Explainer: Naming of Parts for an Instrument of Civilian Slaughter






The PTAB 2.5M anti-armor bomblet has a cylindrical body with a dome-shaped ballistic cap at its front and it terminates in a four-fin tail unit that is structured in a drum configuration. In its Aug. 2, 2012 online posting, Jane’s Air-Launched Weapons noted that the tail unit comes in both short and long versions.The entire bomblet measures 0.87 meters in length, has a body diameter of 60 millimeters and weighs 2.5 kilograms. Just behind the nose is a shaped charge weighing 660 grams and consisting of a RDX/TNT mixture, which is detonated by an ADTS-583 impact fuze.Thirty or more bomblets, or sub-munitions, fit into the RBK-250-275 cluster bombs and the RBK 500 can carry 75. The PTAB 2.5M is able to penetrate up to 120 millimeters of armor. The Soviets originally designed the PTAB 2.5M to be dropped on lines of Allied tanks steadily advancing toward the Iron Curtain countries. On Dec 12, while many were fretting or making jokes about the Mayan Apocalypse, Syrian military aircraft released RBK 250s on the civilian population of Marea, near Aleppo. For a few civilians from Marea, the world did end.  


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Anti-tax conservatives say no to tax-increase deal


BOSTON (AP) — In the city where a protest over tax policy sparked a revolution, modern day tea party activists are cheering the recent Republican revolt in Washington that embarrassed House Speaker John Boehner and pushed the country closer to a "fiscal cliff" that forces tax increases and massive spending cuts on virtually every American.


"I want conservatives to stay strong," says Christine Morabito, president of the Greater Boston Tea Party. "Sometimes things have to get a lot worse before they get better."


Anti-tax conservatives from every corner of the nation echo her sentiment.


In more than a dozen interviews with The Associated Press, activists said they would rather fall off the cliff than agree to a compromise that includes tax increases for any Americans, no matter how high their income. They dismiss economists' warnings that the automatic tax increases and deep spending cuts set to take effect Jan. 1 could trigger a fresh recession, and they overlook the fact that most people would see their taxes increase if President Barack Obama and Boehner, R-Ohio, fail to reach a year-end agreement.


The strong opposition among tea party activists and Republican leaders from New Hampshire to Wyoming and South Carolina highlights divisions within the GOP as well as the challenge that Obama and Boehner face in trying to get a deal done.


On Capitol Hill, some Republicans worry about the practical and political implications should the GOP block a compromise designed to avoid tax increases for most Americans and cut the nation's deficit.


"It weakens the entire Republican Party, the Republican majority," Rep. Steven LaTourette, R-Ohio, said Thursday night shortly after rank-and-file Republicans rejected Boehner's "Plan B" — a measure that would have prevented tax increases on all Americans but million-dollar earners.


"I mean it's the continuing dumbing down of the Republican Party and we are going to be seen more and more as a bunch of extremists that can't even get a majority of our own people to support policies that we're putting forward," LaTourette said. "If you're not a governing majority, you're not going to be a majority very long."


It's a concern that does not seem to resonate with conservatives such as tea party activist Frank Smith of Cheyenne, Wyo. He cheered Boehner's failure as a victory for anti-tax conservatives and a setback for Obama, just six weeks after the president won re-election on a promise to cut the deficit in part by raising taxes on incomes exceeding $250,000.


Smith said his "hat's off" to those Republicans in Congress who rejected their own leader's plan.


"Let's go over the cliff and see what's on the other side," the blacksmith said. "On the other side" are tax increases for most Americans, not just the top earners, though that point seemed lost on Smith, who added: "We have a day of reckoning coming, whether it's next week or next year. Sooner or later the chickens are coming home to roost. Let's let them roost next week."


It's not just tea party activists who want Republicans in Washington to stand firm.


In conservative states such as South Carolina and Louisiana, party leaders are encouraging members of their congressional delegations to oppose any deal that includes tax increases. Elected officials from those states have little political incentive to cooperate with the Democratic president, given that most of their constituents voted for Obama's Republican opponent, Mitt Romney.


