By Sharon Begley NEW YORK (Reuters) - Children in Lebanon, New Hampshire, are more than twice as likely to have their tonsils removed as those in Bangor, Maine. Kids in Lewiston, Maine, are 50 percent more likely to have a CT scan of their head than are kids in Portland, Maine, or Lebanon and Burlington, Vermont. Lebanon's children don't have especially infection-prone tonsils, and Lewiston's don't fall on their heads more than kids elsewhere do. Instead, according to a report released on Wednesday, the glaring variation means that in some cases "children are not receiving enough good care," said pediatrician and health policy analyst Dr David Goodman of the Geisel School of Medicine at Dartmouth University, who led the study for the Dartmouth Atlas Project. But in other cases they "may be receiving unnecessary care that is harmful." Similar research from the project has shown that the rate of medical procedures performed on older Americans covered by Medicare varies enormously depending on where they live. The new report, which focused on northern New England, is the first to show that geographic variability exists in children's healthcare, too, raising questions about why tens of thousands of kids are not receiving recommended care such as screening for lead poisoning and why tens of thousands of others are subjected to potentially unneeded treatments such as CTs for stomachaches. The Dartmouth Atlas was able to examine geographic variations in the medical care provided to children in Maine, New Hampshire and Vermont from 2007 to 2010 because those states are among the few that collect data on all health insurance claims, which the researchers analyzed. "This suggests that there is a significant amount of overuse of medical services in some areas," said Dr Vikas Saini, a cardiologist and president of the Lown Institute, a healthcare think tank in Boston. "Especially because unneeded care can expose children to harmful side effects, this is very troubling." PROCEDURES TO AVOID The idea that Americans undergo millions of unneeded procedures every year has become more widely recognized as a result of the Choosing Wisely campaign, in which medical specialty societies have for the past two years identified procedures that should be avoided or questioned. That whether a child undergoes a procedure depends in part on where he or she lives has been known since the 1970s, when researchers led by Dr John Wennberg of Geisel found that rates of tonsillectomy are 60 percent in some places and less than 20 percent in others. The difference, they found, could not be explained by underlying medical conditions among the children, and was instead more likely due to the local medical culture: Some doctors believe in removing tonsils and others don't. Apart from the tonsillectomy work, research on variations in the healthcare children receive has lagged that on adults. In the new study, the researchers found regional variations in rates of hospitalizations, common surgeries, imaging, prescriptions and office visits such as for well-child care and middle-ear infections. Children in St. Albans and Bennington, Vermont, had triple the number of annual office visits (3.6) as kids in Houlton, Maine (1.2). The presence of large medical centers, children's hospitals and, therefore, pediatricians and specialists hardly mattered: Burlington and Bangor both have such centers, but the rate of office visits was more than 50 percent higher in Burlington. In areas with fewer pediatricians, children went to emergency rooms more often, but what happened to them there varied even more. Some of the greatest variation occurred in "preference-sensitive" care. These are procedures, such as placing tubes in the ears, that have unclear benefits but which parents or physicians may opt for anyway. There is no consensus on which children will get fewer ear infections or less hearing loss thanks to tubes, for instance. As a result, preference ruled: Middlebury, Vermont, has more than four times the rate of tube insertions (15.2 per 1,000 children) as Bangor (3.4). Littleton, New Hampshire, has more than four times the rate of tonsillectomies (10.9 per 1,000 children), which are also of questionable benefit, as Bangor (2.7). Differences in how many kids get ear, nose and throat disease are unlikely to explain these differences, said Lown's Saini. Particularly worrisome to experts is the high rate of CT scans in some places. CT delivers radiation equivalent to 200 to 400 chest X-rays, increasing the risk of cancer decades later. Children in Presque Isle, Maine, had 19.7 head CTs per 1,000, compared to 8.4 in Burlington. The American Academy of Pediatrics says head CTs are "not necessary" for the immediate evaluation of head injuries and pose "considerable danger to children." Bennington had more than triple the rate of abdominal or chest CTs (15.4) as those in Machias, Maine (4). The variation did not depend on whether a major medical center is nearby: The rate in Bangor (11.7) was