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In this March 24, 2013 photo, former Marine Corps Cpl. Marshall Archer, left, a veterans' liaison for the city of Portland, Maine, speaks to a man on a street in Portland. Veterans groups are rallying to fight any proposal to change disability payments as the federal government attempts to address its long-term debt problem. They say they've sacrificed already. (AP Photo/Robert F. Bukaty)
In this March 24, 2013 photo, former Marine Corps Cpl. Marshall Archer, left, a veterans' liaison for the city of Portland, Maine, speaks to a man on a street in Portland. Veterans groups are rallying to fight any proposal to change disability payments as the federal government attempts to address its long-term debt problem. They say they've sacrificed already. (AP Photo/Robert F. Bukaty)
In this March 24, 2013 photo, veterans' liaison Marshall Archer, a former Marine Corps corporal, poses for a photo in Portland, Maine. Veterans groups are rallying to fight any proposal to change disability payments as the federal government attempts to address its long-term debt problem. They say they've sacrificed already. (AP Photo/Robert F. Bukaty)
WASHINGTON (AP) ? Veterans groups are rallying to fight any proposal to change disability payments as the federal government attempts to address its long-term debt problem. They say they've sacrificed already.
Government benefits are adjusted according to inflation, and President Barack Obama has endorsed using a slightly different measure of inflation to calculate Social Security benefits. Benefits would still grow but at a slower rate.
Advocates for the nation's 22 million veterans fear that the alternative inflation measure would also apply to disability payments to nearly 4 million veterans as well as pension payments for an additional 500,000 low-income veterans and surviving families.
"I think veterans have already paid their fair share to support this nation," said the American Legion's Louis Celli. "They've paid it in lower wages while serving, they've paid it through their wounds and sacrifices on the battlefield and they're paying it now as they try to recover from those wounds."
Economists generally agree that projected long-term debt increases stemming largely from the growth in federal health care programs pose a threat to the country's economic competitiveness. Addressing the threat means difficult decisions for lawmakers and pain for many constituents in the decades ahead.
But the veterans groups point out that their members bore the burden of a decade of war in Iraq and Afghanistan. In the past month, they've held news conferences on Capitol Hill and raised the issue in meetings with lawmakers and their staffs. They'll be closely watching the unveiling of the president's budget next month to see whether he continues to recommend the change.
Obama and others support changing the benefit calculations to a variation of the Consumer Price Index, a measure called "chained CPI." The conventional CPI measures changes in retail prices of a constant marketbasket of goods and services. Chained CPI considers changes in the quantity of goods purchased as well as the prices of those goods. If the price of steak goes up, for example, many consumers will buy more chicken, a cheaper alternative to steak, rather than buying less steak or going without meat.
Supporters argue that chained CPI is a truer indication of inflation because it measures changes in consumer behavior. It also tends to be less than the conventional CPI, which would impact how cost-of-living raises are computed.
Under the current inflation update, monthly disability and pension payments increased 1.7 percent this year. Under chained CPI, those payments would have increased 1.4 percent.
The Congressional Budget Office projects that moving to chained CPI would trim the deficit by nearly $340 billion over the next decade. About two-thirds of the deficit closing would come from less spending and the other third would come from additional revenue because of adjustments that tax brackets would undergo.
Isabel Sawhill, a senior fellow in economic studies at The Brookings Institution, a Washington-based think tank, said she understands why veterans, senior citizens and others have come out against the change, but she believes it's necessary.
"We are in an era where benefits are going to be reduced and revenues are going to rise. There's just no way around that. We're on an unsustainable fiscal course," Sawhill said. "Dealing with it is going to be painful, and the American public has not yet accepted that. As long as every group keeps saying, 'I need a carve-out, I need an exception,' this is not going to work."
Sawhill argued that making changes now will actually make it easier for veterans in the long run.
"The longer we wait to make these changes, the worse the hole we'll be in and the more draconian the cuts will have to be," she said.