"If it takes us going off a cliff to convince people we're in a mess, then so be it," South Carolina GOP Chairman Chad Connelly said. "We have a president who is a whiner. He has done nothing but blame President Bush. It's time to make President Obama own this economy."


In Louisiana, state GOP Chairman Roger Villere said that "people are frustrated with Speaker Boehner. They hear people run as conservatives, run against tax hikes. They want them to keep their word."


Jack Kimball, a former New Hampshire GOP chairman, said he was "elated" that conservatives thwarted Boehner. He called the looming deadline a political creation. "The Republicans really need to stand on their principles. They have to hold firm."


Conservative opposition to compromise with Obama does not reflect the view of most Americans, according to recent public opinion polls.


A CBS News survey conducted this month found that 81 percent of adults wanted Republicans in Congress to compromise in the current budget negotiations to get a deal done rather than "stick to their positions even if it means not coming to an agreement." The vast majority of Republicans and independent voters agreed.


Overall, 47 percent in the poll said they blamed Republicans in Congress more than Obama and Democrats for recent "difficulties in reaching agreements and passing legislation in Congress." About one-quarter placed more blame on the Democrats and 21 percent said both were responsible.


Although negotiations broke down last week, Obama still hopes to broker a larger debt-reduction deal that includes tax increases on high earners and Republican-favored cuts to entitlement programs such as Medicare and Social Security. If a compromise continues to prove elusive, lawmakers could pass a temporary extension that delays the cliff's most onerous provisions and gives Congress more time to work out a longer-term solution.


That's becoming the favored path by some Republicans leery of going over the cliff.


Mississippi Republican Chairman Joe Nosef shares his Southern colleagues' disdain for tax increases. But he stopped short of taking an absolute position.


"I really, really feel like the only way that Republicans can mess up badly is if they come away with nothing on spending or something that's the same old thing where they hope a Congress in 10 years will have the intestinal fortitude to do it," he said.


Matt Kibbe, president of the national organization and tea party ally, FreedomWorks, says that going over the cliff would be "a fiscal disaster." He says "the only rational thing to do" is approve a temporary extension that prevents widespread tax increases.


But his message doesn't seem to resonate with conservative activists in the states.


"If we have to endure the pain of the cliff then so be it," said Mark Anders, a Republican committeeman for Washington state's Lewis County. "While it may spell the end of the Republican Party ... at least we will force the government to cut and cut deep into actual spending."


Back where the Boston Tea Party protest took place in 1773, Morabito wonders whether Boehner will survive the internal political upheaval and says Republicans need to unite against Obama.


"It looked like from the very beginning they were just going to cave to what President Obama wanted," she said of the GOP. "I didn't want that to happen. Now I'm hopeful that they're standing up for taxpaying Americans."


___


Associated Press writers Bill Barrow in Atlanta, Rachel La Corte and Michael Baker in Washington state, Thomas Beaumont in Iowa, and AP Director of Polling Jennifer Agiesta in Washington contributed to this report.


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Disney Sets August 9 Release for ‘Cars’ Spin-off ‘Planes’






NEW YORK (TheWrap.com) – Disney will release “Planes,” a spin-off of Pixar‘s “Cars” franchise, August 9, 2013, in the United States. DisneyToon Studios is behind the film with Pixar/Disney Animation chief creative officer John Lasseter producing.


The film follows a fleet of planes, in particular Dusty. “Two and a Half Men” star Jon Cryer was to voice Dusty, but he has dropped out and the studio is now casting the part.






Disney initially intended to release “Planes” direct to video, but it will now send it into theaters domestically and overseas.


“Planes” will compete against a pair of films that summer weekend, both of which should have more adult followings. The big-ticket item will be Sony’s “Elysium,” Neill Blomkamp‘s follow-up to “District 9.” Also opening that weekend is “We’re the Millers,” a New Line drug-smuggling comedy starring Jason Sudeikis and Jennifer Aniston.


Next summer’s biggest animated movies should all be sequels save “Epic,” Fox’s story of a teenage girl caught in a forested battle. Beyonce Knowles‘ leads the voice cast. The other big openers are Despicable Me 2,” “Monsters University” and “Smurfs 2.”


