vineri, 31 august 2012

Analysis: Ryan puts down calculator, picks up bullhorn

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TAMPA, Florida (Reuters) - Paul Ryan built his reputation as a fearless wonk who wasn't afraid to put specific numbers on his small-government ideals. Now that he is the Republican Party's vice presidential nominee, the devil lies in the details.

In a speech that marked his ascension onto the national stage, Ryan spelled out his conservative vision in the broad brush strokes of the presidential campaign, rather than the pointillistic data sets of the House of Representatives Budget Committee.

But the core message at the Republican National Convention was the same. Ryan said he and his boss, Republican presidential nominee Mitt Romney, must place the federal government on a crash diet and overhaul popular benefit programs in order to avoid a European-style debt crisis.

"The choice is whether to put hard limits on economic growth or hard limits on the size of government, and we choose to limit government," Ryan said.

The take-no-prisoners stance has made Ryan a hero to conservatives, but it carries risks with a broader electorate.

While Americans may back the idea of spending cuts in the abstract, they tend to balk when presented with specifics. Polls show that more voters prefer keeping the Medicare health insurance plan for the elderly in place, rather than overhauling it as Ryan proposes.

"As rhetoric, it was an excellent speech in going over those broad principles. Likewise as rhetoric, it glossed over the hard realities of how you would achieve what he was talking about," said Charles Franklin, a professor at Marquette Law School in Milwaukee, Wisconsin.

Perhaps it's not surprising, then, that Ryan used personal stories to illustrate complex economic issues: the shuttered General Motors plant in his hometown of Janesville, Wisconsin, the small business his mother started at age 50, and the importance of Medicare to his mother, who smiled from the audience.

There were sins of omission. Ryan slammed Obama for ignoring a presidential debt panel, but failed to note that he himself served on the panel and voted against its findings. He also failed to mention that the GM plant closed before Obama took office.

Left unsaid were the tradeoffs Ryan and Romney would make in order to scale back the government to the level they envision.

"He didn't say what the tough choices are," said Steven Schier, a political science professor at Carleton College in Northfield, Minnesota. "You get into that in a convention speech, you lose the crowd, you lose the TV audience."

As a vice presidential candidate, Ryan now must play second fiddle to a man who has often been reluctant to provide details of his own economic policies.

Romney has declined to say which tax loopholes he would close in order to lower income tax rates by 20 percent, and his own proposal for Medicare reforms lacks the specifics that would allow independent experts to determine how much they would cost taxpayers and beneficiaries.

Democrats, of course, are happy to fill in the blanks as they argue that Romney and Ryan would gut programs that benefit the middle class and the poor in order to cut taxes for the wealthy. With Ryan's long voting record in Congress and several years of detailed budget proposals, they have plenty of material to work with.

Though Ryan is revered in Washington for his deep knowledge of fiscal policy, his skills as a salesman may be underappreciated.

Only eight of his fellow Republicans in the House of Representatives backed his plan to overhaul the Medicare prescription drug program when he introduced it in 2008. Within three years, nearly all of them supported it.

He has won re-election in his Democratic-leaning district by wide margins.

And he sounded like he was ready for his biggest sales job yet.

"Ladies and gentlemen, our nation needs this debate," he said. "We want this debate. We will win this debate."

(Editing by Leslie Adler)


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Basics about hantavirus outbreak in Yosemite

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FRESNO, Calif. (AP) — Answers to common questions about mice and the hantavirus linked to death of 2 people who visited Yosemite National Park:

___

How common is hantavirus pulmonary syndrome?

Up to 20 percent of all deer mice carry the virus, though levels can be higher. The illness is rare. Through 2011, there have been 587 documented cases since the illness was first identified in 1993.

___

How is it spread?

The most prolific carrier is the deer mouse, which prefers woodlands and high elevations, and can be found in desert areas. The virus in the saliva, feces and urine of infected mice is spread to humans who inhale airborne dust and aerosol particles. Symptoms develop in one to six weeks.

___

How do you tell a deer mouse from other mice?

House mice have solid colors, but deer mice range from gray to reddish brown, with white on their underbellies and sides of their tails.

___

Who is most susceptible?

Unlike the West Nile Virus, which is particularly hard on the elderly and people with compromised immune systems, there is no standard risk factor for humans when it comes to the hantavirus. Among the known cases, 63 percent have been men and 37 percent women. The range of ages was 6 to 83.

___

Can I catch it from someone who is sick?

Probably not. There have been no documented cases of hantavirus being spread by human to human contact.

___

What is the mortality rate?

More than 36 percent of people stricken with hantavirus have died from it. In 2011, half of the 24 people who got it died.

___

What are the signs?

It begins with chills, fever and muscle aches then progresses into a dry cough, headache, nausea and vomiting, then shortness of breath. People with hantavirus are put in intensive care, placed on oxygen and given medicine to prevent kidney failure.

___

How can I avoid exposure?

Open buildings that have been closed for a period of time and let them air out for 30 minutes. Spray mouse droppings with a water and bleach mixture, wait 15 minutes and mop up or wipe with paper towels.

___

Will I get it if I go to Yosemite National Park?

The chances are slim. More than 4 million people visit the park each year. Since 2000 there have been six suspected and confirmed cases.

___

Sources: Centers for Disease Control and Prevention, California Department of Public Health, the U.S. National Library of Medicine, National Park Service.


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Más signos de que IRM son seguras para personas con marcapasos

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NUEVA YORK (Reuters Health) - Un estudio pequeño suma

pruebas de que las imágenes por resonancia magnética (IRM)

serían un examen seguro para las personas con marcapasos o

desfibriladores implantables.

Los fabricantes no recomiendan colocar los dispositivos en

los escáneres de MRI porque el campo magnético recalentaría los

cables metálicos, que quemarían el tejido cardíaco. También

podría alterar las características eléctricas de esos

dispositivos tan delicados.

Pero cada vez más estudios sugieren que esas preocupaciones,

que son puramente teóricas, podrían ser infundadas, según dijo

el doctor Christopher Kramer, vocero de la Asociación

Estadounidense del Corazón (AHA, por su nombre en inglés).

"Con éste y otros estudios previos, podríamos decir que el

99,9 por ciento de los dispositivos no sufren modificaciones

clínicamente relevantes", dijo Kramer, que no participó del

estudio.

AHA no recomienda exponer a personas con marcapasos a MRI y

Medicare no cubre el examen, salvo que el paciente sea parte de

un estudio para investigar la seguridad del procedimiento.

El equipo del doctor Robert Russo, de la Clínica Scripps, La

Jolla, California, revisó las historias clínicas de 109

pacientes con marcapasos o desfibriladores cardioversores

implantables (DCI). A cada uno se le había realizado una o más

MRI clínicamente necesarias.

Los dispositivos estaban apagados durante el procedimiento

o, si los pacientes carecían de un latido viable, se los

colocaba en un ritmo constante que el campo magnético del

escáner no podría alterar.

No se registraron muertes ni fallas de los dispositivos o

arritmias en los pacientes, según publica el equipo en American

Journal of Cardiology.

Y mientras que se registraron variaciones leves en las

determinaciones eléctricas antes y después del procedimiento, no

fueron lo suficientemente grandes como para tener algún efecto

en los pacientes.