That's not the way Sen. Bernie Sanders sees it. The chairman of the Senate Committee on Veterans' Affairs said he recently warned Obama that every veterans group he knows of has come out strongly against changing the benefit calculations for disability benefits and pensions by using chained CPI.
"I don't believe the American people want to see our budget balanced on the backs of disabled veterans. It's especially absurd for the White House, which has been quite generous in terms of funding for the VA," said Sanders, I-Vt. "Why they now want to do this, I just don't understand."
Sanders succeeded in getting the Senate to approve an amendment last week against changing how the cost-of-living increases are calculated, but the vote was largely symbolic. Lawmakers would still have a decision to make if moving to chained CPI were to be included as part of a bargain on taxes and spending.
Sanders' counterpart on the House side, Rep. Jeff Miller, R-Fla., the chairman of the House Committee on Veterans' Affairs, appears at least open to the idea of going to chained CPI.
"My first priority is ensuring that America's more than 20 million veterans receive the care and benefits they have earned, but with a national debt fast approaching $17 trillion, Washington's fiscal irresponsibility may threaten the very provision of veterans' benefits," Miller said. "Achieving a balanced budget and reducing our national debt will help us keep the promises America has made to those who have worn the uniform, and I am committed to working with Democrats and Republicans to do just that."
Marshall Archer, 30, a former Marine Corps corporal who served two stints in Iraq, has a unique perspective about the impact of slowing the growth of veterans' benefits. He collects disability payments to compensate him for damaged knees and shoulders as well as post-traumatic stress disorder. He also works as a veterans' liaison for the city of Portland, Maine, helping some 200 low-income veterans find housing.
Archer notes that on a personal level, the reduction in future disability payments would also be accompanied down the road by a smaller Social Security check when he retires. That means he would take a double hit to his income.
"We all volunteered to serve, so we all volunteered to sacrifice," he said. "I don't believe that you should ever ask those who have already volunteered to sacrifice to then sacrifice again."
That said, Archer indicated he would be willing to "chip in" if he believes that everyone is required to give as well.
He said he's more worried about the veterans he's trying to help find a place to sleep. About a third of his clients rely on VA pension payments averaging just over $1,000 a month. He said their VA pension allows them to pay rent, heat their home and buy groceries, but that's about it.
"This policy, if it ever went into effect, would actually place those already in poverty in even more poverty," Archer said.
The changes that would occur by using the slower inflation calculation seem modest at first. For a veteran with no dependents who has a 60 percent disability rating, the use of chained CPI this year would have lowered the veteran's monthly payments by $3 a month. Instead of getting $1,026 a month, the veteran would have received $1,023.
Raymond Kelly, legislative director for Veterans of Foreign Wars, acknowledged that veterans would see little change in their income during the first few years of the change. But even a $36 hit over the course of a year is "huge" for many of the disabled veterans living on the edge, he said.
The amount lost over time becomes more substantial as the years go by. Sanders said that a veteran with a 100 percent disability rating who begins getting payments at age 30 would see their annual payments trimmed by more than $2,300 a year when they turn 55.
.
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Shipping Containers are of course a popular building material in this day and age, where people are more green and planning on being more sustainable for the earth. While a majority of what we see as far as homes are concerned are all over the world? New York is a relatively surprising location for such a structure.
The first shipping container home in New York is now occupied by its owners after a myriad of issues and construction restrictions? 5 years after purchasing the plot. The home is equipped with radiant heated flooring, and Super Therm insulation for the colder weather months.
Though there has been much criticism to the overall architecture, interior design and ultimate outcome of the space, the owners have overcome a great feat in dealing with their building restrictions and other issues along the way. There?s always room for improvement, and this home will surely pave the way for other NY based shipping container homes.
