Could new NHS diagnostic centres tackle vague cancer symptoms?

Diagnosing cancer means getting tested. And the tests a person has are usually related to their symptoms.

But cancer symptoms aren’t always clear cut. And people often have symptoms like abdominal pain, weight loss, or fatigue that can be caused by a whole host of things, many of which aren’t cancer.

So when people see their GP with these so-called ‘vague’ symptoms it can be difficult to know which test to send them for.

The way the NHS is organised doesn’t help. If a patient has symptoms clearly linked to a particular type of cancer – say, a persistent cough, linked to lung cancer – there are ways for a GP to refer them for a particular test.

But there’s no equivalent way of referring people with non-specific, vague symptoms. As a result, these patients often get sent back and forth between GP and hospital, test after test, until a diagnosis can be made. This can feel like a long, winding road, delaying their diagnosis and potentially life-saving treatment.

How the current referral system works – confusing, right?

Research from Denmark shows that while just under half of cancer patients (48 per cent) started their journey with clear symptoms of a particular type of cancer, the other 52 per cent had to take a more round-about route.

So clearly we need to straighten the ‘roads’ in our health system, to make sure these patients get the appropriate tests just as quickly.

Launching later this year through the ACE (Accelerate, Coordinate, Evaluate) Programme – an NHS England, Cancer Research UK and Macmillan initiative – a number of projects will test out an innovative new way of doing this.

What’s the problem?

Diagnosing cancers earlier has been a top priority for the NHS for a number of years. But too many people are still diagnosed with cancer via an emergency route, such as in A&E.

As we’ve written about before, these people tend to have poorer survival. So clearly something needs to be done.

Patients with an early stage cancer may present to their GP with vague or unspecific symptoms, so only having referral routes for patients with alarm symptoms isn’t likely to be effective.

GPs often feel like they have to send their patients to A&E because there’s nowhere else to send them, and this was actually the safest place for them to get their tests done

– Donna Chung, project manager for London Cancer

GPs regularly review cases of patients who ended up having serious conditions, including cancer. And from these ‘Significant Event Audits’, it turns out that there are a number of different reasons why a patient might end up having their cancer diagnosed in A&E.

One important factor is that, for patients with non-specific but concerning symptoms that are very ill, this is the fastest way of being seen by a specialist. There are various different ways someone could be diagnosed as an emergency, with a third of emergency presentations going via GPs.

Donna Chung, project manager for London Cancer, who works to improve services for people with non-specific symptoms of cancer in London, says: “GPs often feel like they have to send their patients to A&E because there’s nowhere else to send them, and this was actually the safest place for them to get their tests done.”

There’s no such thing as a ‘tickbox patient’

In England, there are GP guidelines about which tests are appropriate for different symptoms. But the reality is that people often don’t fit into these neat categories. A person may have several non-specific symptoms, which could be a result of a different types of cancer, or other diseases entirely.

As Helena Rolfe, a GP from Airedale, explains, “if patients have symptoms like coughing up blood from the lung we know that there is a team of respiratory experts that will be able to see them quickly and to work out what’s wrong.

“But if patients have symptoms like weight loss or feeling very tired, and nothing else is really changing that rapidly, we worry because there must be a reason they’re not feeling well – but there isn’t an urgent specialist that deals with these kinds of symptoms.”

One country that’s tried to tackle this issue is Denmark – and it’s to the Danish health system that England is turning to for answers.

The Danish Experience

Denmark has a similar health service to the UK, where GPs make referrals for diagnostic tests. In 2010, research carried out as part of the International Cancer Benchmarking Partnership (ICBP) showed that both Denmark and the UK lagged behind the rest of Europe in terms of cancer survival.

Part of Denmark’s strategy to address this issue was to set up a way of referring patients with non-specific symptoms of cancer, making sure these patients have appropriate tests quickly.

They call it a ‘Multi-Disciplinary Diagnostic Centre’ (MDC).

“In Denmark, an MDC is a place where a GP can refer their patients if they are unsure what type of cancer they might have,” says Peter Vedsted, a Professor of Diagnostics in Denmark. “Where you say ‘This person is ill, I don’t know what it is, but I need this patient to be thoroughly evaluated.’”

What’s special about this kind of centre is that rather than a patient going back and forth to see different specialists, the specialists are all gathered in one place so that various different tests can be done as soon as possible, and discussed in meetings with each specialist present.

As well as the potential to shorten the time patients wait for tests to be booked, it’s likely to be cheaper too – reducing multiple appointments and unnecessary tests leads to a more efficient use of resources.

“In the old system, there were a lot of possible ‘routes’ between the GP and specialists in the hospital,” he says. “What happens now is that GPs can refer to one centre where you can efficiently use these specialities when you need them. All testing is made during one day, if possible.”

How a diagnosis might work in the new centres

He stresses that this system has really been designed for the benefit of the patient, so they have much shorter waiting times before tests are carried out. On top of this, patients with worrying symptoms have a system that responds to their concerns, offering different options and not leaving people to worry.

“We won’t say ‘well it wasn’t my problem’ and you go home and somebody will pick it up. We are not letting you leave until we have a conclusion,” says Vedsted.

An initial evaluation of the Danish MDC centres has shown that around 16 per cent of patients seen were diagnosed with cancer in their first six months of operation. Altogether, patients referred to the centre had over 80 different symptoms, with many patients showing multiple symptoms.

Importantly, patient experience has been consistently high for the diagnostic centres established in Denmark. More research is underway to assess whether the MDC pathway has reduced the time to diagnosis for patients and whether it was able to diagnose patients at an earlier stage.

So… what to do about it?

There’s no doubt that something needs to be done to help people with non-specific symptoms get an earlier diagnosis, or be reassured that their symptoms are something other than cancer. That’s why the Cancer Taskforce strategy for England, published last July, recommended that the NHS should test whether it’s possible to set up centres similar to those in Denmark. And one way this is being tested is through a number of pilot projects to be run as part of the ACE Programme.