Es más: el equipo detectó variaciones de la misma magnitud

al revisar a 50 pacientes con dispositivos cardíacos que no

habían sido sometidos a MRI, lo que indica que el cambio es

normal.

Russo aclaró que los resultados deben confirmarse con un

estudio más grande, como el Registro MagnaSafe que está llevando

adelante.

Russo y Kramer comentaron que cada vez más centros están

realizando MRI en pacientes con dispositivos cardíacos cuando no

existe una alternativa mejor.

Aunque las autoridades regulatorias de Estados Unidos ya

aprobaron un marcapasos compatible con MRI, hay miles de

pacientes con los modelos anteriores. Y el 50-70 por ciento de

ellos podría necesitar una MRI, sostuvo Russo.

FUENTE: American Journal of Cardiology, online 27 de agosto

del 2012.


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Ireland cuts elderly care, overtime to plug health overspend

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DUBLIN (Reuters) - Ireland's health service will cut back on care for the elderly and overtime pay to find 130 million euros ($163 million) of new savings aimed at halting a spending overrun heavily criticized by one of the country's lenders this week.

Ireland has diligently adhered to the terms of its 85 billion euro EU/IMF bailout and is set to meet its deficit reduction targets for this year, mainly thanks to better-than-expected revenue growth.

However, the social protection and health departments have spent more than anticipated and in a draft document seen by Reuters on Wednesday, the European Commission gave an unusually frank assessment of the performance of the health ministry.

It said that while stubbornly high unemployment had led to larger-than-budgeted demand for free healthcare, the inability to deliver savings "pointed to weaknesses in budget management and accountability".

Ireland's Health Service Executive (HSE) responded by announcing a raft of emergency cuts that included a halving in the use of staff not directly employed by the executive, a 10 percent cut in overtime and a 6 percent reduction in the hours of those who care for the elderly in their homes.

"In compiling these measures, every effort has been taken to target areas that do not impact on direct patient services, with a view to protecting, inasmuch as is possible, the most essential frontline services," the HSE said in a statement.

"However, it is inevitable that some impact on service delivery will be experienced through the implementation of these measures."

The HSE said that were it not to begin to implement the measures through the rest of this year and early next, its deficit, which will stand at 259 million euros by the end of August, would balloon to 500 million euros within four months.

It said the 130 million euro package would be introduced in addition to other non-operational measures, including cash acceleration of receipts from health insurers.

Ireland's health department, which accounts for almost a third of all government spending, was tasked with finding savings of over 500 million euros this year and the Commission's report found that to date, only 22 percent had been achieved.

With Ireland's budget deficit still set to be above 8 percent of gross domestic product (GDP) this year, almost one billion euros of new spending cuts are needed across government in both 2013 and 2014, and charity groups feared the worse.

"The cuts announced today by HSE will inevitably hit the most vulnerable in our community. They will mean that many people desperately in need of care will either be unable to access services or will have their already overstretched services reduced even further," Age Action Ireland said. ($1 = 0.7982 euros)

(Reporting by Padraic Halpin; editing by Stephen Nisbet)


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How Old Is Too Old to Drive?

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A driver who will be 101 in September backed out of a parking lot near an elementary school in Los Angeles, plowing into 11 people, including nine children. Fortunately no one died as a result of the incident on Wednesday, but it highlights the challenge that aging drivers and their families face in deciding when it's time to get off the road.

Although they only account for about 9 percent of the population, National Highway Traffic Safety Administration statistics show senior drivers account for 14 percent of all traffic fatalities and 17 percent of all pedestrian fatalities.

A recent report by Carnegie Mellon University in Pittsburgh and the AAA Foundation for Traffic Safety found the rate of deaths involving drivers 75 to 84 is about three per million miles driven - on par with teen drivers. Once they pass age 85, vehicular fatality rates jump to nearly four times that of teens.

Richard Nix, executive director of Agingcare.com, says many senior drivers don't realize their eyesight, hearing and reflexes aren't as sharp as they used to be. They may be taking medication that impairs judgment, memory or coordination or suffer from arthritis or Alzheimer's. Consequently they may not realize it when they blow past a stop sign, forget to signal a right turn or confuse the gas pedal with the brake.

Even when they admit to themselves that they're driving skills may not be up to par, some older drivers are still reluctant to hand over their keys. According to Nix, loss of driving privileges is a difficult and emotional issue for many.

"People have been driving their whole life and have trouble believing they're incapable of continuing," he said. "They feel like their independence has been taken away."

And Nix points out, it's frequently a difficult subject for loved ones to face as well. They may feel a pang of fear every time their elderly parent gets behind the wheel but are reluctant to confront them for fear of hurting their feelings are starting a battle.

Nix says that if need be enlist the help of other family members, friends or their physician when a loved one presents a danger on the road. In some cases, it may even be appropriate to take legal action, though laws vary from state to state.

Whether an elderly driver comes to the conclusion on their own that it's time to surrender their license or they're forced to do so, it's a big moment and it can be devastating. But the consequences of not doing so may be even more devastating.

Consider the case of George Russell Weller, an 86-year-old Los Angeles driver who suffered from arthritis, nausea as a side-effect of medication, and reduced mobility from a hip replacement. Weller's car struck another car then accelerated around a road closure sign, crashed through wooden sawhorses, and plowed through a busy marketplace crowd, killing 10 people and injuring another 63. Weller told investigators he had accidentally placed his foot on the accelerator pedal instead of the brake.

Agingcare.com offers the following advice for senior drivers to evaluate when it's time to stop driving:

Conditions like cataracts and glaucoma can diminish sight and hamper driving ability. An eye doctor can help establish whether your sight is good enough to drive safely.

Many older drivers no longer have the strength or dexterity to handle a car. They may shrink in height so much they can no longer see over the windshield. This is especially true for seniors who do little or no physical activity.

Alzheimer's can impair memory and judgment. Diabetics risk falling into a coma while driving. Even if you have long periods of time when health issues cause no problems, why risk it?

Medications, especially multiple medications, can greatly impair driving ability. Your doctor should advise you of the dangers your medications present while driving.

If the minor fender-benders are adding up or you simply feel less confident about driving, it's OK to admit it to yourself that your driving days are over.

Also Read

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Medicare's political importance goes beyond seniors

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WASHINGTON (Reuters) - The Medicare debate promises to be front and center in this fall's presidential campaign, as not just seniors but aging baby boomers focus on retiree healthcare.

Recent polling data shows that the issue resonates with boomers in key swing states. In Wisconsin, about 80 percent of respondents aged 50 to 64 ranked Medicare as "important" or "very important" in a Quinnipiac University/CBS/New York Times survey taken August 15-21, versus 91 percent for those 65 and older. Florida and Ohio produced comparable results in the same survey.

There are 41 million seniors and 61 million boomers in the United States. With numbers like that vitally interested in a single issue, the importance of Medicare is likely to grow as the presidential campaign and congressional races move into the post-Labor Day home stretch.

Vice presidential nominee Paul Ryan made that clear in his acceptance speech Wednesday at the Republican National Convention in Tampa, Florida.

The Wisconsin congressman did not mention his plan to revamp the healthcare program for the elderly, which would affect people 54 and younger but not current seniors. Instead, he launched an attack on President Barack Obama for diverting money from Medicare to the broader healthcare overhaul.

