Hasta La Gadget!

<span class="articleLocation”>(Reuters Health) – Just the initial hospitalizations for firearm-related injuries in the United States cost an average $735 million per year, with the government picking up a large portion of the tab, researchers say. 

Medicaid and Medicare pay 41 percent of the total, and private insurers another 20 percent, the study authors report in American Journal of Public Health.

“Firearm-related injuries are at the heart of one of the most heated political discussions in the United States, yet there is surprisingly little scientific research available on the subject,” said lead study author Sarabeth Spitzer of the Stanford University School of Medicine in California. 

“It is important for all parties involved in these discussions to have a clear understanding of the monetary cost of these injuries and where the financial burden falls,” she told Reuters Health by email.

In 2014, firearms caused about 33,700 deaths and 81,000 nonfatal injuries in the U.S., according to the Centers for Disease Control and Prevention. The U.S. homicide rate is seven times higher than that of other developed countries, and the gun homicide rate is 25 times higher, Spitzer and her co-authors note.

To get a conservative estimate of the costs of firearm injuries, the researchers analyzed data from the largest U.S. database of inpatient hospital care. They focused on emergency treatment of firearm injuries that led to hospital admission, excluding readmissions for an older injury or patients who were treated but not admitted. 

Between 2006 and 2014, about 267,000 patients were admitted for firearm-related injuries, and inflation-adjusted costs totaled $6.61 billion. Average costs per admission ranged from $19,600 for self-pay patients to $30,900 for Medicaid patients.

“This study underestimates the true cost of firearm-related injuries as it includes only the first inpatient admission cost,” Spitzer said. “It excludes many other important and costly steps in patient treatment such as emergency department care, readmission, rehabilitation, long-term health care and disability.”

The injury patients were overwhelmingly male across all payer groups. Patients insured by Medicaid, the federal-state insurance program for the poor, stayed in the hospital for an average three days longer than others and had injuries that were more likely to have been caused by assault.

Patients covered by Medicare, the federal health insurance program for people over age 65, were more likely to have self-inflicted injuries and privately-insured patients had more unintentional injuries.

About 43 percent of all hospital admissions were in the South, which also had the highest proportion of self-pay patients. The Northeast had the lowest proportion of admissions with 16 percent.

Of the inflation-adjusted $6.6 billion costs during the study period, Medicaid paid $2.3 billion, or 34.8 percent; Medicare paid $0.4 billion, or 6 percent; private insurers paid $1.32 billion, or 34.8 percent; and self-pay individuals paid $1.56 billion or 23.6 percent.

“We’re an outlier nation in terms of gun problems, and this only looks at a small part of the expense,” said David Hemenway of Harvard University in Boston who wasn’t involved with the study.

The study doesn’t include costs related to long-term issues such as spinal cord injuries and traumatic brain injury, as well as social or job-related costs, such as unemployment, sick leave and psychological impact on loved ones, noted Hemenway, who directs the Harvard Injury Control Research Center.

“It doesn’t even begin to account for the real costs of losing a relative, spouse or community member,” he added. “Gun violence makes it impossible to live a good life in some of these places, especially when industry doesn’t want to move in and people are afraid to go out.”

As the first study to quantify firearm-related costs in about a decade, the data could have major implications for public policy changes and healthcare funding, said Konstantinos Economopoulos of Massachusetts General Hospital in Boston, who was not involved in the research. In the past 30 years of funding from the National Institutes of Health, for example, six awards have supported firearm-injury studies, he said.

“The financial burden . . . falls mainly on the shoulders of the government (through Medicaid) and the uninsured,” he told Reuters Health by email. “There is an ethical – but also financial – imperative need for an increase in funding for future research to tackle the ongoing epidemic of firearm-related injuries.”

SOURCE: bit.ly/2octnE0 American Journal of Public Health, online March 21, 2017.

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Major progressive organizations are pushing the Democratic Senatorial Campaign Committee to deny funding to any Democratic senator who votes for, or otherwise enables the confirmation of, Supreme Court nominee Neil Gorsuch.

