爱上海EH Tag Archive


True cost of medical malpractice

first_imgThe debates over health care reform may soon become more informed. A new study undertaken by a group of researchers, including Harvard Kennedy School (HKS) Professor Amitabh Chandra, provides a detailed snapshot of U.S. medical malpractice claims, awards, and frequency by specialty.“Malpractice Risk According to Physician Specialty” was published in the Aug. 18 issue of the New England Journal of Medicine (NEJM).“We were surprised that the probability of facing at least one malpractice claim over the average physician’s career was so high and particularly that so many claims did not result in payment,” says Chandra, HKS professor of public policy and corresponding author of the NEJM report. “The malpractice insurance that physicians purchase does not insure them from the emotional costs of being involved in litigation. These hassle costs have no social value, but given the frequency of litigation supports physicians’ perceptions of the inefficiency of the current malpractice system”Despite the tremendous interest in medical malpractice and its reform, data are lacking on the proportion of physicians who face malpractice claims according to physician specialty, the size of payments according to specialty, and the cumulative incidence of being sued during the course of a physician’s career,” the authors contend.The researchers analyzed physician-level data on malpractice claims provided by a large physician-owned liability insurer covering the years from 1991 through 2005. It included doctors practicing in all 50 states and the District of Columbia.The results showed that more than 7 percent of all physicians faced a malpractice claim during any given year, while specialists in some areas were much more prone to claims than others.“The proportion of physicians facing a claim each year ranged from 19.1 percent in neurosurgery, 18.9 percent in thoracic–cardiovascular surgery, and 15.3 percent in general surgery to 5.2 percent in family medicine, 3.1 percent in pediatrics, and 2.6 percent in psychiatry,” the authors write. “The mean indemnity payment was $274,887, and the median was $111,749. Mean payments ranged from $117,832 for dermatology to $520,923 for pediatrics.”Overall, the data shows that just 1.6 percent of physicians in any given year faced a claim that resulted in payment.The article is posted on the website of the New England Journal of Medicine.last_img read more

Read More


Cisco will acquire WebEx company

first_imgThe acquisition has been approved by both boards and is expected to close in the fourth quarter of fiscal 2007, Cisco said. Cisco said it expects the transaction to have a neutral effect on its fiscal year 2008 earnings after one-time charges are subtracted. The total purchase price will be about $2.9 billion when factoring in WebEx’s $300 million in cash on hand. San Jose-based Cisco has recently made a number of acquisitions, branching out from its core business of supplying networking gear, namely in communications, social networking and other areas that help drive traffic over the network and increase demand for its core equipment. The acquisition was Cisco’s 119th since 1993 and follows several other major recent takeovers by the company. Cisco is in prime position to shop around, as a surge in demand from service providers snapping up sophisticated new networking gear has left the company sitting on a mountain of cash. Cisco is Silicon Valley’s most richly valued company with a current market capitalization of about $156 billion. Cisco finished the second quarter of the current fiscal year with nearly $21 billion in cash. SAN FRANCISCO – Cisco Systems has agreed to acquire the online meeting company WebEx Communications for about $3.2 billion in cash, a takeover that furthers Cisco’s push beyond its core market for networking gear and into the lucrative arena of business communications. Cisco Systems Inc., the leading maker of routers and switches that direct data over computer networks, said Thursday it will pay $57 per share of WebEx Inc. That represents a 23 percent premium over WebEx’s closing price of $46.20 Wednesday on the Nasdaq Stock Market. Shares of WebEx soared $10.17, or 22 percent, to close at $56.37 on the Nasdaq Stock Market. Cisco shares fell 6 cents to $25.79. 160Want local news?Sign up for the Localist and stay informed Something went wrong. Please try again.subscribeCongratulations! You’re all set!last_img read more