more than double that in Lebanon, (4.7), though both have large hospitals. Use of medication for attention deficit hyperactivity disorder (ADHD) varied by a factor of 2, with 2.9 percent of Fort Kent, Maine's, children on the drugs but 8.1 percent of Ellsworth's. There was a comparable gap in use of antidepressants and antipsychotics, whose use in children has been widely criticized. More doctors in an area did not necessarily increase the rate of questionable procedures, while fewer doctors did not reduce it. Instead, overuse is likely a result of the prevailing "medical culture," said Saini: Doctors who walk the same hospital corridors and socialize through the same professional and other organizations trade anecdotes about what works. "Most of what we do in medicine doesn't have empirical evidence" for whether it works and for whom, said Saini. "Instead, it's driven by anecdotal evidence and professional opinion," which doctors who practice in the same area are likely to hear about and be influenced by, especially early in their careers. Although the Dartmouth researchers underlined the overuse of some medical procedures in some places, they also found worrisome underuse of proven therapies. Practice guidelines call for strep throat to be treated with antibiotics. More than 90 percent of such cases were properly treated in Exeter and Derry, New Hampshire, while only 41 percent to 47 percent were in Calais, Presque Isle, and Houlton, Maine. The Dartmouth Atlas Project published the data at www.dartmouthatlas.org. (Reporting by Sharon Begley; Editing by Douglas Royalty)
Director Matt Shakman hopes fans who have enjoyed Wanda's journey "will find that the finale is surprising but also satisfying."
- The Telegraph
The Duke and Duchess of Sussex’s autumn 2018 tour of Australia, New Zealand, Fiji and Tonga was “stressful” for staff, with at least one aide visibly upset after a discussion with the Duchess. One engagement in particular has long been shrouded in mystery, with no credible explanation given as to why the Duchess was abruptly whisked from a market in Fiji’s capital Suva, cutting short the visit. At the time, even palace aides appeared confused about what had happened, with a succession of contradictory briefings. The engagement was organised to allow Meghan to learn more about a UN Women's project called Markets for Change, which promotes women's empowerment in marketplaces throughout the Pacific. Sources have now claimed that the Duchess was upset when she saw branding for UN Women, an organisation she had worked with before. Meghan had allegedly said she would only go to the market if there was no branding for the organisation, a source told the Times, although the reason behind it is unknown.
These musicians blazed new trails for the genre, often collaborating with or inspiring some of rock's biggest male performers.
- Associated Press
Legislators in more than 20 states have introduced bills this year that would ban transgender girls from competing on girls’ sports teams in public high schools. The Associated Press reached out to two dozen state lawmakers sponsoring such measures around the country as well as the conservative groups supporting them and found only a few times it’s been an issue among the hundreds of thousands of American teenagers who play high school sports. In South Carolina, for example, Rep. Ashley Trantham said she knew of no transgender athletes competing in the state and was proposing a ban to prevent possible problems in the future.
Turkey is not necessarily aiming to return to the U.S. F-35 fighter jet programme from which it was removed over its purchase of Russian defence systems, the Turkish defence industry chief said on Wednesday. He said the primary goal was for Turkey to get compensated for its losses. Ankara had ordered more than 100 F-35s and has been making parts for it but was removed from the programme in 2019 after it acquired Russian S-400 missile defence systems, which Washington says threaten the jets.
- USA TODAY
At least 13 people died after an SUV with 25 passengers collided with a semitruck full of gravel near the U.S.-Mexican border in California.
- Associated Press
A former Pakistani prime minister Wednesday defeated a ruling party candidate in Senate elections in a major setback to the government of Prime Minister Imran Khan, election authorities and opposition parties said. Yusuf Raza Gilani defeated the ruling Tehreek-e-Insaf party's Hafeez Sheikh, an adviser to Khan who was made finance minister in December 2020, an indication he will continue this position after becoming a Senator.
- Associated Press
About 300 refugees from a Christian minority community from Myanmar held a demonstration in India's capital on Wednesday against last month’s military takeover in their country and demanded the immediate release of Aung San Suu Kyi and other Myanmar leaders. The demonstration was held at Jantar Mantar, an area of New Delhi close to Parliament that is often used for protests.