Category: Architecture Tags: Custom Design, Green Design, Industrial Design, Shipping Container, Shipping Container Homes, Shipping Container House
Source: http://inthralld.com/2013/03/new-yorks-first-occupied-shipping-container-home/
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Contact: Sara LaJeunesse
SDL13@psu.edu
814-863-4325
Penn State
Canola oil and high-oleic canola oils can lower abdominal fat when used in place of other selected oil blends, according to a team of American and Canadian researchers. The researchers also found that consuming certain vegetable oils may be a simple way of reducing the risk of metabolic syndrome, which affects about one in three U.S. adults and one in five Canadian adults.
"The monounsaturated fats in these vegetable oils appear to reduce abdominal fat, which in turn may decrease metabolic syndrome risk factors," said Penny Kris-Etherton, Distinguished Professor of Nutrition, Penn State.
In the randomized, controlled trial, 121 participants at risk for metabolic syndrome received a daily smoothie containing 40 grams (1.42 ounces) of one of five oils as part of a weight maintenance, heart-healthy, 2000-calorie per day diet. Members of the group had five risk factors characterized by increased belly fat, low "good" hdl cholesterol and above average blood sugar, blood pressure and triglycerides that increase the risk of heart disease, stroke and type 2 diabetes. The researchers repeated this process for the remaining four oils.
The results were presented at the American Heart Association's EPI/NPAM 2013 Scientific Sessions in New Orleans.
Results showed that those who consumed canola or high-oleic canola oils on a daily basis for four weeks lowered their belly fat by 1.6 percent compared to those who consumed a flax/safflower oil blend. Abdominal fat was unchanged by the other two oils, which included a corn/safflower oil blend and high-oleic canola oil enriched with an algal source of the omega-3 DHA. Both the flax/safflower and corn/safflower oil blends were low in monounsaturated fat.
According to the American Heart Association, many of the factors that contribute to metabolic syndrome can be addressed by a healthy diet, exercise and weight loss, which can significantly reduce health risks of this condition.
"It is evident that further studies are needed to determine the mechanisms that account for belly fat loss on a diet high in monounsaturated fatty acids," said Kris-Etherton. "Our study indicates that simple dietary changes, such as using vegetable oils high in monounsaturated fatty acids, may reduce the risk of metabolic syndrome and therefore heart disease, stroke and type 2 diabetes."
###
Other authors on the paper include Peter Jones and Shuaihua Pu of the University of Manitoba in Winnipeg; Sheila West, Xiaoran Liu, Jennifer Fleming and Cindy McCrea of Penn State; Benit Lamarche and Patrick Couture of Laval University in Quebec; and David Jenkins of the University of Toronto. The government of Canada, the Canola Council of Canada and Dow Agrosciences funded this research.
?
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.
Contact: Sara LaJeunesse
SDL13@psu.edu
814-863-4325
Penn State
Canola oil and high-oleic canola oils can lower abdominal fat when used in place of other selected oil blends, according to a team of American and Canadian researchers. The researchers also found that consuming certain vegetable oils may be a simple way of reducing the risk of metabolic syndrome, which affects about one in three U.S. adults and one in five Canadian adults.
"The monounsaturated fats in these vegetable oils appear to reduce abdominal fat, which in turn may decrease metabolic syndrome risk factors," said Penny Kris-Etherton, Distinguished Professor of Nutrition, Penn State.
In the randomized, controlled trial, 121 participants at risk for metabolic syndrome received a daily smoothie containing 40 grams (1.42 ounces) of one of five oils as part of a weight maintenance, heart-healthy, 2000-calorie per day diet. Members of the group had five risk factors characterized by increased belly fat, low "good" hdl cholesterol and above average blood sugar, blood pressure and triglycerides that increase the risk of heart disease, stroke and type 2 diabetes. The researchers repeated this process for the remaining four oils.
The results were presented at the American Heart Association's EPI/NPAM 2013 Scientific Sessions in New Orleans.
Results showed that those who consumed canola or high-oleic canola oils on a daily basis for four weeks lowered their belly fat by 1.6 percent compared to those who consumed a flax/safflower oil blend. Abdominal fat was unchanged by the other two oils, which included a corn/safflower oil blend and high-oleic canola oil enriched with an algal source of the omega-3 DHA. Both the flax/safflower and corn/safflower oil blends were low in monounsaturated fat.