The ACE Programme is testing new ways to get more cancers diagnosed early across England. And is in the process of establishing a number of projects to look at how to set up a similar model in the NHS to that used in Denmark.

The projects, which will be based in different areas of the country, are all testing the same concept: offering patients with non-specific symptoms a range of different tests in one centre, and bringing specialists together to discuss the results.

But they are doing this in slightly different ways. For example, some projects are only accepting patients that are referred by their GP, while others are also considering referrals from their local pharmacist or through A&E.

Some are bringing the specialists together in the same building, while others might be based at several centres, and discuss patients using virtual technology.

The projects are aiming to have their centres set up by December 2016, and over the following 3 years, will be monitored to see whether they’re are actually making a difference, both in speeding up the time to diagnosis, but also, crucially, in improving how patients rate their care. And as well as seeing if this works overall, it will be able to see whether there are any differences between projects, for example between centres in cities or in more rural settings.

Bringing the right people together at the right time

When the NHS was set up, specific routes to diagnosis were designed for patients with particular diseases. Bringing together specialists working on different types of cancer in one place to accurately diagnose a patient is a completely new way of working in our health system. It could revolutionise not only the way in which cancer is diagnosed, but also help speed up the diagnosis of other diseases such as diabetes, heart disease and rheumatoid arthritis.

“Cancer is the disease that has led to this innovation in the healthcare system, but it can be applied to all the big diseases with a time-dependent diagnosis,” says Professor Vedsted.

London Cancer’s Donna Chung sees the future of MDCs in the UK as being able to diagnose patients with any type of non-specific symptoms, and suggests that they’ll help “bring together the specialists needed to  diagnose patients efficiently.”

“This will improve services both for people that are eventually diagnosed with cancer, but also for those that have other serious concerns which need to be investigated,” she says.

Straightening the road to an accurate diagnosis for certain cancers is no easy task. But if these projects work they could offer a completely new way of working in the NHS, with the potential for huge improvements. And that’s a journey we’re looking forward to taking.

Louise Bartelt is a programme officer at Cancer Research UK

• You can receive updates on the projects by emailing ACEteam@cancer.org.uk

from Cancer Research UK - Science blog http://ift.tt/20GbcQS

Diagnosing cancer means getting tested. And the tests a person has are usually related to their symptoms.

But cancer symptoms aren’t always clear cut. And people often have symptoms like abdominal pain, weight loss, or fatigue that can be caused by a whole host of things, many of which aren’t cancer.

So when people see their GP with these so-called ‘vague’ symptoms it can be difficult to know which test to send them for.

The way the NHS is organised doesn’t help. If a patient has symptoms clearly linked to a particular type of cancer – say, a persistent cough, linked to lung cancer – there are ways for a GP to refer them for a particular test.

But there’s no equivalent way of referring people with non-specific, vague symptoms. As a result, these patients often get sent back and forth between GP and hospital, test after test, until a diagnosis can be made. This can feel like a long, winding road, delaying their diagnosis and potentially life-saving treatment.

How the current referral system works – confusing, right?

Research from Denmark shows that while just under half of cancer patients (48 per cent) started their journey with clear symptoms of a particular type of cancer, the other 52 per cent had to take a more round-about route.

So clearly we need to straighten the ‘roads’ in our health system, to make sure these patients get the appropriate tests just as quickly.

Launching later this year through the ACE (Accelerate, Coordinate, Evaluate) Programme – an NHS England, Cancer Research UK and Macmillan initiative – a number of projects will test out an innovative new way of doing this.

What’s the problem?

Diagnosing cancers earlier has been a top priority for the NHS for a number of years. But too many people are still diagnosed with cancer via an emergency route, such as in A&E.

As we’ve written about before, these people tend to have poorer survival. So clearly something needs to be done.

Patients with an early stage cancer may present to their GP with vague or unspecific symptoms, so only having referral routes for patients with alarm symptoms isn’t likely to be effective.

GPs often feel like they have to send their patients to A&E because there’s nowhere else to send them, and this was actually the safest place for them to get their tests done

– Donna Chung, project manager for London Cancer

GPs regularly review cases of patients who ended up having serious conditions, including cancer. And from these ‘Significant Event Audits’, it turns out that there are a number of different reasons why a patient might end up having their cancer diagnosed in A&E.

One important factor is that, for patients with non-specific but concerning symptoms that are very ill, this is the fastest way of being seen by a specialist. There are various different ways someone could be diagnosed as an emergency, with a third of emergency presentations going via GPs.

Donna Chung, project manager for London Cancer, who works to improve services for people with non-specific symptoms of cancer in London, says: “GPs often feel like they have to send their patients to A&E because there’s nowhere else to send them, and this was actually the safest place for them to get their tests done.”

There’s no such thing as a ‘tickbox patient’

In England, there are GP guidelines about which tests are appropriate for different symptoms. But the reality is that people often don’t fit into these neat categories. A person may have several non-specific symptoms, which could be a result of a different types of cancer, or other diseases entirely.

As Helena Rolfe, a GP from Airedale, explains, “if patients have symptoms like coughing up blood from the lung we know that there is a team of respiratory experts that will be able to see them quickly and to work out what’s wrong.

“But if patients have symptoms like weight loss or feeling very tired, and nothing else is really changing that rapidly, we worry because there must be a reason they’re not feeling well – but there isn’t an urgent specialist that deals with these kinds of symptoms.”

One country that’s tried to tackle this issue is Denmark – and it’s to the Danish health system that England is turning to for answers.

The Danish Experience

Denmark has a similar health service to the UK, where GPs make referrals for diagnostic tests. In 2010, research carried out as part of the International Cancer Benchmarking Partnership (ICBP) showed that both Denmark and the UK lagged behind the rest of Europe in terms of cancer survival.

Part of Denmark’s strategy to address this issue was to set up a way of referring patients with non-specific symptoms of cancer, making sure these patients have appropriate tests quickly.