- The Daily Beast
Ben Birchall/WPA Pool/GettyMeghan Markle has denied detailed accusations of “bullying” her former Buckingham Palace staff and accused opponents of conducting a “calculated smear campaign” in advance of her much-hyped CBS interview with Oprah Winfrey this Sunday.If Meghan and Prince Harry had anticipated an open field to criticize the royal family and/or air various grievances, certain Buckingham Palace sources seem determined to torpedo their ambitions prior to Sunday night.Harry and Meghan Are Begged to Delay Oprah Broadcast While Prince Philip Is Gravely IllRoyal aides told The Times of London that Meghan was the subject of an official bullying complaint made in October 2018 by Jason Knauf, Meghan and Harry’s former communications secretary. The Times reported that the complaint detailed how Meghan allegedly “drove two personal assistants out of the household and was undermining the confidence of a third staff member.” Prince Harry asked Knauf not to pursue the complaint, a source told the paper.“Staff would on occasion be reduced to tears” because of the duchess, The Times reported. One aide, anticipating a confrontation with Meghan, told a colleague: “I can’t stop shaking.” Another aide claimed it felt “more like emotional cruelty and manipulation, which I guess could also be called bullying.”Knauf, in an email to Simon Case, then the Duke of Cambridge’s private secretary, said the palace’s head of HR, Samantha Carruthers, “agreed with me on all counts that the situation was very serious.” He added: “I remain concerned that nothing will be done.”Knauf, who is now chief executive of Prince William and Kate Middleton’s Royal Foundation, said in his email: “I am very concerned that the Duchess was able to bully two PAs out of the household in the past year. The treatment of X was totally unacceptable… The Duchess seems intent on always having someone in her sights. She is bullying Y and seeking to undermine her confidence. We have had report after report from people who have witnessed unacceptable behavior towards Y.”Sympathetic sources around Harry and Meghan relayed their frustration and hurt with the attitudes of palace officials in Finding Freedom: Harry and Meghan and the Making of a Modern Royal Family.However, palace sources told The Times that the bullying allegations had not been investigated by the palace and that officials had made Meghan more “welcome” than the couple’s supporters have long claimed. One source said of the bullying complaint: “I think the problem is, not much happened with it. It was, ‘How can we make this go away?,’ rather than addressing it.”Another source told The Times: “Senior people in the household, Buckingham Palace and Clarence House, knew that they had a situation where members of staff, particularly young women, were being bullied to the point of tears. The institution just protected Meghan constantly. All the men in grey suits who she hates have a lot to answer for, because they did absolutely nothing to protect people.”The paper said the sources were speaking out now in advance of Meghan’s Sunday night interview to give their view of Harry and Meghan’s royal life, presumably anticipating that it may be very different from what the couple may relay to Winfrey. The broadcast of the interview—the result of a reported two years’ worth of planning by Meghan and Winfrey—is being criticized as ill-timed given the illness and hospitalization of Prince Philip.Buckingham Palace declined to comment to The Times.The paper also details how Meghan wore earrings to a formal dinner in 2018 that were a wedding gift from Saudi Arabian Crown Prince Mohammed bin Salman, who the CIA concluded last week had ordered the assassination of Washington Post columnist Jamal Khashoggi. The dinner took place three weeks after Khashoggi was killed. At the time Meghan said the earrings were borrowed. “The duchess does not deny this was what she said, despite being aware of their provenance,” The Times reported.In a statement to The Times, a spokesperson for the Sussexes said of the various allegations: “Let’s just call this what it is—a calculated smear campaign based on misleading and harmful misinformation. We are disappointed to see this defamatory portrayal of The Duchess of Sussex given credibility by a media outlet. It’s no coincidence that distorted several-year-old accusations aimed at undermining The Duchess are being briefed to the British media shortly before she and The Duke are due to speak openly and honestly about their experience of recent years.“In a detailed legal letter of rebuttal to The Times, we have addressed these defamatory claims in full, including spurious allegations regarding the use of gifts loaned to The Duchess by The Crown. The Duchess is saddened by this latest attack on her character, particularly as someone who has been the target of bullying herself and is deeply committed to supporting those who have experienced pain and trauma. She is determined to continue her work building compassion around the world and will keep striving to set an example for doing what is right and doing what is good.”Read more at The Daily Beast.Get our top stories in your inbox every day. Sign up now!Daily Beast Membership: Beast Inside goes deeper on the stories that matter to you. Learn more.