According to the American Heart Association, many of the factors that contribute to metabolic syndrome can be addressed by a healthy diet, exercise and weight loss, which can significantly reduce health risks of this condition.
"It is evident that further studies are needed to determine the mechanisms that account for belly fat loss on a diet high in monounsaturated fatty acids," said Kris-Etherton. "Our study indicates that simple dietary changes, such as using vegetable oils high in monounsaturated fatty acids, may reduce the risk of metabolic syndrome and therefore heart disease, stroke and type 2 diabetes."
###
Other authors on the paper include Peter Jones and Shuaihua Pu of the University of Manitoba in Winnipeg; Sheila West, Xiaoran Liu, Jennifer Fleming and Cindy McCrea of Penn State; Benit Lamarche and Patrick Couture of Laval University in Quebec; and David Jenkins of the University of Toronto. The government of Canada, the Canola Council of Canada and Dow Agrosciences funded this research.
?
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.
Source: http://www.eurekalert.org/pub_releases/2013-03/ps-mfr032913.php
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This year the?Australian Fitness & Health Expo?will be held on April 20-21 at the Sydney Convention & Exhibition Centre and I'm?definitely?attending again!
Last year highlights were for me the Healthy Eating Zone and the Zumba Main Stage with live demonstrations. It was also great fun to try and discover many new health foods and by the end of the day I had collected quite a few samples and brochures!
Giveaway
Like last year, I have teamed up with the Australian Fitness & Health Expo??again?and have not one but 3?double-passes to giveaway to three lucky Sydney-based readers?to attend the event!?Each double pass is worth $59.
To enter?:
Head-over to?Mademoiselle Slimalicious? Facebook Page?(make sure you LIKE the page if you haven't already) and leave a?comment on my?Facebook page?wall telling me?why you would like to attend the expo and who you would like to go with!
Giveaway is open to residents of NSW (Australia) and closes on?15th April 2012 at?9 pm?(EAST).?The winners will be?announced?on Facebook shortly after the end of the competition. Prizes kindly donated by Australian Fitness & Health Expo, total prize pool value: $118
Source: http://www.mslimalicious.com/2013/03/australian-fitness-health-expo-giveaway.html
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WASHINGTON (AP) ? A senior Air Force general is being nominated to take over as commander of all U.S. and NATO forces in Europe.
Gen. Philip M. Breedlove is the top Air Force commander in Europe. Defense Secretary Chuck Hagel says Breedlove is particularly well qualified. Hagel announced the nomination Thursday.
If confirmed, Breedlove would be the first Air Force general to hold the top NATO job since Joseph Ralston served in the post from 2000-2003.
Breedlove would succeed Navy Adm. James Stavridis, who has held the job since 2009.
President Barack Obama chose Breedlove after his first choice for the job, Marine Gen. John Allen, announced he would retire after 19 months commanding allied forces in Afghanistan because of his wife's health issues.
Source: http://news.yahoo.com/hagel-says-air-force-general-pick-nato-post-185002937.html
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A multi-institutional study has revealed that BRAF-positive metastatic malignant melanomas develop resistance to treatment with drugs targeting the BRAF/MEK growth pathway through a major change in metabolism. The findings, which will be published in Cancer Cell and have been released online, suggest a strategy to improve the effectiveness of currently available targeted therapies.
"We were surprised to find that melanoma cells treated with the BRAF inhibitor vemurafenib dramatically change the way they produce energy to stay alive," says David E. Fisher, MD, PhD, chief of Dermatology at Massachusetts General Hospital (MGH) and a co-corresponding author of the Cancer Cell paper. "While current BRAF inhibitor treatment is a major improvement ? shrinking tumors in most patients and extending survival for several months ? patients eventually relapse. So there is an ongoing need to improve both the magnitude and durability of these responses."
