STUDY: HOSPITAL RANKINGS MAY RELY ON FAULTY DATA; U.S. NEWS RESPONDS

Summary: “The October 2016 issue of The Joint Commission Journal on Quality and Patient Safety, 

features the article ‘Consumer Rankings and Health Care: Toward Validation and Transparency,’ by 

Bala Hota, MD, MPH, and co-authors, Rush University Medical Center (RUMC), Chicago.” according to 

a press release on EurekAlert. “After RUMC received a lower than expected ranking for patient safety 

in the 2015-16 U.S. News & World Report’s (USNWR) ‘Best Hospitals’ rankings, the authors compared 

the data that USNWR used for their hospital to their own internal data. The authors found that the 

USNWR data showed many more patient safety events, such as pressure ulcers, almost all of which 

had actually been present at the patient’s admission. Suspecting a broader problem, Hota et al. 

analyzed data on a sample of hospitals and found that RUMC was not the only organization with 

discrepancies in data. False-positive event rates were common among high-transfer and high-volume 

hospitals. The authors conclude more transparency and validation is needed for consumer-based 

benchmarking methods. In response to these findings and concerns raised by others, USNWR made 

changes to its methodology and data sources in 2016. In an accompanying editorial, ‘The Quality 

Measurement Crisis: An Urgent Need for Methodological Standards and Transparency,’ David M. 

Shahian, MD, Elizabeth Mort, MD, MPH, and Peter J. Pronovost, MD, PhD, reflect on the Hota et al. 

article to conclude, ‘Just as health care providers have ethical and moral responsibilities to the public 

they serve, rating organizations and journalists that grade providers have similar obligations–in their 

case, to ensure measure validity and methodological transparency.’ RUMC further explored the 

importance of rating organization’s validity and methodological transparency in the following essay, 

‘Hospital Rankings Have Room for Improvement.'” Study: Hospital rankings may rely on faulty 

data,” EurekAlert! Science News. In response, Ben Harder, head of the U.S. News and Word Report 

quality ranking efforts, posted a description of how “quality measurement is a journey,”

US News : Finland, U.S. to Deepen Military Ties Through Pact

US News

Finland, U.S. to Deepen Military Ties Through Pact

Friday, October 7, 2016 - 07:13

Finland and the United States have signed a bilateral defense cooperation pact pledging closer military collaboration at the time when the Nordic country is increasingly concerned over Russia's activities in the Baltic Sea region

Trending News : WikiLeaks Releases Private Clinton Speeches, Hacking Blamed on Russia

By MICHAEL BIESECKER, CHAD DAY and JEFF HORWITZ, Associated Press

WASHINGTON (AP) — Hillary Clinton told bankers behind closed doors that she favored "open trade and open borders" and said Wall Street executives were best-positioned to help reform the U.S. financial sector, according to transcripts of her private, paid speeches leaked Friday.

The leaks were the result of another email hacking intended to influence the presidential election.

Excerpts of the speeches given in the years before her 2016 presidential campaign included some blunt and unguarded remarks to her private audiences, which collectively had paid her at least $26.1 million in speaking fees. Clinton had refused to release transcripts of the speeches, despite repeated calls to do so by her primary opponent, Sen. Bernie Sanders.

The excerpts were included in emails exchanged among her political staff, including Campaign Chairman John Podesta, whose email account was hacked. The WikiLeaks organization posted what it said were thousands of Podesta's emails. It wasn't immediately clear who had hacked Podesta's emails, though the breach appeared to cover years of messages, some sent as recently as last month.

Among the emails was a compilation of excerpts from Clinton's paid speeches in 2013 and 2014. It appeared campaign staff had read all Clinton's speeches and identified passages that could be potentially problematic for the candidate if they were to become public.

One excerpt put Clinton squarely in the free-trade camp, a position she has retreated on significantly during the 2016 election. In a talk to a Brazilian bank in 2013, she said her "dream" is "a hemispheric common market, with open trade and open borders" and asked her audience to think of what doubling American trade with Latin America "would mean for everybody in this room."

Donald Trump, the Republican nominee, has made opposition to trade deals a cornerstone of his campaign.

Podesta posted a series of tweets Friday night, calling the disclosures a Russian hack and raising questions about whether some of the documents could have been altered.

"I'm not happy about being hacked by the Russians in their quest to throw the election to Donald Trump," Podesta wrote. "Don't have time to figure out which docs are real and which are faked."

Podesta's comments came just hours after U.S. officials publicly accused the Russian government of directing cyberattacks on political organizations and American citizens in an attempt to interfere with U.S. elections.