- LA Times
Lakers center Marc Gasol will not play against the Phoenix Suns on Tuesday because of the NBA's health and safety protocols.
- Associated Press
ORLANDO, Fla. (AP) — “Trump needs you,” one fundraising email implored. “President Trump’s Legacy is in your hands," another pleaded. Others advertised “Miss Me Yet?” T-shirts featuring Donald Trump's smiling face.
For the first time ever, the celebrity dermatologist let a patient take a smoke break halfway through the procedure to calm down.
See-through fabric, cutouts, bright colors, and backless designs made for some of the best daring wedding dresses.
- The Independent
John Brennan says ‘there are so few Republicans in Congress who value truth, honesty, and integrity’
- Business Insider
A former firefighter charged in the Capitol riot took a bus organized by Turning Point USA to DC, filing says
TPUSA founder Charlie Kirk has since-deleted tweets that promoted buses to DC as well as free hotel rooms in the Capitol for Trump supporters.
A third woman has accused influential Democratic politician Andrew Cuomo of sexual harassment.
- The Week
Manhattan DA investigators are reportedly focusing on the Trump Organization's chief financial officer
Investigators with the Manhattan District Attorney's office are taking a closer look at Trump Organization CFO Allen Weisselberg, as they continue a probe into former President Donald Trump and his family business, people with knowledge of the matter told The New York Times. They are investigating potential financial fraud, and whether Trump and the Trump Organization manipulated property values in order to receive loans and reduce property taxes, the Times reports. Weisselberg, 73, has worked for the Trump Organization for decades, starting at the company when it was helmed by Fred Trump, the former president's father. Two people familiar with the matter said prosecutors have been asking witnesses about Weisselberg, and spoke with one person about Weisselberg's sons — Barry, the property manager of Trump Wollman Rink in Central Park, and Jack, who works at Ladder Capital, one of Trump's lenders. None of the Weisselbergs have been accused of wrongdoing, and there is no indication Barry and Jack are a focus of the probe, the Times says. The investigation began more than two years ago, with the district attorney looking into hush money payments made to two women who said they had affairs with Trump. Michael Cohen, Trump's former personal lawyer and fixer, arranged the payments, and pleaded guilty to federal campaign finance charges. He testified before Congress that Weisselberg came up with a strategy to hide the fact that the Trump Organization was reimbursing Cohen for making payments to one of the women, pornographic actress Stormy Daniels. Trump has called the investigation "a witch hunt." More stories from theweek.com7 scathingly funny cartoons about Trump's CPAC appearanceReport: Some Fox News staffers are furious over Kayleigh McEnany joining the networkMike Pence comes out of hiding to nod towards Trump's election lies
Three men and a woman pleaded not guilty on Tuesday to a charge of criminal damage over their alleged role in the toppling of a statue of 17th century slave trade magnate Edward Colston in Bristol in southwest England last year. The statue was pulled down and tossed into Bristol harbour during an anti-racism demonstration on June 7 that was part of a global wave of Black Lives Matter protests. The toppling of the statue led to other memorials of figures linked to the slave trade being taken down or their future being debated, triggering a backlash from government ministers who said this amounted to censoring history.
The military veteran announced his campaign on social media as Georgia Democrats aim to oust the freshman representative. Sgt. Marcus Flowers has announced his official campaign against Rep. Marjorie Taylor Greene for her seat in Georgia’s 14th Congressional district. In his newly released campaign video shared on social media, the military veteran laid out his case as a Democratic candidate.
- LA Times
The Clippers fell short against the Celtics 117-112 on Tuesday in Boston, despite Reggie Jackson's 25-point night in the absence of Kawhi Leonard.