In about half the cases of malignant melanoma ? the most deadly form of skin cancer ? tumor growth is driven by mutations in the BRAF gene. Research by investigators at the MGH Cancer Center and elsewhere has shown that treatment with drugs that block BRAF activity temporarily halts tumor growth. Combining a BRAF inhibitor with a drug that targets MEK, another protein in the same growth pathway, strengthens and extends the antitumor response. The current study was designed to investigate how BRAF inhibition changes metabolic activity within melanoma cells and to find other possible treatment targets.
The most common way that cells convert glucose into energy is called oxidative phosphorylation and largely relies on the activity of the cellular structures called mitochondria. Many cancer cells use an alternative mechanism that produces the energy compound ATP without involving mitochondria. A series of experiments by the MGH team revealed that the elevated BRAF activity in BRAF-positive melanoma cells suppresses oxidative phosphorylation by reducing expression of a transcription factor called MITF. Suppressing production of MITF reduced levels of a protein called PGC1? that regulates the generation and function of mitochondria. But melanoma cells treated with a BRAF inhibitor showed elevated MITF activity, along with increased expression of oxidative phosphorylation genes and greater numbers of mitochondria. By switching to oxidative phosphorylation to supply the energy they need, the tumor cells increased their ability to survive in spite of BRAF inhibitor treatment.
"These findings suggest that combination treatment with mitochondrial inhibitors could improve the efficacy of BRAF inhibitors in malignant melanoma," says Fisher, the Wigglesworth Professor of Dermatology at Harvard Medical School. "Several small molecules that target mitochondrial metabolism have been identified by investigators here at the MGH and elsewhere, and laboratory investigations of specific combinations of BRAF inhibitors with mitochondrial antagonists are currently underway."
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Massachusetts General Hospital: http://www.mgh.harvard.edu
Thanks to Massachusetts General Hospital for this article.
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Mar. 11, 2013 ? New research shows that a tiny piece of RNA has an essential role in ensuring that embryonic tissue segments form properly.
The study, conducted in chicken embryos, determined that this piece of RNA regulates cyclical gene activity that defines the timing of the formation of tissue segments that later become muscle and vertebrae.
Genes involved in this activity are turned on and off in an oscillating pattern that matches the formation of each tissue segment. If the timing of these genes' activity doesn't remain tightly regulated, the tissue either won't form at all or will form with defects.
One gene long associated with this segmentation "clock" is called Lfng. Researchers established in this study that a single microRNA -- a tiny segment of RNA that has no role in producing any protein -- is key to turning off Lfng at precisely the right time as tissues form in this oscillating pattern.
When the microRNA was deleted or manipulated so that it wouldn't bind when it was supposed to, the oscillatory pattern of the genetic clock was broken and tissue development was abnormal.
"It's a big deal to find that a single interaction between a microRNA and its target has this very profound effect when you interfere with its function," said Susan Cole, associate professor of molecular genetics at The Ohio State University and lead author of the study. "There are very few cases where interfering with just one microRNA during development can make this much of a difference. But here, this regulation is so tight that this turns out to be incredibly important.
"We don't think this is exclusive to chickens because the site where the microRNA binds to the RNA segment produced by Lfng is found in chickens, humans, mice and zebrafish."
A better understanding of these segmentation clocks could lead to new ways to treat certain human conditions that are traced to embryonic development. Defects in the clock are implicated in vertebral malformations, and the correct patterning of the nervous system and blood vessels depends on proper timing of the earliest stages of development.
The research is published in the journal Developmental Cell.
This work focuses on the formation of somites, which are tissue segments in the mesoderm of embryos that give rise to the ribs, vertebrae and muscle in all vertebrates, including humans.
Within the segmentation clock, genes are turned on and make RNA, and resulting proteins then turn off the genes, and so on, and the pattern repeats until all necessary somites are formed. Experts in tissue segmentation liken the oscillating cycle of gene activation and de-activation that cells go through before they form somites to the wave that fans perform in a stadium.
