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On the Road During a Pandemic, From Austin, Texas, to Metro D.C. – The Nation

Posted on October 8, 2020 by Danzig

Matthew Gossage with his new baby. (Abby Batko-Taylor)

Before. Nope. Youve now just infected your other clean hand with germs, my wifes OB/GYN dryly instructed. She then put on her own latex gloves and demonstrated how to put them on and take them off while keeping your hands sterile.Ad Policy

We were in my wife and newborn sons hospital room the day after his birth, on Leap Day, February 29. CNN, muted on the TV above us, was showing the same three b-roll shots of ambulances in front of a nursing home in King County, Wash., outside of Seattle; over and over again.

My wife had given birth to our son a week before all hospitals in Austin closed to visitors. I had been able to be in the delivery room and attempt to sleep in their room with them. Our doctors were on daily calls about the pandemic and preparing for it: Get ready. This is going to be serious.

Yeah, you should probably just stay home and not leave the house, the OB/GYN recommended in her usual inconclusively sarcastic tone, which previously had always been reassuring.

Three days later, people at the supermarket glanced at my purple latex gloves, not wanting to make eye contact afterward. Hes brought the germs. Or maybe my hands were simply another reminder that unforeseen change was coming. Ordinary life was unraveling. Or fleeting.

There were no reported cases yet in Austin. Yet the sense was Its coming

It was 3 am, and the grocery store was busier than a Saturday afternoon. Going to the store at that hour had always been so relaxing for me. I had been able to take my time, getting stoned beforehand and going slowly through the aisles. This night carts were everywhere. Family members and college roommates yelled at one another across other carts.

They got baked beans.

Yeah! Get em all.

Freshly printed signs from the customer service desk were Scotch-taped to some shelves: Limit 2.

I had a detached perspective, still ecstatic over the healthy birth of our second son.

No diapers. OK.

No wipes. OK.

My family had entered a nurturing and joyous bubble that was about to overlap with a global and collective bubble of sickness, hundreds of thousands of deaths, a foreseeable yet unstoppable economic depression, disruption, and anxiety.

I strolled down the aisles away from the shelves that formerly held canned goods and pasta and toilet paper, and tried out the produce section. I crossed paths with a fellow bemused middle-aged man, and we shared a smile.

Time to get creative, I said as we both looked on a large shelf with nothing but cucumbers.

The composting toilet got here! Another brown box had arrived on our porch.

Months into the pandemic now, I felt I should be getting an honorary mention from Jeff Bezos for doing my part to get him to $200 billion in wealth. (I know hes been busy, so a Christmas card would be fine.)

I opened the Luggable Loo box and put the portable toilet in our Front of moving truck pile in our moving staging area. It shared a plastic bin with gloves, hand sanitizer, wipes, and granola bars, so it wouldnt get mixed up with our stuff that would be packed into the back of the moving truck.

We were leaving Austin after 15 years, moving outside Washington, D.C., to be close to family who could help with our domestic chaos, which had yet to become normalized. To minimize sharing germs (as our oldest son, a 4-year old, understood this new world), we planned our driving route to avoid going inside, anywhere.

Well, there are some unintended benefits to this now. Somewhere between Texarkana and Little Rock, this crossed my mind as I sat with my pants down at my ankles, using our new toilet in an empty parking lot behind a permanently closed Mexican restaurant: There are a lot of closed businesses now to privately take a shit outside of.Current Issue

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I am not alone in finding time on the john to be one of the more relaxing and thought-provoking daily activities. (In this case, the john is a seat on a bucket, with a bag, which you seal and then keep in the bucket until it can be disposed.) It was an unseasonably cool afternoon. A thunderstorm had passed, and I watched as a portly raccoon stumbled out of the dumpster across the lot from me. Maybe the place had just closed

The swirl of recent events went through my head again on that toilet outside the restaurant. A new healthy son, a global pandemic, shutdowns, working from home with no day care for our oldest son, a cross-country move with no one helping, so my wife and I could try to stay healthy and be able to take care of young children.

After I had my turn on the toilet, it was my wifes turn, and I took over holding the baby. I thought of the people we knew and worked with in Austin who had had Covid-19 already. A young woman with two children had just come out of a fever that kept her on the couch for days. Her oldest son is 12, and had been taking care of the baby while the mom lay prostrate. He kissed his mother on her forehead when she got up for the first time. I thought you were dying, he told her through tears.

I kissed my sons forehead, then his cheeks, knees, and belly, I said to him, Well, I knew we were heading for interesting times, before handing him back, packing up the Luggable Loo, and buckling up for the drive.

Scenes From a Pandemic is a collaboration between The Nation and Kopkind, a living memorial to radical journalist Andrew Kopkind, who from 198294 was the magazines chief political writer and analyst. This series of dispatches from Kopkinds far-flung network of participants, advisers, guests, and friends is edited by Nation contributor and Kopkind program director JoAnn Wypijewski, and appears weekly on thenation.com and kopkind.org.

Dole effect as a measurement of the low-latitude hydrological cycle over the past 800 ka – Science Advances

Posted on October 8, 2020 by Danzig

INTRODUCTION

A variety of geological proxies has been developed to reconstruct the history of the low-latitude hydrological cycle, which plays a crucial role in the global moisture and heat transport. In the past decade, the strong similarity of 18O variations between atmospheric O2 (18Oatm) and Chinese stalagmite, either on orbital or on millennial time scales, has raised the debate on the correlation between 18Oatm and the low-latitude hydrology (15). As a chemical signal of the atmosphere, 18Oatm is an integrated result of different processes that occurred over the globe, which is able to reflect biogeochemical and thus climatic changes at a planetary scale compared with regional proxies.

Interpreting the climate significance of 18Oatm, however, turns out not to be straightforward. The 18Oatm value is determined by the oxygen isotopic fractionation associated with photosynthesis and respiration of biosphere as well as the hydrological cycle, which is today more enriched by 23.5 0.3 than oceanic water. This isotopic offset is traditionally referred to as the Dole effect. The respiration of both terrestrial and marine biosphere preferentially consumes 16O over 18O, causing a nearly equivalent isotope effect of ~19 [e.g., (6)]. This is the biggest source of the Dole effect. On land, plant transpiration can cause an isotopic enrichment of leaf water relative to soil water, resulting in a globally integrated photosynthetic Dole effect of 4 to 8 [e.g., (6, 7)]. In the marine realm, O2 produced by phytoplankton shows an 18O enrichment of less than 6 with respect to ambient seawater (8). The hydrological cycle, however, changes 18Oatm in an opposite direction to the aforementioned two processes. This is because the ocean-to-land moisture transfer can always result in an isotopic depletion of terrestrial rainfall with respect to seawater. Rainwater is subsequently used by the terrestrial biosphere, which thus decreases the Dole effect (2, 6).

The fluctuation of the Dole effect (DE) over the past 800 thousand years (ka) has been reconstructed by removing the imprint of seawater 18O from ice corederived 18Oatm records [e.g., (3, 6)]. During the mid-to-late Pleistocene, varying global ice volume is the first-order reason causing mean oceanic water 18O changes. Accordingly, the reconstructed or the modeled ice-volume isotopic effect (18Osw) (9, 10) was subtracted from 18Oatm to obtain the DE [e.g., (3)]. Using this approach, the reconstructed DE shows strong variance in the precession bands with an amplitude of ~1.2, believed related to low-latitude hydrological changes (3, 6). However, the DE record contains additional and important variance at the ~100-ka periodicity, suggesting a substantial influence of ice-sheet volume on the DE, possibly via changing terrestrial productivity at mid-to-high latitudes (3). This, therefore, impedes the use of the DE as a proxy for the low-latitude hydroclimate.

In this study, we generated a new DE* (to distinguish from the traditional definition of DE) record by removing the globally stacked sea surface 18O (18Osurf) from 18Oatm, which shows pronounced precession cycles (~23 and ~19 ka) but almost no ~100-ka periodicity over the past 800 ka. Furthermore, we used the Community Climate System Model version 3 (CCSM3) to perform a 300-ka transient simulation of global climate change. The modeled terrestrial rainfall changes between 30N and 30S strongly resemble the DE*. We therefore propose that the low-latitude hydrology is the only important forcing for the DE* on orbital time scales, while the influence of other climate factors, if any, should be minor.

We argue that 18Oatm has a stronger relevance with isotopic values of sea surface compared with those of the entire ocean because (i) the terrestrial biosphere uses waters originally evaporated from sea surface and (ii) nearly 100% photosynthesis and 95% respiration of the marine biosphere occur within ocean mixed layers (7). Therefore, it is more reasonable to use 18Osurf rather than 18Osw (or mean oceanic water 18O) to calculate the DE*. 18Osurf is different from 18Osw, because in addition to varying ice volume, hydrological changes at mid-to-low latitudes can also exert substantial influence on 18Osurf through altering evaporation, precipitation, runoff, and reservoir size of liquid water on land. Moreover, 18Osurf can be reliably reconstructed by removing temperature effect from planktonic foraminiferal 18O. Through compiling parallel measurements of planktonic foraminiferal 18O and sea surface temperature (SST) from marine sediment cores, a global 18Osurf stack over the past 800 ka has been generated by Shakun et al. (11) (Figs. 1 and 2A). We update the 24 to 0 ka BP (Before Present) interval of this stack by using high-resolution and 14C-constrained reconstructions with Mg/Ca-SST results (Materials and Methods as well as the Supplementary Materials, Fig. 1, and fig. S1).

Monsoon domain (green) was defined by Wang and Ding (1). Blue and red lines indicate the mean position of the Intertropical Convergence Zone for August and February, respectively (solid for monsoon trough and dashed for trade wind convergence) (24). Blue (11) and red (this study) dots indicate 18Osurf reconstructions used for the generation of a global stack. WAIS, West Antarctic Ice Sheet; EPICA, European Project for Ice Coring in Antarctica.

(A) A global stack of 18Osurf (blue, with 1 standard error) [this study, (11)] and the modeled 18Osw (red) (10). (B) Normalized 18Osurf and 18Osw are obtained by the z-standard method, which are further used to calculate the difference. (C) A composite 18Oatm record from Antarctic ice cores, including the WAIS Divide and the Siple Dome (50 to 0 ka BP) (2, 5), the Vostok (100 to 50 ka BP) (12), and the EPICA Dome C (800 to 100 ka BP) (1317). (D) Chinese stalagmite 18O, compiled by Cheng et al. (18). (E) A compilation of Bornean stalagmite 18O (1922). The duration of terminations I to V is marked by yellow bars. In (B) to (E), dashed lines indicate the linear regression of each proxy record over the past 430 ka.

Discrepancies between the 18Osurf stack and the modeled 18Osw (10) are described in the Supplementary Materials (figs. S1 to S4). Briefly, the 18Osurf and the 18Osw show three robust discrepancies over the past 430 ka (Fig. 2). First, with respect to 18Osw, isotopic values of several interstadials within an interglacial period are more comparable in 18Osurf [marine isotope stage (MIS) 11c versus 11a, 9e versus 9c and 9a, 5e versus 5c and 5a, Fig. 2A]. Second, at the recent five glacial terminations, the rise of 18Osurf lags that of 18Osw by 3 to 4 ka (marked by yellow bars in Fig. 2; also, see figs. S1 to S3). Third, 18Osurf exhibits a long-term trend toward lighter isotopic values for the past 430 ka, which was also noted by Shakun et al. (11). This secular trend is clearly revealed in the difference between 18Osurf and 18Osw, showing a decreasing tendency over this period (Fig. 2B and fig. S4).

The aforementioned features of 18Osurf are shared by 18Oatm (1217) and tropical-subtropical stalagmite 18O (Fig. 2) (1822), including comparable amplitude of interstadials within an interglacial (MIS 11, 9, and 5), positive 18O excursions at glacial terminations, and the long-term trend over the past 430 ka. Together, the common features among different climate archives can be interpreted as that the distinct isotopic imprint of sea surface was transferred to continental precipitation and leaf water via the hydrological cycle, which was subsequently recorded by stalagmite and 18Oatm. Therefore, 18Osurf should be used to adjust precipitation isotopic records (e.g., stalagmite 18O, plant wax hydrogen isotope) and calculate the DE*.

As illustrated in Fig. 3, compared with the previous estimate of the DE (18Oatm 18Osw), the new DE* (18Oatm 18Osurf, Materials and Methods) displays a considerably better match with precession in amplitude over the past 800 ka. An evident mismatch between the previous DE and precession is found between 450 and 360 ka BP (Fig. 3A), which is improved between the DE* and precession but still exists to some extent (Fig. 3C). Note that during this period, 18Oatm and 18Osurf contain relatively less variance in the precession bands (Fig. 2, A and C), and astronomically tuned age models of both climate records have relatively large uncertainties (the establishment of chronologies are described in Materials and Methods) (17, 23). Therefore, the ambiguity of precession signals in climate reconstructions together with age model uncertainties may partly explain this mismatch.

(A) The previous estimate of DE (red) and precession (gray). (B) Eccentricity cycles. (C) The new estimate of DE* (blue, with 1 standard error) and precession (gray). (D) The global stack of benthic foraminiferal 18O (23). Eccentricity, obliquity, and precession are derived from Berger (41), which are further normalized to calculate the ETP (E + T-P). Cross-spectral analysis results of the ETP with the previous (E) and the new (F) estimate of DE, respectively, over the past 800 ka. In (E) and (F), the spectrum of each record is presented with the 95% confidence level (dashed lines). Below, coherency spectra are indicated by gray-filled curves associated with the 95% Monte Carlo false-alarm level (black dashed lines). The time-series analysis was performed using the REDFIT program (46). The numbers denote primary orbital cycles.

The DE* shows no evident imprint of an individual glacial-interglacial cycle, nor does it respond to an increase in the magnitude of glacial-interglacial cycles that occurred after glacial termination V, referred to as the Mid-Brunhes Event. In contrast to the previous estimate of DE, the spectrum of the DE* shows strong variance in the ~19-, ~23-, and ~41-ka bands but lacks variance in the ~100-ka bands (Fig. 3F). This suggests that the presence of the ~100-ka periodicity in the previous DE (Fig. 3E) (3) is an artificial signal. Together, precession and obliquity to a lesser extent are dominant forcing of the DE* over the past 800 ka, while the influence of 100-ka cycles (ice volume) seems negligible.

The DE* exhibits a remarkable similarity to Chinese stalagmite 18O (hereafter refers to the one adjusted for 18Osurf changes, simply by subtracting 18Osurf from stalagmite 18O) over the past 640 ka (R = 0.60; P < 0.001), both following the temporal rhythm of the Northern Hemisphere summer insolation (Fig. 4). Their spectra are also well matched, both showing strong variance in the precession bands (Fig. 4D). In addition, the Mid-Brunhes Event is not reflected in Chinese stalagmite 18O reconstructions, either (Fig. 4A) (18).