They call it a ‘Multi-Disciplinary Diagnostic Centre’ (MDC).

“In Denmark, an MDC is a place where a GP can refer their patients if they are unsure what type of cancer they might have,” says Peter Vedsted, a Professor of Diagnostics in Denmark. “Where you say ‘This person is ill, I don’t know what it is, but I need this patient to be thoroughly evaluated.’”

What’s special about this kind of centre is that rather than a patient going back and forth to see different specialists, the specialists are all gathered in one place so that various different tests can be done as soon as possible, and discussed in meetings with each specialist present.

As well as the potential to shorten the time patients wait for tests to be booked, it’s likely to be cheaper too – reducing multiple appointments and unnecessary tests leads to a more efficient use of resources.

“In the old system, there were a lot of possible ‘routes’ between the GP and specialists in the hospital,” he says. “What happens now is that GPs can refer to one centre where you can efficiently use these specialities when you need them. All testing is made during one day, if possible.”

How a diagnosis might work in the new centres

He stresses that this system has really been designed for the benefit of the patient, so they have much shorter waiting times before tests are carried out. On top of this, patients with worrying symptoms have a system that responds to their concerns, offering different options and not leaving people to worry.

“We won’t say ‘well it wasn’t my problem’ and you go home and somebody will pick it up. We are not letting you leave until we have a conclusion,” says Vedsted.

An initial evaluation of the Danish MDC centres has shown that around 16 per cent of patients seen were diagnosed with cancer in their first six months of operation. Altogether, patients referred to the centre had over 80 different symptoms, with many patients showing multiple symptoms.

Importantly, patient experience has been consistently high for the diagnostic centres established in Denmark. More research is underway to assess whether the MDC pathway has reduced the time to diagnosis for patients and whether it was able to diagnose patients at an earlier stage.

So… what to do about it?

There’s no doubt that something needs to be done to help people with non-specific symptoms get an earlier diagnosis, or be reassured that their symptoms are something other than cancer. That’s why the Cancer Taskforce strategy for England, published last July, recommended that the NHS should test whether it’s possible to set up centres similar to those in Denmark. And one way this is being tested is through a number of pilot projects to be run as part of the ACE Programme.

The ACE Programme is testing new ways to get more cancers diagnosed early across England. And is in the process of establishing a number of projects to look at how to set up a similar model in the NHS to that used in Denmark.

The projects, which will be based in different areas of the country, are all testing the same concept: offering patients with non-specific symptoms a range of different tests in one centre, and bringing specialists together to discuss the results.

But they are doing this in slightly different ways. For example, some projects are only accepting patients that are referred by their GP, while others are also considering referrals from their local pharmacist or through A&E.

Some are bringing the specialists together in the same building, while others might be based at several centres, and discuss patients using virtual technology.

The projects are aiming to have their centres set up by December 2016, and over the following 3 years, will be monitored to see whether they’re are actually making a difference, both in speeding up the time to diagnosis, but also, crucially, in improving how patients rate their care. And as well as seeing if this works overall, it will be able to see whether there are any differences between projects, for example between centres in cities or in more rural settings.

Bringing the right people together at the right time

When the NHS was set up, specific routes to diagnosis were designed for patients with particular diseases. Bringing together specialists working on different types of cancer in one place to accurately diagnose a patient is a completely new way of working in our health system. It could revolutionise not only the way in which cancer is diagnosed, but also help speed up the diagnosis of other diseases such as diabetes, heart disease and rheumatoid arthritis.

“Cancer is the disease that has led to this innovation in the healthcare system, but it can be applied to all the big diseases with a time-dependent diagnosis,” says Professor Vedsted.

London Cancer’s Donna Chung sees the future of MDCs in the UK as being able to diagnose patients with any type of non-specific symptoms, and suggests that they’ll help “bring together the specialists needed to  diagnose patients efficiently.”

“This will improve services both for people that are eventually diagnosed with cancer, but also for those that have other serious concerns which need to be investigated,” she says.

Straightening the road to an accurate diagnosis for certain cancers is no easy task. But if these projects work they could offer a completely new way of working in the NHS, with the potential for huge improvements. And that’s a journey we’re looking forward to taking.

Louise Bartelt is a programme officer at Cancer Research UK

• You can receive updates on the projects by emailing ACEteam@cancer.org.uk

from Cancer Research UK - Science blog http://ift.tt/20GbcQS

Locate constellation Cassiopeia the Queen

Erick wrote:

Do you have any information on Cassiopeia’s Chair?

Erick, you’ve used the lovely old-fashioned name for this constellation. In the 1930s, the International Astronomical Union gave this constellation the official name of Cassiopeia the Queen. But sky watchers still see the chair, and speak of it.

The official borders of the constellation Cassiopeia (and all 88 constellations) were drawn up by the International Astronomers Union in the 1930s. Read more

For much of the Northern Hemisphere, Cassiopeia is out all night long every day of the year. At present, Cassiopeia appears in the northwest at nightfall, and rather low in the north-northeast before dawn, as depicted above. Image credit: AlltheSky.com

Cassiopeia was an Ethiopian queen in ancient Greek mythology. According to legend, she boasted she was more beautiful than the sea nymphs called the Nereids. Her boast angered Poseidon, god of the sea, who sent a sea monster (Cetus the Whale) to ravage the kingdom. To pacify the monster, Cassiopeia’s daughter, Princess Andromeda, was left tied to a rock by the sea. Cetus was about to devour her when Perseus the Hero happened by on Pegasus, the Flying Horse. Perseus rescued the princess, and all lived happily . . . and the gods were pleased, so all of these characters were elevated to the heavens as stars.

Only Cassiopeia suffered an indignity. At nightfall, this constellation has more the shape of the letter M, and you might imagine the Queen reclining on her starry throne. But, at other times of year or night – as in the wee hours between midnight and dawn in February and march – Cassiopeia’s Chair dips below the celestial pole. And then this constellation appears to us on Earth more like the letter W. It’s then that the Lady of the Chair, as she is sometimes called, is said to hang on for dear life. If Cassiopeia the Queen lets go, she will drop from the sky into the ocean below, where the Nereids must still be waiting.