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Showrooming little threat to clothiers in ho-hum holidays






Chicago (Reuters) – In retail, showrooming has not hit shirts yet.


Showrooming, the retail term for shoppers who try a product, then buy it cheaper on Amazon.com or other websites, has driven retailers to the point of hiding barcodes, improving their own websites and coming up with methods to get people to complete their purchase in the store.






But brand-name clothing retailers have an advantage over companies that sell items you can buy anywhere, like televisions and home goods.


Specialty apparel retailers are some of the least affected by showrooming since the more exclusive the product is, the harder it is to showroom,” said Joel Bines, managing director of the retail practice at advisory firm AlixPartners.


That, in turn, has helped retailers like Gap Inc and Lululemon Athletica Inc find favor with investors.


A survey of 2,010 adults conducted by AlixPartners showed consumers who shop for apparel were among the least likely (35 percent) to go to other websites after they liked an item at a store, compared with 42 percent of electronics shoppers and 41 percent of those looking for accessories like watches and jewelry.


“If you look at some of the most successful (clothes) companies in the past few years, they are those that have that moat around them,” said hedge fund manager Shawn Kravetz, who runs Esplanade Capital in Boston.


He cites yogawear maker Lululemon and Gap as good examples of how it can help to have clothes that are not sold elsewhere.


If a shopper wants to buy a Banana Republic or Nordstrom shirt from the latest season, they have to buy it either from their stores or online shop.


Discount retailers like Zappos, Amazon and others stock brand-name products, but the merchandise is often not from the current season or limited in colors and sizes.


“I don’t need to see if a television fits my body shape when I buy a TV,” said Joe Megibow, senior vice president of omni-channel e-commerce at American Eagle Outfitters. The teen clothes retailer has seen better sales than its peers over the past year.


“I can get a sense of the TV and I’m good. Clothing is different. Does it fit me, is it my style, do I like the quality of the material and how it is put together. There’s so much more with apparel that matters,” he said.


That is the part of the reason, analysts say, why online-only clothing companies like Bonobos and Gap’s Piperlime have started opening brick-and-mortar stores or tied up with retailers to sell their products in physical locations.


Choice and easy availability are the two most important aspects of shopping, especially during a holiday season that has lost steam after what looked like strong Thanksgiving sales.


Estelle Tran, an “impulsive” shopper in her twenties, agreed.


“If I want to buy books, tech items, DVDs, I would definitely buy online. For clothes, I would rather (visit stores) as it is also a fun experience to try on clothes,” said the Chicago-based finance auditor.


Tran said she would definitely check prices online if she was spending more than $ 100.


Luxury and high-priced items can be more susceptible to showrooming, because pricing is what drives the behavior, said Marshal Cohen, chief economist at the consultancy NPD Group.


“With electronics and certain consumer goods it is very easy to compare specific brands across multiple websites. But (showrooming is) happening and it will be growing. If a (clothes) retailer isn’t taking it seriously, they are going to fall behind,” said Bolette Andersen, principal in KPMG’s retail industry practice.


ROOM TO GROW


Some investors are betting on apparel stocks because of their relative insulation from the threat of showrooming.


While the S&P Apparel Index has returned a sizzling 27.71 percent year to date, according to Reuters data, far outperforming the S&P 500, which is up 14.80 percent, more gains may be coming.


“We still think there’s plenty of room to grow,” said Brian Peery, co-portfolio manager at Hennessy Funds. Its growth fund, heavily weighted in apparel and consumer discretionary goods shares, is up 30 percent over the year.


“As we look into the sector 12-18 months, we continue to buy the discretionary area. Two of our heaviest investments would be Foot Locker Inc and TJX Companies Inc,” he said.


Discount chains like TJX and Ross Stores, which sell branded clothes at low prices, have benefited from the surge in bargain-seeking shoppers.


Even the stocks of retailers like Gap and American Eagle that have staged or are staging turnarounds have gotten a good boost over the year. Gap has soared 69 percent and American Eagle is up 31 percent.