Credo, AllofUs, UltraViolet, Friends of the Earth Action, Demand Progress and other online activism heavyweights have already amassed hundreds of thousands of signatures on a petition to be delivered to the DSCC. 

Representatives from the groups plan to deliver the petition to committee headquarters in Washington, D.C., on Monday and demand a meeting with DSCC chair Sen. Chris Van Hollen (Md.). Some liberal leaders are also scheduled to speak out against Gorsuch at a rally in lower Manhattan on Saturday. 

“We need clear lines in the sand that demonstrate whether or not Senate Democrats are with us or against us. One of the clearest lines is where money flows from the DSCC,” said Erich Pica, president of Friends of the Earth Action, an environmental organization.

Progressives are adamant about blocking Gorsuch’s confirmation, because of his extremely conservative legal record. They believe he will pose a threat to major environmental regulations, abortion rights, worker protections and campaign finance laws.

They’re also still angry that Senate Republicans refused to grant hearings to Merrick Garland, former President Barack Obama’s Supreme Court nominee. Garland was far more moderate than Gorsuch, they note.

“Given how the Senate Republicans treated Merrick Garland, there is no reason to capitulate to the Republican demands,” Pica said.

The actions in the coming days are designed to win over centrist Democratic senators considering backing Gorsuch, refusing to filibuster him or cutting some other kind of bipartisan deal that would ensure his confirmation.

Democratic Sens. Joe Manchin (W.Va.) and Heidi Heitkamp (N.D.), both of whom are up for re-election in states President Donald Trump won handily, announced on Thursday that they would vote for Gorsuch.

But Sen. Claire McCaskill (Mo.), who also faces a tough re-election battle, declared Friday that she would join an attempt to filibuster Gorsuch.

This brings the number of Democrats who have vowed to block the nominee to at least 38. Senate Democrats need 41 of their caucus members to agree to filibuster Gorsuch to prevent his nomination from coming up for a vote. Republicans could respond by eliminating the filibuster altogether, but Democrats are skeptical that they have the votes to do so and are willing to test the GOP’s resolve.

The progressive groups intend to show that not blocking Gorsuch would mean paying a significant political price ― more significant for red-state Democrats, even, than breaking with the president. The success Democrats had in opposing Republicans’ Obamacare replacement bill makes their argument more compelling, according to some of the progressive activists behind Monday’s action.

Some activists even argue that it is not worth the cost of helping seat someone they regard as dangerous if blocking Gorsuch proves a political liability for some vulnerable Democrats.

“Any Democrat who would help advance Gorsuch’s nomination is helping Trump attack vulnerable communities, and especially women. I don’t think we need those Democrats,” said Karin Roland, chief campaigns officer of the women’s rights group UltraViolet.

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A British soldier who served in World War II is now coming out as transgender at the age of 90.

Patricia Davies of Leicestershire, England, spent 87 years of her life known as “Peter” to the outside world.

Now she says life’s too short to not be who she really is.

Patricia is taking estrogen to transition.

“It feels like a weight has been lifted off my shoulders. I was living a lie,” she said, according to HuffPost UK. “I have been keeping quiet. I have slowly started to tell some of my neighbors. Everybody said ‘Don’t worry, as long as you’re happy.’”

Davies says she has known she was a woman since the age of three.

“I didn’t want to play with girls’ toys. I didn’t want toy soldiers. I wanted an ironing board,” she said, according to the Mirror. “My mother seemed to go along with it. We went to see ‘Peter Pan’ and I wanted to be a fairy. She made me a wand. She didn’t say it was strange.”

Prior to her transition, Davies was married to a woman for 63 years.

“I was 60 when it all came pouring out to my wife, she was very sympathetic and helped me all the way but we agreed to keep it quiet,” Davies said, according to the Independent. “She used to buy me jewelry and she would call me Patricia. I kept it a complete secret.”

Davies’ wife died six years ago. Davies continues to wear her ring during interviews.