Back in stock! Order your 2016 EarthSky Lunar Calendar today!

W-shaped constellation Cassiopeia on left side of photo, above mountains. Meteor to far left, above Cassiopeia. Photo taken on the morning of April 19, 2013, by John Bozzell of Las Cruces, NM. Thank you John! View larger.

Bottom line: This post tells you how to find the constellation Cassiopeia the Queen on winter evenings, and it explains the mythology of this constellation.

A planisphere is virtually indispensable for beginning stargazers. Order your EarthSky Planisphere.

Enjoying EarthSky so far? Sign up for our free daily newsletter.

from EarthSky http://ift.tt/1A9eGQF

Erick wrote:

Do you have any information on Cassiopeia’s Chair?

Erick, you’ve used the lovely old-fashioned name for this constellation. In the 1930s, the International Astronomical Union gave this constellation the official name of Cassiopeia the Queen. But sky watchers still see the chair, and speak of it.

The official borders of the constellation Cassiopeia (and all 88 constellations) were drawn up by the International Astronomers Union in the 1930s. Read more

For much of the Northern Hemisphere, Cassiopeia is out all night long every day of the year. At present, Cassiopeia appears in the northwest at nightfall, and rather low in the north-northeast before dawn, as depicted above. Image credit: AlltheSky.com

Cassiopeia was an Ethiopian queen in ancient Greek mythology. According to legend, she boasted she was more beautiful than the sea nymphs called the Nereids. Her boast angered Poseidon, god of the sea, who sent a sea monster (Cetus the Whale) to ravage the kingdom. To pacify the monster, Cassiopeia’s daughter, Princess Andromeda, was left tied to a rock by the sea. Cetus was about to devour her when Perseus the Hero happened by on Pegasus, the Flying Horse. Perseus rescued the princess, and all lived happily . . . and the gods were pleased, so all of these characters were elevated to the heavens as stars.

Only Cassiopeia suffered an indignity. At nightfall, this constellation has more the shape of the letter M, and you might imagine the Queen reclining on her starry throne. But, at other times of year or night – as in the wee hours between midnight and dawn in February and march – Cassiopeia’s Chair dips below the celestial pole. And then this constellation appears to us on Earth more like the letter W. It’s then that the Lady of the Chair, as she is sometimes called, is said to hang on for dear life. If Cassiopeia the Queen lets go, she will drop from the sky into the ocean below, where the Nereids must still be waiting.

Back in stock! Order your 2016 EarthSky Lunar Calendar today!

W-shaped constellation Cassiopeia on left side of photo, above mountains. Meteor to far left, above Cassiopeia. Photo taken on the morning of April 19, 2013, by John Bozzell of Las Cruces, NM. Thank you John! View larger.

Bottom line: This post tells you how to find the constellation Cassiopeia the Queen on winter evenings, and it explains the mythology of this constellation.

A planisphere is virtually indispensable for beginning stargazers. Order your EarthSky Planisphere.

Enjoying EarthSky so far? Sign up for our free daily newsletter.

from EarthSky http://ift.tt/1A9eGQF

Occupational Health News Roundup [The Pump Handle]

At NPR, reporter Howard Berkes writes about the failure of federal laws to protect workers who are left out of the workers’ compensation system. He begins his story with Kevin Schiller, a building engineer for Macy’s department stores for more than two decades. While working in a storage room in a Macy’s in Denton, Texas, a mannequin fell from 12 feet above, hitting Schiller and forcing him to hit his head on a shelf and then the concrete floor. Berkes writes:

Schiller has hardly worked since, given persistent headaches, memory loss, disorientation and extreme sensitivity to bright light and loud sound.

He now has to post notes on the front door and refrigerator of his apartment, reminding him to take medications and keep appointments. In case he is stopped by police, he carries a letter from his doctor that says he may appear drunk owing to a head injury.

“I’m next to poverty,” Schiller says. “I sit in a dark room. I watch TV like an old 80- or 90-year-old person.”

Schiller, 54, is among 1.5 million workers in Texas and Oklahoma who don’t have state-regulated workers’ compensation to turn to when they’re injured on the job. Millions more may join them as more states consider giving employers the right to opt out of state workers’ comp systems.

Berkes reports that employers who opt out of state workers’ comp systems claim that injured workers are still protected through the federal Employee Retirement Income Security Act (ERISA). However, the federal law isn’t providing for hurt workers as employers have promised. In Schiller’s case, if Macy’s hadn’t opted out of the state workers’ comp system, he could have appealed the company’s denial of benefits and received an independent review of his case. But instead, as Berkes reports:

Schiller was turned away by the state workers’ comp agency and a state court, which cited a mandatory arbitration agreement in the Macy’s opt-out plan. Most of the 50 Texas plans obtained by NPR and ProPublica contain mandatory arbitration clauses.

So Schiller first went through an internal appeals process at Macy’s, which is typical of opt-out plans in Texas and Oklahoma. People paid by employers decide whether employers are fair. Macy’s rejected Schiller’s appeals.

“There is no unbiased arbiter, so there can never be any true fairness,” says Bob Burke, a former Oklahoma commerce secretary who leads legal challenges to Oklahoma’s opt-out law.

Workers theoretically have an easier time taking their cases to federal court. But federal judges, under ERISA, must first determine whether employer decisions are “arbitrary and capricious” and can only reject benefits decisions if employers were unreasonable or did not adhere to their plans.

“You really have to show that [benefits decisions are] irrational or contrary to the terms of the plan,” says Karen Handorf, a private ERISA attorney who spent 25 years enforcing ERISA at the Labor Department.

So as long as employers follow their plans, they are likely to prevail. It doesn’t matter how unfair the plans or decisions may be.

Visit NPR to read Berkes’ full investigation. The article is part of the Insult to Injury series published by NPR and ProPublica.