R. Shawn Neville, president of Avery Dennison retail branding and information solutions, said another reason that apparel and to a broader extent other consumer discretionary stocks do well is because of their sustainability.


“In uncertain times, investors look towards market segments that have strong underlying demand which are more stable, like the apparel industry,” Neville said.


Moreover, in times of economic uncertainty, shoppers can still afford clothes and shoes, as opposed to a new car, home, or expensive vacations, helping apparel stocks do well, he said.


“Though Amazon is clearly stealing some share in various categories, clothes retailers, say Abercrombie & Fitch isn’t going anywhere. They’re not being run out of the shopping mall,” said Esplanade’s Kravetz.


(Editing by Jeffrey Benkoe)


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‘Walking Dead’ Showrunner Glen Mazzara Leaving






NEW YORK (TheWrap.com) – Glen Mazzara, who led AMC‘s “The Walking Dead” to ratings highs after the exit of Frank Darabont, is leaving the show.


The announcement came with the unsurprising news of a fourth-season pickup for the series. It continues AMC’s rocky record with its showrunners, but the network said the decision was mutual.






While AMC has clashed with showrunners before over money, a person familiar with the situation told TheWrap that this time the issue is “100 percent not about money or contracts.”


Rather, it is about a difference of opinion over where the show should go in the fourth season and beyond. It involves AMC, Mazzara and the show’s writers and producers, who include Robert Kirkman, creator of the comics that provide the basis of the series.


Kirkman might be the fans’ choice to take over as showrunner, given that most of its characters were born on his pages. But he also has a busy career writing comics and novels.


In a statement, Kirkman said he believes Mazzara and AMC came to the decision “in the best interest of the future of the show.”


In an interview with TheWrap in October, Mazzara said he would love to remain with the show until the end, “if AMC and the fans would have me.”


“I would love to be the guy shutting the lights off,” he said at the time.


It didn’t work out that way, even though Mazzara has made “The Walking Dead” this season’s top-rated drama — even beating network shows. It also has a legitimate shot at ending the season as TV’s top scripted show overall.


“Both parties acknowledge that there is a difference of opinion about where the show should go moving forward, and conclude that it is best to part ways,” AMC said in a statement.


AMC also said the decision is “amicable” and that Mazzara will remain showrunner for the remainder of the third season, which resumes airing in February. The episodes have already been filmed, and Mazzara will oversee postproduction.


He is also looking for his next project.


“My time as showrunner on ‘The Walking Dead’ has been an amazing experience, but after I finish season 3, it’s time to move on,” said Mazzara. “I have told the stories I wanted to tell and connected with our fans on a level that I never imagined. It doesn’t get much better than that. Thank you to everyone who has been a part of this journey.”


Mazzara took over the show after Darabont parted ways with it after its first season. Darabont was just one of several showrunners to have issues with AMC.


Jason Horwitch left “Rubicon” during its lone season. The third season of “Hell on Wheels” was briefly put on hold last month when showrunner John Shiban left.


“Mad Men” creator Matthew Weiner nearly walked from the show during a contract dispute last year. And “Breaking Bad” briefly looked into leaving AMC before creator Vince Gilligan’s contract was renewed.


Kirkman’s full statement included his thanks to Mazzara and the show’s fans.


“I am in full support of both AMC and Glen Mazzara in the decision they have come to and believe the parties came to this decision in the best interest of the future of the show,” Kirkman said. “I thank Glen for his hard work and appreciate his many contributions to ‘The Walking Dead’ and look forward to working with him as we complete post production on Season 3. I am also excited to begin work on another spectacular season of this show that I know means so much to so many people. This show has always been the result of a wide range of extremely talented men and women working tirelessly to produce their best work collectively. I believe the future is bright for ‘The Walking Dead.’ Thank you to the fans for your continued support.”


Executive producer Gale Anne Hurd also expressed her thanks.


“I am appreciative and grateful to Glen for his hard work on ‘The Walking Dead,’” she wrote. “I am supportive of AMC and Glen’s decision and know that the series is in great hands with one of the most talented and dedicated casts and crews in the business. I look forward to the show’s continued success.”