The next night, Mitt Romney stuck to the script, mentioning Medicare only once in an attack on Obama as part of his presidential nomination acceptance speech.

Democrats responded by pounding at the Republican plan that, as they say in their ads, would "end Medicare as we know it."

Medicare moved to the forefront of the campaign three weeks ago after Romney chose Ryan as his running mate. The "Ryan plan," much of which Republicans incorporated into their party's platform at the convention, would replace Medicare's wide-ranging coverage of health services for the elderly with a voucher program for seniors to buy their own care.

Polls consistently show that Republicans have an edge among seniors, whose defense of Medicare has traditionally made it a politically untouchable issue. Obama and his fellow Democrats hope the Ryan plan will shift some of that support their way.

Party strategists believe even richer spoils could be had among baby boomers. That group, which includes large numbers of the independent middle-class voters Obama needs for re-election, tends to favor Democrats.

"Baby boomers are particularly concerned about the stability of their retirement," said U.S. Representative Steve Israel of New York, chairman of the Democratic Congressional Campaign Committee.

"If you're a baby boomer in the middle class, since 2000 you've seen the value of your paycheck decline, the value of your home decline and you've seen your 401(k) diminish and you're worried about your retirement," Israel said. "What's the Romney-Ryan solution? End Medicare."

Republicans, who spent the better part of two years emphasizing "reform" of Medicare, now portray themselves as the program's protectors.

"Medicare is a promise and we will honor it," Ryan said on Wednesday. "A Romney-Ryan administration will protect and strengthen Medicare for my mom's generation, for my generation and for my kids and yours."

Medicare, which is expected to become financially insolvent in 2024, covers almost 50 million elderly and disabled people. Soaring U.S. healthcare costs have made it a target in efforts to reduce the federal deficit.

Seniors oppose the Ryan plan by 2 to 1, according to recent polls that also show widespread opposition among all registered voters.

After weeks of campaign warfare, however, the Medicare battle has not translated into an electoral advantage for Obama among seniors, according to some polls.

The Quinnipiac University/CBS/New York Times survey showed elderly voters favoring Romney in Florida, where he led Obama by 13 percentage points, and in Ohio, where he led by eight. Romney also had a slight lead in Wisconsin.

"Seniors are split, especially in retiree-rich swing states like Florida, and I don't think they're going to change their opinions about who to vote for based on Medicare," said Susan MacManus, who teaches government and international affairs at the University of South Florida.

BOOMERS, THE REAL TARGET

Baby boomers are more supportive of Obama generally. Voters aged 50 and 64 favored Obama by four to six percentage points in Florida, Ohio and Wisconsin, according to the Quinnipiac poll. They were also more likely than seniors to trust the president on healthcare and Medicare.

Obama spokesman Adam Fetcher declined to discuss the campaign's Medicare strategy in detail, but he acknowledged that the game plan extends beyond senior citizens.

"The unpopularity of the Romney-Ryan Medicare voucher plan is an opportunity for the president to close the gap among seniors as well as other demographics," he said.

Analysts say boomers who are not yet retired could be more receptive than seniors because their retirement is a worrisome unknown. "Boomers are the real target group," MacManus said. "A lot of them have had everything they planned for turn upside down with the recession and housing prices going down. They're the ones in turmoil, and they haven't heard they're going to be exempt from any reforms."

An AARP survey released this month shows retirement to be a major source of anxiety among boomers, with large majorities expressing doubts about their ability to retire comfortably.

Democratic strategists say the Obama campaign will focus on selected races for the U.S. Senate and House where, analysts say, the party could have its best shot at delivering a policy message capable of influencing voters.

"It helps Obama, especially in the swing states that he's got to win. If they can make the case against a Republican Senate candidate on Medicare, that also hurts Romney and helps Obama," said Jennifer Duffy of the Cook Political Report, a nonpartisan group that analyzes U.S. politics.

The political calculation will figure into Democrats' spending on House and Senate race television ads leading up to the November 6 election.

"If we thought Medicaid was an issue that appealed only to senior citizens, we wouldn't be going up on television with it," said a Democratic campaign official.

(Editing by Fred Barbash and Douglas Royalty)


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Tiny Singapore risks economic gloom without big baby boom

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SINGAPORE (Reuters) - History suggests Singapore will enjoy a welcome baby boom in this Year of the Dragon, the most auspicious for births in the Chinese zodiac.

But after 25 years of state-sponsored matchmaking and fertility-boosting campaigns, the government's attempts to arrest a sliding birth rate are falling flat, with potentially profound consequences for the wealthy Asian city-state.

The calls to conception are now urgent and constant to citizens whose fertility ranks last among 222 nations in the U.S. Central Intelligence Agency's World Factbook.

Faced with dismal statistics like that, the government has begun a review of population and immigration policy and says it plans new measures to encourage births by the time it publishes the results of its consultation early next year.

The message to have more babies is all the more pressing as resentment builds over an influx of foreigners who now make up more than a third of the population of 5.2 million, a factor that is eroding support for the long-ruling People's Action Party.

"We have a problem. The long-term trend is down but we cannot give up," Prime Minister Lee Hsien Loong said in a speech on Sunday about the nation's future. "We need to create the right environment, the right social environment, the right ethos so that Singaporeans want to settle down and have kids."

Social and economic engineering is nothing new in Singapore, where a firm government hand helped to steer a small island with no natural resources into one of the world's most affluent countries in a little over a generation.

But the relentless drop in the birth rate reveals the limits of that influence in what has been described as a "nanny state".

For a global trade and financial center like Singapore, its extremely low fertility rate has implications for economic growth, tax revenues, healthcare costs and immigration policy as the number of elderly people looks set to triple by 2030.

There are now 6.3 Singaporeans of working age for every senior citizen. By 2030, the ratio will be closer to 2:1.

At current levels, the birth rate implies that the local population will fall by half within a generation, said Sanjeev Sanyal, a Singapore-based global strategist at Deutsche Bank.

"Even to attract a pipeline of good quality foreign talent, you need socio-political continuity and stability that can only be provided by a robust anchor population," he said.

WORK/LIFE BALANCE

If there were any doubts about the government's blatant message, the mint maker Mentos put out an advertisement urging married Singaporeans to do their civic duty on the evening of the August 9 National Day festivities.

"I'm talking about making a baby, baby," went the video's rapped lyrics, accompanied by hip-thrusting animated hearts. "It's National Night, let's make Singapore's birthrate spike."

Not long ago, Singapore had the opposite problem.

From the mid-1960s, with post-war baby boomers hitting child-bearing age, the fears were that a population surge would threaten the development of the newly independent nation.

With the slogan "Stop at two", the government penalized big families, legalized abortion and rewarded sterilization. It was so effective that, by 1987, the policy was reversed and the slogan became "Have three or more if you can afford it".

Conspiring against more births are powerful contraceptives in the form of intense career pressure, long work hours, small apartments, waiting lists for nursery care and soaring prices.

"Work/life balance is what everybody's after," said Evonne, a marketing professional in her 30s, adding she and her husband plan to have one child. "If you don't want kids, no matter what the government throws at you, I don't think you really care."

The 2010 census showed Singaporeans are marrying later than a decade earlier. In the age group 30-34, a key time for career, 43 percent of men and 31 percent of women were not married.

For women in their 40s who were or had been married, those with only one child rose to 19 percent from 15 percent.