(A) The DE* (blue, with 1 standard error) and Chinese stalagmite 18O (orange, after adjusted for changes in 18Osurf) (17). (B) Simulated terrestrial rainfall changes between 30N and 30S (annual mean, green) and July 21 daily insolation at 20N (gray) (41). (C) Simulated terrestrial rainfall changes over 0 to 30N (annual mean, red) and 0 to 30S (annual mean, blue). Simulation results are from the experiment CCSM3_orb+ghg + ice (Materials and Methods), which are further fitted using the Savitzky-Golay algorithm with 15 points at second order. In (D) and (E), spectra of the 800-ka DE*, the 640-ka Chinese stalagmite 18O, and the 300-ka simulation output are presented with the 95% confidence level (dashed lines). Below, coherency spectra of their cross-spectral analysis are indicated by gray-filled curves associated with the 95% Monte Carlo false-alarm level (black dashed lines). The time-series analysis was performed using the REDFIT program (46). The numbers denote primary orbital cycles.

An accelerated simulation was performed using the CCSM3 from 300 to 0 ka BP, forced by orbital-driven insolation, greenhouse gases, and ice sheets (Exp_orb+ghg + ice; Materials and Methods and figs. S5 and S6). To evaluate the effect of different forcing on the hydrological cycle, two additional experiments were run, forced by orbital parameters (Exp_orb) and orbital parameters plus greenhouse gases (Exp_orb+ghg), respectively (Materials and Methods and figs. S5 and S7). Terrestrial rainfall changes in a specific region are indicated by their proportion in the global total.

In the model output of the Exp_orb+ghg + ice (fig. S6), except for those over 60S to 90S, terrestrial rainfall changes over other latitudes all contain strong variance in the precession bands. Especially over 0 to 30N, precession is the predominated cycle for the past 300 ka. Terrestrial rainfall changes over 30N to 60N and 60N to 90N also include additional but less important variance in the 100-ka bands. Our simulation successfully reproduces a fundamental feature of the global hydrological cycle as revealed in many geological records [e.g., (24)] that terrestrial rainfall changes between Northern and Southern Hemisphere low latitudes are antiphased in the precession bands (Fig. 4C and figs. S6 and S8).

Because terrestrial rainfall changes over 0 to 30N show stronger variations than over 0 to 30S (Fig. 4C), the combined rainfall changes between 30N and 30S show strong variance only in the precession bands and follow the temporal rhythm of the Northern Hemisphere summer insolation (Fig. 4B). Using cross-spectral analysis, simulated rainfall changes between 30N and 30S are strongly coherent with the DE* in the precession bands (Fig. 4E). Negative shifts of the DE* (and Chinese stalagmite 18O) are always concurrent with large terrestrial rainfall between 30N and 30S, and vice versa. Moreover, due to a high fraction of tropical rainfall in the global total, temporal changes of the global terrestrial rainfall are also highly similar to those over 0 to 30N, showing a domination of precession cycles (fig. S6).

A comparison of model output reveals that all three experiments generate similar results on terrestrial rainfall changes in tropics (fig. S7). This suggests that solar insolation is much more important than greenhouse gases and ice volume in regulating the temporal pattern of tropical hydroclimate. Including the ice-volume forcing in the model can enhance and weaken the variance in the precession bands over 0 to 30N and 0 to 30S, respectively (fig. S7).

Previously, three factors were considered important for causing the Dole effect fluctuation on orbital time scales: changes in the ratio of terrestrial to marine productivity (6, 7), vegetation changes induced respectively by ice volume (3), and the low-latitude hydrological cycle [e.g., (2, 6)]. Estimates of paleoproductivity are still subject to large uncertainties. Nevertheless, it is generally accepted that changes in the global biogenic productivity were significantly affected by glacial-interglacial cycles during the late Quaternary (25). With respect to interglacial periods, a substantial reduction of terrestrial productivity and a slight increase (or unchanged) of marine productivity during glacial time have been found (25, 26). Because no evident imprint of glacial-interglacial cycles (100-ka periodicity) is detected in the DE* as aforementioned, past changes in the land/sea productivity ratio seem not critical for the DE*. This inference is supported by recent studies that suggest a nearly equivalent Dole effect value generated by modern terrestrial and marine biosphere [e.g., (8)]. This is in contrast to the previous estimate, which considered a higher terrestrial Dole effect than the marine value (6, 7).

The absence of 100-ka glacial-interglacial cycles in the DE* also excludes an important role of the ice volume. In high latitudes, the photosynthetic Dole effect of boreal biomes is partially canceled out by the respiratory effect in soils (27). Therefore, pronounced changes in the amount of boreal biomes due to the expansion and the retreat of ice sheets are inferred to exert limited influence on the global DE* (8).

The dominance of precession cycles in the new DE*, however, highlights the role of the low-latitude hydrology and vegetation as previously thought [e.g., (2, 6)]. Tropical and subtropical vegetation comprises the major part of the global productivity on land (4). On one hand, the respiratory Dole effect in low latitudes is considered lower than the global mean value due to slow diffusion of O2 in wet soils [e.g., (28)]. A strengthened hydrological cycle and subsequently an expansion of wetlands can therefore decrease the global respiratory Dole effect. On the other hand, a strengthened hydrological cycle is associated with the enhanced convection intensity over oceanic moisture source areas, the increased isotopic fractionation during the ocean-to-land moisture transfer, and the expansion of monsoon realms [e.g., (29)]. All these processes can result in the isotopic depletion of meteoric waters on land. The substantial impact of precipitation isotope composition on 18Oatm has been clearly revealed by the strong similarity between Chinese stalagmite 18O and the DE* (Fig. 4). Furthermore, elevated humidity levels over vegetated areas can decrease the evaporative enrichment of leaf water 18O [e.g., (6)]. Together, the respiratory and the photosynthetic Dole effect of the low latitude both decrease during periods with a strengthened hydrological cycle.

Apparently, our simulation supports the correlation between the tropical hydroclimate and the DE* on orbital time scales. Given its high proportion in the global terrestrial rainfall and its spectral distribution, the tropical hydrological cycle can most likely explain the DE* (fig. S7). In addition to stronger rainfall changes over 0 to 30N than over 0 to 30S, generally stronger continentality and higher altitudes in the Northern Hemisphere can decrease meteoric water 18O values to a greater extent due to the moisture isotopic fractionation along transport paths (2). Therefore, the northern low-latitude Dole effect signal should overwhelm the southern counterpart, and the global DE thus follows the temporal pattern of the Northern Hemisphere summer insolation (Fig. 4).

The obliquity cycle is recognizable in the DE* but nearly undetectable in Chinese stalagmite 18O (Fig. 4D), suggesting that meteoric water 18O is a very important but not the only cause for the DE* as aforementioned. Although terrestrial rainfall changes over northern and southern high latitudes include weak variance in the obliquity bands as shown in our model output (figs. S6 and S9), they unlikely can account for the obliquity cycle of the DE* because of their small contribution to the global terrestrial rainfall (figs. S6). We thus exclude high latitude-sourced causes for the obliquity cycle in the DE*.

In contrast to our transient simulation, some equilibrium simulations have revealed that large obliquity can enhance summer monsoon intensity in both hemispheres, particularly in the Northern Hemisphere [e.g., (30)]. Although it is model dependent, the effect of obliquity has been clearly observed in some regional monsoon reconstructions [e.g., (30)]. Therefore, the obliquity cycle of the DE* can also be interpreted in the context of the low-latitude hydrology. High-obliquity values should correspond to relatively low Dole effect values, as confirmed by our data analysis (fig. S9). To summarize, the hydroclimate over low-latitude vegetated areas should be the only dominant cause for the orbital-scale DE* over the past 800 ka.

Among a few different but interrelated forms of the low-latitude hydrological cycle (e.g., the El NioSouthern Oscillations and the Intertropical Convergence Zone), monsoons are recognized as the most mutable component and represent the dominant mode of annual low-latitude variation (Fig. 1) (1). Moreover, a compilation of geological records has confirmed the coherent variability of regional monsoons across orbital to millennial time scales (Fig. 1) (24). This has further led to an evolving concept, the geological evolution of global monsoon [e.g., (24)]. Because monsoons are viewed as a planetary-scale rather than a regional phenomenon, it would be significant if a common proxy could be found to describe the global monsoon or low-latitude hydrological changes. Because of its global character and strong correlation with simulated tropical rainfall changes (Fig. 4), the DE* is suggested as such a potential proxy on orbital time scales.

The low-latitude hydrological cycle as a whole, as revealed by the DE*, appears to be governed by insolation forcing only. This differs from regional hydroclimate reconstructions, which show substantial response to a set of other factors besides solar insolation, including changing ice volumes, greenhouse gas concentrations, SST, sea-land distribution, and orography (31). Therefore, a global proxy is in favor of going beyond regional character and complexity and is advantageous to identify common and most fundamental mechanisms for the operation of the low-latitude hydroclimate at a large spatial extent.

The idea of questing for a global monsoon proxy is similar to using benthic foraminiferal 18O as an indicator for the global glacial-interglacial cycles. Although regional ice sheets can have different timing of advance and retreat, benthic foraminiferal 18O has been used as a globally integrated proxy to depict the cyclicality, duration, and transition of Quaternary glacial-interglacial climate. Likewise, the DE* may become a benchmark to measure the dynamics of the low-latitude hydrological cycle during the Quaternary.

Paired measurements of planktonic foraminiferal 18O (18Oc) and Mg/Ca-SST with 14C-constrained chronology from 36 cores were compiled to generate a global stack of 18Osurf (Fig. 1, fig. S1, and table S1). We excluded published alkenone-SST reconstructions. Although, in many regions, Mg/Ca-SST and alkenone-SST records are largely consistent on orbital time scales, they show discrepancies on millennial time scales mainly due to their different seasonal preferences (32). 18Oc and Mg/Ca-SST are both sourced from calcareous shells, which can therefore provide more robust reconstructions of 18Osurf than using alkenone-SST. Through applying the Marine13 dataset to recalibrate 14C dates (33), the age model of nearly all records was readjusted. One record was left on its original 14C and ice-core tuned age model (MD97-2120). The time resolution of most reconstructions is <500 years (n = 32), while four other records range between 520 and 580 years. In each core, 18Osurf [, SMOW (Standard Mean Ocean Water)] was calculated by (SST-16.5)/4.8 + 18Oc [, PDB (Pee Dee Belemnite)] + 0.27 (34). An evenly spaced 18Osurf with a resolution of 500 years was further produced by averaging data in 1000-year bins. For stacking, each 18Osurf record was shifted to a mean of zero and combined as unweighted global averages. Last, because only the amplitude of 18Osurf changes is concerned, both 18Osurf stacks produced in this study and by Shakun et al. (11) were shifted with a late Holocene value of zero (Fig. 2). Considered propagating uncertainties of 18Oc and Mg/Ca measurements, the Mg/Ca-SST calibration, and the seawater 18O-paleotemperature equation, the standard error (1) of a single 18Osurf estimate is approximately 0.30 (35). The standard error (1) of the 18Osurf stack is between 0.06 and 0.08, depending on the number of available data points.

The chronology of Chinese stalagmite records was established by radiometric dating, with a typical error of <1 and 1 to 3.5 ka (1), respectively, for the interval 400 to 0 ka BP and 640 to 400 ka BP (18). Age models of marine and ice-core records are basically derived from the astronomical tuning, with an uncertainty less than 4 ka for most periods of the past 800 ka (23, 36, 37). The global stack of 18Osurf (800 to 23.5 ka BP) (11) and the modeled 18Osw (800 to 0 ka BP) (10) are both plotted against the LR04 age model (23). The 18Oatm record is plotted against the AICC2012 age model (36, 37), with that between 640 and 100 ka BP being retuned to the Chinese stalagmite chronology according to the similarity between 18Oatm and stalagmite 18O (17). Applying the AICC2012 age model to the entire 18Oatm record, however, would not change the spectral analysis results of the DE and the DE* and thus the conclusions of this study. Because the 18Oatm record contains strong variance in the precession bands, and the recognition of precession cycles in 18Oatm is additionally constrained by a few discrete absolute dating results (36, 37), the spectral analysis of 18Oatm and the DE* does not seem to be substantially influenced by the tuning method.

We followed the approach of Extier et al. (17). Series of 18Osw, 18Osurf, and 18Oatm were first interpolated to 100-year resolution and then fitted using the Savitzky-Golay algorithm with 31 points at second order. Fitted curves of 18Osw and 18Osurf were extracted from that of 18Oatm, respectively, to calculate the DE and the DE*. Given the standard error of the 18Osurf stack (0.05 to 0.12, 1) [this study, (11)] and the 18Oatm measurement (0.04, 1) (13), the standard error of the DE* was estimated to be around 0.07 to 0.15 (1).

The CCSM3 includes dynamically coupled atmosphere, ocean, land, and sea ice components (38, 39). The atmosphere model has a ~3.75 horizontal resolution (T31, varying from 340 km at the equator to 40 km around Greenland) and 26 hybrid coordinate levels in the vertical. The land model has the same T31 resolution. The ocean model has a 3 horizontal resolution with 25 vertical levels. The resolution of the sea ice model is identical to that of the ocean model, including a subgrid-scale ice thickness distribution.

To distinguish the effect of each forcing on the global climate, three experiments were designed, forced by orbital parameters (Exp_orb), orbital parameters combined with greenhouse gases (Exp_orb+ghg), and orbital parameters combined with greenhouse gases and ice volume (Exp_orb+ghg + ice), respectively (figs. S5 and S7). In the first two experiments, orbital parameters and greenhouse gases were advanced by 100 years at the end of each model year. In the third experiment, the continental ice-sheet volume and the position of coastlines were altered at steps of an equivalent 40-m sea level rise or fall to reconfigure and restart the model. The upper ocean and the atmosphere are considered to reach quasi-equilibrium in these accelerated simulations (40). Annual-mean rainfall changes over lands of six latitude bins, 90N to 60N, 60N to 30N, 30N to 0, 0 to 30S, 30S to 60S, and 60S to 90S, were calculated and shown in this study. Terrestrial rainfall changes in a specific region were represented by their proportion in the global total (Fig. 4 and figs. S6 and S7).

As shown in fig. S5, the orbital and greenhouse gases forcing were reconstructed from Berger (41) and the Antarctic ice core records (42, 43), respectively. Continental ice-volume and sea-level changes were calculated by scaling the ICE-5G ice distributions for the past 21 ka (44) to the globally stacked benthic foraminiferal 18O record (23). A part of simulation results has been published by Lu et al. (45).