In other news:

Huffington Post: Reporter Scilla Alecci investigates the impact that toxic lead in electronic recycling facilities has had on workers and their families. She begins her story with Anthony Harrell, who worked in an electronics scraps recycling facility in Cincinnati and ended up exposing his children to the neurological toxin. Harrell said management never alerted him that he’d be handling items containing lead, they never told him to wear protective clothing or to clean his clothes before going home to his family. Alecci writes: “Each time Harrell’s children would touch his hair and hands, or hug him after work, they would inadvertently come in contact with the toxic metal, which is difficult to wash off with normal soap. Jeriyah, now 6, takes medication for attention deficit hyperactivity disorder, and has a hard time learning and staying focused. Her doctors say her difficulties stem from lead exposure.”

KQED: Tracie McMillan reports that farmworkers in California’s Ventura and Santa Barbara counties are joining with low-wage food service workers to call for better wages and a new “bill of rights.” The bill of rights demands that existing worker protections be enforced, such as those regarding rest breaks and wage theft, calls for a worker complaint hotline, and asks that jobs be held for pregnant women who need to leave the field to avoid harmful pesticides, among other measures. McMillan reports: “More than 80 groups back the list of demands in the bill, says Lucas Zucker, policy director for Central Coast Alliance United for a Sustainable Economy, one of the groups leading the charge. The movement has garnered support from the United Farm Workers, Planned Parenthood and Maria Echaveste, who formerly headed up the federal Department of Labor’s wage and hour division.”

Houston Chronicle: Reporter Craig Hlavaty writes about a recent incident between a Walmart worker in Devine, Texas, and an open carry advocate who entered the store with a gun. Video shows a store employee asking the customer to show his handgun license. The two argue and the man with the gun eventually leaves. According to the article, Walmart managers are now tasked with the job of confirming that customers who are openly carrying guns have the proper license. Hlavaty reports: “Brian Nick, the senior director of National Media Relations for Walmart, says that this practice is currently in place in Walmart stores across Texas that sell alcohol (in Texas’ case, that means beer and wine).’We will continue to allow customers to carry firearms on Walmart property as long as they follow local, state and federal firearm laws,’ Nick says.”

San Jose Mercury News: Tracey Kaplan writes about the life and death of Don White, a 63-year-old elevator mechanic who was working in Levi’s Stadium in Santa Clara, Calif., in preparation for this weekend’s Super Bowl game. In 2013, White was working in an elevator shaft when a 14,000-pound counterweight silently dropped toward him, crushing him to death. Cal-OSHA fined White’s employer, Schindler Elevator, $18,000. White was one of two workers killed while working on the stadium in the run-up to the Super Bowl. The second was Ed Erving Lake Jr., 60, who died after a load of rebar tumbled off a forklift and crashed into him. Kaplan writes: “Shortly before Don was killed, he called Wendy (his wife) from his motel room near the stadium in Santa Clara, expressing concern that there were a lot of ‘newbie’ apprentices on the stadium job. One had dropped a tool down the elevator shaft, gouging his arm.”

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for nearly 15 years.

from ScienceBlogs http://ift.tt/1RZ4LH4

At NPR, reporter Howard Berkes writes about the failure of federal laws to protect workers who are left out of the workers’ compensation system. He begins his story with Kevin Schiller, a building engineer for Macy’s department stores for more than two decades. While working in a storage room in a Macy’s in Denton, Texas, a mannequin fell from 12 feet above, hitting Schiller and forcing him to hit his head on a shelf and then the concrete floor. Berkes writes:

Schiller has hardly worked since, given persistent headaches, memory loss, disorientation and extreme sensitivity to bright light and loud sound.

He now has to post notes on the front door and refrigerator of his apartment, reminding him to take medications and keep appointments. In case he is stopped by police, he carries a letter from his doctor that says he may appear drunk owing to a head injury.

“I’m next to poverty,” Schiller says. “I sit in a dark room. I watch TV like an old 80- or 90-year-old person.”

Schiller, 54, is among 1.5 million workers in Texas and Oklahoma who don’t have state-regulated workers’ compensation to turn to when they’re injured on the job. Millions more may join them as more states consider giving employers the right to opt out of state workers’ comp systems.

Berkes reports that employers who opt out of state workers’ comp systems claim that injured workers are still protected through the federal Employee Retirement Income Security Act (ERISA). However, the federal law isn’t providing for hurt workers as employers have promised. In Schiller’s case, if Macy’s hadn’t opted out of the state workers’ comp system, he could have appealed the company’s denial of benefits and received an independent review of his case. But instead, as Berkes reports:

Schiller was turned away by the state workers’ comp agency and a state court, which cited a mandatory arbitration agreement in the Macy’s opt-out plan. Most of the 50 Texas plans obtained by NPR and ProPublica contain mandatory arbitration clauses.

So Schiller first went through an internal appeals process at Macy’s, which is typical of opt-out plans in Texas and Oklahoma. People paid by employers decide whether employers are fair. Macy’s rejected Schiller’s appeals.

“There is no unbiased arbiter, so there can never be any true fairness,” says Bob Burke, a former Oklahoma commerce secretary who leads legal challenges to Oklahoma’s opt-out law.

Workers theoretically have an easier time taking their cases to federal court. But federal judges, under ERISA, must first determine whether employer decisions are “arbitrary and capricious” and can only reject benefits decisions if employers were unreasonable or did not adhere to their plans.

“You really have to show that [benefits decisions are] irrational or contrary to the terms of the plan,” says Karen Handorf, a private ERISA attorney who spent 25 years enforcing ERISA at the Labor Department.

So as long as employers follow their plans, they are likely to prevail. It doesn’t matter how unfair the plans or decisions may be.

Visit NPR to read Berkes’ full investigation. The article is part of the Insult to Injury series published by NPR and ProPublica.