Read More


A 500millionyear survey of Earths climate reveals dire warning for humanity

first_img 400 32.2˚C 300 By Paul VoosenMay. 22, 2019 , 2:25 PM When it opens next month, the revamped fossil hall of the Smithsonian Institution’s National Museum of Natural History in Washington, D.C., will be more than a vault of dinosaur bones. It will show how Earth’s climate has shifted over the eons, driving radical changes in life, and how, in the modern age, one form of life—humans—is, in turn, transforming the climate.To tell that story, Scott Wing and Brian Huber, a paleobotanist and paleontologist, respectively, at the museum, wanted to chart swings in Earth’s average surface temperature over the past 500 million years or so. The two researchers also thought a temperature curve could counter climate contrarians’ claim that global warming is no concern because Earth was much hotter millions of years ago. Wing and Huber wanted to show the reality of ancient temperature extremes—and how rapid shifts between them have led to mass extinctions. Abrupt climate changes, Wing says, “have catastrophic side effects that are really hard to adapt to.”But actually making the chart was unexpectedly challenging—and triggered a major effort to reconstruct the record. Although far from complete, the research is already showing that some ancient climates were even more extreme than was thought. 250 100 200 A 500-million-year survey of Earth’s climate reveals dire warning for humanity Millions of years ago 450 Country * Afghanistan Aland Islands Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia, Plurinational State of Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Cote d’Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People’s Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People’s Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia, the former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Martinique Mauritania Mauritius Mayotte Mexico Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Norway Oman Pakistan Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Qatar Reunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela, Bolivarian Republic of Vietnam Virgin Islands, British Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe 80˚ 50 500 21.1˚ 150 2 Click to view the privacy policy. Required fields are indicated by an asterisk (*) 60˚ 90˚F Ancient glaciations are easy enough to trace, as are hothouse periods when palms grew near the poles. But otherwise little is certain, especially early in the Phanerozoic, which spans the past 541 million years. Paleoclimate scientists study their own slices of time and use their own specialized temperature proxies—leaf shape, say, or growth bands in fossilized corals—which often conflict. “We don’t talk to each other all that much,” says Dana Royer, a paleoclimatologist at Wesleyan University in Middletown, Connecticut. So at a meeting last year, Wing and Huber assembled a loose-knit collaboration, dubbed Phantastic, dedicated to putting together a rigorous record. “Most people came away quite inspired to do something about this,” says Dan Lunt, a paleoclimate modeler at the University of Bristol in the United Kingdom.The value of a deep-time temperature curve extends beyond the exhibit. Similar curves exist for atmospheric carbon dioxide (CO2). Combine the two and you can see how much warming CO2 caused in the past, says Jessica Tierney, a paleoclimatologist at the University of Arizona in Tucson. Because the latest climate models seem to forecast more warming than earlier ones, “using paleoclimate to constrain the models is becoming much more important,” she says. “We feel we have to step up.”center_img 4 3 Sign up for our daily newsletter Get more great content like this delivered right to you! Country 50˚ Email Paleobotanist Scott Wing stands in wintry Wyoming badlands, where alligators swam 56 million years ago. 350 15.5˚ Fever line A preliminary global temperature curve shows that marine life diversified in extreme heat (1) before land-based plants absorbed carbon dioxide (CO2) and polar ice caps formed (2). Volcanoes and erosion swung CO2 levels up and down (3), but mammals evolved in a warm period (4). Now, humans are rapidly warming the climate again (5). 70˚ Today World without polar caps 26.7˚ SMITHSONIAN INSTITUTION NATIONAL MUSEUM OF NATURAL HISTORY, ADAPTED BY N. DESAI/SCIENCE 10˚ 5 World with polar caps 1 But ancient global temperatures are elusive because they varied with location and season, and because the gauges drop away as you move deeper in time: Tree rings go back only thousands of years and ice cores only a million years or so. Still, oxygen isotopes in tiny fossilized shells on the ocean floor give a fairly reliable longer-term record. Because water molecules with lighter oxygen variants evaporate faster and end up locked in ice sheets, the ratio of light to heavy isotopes in the fossils indicates the volume of global ice, a rough guide to temperatures.However, ocean floor older than 100 million years or so is scarce, devoured by the constant churn of plate tectonics. To go deeper in time, Ethan Grossman, a geochemist at Texas A&M University in College Station, looks for marine fossils found on land—mostly teeth and once-common bivalves called brachiopods. They tend to be from the shallow, isolated seas that formed inside ancient supercontinents. To glean temperatures from those fossils, scientists have to assume those seas had a balance of oxygen isotopes similar to the ocean today.This “water problem” is decades old. But scientists in Phantastic are attacking it with a second thermometer, based on a new technique, called clumped isotopes, that measures the abundance of two or more rare isotopes. Using sensitive mass spectrometers, they analyze the fossil shells for carbonate molecules that contain a heavy isotope of oxygen bound to a heavy carbon, which form more frequently at lower temperatures. The results will be misleading if the fossil has been exposed to heat and pressure during its burial, but researchers have learned how to identify altered specimens. “We’ve moved into the place where we can apply it,” says Kristin Bergmann, a geobiologist at the Massachusetts Institute of Technology in Cambridge, who is using clumped isotopes to prepare a temperature record of the past billion years.In collaboration with Gregory Henkes, a geochemist at the State University of New York in Stony Brook, and others, Grossman has gone through his samples, tossing out those that show signs of alteration, and analyzed their clumped isotopes. The results match his existing oxygen-isotope measures, and they tell a startling story, he and Henkes reported last year in Earth & Planetary Science Letters. Some 450 million years ago, ocean waters averaged 35°C to 40°C, more than 20°C warmer than today. Yet marine life thrived, even diversified. “It’s unsettling for the biologists, these warm temperatures we’re proposing,” Grossman says. “These are extreme for modern organisms.”To turn such data into a global temperature curve, researchers need to fill gaps in geography and time. One Phantastic collaborator, Christopher Scotese, a geologist at Northwestern University in Evanston, Illinois, has come up with a simple way to spread limited data into a global picture. He uses the presence of polar ice caps to indicate whether the world had a steep temperature differential between the equator and its poles.Other collaborators are using the sparse data to calibrate computer simulations of the ancient climate, the way weather models use satellite data as a reality check. Lunt and Paul Valdes, also at Bristol, are ground-truthing a suite of several hundred paleoclimate simulations. They’ve been able to extrapolate temperatures across the planet for broad stretches of the Phanerozoic.Although Wing and Huber are pleased with the work they’ve seeded, they also ran out of time. The temperature curve they’re presenting at the museum opening is a beta, Wing says. “It’s sort of jamming together different kinds of observations, different kinds of models, different kinds of procedures, and probably different assumptions.” The plan is to replace it once the Phantastic team’s efforts reach maturity. But even the draft version should open eyes, Grossman says. “This kind of work gives people a sense of how easy it is to tip into a warm period. Because the world has been warm.”*Correction, 24 May, 11:40 a.m.: A previous version of this story incorrectly stated that brachiopods are extinct. IRA BLOCK last_img read more

Read More