The issue is acute for the ethnic Chinese who make up 74 percent of Singapore's citizens and permanent residents, a majority that has ebbed from nearly 78 percent in 1990. Statistics show ethnic Chinese are having fewer babies than the Malay and Indian communities and are more likely to be single.

Officials have sought to balance the call for more children with a message that the country must remain open to immigration to provide the labor and expertise needed for future growth.

Not all are convinced, as many Internet posts show.

Gilbert Goh, who runs a support group, Transitioning, for the unemployed, decried "relentless messages sent out by the government to accept foreigners" because of the low birth rate.

"Besides seemingly solving the whole birth rate issue here for our government, foreigners also are brought in to solve a bigger issue for employers -- cheap hard-working labor," he wrote on his website.

Simmering anger over immigration is widely believed to have contributed to the People's Action Party's unexpected loss of seats in last year's parliamentary elections.

SINGAPORE "WILL FOLD UP"

Saying it recognizes concerns about jobs, living standards and social cohesion, the government has put tighter controls on the number of foreigners it lets in, particularly lower-skilled and lower-wage workers.

In July, it put out a paper for public input on ways to encourage Singaporeans to marry and have families as part of its review of population and immigration policy.

The paper -- "Our Population Our Future" -- set out a troubling scenario for an ageing society if birth trends persist, including a less vibrant economy, an exodus of major companies and a shrinking number of workers and consumers.

To encourage parenthood, the government gives out baby bonuses of up to S$4,000 ($3,200) for each of the first two children, rising to S$6,000 for the third and fourth. It also matches deposits made into a Child Development Account.

The Social Development Network, part of a government agency, offers free romantic advice by its "Dr Love" and oversees the activities of private dating agencies.

To reverse the trend, Lee said on Sunday, changes in social and workplace attitudes are needed, along with more support for families with housing and affordable, accessible childcare.

If women were having at least two children, that would mean a rise in the population. But at a fertility rate of 0.78, according to the CIA, the number of Singaporeans is waning.

The government has different data showing women, on average, giving birth to 1.2 babies in a lifetime -- down from 1.87 in 1990 and 1.42 in 2001 and far below the replacement rate.

The city-state is not alone. Hong Kong, Taiwan and South Korea also have very low fertility rates and many of the same cost, space and career pressures.

Among Southeast Asian neighbors, Thailand's fertility rate of 1.66 is below replacement but the populations are growing in Indonesia (2.23), Malaysia (2.64) and the Philippines (3.15).

Lee Kuan Yew, the country's founding leader and father of the current prime minister, warned in August that Singapore "will fold up" unless it reverses the drop in the birth rate.

"Do we want to replace ourselves or do we want to shrink and get older and be replaced by migrants and work permit holders?" said Lee, who launched the "Stop at two" campaign in 1966.

Some hope for a zodiac-linked baby boom that is borne out by government figures. Births rose in previous Dragon years in 1976, 1988 and 2000, but those were only minor spikes in a steady decline in Singapore's fertility rate from 3.07 in 1970.

The government is promising new measures to encourage births and help families but unless career and cost pressures change dramatically, there may be little effect.

"Can Singaporeans be persuaded to have more children?" was the survey question during a recent television panel discussion on the birth rate. Channel News Asia's telephone poll may not have been completely scientific, but the answer was clear -- a resounding 74 percent of respondents said "no".

($1 = S$1.25)

(Editing by Jason Szep and Nick Macfie)


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Surgeon, officials review botched Ohio transplant

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COLUMBUS, Ohio (AP) — Health officials and a consulting surgeon are reviewing a living-donor kidney transplant program that's been temporarily suspended by a northwest Ohio hospital, where a donated kidney apparently was put with medical waste instead of going to the intended recipient in what medical experts describe as a rare accident.

The University of Toledo Medical Center apologized and put two nurses and an administrator of surgical services on paid leave without public explanation following the Aug. 10 incident. It also sent letters notifying 975 patients and potential organ donors and recipients that they may need to make other arrangements for services typically provided through the program under review.

UTMC is "committed to ensuring safeguards are put in place to prevent such an incident from ever happening again," Dr. Jeffrey Gold, the vice president for health affairs, said in a statement. The review is expected to take several weeks.

State health officials say they're looking into the botched transplant on behalf of the Centers for Medicare and Medicaid Services, and UTMC hired a Texas surgeon to evaluate its transplant procedures. Dr. Marlon Levy, surgical director for transplantation at Baylor All Saints Medical Center at Fort Worth, was expected to visit Toledo on Thursday and Friday.

The hospital has refused to publicly share much detail about how the kidney was rendered unusable during the transplant, which typically is an hourslong surgery involving a five-person medical team removing the organ from a donor, transferring it to a steel container and transplanting it to a patient in close proximity.

"Somehow, some way, an inexplicable human error made someone think that the kidney apparently was already in the recipient body when it was not," the UTMC president, Dr. Lloyd Jacobs, told The Blade in Toledo.

The local health commissioner, Dr. David Grossman, told the newspaper that a doctor who was involved said a nurse accidentally disposed of the kidney. Grossman did not respond to phone messages from The Associated Press.

The man who donated the kidney and the intended recipient, his sister, have been released from the medical center. The hospital hasn't identified the family, and it can't say whether the sister has received a different kidney, UTMC spokesman Tobin Klinger said. There was a "good chance" of finding another compatible donor, the facility has said.

Kidneys are the most commonly transplanted organ. More than 5,700 kidney transplants involving living donors and 11,000 with deceased donors were performed last year in the United States, according to the Organ Procurement and Transplantation Network, which maintains the national patient waiting list and is administered by the United Network for Organ Sharing. UTMC performed 16 of those living-donor kidney transplants and 37 deceased-donor transplants in 2011.

The types of problems that lead to unsuccessful transplants — and occasionally program suspension or termination — are uncommon but can include an unexpected donor disease transmission or the death of a living donor, said Joel Newman, a spokesman for UNOS, the private, nonprofit, government-contracted organization that manages the organ transplant system in the U.S.

"The occurrence of such events is rare, but in those instances it is a very common procedure for the program to inactivate for a period of time, do some root cause analysis and really try to address any sort of issues that can be corrected," Newman said.

As UTMC takes such steps, three workers are suspended. The administrator of surgical services, Edwin Hall, isn't commenting, according to a woman who answered the phone at his Michigan home on Wednesday. The two suspended nurses, Melanie Lemay and Judith Moore, could not be reached for comment.

The surgeon involved in the transplant has not been suspended.

___

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New DNA Analysis Shows Ancient Humans Interbred with Denisovans

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Tens of thousands of years ago modern humans crossed paths with the group of hominins known as the Neandertals. Researchers now think they also met another, less-known group called the Denisovans. The only trace that we have found, however, is a single finger bone and two teeth, but those fragments have been enough to cradle wisps of Denisovan DNA across thousands of years inside a Siberian cave. Now a team of scientists has been able to reconstruct their entire genome from these meager fragments. The analysis adds new twists to prevailing notions about archaic human history.