In other news:

Huffington Post: Reporter Scilla Alecci investigates the impact that toxic lead in electronic recycling facilities has had on workers and their families. She begins her story with Anthony Harrell, who worked in an electronics scraps recycling facility in Cincinnati and ended up exposing his children to the neurological toxin. Harrell said management never alerted him that he’d be handling items containing lead, they never told him to wear protective clothing or to clean his clothes before going home to his family. Alecci writes: “Each time Harrell’s children would touch his hair and hands, or hug him after work, they would inadvertently come in contact with the toxic metal, which is difficult to wash off with normal soap. Jeriyah, now 6, takes medication for attention deficit hyperactivity disorder, and has a hard time learning and staying focused. Her doctors say her difficulties stem from lead exposure.”

KQED: Tracie McMillan reports that farmworkers in California’s Ventura and Santa Barbara counties are joining with low-wage food service workers to call for better wages and a new “bill of rights.” The bill of rights demands that existing worker protections be enforced, such as those regarding rest breaks and wage theft, calls for a worker complaint hotline, and asks that jobs be held for pregnant women who need to leave the field to avoid harmful pesticides, among other measures. McMillan reports: “More than 80 groups back the list of demands in the bill, says Lucas Zucker, policy director for Central Coast Alliance United for a Sustainable Economy, one of the groups leading the charge. The movement has garnered support from the United Farm Workers, Planned Parenthood and Maria Echaveste, who formerly headed up the federal Department of Labor’s wage and hour division.”

Houston Chronicle: Reporter Craig Hlavaty writes about a recent incident between a Walmart worker in Devine, Texas, and an open carry advocate who entered the store with a gun. Video shows a store employee asking the customer to show his handgun license. The two argue and the man with the gun eventually leaves. According to the article, Walmart managers are now tasked with the job of confirming that customers who are openly carrying guns have the proper license. Hlavaty reports: “Brian Nick, the senior director of National Media Relations for Walmart, says that this practice is currently in place in Walmart stores across Texas that sell alcohol (in Texas’ case, that means beer and wine).’We will continue to allow customers to carry firearms on Walmart property as long as they follow local, state and federal firearm laws,’ Nick says.”

San Jose Mercury News: Tracey Kaplan writes about the life and death of Don White, a 63-year-old elevator mechanic who was working in Levi’s Stadium in Santa Clara, Calif., in preparation for this weekend’s Super Bowl game. In 2013, White was working in an elevator shaft when a 14,000-pound counterweight silently dropped toward him, crushing him to death. Cal-OSHA fined White’s employer, Schindler Elevator, $18,000. White was one of two workers killed while working on the stadium in the run-up to the Super Bowl. The second was Ed Erving Lake Jr., 60, who died after a load of rebar tumbled off a forklift and crashed into him. Kaplan writes: “Shortly before Don was killed, he called Wendy (his wife) from his motel room near the stadium in Santa Clara, expressing concern that there were a lot of ‘newbie’ apprentices on the stadium job. One had dropped a tool down the elevator shaft, gouging his arm.”

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for nearly 15 years.

from ScienceBlogs http://ift.tt/1RZ4LH4

The science of Hillary Clinton’s coin toss victories (Synopsis) [Starts With A Bang]

“[T]he coin of life has meaning and value no matter what side it lands on. It’s each individual’s choice whether to bet on the outcome or not, but ultimately your coin of life will be spent somehow.” -Virgil Kalyana Mittata Iordache

Coin flips are traditionally the way to settle disputes with two choices and equal probabilities. They’re ubiquitous not only in sporting events, but in events as important as elections, with thirty five states having adopted a coin flip as their official tiebreaker method. Yesterday, in Iowa, the democratic election was so close that there were six county delegate seats that needed to be decided by coin flip.

Image credit: flickr user Nicu Buculei, via http://ift.tt/1KAo81y.

Hillary Clinton won all six, leading some to speculate that there must be some foul play at work. However, a closer look at the odds revealed what you might have suspected all along: that quite often, the probability of one of many unlikely outcomes can be just as high than the probability of one of the most likely outcomes. In other words, there’s no reason to suspect foul play at all.

Image credit: Ethan Siegel, using MS Excel.

Go read the whole story over on Forbes!

from ScienceBlogs http://ift.tt/1QZbSOk

“[T]he coin of life has meaning and value no matter what side it lands on. It’s each individual’s choice whether to bet on the outcome or not, but ultimately your coin of life will be spent somehow.” -Virgil Kalyana Mittata Iordache

Coin flips are traditionally the way to settle disputes with two choices and equal probabilities. They’re ubiquitous not only in sporting events, but in events as important as elections, with thirty five states having adopted a coin flip as their official tiebreaker method. Yesterday, in Iowa, the democratic election was so close that there were six county delegate seats that needed to be decided by coin flip.

Image credit: flickr user Nicu Buculei, via http://ift.tt/1KAo81y.

Hillary Clinton won all six, leading some to speculate that there must be some foul play at work. However, a closer look at the odds revealed what you might have suspected all along: that quite often, the probability of one of many unlikely outcomes can be just as high than the probability of one of the most likely outcomes. In other words, there’s no reason to suspect foul play at all.

Image credit: Ethan Siegel, using MS Excel.

Go read the whole story over on Forbes!

from ScienceBlogs http://ift.tt/1QZbSOk

152/366: Fun With Motion Blur [Uncertain Principles]

This one was a whole bunch of work for one smallish shot…

So, in past rounds of “science-y things with my fancy camera,” I looked at the effect of ISO settings and apertures. This time out, I wanted to look at something moving, and the way that it blurs with increasing exposure time.

My initial thought was to try to take pictures of a falling ball, but it’s too hard to get that to work consistently without setting up some kind of electronic trigger, and I wasn’t willing to do that. But, of course, a swinging pendulum will always be in a relatively narrow range of positions, making it a better moving target.

So, the composite below is a bunch of shots of a yo-yo hung from the ceiling in our basement, swinging back and forth. The focus was set to manual, the f-stop maxed out, and I adjusted the shutter speed and ISO level to get approximately the same exposure each time. I got it in nearly the same position each time by the simple expedient of holding down the shutter button in continuous shooting mode and hoping for the best.