Davies finally decided to transition in 2015 after seeing “Boy Meets Girl,” a BBC sitcom featuring transgender characters.

The show made her feel that the world had progressed to the point where she could be herself.

“It’s not 100 percent safe now but it’s much better than it was. People that I have told seem to be very accommodating and haven’t thrown abuse at me,” Davies said, according to HuffPost UK. “I’m known to pretty much all the old faces in the village. I’m quite content now and I wear a skirt and blouse. I don’t wear any men’s clothes any more.”

“If people don’t like what they see then I don’t care but no one seems to be causing me any trouble. Nobody questions it though. Nobody seems to bat an eyelid, they accept me as I am.”

David Moye covers weird news and viral stories. Tips? Feedback? Send an email or follow him on Facebook or Twitter. 

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<span class="articleLocation”>(Reuters Health) – The likelihood that U.S. women with early-stage cancer in one breast will have both breasts removed varies depending on where they live, a new study shows.

For example, between 2010 and 2012, among women ages 20 to 44 with cancer in one breast, about 15 percent had both breasts removed in the District of Columbia, compared to about 49 percent in South Dakota.

“The variation is very striking,” said senior author Ahmedin Jemal, of the American Cancer Society in Atlanta.

When women have breast cancer in one breast, having both breasts removed usually isn’t helpful, experts say. Last year the American Society of Breast Surgeons issued a statement to discourage women with one-sided, or unilateral, breast cancer who don’t have a genetic or family risk for the disease from undergoing a double, or contralateral, mastectomy.

Still, Jemal and his colleagues point out in JAMA Surgery, past research has found an increase in contralateral mastectomies among women with early stage cancer in one breast.

For women at average risk and cancer in one breast, “taking off the other breast doesn’t significantly reduce the risk of a cancer on the other side, because their risk wasn’t that high to begin with,” said Dr. Laurie Kirstein, a breast surgical oncologist at Memorial Sloan Kettering Cancer Center in New York City who wasn’t involved in the new study.

To examine trends across states, the researchers analyzed data collected between 2004 and 2012 from more than 1.2 million women with early stage cancer in one breast.

Across the country, the proportion of such women ages 20 to 44 who opted for contralateral mastectomy rose from about 11 percent to about 33 percent. Over the same period, the proportion of similar women age 45 and older who had both breasts removed rose from about 4 percent to about 10 percent.

Rates of contralateral mastectomy varied by state but were consistently highest in women ages 20 to 44.

During the last two years of the study, more than 40 percent of women in that age range who lived in South Dakota, Iowa, Colorado, Missouri, Nebraska, Tennessee, Maine and Montana chose to have both breasts removed. That was true for less than 25 percent of such women who lived in New Hampshire, Delaware, New Jersey, Louisiana, Idaho, Alaska, South Carolina, Nevada, Massachusetts, Wyoming, Hawaii and the District of Columbia.

The researchers also looked at the proportion of women undergoing reconstructive surgery after having both breasts removed. They found that while the highest rates of double breast removals were generally clustered in the Midwest, the highest rates of breast reconstruction afterward were generally clustered in the Northeast.

Jemal told Reuters Health that the study can’t explain why so many women are opting for contralateral mastectomies, but the rate in the U.S. is higher than in other countries.

For example, only 2 percent to 3 percent of women in the UK with cancer in one breast have the other breast removed, too, compared to 13.5 percent in the U.S.

The researchers didn’t have information on how many of the women in the study were at higher risk for breast cancer because it runs in their family or because they had been treated in the past with radiation therapy to the chest.

Kirstein told Reuters Health that for women with a genetic predisposition to breast cancer, “the bilateral mastectomy is seen as a risk reducing procedure.”

She said some women who aren’t at higher risk still choose to have the cancer-free breast removed even after learning about the risks and benefits.

The variation in rates by state may be explained by healthcare access, income and what women suggest to each other about treatments, she told Reuters Health.

Doctors need to have detailed conversations with women about their treatment options, said Jemal.