"Denisova is a big surprise," says John Hawks, a biological anthropologist at the University of Wisconsin–Madison who was not involved in the new research. On its own, a simple finger bone in a cave would have been assumed to belong to a human, Neandertal or other hominin. But when researchers first sequenced a small section of DNA in 2010—a section that covered about 1.9 percent of the genome—they were able to tell that the specimen was neither. "It was the first time a new group of distinct humans was discovered" via genetic analysis rather than by anatomical description, said Svante Pääbo, a researcher at the Max Planck Institute (M.P.I.) for Evolutionary Anthropology in Germany, in a conference call with reporters.

Now Pääbo and his colleagues have devised a new method of genetic analysis that allowed them to reconstruct the entire Denisovan genome with nearly all of the genome sequenced approximately 30 times over akin to what we can do for modern humans. Within this genome, researchers have found clues into not only this group of mysterious hominins, but also our own evolutionary past. Denisovans appear to have been more closely related to Neandertals than to humans, but the evidence also suggests that Denisovans and humans interbred. The new analysis also suggests new ways that early humans may have spread across the globe. The findings were published online August 30 in Science.

Who were the Denisovans?
Unfortunately, the Denisovan genome doesn't provide many more clues about what this hominin looked like than a pinky bone does. The researchers will only conclude that Denisovans likely had dark skin. They also note that there are alleles "consistent" with those known to call for brown hair and brown eyes. Other than that, they cannot say.

Yet the new genetic analysis does support the hypothesis that Neandertals and Denisovans were more closely related to one another than either was to modern humans. The analysis suggests that the modern human line diverged from what would become the Denisovan line as long as 700,000 years ago—but possibly as recently as 170,000 years ago.

Denisovans also interbred with ancient modern humans, according to Pääbo and his team. Even though the sole fossil specimen was found in the mountains of Siberia, contemporary humans from Melanesia (a region in the South Pacific) seem to be the most likely to harbor Denisovan DNA. The researchers estimate that some 6 percent of contemporary Papuans' genomes come from Denisovans. Australian aborigines and those from Southeast Asian islands also have traces of Denisovan DNA. This suggests that the two groups might have crossed paths in central Asia and then the modern humans continued on to colonize the islands of Oceania.

Yet contemporary residents of mainland Asia do not seem to posses Denisovian traces in their DNA, a "very curious" fact, Hawks says. "We're looking at a very interesting population scenario"—one that does not jibe entirely with what we thought we knew about how waves modern human populations migrated into and through Asia and out to Oceania's islands. This new genetic evidence might indicate that perhaps an early wave of humans moved through Asia, mixed with Denisovans and then relocated to the islands—to be replaced in Asia by later waves of human migrants from Africa. "It's not totally obvious that that works really well with what we know about the diversity of Asians and Australians," Hawks says. But further genetic analysis and study should help to clarify these early migrations.

Just as with modern Homo sapiens, the genome of a single individual cannot tell us exactly what genes and traits are specific to all Denisovans. Yet, just one genome can reveal the genetic diversity of an entire population. Each of our genomes contains information about generations far beyond those of our parents and grandparents, said David Reich, a researcher at the Massachusetts Institute of Technology–Harvard University Broad Institute and a co-author on the paper. Scientists can compare and contrast the set of genes on each chromosome—passed down from each parent—and extrapolate this process back through the generations. "You contain a multitude of ancestors within you," Reich said, borrowing from Walt Whitman.

The new research reveals that the Denisovans had low genetic diversity—just 26 to 33 percent of the genetic diversity of contemporary European or Asian populations. And for the Denisovans, the population on the whole seems to have been very small for hundreds of thousands of years, with relatively little genetic diversity throughout their history.

Curiously, the researchers noted in their paper, the Denisovan population shows "a drastic decline in size at the time when the modern human population began to expand."

Why were modern humans so successful whereas Denisovans (and Neandertals) went extinct? Pääbo and his co-authors could not resist looking into the genetic factors that might be at work. Some of the key differences, they note, center around brain development and synaptic connectivity. "It makes sense that what pops up is connectivity in the brain," Pääbo noted. Neandertals had a similar brain size–to-body ratio as we do, so rather than cranial capacity, it might have been underlying neurological differences that could explain why we flourished while they died out, he said.

Hawks counters that it might be a little early to begin drawing conclusions about human brain evolution from genetic comparisons with archaic relatives. Decoding the genetic map of the brain and cognition from a genome is still a long way off, he notes—unraveling skin color is still difficult enough given our current technologies and knowledge.

New sequencing for old DNA
The Denisovan results rely on a new method of genetic analysis developed by paper co-author Matthias Meyer, also of M.P.I. The procedure allows the researchers to sequence the full genome by using single strands of genetic material rather than the typical double strands required. The technique, which they are calling a single-stranded library preparation, involves stripping the genetic material down to individual strands to copy and avoids a purification step, which can lose precious genetic material.

The finger bone—just one disklike phalanx—is so small that it does not contain enough usable carbon for dating, the researchers note. But by counting the number of genetic mutations in a genome and comparing them with other living relatives, such as modern humans and chimpanzees, given assumed rates of mutations since breaking with a last common ancestor, "for the first time you can try to estimate this number into a date and provide molecular dating of the fossil," Meyer said. With the new resolution, the researchers estimate the age of the bone to 74,000 to 82,000 years ago. But that is a wide window, and previous archaeological estimates for the bone are a bit younger, ranging from 30,000 to 50,000 years old. These genetic estimations are also still in limbo because of ongoing debate about the average rate of genetic mutations over time, which could skew the age. "Nevertheless," the researchers noted in their paper, "the results suggest that in the future it will be possible to determine dates of fossils based on genome sequences."

This new sequencing approach can be used for any DNA that is too fragmented to be read well through more traditional methods. Meyer noted that it could come in handy for analysis of both ancient DNA and contemporary forensic evidence, which also often contains only fragments of genetic material.

Hawks is excited about the new sequencing technology. It is also helpful to have a technology developed specifically for the evolutionary field, he notes. "We're always using the new techniques from other fields, and this is a case where the new technique is developed just for this."

Hawks himself has heard from the researchers that have worked with the Denisovan samples that "the Denisovan pinky is just extraordinary" in terms of the amount of DNA preserved in it. Most bone fragments would be expected to contain less than 5 percent of the individual's endogenous DNA, but this fortuitous finger had a surprising 70 percent, the researchers noted in the study. And many Neandertal fragments have been preserved in vastly different states—many are far worse off than this Denisovan finger bone.

The new sequencing approach could also improve our understanding of known specimens and the evolutionary landscape as a whole. "It's going to increase the yield from other fossils," Hawks notes. Many of the Neandertal specimens, for example, have only a small fraction of their genome sequenced. "If we can go from 2 percent to the whole genome, that opens up a lot more," Hawks says. "Going back further in time will be exciting," he notes, and this new technique should allow us to do that. "There's a huge race on—it's exciting."

The Denisovans might be the first non-Neandertal archaic human to be sequenced, but they are likely not going to be the last. The researchers behind this new study are already at work using the new single-strand sequencing technique to reexamine older specimens. (Meyer said they were working on reassessing old samples but would not specify which specimens they were studying—the mysterious "hobbit" H. floresiensis would be a worthy candidate.) Pääbo suggests Asia as a particularly promising location to look for other Denisovan-like groups. "I would be surprised if there were not other groups to be found there in the future," he said.