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Long-lived bats offer clues on diseases, aging






HONG KONG (Reuters) – The bat, a reservoir for viruses like Ebola, SARS and Nipah, has for decades stumped scientists trying to figure out how it is immune to many deadly bugs but a recent study into its genes may finally shed some light, scientists said on Friday.


Studying the DNA of two distant bat species, the scientists discovered how genes dealing with the bats’ immune system had undergone the most rapid change.






This may explain why they are relatively free of disease and live exceptionally long lives compared with other mammals of similar size, such as the rat, said Professor Lin-Fa Wang, an infectious disease expert at the Duke-NUS Graduate Medical School in Singapore who led the multi-centre study.


“We are not saying bats never get sick or never get infections. What we are saying is they handle infections a lot better,” Wang said in a telephone interview.


What was missing from both species of bats was a gene segment known to trigger extreme, and potentially fatal, immune reactions to infections, called the cytokine storm.


Cytokine storms end up killing not only offending viruses in the body, but the host’s own cells and tissues too.


“Viruses rarely kill the host. The killing comes from the host’s immune response. So it looks like what bats are doing is depress the inflammation (cytokine storm). If we can learn that, we can design drugs to minimize the inflammation damage and control viral infection,” Wang said.


The study, which saw the participation of researchers from China, Denmark, Australia and the United States, was published on Friday in the journal Science.


Compared with other mammals of similar size, bats live a long time, with lifespans of between 20 and 40 years. Rats live between 2 and 3 years, on average.


IMMUNE GENES LINKED TO FLIGHT


Interestingly, Wang and his colleagues found that the highly evolved genes that give bats their superior immune system also enable them to fly.


Out of more than 5,000 types of mammals on the planet, bats are the only one capable of sustained flight and some species can fly more than 1,000 km in a single night.


Such intense physical exertion is known to produce toxic “free radicals” that cause tissue damage and it is these same genes that give the bat the ability to repair itself, Wang said.


“What we found was the genes that evolved fastest were genes involved in repairing DNA damage. That makes sense … because when you fly, metabolism goes up and it generates free radicals that are toxic to cells,” Wang said.


“Because bats fly, they (would have had) to evolve and adapt … to get genes that can repair DNA damage.”


Wang said we have much to learn from the bat, which has evolved to avoid disease and live exceptionally long lives.


“Cancer, ageing and infectious disease, these are the three major areas of concern for people,” he said.


“We have studied rats for 150 years to understand how to do better in these three areas. Now we have a system, the bat, that has done very well in evolution. We can learn from the bat. With modern techniques, we can design new drugs to slow down the ageing process, treat cancer, fight infections.”


(Editing by Robert Birsel)


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Final day of funerals for Newtown shooting victims




The final three victims of the massacre at Sandy Hook Elementary School will be laid to rest today, ending a somber week funerals.



A mass will take place today at St. Rose of Lima Catholic Church for Josephine Gay, who had celebrated her 7th birthday on Dec. 11.



Friends and family have been asked to wear Josephine's favorite color, purple, in her honor.



PHOTOS: Victims of Sandy Hook Massacre



A homegoing celebration will take place at The First Cathedral in Bloomfield, Conn., for Ana Marquez-Greene. The 6-year-old with a beaming voice sang in a home video with her brother, who was also at Sandy Hook Elementary School during the massacre, and seemed destined to take after her father, a jazz musician.



Emilie Parker, the budding artist who carried her markers and pencils everywhere, will be laid to rest in Ogden, Utah today.



The 6-year-old would have been would one of the first to comfort her classmates at Sandy Hook Elementary School, had a gunman's bullets not claimed her life, her father said.



"My daughter Emilie would be one of the first ones to be standing and giving support to all the victims because that's the kind of kid she is," her father, Robbie Parker, said last Saturday.



"She always had something kind to say about anybody," Parker said. "We find comfort reflecting on the incredible person Emilie was and how many lives she was able to touch."



WATCH: Emilie's father speaks about his daughter


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Showrooming little threat to clothiers in ho-hum holidays






Chicago (Reuters) – In retail, showrooming has not hit shirts yet.


