment across three common areas: deficits in social interactions and understanding, repetitive behaviour and interests, and impairments in language and communication development.
Evidence from twin studies shows there is a strong genetic component to ASD and previous studies suggest that genes that direct brain development may be involved in the disorder. In approximately 70% of cases, when one identical twin has ASD, so does the other. However, in 30% of cases, identical twins differ for ASD. Because identical twins share the same genetic code, this suggests non-genetic, or epigenetic, factors may be involved.
Epigenetic changes affect the expression or activity of genes without changing the underlying DNA sequence they are believed to be one mechanism by which the environment can interact with the genome. Importantly, epigenetic changes are potentially reversible and may therefore provide targets for the development of new therapies.
The researchers studied an epigenetic mechanism called DNA methylation. DNA methylation acts to block the genetic sequences that drive gene expression, silencing gene activity. They examined DNA methylation at over 27,000 sites across the genome using samples taken from 50 identical twin pairs (100 individuals) from the UK Medical Research Council (MRC) funded Twins Early Development Study (TEDS): 34 pairs who differed for ASD or autism related behaviour traits, 5 pairs where both twins have ASD, and 11 healthy twin pairs.
Dr Chloe Wong, first author of the study from King's College London's Institute of Psychiatry, says: "We've identified distinctive patterns of DNA methylation associated with both autism diagnosis and related behaviour traits, and increasing severity of symptoms. Our findings give us an insight into the biological mechanism mediating the interaction between gene and environment in autism spectrum disorder."
DNA methylation at some genetic sites was consistently altered for all individuals with ASD, and differences at other sites were specific to certain symptom groups. The number of DNA methylation sites across the genome was also linked to the severity of autism symptoms suggesting a quantitative relationship between the two. Additionally, some of the differences in DNA methylation markers were located in genetic regions that previous research has associated with early brain development and ASD.
Professor Jonathan Mill, lead author of the paper from King's College London's Institute of Psychiatry and the University of Exeter, says: "Research into the intersection between genetic and environmental influences is crucial because risky environmental conditions can sometimes be avoided or changed. Epigenetic changes are potentially reversible, so our next step is to embark on larger studies to see whether we can identify key epigenetic changes common to the majority of people with autism to help us develop possible therapeutic interventions."
Dr Alycia Halladay, Senior Director of Environmental and Clinical Sciences from Autism Speaks who funded the research, says: "This is the first large-scale study to take a whole genome approach to studying epigenetic influences in twins who are genetically identical but have different symptoms. These findings open the door to future discoveries in the role of epigenetics in addition to genetics in the development of autism symptoms."
###
The study was funded by Autism Speaks, Medical Research Council UK (MRC) and the Brain and Behavior Research Foundation (NARSAD). The twins were selected from the Twins Early Development Study (TEDS) which is funded by the MRC with additional support from the US National Institutes of Health.
Paper reference: Wong, C.C.Y et al. 'Methylomic analysis of monozygotic twins discordant for autism spectrum disorder and related behavioural traits' Molecular Psychiatry (2013) doi: 10.1038/mp.2013.41
For a copy of the paper or interviews with the authors, please contact Seil Collins, Press Officer, King's College London, Institute of Psychiatry. Email: seil.collins@kcl.ac.uk or tel: (+44) 0207 848 3577/(+44) 07718 697 176
About King's College London:
King's College London is one of the top 30 universities in the world (2012/13 QS international world rankings), and was The Sunday Times 'University of the Year 2010/11', and the fourth oldest in England. A research-led university based in the heart of London, King's has more than 25,000 students (of whom more than 10,000 are graduate students) from nearly 140 countries, and more than 6,500 employees. King's is in the second phase of a 1 billion redevelopment programme which is transforming its estate.
King's has an outstanding reputation for providing world-class teaching and cutting-edge research. In the 2008 Research Assessment Exercise for British universities, 23 departments were ranked in the top quartile of British universities; over half of our academic staff work in departments that are in the top 10 per cent in the UK in their field and can thus be classed as world leading. The College is in the top seven UK universities for research earnings and has an overall annual income of nearly 525 million (year ending 31 July 2011).
King's has a particularly distinguished reputation in the humanities, law, the sciences (including a wide range of health areas such as psychiatry, medicine, nursing and dentistry) and social sciences including international affairs. It has played a major role in many of the advances that have shaped modern life, such as the discovery of the structure of DNA and research that led to the development of radio, television, mobile phones and radar.
King's College London and Guy's and St Thomas', King's College Hospital and South London and Maudsley NHS Foundation Trusts are part of King's Health Partners. King's Health Partners Academic Health Sciences Centre (AHSC) is a pioneering global collaboration between one of the world's leading research-led universities and three of London's most successful NHS Foundation Trusts, including leading teaching hospitals and comprehensive mental health services. For more information, visit: http://www.kingshealthpartners.org.
The College is in the midst of a five-year, 500 million fundraising campaign World questions|King's answers created to address some of the most pressing challenges facing humanity as quickly as feasible. The campaign's five priority areas are neuroscience and mental health, leadership and society, cancer, global power and children's health. More information about the campaign is available at http://www.kcl.ac.uk/kingsanswers.
[ | E-mail | Share ]
?
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
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Kon-Tiki hits American theaters this week, months after it was nominated for the Best Foreign Film Oscar. It?s a narrative retelling of Kon-Tiki, the 1951 Academy-Award winning documentary directed by Thor Heyerdahl about his voyage across the South Seas in a raft of his own creation. Here are some other compelling real-life stories caught on film?that were then scripted and remade.
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Public release date: 23-Apr-2013
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