Taking this technique to specimens from Africa is also likely to yield some exciting results, Hawks says. Africa, with its rich human evolutionary history, holds the greatest genetic diversity. The genomes of contemporary pygmy and hunter–gatherer tribes in Africa, for example, have roughly as many differences as do those of European modern humans and Neandertals. So "any ancient specimen that we find in Africa might be as different from us as Neandertals," Hawks says. "Anything we find from the right place might be another Denisovan."

Follow Scientific American on Twitter @SciAm and @SciamBlogs. Visit ScientificAmerican.com for the latest in science, health and technology news.
© 2012 ScientificAmerican.com. All rights reserved.


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Ryan’s VP Spin

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TAMPA, Fla. — Paul Ryan’s acceptance speech at the Republican convention contained several false claims and misleading statements. Delegates cheered as the vice presidential nominee: Accused President Obama’s health care law of funneling money away from Medicare “at the expense of the elderly.” In fact, Medicare’s chief actuary says the law “substantially improves” the system’s finances, and Ryan himself has embraced the same savings.Accused Obama of doing “exactly nothing” about recommendations of a bipartisan deficit commission — which Ryan himself helped scuttle.Claimed the American people were “cut out” of stimulus spending. Actually, more than a quarter of all stimulus dollars went for tax relief for workers.Faulted Obama for failing to deliver a 2008 campaign promise to keep a Wisconsin plant open. It closed less than a month before Obama took office.Blamed Obama for the loss of a AAA credit rating for the U.S. Actually, Standard & Poor’s blamed the downgrade on the uncompromising stands of both Republicans and Democrats.

And when he wasn’t attacking Obama, Ryan was puffing up the record of his running mate, Mitt Romney, on taxes and unemployment.

Note to Readers

Our deputy managing editor, Robert Farley, is on the scene in Tampa at the convention center. This story was written with the help of the entire staff, based in Philadelphia and Washington, D.C. Next week, we will dispatch our managing editor, Lori Robertson, to Charlotte, N.C., for the Democratic convention. We intend to vet the major speeches at both conventions for factual accuracy, applying the same standards to both.

Taking Money from Medicare?

Ryan continued the campaign’s false line of attack that Obama had “funneled” money out of Medicare to pay for the federal health care law “at the expense of the elderly.” But that’s contradicted by Medicare’s chief actuary, in a statement at the end of the most recent report of the system’s trustees (our emphasis added):

Medicare Actuary, April 23, 2012: [Obama's] Affordable Care Act makes important changes to the Medicare program and substantially improves its financial outlook …

Medicare’s money isn’t being taken away. The Affordable Care Act calls for slowing the growth in spending, a move that — if successful — would keep the hospital insurance trust fund solvent for longer than if the reductions didn’t happen.

Ryan himself proposed keeping most of these same spending cuts in his most recent “Path to Prosperity” budget. Yet, Ryan criticized Obama’s cuts as “the biggest, coldest power play of all” and suggested seniors would suffer as a result.

Ryan, Aug. 29: And the biggest, coldest power play of all in Obamacare came at the expense of the elderly. … [T]hey just took it all away from Medicare, $716 billion funneled out of Medicare by President Obama.

The Affordable Care Act calls for a $716 billion reduction in the future growth of Medicare spending over 10 years, with most of that — about $415 billion — coming from a reduction in the future growth of payments to hospitals through Medicare Part A. And Medicare Part A’s trust fund, as we’ve explained before, is in trouble financially. It’s set to be insolvent in 2024, even with these spending cuts. Without them, the trust fund wouldn’t be able to fully pay projected benefits in 2016, the Medicare trustees estimate.

Deficit Commission

Ryan accused Obama of doing “exactly nothing” about recommendations from a bipartisan presidential commission to reduce the deficit. But Ryan himself was among a minority of commission members whose opposition scuttled the plan and prevented it from being sent automatically to Congress for action.

Ryan: He created a new bipartisan debt commission. They came back with an urgent report. He thanks them, sent them on their way, and then did exactly nothing. Republicans stepped up with good-faith reforms and solutions equal to the problems. How did the president respond? By doing nothing — nothing except to dodge and demagogue the issue.

The National Commission on Fiscal Responsibility and Reform’s report proposed deep spending cuts in both domestic and military spending, and an overhaul of the tax code that would have lowered rates but raised revenues — all in an attempt to slow the growth of government by $4 trillion over 10 years.

Many Republicans, including Ryan, opposed the military cuts and new tax revenue, while many Democrats opposed changes to Social Security that included raising the full retirement age.

The 18-member commission needed a super majority of 14 votes in order to bring the report to a vote in Congress. But it received the support of just 11 members. Seven members, including Ryan, opposed it, thus blocking congressional action.

In a statement on the final report, Ryan said he “could not support the plan in its entirety,” but said some elements of it were “worthy of further pursuit.”

Ryan opposed the commission’s approach to paying for lower federal income tax rates by taxing capital gains and dividends as ordinary income (see footnote on page 29). In his own latest budget plan, Ryan proposed to keep the current capital gains tax rate, arguing that to do otherwise “could precipitate a flight of capital away from job-creating businesses.”

Like Ryan, Obama thanked the commission in a Dec. 3, 2010, statement that promised to “study closely” its proposals for possible inclusion in his own budget plans. Nine months later, Obama submitted a deficit reduction plan to the Joint Select Committee on Deficit Reduction that was designed to reduce the deficit by $3.6 trillion over 10 years through a package of spending cuts and tax hikes.

Obama and House Speaker John Boehner, a Republican, tried to work out a so-called “Grand Bargain” that would have reduced the deficit through a mix of tax hikes and spending cuts — and even changes to Social Security. The New York Times reported that the Grand Bargain would have raised the retirement age and changed the formula for calculating benefits. But, as the Times reported, the deal fell through as members of Boehner’s caucus objected to raising taxes.

In short, both Ryan and Obama have proposed deficit-reduction plans — and each opposed the other’s plan.

Stimulus Deceit

Ryan falsely claimed that the stimulus failed to help taxpayers and that it “cut out” the American people. Actually, more than 25 percent of stimulus dollars went to provide tax relief for workers.

Ryan: [The stimulus] cost $831 billion. The largest one-time expenditure ever by our federal government. … You, the American people of this country, were cut out of the deal.

The nonpartisan Joint Committee on Taxation calculated that about $230 billion of the American Recovery and Reinvestment Act provided tax relief. Much of that money, about $116 billion, funded the Making Work Pay tax credit for workers. In 2009 and 2010, the credit gave up to $400 to individuals earning up to $75,000, and gave up to $800 to couples earning up to $150,000.

Janesville Plant Closing

Ryan cited the closing of a GM plant in his hometown of Janesville, Wis., as evidence of Obama’s failing to deliver on promises made in the 2008 presidential campaign. But as it happens, the plant closed before Obama even took office.

Ryan: My own state voted for President Obama. When he talked about change, many people liked the sound of it, especially in Janesville, where we were about to lose a major factory.

A lot of guys I went to high school with worked at that GM plant. Right there at that plant, candidate Obama said: “I believe that if our government is there to support you, this plant will be here for another hundred years.” That’s what he said in 2008.

Well, as it turned out, that plant didn’t last another year. It is locked up and empty to this day. And that’s how it is in so many towns today, where the recovery that was promised is nowhere in sight.