Showrooming, the retail term for shoppers who try a product, then buy it cheaper on Amazon.com or other websites, has driven retailers to the point of hiding barcodes, improving their own websites and coming up with methods to get people to complete their purchase in the store.






But brand-name clothing retailers have an advantage over companies that sell items you can buy anywhere, like televisions and home goods.


Specialty apparel retailers are some of the least affected by showrooming since the more exclusive the product is, the harder it is to showroom,” said Joel Bines, managing director of the retail practice at advisory firm AlixPartners.


That, in turn, has helped retailers like Gap Inc and Lululemon Athletica Inc find favor with investors.


A survey of 2,010 adults conducted by AlixPartners showed consumers who shop for apparel were among the least likely (35 percent) to go to other websites after they liked an item at a store, compared with 42 percent of electronics shoppers and 41 percent of those looking for accessories like watches and jewelry.


“If you look at some of the most successful (clothes) companies in the past few years, they are those that have that moat around them,” said hedge fund manager Shawn Kravetz, who runs Esplanade Capital in Boston.


He cites yogawear maker Lululemon and Gap as good examples of how it can help to have clothes that are not sold elsewhere.


If a shopper wants to buy a Banana Republic or Nordstrom shirt from the latest season, they have to buy it either from their stores or online shop.


Discount retailers like Zappos, Amazon and others stock brand-name products, but the merchandise is often not from the current season or limited in colors and sizes.


“I don’t need to see if a television fits my body shape when I buy a TV,” said Joe Megibow, senior vice president of omni-channel e-commerce at American Eagle Outfitters. The teen clothes retailer has seen better sales than its peers over the past year.


“I can get a sense of the TV and I’m good. Clothing is different. Does it fit me, is it my style, do I like the quality of the material and how it is put together. There’s so much more with apparel that matters,” he said.


That is the part of the reason, analysts say, why online-only clothing companies like Bonobos and Gap’s Piperlime have started opening brick-and-mortar stores or tied up with retailers to sell their products in physical locations.


Choice and easy availability are the two most important aspects of shopping, especially during a holiday season that has lost steam after what looked like strong Thanksgiving sales.


Estelle Tran, an “impulsive” shopper in her twenties, agreed.


“If I want to buy books, tech items, DVDs, I would definitely buy online. For clothes, I would rather (visit stores) as it is also a fun experience to try on clothes,” said the Chicago-based finance auditor.


Tran said she would definitely check prices online if she was spending more than $ 100.


Luxury and high-priced items can be more susceptible to showrooming, because pricing is what drives the behavior, said Marshal Cohen, chief economist at the consultancy NPD Group.


“With electronics and certain consumer goods it is very easy to compare specific brands across multiple websites. But (showrooming is) happening and it will be growing. If a (clothes) retailer isn’t taking it seriously, they are going to fall behind,” said Bolette Andersen, principal in KPMG’s retail industry practice.


ROOM TO GROW


Some investors are betting on apparel stocks because of their relative insulation from the threat of showrooming.


While the S&P Apparel Index has returned a sizzling 27.71 percent year to date, according to Reuters data, far outperforming the S&P 500, which is up 14.80 percent, more gains may be coming.


“We still think there’s plenty of room to grow,” said Brian Peery, co-portfolio manager at Hennessy Funds. Its growth fund, heavily weighted in apparel and consumer discretionary goods shares, is up 30 percent over the year.


“As we look into the sector 12-18 months, we continue to buy the discretionary area. Two of our heaviest investments would be Foot Locker Inc and TJX Companies Inc,” he said.


Discount chains like TJX and Ross Stores, which sell branded clothes at low prices, have benefited from the surge in bargain-seeking shoppers.


Even the stocks of retailers like Gap and American Eagle that have staged or are staging turnarounds have gotten a good boost over the year. Gap has soared 69 percent and American Eagle is up 31 percent.


R. Shawn Neville, president of Avery Dennison retail branding and information solutions, said another reason that apparel and to a broader extent other consumer discretionary stocks do well is because of their sustainability.


“In uncertain times, investors look towards market segments that have strong underlying demand which are more stable, like the apparel industry,” Neville said.