The downward part of the cycle -- when the wave fans are seated -- is just as critical as the upward cycle, when fans are standing. This means the RNA that genes make on their way up must be destroyed so the genes can be turned off. Existing mathematical models of the segmentation clock suggest that the half-life of RNA is tightly controlled, but can't say how.
"We were interested in identifying the mechanisms that made this RNA unstable enough that it would make these perpetual oscillations," Cole said. A graduate student in her lab pointed the way to microRNAs, which can destabilize their target transcripts -- segments of RNA produced early in the gene expression process.
"MicroRNAs can either stop protein from being made or target an RNA to be destroyed. That's what we think is happening here: It's targeting RNA to be destroyed," said Cole, also an investigator in Ohio State's Comprehensive Cancer Center.
The microRNA identified in the study is known as mir-125a-5p. While microRNAs used to be considered useless parts of the genome, they are now recognized for their power in influencing protein production -- even though they don't actually help with protein production.
The researchers used multiple techniques to block mir-125a-5p in chicken embryos as the segmentation clock was running, either blocking all activity of the microRNA or interfering with its ability to bind with RNA encoded by the Lfng gene.
"When the clock doesn't oscillate the cells don't make nice, regular somites, but instead make nothing or partially formed somites," Cole said. "This has really important applications for the mechanisms that control the clock, and could gives us hints about how the timeframe of this clock varies from species to species."
In chickens, each somite forms in 90 minutes. In zebrafish, it takes 30 minutes, while in mice each somite forms in two hours and in humans, five hours.
Cole also plans to study how this regulation occurs in mammals and whether this microRNA's interaction with Lfng is involved in disease processes affected by this gene.
This work was supported by the National Science Foundation, the National Institutes of Health and a Pelotonia Predoctoral Fellowship.
Co-authors include Maurisa Riley, Matthew Bochter and Kanu Wahi of the Department of Molecular Genetics and Gerard Nuovo of the Department of Pathology, all at Ohio State. Riley now works at MD Anderson Cancer Center.
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Source: http://feeds.sciencedaily.com/~r/sciencedaily/top_news/~3/UQeytQek83E/130311150823.htm
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Billionaire investor Carl Icahn, who is fighting Dell Inc. founder Michael Dell's plan to take the struggling company private, has entered a confidentiality agreement that would give him access to the computer maker's financial records.
Michael Dell, who is also Dell's CEO, is planning a $24.4 billion buyout that would make the Round Rock, Texas, company a privately owned business. But Icahn and other investors say the price of $13.65 per share is too low.
Icahn's company, Icahn Enterprises, has said it holds a substantial stake in the company.
Icahn wants the company to pay a special dividend of $9 per share, financed with existing cash and new debt, if shareholders reject the buyout offer.
The investor told Dell executives in a recent letter that if they decline to promise this one-time payout, then he wants the company to combine a shareholder vote on the buyout with its annual election of directors,
In that case, Icahn would nominate candidates who would implement the special dividend if they are elected, and Icahn and his company could provide more than $5 billion in loans to ensure prompt payment of the dividend.
Icahn wrote in his letter to Dell last week that the PC maker's future is bright, and all shareholders should benefit from that, not just Michael Dell. Icahn is known for buying out-of-favor stocks and boosting them by pressuring or replacing boards of directors, installing new management and other bare-knuckle tactics.
Analysts say Icahn's entry into the debate over the deal makes it less likely that shareholders will accept Dell's current buyout offer.
Shareholder Forum, a group that fights for shareholder rights, plans to demand copies of the same records that Icahn is getting, according to Gary Lutin, a former investment banker who runs the group. The Shareholder Forum last week sent a letter to Dell's board seeking access to the information that influenced the decision to sell the company at $13.65 per share. The forum wants to bring in independent experts to review whether the proposed buyout is the best choice for the company and its shareholders.
Dell appointed a special committee of directors last August after Michael Dell notified the company that he was exploring a buyout bid in partnership with other investors. Michael Dell has agreed to contribute 273 million shares of the company stock that he controls and $750 million in cash to help finance the buyout, which relies primarily on loans from PC software maker Microsoft Corp. and an assortment of banks.