Here’s what Obama told workers during a campaign stop at the struggling GM plant in Janesville back in 2008:

Obama, Feb. 13, 2008: And I believe that if our government is there to support you, and give you the assistance you need to re-tool and make this transition, that this plant will be here for another hundred years. The question is not whether a clean energy economy is in our future, it’s where it will thrive. I want it to thrive …

It’s true that the plant didn’t last another year, as Ryan said. In fact, the Business Journal in Milwaukee wrote that the assembly plant shut down on Dec. 23, 2008, at the tail end of the Bush administration, a victim of the financial crisis and dwindling demand for the SUVs produced at the plant. That’s nearly one month before Obama was sworn into office.

About 100 workers were kept on in 2009 to finish a truck order and help shut down the plant, according to the Associated Press.

‘Downgraded America’

Ryan faulted Obama for a credit downgrade for which Ryan’s own party shares equal responsibility. Ryan said that “a presidency that began with such anticipation now comes to such a disappointing close,” adding:

Ryan, Aug. 29: [Obama's presidency] began with a perfect AAA credit rating for the United States; it ends with the downgraded America.

Ryan refers to the decision of Standard & Poor’s, the credit rating agency, to downgrade its score for U.S. Treasury obligations from AAA to AA+ on Aug. 5, 2011. That took place just four days after Congress voted to raise the federal debt ceiling, following lengthy negotiations in which House Republicans sought to force concessions from Obama and Senate Democrats as the price for raising the ceiling and averting the first default on Treasury debt payments in U.S. history.

In its report, Standard & Poor’s blamed both Republicans and Democrats for failing to come to agreement on spending cuts or revenue increases sufficient to reduce U.S. deficits significantly. It said:

S&P, Aug. 5, 2011: The political brinksmanship of recent months highlights what we see as America’s governance and policymaking becoming less stable, less effective, and less predictable than what we previously believed. The statutory debt ceiling and the threat of default have become political bargaining chips in the debate over fiscal policy. …

Republicans and Democrats have only been able to agree to relatively modest savings on discretionary spending while delegating to the Select Committee [of Congress] decisions on more comprehensive measures. It appears that for now, new revenues have dropped down on the menu of policy options.

Ryan, of course, is among those Republicans opposed to any “new revenues” from tax increases.

Puffing Up Romney’s Record

Running through Romney’s credentials, Ryan boasted about Romney’s fiscal and jobs record as governor of Massachusetts. But there’s a bit less there than Ryan lets on.

Ryan: He was the Republican governor of a state where almost nine in 10 legislators are Democrats, and yet he balanced the budget without raising taxes. Unemployment went down, household incomes went up, and Massachusetts, under Gov. Mitt Romney, saw its credit rating upgraded.

It’s true that Romney balanced the state budget every year — as Massachusetts’ Constitution requires — and Romney never raised personal income taxes. But as we have noted whenever this claim has arisen — which has been frequently — Romney did hike  government fees by hundreds of millions of dollars, and he also closed loopholes on some corporate taxes.

Ryan also said that under Romney, “unemployment went down.” That’s true. According to unemployment data from the Bureau of Labor Statistics, the unemployment rate in Massachusetts went from 5.6 percent when Romney took office in January 2003 to 4.6 percent when he left office in January 2007.

But when considered in light of an improving national economy, Romney’s record on unemployment is a bit less impressive. Massachusetts’ unemployment rate was slightly lower than the national rate when Romney took office, and it was roughly the same as the national rate when he left.

– Robert Farley, with Brooks Jackson, Eugene Kiely, Lori Robertson and Ben Finley

Also Read

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Surgeon, officials review Ohio transplant error

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COLUMBUS, Ohio (AP) — Health officials and a consulting surgeon are reviewing a living-donor kidney transplant program that's been temporarily suspended by a northwest Ohio hospital, where a donated kidney apparently was put with medical waste instead of going to the intended recipient in what medical experts describe as a rare accident.

The University of Toledo Medical Center apologized and put two nurses and an administrator of surgical services on paid leave without public explanation following the Aug. 10 error. It also sent letters notifying 975 patients and potential organ donors and recipients that they may need to make other arrangements for services typically provided through the program under review.

UTMC is "committed to ensuring safeguards are put in place to prevent such an incident from ever happening again," Dr. Jeffrey Gold, the vice president for health affairs, said in a statement. The review is expected to take several weeks.

State health officials say they're looking into the error on behalf of the Centers for Medicare and Medicaid Services, and UTMC hired a Texas surgeon to evaluate its transplant procedures. Dr. Marlon Levy, surgical director for transplantation at Baylor All Saints Medical Center at Fort Worth, was expected to visit Toledo on Thursday and Friday.

The hospital has refused to publicly share much detail about how the kidney was rendered unusable during the transplant, which typically is an hourslong surgery involving a five-person medical team removing the organ from a donor, transferring it to a steel container and transplanting it to a patient in close proximity.

"Somehow, some way, an inexplicable human error made someone think that the kidney apparently was already in the recipient body when it was not," the UTMC president, Dr. Lloyd Jacobs, told The Blade in Toledo.

The local health commissioner, Dr. David Grossman, told the newspaper that a doctor who was involved said a nurse accidentally disposed of the kidney. Grossman did not respond to phone messages from The Associated Press.

The man who donated the kidney and the intended recipient, his sister, have been released from the medical center. The hospital hasn't identified the family, and it can't say whether the sister has received a different kidney, UTMC spokesman Tobin Klinger said. There was a "good chance" of finding another compatible donor, the facility has said.

Kidneys are the most commonly transplanted organ. More than 5,700 kidney transplants involving living donors and 11,000 with deceased donors were performed last year in the United States, according to the Organ Procurement and Transplantation Network, which maintains the national patient waiting list and is administered by the United Network for Organ Sharing. UTMC performed 16 of those living-donor kidney transplants and 37 deceased-donor transplants in 2011.

The types of problems that lead to unsuccessful transplants — and occasionally program suspension or termination — are uncommon but can include an unexpected donor disease transmission or the death of a living donor, said Joel Newman, a spokesman for UNOS, the private, nonprofit, government-contracted organization that manages the organ transplant system in the U.S.

"The occurrence of such events is rare, but in those instances it is a very common procedure for the program to inactivate for a period of time, do some root cause analysis and really try to address any sort of issues that can be corrected," Newman said.

As UTMC takes such steps, three workers are suspended. The administrator of surgical services, Edwin Hall, isn't commenting, according to a woman who answered the phone at his Michigan home on Wednesday. The two suspended nurses, Melanie Lemay and Judith Moore, could not be reached for comment.

The surgeon involved in the transplant has not been suspended.

___

Follow Kantele Franko on Twitter at http://www.twitter.com/kantele10 .


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Hormone therapy use among women continues to drop

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NEW YORK (Reuters Health) - Years after a large study on hormone replacement therapy revealed health risks among older women using it to prevent chronic disease, the number of women who take hormones continues to decline, according to a new study.

The researchers found that in 2009 and 2010, less than five percent of women over age 40, who had already gone through menopause, use either estrogen alone or estrogen and progestin. That compared to about 22 percent in 1999 and 2000.

Dr. JoAnn Manson, a leader of the Women's Health Initiative (WHI) research and a professor at Harvard Medical School, said it was appropriate that there was a decline in the number of women using hormones.

The WHI reported in 2002 that taking estrogen plus progestin appeared to increase the risks of stroke, heart disease and breast cancer.