Moreover, in times of economic uncertainty, shoppers can still afford clothes and shoes, as opposed to a new car, home, or expensive vacations, helping apparel stocks do well, he said.


“Though Amazon is clearly stealing some share in various categories, clothes retailers, say Abercrombie & Fitch isn’t going anywhere. They’re not being run out of the shopping mall,” said Esplanade’s Kravetz.


(Editing by Jeffrey Benkoe)


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Acortar las internaciones no significa peor atención: estudio EEUU






NUEVA YORK (Reuters Health) – Los hospitales de Asuntos del


Veterano (AV) de Estados Unidos pudieron reducir la duración de






las internaciones sin aumentar la cantidad de reingresos.


“A medida que los hospitales se volvieron más eficientes,


creció la preocupación porque estuvieran dándole el alta a


pacientes más enfermos y más rápido”, dijo el autor principal de


un nuevo estudio, doctor Peter Kaboli, del Sistema de Salud de


AV de la ciudad de Iowa. “De hecho, encontramos lo opuesto”,


agregó.


En Annals of Internal Medicine, el equipo de Kaboli escribe


que se está presionando a los hospitales para que disminuyan el


tiempo que los pacientes pasan allí. Pero algunos cuestionan si


el alta temprana eleva el riesgo de reinternación. Estas


segundas hospitalizaciones le cuestan Medicare unos 17.000


millones de dólares por año, según reveló un estudio del 2009.


Es más: el 1 de octubre del 2012, los Centros de Servicios


de Medicare y Medicaid comenzaron a utilizar las tasas de


reinternaciones y los resultados en los pacientes como dos


indicadores para determinar cuánto dinero deberían reembolsarles


a los hospitales.


El equipo de Kaboli estudió si la reducción del tiempo de


internación en los 129 hospitales de AV aumentaba la cantidad de


reinternaciones a los 30 días del alta médica. Para eso, analizó


más de 4 millones de historias clínicas electrónicas de AV de


los pacientes atendidos entre 1997 y el 2010.


En ese período, el tiempo promedio de internación se redujo


de 5,5 a 4 días y la cantidad de pacientes reinternados dentro


de los 30 días posteriores al alta médica cayó alrededor de 3


puntos porcentuales (del 16,5 por ciento en 1997 al 13,8 por


ciento en el 2010).


“Parecería que (la duración de la internación) no haría una


diferencia, pero al demostrar que reduce las reinternaciones


notamos que es una medida positiva”, dijo Kaboli.


Aun así, el equipo halló un punto en el que la internación


más breve estaba asociada con un aumento de los reingresos. Los


hospitales con internaciones de por lo menos un día menos que el


tiempo promedio registraban un aumento de las reinternaciones.


Por otro lado, el equipo observó que la cantidad de


pacientes que morían en el hogar dentro de los 90 días


posteriores al alta médica también fue disminuyendo en esos 14


años.


“Pudimos cuidar mejor a los pacientes, con mejor calidad de


la atención y con una reducción de las tasas de mortalidad al


mismo tiempo”, resumió Kaboli.


El doctor Manesh Patel, profesor asistente de cardiología de


la Duke University, en Durham, opinó que el estudio demuestra


que el sistema de AV mejoró en las áreas más sensibles para los


pacientes.


“La buena noticia es que existiría una conexión (…)


Algunas de las medidas que implementamos serían razonables”,


sostuvo Patel, que no participó del estudio, pero investiga el


tema de las reinternaciones.


FUENTE: Annals of Internal Medicine, online 17 de diciembre


del 2012


Seniors/Aging News Headlines – Yahoo! News





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Predicting who's at risk for violence isn't easy


CHICAGO (AP) — It happened after Columbine, Virginia Tech, Aurora, Colo., and now Sandy Hook: People figure there surely were signs of impending violence. But experts say predicting who will be the next mass shooter is virtually impossible — partly because as commonplace as these calamities seem, they are relatively rare crimes.


Still, a combination of risk factors in troubled kids or adults including drug use and easy access to guns can increase the likelihood of violence, experts say.