“First, the surgeons have to have this discussion with the patient,” he said. “Second, patients have to take time to make a decision. They don’t want to make the decision right away, because anxiety is very high right after diagnosis.”

Kirstein said she asks patients to think of how they’ll feel about their decision in 10 years.

“We support whatever the patients want to do, but we want them to understand what they’re doing,” she said.

SOURCE: bit.ly/2nE8hg7 and bit.ly/2nE7cEV JAMA Surgery, online March 29, 2017.

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LOS ANGELES ― A notorious jailhouse informant program in Orange County has been maintained and promoted for decades by the OC Sheriff’s Department, whose leadership and staff were committed to illegally concealing it ― those are the explosive allegations from Assistant Public Defender Scott Sanders stemming from his review of more than 5,600 internal sheriff’s department documents.

The trove of documents still remains under seal from the public, but Sanders outlined his extensive findings in a blistering motion filed Thursday in the ongoing case against Scott Dekraai, Sanders’ client. Dekraai pleaded guilty to killing his ex-wife and seven other people at a Seal Beach hair salon in 2011, in what remains the deadliest mass shooting in county history.

Dekraai still awaits the penalty phase of his case, which has stalled because of egregious misconduct from prosecutors and sheriff’s deputies in their use of jail informants. 

According to Sanders’ latest brief, it appears the government deception was far worse than previously understood.

OCSD stopped calling informants “informants” and started calling them “sources of information” in order to mislead, according to Sanders.

The new document trove, along with OCSD policy manuals Sanders had previously obtained, reveal that the sheriff’s department changed official vernacular inside the agency in an attempt to “create cover for false testimony [by their deputies] about the use of informants.” 

Sanders says deputies were ordered to stop calling informants “informants” and instead call them “sources of information.” Sanders argues the agency later changed its policy manuals to suggest that “informants” and “sources of information” were two different categories of inmates.

Sanders calls the switch ― which allowed deputies to deny a jailhouse informant program existed during the Dekraai hearings ― a “shameful ‘inside joke’” played on Dekraai, his defense team and the court.  

The sheriff’s department currently denies that an informant program exists ― but it admitted to cultivating “hundreds” of informants a decade ago, Sanders says. 

While the pile of evidence that a jail informant program exists in the county has only grown in the years since Dekraai’s case began, the sheriff’s department has continued to deny it.

“The deputies in the jail are not conducting investigations … we don’t have our folks working informants,” Sheriff Sandra Hutchens has said.

But the cache of documents Sanders reviewed contains numerous internal memos circulated widely among command staff within the OCSD describing the “need to develop and cultivate informants, the importance of utilizing informants and the details of what informants were sharing,” Sanders notes.

The documents Sanders has examined suggest that the sheriff’s department has “likely managed well over a thousand informants over the past several decades.”

Sanders cites an email from the document trove that reveals the Special Handling unit, which formerly oversaw inmates and informants inside county jails, claimed that nearly a decade ago it had already “cultivated hundreds of jailhouse informants.”

Sanders says that according to the contents of the document trove, numerous high-ranking staff members reporting to Sheriff Hutchens are “fully knowledgeable” about the jailhouse informant program. Those include newly named OCSD public information officer Lt. Lane Lagaret, who previously served as a special handling unit supervisor during the controversial period that produced the once-secret deputy log.

Sanders specifically cites an email that was allegedly once posted on the wall of the special handling unit’s office, sent to Lagaret by deputies under his command, which Sanders says “emphasized” the role of deputies in their “cultivating and managing” informants in the jail. The contents of that email is redacted from Sanders’ brief as it remains under seal.

The Huffington Post contacted Lagaret about Sanders’ allegations against OCSD. Lagaret said he’d heard about the brief, but had not read it. 

“I am not going to make a statement in reference to the brief or any of its contents,” Lagaret said. “In reference to the email Sanders is referencing, I haven’t read the brief and do not know of any email he references.” 

HuffPost asked for a copy of the email and forwarded the section of the brief describing the email to Lagaret so he could review the allegations, but Lagaret declined to comment further.