Dell's special committee has said it already considered a special dividend during a "rigorous" five-month review that culminated with the buyout plan. It said last week that it is conducting a search for better alternatives to the proposed buyout, and Icahn and others are welcome to participate.
Dell shares rose 21 cents to close at $14.37 Monday. Shares of Icahn Enterprises rose 40 cents to $61.20.
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Source: http://www.sciencedaily.com/rss/mind_brain/child_development.xml
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Washington, Mar 10 (ANI): The New York Stock Exchange (NYSE) is preparing to be able to operate without human traders in case another disaster forces the shutdown of its historic trading floor in downtown Manhattan.
According to report by The Wall Street Journal, NYSE Euronext will submit details of the plan to the U.S. Securities and Exchange Commission.
People involved in the preparations said that if activated, the plan would represent the first time the 221-year-old exchange would rely entirely on computer systems.
According to Fox news, the sources revealed that the disaster plan would shift trading entirely to Arca, NYSE's all-electronic sister market.
It would replace NYSE's current backup plan that calls for the exchange to remain open in a limited capacity while sending orders to Arca to be filled, they added.
Superstorm Sandy forced the first weather-related multi-day shutdown of the U.S. stock market in over 120 years when it struck the East Coast in October. (ANI)
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Mar. 10, 2013 ? A clinical decision support tool helped physicians identify patients at high risk of bleeding complications prior to undergoing a coronary intervention procedure and helped guide the use of bleeding avoidance strategies, leading to less complications and a shorter hospital stay, according to a study being presented March 10 at the American College of Cardiology Scientific Sessions.
More than 1.3 million percutaneous coronary interventions (PCIs) are performed each year in the United States. Bleeding during and after these procedures is a common risk (3 -- 6%).
"Bleeding complications after PCI can lead to worse outcomes for the patient, including death, as well as an increase in the length of stay in the hospital, which leads to an increase in hospital costs," says the study's lead author Craig E. Strauss, MD, MPH, a research cardiologist at the Minneapolis Heart Institute Foundation and physician at the Minneapolis Heart Institute? at Abbott Northwestern Hospital in Minneapolis.
Therefore, the cardiologists across the Allina Health System used a validated pre-PCI bleeding risk score to accurately identify high-risk patients, allowing them to employ strategies to avoid bleeding and improve patient outcomes. Among those strategies, bivalirudin (Angiomax, The Medicines Company) is a direct thrombin inhibitor that has been shown to reduce bleeding complications in PCI.
"This risk-stratification tool can be used real-time in the cath lab to identify and mitigate a patient's risk for bleeding around the time of the procedure," says Strauss. "The cath lab team uses a web-based calculator, which takes less than 1-2 minutes, and determines the risk category of each patient." Due to the ease of use, the tool achieved a high adoption rate of 92 percent at three high-volume PCI centers in Minnesota.
Among the 2,608 PCI cases performed at the three PCI centers, 24.4 percent of the patients were identified as high risk for bleeding complications. The use of bivalirudin as a bleeding avoidance strategy in high-risk patients increased from 24.2 percent pre-implementation of the risk-stratification protocol to 60.3 percent after the implementation of the protocol.
Among high bleeding risk patients, the researchers reported significant reductions in overall complications (22.8% vs. 14.9%), bleeding events within 72 hours (7.7% vs. 2.1%), and median length of hospital stay (2.9 vs. 2.3 days) following protocol implementation. There also was a reduction in the use of blood transfusions and death. Finally, the total variable costs decreased from approximately $15,000 to $14,200.
"This clinical decision support tool helps cardiologists objectively validate which patients are at high risk for bleeding complications based on existing evidence," Strauss says. "Previously, we could attempt to identify which patients were at risk based on clinical intuition, but this tool gives a much more accurate assessment, as shown through the improved patient outcomes. Furthermore, this tool can help reduce the variability in practice patterns among physicians that can be costly to the healthcare system."
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