But warning signs "only become crystal clear in the aftermath, said James Alan Fox, a Northeastern University criminology professor who has studied and written about mass killings.


"They're yellow flags. They only become red flags once the blood is spilled," he said.


Whether 20-year-old Adam Lanza, who used his mother's guns to kill her and then 20 children and six adults at their Connecticut school, made any hints about his plans isn't publicly known.


Fox said that sometimes, in the days, weeks or months preceding their crimes, mass murderers voice threats, or hints, either verbally or in writing, things like "'don't come to school tomorrow,'" or "'they're going to be sorry for mistreating me.'" Some prepare by target practicing, and plan their clothing "as well as their arsenal." (Police said Lanza went to shooting ranges with his mother in the past but not in the last six months.)


Although words might indicate a grudge, they don't necessarily mean violence will follow. And, of course, most who threaten never act, Fox said.


Even so, experts say threats of violence from troubled teens and young adults should be taken seriously and parents should attempt to get them a mental health evaluation and treatment if needed.


"In general, the police are unlikely to be able to do anything unless and until a crime has been committed," said Dr. Paul Appelbaum, a Columbia University professor of psychiatry, medicine and law. "Calling the police to confront a troubled teen has often led to tragedy."


The American Academy of Child & Adolescent Psychiatry says violent behavior should not be dismissed as "just a phase they're going through."


In a guidelines for families, the academy lists several risk factors for violence, including:


—Previous violent or aggressive behavior


—Being a victim of physical or sexual abuse


—Guns in the home


—Use of drugs or alcohol


—Brain damage from a head injury


Those with several of these risk factors should be evaluated by a mental health expert if they also show certain behaviors, including intense anger, frequent temper outbursts, extreme irritability or impulsiveness, the academy says. They may be more likely than others to become violent, although that doesn't mean they're at risk for the kind of violence that happened in Newtown, Conn.


Lanza, the Connecticut shooter, was socially withdrawn and awkward, and has been said to have had Asperger's disorder, a mild form of autism that has no clear connection with violence.


Autism experts and advocacy groups have complained that Asperger's is being unfairly blamed for the shootings, and say people with the disorder are much more likely to be victims of bullying and violence by others.


According to a research review published this year in Annals of General Psychiatry, most people with Asperger's who commit violent crimes have serious, often undiagnosed mental problems. That includes bipolar disorder, depression and personality disorders. It's not publicly known if Lanza had any of these, which in severe cases can include delusions and other psychotic symptoms.


Young adulthood is when psychotic illnesses typically emerge, and Appelbaum said there are several signs that a troubled teen or young adult might be heading in that direction: isolating themselves from friends and peers, spending long periods alone in their rooms, plummeting grades if they're still in school and expressing disturbing thoughts or fears that others are trying to hurt them.


Appelbaum said the most agonizing calls he gets are from parents whose children are descending into severe mental illness but who deny they are sick and refuse to go for treatment.


And in the case of adults, forcing them into treatment is difficult and dependent on laws that vary by state.


All states have laws that allow some form of court-ordered treatment, typically in a hospital for people considered a danger to themselves or others. Connecticut is among a handful with no option for court-ordered treatment in a less restrictive community setting, said Kristina Ragosta, an attorney with the Treatment Advocacy Center, a national group that advocates better access to mental health treatment.


Lanza's medical records haven't been publicly disclosed and authorities haven't said if it is known what type of treatment his family may have sought for him. Lanza killed himself at the school.


Jennifer Hoff of Mission Viejo, Calif. has a 19-year-old bipolar son who has had hallucinations, delusions and violent behavior for years. When he was younger and threatened to harm himself, she'd call 911 and leave the door unlocked for paramedics, who'd take him to a hospital for inpatient mental care.


Now that he's an adult, she said he has refused medication, left home, and authorities have indicated he can't be forced into treatment unless he harms himself — or commits a violent crime and is imprisoned. Hoff thinks prison is where he's headed — he's in jail, charged in an unarmed bank robbery.


___


Online:


American Academy of Child & Adolescent Psychiatry: http://www.aacap.org


___


AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner


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