We note that the Exp_orb+ghg + ice output contains some suspicious signals, including pulsed changes during the recent three glacial terminations (fig. S7, A and B), and relatively weak terrestrial rainfall during interglacial peaks (MIS 7e, 5e, and 1) over 0 to 30N (fig. S7A). The former is induced by a rapid jump in the ice-volume forcing (fig. S5), and the atmosphere and surface ocean in the model need time to reach quasi-equilibrium. The latter seems to contradict with climate reconstructions, which indicate that interglacial peaks were always characterized by very humid conditions over the Northern Hemisphere tropical lands [e.g., (36)]. In this study, we mainly focus on astronomical cycles of simulation output, which is therefore not subject to these unreal signals.

Acknowledgments: Funding: This research is funded by the National Science Foundation of China (nos. 41776054, 41525020, 91128208, 41606045, and 41976047) and the National Key Research and Development Program (2018YFE0202401). Author contributions: E.H. conceived the study, compiled all data shown in this study, and wrote the manuscript. M.Y. and Y.W. analyzed the CCSM3 simulation results. S.L. generated the global stack of sea surface oxygen isotope record. All authors discussed the results and commented on the manuscript. Competing interests: The authors declare that they have no competing interests. Data and materials availability: All data needed to evaluate the conclusions in the paper are present in the paper and/or the Supplementary Materials. Additional data related to this paper may be requested from the authors.

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Dole effect as a measurement of the low-latitude hydrological cycle over the past 800 ka - Science Advances

Unilux unveils UVX portable inspection strobes – Labels and Labeling

Posted on October 8, 2020 by Danzig

Unilux, a stroboscopic inspection lighting specialist has introduced UVX, a new line of portable UV inspection strobes with improved efficiency and optical brighteners allowing defects detection at full production speed.

New UVX inspection strobes excite UV-visible inks and optical brighteners over a wider area, making it easy to spot issues across the entire web width confirming the quality without slowing production. By spreading the usable illumination more evenly, UVX strobes provide a true representation of quality by eliminating hot spots.

Portable LED9 and LED12 UVX strobes provide the ability to inspect anywhere on the press and feature quick-change batteries for added convenience. Stationary LED2000 UV inspection systems provide full-width inspection and feature Smart Assist controls, which allow to daisy-chain multiple units for the simultaneous inspection of standard and UV-visible inks and coatings.

UV LED technology has improved since our award-winning LEDUV inspection strobes, said Mike Simonis, president of Unilux. With UVX, weve leveraged those improvements using experience that only comes from decades of problem solving in security printing, cold seal, and coating to meet customers evolving requirements.

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Unilux unveils UVX portable inspection strobes - Labels and Labeling

Opinion: Congress must investigate reports of forced hysterectomies of migrant women – Pocono Record

Posted on October 8, 2020 by Danzig

Drs. Max Cooper and Asanthi Ratnasekera pennlive.com (TNS)| Pennlive.com

As doctors, we believe forced hysterectomies, as alleged by a whistle blower at an ICE facility in Georgia, against detained migrant women is a violation of every medical value we swore to uphold as physicians. And every healthcare professional who went into medicine to heal others has a duty to speak up and support a full investigation into this horrific mutilation of women.

From the whistleblower's allegations, migrant women detained at a facility in Georgia did not give informed consent to have hysterectomies performed on them. As detainees of Immigration and Customs Enforcement, held behind bars with little to no rights or freedom, they most likely followed orders out of fear. They were coerced into hysterectomies. This procedure entails the removal of all or part of a woman's uterus, which can be indicated for a host of medical reasons but has the end effect of stopping any future pregnancy.

From a medical perspective, the that must be answered, and they revolve around whether the women were fully informed about the procedure, risks and benefits, potential complications and alternatives. This sharing of information and transparency is the foundation of the ethical practice of medicine.

The most grotesque moments in medicine occurred due to the absence of informed, non-coerced consent.

Between 1933 and its abolition in 1977, the Eugenics Board of North Carolina oversaw the sterilization of roughly 7,500 people. By law, the board could order the sterilization of "mentally diseased, feeble-minded, or epileptic patients" for the goal of preventing them from having children who may become a burden on taxpayers. The victims were overwhelmingly black, poor and disabled people.

In 1973, Minnie Lee and Mary Alice Reif were sterilized at the ages of 12 and 14 in Alabama after their mother, who couldn't read and thought she consented to her daughters getting "shots", signed the surgical consent for a tubal ligation with an "X."

In 1932, 600 men were promised free medical care if they took part in a study of "bad blood." But, they were deceived and for the roughly 400 with latent syphilis, medical care was actively withheld to observe the natural course of the disease. The men were black, poor, and many of them were sharecroppers and had never seen a doctor. The Tuskegee experiment tracked the men over decades. They were given placebos, not penicillin, which was a recommended cure by 1947. The men slowly went mad and blind, and 128 of them died from syphilis. At no time did they give their informed consent.

Today, if physicians did any of these things to a patient, even if that patient were a detainee, we would be sued, lose our medical license, or go to jail. If we encounter communication barriers, language differences or a patient is deaf or blind, we use official translators to ensure all aspects of a treatment or procedure are communicated clearly. The treating physician or performing surgeon must document this communication. A patient's request for a second opinion must be granted.

In emergency medicine, immediate intervention may be necessary to save a patient's life. Informed consent may not be possible in life-threatening situations where the patient isn't conscious. If the patient were, then we explain usually on the walk to the operating room their injuries could kill them unless we intervene with surgery.

After the surgery, we explain to patients and their families all the procedures we performed on them to save their lives, potential complications, outcomes, and next steps as needed. In non-life-threatening situations, we go through all the steps to ensure the patient provides informed consent. In all cases, we document the time we spend explaining treatment and procedures to patients. Anything less before a physician performs a medical procedure on a patient would be unethical and inhumane.

The allegations that hysterectomies were performed on detained migrant women rightfully provokes our public outrage. The U.S. House of Representatives is right to investigate whether the women gave informed, non-coerced consent.

Modern medicine should have moved well past our past barbarities. Yet if the allegations of forced hysterectomies are true allegations that the physician implicated has denied then what happened to these migrant women is an atrocity.

Under international law, "imposing measures intended to prevent births" within a group is an element in genocide. (The next item international law defines as an element in genocide is "forcibly transferring children of the group to another group," another atrocity associated with ICE and the Trump Administration.)

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Opinion: Congress must investigate reports of forced hysterectomies of migrant women - Pocono Record

Has Trump endorsed ‘racehorse theory’? POTUS likely a believer in controversial notion about ‘superior people’ – MEAWW

Posted on October 8, 2020 by Danzig

President Donald Trump recently made a reference to the controversial "racehorse theory" of human breeding, which has become a subject of scrutiny by critics as many wonder whether the Republican actually endorses it. The "racehorse theory" is an offensive and dangerous notion that selective breeding can boost a particular nation in certain ways. The controversial "racehorse theory," infamously practiced by the Nazis when they massacred millions of Jews, involves selective breeding and eugenics. The theory, which was initially used for horses and breeding, was later used to justify the selective breeding of humans. The unfounded theory espouses that human race can be made better by selective breeding, a claim which has been widely discredited.

Trump, on September 18, the night Ruth Bader Ginsburg died, made a campaign appearance in Bemidji, Minnesota, and made an alarming reference to eugenics and the racehorse theory. "You have good genes, you know that right? the president said to a nearly all-white crowd. A lot of it is about the genes, isnt it? Dont you believe? The racehorse theory, Trump said. You think were so different? You have good genes in Minnesota."

Author of 'NeuroTribes', Steve Silberman, also slammed Trump's reference to the theory, likening it to the Nazis. Silberman tweeted: "As a historian who has written about the Holocaust, I'll say bluntly: This is indistinguishable from the Nazi rhetoric that led to Jews, disabled people, LGBTQ, Romani and others being exterminated. This is America 2020. This is where the GOP has taken us."

As a historian who has written about the Holocaust, I'll say bluntly: This is indistinguishable from the Nazi rhetoric that led to Jews, disabled people, LGBTQ, Romani and others being exterminated. This is America 2020. This is where the GOP has taken us. https://t.co/CHMLg804mp

President Trump also appeared to make a reference to eugenics during the first 2020 presidential debate against his political rival, Democratic nominee Joe Biden on September 29. Trump told Biden: "You could never have done the job we did. You dont have it in your blood."

The Republican has also referred to the "racehorse theory" before he won the presidency. Trump, while talking to CNN's Larry King in 2007, had said: "You can absolutely be taught things. Absolutely. You can get a lot better. But there is something. You know, the racehorse theory, there is something to the genes. And I mean, when I say something, I mean a lot."

This is not the first time Trump's reference to eugenics has come under the scanner and has been analyzed. The Republican's biographer, Michael D'Antonio, the author of 'The Truth About Trump', had previously stated that the Trump family has a "very deep attraction" to eugenics. D'Antonio, while talking to Rolling Stone, had said: "The family subscribes to a racehorse theory of human development, that they believe that there are superior people, and that if you put together the genes of a superior woman and a superior man, you get superior offspring."

President Trump, who contracted the novel coronavirus last week, came back to the White House from the Walter Reed Medical Center on Monday, October 5. However, he is still believed to be infectious and received widespread backlash for removing his mask when he returned to the White House, and urged Americans to not to fear the COVID-19 disease that has killed over 209,000 people in the country.

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Has Trump endorsed 'racehorse theory'? POTUS likely a believer in controversial notion about 'superior people' - MEAWW

Freaks Is the Granddaddy of Disabled Horror, for Better and Worse – IndieWire

Posted on October 8, 2020 by Danzig

[Editors Note: This is Part 1 in a four-part series on disability and horror.]

Watching horror films is a disabling experience, Angela M. Smith, Associate Professor of English and Gender Studies for the University of Utah and author of the book Hideous Progeny: Disability, Eugenics, and Classic Horror Cinema, said. Its a controlled encounter with discomfort, with the vulnerability of our minds and bodies to images and suggestions that opens us to unwilled transformations.

The horror film revels in the world of deformity and grotesqueness and, to a disabled viewer, that can be confusing in how relatable it is. For many, to be disabled is also to look different, so how does a person with a disability approach the horror genre when the presented thing to fear is themselves?

Smith said people werent ready for Freaks in the 1930s, and shes absolutely correct. Freaks, for better and worse, remains one of the only U.S. features to have a predominately disabled cast despite being released 88 years ago. Directed by Dracula helmer Tod Browning, Freaks tells the story of a circus troupe and what happens when they discover that little person Hans (Harry Earles) is being poisoned and duped by the able-bodied Cleopatra (Olga Baclanova).

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Freaks, weirdly enough, feels like an authentic horror feature. Even now, the majority of films see able-bodied actors portraying disability that, coupled with able-bodied screenwriters and directors, presents a tableau of disability an imitation. Freaks is the story of a close-knit family, a group of outcasts who support and love each other.

I want to be part of that community, Salome Chasnoff, director of the documentary on disability in horror, Code of the Freaks said to IndieWire. I love the affection and commitment they have to each other. I want to live in a world where people are that committed to me.

Much of this comes from the fact that Browning himself was a part of a traveling circus in his youth. He saw the disabled people that commonly populated what were then called freak shows and wanted to find a way to pay tribute to them. So when star Earles brought up to Browning that he should adapt the short story Spurs by Tod Robbins, the director made MGM buy it for Browning to direct. The basic tenets of the story in Spurs remain, namely the relationship between Hans and Cleopatra, but Browning and a series of directors worked to create a depiction that, at the time, presented the circus performers as people.

Everett Collection (freaks1932-fsct08)

And that warmth is found in snatches throughout Freaks. Outside of the community Chasnoff refers to, there are various storylines showing the day-to-day world of these performers. Frances OConner, who has no arms, is seen casually eating with her feet while performer Prince Randian, known as The Living Torso, rolls a cigarette with his mouth. These scenes, presented so matter-of-factly, display disability as normal. What looks unconventional to an able-bodied person is basic and unspectacular. In these scenes Browning tries to destigmatize the disabled and remind them, in 1932, that theyre people.

Its one of the few films where we can see our disabled ancestors before they were excised from the movies, Carrie Sandhal, Associate Professor in the Department of Disability and Human Development at the University of Illinois at Chicago said. We got to see them as actors as well as people.

For many disabled people who grew up without others like them, Freaks became a gateway feature to champion. The shooting process was difficult, unaided by the fact that the circus performers were forced to eat outside the MGM commissary, due to complaints from the studios stars about seeing them. And once the film was finished, head of production Irving Thalberg was not happy with what he saw. Test screenings were rumored to have audiences fleeing the theater. One woman allegedly threatened to sue MGM because the sight of the disabled actors on-screen caused her to have a miscarriage. Its unclear whether much of this was created by MGM itself in order to better sell Freaks as a horror feature.

Regardless, the studio immediately excised 30 minutes out of the movie, much of which were scenes showing the circus performers in a positive light. Its a classic film tragedy that still stings today, especially for disabled performers like Adam Pearson who believe Freaks is a masterpiece.

Its so unfortunate that half of it is on the cutting room floor, he said. It got completely bastardized and diluted by the studio.

After further cuts, many of which are now lost, the feature was transformed into a horror movie aimed at able-bodied audiences. Reviews were negative and Freaks was a box office bomb. Not only did it effectively end Brownings career as a director, many of the able-bodied actors were blacklisted. The actors with disabilities, like the conjoined twins Daisy and Violet Hilton, were left purely making features that treated them as the freaks MGM wanted them to be.

Courtesy Everett Collection

As Smith lays out, the way Freaks turned out was par for the course in 1930s cinema. As she explained, eugenics was a huge element of not just horror films at the time but within society.

There wasa [belief] in external appearance as something thatcould reveal inner pathology, she said. So visible disability or difference was interpreted as a sign of this inner deviance, which was also interpreted in terms of immorality and criminality.

That theme is seen in 1930s features such as Frankenstein and Dr. Jekyll and Mr. Hyde, but its not so clear-cut in Freaks.

In the 1930s, audiences didnt want to confront difference and accept human variability, and so they condemned Freaks, Smith said.

The characters arent aesthetically conventional, but for over half the movie we see them as kind-hearted, normal people. In fact, the irony Browning presents is that for all of Cleopatras beauty she is so cold-hearted that shes willing to kill Hans for his money. The film languished for several decades until the 1960s when it was embraced by the counterculture as an example of oppression, injustice, and rebellion. And within the last few decades the movie has been the subject of fierce discussion by disabled advocates, critics, and movie lovers about whether its genius or exploitative.

It definitely exploits the sensationalistic thrills of the freak show, presenting these bodies as deviant and threatening, but only after it shows us that these performers are quite ordinary people, driven to defend themselves against supposedly normal individuals who prey on and harm them, Smith said.

But it also forces the viewer, more able-bodied than not, to confront the nature of difference and realize how we view those who are different, and disability by extension, has more to do with societal norms and our prejudices than the person themselves.