Composite of a swinging yo-yo shot with different exposure times.

The colors are kind of wonky because I couldn’t find the dark blue plastic yo-yo we have somewhere, only one that’s clear plastic with writing on it. At the longer exposures, that’s blurred out enough to be nearly invisible without cranking the contrast way up.

I may re-do this at a later date, just to get cleaner images, but this is a decent proof-of-principle for the effect I wanted. It’s kind of impressive to me how fast the shutter can be and still produce significant blurring– this is only moving at a few meters per second, and yet there’s very definite blurring at a shutter speed considerably higher than the standard video frame rates.

Anyway, that was fun. And as a bonus, it explains why so many of my photos of the kids look kind of fuzzy…

from ScienceBlogs http://ift.tt/1SDuXWj

This one was a whole bunch of work for one smallish shot…

So, in past rounds of “science-y things with my fancy camera,” I looked at the effect of ISO settings and apertures. This time out, I wanted to look at something moving, and the way that it blurs with increasing exposure time.

My initial thought was to try to take pictures of a falling ball, but it’s too hard to get that to work consistently without setting up some kind of electronic trigger, and I wasn’t willing to do that. But, of course, a swinging pendulum will always be in a relatively narrow range of positions, making it a better moving target.

So, the composite below is a bunch of shots of a yo-yo hung from the ceiling in our basement, swinging back and forth. The focus was set to manual, the f-stop maxed out, and I adjusted the shutter speed and ISO level to get approximately the same exposure each time. I got it in nearly the same position each time by the simple expedient of holding down the shutter button in continuous shooting mode and hoping for the best.

Composite of a swinging yo-yo shot with different exposure times.

The colors are kind of wonky because I couldn’t find the dark blue plastic yo-yo we have somewhere, only one that’s clear plastic with writing on it. At the longer exposures, that’s blurred out enough to be nearly invisible without cranking the contrast way up.

I may re-do this at a later date, just to get cleaner images, but this is a decent proof-of-principle for the effect I wanted. It’s kind of impressive to me how fast the shutter can be and still produce significant blurring– this is only moving at a few meters per second, and yet there’s very definite blurring at a shutter speed considerably higher than the standard video frame rates.

Anyway, that was fun. And as a bonus, it explains why so many of my photos of the kids look kind of fuzzy…

from ScienceBlogs http://ift.tt/1SDuXWj

New England Communities Addressing Climate Change

By Curt Spalding, Regional Administrator

Over the past several years I have witnessed New England communities grapple with challenges that are likely indicators of our changing climate. The sea is creeping into parking lots at high tide in low-lying Rhode Island. The Cape Cod National Seashore rebuilds access to beaches as the sea eats away dunes that have loomed for centuries. After Tropical Storm Irene, we saw Vermont communities helping each other and their state recover from the damage.

As more and more communities deal with rising sea levels, increased coastal erosion, seasonal changes, more intense and frequent storms, flooding, heat waves, public health threats, and threats to native species, I am often asked “What advice does EPA have? Who has already begun addressing these problems?”

I’m proud that our office has just launched an online resource to further help New England communities navigate how to respond to climate change. This resource, called RAINE (it stands for “Resilience and Adaptation in New England,”) is full of links, documents and information on how more than 100 New England communities are taking action to adapt to climate change.

When a town in Southern New England faces flooding, it can check the database and find guidance from Vermont’s experience after Tropical Storm Irene. When a beach community wants to find out how it can provide economic incentives to homeowners to provide extra protection for flooding they can look to Hull, Massachusetts. Hull provides a rebate on building department fees for homeowners who increase their building height above the base flood elevation. Users can see how communities are working with local businesses to adapt, such as in Misquamicut Beach Rhode Island, where businesses that were swept away by Superstorm Sandy are now rebuilding so they can get out of the way if another storm surge threatens them.

Becoming more “resilient” takes effort and forethought. Our communities need leaders who guide us to make investments today that will help us be more resilient tomorrow. The bottom line is, resilience is about people taking action to prepare wisely for the future. The RAINE database helps communities share what they have learned about adjusting to our changing climate, so that other communities can gain from their experience.

On the heels of the Paris climate agreement, with more than 190 countries coming together to reduce emissions in order to lessen the impacts of climate change, our RAINE database is further evidence that what is global is also local. New England communities are leading the way, learning from each other, connecting, and working together to address the impacts we are facing. I may be biased, but it seems to me that New England communities are often leaders when it comes to protecting and living sustainably in our environment.

With RAINE, each community isn’t on their own to reinvent the wheel. We welcome New England’s community leaders to use the RAINE database to learn what others are doing, and we invite you to share your experiences with other local decision makers. We can learn from each other as we tackle the challenges of a changing climate.

RAINE website http://ift.tt/1P4aNCw .

About the author: Curt Spalding is the Regional Administrator of EPA’s New England office, located in Boston.

from The EPA Blog http://ift.tt/1JWddnM

By Curt Spalding, Regional Administrator

Over the past several years I have witnessed New England communities grapple with challenges that are likely indicators of our changing climate. The sea is creeping into parking lots at high tide in low-lying Rhode Island. The Cape Cod National Seashore rebuilds access to beaches as the sea eats away dunes that have loomed for centuries. After Tropical Storm Irene, we saw Vermont communities helping each other and their state recover from the damage.

As more and more communities deal with rising sea levels, increased coastal erosion, seasonal changes, more intense and frequent storms, flooding, heat waves, public health threats, and threats to native species, I am often asked “What advice does EPA have? Who has already begun addressing these problems?”

I’m proud that our office has just launched an online resource to further help New England communities navigate how to respond to climate change. This resource, called RAINE (it stands for “Resilience and Adaptation in New England,”) is full of links, documents and information on how more than 100 New England communities are taking action to adapt to climate change.