The joint statement from the office of the Director of National Intelligence and the Homeland Security Department cited disclosures of "alleged hacked emails" on sites like DCLeaks.com and WikiLeaks as being "consistent with the methods and motivations of Russian-directed efforts."

The statement didn't refer by name to the affected political institutions, but federal authorities are investigating cyberattacks on the computer systems of the Democratic National Committee and the Democratic Congressional Campaign Committee.

Republican National Committee chairman Reince Priebus said in a statement, "It's not hard to see why she fought so hard to keep her transcripts of speeches to Wall Street banks paying her millions of dollars secret."

The emails released Friday included exchanges between Podesta and other Clinton insiders, including campaign manager Robby Mook. Most were routine, including drafts of Clinton speeches, suggested talking points for campaign surrogates and suggested tweets to be sent out from Clinton's account.

The excerpts include quotes from an October 2013 speech at an event sponsored by Goldman Sachs, in which Clinton conceded that presidential candidates need the financial backing of Wall Street to mount a competitive national campaign.

"Running for office in our country takes a lot of money, and candidates have to go out and raise it," Clinton said. "New York is probably the leading site for contributions for fundraising for candidates on both sides of the aisle, and it's also our economic center. And there are a lot of people here who should ask some tough questions before handing over campaign contributions to people who were really playing chicken with our whole economy."

In the same speech, Clinton was also deferential to the New York finance industry, exhorting wealthy donors to use their political clout for patriotic rather than personal benefit. She also spoke of the need to include Wall Street perspectives in financial reform.

"The people that know the industry better than anybody are the people who work in the industry," Clinton said.

In an April 2013 speech to the National Multifamily Housing Council, Clinton said politicians must balance "both a public and a private position" while making deals. Clinton gave an example from the movie "Lincoln," and the deal-making that went into passage of the 13th Amendment, a process she compared to sausage-making.

"It is unsavory, and it always has been that way, but we usually end up where we need to be," Clinton said. "But if everybody's watching, you know, all of the back room discussions and the deals, you know, then people get a little nervous to say the least. So, you need both a public and a private position."

Clinton's speeches often touched on technology and privacy. In an April 2014 speech to JPMorgan, she denounced National Security Agency leaker Edward Snowden for going abroad, saying, "if he really cared about raising some of these issues and stayed right here in the United States, there's a lot of whistleblower protections."

But she told her audience that her time in the public eye left her sympathetic to privacy concerns.

"As somebody who has had my privacy scrutinized and violated for decades, I'm all for privacy, believe me," she said.

Speaking on international affairs, Clinton's comments were largely in line with her positions as secretary of state, if sometimes more blunt.

"The Saudis have exported more extreme ideology than any other place on Earth over the course of the last 30 years," she told the Jewish United Fund at a 2013 dinner.

The speech transcripts were produced under an agreement Clinton routinely imposed on any organization that hired her to speak. The contracts, such as ones crafted by the Harry Walker Agency, required the organizations to hire, at their own expense, a stenographer who would provide the transcripts to Clinton and not keep copies for themselves.

In some cases, the contracts themselves were obtained by news organizations under public records laws because Clinton was being paid to speak by public universities or colleges.

___

Source USNEWS.COM

British pound shaken by 6 percent 'flash crash'

FILE - In this Sept. 13, 2016 file photo, a member of staff at a branch of Halifax bank, in London, displays a new British 5 pound sterling note, made from polymer, which is being launched Tuesday. The beleaguered British pound plummeted briefly to a fresh 31-year low Friday, Oct. 7, 2016, amid intensifying concerns about Britain's exit from the European Union. The pound tumbled nearly 6 percent in early Asian trading, falling as low as $1.1789, according to FactSet data. (AP Photo/Alastair Grant, File) THE ASSOCIATED PRESS

By KELVIN CHAN, AP Business Writer

HONG KONG (AP) — The beleaguered British pound suffered a "flash crash" on Friday in which it briefly plummeted 6 percent within minutes to a new 31-year low, intensifying concerns about Britain's exit from the European Union.

The pound tumbled from $1.2600 to as low as $1.1789, a 6 percent drop in the space of two minutes, according to financial data provider FactSet. That's a huge move for a currency, even for the volatile pound, which then recovered most of that ground to trade at $1.2365.

Market watchers were baffled by the move, which they blamed on various factors including a trader's "fat finger" mistake, a rogue automated trading algorithm making decisions based on news websites or social media; or comments made by France's president, Francois Hollande.

Hollande said "Britain wants to leave but not pay anything. That's not possible." His comments suggest he will push for a hard stance in negotiating Britain's exit, known as Brexit, from the bloc's tariff-free single market.