[Tod Browning] was a huckster. He had come from exploitation, Tommy Heffron, film and video artist and an Assistant Professorin the Scripps Howard School of Journalism and Communications at Hampton University, said. But for all of Brownings hucksterism, Heffron said the director still created empathy in his characters while simultaneously making a film so shocking it was banned in England for 32 years. More importantly, for Heffron especially, the fact that audiences are still talking about it 88 years later speaks volumes. Its something Pearson seconds, especially factoring in that it remains the only U.S. film to have a predominately disabled cast.

Freaks is divisive, its dated, but its also groundbreaking, entertaining, and frustrating. Have we necessarily improved when it comes to disability in horror? The answer is uncertain. But this Halloween season it might be worth diving deeper into the world of horror to find out the disability narratives underneath.

History of Coerced Sterilization in the United States – Teen Vogue

Posted on October 8, 2020 by Danzig

News broke last week of an official complaint filed against immigration officials alleging a pattern of hysterectomies without informed consent on women from a U.S. Immigration and Customs Enforcement (ICE) detention facility in Georgia. Dawn Wooten, the nurse who blew the whistle on the allegations of abuse, and who legal advocacy groups filed the complaint on her behalf, had worked at the privately-operated Irwin County Detention Center in Ocilla, Georgia, for three years. During that time, she alleged multiple hysterectomies were performed on Spanish-speaking immigrants, many of whom said they did not understand the procedure. ICE has denied the claims, the doctor accused of performing the procedures has denied the claims through attorneys, and the hospital where the procedures would have taken place, said it only has records showing that two hysterectomies were performed on those in immigration custody since 2017, according to the Washington Post.

While the cruelty of the allegations came as a shock to many, coerced sterilization is not unprecedented in the broader history of reproductive injustice and violence against people considered "undesirable" in the United Statesoften disabled and indigenous people, people of color, and immigrants.

Racism has been part and parcel of American reproductive healthcare from its beginning. J. Marion Sims, the man known as the "father of modern gynecology," exemplifies this. Sims garnered acclaim for groundbreaking gynecological surgical techniques that he perfected after performing dozens of experimental surgeries on enslaved Black women in Montgomery, Alabama, beginning in 1845. Sims operated on Black women without anesthesia, even though he used it during surgeries on white patients during the period. Sims's decision to operate on Black women without anesthesia went beyond a lack of care for the women; it was tied to pernicious assumptions that Black people were not susceptible to pain. "There was a belief at the time that Black people did not feel pain in the same way," explained Vanessa Northington Gamble, a physician and professor of medical humanities, in an interview with NPR in 2018. "Their pain was ignored," Gamble says. Baseless theories like these continue to inform modern medicine in measurable ways. Racial biases and false beliefs are associated with Black patients receiving less pain medication for broken bones and cancer than white patients, according to research published in 2016 by the National Academy of Sciences.

A generation after Sims built his career on the backs of Black women, the eugenics movement was growing popular in the United States. With it, States began to pass laws mandating compulsory sterilization for specific populations. The state of Indiana is widely considered to have adopted the world's first eugenic sterilization law in 1907, and similar laws were later adopted in 31 other states across the country during the 20th century. The target populations of these laws were defined in legal or pseudo-medical terms"imbeciles," the "feeble-minded"but the laws were deployed in ways that disproportionately victimized poor women and women of color.

Rather than pushing back on eugenic policies during the progressive era that ensued, physicians, legislators, and social reformers further legitimized their prejudiced pseudo-medical norms. American magnates like the Carnegie Foundation and John D. Rockefeller shelled out to fund projects at the Eugenics Record Office, a private research institute that openly supported sterilization as a solution to what it called "defective and delinquent classes of the community." In 1927, when the constitutional legality of compulsory sterilization was questioned in Buck v Bell, the Supreme Court also affirmed that permitting compulsory sterilization of "those who are manifestly unfit" did not violate the constitutional rights of those persons, by a vote of eight to one. Carrie Buck, the plaintiff, was classified at the time as "feeble-minded," but as has been noted, it was actually societal prejudice that earned her this unclear label. Justice Oliver Wendell Holmes, who authored the majority opinion in Buck v Bell, went so far as to claim that compulsory sterilization policies were "better for all the world." Rhetoric like this that framed eugenic sterilization as a positive public health strategy helped ensure the longevity and widespread impact of shameful coerced sterilization policies across the country.

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History of Coerced Sterilization in the United States - Teen Vogue

The ICE Detention Facility Sterilizations Are Nothing New in US History – Study Breaks

Posted on October 8, 2020 by Danzig

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Are we Nazi Germany? This is the incredulous response when people hear that an American detention facility has been accused of performing nonconsensual hysterectomies the surgical removal of the uterus on women. Because of the terror associated with Hitlers reign, people tend to connect any extreme systemic violence to that period of history. While it is certainly true that the human rights violations of Nazi Germany were abhorrent, there is just as much violent oppression throughout American history. In fact, the sterilization of women of color has been a huge problem in the United States since the 19th century. The sterilizations that took place at Irwin County Detention Center do not constitute a terrible exception; instead, such occurrences are the norm.

America is a country with a deeply racist past, built through the labor of slaves. While chattel slavery is the most obviously violent form that racism has taken throughout Americas history, BIPOC (Black, Indigenous, people of color) have faced oppression in a multitude of ways throughout the decades.

Often undergirding the rationale for racist oppression is eugenics, the belief that reproduction should be encouraged in certain desirable groups and discouraged in other undesirable groups. Of course, desirable, in most cases, refers to white, particularly white upper-class people. On the other hand, undesirable generally refers to people of color. Essentially, eugenics calls for the population of people of color to be reduced or at the very least not increased by any means necessary.

Even before the term eugenics was commonly known, plantation owners during American slavery controlled the reproductive lives of their female slaves. Enslaved women were often beaten to the point of infertility, and those who did carry out successful pregnancies were often separated from their children. As the field of eugenics became more popular, doctors and scientists tried different methods to discourage certain groups from reproducing while encouraging others.

In the early to mid 1900s, they frequently blocked upper-class white women from accessing birth control or voluntary hysterectomies, due to their desirable genetics. Around the same time, large numbers of Black women who visited hospitals left without their reproductive organs intact. These women almost never gave consent to the procedure, and were often not even notified that it was happening. After coming to the hospital for routine checkups or minor emergencies, hundreds of women left confused and irreparably harmed by doctors who were supposed to care for them.

According to the whistleblowers report, the women at the Irwin County Detention Center reacted in much the same way when asked about what had happened to them: confused and hurt. Many of the women at the facility visited an outside gynecologist who performed hysterectomies even when the womens medical issues did not call for the surgery. One woman explained that she went into the gynecologists office to have a cyst removed, but he performed a hysterectomy and she left without her uterus.

The gynecologist sterilized women at the facility in other ways as well. One section of the report describes the predicament of a woman who was scheduled to have her left ovary removed, but the gynecologist removed the right one mistakenly. He then went back in to correct the mistake by removing the left one. By the end of her time in the gynecologists office, she was infertile. Whether by medical incompetence or intentional harm, the gynecologist destroyed her reproductive future. At the time of the report, he had become so notorious among the women of the detention center for his sterilizations that he had been nicknamed the uterus collector.

In the world of medicine, patients must be fully informed about what a procedure entails before they can consent to it. As written in the report, the women who visited the gynecologist often expressed that they did not understand why they needed a hysterectomy. In the case of the first woman described above, she went in for a cyst removal and yet received a hysterectomy. Her doctors were not clear with regard to what procedure she needed and why. These women did not and could not have given proper informed consent.

If such gross negligence occurred at a hospital in a predominantly white, upper-class neighborhood, there would be severe and swift consequences for the doctors involved. Yet the Irwin County Detention Centers gynecologist was permitted to continue practicing. Presumably, he was allowed to mistreat these women and perform these sterilizations because, as immigrants and women of color, they are undesirable. Essentially, the Irwin County Detention Center facilitated the practice of eugenics by preventing women of color from reproducing.

There is no doubt that the information coming from the Irwin County Detention Center is disturbing and horrifying. However, it is important to note that none of the atrocities detailed in the report are new or different from what has been happening all over America for centuries. In the last 100 years alone, tens of thousands of Black, Latina and Indigenous women have endured forcible sterilizations because people in power do not believe that they should be able to reproduce. The actions of the gynecologist at the Irwin County facility are not a blip, or an exception; they are part of a long pattern in the history of eugenics. Yet, perhaps the outrage that people are demonstrating in reaction to the whistleblowers report of the detention center sterilizations is exactly what is needed; it is, above all, vital that those fighting for justice never become numb to the racist atrocities of America.

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The ICE Detention Facility Sterilizations Are Nothing New in US History - Study Breaks

Trump’s ‘racehorse theory’ is divisive and dangerous – SC Times

Posted on October 8, 2020 by Danzig

Patrick Henry, Times columnist Published 5:01 p.m. CT Oct. 2, 2020

On Sept. 18, Donald Trump was in Bemidji,153 miles from here, but we were on his mind.

"From St. Paul to St. Cloud, from Rochester to Duluth, and from Minneapolis, thank God we still have Minneapolis, to right here, right here with all of you great people, this state was pioneered by men and women who braved the wilderness and the winters to build a better life for themselves and for their families. They were tough and they were strong."

Standard political oratory salute the audience with the narrative they like to tell about themselves (though thank God we still have Minneapolis refers back to his preposterous claim, earlier in the speech,that if Joe Biden wins, people will be saying of that city, It used to be over there. Its all ashes now).

Patrick Henry(Photo: Times photo)

But Trump didnt stop there. What he said next was not just a dog whistle, but as one commentator has noted, a train whistle.

You have good genes. You know that, right? You have good genes. A lot of its about the genes, isnt it? Dont you believe? The racehorse theory you think was so different? You have good genes in Minnesota. (The voice recognition software at rev.com, where the transcription of the speech can be found, misheard and produced resource theory. In the video of the speech its perfectly clear: racehorse.)

The audience at Bemidji Aviation Services was overwhelmingly white. Standing right behind Trump were people who are looking for our votes: Rep. Tom Emmer, for CD6;Michelle Fischbach, for CD7;Jason Lewis, for U.S. Senate. When the president made his genes remark, all three of them smiled approvingly and Fischbach applauded while grinning.

Earlier in the speech Trump had detonated his usual blast at recent arrivals to Minnesota. Dripping with sarcasm, he said, Lots of luck. Youre having a good time with the refugees. He then, of course, singled out Somalis.

By the time he got to genes, his meaning couldnt have been more evident. Its white people who are tough and strong, who deserve to build a better life for themselves and for their families. People of color are a threat.

Do we believe in the gene thing? I mean, I do, Trump is on tape saying on another occasion. And he also said this: "All men are created equal. Well, it's not true. Because some are smart; some aren't."

Youd think that conservative Americans, who pledge allegiance to the Founders, would recoil from such a blatant contradiction of a central theme of the Declaration of Independence.

Of course some people are smarter than others, but Thomas Jeffersons point is that in all matters of public policy, everyone is on an equal footing. IQ has nothing nothing to do with it.

Donald Trumps adherence to eugenics the racehorse theory of breeding for people is among the scariest of his authoritarian inclinations. We need to be wary of it the way Germans needed to be wary in the early 1930s. Its not just that You [white Minnesotans] have good genes. Its the clear implication that other peoples genes are bad, which easily slips over into dangerous meaning such people must be kept out, deported, eliminated one way or another.

Trumps gene theory, which grounds his admiration for the pioneers who braved the wilderness and the winters, spills over into his convictions about education.

He has recently condemned the New York Times 1619 Project, which brings into focus the central role of slavery in American history. He proposes withholding federal funding from California until it jettisons the 1619 Project from school curricula. He has decried what he calls ideological poison, that if not removed will dissolve the civic bonds that tie us together,and has said that under his plan, Our youth will be taught to love America with all of their heart and all of their soul.

To say that the only way youth will love America with all of their heart and all of their soul is to be taught exclusively about the good things the good genes did to be Minnesota specific: overlooking the decimation of Native peoples; forgetting the Duluth lynching; disregarding the research of St. Cloud State professor Christopher Lehman in Slaverys Reach: Southern Slaveholders and the North Star State is to treat youth (and those of us no longer young, too) with condescension and contempt. The civic bonds that tie us together are threatened far more by Trumps 20,000+ documented lies than by the truth about our history.

Recent Times interviews with local candidates were instructive, but the questions thrown were mostly Wiffle Balls. Given Trumps total takeover of the GOP, every Republican candidate at every level, state and federal, must be asked on the record Do you endorse or repudiate Donald Trumps racehorse theory? There is no middle ground.

This is the opinion of Patrick Henry, retired executive director of the Collegeville Institute for Ecumenical and Cultural Research and author of the forthcoming Flashes of Grace: 33 Encounters with God. His column is published the first Sunday of the month.

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Trump's 'racehorse theory' is divisive and dangerous - SC Times

Baptist Home podcast series spotlights ‘Biblical Perspectives on Aging’ – The Pathway

Posted on October 8, 2020 by Danzig

IRONTON The Baptist Home launched a new podcast this month to spotlight what Gods Word says about aging.

For more than 107 years, The Baptist Home has been known for providing compassionate, Christlike care to the aging. More recently, The Baptist Home has been working to share their time-earned insights on aging issues by offering many educational resources for churches, pastors, caregivers, and other agencies focused on improving the quality of life for the aging. This month marks a new frontier for the ministry of The Baptist Home with the launch of their new podcast, Biblical Perspectives on Aging.

Based on Psalm 71, the Biblical Perspectives on Aging weekly podcast will feature one-on-one conversations with Christian aging experts from The Baptist Home and other industry leaders who will fearlessly apply biblical truths to difficult and sometimes controversial aging issues related to moral relativism, eugenics, ageism, sanctity of life, and ethics and aging.

The podcasts first guest, Ben Mitchell, retired Graves Professor of Moral Philosophy at Union University in Tennessee and author of Ethics and Moral Reasoning, discusses moral relativisms impact on ethics and aging. In the interview, Mitchell was enthusiastic about the new podcast saying, Im a Boomer. There are many of us who will have to learn both what it means to honor our fathers and mothers and what it means to have our children care for us. With a growing aging population which is living longer, but not always more healthily, the issues are alive and more urgent in many cases.

Baptist Home President Rodney Harrison, former Dean of Postgraduate Studies at Midwestern Baptist Theological Seminary, spearheaded the launch of the podcast and is passionate about addressing resident rights and aging issues. When asked about his goals for the podcast, Harrison shared, Our objective is to bring together the foremost voices from the academy and practice to speak to the issues of aging from a biblical worldview. The podcast is a resource for all who hold to the sanctity of life to natural death, be they pastors, students, the elderly or children of aging parents.