"We now understand that women more distant from the onset menopause and at increased risk of cardiovascular disease have adverse outcomes on hormone therapy and that hormone therapy should not be used for prevention of heart disease or prevention of chronic disease because it is associated with some risks," Manson, chief of preventive medicine at Brigham and Women's Hospital, told Reuters Health.

The latest report, which included survey responses from more than 10,000 women, shows a steady drop and supports the results from other studies assessing the short-term impacts of the WHI.

Brian Sprague, the lead author of the current study and a professor at the University of Vermont, and his colleagues found that as the years progressed, fewer and fewer women reported taking hormones.

"From this study we have no way of teasing out what's driving these changes," Sprague said, adding that it's likely due to concerns from both women and their physicians about the health risks of taking hormones.

AN OVERREACTION?

The increased breast cancer risk from hormone therapy was a major driver in turning people away from hormone therapy, said Dr. Robert Langer, a research member of the WHI and currently the principal investigator at the Jackson Hole Center for Preventive Medicine in Jackson, Wyoming.

"I think it's a really substantial overreaction" to the harms that were found in the Women's Health Initiative (WHI) study, Langer told Reuters Health.

The WHI found that eight additional women out of every 10,000 would get breast cancer, an increased risk of 26 percent.

But he said those results applied to older women taking hormones to prevent chronic disease, not necessarily to younger women seeking relief from menopausal symptoms.

"The pendulum may have swung too far in the direction away from hormone therapy use," Manson said.

Hormones are considered the most effective treatment for moderate and severe symptoms of menopause, such as hot flashes and night sweats.

For those women who use hormones, the U.S. Food and Drug Administration recommends they be at the lowest dose and for the shortest amount of time.

Manson said it's possible that concerns over the health risks of hormone therapy may be preventing women from getting relief from symptoms.

"In a younger woman who has hot flashes, night sweats, and impaired quality of life, it is very likely that the benefits of short term hormone therapy will outweigh the risks," she said.

She advises any woman seeking relief for menopause symptoms to discuss her individual risks and benefits of hormone therapy with a doctor.

After the initial findings in 2002, subsequent studies - both from WHI data and other trials - have tried to clarify the health risks of hormone therapy for different age groups.

For younger women closer to menopause, for instance, some studies have found an increased risk of breast cancer while others have found a lower risk of heart disease and death compared to women not taking hormones.

Manson is part of an ongoing trial looking at the effects of hormone therapy on heart disease risk for women ages 42 to 58 - a younger age group on average than the WHI.

Another ongoing study is comparing the heart disease risks among women who begin taking hormone therapy soon after menopause or more than a decade later.

SOURCE: http://bit.ly/PR3Yo5 Obstetrics & Gynecology, September 2012.


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U.S. cases of West Nile virus set record, deaths rise: CDC

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NEW YORK (Reuters) - A total of 1,590 cases of West Nile virus, including 66 deaths, were reported through late August this year in the United States, the highest human toll by that point in the calendar since the mosquito-borne disease was first detected in the country in 1999, health officials said on Wednesday.

The toll is increasing quickly. "We think the numbers will continue to rise," said Dr. Lyle Petersen, director of the U.S. Centers for Disease Control and Prevention's Division of Vector-Borne Infectious Diseases.

Through last week, 1,118 cases and 41 deaths had been reported. The updated figures represent a 40 percent increase in the number of cases and a 61 percent spike in the number of deaths, but are short of the all-time record for a full year: 9,862 cases and 264 deaths in 2003.

In hard-hit Texas, the number of confirmed cases soared to 894, with 34 people dead, this year as of Wednesday, according to the Texas Department of State Health Services. Over half of the deaths occurred in the north of the state.

"It looks like it is going to be our worst year ever," said Dr. David Lakey, commissioner of the Texas Department of State Health Services. "As I look at the data, I'm not convinced we have peaked."

All 48 contiguous states have reported cases of West Nile virus in birds, which act as hosts; in mosquitoes, which transmit it by biting birds and then mammals including humans, or in people. Only Alaska and Hawaii have been spared. And 43 states have at least one human case.

The Ohio Department of Health reported on Wednesday that a 76-year-old man had died from the virus, the state's first fatality this year.

"The virus is endemic at this point throughout the United States," with the possible exception of high-altitude regions such as the Rocky Mountains, said the CDC's Petersen. "There is a risk almost everywhere."

So far, however, more than 70 percent of the human cases have been reported in just six states: Texas, South Dakota, Mississippi, Oklahoma, Louisiana, and Michigan.

Only 2 percent to 3 percent of cases of West Nile fever are reported to health officials, said Petersen, which suggests that the actual number of cases is 30 to 50 times higher than reported.

That is partly because an estimated 80 percent of infected people have no symptoms, said Dr. Robert Haley, of the University of Texas Southwestern Medical Center in Dallas, in an essay last week in the Journal of the American Medical Association.

About 20 percent of infections cause only mild symptoms, including aches and fever, explained Haley. One in 150 people infected with the virus develop neurological conditions such as meningitis, encephalitis and other illnesses that can cause disorientation, cognitive impairment, muscle weakness, and movement problems that resemble those of Parkinson's disease.

Of those who develop this "neuroinvasive" form of West Nile, an estimated 4 percent to 18 percent die, said Haley, mostly those who are older or suffering from other illnesses.

THE HOTTER THE WEATHER, THE FASTER THE VIRUS

There is no treatment for West Nile infection, and no vaccine. The disease is transmitted by Culex pipiens mosquitoes, also known as common house mosquitoes, and the only preventive measure is to avoid being bitten.

People can reduce their risk by eliminating the small pools of standing water - in bird baths, outdoor flower pots and the like - where C. pipiens breed.

Public health experts and entomologists are baffled about why 2012 is such a big year for West Nile. But Petersen said a U.S. heat wave has been an important contributing factor.

"Higher temperatures foster faster reproduction of both the mosquito and the virus," said Tony Goldberg, professor of epidemiology at the University of Wisconsin, Madison, who has studied urban outbreaks of West Nile since shortly after the virus arrived in the Midwest.

"The hotter it is, the faster the virus can replicate," said entomologist Gabe Hamer of Texas A&M University.

As the virus reproduces more quickly inside its bird host -- it likes species from robins and blue jays to sparrows -- there is a greater chance that a mosquito biting the bird will pick up a large number of viruses and transmit them to its next victim.

Higher temperatures also increase mosquito activity, making them more likely to be flying around, especially at night, and looking for a meal.

Another factor contributing to this year's outbreak is the continuing cycle of droughts and downpours, a precipitation pattern predicted by models of climate change.

Intense rain fills drainage ditches, storm sewers and culverts, and washes grass clippings, leaves and other organic matter into those pools of standing water, explained Wisconsin's Goldberg. Mosquitoes prefer to breed in water that has rotting organic matter.

With normal rainfall, those breeding pools are washed away in the next storm. But when heavy spring rains are followed by summer dry spells, as has been the case in much of the United States this year, the breeding pools remain for weeks or months, said Goldberg, and the mosquito population explodes.

"As we keep getting more climate extremes," he said, "there will be more years with many more cases of West Nile."

(Additional reporting by Marice Richter in Texas, editing by Michele Gershberg and Vicki Allen)


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