The comments were made hours before the flash crash, but may have had an effect on trading only when Asian markets opened.

Some speculated the crash could have been caused by a combination of these reasons.

Kathleen Brooks, research director at Forex.com and City Index, said that computerized trading programs that scan news sites could have been prompted to start selling pounds by the increase in negative headlines about Britain. Once the pound started moving lower, she said, other computerized trading programs could have followed suit, compounding the drop.

The crash occurred during a "twilight period" between major market trading hours — after the close of markets in the U.S. and just as Asian traders were starting their day. That means the volume of trading was likely lower than usual, and that relatively smaller trades can have an outsize impact.

"Whatever it was, it shows us that the pound is looking very vulnerable right now," said Alex Edwards, currency analyst at UKForex.

The pound has now lost about 17 percent since hitting a 2016 high of $1.50 on the day of the June 23 referendum in which British voters opted to leave the EU.

The decline has accelerated after British Prime Minister Theresa May said Sunday said she would trigger two years of formal exit talks before April. She emphasized the need to control immigration of EU citizens, suggesting she would sacrifice Britain's access to the EU single market if needed. The EU has long said Britain cannot close its doors to EU citizens while remaining in the EU market.

As the date of the official exit negotiations approach, the pound could face more steep losses, said Edwards. Pound "traders, importers and exporters might want to fasten their seatbelts."

Federal government: Mylan has been overcharging for EpiPens

Even the federal government is apparently paying too much for EpiPens, along with angry patients and insurers

FILE - In this Wednesday, Sept. 21, 2016, file photo, Mylan CEO Heather Bresch holds up EpiPens while testifying on Capitol Hill in Washington, before the House Oversight Committee hearing on EpiPen price increases. Now the federal government, responding to Congressional inquiries, says EpiPen's maker has been overcharging Medicaid for years because the emergency shot is classified incorrectly as a generic medicine, so Mylan has been paying the government much-lower rebates off the price than it should. (AP Photo/Pablo Martinez Monsivais, File) THE ASSOCIATED PRESS

By LINDA A. JOHNSON, AP Medical Writer

TRENTON, N.J. (AP) — Even the federal government is apparently paying too much for EpiPens, along with angry patients and insurers.

The skyrocketing price of the life-saving allergy shot, which has triggered a storm of criticism, is only part of the problem. Now the federal government, responding to Congressional inquiries, says Medicaid for years has been paying too much for EpiPens because the emergency shot is classified incorrectly as a generic medicine.

The federal government says EpiPen is a branded drug, which means the drug's maker, Mylan, should have been paying the government a far higher rebate under the government's complex pricing rules.

Mylan, which has been blasted for hiking the price of a pair of EpiPens to $608 from $94 since 2007, denies wrongdoing. It says that EpiPen meets Medicaid's definition of a generic product and that it was classified that way when Mylan acquired rights to the product in 2007.

The company could face steep penalties, though.

According to the Centers for Medicare & Medicaid, manufacturers that pay insufficient rebates may be fined by the Department of Health and Human Services for violating the rebate rules, sued for overcharging the government or hit with other penalties.

CMS spokesman Aaron Albright would not comment Thursday on whether the agency would try to correct the misclassification of EpiPen, recoup money, or seek penalties from Mylan.

But in a letter sent late Wednesday to senators and congressmen probing EpiPen's exorbitant price hikes, Andy Slavitt, acting director of CMS, wrote that EpiPen doesn't meet the definition of a generic drug because it was approved as a brand-name drug and is protected by a patent. Slavitt wrote that CMS "has expressly told Mylan that the product is incorrectly classified."

Albright couldn't immediately say when Mylan was told that, but said the pharmaceutical industry was given guidelines explaining the classifications in 2010.

For nine years, the government says, Mylan has been paying rebates of 13 percent, as required for generic products when it should have been paying the 23.1 percent rebate required for brand-name drugs.

In addition, CMS said Mylan hasn't been paying Medicaid a second rebate that is required whenever the price of a brand-name drug price rises more than inflation. The price of an Epipen pack rose 23 percent a year on average between 2007 and 2016. Inflation has averaged less than 2 percent a year over the same period.

The prior maker of EpiPen apparently also was underpaying. CMS records indicate the product's status was changed from brand-name to generic in the fourth quarter of 1997, according to Slavitt's letter. It's unclear why the change was made.

Mylan said in a statement that it "simply continued to classify the product the same way," as that was "consistent with longstanding written guidance from the federal government."