Andy Braams, pastor, adjunct professor at Midwestern Baptist Theological Seminary, and host of the weekly podcast, Christian Educator Weekly, also serves as the host for Biblical Perspectives on Aging and is excited about the podcast saying, As a middle-aged adult with aging family members and as a pastor of a church with many senior adults, this podcast is not just an opportunity to serve others by hosting, it is a personal opportunity to learn and grow so I can better serve the aging in my life. The initial interviews I have conducted have already been a tremendous encouragement to me personally, and I look forward to continuing to gain insights to benefit everyone who may listen to this podcast. And although my voice serves as host for this podcast, my commitment is to ask questions from each guest to enable and encourage all of us to truly become a voice for the aging.

The Baptist Home was established in 1913 and has four campuses across the state of Missouri, in Arcadia Valley (Ironton), Ashland, Chillicothe, and Ozark. The Baptist Home provides continuum of care retirement communities in a Southern Baptist, faith-based setting and is unlike many long-term care facilities in that it operates without direct Medicare or Medicaid reimbursement. Residents living in assisted and nursing units pay for as much of their cost as they are able, but if funds are depleted The Homes benevolent program enables them to receive the same care and services as private pay individuals for the rest of their lives. Residents who are able to live in the active living apartments do not receive benevolent support but do have access to long-term care services should they require higher levels of care.

For more information about independent living, assisted living, or nursing care services, call (866) 454-2709 or visit http://www.thebaptisthome.org. To listen to Ben Mitchells and other aging experts full interviews, download the Biblical Perspectives on Aging podcast on iTunes, Spotify, iHeartRadio, Google Podcasts, or listen via the podcasts landing page, http://www.biblicalperspectives.org. Interviews are also available for viewing on YouTube at TheBaptistHome1.

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Baptist Home podcast series spotlights 'Biblical Perspectives on Aging' - The Pathway

ZEISS partners with Microsoft for better patient care through data-driven healthcare and to enhance quality and efficiency in manufacturing – Stories…

Posted on October 8, 2020 by Danzig

ZEISS provides quality assurance solutions delivering meaningful information on parts dimensions, component behavior and defect detection (ZEISS).

Oberkochen, Germany, and Redmond, Wash., October 7, 2020 Today, ZEISS Group and Microsoft Corp. announced a multi-year strategic partnership to accelerate ZEISS transformation into a digital services provider that is embracing a cloud-first approach. By standardizing its equipment and processes on Microsoft Azure as its preferred cloud platform, ZEISS will be able to provide its customers with enhanced digital experiences, address changing market needs more quickly and increase its productivity.

Leveraging Azure high-performance compute, AI, and IoT services, ZEISS will work with Microsoft to provide original equipment manufacturers (OEMs) with new quality management solutions, enable microchip manufacturers to build more powerful, energy-efficient microchips, and deliver new digital healthcare solutions for improved clinical workflows, enhanced treatments, and device maintenance. Furthermore, ZEISS will create a seamless experience for its customers through one digital platform and manage all digital ZEISS products through one cloud-native platform to enhance continuous and agile product development.

Microsofts datacenter regions around the globe help meet the regional needs of ZEISS customers while delivering against highest security, privacy and resiliency standards. ZEISS will build on Microsofts experience in software development to grow its own digital capabilities while helping Microsoft enhance its customer-driven product innovation through deep industry insights.

Connected quality platform drives industrial efficiency

Initially, ZEISS will enable its solutions in the Industrial Quality & Research segment to be run on a connected quality platform built on Azure, allowing direct integration into the customers production process. The platform will help gain business insights and foster collaboration across domains, assets and processes that have traditionally been managed in siloed, proprietary systems.

ZEISS provides metrology and quality assurance solutions delivering meaningful information on parts dimensions, component behavior and defect detection. Real-time and large-scale analysis of data that is collected at all stages of the manufacturing process is key to efficient and effective quality assurance, tightly integrated with todays and tomorrows IoT-enabled production processes.

Quality is also a key objective of a new ZEISS audit trail solution, initially focused on highly regulated manufacturing industries, such as medical technology which is particularly sensitive to quality assurance. The solution will allow customers to identify root causes and react quickly on quality issues to reduce down-time and keep productivity up. The software will allow customers to track, trace, visualize and analyze process and product data with the help of Azure AI services to identify failure root causes more quickly.

High-performance computing enables more powerful, energy-efficient microchips

The ZEISS Semiconductor Manufacturing Technology segment (SMT) enables chip manufacturers worldwide to produce smaller, more powerful, more affordable and more energy-efficient microchips which are used in essentially every technical device today. Optical lithography applying deep ultra violet (DUV) and even extreme ultra violet (EUV) light allows to manufacture chips at structure sizes 4,000 times thinner than a human hair or, more scientifically, at single-digit nanometer sizes. Lithography systems include extremely complex and ultra-precisely shaped aspherical lenses (DUV) and mirrors (EUV). ZEISS SMT is a technological leader in this field of the semiconductor industry. Especially the development of next-generation, so-called High-NA EUV systems requires the most complex optical calculations calling for massive compute power.

Using Azure high-performance compute capabilities, ZEISS is now able to dynamically burst to the cloud to complement its sophisticated on-premises high-performance computing cluster and handle peaks more efficiently. Such capabilities enable the development of future leading-edge EUV lithography tools. Optical lithography and especially EUV technology advancements are driving digitalization and are keeping Moores Law alive for many years to come.

Data-driven healthcare solutions improve patient care

ZEISS Medical Technology provides comprehensive solutions for ophthalmic professionals and microsurgeons, consisting of devices, implants, consumables and services. Through the partnership, ZEISS will connect its medical technology to Microsofts cloud and leverage Azure AI and IoT technologies for new digital services such as improved clinical workflows, enhanced treatments, and device maintenance in a secure environment that enables compliance with regulatory requirements in the health industry. These solutions will help improve the quality of life of patients and drive progress, efficiency and access to healthcare.

Cloud-native ZEISS platforms enhance customer experience and boost internal productivity

ZEISS Digital Innovation Partners and ZEISS Corporate IT already partner very closely with Microsoft and will further intensify and scale this partnership going forward. Together with Microsoft, ZEISS Corporate IT has developed a cloud-native digital integration platform running on Azure to integrate all customer-facing digital ZEISS products into ZEISS Enterprise IT. ZEISS can apply the latest technology developments and share its manufacturing and medical technology insights at the same time to support Microsofts customer-driven product innovations.

ZEISS Digital Innovation Partners builds on these integration capabilities and uses Azure cloud and DevOps services to enable a seamless and coherent end-to-end digital journey for ZEISS customers, for example quality experts and eyecare professionals. The digital customer interaction platform MY ZEISS will integrate various customer-facing solutions into one platform so that customers can easily manage their Zeiss touchpoints through one central web application.

As a global leader in optics and optoelectronics, ZEISS is committed to digitally enable its customers business models, products, and services. We are proud to join forces with Microsoft in our quest to apply precision optics, IoT capabilities, artificial intelligence and machine learning to the most demanding processes in healthcare and manufacturing, says Dr. Karl Lamprecht, ZEISS President and CEO. Improving the patients life and doctors work and driving industrial quality assurance in the production process have always been top of mind for us. We are taking our expertise to the next digital level together with Microsoft, a leading innovator and provider of digital technologies.

Zeiss is driving innovations across industries to improve the quality of individual lives and create industrial efficiencies by overcoming data silos and integrating digital experiences, said Scott Guthrie, Executive Vice President Cloud + AI at Microsoft. Harnessing the power of Microsofts cloud, AI and IoT services, ZEISS is transforming into a leading digital services provider.

ZEISS and Microsoft will also explore opportunities to collaborate and co-innovate across other ZEISS segments and units including Consumer Markets, ZEISS Ventures and Corporate Research and Technology.

About ZEISS

ZEISS is an internationally leading technology enterprise operating in the fields of optics and optoelectronics. In the previous fiscal year, the ZEISS Group generated annual revenue totaling more than 6.4 billion euros in its four segments Semiconductor Manufacturing Technology, Industrial Quality & Research, Medical Technology and Consumer Markets (status: 30 September 2019).

For its customers, ZEISS develops, produces and distributes highly innovative solutions for industrial metrology and quality assurance, microscopy solutions for the life sciences and materials research, and medical technology solutions for diagnostics and treatment in ophthalmology and microsurgery. The name ZEISS is also synonymous with the worlds leading lithography optics, which are used by the chip industry to manufacture semiconductor components. There is global demand for trendsetting ZEISS brand products such as eyeglass lenses, camera lenses and binoculars.

With a portfolio aligned with future growth areas like digitalization, healthcare and Smart Production and a strong brand, ZEISS is shaping the future of technology and constantly advancing the world of optics and related fields with its solutions. The companys significant, sustainable investments in research and development lay the foundation for the success and continued expansion of ZEISS technology and market leadership.

With over 31,000 employees, ZEISS is active globally in almost 50 countries with around 60 sales and service companies, 30 production sites and 25 development sites. Founded in 1846 in Jena, the company is headquartered in Oberkochen, Germany. The Carl Zeiss Foundation, one of the largest foundations in Germany committed to the promotion of science, is the sole owner of the holding company, Carl Zeiss AG.

Further information at http://www.zeiss.com

About Microsoft

Microsoft (Nasdaq MSFT @microsoft) enables digital transformation for the era of an intelligent cloud and intelligent edge. Its mission is to empower every person and every organization on the planet to achieve more.

Microsoft Media Relations

WE Communications for Microsoft(425) 638-7777rrt@we-worldwide.com

New Funding to Bring Mental Health Care to Homeless Shelters, Encampments – WTTW News

Posted on October 8, 2020 by Danzig

The city of Chicago on Tuesdayannounced $8 million in grants to 32 organizations to expand mental health care servicesat 20 clinics around the city. The move comes after years of debate over city-run clinics that were shut down during the administration of former Chicago Mayor Rahm Emanuel. But Tuesdays announcement also included news about mental health services for some of Chicagos most vulnerable residents.

The city plans to set aside $1.6 million a year in federal funds to provide mental health services to Chicagoans experiencing homelessness. The money will go to Lawndale Christian Health Center and Heartland Alliance Health to work with people living in encampments and in shelters.

Were already there in the shelters, but this will allow us to expand to additional shelters, said Ed Stellon, executive director of Heartland Alliance Health. It will also allow us to add more services, especially a lot more behavioral health services.

Its part of a holistic approach, addressing not just mental and physical health care, but other factors that play into health, like safety, housing and access to food.

Behavioral health is a big driver of all of this, Stellon said. If Im also hearing voices, or Im incredibly sad and depressed and down it might not be the priority to take care of myself.

(WTTW News)

Even when they cant serve people in person, Heartland wants to use some of the funding on telehealth services.

We can meet that need, even if we have to be remote because of the pandemic, or just because were not there that day, Stellon said.

Heartland works in about 20 shelters on the citys North and South sides. Lawndale Christian Health Center works in about a dozen West Side shelters. LCHC is also planning to use the money to bring in behavioral health and primary care providers and to work on COVID-19 infection control and testing.

Its really going to be an all-out effort to see how we can take care of some of the most vulnerable that we have in our society, said Dr. Thomas Huggett, director of mobile health for Lawndale Christian Health Center.

Its also a way to address the inequities that have long plagued Chicago. Huggett says when the city housed people at high risk during the pandemic in hotel rooms, 70% were African American. It really is a racial equity issue, he said. We want to make sure that folks experiencing homelessness really get the services that they need and deserve.

Working on the West Side, Huggett is keenly aware of the epidemic within the pandemic: opioid overdose deaths, the vast majority of which are related to fentanyl, a synthetic opioid that is many times stronger than morphine.

As we are improving our psychiatry care, we also want to improve our care of folks who are suffering with opioid use disorder to make sure they get the medications and the support that they really need in their recovery process, Huggett said.

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New Funding to Bring Mental Health Care to Homeless Shelters, Encampments - WTTW News

Healthcare companies cashing in on financing vehicle boom – Modern Healthcare

Posted on October 8, 2020 by Danzig

While RSM's analysis isn't broken down by industry, healthcare has clearly been a big beneficiary. On Tuesday, Medicare Advantage startup Clover Health announced it will go public through a $3.7 billion merger with the SPAC Social Capital Hedosophia Holdings Corp. III. Last week, telehealth provider Hims, Inc. said it will go public through a $1.6 billion combination with Oaktree Capital Management, also a SPAC. In July, acute-care telemedicine provider SOC Telemed revealed it, too, will go public using SPAC Healthcare Merger Corp. in a combination worth $720 million.

The investment bank Jefferies said Tuesday there have been 16 SPAC transactions focused on the healthcare industry so far 2020.

In their IPO paperwork, SPACs outline the type of company they're looking to buy, such as health IT or life sciences. Federal securities law prohibits them from naming specific targets or reaching out to target companies before they go public.

The shift to telehealth during the COVID-19 pandemic has shown digital health technology to be indispensable and has triggered a wave of renewed interest among investors.

Countless patients and providers have used digital health services for the first time during the pandemic, and have realized it can work in many cases, Wolf said. Other aspects of patients' lives, such as shopping, school and dining are customized and convenient.

"Except perhaps the most important part of our lives," he said. "People are recognizing this and pouring money into it."

There's a number of reasons behind the recent rise in SPAC IPOs. Perhaps the biggest is the pandemic-induced volatility in the stock market and leveraged loans market. With many companies struggling to raise capital the old-fashioned way, they've turned to SPACs.

The typical IPO process involves a lot of risk, cost and time. First off, there's a drawn-out underwriting process where bankers price the shares. Executives then hit the road to charm investors. After all that, they could have a bad day when their stocks officially hit the market, said Albert Vanderlaan, a partner in Orrick's technology companies and capital markets groups.

"They've effectively de-risked and taken the IPO book-building process of out of it without having to go through that level of uncertainty that's attributed to the capital markets for an IPO," he said.

With a SPAC, the process of going public is faster and quieter, Wolf said.

"There's a lot of uncertainty with the traditional IPO process," he said. "But with the SPAC, you've already raised all this money and you just come up to me and say, 'We'll buy you.' It's more of a private conversation."

Another factor is the uptick in public market valuations. While previously there wasn't much added benefit to going through the IPO process, valuations being at an all-time high means more companies want to tap into that, Watson said. The temporary closure of the leveraged loans market in the second quarter also made it very difficult to execute private equity buyouts, she said.

Another plus for SPACs is the fact that more reputable names are getting involved, as opposed to the 1990s and early 2000s, Vanderlaan said. Prominent hedge fund manager Bill Ackerman, for example, announced a $4 billion IPO for his SPAC, Pershing Square Tontine Holdings, Ltd., in July. And private equity firm Apollo Global Management's SPAC, Apollo Strategic Growth Capital, filed for an IPO worth $750 million last month.