“I don’t intend to comment on what he wrote until called upon to do so in court,” Lagaret said.

There are likely still countless key documents missing.

Sanders says the recent trove of documents, along with other internal records he’s obtained, reveals the “true scope of the jailhouse informant effort” and indicates the presence of far more internal OCSD documentation surrounding their informant effort than has been turned over or even known to exist.

These new documents reference other kinds of logs beyond the special handling log ― module deputy logs, sergeant activity logs, daily briefing logs, administrative segregation logs, none of which have been turned over to the court.

In the Dekraai case, the more than 1,000 pages in the special handling log that OCSD turned over represents just seven of the 65 months Dekraai has spent jailed in the county.

Deputies who have testified in the Dekraai case committed “flagrant perjury,” the public defender says.

In a 2013 statement Tunstall made in a search warrant for a different case, the deputy wrote that he had “cultivated, interviewed and supervised numerous confidential informants” and that one of the duties of his unit included “developing” informants. In 2015, though, he disavowed his earlier admissions, claiming he had used the “wrong” words. 

But Sanders cites testimony given by Tunstall in two prior cases elicited by Assistant District Attorney Ebrahim Baytieh, in which Tunstall freely admitted his duties included developing informants. Sanders also cites a letter Tunstall wrote in support of the outstanding work of one his best jailhouse informants. 

In Garcia’s original testimony in 2014, he never mentioned an entire jail records system that special handling deputies use to track inmates and informants. In 2015, when questioned about why he didn’t bring up the system, he claimed he couldn’t talk about it in court because that’s how the deputies were trained. 

But Sanders located testimony from Garcia in a separate 2009 homicide case in which he appeared to speak openly about the tracking system, how it was used to document the movements of inmates, and how that information was compiled within a computer database.

During Grover’s 2014 testimony in the Dekraai case, he downplayed his work with informants, saying he spent “less than zero” time working with informants. “That’s not my focus,” he said. “That’s not my scope. I generally am consumed with administrative duties.”

But the once-hidden special handling log contains daily entries by Grover depicting his interaction with informants over nearly five years. Sanders also obtained an internal performance evaluation of Grover in which Grover “proudly wrote of his efforts with informants.” In that record, Sanders says, his first major accomplishment he wanted to discuss with his supervisor involved a jailhouse informant. Further, a newly discovered slideshow presentation regarding informant use appears to have been created by Grover and directs those who view it to contact him. 

Sanders also cites a key email written by Grover before his testimony in the Dekraai case, stating that OCSD was no longer calling informants “informants.”

OCDA delayed the release of additional deputy logs in order to ensure a death sentence in a separate murder case, Sander says.

In June, after years of denials, the OCDA’s office finally acknowledged that an informant program does indeed exist and that sheriff’s deputies actively “recruited and utilized” informants and rewarded them for information. The admission followed the discovery of the 1,000-page special handling log that shed new light on the scope of the informant program inside county jails. 

But Sanders says a series of emails discovered in the new document cache indicate that the OCDA took possession of still more deputies’ logs in June 2016 and decided to delay their release to the court until December 2016.

Sanders argues that a deeply troubling but “likely” explanation for the delay was related to the timing of the sentencing in a separate murder case ― that of Daniel Wozniak, whom Sanders also represents. According to Sanders, the mere existence of these logs would have impeached testimony in hearings held earlier in the Wozniak case. 

By withholding the log until after Wozniak’s case was completed in September 2016, it helped to “ensure that a death sentence … would be imposed” on Wozniak without the issue emerging or the case being delayed, Sanders says.

When asked about the allegations, OCDA directed The Huffington Post to a December 2016 OCDA press release about the special handling log. The release does not address the allegations of intentional delay.

OC District Attorney Tony Rackauckas has maintained that no one in his office intentionally behaved inappropriately in relation to the jailhouse informant program. OCSD argues similarly and that it has taken steps to create more robust ways of documenting and managing inmates.

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