The amount Medicare and Medicaid spent on EpiPens rose to $486.8 million in 2015 from $86.5 million in 2011, a jump of 463 percent, Slavitt's letter says.

In response, Senate Finance Committee member Ron Wyden, D-Oregon, and House Energy and Commerce Committee member Frank Pallone, D-New Jersey, said in a statement that Mylan is "bilking taxpayers out of millions of dollars."

Mylan shares fell 3 percent to $36.84 Thursday.

Florida Gov. Warns ‘This Storm Will Kill You’ FROM USA.COM

More than 100 have been killed by Hurricane Matthew in the Caribbean.

A man walks near the Cocoa Beach Pier as Hurricane Matthew approaches Thursday in Cocoa Beach, Florida. (MARK WILSON/GETTY IMAGES)

More than 2 million people have been urged to evacuate coastal South Carolina, Georgia and Florida as of Thursday morning, as Florida's governor matter-of-factly warned, "this storm will kill you."

More than 100 people have died in the Caribbean as a result of the massive storm. While it briefly was down-graded to a Category 3 storm, the National Hurricane Center said late Thursday morning that it had again reached the Category 4 level.

"Do not surf. Do not go on the beach. This will kill you," Gov. Rick Scott said at a press conference Thursday. "There is no reason not to leave."

"Millions will lose power, possibly for a long period of time," Scott said. "Evacuate, evacuate, evacuate."

[READ: South Carolina Urges 1.1 Million to Evacuate Ahead of Hurricane Matthew]

Meteorologist Bill Karins of NBC said Thursday he was "confident saying this is going to be a major hurricane in the history of Florida." Tropical storm conditions are expected to develop in Florida for the first time Thursday. States of emergency were declared in South Carolina, Georgia and Florida earlier this week.

The Caribbean has already been ravaged by the storm's wake, with the storm heading to the the Bahamas Thursday morning. The storm made landfall Tuesday in Haiti as a Category 4. At least 28 people died from Matthew in Haiti, the Dominican Republic and St. Vincent and the Grenadines, officials said.

Mourad Wahba, the U.N. secretary-general's deputy special representative for Haiti, described Matthew as the "largest humanitarian event" in Haiti since the devastating 2010 earthquake, which killed more than 200,000 according to Oxfam International, though exact casualty figures still vary.

President Barack Obama addressed the imminent U.S. landfall of Hurricane Matthew Wednesday, in remarks at Federal Emergency Management Agency headquarters in Washington. Obama was briefed by FEMA Administrator Craig Fugate and said, "I want to emphasize to the public: This is a serious storm."

Updated on Oct. 6, 2016: This story was updated as new information became available.

Original : http://www.usnews.com/news/articles/2016-10-06/hurricane-matthew-causes-massive-evacuation-2-million-urged-to-head-away-from-coast

The Best Of BATTLEFIELD 1 Single Player Campaign Intro Cutscene

In Battlefield 1 you’ll experience a series of what we call War Stories: personal stories focusing on different protagonists with unique backgrounds and skills. While our characters are at war, the stories in Battlefield 1 are personal. They’re about people rather than history or battles.

The Great War is diverse. We knew we wanted to embrace that variety. There were so many different perspectives and characters in World War 1 and we wanted to cover as much ground as possible.

This made us reconsider the format of what we’d offer in Battlefield 1 single player. We felt that to have one character hopping through those different settings wouldn’t be as immersive or totally respectful to the setting. So we decided on an anthology format; a set of characters with their own more focused stories. That way we can have immersion and variety – a double win.

One example is the War Story Through Mud and Blood. It takes place late in the war and centers on a British Mark V Tank crew. The story focuses on a young soldier assigned to the crew as the tank’s driver. However, our protagonist has no experience of these modern war vehicles and need to learn – and learn fast. Our hero is also struggling with earning the trust of his fellow crew members, so there’s a social dynamic in the story, making the whole thing something personal. Danny Edwards, our driver character, is not an ace sniper. He’s not a crack pilot. He’s not a demo expert. He’s a former chauffeur – a volunteer new to the war. He can drive and he can fix things. That’s where we start.

In previous Battlefield iterations we’ve experienced the story through the eyes of one main character, and it was very rare that the camera cut anywhere. But in Battlefield 1 we decided we wanted stronger characters instead of just telling players “you are the character”. One way to do this was to invoke classic cinematics that lets you see your character more than in first-person-theater. We wanted the player to see and feel what the characters are going through, rather than just experiencing it from behind their eyes. That has really payed off for us not just in storytelling ability, but in emotional engagement. 

Watch And Enjoy