Investors tend to feel more secure putting their money in SPACs because SPACs are required to spend the money raised through their IPOs within two years or return it to their investors, said John Washlick, a shareholder with Buchanan, Ingersoll & Rooney. They're also limited in how they can spend the money.

That said, investors still need to research the executives behind any SPAC they consider buying into, Washlick said. Investors should make sure those involved have good track records, especially in the industry they're targeting.

"Raising money is one thing, but what are you going to do with it?" he said. "How are you going to spend it responsibly so that my $10 becomes more than $10? I'm looking for a return on it, not to give it back."

Due diligence is equally important for companies looking at merging with SPACs. Experts recommend companies get a capital commitment and assurance they'll be able to keep their management team.

Many SPACs are subsidiaries of private equity firms. Much like private equity buyouts, there is wide variation in how much involvement the new owners will have in their companies, Watson said. Today's SPACs tend to be led by industry insiders who have expertise in the areas they're targeting, which can be a boon to the companies they buy. "Some are very hands on," Watson said. "Some make the investment and sit in the background."

For private equity-owned SOC Telemed, which provides telemedicine to more than 500 hospitals in 47 states, having access to the healthcare industry expertise within Healthcare Merger Corp.'s executive ranks was one draw behind the deal, said Paul Ricci, SOC Telemed's interim CEO. Another obvious one was the rapid access to capital, he said.

"Virtualized care became an important element of dealing with the pandemic and the pandemic revealed to people how flexible this class of care delivery is," Ricci said, "and therefore I think there is an accelerated focus on investments behind it."

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Healthcare companies cashing in on financing vehicle boom - Modern Healthcare

Health care is already benefiting from VR – The Economist

Posted on October 8, 2020 by Danzig

Oct 1st 2020

A SOLDIER WATCHES a car approaching a check-point on a hot, dusty road. As the vehicle slows to a stop in front of him, he asks the driver to get out and show his identification. Seconds later, the rattle of gunfire pierces the air, followed by a bang and an intense, searing flash. Knocked to the ground and scrambling to safety, the soldier turns to see a flaming wreck where the car had been just moments before.

The scene pauses. A voice in the soldiers ear says: Lets rewind the simulation to the seconds just before the explosiondescribe exactly what happened. The voice is a therapist, speaking to a veteran who is placed in a virtual environment. The simulation they are watching has been modelled on the veterans own experiences in a war zone, events that have led him to develop post-traumatic stress disorder (PTSD).

This is the Bravemind system, developed in 2005 by Albert Skip Rizzo and Arno Hartholt, experts in medical virtual reality at the University of Southern California, to treat soldiers returning home from the wars in Iraq and Afghanistan. Immersed in a virtual environment that mimics their traumatic experiences, veterans narrate the scene to a therapist, who can control how the events in the simulation unfold. The sounds, time of day and number of people or vehicles on the scene can all be customised. Over several sessions, the veteran is exposed to increasingly intense scenarios that get closer to reliving the memory of the original trauma. The aim of the therapy is to steadily dampen the veterans negative reactions to the memory. Bravemind is now used in around 60 treatment centres around the world.

Bravemind builds on a well-established psychological technique known as exposure therapy, in which people are brought to face their fears in a controlled way. VR adds a way of creating detailed, carefully tuned scenarios that can elicit different levels of fear. It works because, even when people know they are watching computer graphics, their brains nonetheless react to virtual environments as if they were real.

Someone who is afraid of heights will find that their heartbeat quickens and palms get clammy even if the precipitous drop they can see is clearly a computer graphic in a VR headset. This is because the brains limbic system, which controls the fight-or-flight response, activates within milliseconds in response to potential threats, long before the logical part of the brainwhich knows the VR experience is not physically realcan intervene.

Scientists have used VR systems to create and control complex, multi-sensory, 3D worlds for volunteers in their labs since the 1990s. Rather as an aircraft simulator can train and test pilots in a wide variety of settings, virtual worlds allow psychologists and neuroscientists to watch peoples cognitive and emotional responses in situations that are difficult to set up or control in the real world. But the technology has usually been too clunky and expensive for widespread clinical use.

That has started to change, thanks to the falling costs of computing and the increasing capability of the new generation of VR systems. At the same time, the scientific evidence base for the clinical uses of VR has grown. The technology has been successfully applied to tackling schizophrenia, depression and phobias (including the fear of flight, arachnophobia, social anxiety and claustrophobia), and reducing pain in cancer patients undergoing chemotherapy. It can help train spatial-navigation skills in children and adults with motor impairments and assist in rehabilitation after a stroke or traumatic brain injury. The kit can also be used to monitor people and identify medical problems: VR has been used to diagnose attention-deficit hyperactivity disorder (ADHD) and Parkinsons and Alzheimers diseases.

Though each condition is unique, researchers have found common ground rules for designing virtual experiences that work: therapists need to be in control of the scene, deciding what a patient sees and hears in order to modify the strength of the fearful stimulus; the therapy works best when the patient is embodied within an avatar, rather than floating, so that they feel present within the scene; and the patient needs agency, so that they can leave the scene if it gets too overwhelming for them. All this adds up to giving the patient the illusion of control and makes the VR experience feel psychologically real.

In some cases the therapeutic regime is so robust that, instead of a real-life therapist guiding a patient through an anxiety-inducing simulation, an animated avatar can do the job instead. A clinical trial showed that such an automated system, designed by Daniel Freeman, a psychiatrist at the University of Oxford, helped people reduce their fear of heights. In the simulation, a virtual counsellor guided patients up a virtual ten-storey office complex, where the upper floors overlooked a central atrium. At each floor, the counsellor set the patient tasks designed to test and help them manage their fear responses, such as walking to the edge of a balcony while the safety barrier was lowered or riding on a moving platform over the space above the atrium.

Dr Freeman found that six sessions of virtual, automated therapy over two weeks significantly reduced peoples fear of heights, compared with people who had no therapy. A similar automated virtual therapy for arachnophobia, developed by Philip Lindner at Stockholm University, helped patients eventually touch spiders. The reduction in fear was still apparent when the participants were followed up a year later.

For doctors, virtual environments also provide a risk-free way to practise important procedures. Surgeons operate in high-pressure environments with a lot of cognitive demands. Youve got to learn very rapidly, and youve got to make decisions under time pressure, with millimetre precision, says Faisal Mushtaq, a cognitive neuroscientist at the University of Leeds in England.

Practising with computer simulations can help. In the NeuroVR system, developed by a group of Canadian hospitals and universities, surgeons can use MRI scans from their patients to rehearse removing brain tumours before going in with the knife for real. The surgeon gets a 3D view of the tumour on screens and practises cuts and movements by manipulating instruments attached to a robotic arm that responds with haptic feedback. This allows users to sense whether they are cutting through hard or soft material, or through a tumour versus healthy tissue. An advantage of such a system is that, once a doctor is trained, the technology can be used to perform remote surgery. Both virtual training and remote procedures for patients are useful at a time when covid-19 has forced health-care systems around the world to keep doctors and non-emergency patients apart.

When surgeons try to reconstruct a limb, a key problem is identifying important blood vessels that need to be protected during the surgery. In the past a surgeon would try to identify those vessels using an ultrasound probe, but the process is lengthy and imprecise. So James Kinross, a consultant surgeon at Imperial College London, has been experimenting with Microsofts HoloLens, an augmented-reality headset, which can overlay computer-generated text and images onto the real world.

Dr Kinross has used a CT scan of a patients limb to highlight the most important blood vessels. He reconstructed that scan as a 3D model in Unity, a games engine. The HoloLens then overlaid that simulation onto the patients real limb in the operating theatre during treatment. What it meant was that the surgeon could immediately visualize, and very precisely map, the anatomy of these blood vessels, and very quickly identify them and protect them, says Dr Kinross, who has also used this technique during cancer surgery to help surgeons identify and protect healthy tissue. The adoption of the technology has proceeded very smoothly, he adds, because it is easy to learn and provides an immediate and very obvious advantage to the clinician.

He thinks the technology could be pushed much further and wants to try some real-time collaboration with his colleagues during a surgical procedure. So if youre running an operation thats challenging, or you want to have a discussion with a peer, its very easy to do and they can have a first-person view of what youre looking at, he says.

Medical uses for computer simulations are promising, but how useful they are will take time to evaluate. That will require robust clinical trials and discussions of frameworks for data protection on technologies that could, if their potential is achieved, become a new type of medical device.

We dont want to poison the well, says Dr Mushtaq. We dont want to put out systems that are ineffective, that are going to cost our health-care system, and that are going to negatively impact on the growth of this sector. His research focuses on closing some of those knowledge gaps by examining how the lessons users learn from practising on virtual simulators translate into skills in the real world. Surprisingly, the fidelity of the images to real surgery is not so important. Something can look very, very, flashyits got all the blood spewing everywhere and so on, he says. But it doesnt necessarily translate to better learning.

Defining the validity of a simulator can take several forms. The most basic is face validity, which reflects how well a simulation looks like the task in the real world. Construct validity is a way of comparing performance differences on the simulation between experts and novices. Finally, predictive validity is most useful, because it measures how well a persons performance on a simulator predicts their ability to do the same task in the real world.

This can also be used to flag when learners are struggling, and provide early intervention and support. Dr Mushtaq and his colleagues have demonstrated both construct and predictive validity for the Nissin (formerly Moog) Simodont dental-surgery simulator, used by the University of Leeds to train its students. In research published in 2019, they found that scores on the simulator predicted someones performance in a clinic two years later.

Video-game engines have made face validity easier to achieve for simulators. The next step is to measure construct and predictive validity more robustly. Unfortunately, precious little of this kind of validation work is undertaken by academics or companies selling simulators. To help grease the wheels and encourage researchers to build a body of knowledge, Dr Mushtaq and his colleagues recently created a set of tools and protocols that streamline human-behaviour research and make use of the Unity game engine as a platform. This Unity Experiment Framework takes care of the tedious programming stepsdownloading files that track all of a users movements, for example, or anonymising participantsneeded to turn the game engine into an environment optimised for studying people.

Mark Mon-Williams, a cognitive psychologist at the University of Leeds who has worked with VR for more than two decades, reckons simulated worlds have huge potential for improving education and physical and mental health. But if youre going to make the most of that powerful set of tools, he says, then use the scientific process to ensure that its done properly.

This article appeared in the Technology Quarterly section of the print edition under the headline "Getting better"

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Health care is already benefiting from VR - The Economist

Health Care: The Best and the Rest | by David Oshinsky – The New York Review of Books

Posted on October 8, 2020 by Danzig

Which Country Has the Worlds Best Health Care?

by Ezekiel J. Emanuel

PublicAffairs, 453 pp., $30.00

Bow your heads, folks, conservatism has hit America, The New Republic lamented following the 1946 elections. All the rest of the world is moving Left, America is moving Right. Having dominated both houses of Congress throughout President Franklin Roosevelts three-plus terms in office (19331945), Democrats lost their majorities in a blowout. Some blamed it on the death of FDR, others on the emerging Soviet threat or the bumpy return to civilian life following World War II. The incoming Republican Class of 46 would leave a deep mark on history; its members, including Californias Richard Nixon and Wisconsins Joseph McCarthy, were determined to root out Reds in government and rein in the social programs of the New Deal.

One issue in particular became fodder for the Republican assault. In 1945 President Harry Truman had delivered a special message to Congress laying out a plan for national health insurancean idea the pragmatic and immensely popular FDR had carefully skirted. As an artillery officer in World War I, Truman had been troubled by the poor health of his recruits, and as chairman of a select Senate committee to investigate the defense program during World War II, his worries had grown. More than five million draftees had been rejected as unfit for military service, not counting the 1.5 million discharged for medical reasons following their induction. For Truman, these numbers went beyond military preparedness; they spoke to the glaring inequities of American life. People with low or moderate incomes do not get the same medical attention as those with high incomes, he said. The poor have more sickness, but they get less medical care.

Truman proposed federal grants for hospital construction and medical research. He insisted, controversially, not only that the nation had too few doctors, but that the ones it did have were clustered in the wrong places. And he addressed the principal reason that forced so many Americans to forgo vital medical care: They cannot afford to pay for it.

The facts seemed to bear him out. Close to half the counties in the United States lacked a general hospital. Government estimates showed that about $11 million was spent annually on new treatments and cures for disease, as opposed to $275 million for industrial research. Though the nation claimed to have approximately one physician per 1,500 people, the ratio in poor and rural counties regularly dipped below one per 3,000, the so-called danger line. On average, studies showed, two thirds of the population lacked the means to meet a sustained health crisis.

The concept of government health insurance was not entirely new. A few states had toyed with instituting it, but their intent was to replace wages lost to illness or injury, not to pay the cost of medical care. Trumans plan called for universal health insuranceunlike the Social Security Act of 1935, which excluded more than 40 percent of the nations labor force, mostly agricultural and domestic workers. Funded by a federal payroll tax, the plan offered full medical and dental coverageoffice visits, hospitalization, tests, procedures, drugsto all wage and salary earners and their dependents. (Needy persons and other groups were promised equal coverage paid for them by public agencies.)

People would be free to choose their own doctors, who in turn could participate fully, partly, or not at all in the plan. Private health insurance programs would continue to operate, with policyholders required to contribute to the federal system as wella stipulation the president compared to a taxpayer choosing to send a child to private school. What I am recommending is not socialized medicine, Truman insisted. Socialized medicine means that all doctors work as employees of government. The American people want no such system. No such system is here proposed.

It did him no good. At the first Senate hearing on the proposal, Ohios Robert A. Taft, a perennial presidential candidate known to his admirers as Mr. Republican, denounced it as the most socialistic measure that this Congress has ever had before it. A shouting match ensued, with one Democrat warning Taft to shut your mouth up and get out of here. Taft retreated, but not before vowing to kill any part of the plan that reached the Senate floor.

Taft was not without allies. A predictable coalition soon emerged, backed by pharmaceutical and insurance companies but directed by the American Medical Association, which levied a $25 political assessment on its members to finance the effort. At its crudest, the campaign pushed a kind of medical McCarthyism by accusing the White House of inventing ways to turn a brave, risk-taking people into a bunch of dainty, steam-heated, rubber-tired, beauty-rested, effeminized, pampered sissieseasy pickings for the nations godless cold war foe. UNAMERICAN SYSTEM BLUEPRINTED IN THE KREMLIN HEADQUARTERS OF THE COMMUNIST INTERNATIONALE, read one AMA missive describing the origins of Trumans plan.