When a town in Southern New England faces flooding, it can check the database and find guidance from Vermont’s experience after Tropical Storm Irene. When a beach community wants to find out how it can provide economic incentives to homeowners to provide extra protection for flooding they can look to Hull, Massachusetts. Hull provides a rebate on building department fees for homeowners who increase their building height above the base flood elevation. Users can see how communities are working with local businesses to adapt, such as in Misquamicut Beach Rhode Island, where businesses that were swept away by Superstorm Sandy are now rebuilding so they can get out of the way if another storm surge threatens them.

Becoming more “resilient” takes effort and forethought. Our communities need leaders who guide us to make investments today that will help us be more resilient tomorrow. The bottom line is, resilience is about people taking action to prepare wisely for the future. The RAINE database helps communities share what they have learned about adjusting to our changing climate, so that other communities can gain from their experience.

On the heels of the Paris climate agreement, with more than 190 countries coming together to reduce emissions in order to lessen the impacts of climate change, our RAINE database is further evidence that what is global is also local. New England communities are leading the way, learning from each other, connecting, and working together to address the impacts we are facing. I may be biased, but it seems to me that New England communities are often leaders when it comes to protecting and living sustainably in our environment.

With RAINE, each community isn’t on their own to reinvent the wheel. We welcome New England’s community leaders to use the RAINE database to learn what others are doing, and we invite you to share your experiences with other local decision makers. We can learn from each other as we tackle the challenges of a changing climate.

RAINE website http://ift.tt/1P4aNCw .

About the author: Curt Spalding is the Regional Administrator of EPA’s New England office, located in Boston.

from The EPA Blog http://ift.tt/1JWddnM

Watch cosmonauts’ spacewalk February 3

Russian cosmonaut Alexander Skvortsov, Expedition 40 flight engineer is pictured in this close-up view during a session of extravehicular activity (EVA) in 2014. During the five-hour, 11-minute spacewalk, Skvortsov and cosmonaut Oleg Artemyev (out of frame) deployed a small science satellite, retrieved and installed experiment packages and inspected components on the exterior of the orbital laboratory. Image via NASA.

On Wednesday, February 3, 2016, NASA TV will broadcast live coverage of a spacewalk by two Russian cosmonauts aboard the International Space Station (ISS). The coverage will begin at 7:30 a.m. ET (1230 UTC). The spacewalk itself will start at approximately 8:10 a.m. ET (1310 UTC) and last 5.5 hours. Watch here.

The ISS cosmonauts – Expedition 46 Flight Engineers Yuri Malenchenko and Sergey Volkov of Roscosmos – will deploy and retrieve several experiment packages on the Zvezda and Poisk modules and install devices called gap spanners, which will be placed on the hull of the station to facilitate the movement of crew members on future spacewalks.

Malenchenko and Volkov also will install the Vinoslivost experiment, which will test the effects of the space environment on various structural material samples, and test a device called the Restavratsiya experiment, which could be used to glue special coatings to external surfaces of the station’s Russian segment.

The pair will retrieve the EXPOSE-R Experiment, a collection of biological and biochemical samples placed in the harsh environment of space. The EXPOSE program is part of the European Space Agency’s (ESA) research into astrobiology, or the study of the origin, evolution and distribution of life in the universe.

The spacewalk will be the 193rd in support of space station assembly and maintenance, the sixth spacewalk for Malenchenko and the fourth spacewalk for Volkov. Both will wear Russian Orlan spacesuits bearing blue stripes.

Enjoying EarthSky? Sign up for our free daily newsletter today!

Bottom line: NASA TV will broadcast live coverage of a 5.5-hour spacewalk by two Russian cosmonauts aboard the International Space Station beginning at 7:30 a.m. ET (1230 UTC) on Wednesday, February 3, 2016.

Read more from NASA.

from EarthSky http://ift.tt/1SCOWoc

Russian cosmonaut Alexander Skvortsov, Expedition 40 flight engineer is pictured in this close-up view during a session of extravehicular activity (EVA) in 2014. During the five-hour, 11-minute spacewalk, Skvortsov and cosmonaut Oleg Artemyev (out of frame) deployed a small science satellite, retrieved and installed experiment packages and inspected components on the exterior of the orbital laboratory. Image via NASA.

On Wednesday, February 3, 2016, NASA TV will broadcast live coverage of a spacewalk by two Russian cosmonauts aboard the International Space Station (ISS). The coverage will begin at 7:30 a.m. ET (1230 UTC). The spacewalk itself will start at approximately 8:10 a.m. ET (1310 UTC) and last 5.5 hours. Watch here.

The ISS cosmonauts – Expedition 46 Flight Engineers Yuri Malenchenko and Sergey Volkov of Roscosmos – will deploy and retrieve several experiment packages on the Zvezda and Poisk modules and install devices called gap spanners, which will be placed on the hull of the station to facilitate the movement of crew members on future spacewalks.

Malenchenko and Volkov also will install the Vinoslivost experiment, which will test the effects of the space environment on various structural material samples, and test a device called the Restavratsiya experiment, which could be used to glue special coatings to external surfaces of the station’s Russian segment.

The pair will retrieve the EXPOSE-R Experiment, a collection of biological and biochemical samples placed in the harsh environment of space. The EXPOSE program is part of the European Space Agency’s (ESA) research into astrobiology, or the study of the origin, evolution and distribution of life in the universe.

The spacewalk will be the 193rd in support of space station assembly and maintenance, the sixth spacewalk for Malenchenko and the fourth spacewalk for Volkov. Both will wear Russian Orlan spacesuits bearing blue stripes.

Enjoying EarthSky? Sign up for our free daily newsletter today!

Bottom line: NASA TV will broadcast live coverage of a 5.5-hour spacewalk by two Russian cosmonauts aboard the International Space Station beginning at 7:30 a.m. ET (1230 UTC) on Wednesday, February 3, 2016.

Read more from NASA.

from EarthSky http://ift.tt/1SCOWoc