Precious freedoms were at stake, Americans were told: when the president claimed that medical choices would remain in private hands, he was lying; federal health insurance meant government control; decisions once made by doctors and patients would become the province of faceless bureaucrats; quality would suffer and privacy would vanish. Skeptics were reminded of Lenins alleged remarklikely invented by an opponent of Trumans heath planthat socialized medicine represented the keystone to the arch of the socialized state.

The economist Milton Friedman once described the AMA as perhaps the strongest trade union in the United States. It influenced medical school curriculums, limited the number of graduates, and policed the rules for certification and practice. For the AMA, Trumans proposal not only challenged the professions autonomy, it also made doctors look as if they could not be trusted to place the countrys needs above their own. As a result, the AMA ran a simultaneous campaign congratulating its members for making Americans the healthiest people in the world. The existing system worked, it claimed, because so many physicians followed the golden rule, charging patients on a sliding scale that turned almost no one away. If the patient was wealthy, the fee went up; others paid less, or nothing at all. What was better in a free society: the intrusive reach of the state or the big-hearted efforts of the medical community?

Given the stakes, the smearing of national health insurance was not unexpected. What did come as a surprise, however, was the palpable lack of support for the idea. For many Americans, the return to prosperity following World War II made Trumans proposal seem less urgent than the sweeping initiatives that had ended the bread lines and joblessness of the Great Depression. Even the Democratic Partys prime constituencyorganized laborshowed limited interest. During the war, to compensate workers for the income lost to wage controls, Congress had passed a law that exempted health care benefits from federal taxation. Designed as a temporary measure, it proved so popular that it became a permanent part of the tax code.

Unions loved the idea of companies providing health insurance in lieu of taxable wages. It appeared to offer the average American the sort of write-off reserved for the privileged classes, and indeed it did. Current studies show that union members are far more likely to have health insurance and paid sick leave than nonunion workers in the same industry. Employer-sponsored health insurance now amounts to the nations largest single tax exemption, costing the government more than $250 billion annually in lost revenue.

At about the same time, popular insurance plans like Blue Cross emerged to offer cheap, prepaid hospital care, followed by Blue Shield for doctors visits. In 1939 fewer than six million people carried such insurance; by 1950, that number had increased fivefold. In the years after Trumans plan died in Congress, the government filled some of the egregious gaps in the private insurance system with expensive programs for the poor, the elderly, and others in high-risk categories, thereby cementing Americas outlier status as the worlds only advanced industrial nation without universal health care.

What the United States does have in common with several of these nations, says Ezekiel Emanuel in his valuable Which Country Has the Worlds Best Health Care?, is that its health care struggles have not been unlike theirs, despite the markedly different outcomes. The United Kingdom, for example, decided in favor of national health care at the very moment that Trumans plan was being shredded. And the main adversary turned out to be the British Medical Association, which used the hated specter of Nazism (as opposed to Bolshevism) to demonize the proposed National Health Service as a Hitlerian menace run by a medical fuhrer.

The NHS succeeded because the Labour Party won a landslide victory in 1945 in a country battered by war and facing a bleak economic futureprecisely the opposite of the American experience. Opinion polls in the UK showed strong support for a government-run system offering universal, comprehensive, and free health care financed by general taxation. But the threat of a physicians strike forced Labours health minister, Aneurin Bevan, to scrap the idea of turning doctors into full-time government employees. Senior specialists (or consultants) would be allowed to see private patients beyond their salaried employment in Britains government-run hospitals, and general practitioners could retain their status as independent contractors, though they would get virtually all their income through the NHS. Generous pensions and other benefits sweetened the deal. I stuffed their mouths with gold, Bevan recalled.

The UK and the US are the bookends of the eleven health care systems that Emanuel has studiednot so much to determine which one is best or worst, as which one most closely resembles a socialized system. (The others are Australia, Canada, China, France, Germany, the Netherlands, Norway, Switzerland, and Taiwan.) The UK excels in universal coverage, simplicity of payment, and protection of low-income groups. While the NHS remains quite popular, it also is seriously underfunded: the UK ranks dead last in both health care spending per capita ($3,900) and health care spending as a percentage of gross domestic product (9.6) among the six European nations under examination. The most common complaints, not surprisingly, concern staff shortages and wait times for primary care appointments, elective surgeries, and even cancer treatments, which can stretch for months. The public does not want to replace the system with an alternative, writes Emanuel. All the public wants is a fully operational NHS.

By contrast, the US health care systemif one can call it thatexcludes more people, provides thinner coverage, and is far less affordable. It combines socialized medicine practiced by the Department of Veterans Affairs, four-part federal Medicare (A, B, C, D) for the elderly and disabled, state-by-state Medicaid for the poor, health coverage provided by employers, and policies bought privately through an insurance agent or an Affordable Care Act exchangeall of which still leave 10 percent of the population unprotected. Among the biggest problems, says Emanuel, is that Americans are baffled by their health care: uncertain of the benefits theyre entitled to, the providers that will accept their insurance, the amount of their deductibles and copays, and the accuracy of the bills they receive. It is a system, moreover, in which people are regularly switching insurers out of choice or necessitya process known as churning. The United States basically has every type of health financing ever invented, Ezekiel adds. This is preposterous.

And extremely expensive. America dwarfs other nations in both health care spending per capita ($10,700) and health care spending as a percentage of GDP (17.9). Hospital stays, doctor services, prescription drugs, medical devices, laboratory testingthe excesses are legion. Childbirth costs on average about $4,000 in Western Europe, where midwives are used extensively and charges are bundled together, but close to $30,000 in the US, where the patient is billed separately by specialistsradiologists, pathologists, anesthesiologistswhom she likely never meets, and where charges pile up item by item in what one recent study called a wasteful overuse of drugs and technologies. There is no evidence that such extravagance makes for better health care outcomes. The rates of maternal and infant death in the US are higher than in other industrialized nations, partly because the poor, minorities, and children are disproportionately uninsured.

For head-spinning price disparities, however, nothing compares to pharmaceuticals. Americans account for almost half the $1 trillion spent annually for prescription drugs worldwide, while comprising less than 5 percent of the worlds population. It is probably no coincidence that the pharmaceutical industry spent almost twice as much on political lobbying between 1998 and 2020 as its nearest competitor, the insurance industry. (The hospital/nursing home industry came in eighth.) Drug companies won patent protection, restraint-free pricing, and direct-to-consumer advertising (outside the US, only New Zealand allows this). This high spending for drugs, writes Emanuel, with some understatement, is a result of high drug prices, not high drug use by Americans.

How do other countries keep drug costs down? By using the full power of government (or a surrogate) to negotiate lower prices, as opposed to the market fragmentation that diminishes consumer leverage in the United States. Some governments shop for pharmaceuticals, paying no more than the lowest prices charged by other developed nations. And some use an internal metric that pegs prices to what that country already pays for drugs in the same class. Canada, which employs both methods, has become a haven for consumers south of the border, even though the importation of prescription drugs into the United States is generally illegal. Emanuel favors no single approach; he is open to almost anything that avoids the highway robbery Americans wearily tolerate. I am agnostic about how best to regulate drug prices, he admits, but having some objective and rigorous system for setting prices is definitely better than leaving it to drug companies with monopoly pricing power.

Emanuel is a man of many lists. I rank everything, he writes:

I rank the 10 best meals Ive ever had (#1 Alinea in Chicago). I rank chocolates (#1 Askinosie). I rank Alpine cheeses (#1 is a tie between Alpha Tolman and Alp Blossom). I rank colleges. I rank academic departments of bioethics and health policy that compete with my own. I rank the meals I cook, the races I run, the bike rides I take, the speeches I give.

A bit obsessive, no doubt, though its hard to imagine anyone better suited to rank the worlds health care systems than an oncologist with a Harvard medical degree and a Harvard Ph.D. in political philosophy who was deeply involved in crafting the Affordable Care Act and currently chairs the Department of Medical Ethics and Health Policy at the University of Pennsylvania. Emanuel likes controversy and the limelight that comes with it. Several years ago, he wrote an essay for The Atlantic insisting that he had no interest in living past seventy-five, the approximate age, he said, at which people appear more burdensome than productive. Rather than killing himself, Emanuel vowed to refuse all measures to prolong his life, from cancer screenings to antibiotics to the flu shot. (Those who skimmed the lengthy piece may have overlooked the disclaimer I retain the right to change my mind carefully tucked into the final paragraph.) Few people took him seriously, I suspect, beyond the likes of Newt Gingrich and Sarah Palin, who had previously (and falsely) accused Emanuel of wanting to create death panels to deny treatment to the elderly and disabled.

Ranking the worlds health care is something of a cottage industry. The gold standard, until now, has been the Commonwealth Fund, which publishes periodic assessments comparing the US system to those of ten other countries, much as Emanuel has done. The 2017 Commonwealth study includes two nations (Sweden and New Zealand) not on Emanuels list; his study includes two nations (Taiwan and China) not on the Commonwealth list. Both employ similarly broad categories such as access, equity, coverage, efficiency, financing, and delivery. The Commonwealth studies rely heavily on surveys of patients and primary care doctors, as well as comparative data drawn from sources like the World Health Organization. Emanuel takes a more qualitative approach, providing histories of each nation that elegantly describe the impact of politics and culture on current policy. He also is more hesitant to rely on data that are not easily compared among nations with different approaches to managed care. Such numbers, he writes, must be taken with heaping grains of salt.

So who are the winners and losers? The 2017 Commonwealth study ranks the UK first, followed closely by Australia and the Netherlands. In last place, hands down, is the United States, which fails in almost every category. Emanuel ranks the United States next to lastbut only because his study includes China. While acknowledging dramatic progress made there in health care outcomes such as infant mortality and life expectancy, Emanuel has little good news to report about China beyond the hope that its rapidly growing middle class will soon be demanding better medical care.

And first place? The answer isblank. There are too many variables and too few precise measurements to pick an overall winner, Emanuel confesses to the reader on page 351. The best that he can do is to lump the eleven nations into tiers, with Germany, the Netherlands, Norway, and Taiwan at the top. Which ranks highest depends on your priorities. If your main ones are the choice of doctor and hospital, short waiting times, and good long-term care, you probably will pick Germany. If youre focused on rock-bottom prescription drug prices and an outstanding electronic records system, Taiwan is the place. If you worry about copayments and deductibles, England and Canada await. Finding the best heath care, it appears, is harder than finding the best Alpine cheese.

Shortly after this book was published, Emanuel was interviewed on a podcast with a very insistent host. Asked point-blank which nation had the best health care, he first refused to say. I was ready for your evasive answer, the host responded. Which system would you want to buy into? Cornered, Emanuel chose the Netherlands. I think that they have a very good combination, he declared:

You get to choose your private insurer, you get to choose your primary care doctor. And their primary care doctors are really gatekeepers to a higher level of care. Theyre also innovative. But there are lots of other alternatives Id be more than happy with.

This is hardly a revelation. The Dutch have long been content with their system. It doesnt lead in any of the main categories, but it does everything well. Where Emanuel and fellow rankers part ways is in their vision of the future. Emanuel is bullish on America. He sees it emerging as a world health care leader, despite its dismal current standing and the politically charged opposition of most Republicans to meaningful change. The United States does excel on some dimensions, particularly innovation and experimentation in payment models and care delivery, he writes. Im optimistic about [its] long-term performance. Time will tell.

The first order of business, Emanuel believes, is universal coverage. No system that shuts out so many people can claim to be just or effective. Other industrialized nations have achieved universal coverage through automatic enrollment, and Emanuel thinks it could work here by funneling people into Medicaid or one of the lower-cost insurance exchanges. The process will entail larger government subsidies for the uninsured and underinsured, including middle-class families, but it will also ease the rampant confusion that keeps millions of Americans from claiming the benefits they already are entitled to. Emanuel sees automatic enrollment as both essential and nonthreateninga social good requiring little systemic change.

More controversial is his recommendation aimed at bringing some order to the current system. He likes the idea of having everyone covered by one of two options: either employer-sponsored insurance or a government-sponsored alternative that combines Medicare, Medicaid, and the Obamacare exchanges into a coherent entity. At the very least, it would be simpler to navigate, streamline medical billing, reduce the administrative quagmire faced by providers, and supply some added leverage against monopolistic price-gouging. Studies estimate that the United States spends a staggering $500 billion annually on billing and insurance-related costs, with $240 billion classified as excessor waste. The average US physician practice spends four times as much on billing as its Canadian counterpart.

It is hard to imagine that anyone intended to design a system this dysfunctional. The good news, says Emanuel, is that underperformance of such magnitude inevitably spurs innovation. The surge in costs has generated new interest in payment models that have worked elsewhere, such as capitation, which pays the physician a fixed fee for a patients care over a specified period of time, and bundling, which puts multiple health care services under a single billing code. America is becoming a leader in coordinating the care of patients with chronic physical and mental conditionsinnovations Emanuel clearly lays out here. Even the systems once-static care delivery system has been invigorated by additions like the physicians assistant, who is licensed to treat illness and prescribe medication, and the virtual office visit that has become so essential during the current pandemic.

Covid-19 arrived just as Emanuels book was heading to the printer. Not surprisingly, his editor asked him to compose an addendum suggesting what the coronavirus might tell us about the nations health care system. Written obviously in haste, it still covers the bases rather well. The absence of universal coverage, combined with high deductibles and copays, made it less likely for people with symptoms to seek medical help, thus endangering them and the rest of us. Americas hospitals and health care facilities now face a sea of red ink, with losses estimated in the hundreds of billions of dollars. Elective surgeries, a primary revenue stream, have slowed to a trickle, while prices for drugs and protective equipment have steadily mounted. It is too early, of course, to attempt a serious ranking of the effectiveness of countries responses to Covid-19. That surely will come, with perhaps predictable results. What can be noted at this point is the exemplary performance of the nations front-line health workers and first responders.

There are signs that the pandemic has had an effect on public attitudes. Since June, voters in deep red Oklahoma and Missouri have defied their political leaders by supporting constitutional amendments that require the expansion of eligibility for Medicaid, one of the provisions of Obamacare that many Republican-controlled state governments have refused to implement. South Dakota may follow suit in 2022. The AMA has also evolved over the years: its current vision on health care reform now calls for freedom of choice, freedom of practice, and universal access for patients, which is another way of saying that it endorses the expansion of the Affordable Care Act for those without insurance while still opposing a single-payer national health plan. This alone is progressseventy-five years after President Trumans clarion call for health care justice.

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Health Care: The Best and the Rest | by David Oshinsky - The New York Review of Books

Diversity in health care starts at the beginning – Nevada Today

Posted on October 8, 2020 by Danzig

Since 1968, National Hispanic Heritage Month has been recognized by the federal government and celebrated across the United States annually, from Sept. 15 to Oct. 15 to acknowledge the history, culture, and contributions of Americans whose ancestry can be traced to over 20 countries in Latin America, including Mexico, Central and South America, and the Caribbean. There are approximately 60 million people residing in the U.S. representing approximately 18% of the population, who have ancestries connected to these countries.

The University of Nevada, Reno School of Medicine (UNR Med) and University Health join in celebrating this annual commemoration as part of our commitment to diversity and inclusion and our ongoing efforts to increase the representation of Hispanics, and others from populations underrepresented in medicine, who serve our community as healthcare providers.

Diversity in health care benefits students and their future patients.

Diversity enhances the learning experience of all students through broadened perspectives, intellectual engagement, social skills, empathy, and racial understanding all critical components of medical education for future physicians. Ultimately, diversity helps equip future physicians to combat health care disparities, which will positively impact health care outcomes for their patients.

The future of medicine doesnt just lie in technological advancements or scientific discoveries, says first-year medical student, Leanne Perez. The future of medicine is about diversity, and reflecting a new, dynamic generation of doctors who represent every and any patient.

UNR Med is making great strides in training a broader spectrum of future physicians, capable of relating to patients and speaking their language, both literally and figuratively.

For second-year UNR Med medical student Sergio Trejo, being Hispanic and a Spanish speaker has been an enormous asset in understanding cultural subtleties and prominent social health determinants. I volunteer as an interpreter and student provider for clinics that serve underserved communities and interact with English language-challenged patients in navigating the health care field. When patients are able to precisely describe what brings them into the clinic in their own language with a health care professional who understands them, theyre overcome with a sense of relief and gratefulness. This is my motivation for dedicating my career to serving underserved populations, especially those who face massive language barriers.

Diversity in health care advances academic excellence.

The Association of American Medical Colleges (AAMC) reports that Hispanic matriculation to U.S. medical schools was 6.2% for the 2018-19 academic year. At UNR Med, the number of enrolled Hispanic medical students has more than doubled since 2011, reaching 20% for the 2020-21 academic year. In addition, more than half of the UNR Med Class of 2024 medical students represent UNR Med Mission-Based Diversity Groups, reflecting Nevadas diverse population. During this same period of time, the size of our application pool continued to grow and the average academic credentials of incoming students remained consistent or improved.

Commitment to diversity starts with engaging in outreach that exposes young people from groups underrepresented in medicine to role models and that inspires them to pursue a career in healthcare, said Tamara Martinez-Anderson, director of admissions. It is also reflected in a holistic admissions process that requires academic and professional readiness for medical school, but also considers how each candidates diverse competencies, attributes and backgrounds align with our mission and values. We know that achieving our vision of a healthy Nevada benefits when we enroll future doctors who are collaborative, resilient and adaptable and who are committed to providing compassionate, sensitive and culturally competent care.

UNR Meds total enrollment of Hispanic students is around 54 students, including the School of Medicine, Physician Assistant Studies Program and Speech Pathology and Audiology student bodies. Over the past four years, UNR Med has nearly tripled Latinx and Black faculty representation.

Diversity in health care starts long before medical school.

Pre-med pipeline programs and initiatives have been shown to help underrepresented students better prepare for the medical school admissions process. Developing and expanding these avenues of educational support continue to be a strong priority for UNR Meds Office of Admissions.

The mission of the Community of Bilingual English-Spanish Speaker Exploring Issues in Science and Health (CBESS) program is to create opportunities to position bilingual high school students as insiders into STEM-healthcare fields. CBESS aims to increase diversity in the health care workforce by providing programming for Spanish-English bilingual high school juniors through networking events with health care professionals, medical school tours, and a variety of other activities. The initiative is collaboration between the Universitys College of Education, Raggio Research Center, School of Community Health Sciences and School of Medicine.

Sergio Trejo became involved with CBESS, and his experience as a student in the program led him to choose UNR Med for medical school. Ive always been interested serving underserved communities, especially those who face prominent language barriers. I decided to attend UNR Med because Tamara Martinez-Anderson and other faculty demonstrated how UNR Med has similar goals in striving to alleviate health disparities for Nevada's underserved populations and beyond.

In support of first-generation and low-income undergraduate students who are preparing for the medical school application process, the Office of Admissions has partnered with the University of Nevada, Reno TRiO Scholars Program to offer pre-med advising and learning support. Also available is a one-year Post-Baccalaureate Certificate that provides a small and select group of students, frequently from non-traditional or underrepresented backgrounds, with the opportunity to demonstrate their academic readiness in a pipeline program that mimics the intensity of medical school.

Another pipeline program involves early interventions to make reaching the goal of medical school more sustainable over the long term. The BS-MD Program grants exceptional high school students conditional direct-entry admission to UNR Med upon completion of all requirements of a structured, four-year undergraduate pre-med program at the University of Nevada, Reno.

As a first-generation medical student, Leanne Perezs dream of becoming a physician felt discouraging at first, so the BS-MD program was key to guiding her throughout her undergraduate degree all the way to medical school. I am honored to represent the Hispanic community, as it is so important for minority populations to identify with their physicians. Coming from an underrepresented community, I am so proud to attend a medical school that prioritizes diversity and outreach.

Our commitment to diversity is a pledge to seeing that all members of our community are able to access the quality health care they need, said UNR Med Dean, Thomas L. Schwenk, M.D. In northern Nevada, we not only have great health care infrastructure but a School of Medicine that is actively partnering with our health care community to build relationships and increase access to, and equity in health care for all.

UNR Meds success in recruiting, enrolling and graduating increasing Hispanic medical students is reflective of the broader University of Nevada, Reno goal to become a Hispanic-Serving Institution, with Hispanic students making up at least 25% of the undergraduate, full-time student population.

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Diversity in health care starts at the beginning - Nevada Today

Respiratory therapists: Vital part of health care team – Brownwood Bulletin

Posted on October 8, 2020 by Danzig

Special to the Bulletin

WednesdayOct7,2020at4:42PM

Respiratory therapists and the work they do will be observed during Respiratory Therapist Week later this month, Oct. 25-31.

Respiratory therapy (RT) is part of the critical care team in a hospital, from newborns to elderly. RT also has hands-on care for COVID 19 patients.

RT is usually thought of as the people who give breathing treatments. However, it goes a lot further than that. RT is part of a core and experienced team who responds to all respiratory and cardiac arrests.

RTs education certainly focuses on the heart and lungs, but RT professionals learn so much more. From simple lab values, chest X-rays, CT scans to hemodynamics, RT manages ventilators from neonates to geriatrics.

All of the RT professionals at Brownwood Regional Medical Center are required to have special certifications including ACLS (advanced cardiac life support), PALS (pediatric advanced life support, and NRP (neonatal resuscitation program).

There is much more RT could tell the public. Brownwood Regional Medical Center has an amazing RT team with more than 115 years combined experience.

The medical diretor is Dr. Roy Byrd.

https://www.respiratorytherapyzone.com/respiratory-care-week-guide/

Respiratory therapists: Vital part of health care team - Brownwood Bulletin

MedaSource: Depth and Breadth in Life Sciences and Healthcare Consulting – BioSpace

Posted on October 8, 2020 by Danzig

According to Forbes, the healthcare services market exceeds $50 billion, which isnt surprising given the complexity of the interactions between biotechnology companies, pharmaceutical companies, medical device companies, distributors, health care institutions, organized physician groups and other stakeholders. Its also a field that largely works in the background and is involved in a rapidly expanding list of activities, including digital health transformation, market growth, operational efficiency and others.

One such company is Medasource, which was founded in 2000 and falls under the umbrella of the Eight Eleven Group, a leading human capital solutions firm specializing in technology and business support. Both are headquartered in Indianapolis.

Medasources practice areas include Health IT, Business Applications, Revenue Cycle Management and Pharmaceutical & Life Sciences.

Michael Haas, Medasources Pharmaceutical & Life Sciences Vertical Director, describes the company as a national healthcare consulting and project services company."

"We partner with hundreds of customers across health systems, pharma, biotech and device companies across the U.S. to drive clinical research and improve patient care, Haas said.

And they are by no means a small consulting firm. They have significant reach across the United States with 32 physical offices and thousands of medical & scientific consultants on assignment this year.

Haas indicates that they partner with industry leaders to provide the expertise needed across critical functions, including translational sciences, medical affairs, clinical development, safety, research informatics and regulatory affairs. They partner to manage entire projects and complement existing teams.

For example, Haas said, our consultant pool is comprised of the scientific, clinical, analytical, and technical expertise needed to drive research and commercial operations. Additionally, our provider vertical focuses on assisting large health systems and academic medical centers execute clinical research and trials.

The COVID-19 pandemic, Haas notes, has been a disruptive year for much of the healthcare and life sciences industry.

He said that early on, Clinical Laboratory teams and Clinical Trials Offices within their healthcare delivery portfolio came to a standstill, while Clinical Engineering teams rushed to ensure proper inventory levels and functionality of critical equipment.

However, this summer, they have been quickly scaling clinical laboratory teams as COVID-19 testing increased along with growing patient volumes and procedures.

With big pharma, weve focused on consulting efforts around the design, management and monitoring of new infectious disease studies, Haas said.

In addition, Medasource has partnered with numerous state governments, cities and counties to build and manage entire teams to combat the spread of COVID-19 throughout the U.S.

Medasource also has two key Workforce Transformation Solutions, Elevate and Project Patriot. Elevate is an entry-level consulting program designed, to infuse your culture with the best and brightest associate or junior-level candidates, Haas said. Our clients use this program to address succession planning and build cost-effective, scalable teams.

Project Patriot is the companys national Veteran consulting program. It assists all veterans and transitioning military and their families by, he said, engaging, equipping and empowering them to successfully explore careers in the healthcare and life sciences industries.

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MedaSource: Depth and Breadth in Life Sciences and Healthcare Consulting - BioSpace

Value-based Care After COVID-19: What Healthcare Leaders Need to Know – Medical Economics

Posted on October 8, 2020 by Danzig

In truth, COVID-19 only emphasized providers need to diversify by augmenting fee-for-service (FFS) income with VBC revenue streams. As patient volumes and FFS payments dried up, provider performance data shows that savings per case in bundled payment programs remained high and capitated payments continued. Financially, providers who chose to stay in VBC contracts but opt out of the risk associated with COVID-19 patients will likely fare better than those who did not.

Thats good, because there are unmistakable signs that VBC is poised to accelerate.

First, the economic burdens caused by the pandemic have intensified pressure to reduce healthcare spending. Governments, employers and consumers all are demanding greater value for their healthcare dollars. Moreover, the Centers for Medicare & Medicaid Services (CMS) has voiced its intent to double down on VBC and accelerate new mandatory bundled payment models.

Although prior to the pandemic less than 20% of Medicare spending was in VBC contracts, CMS has announced it wants to move 100% of Medicare providers into two-sided risk arrangements by 2025. Likewise, CMS wants half of its Medicaid and commercial contracts in VBC models by 2025and most commercial payers are following their lead.

But even if Medicare fails to reach 100% participation by 2025, the momentum shift is clear. VBC is moving ahead.

Join the race in progress

In some organizations, historical payer/provider tensions fuel a mindset that VBC contracts are stacked against providers. What providers should understand, however, is that VBC arrangements actually offer opportunities to improve care for their patients while also increasing revenue as compared with fee-for-service.

One key to doing so is to join the VBC race sooner rather than later. CMS has offered voluntary VBC initiatives since 2012, which means a sizable number of providers are already gaining valuable experience. Keep in mind:

Manage risk through knowledge

After deciding to make the shift to VBC, there are ways to manage risk and increase the upside potential. To start, providers must understand how each VBC program works and where the risk lies.

There are dozens of VBC options available from both government and commercial payers, and most are complicated. Medicare programs, though challenging, typically are more accessible and transparent than most commercial plans. For that reason, it generally makes sense for providers to make their initial foray into VBC through a Medicare initiative.

Regardless, its essential to understand exactly how a given VBC arrangement works. For example, organizations must know the standards against which they will be measured. Make sure to recognize the biases in the model as well. Regional wage indices, for instance, create better pricing in some markets and pricing disadvantages in others. Similarly, peer-adjusted trend factors in the Bundled Payments for Care Improvement Advanced (BPCI-A) program have created favorable price opportunities for some bundles and negative pricing for others.

ACOs must understand how their benchmarks are set, and how that affects their ability to succeed against those benchmarks. Even the best-designed contracts have biases, so it is imperative to understand what they are and how they could impact the ability to perform within the contract.

Since risk mitigation depends on properly managing episodes of care, providers should also assess their capacity to redesign care pathways. Ask questions such as:

Once providers fully understand how a VBC program works and their capacity to operate within it, data analysis is crucial to risk management. Through data, providers can see whether the juice is worth the squeeze by quantifying risk, improvement opportunities and potential reward.

That process starts with looking at historical performance in the areas where organizations will be measuredsuch as hospital readmission rates or skilled nursing facility lengths of stay, for example. Organizations should evaluate how their providers measure against regional peers on those metrics. Also consider the organizations appetite for loss. In situations where the data identify an unpalatable risk level, providers can use insurance products designed to protect against downside risk in specific programs.

Welcome new opportunities

COVID-19 has solidified the need for VBC; its here to stay.

Although VBC represents a substantial shift in the healthcare ecosystem, providers must not overlook the tremendous revenue potential it affords in addition to its patient care benefits. The transition may seem daunting, but there are ways to box and manage the risk. The earlier providers start down the VBC path, the greater their chances for long-term VBC success.

York is vice president of value-based care at Coverys. Terry is CEO of Archway Health

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Value-based Care After COVID-19: What Healthcare Leaders Need to Know - Medical Economics

Free sessions on legal and financial issues for those with neurological conditions – Norton Healthcare

Posted on October 8, 2020 by Danzig

The 2020 Neuroscience Expo will host a morning of free online sessions with legal and financial advisers, tailored exclusively to those dealing with a neurological condition and their caregivers.

Living a happy, fulfilling life goes beyond exceptional medical care. It includes caring for the whole person and their day-to-day struggles.

This Norton Neuroscience Institute event gives individuals living with a neurological condition and their family, caregivers, support care providers and others a way to collect valuable information.

Friday, Oct. 23, 9 a.m. to 12:30 p.m.

This years Norton Neuroscience Institute conference will be livestreamed, but space is limited.

This years track for legal and financial resources features the following sessions:

Learn how to create a life care plan for you or a loved one.

Jefferey Yussman and Gordon Homes

Living with a disability can be challenging and requires planning for future needs. Youll learn ways you can financially prepare for the future.

Jefferey Yussman and Gordon Homes

If you wanted to know about the importance of having your affairs in order, this presentation will outline the various legal documents that would ensure your peace of mind.

Victor E. Tackett Jr.

Is it time to apply for disability? Where do I begin? Learn the latest on Social Security disability applications and the process of filing a disability claim.

Sam Schad

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Free sessions on legal and financial issues for those with neurological conditions - Norton Healthcare

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