Kaiser Permanente to Add 500 Jobs in Colorado

The office of Colorado Gov. John Hickenlooper has announced that health care provider Kaiser Permanente plans to open an information technology (IT) campus in Englewood in January. Along with the opening of the campus will be about 500 jobs by 2015. Here are the details.

* Kaiser Permanente's new IT campus will be a 120,000-square-foot, five story building located near major highways, several shops, cafes and fitness centers. The facility will include a day care center and an independently operated deli.

* Hickenlooper said that the company's plan is "welcome news" in Colorado and credited the state's high-tech workforce, healthy business ecosystem and excellent quality of life as an attraction for employers looking to create new jobs. "Kaiser Permanente's new IT campus is another win for Colorado," the governor said.

* Kaiser Permanente Colorado's president, Donna Lynne, DrPH, stated that the demographics of metro Denver, a healthy real estate market and "an expansive talent pool of potential employees" made Englewood an ideal location for the new campus.

* Currently, Kaiser Permanente employs about 6,000 IT professionals nationwide.

* Kaiser Permanente operates the largest non-governmental medical record system in the world, according to Hickenlooper's office, with its HealthConnect electronic health record of it more than 9 million members nationwide made accessible to more than 16,000 physicians.

* Members also have access to electronic health information management features, including online appointment scheduling, prescription refills, lab test results, eligibility and benefits information and children's immunization records.

* According to Phil Fasano, the executive vice president and chief information officer of Kaiser Permanente, the new IT campus in Colorado will help the company honor its commitment to use technology to facilitate patient care and improve health outcomes.

* Kaiser Permenente is Colorado's largest nonprofit health plan, with a state membership of about 535,000. The company has 26 medical offices in Colorado and with 6,000 staff and physicians employed in the state, it is one of Colorado's largest private employers.

* In 2011, Kaiser Permanente directed more than $90 million to services, partnerships and programs directly benefiting Colorado communities, the company stated, including discounted and free care to more than 9,000 low income patients. Kaiser Permanente supports community programs in Colorado that include LiveWell Colorado, Weigh and Win and Denver B-cycle.

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Cave Artists Had Leg Up On Moderns

Who was the better artist, a caveman or Leonardo da Vinci?

It turns out that early depictions of four-legged animals walking are more accurate in some ways than modern ones—even those crafted by the Renaissance master. The study is in the journal PLoS ONE. [Gabor Horvath et al, Cavemen Were Better at Depicting Quadruped Walking than Modern Artists: Erroneous Walking Illustrations in the Fine Arts from Prehistory to Today]

Without fancy cameras, we two-leggers can have trouble visualizing the sequence of leg motion in a quadruped's gait. Hungarian scientists recently analyzed a thousand statues, paintings and other art created in prehistory or more recently. Specifically, the researchers checked how the legs of ostensibly moving quadrupeds hit the ground, to see if these depictions matched actual animal locomotion.

Of course, 19th century photographer Eadweard Muybridge famously captured a horse's motion in stop-motion photographs. Artwork in the centuries prior to his photos got the legs wrong 84 percent of the time. The error rate dropped to 58 percent after his photos came out. But prehistoric artists topped all with just a 46 percent error rate. Perhaps those cave painters paid such close attention to detail because they wanted to avoid being starving artists.

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Residents go home after toxic chemicals cleared in NJ train wreck

PAULSBORO, New Jersey (Reuters) - Residents evacuated after last week's freight train derailment spewed toxic vinyl chloride began returning home on Friday as tests of the air came back clean, a Coast Guard official said.

Exactly one week after a bridge collapsed, derailing seven of the 82 Conrail freight-train cars crossing the Mantua Creek, residents who were ordered out of 148 homes nearest the wreck were allowed back into their homes on Friday afternoon.

Coast Guard Captain Kathy Moore said air tests in the south New Jersey town showed no further evidence of vinyl chloride, which had leaked from a gash in one tanker that tumbled into the waterway that feeds into the Delaware River near Philadelphia.

At the time of the wreck, authorities said 12,000 gallons (45,425 liters) of vinyl chloride had escaped.

Groups of residents were being led to their homes by law enforcement and air quality officials. The Coast Guard also offered in-home air quality checks to any resident seeking further assurance that their home is safe.

"Our priority has been and continues to be the safety of Paulsboro residents," Moore said.

Earlier in the week, residents said they were anxious to get back home after living in a series of hotels.

"I've been in tears because I want to go home," said Terri Manning, 51, who was evacuated with her husband and son from their home about 200 yards from the wreck.

"My parakeet is in the house. She's probably dead by now," said Manning, a farmers market worker who said she had spent all her cash paying for hotels and other emergency living expenses.

Vinyl chloride is a highly toxic and flammable industrial chemical. Exposure to it can cause respiratory problems, coughing and light-headedness, said Lawrence Ragonese, spokesman for the state Department of Environmental Protection.

The failed rail-bridge is near both residential and commercial sections of the town of 6,100 people, which is also home to two oil refineries as well as chemical plants.

Conrail is jointly owned by rail operators CSX Corp and Norfolk Southern Corp.

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Dow, S&P rise on jobs, but Apple bites Nasdaq again

NEW YORK (Reuters) - The Dow and the S&P 500 advanced modestly on Friday, though another sell-off in Apple depressed technology shares and kept the Nasdaq negative, overshadowing a sharply better-than-expected jobs report.

Trading was light, continuing the week's trend of slight moves and anemic volume. The S&P 500 ended up a mere 0.1 percent for the week, following several volatile sessions that repeatedly pushed it in and out of positive territory. The benchmark index is just 3.8 percent below the 2012 intraday high of 1,474.51 reached in mid-September.

Equities opened higher after the non-farm payrolls report, which showed 146,000 jobs added in November, far more than had been expected, while the U.S. unemployment rate dropped to 7.7 percent. A sour reading on consumer sentiment caused an erosion of those gains, though markets rebounded going into the close.

The Thomson Reuters/University of Michigan's consumer sentiment index for early December fell to its lowest level since August. Sentiment fell on growing concerns over the "fiscal cliff" debates in Washington, which have been a major factor preventing broader moves as well.

"We're not as concerned as we were a few months ago because of improvement like you can see in the employment number, but there's such a wild card over the cliff," said Bruce McCain, chief investment strategist at Key Private Bank in Cleveland, Ohio. "There are such concerns about what could happen that markets will be overhung until a resolution is more certain."

One of the biggest drags on the Nasdaq was Apple which fell 2.6 percent to $533.25, extending its losses for the week to 8.9 percent. This was the worst week for the stock since May 2010, and with the losses, the stock of the largest U.S. company by market value is now down 24.4 percent from an all-time intraday high reached in late September.

In Friday's session, Apple's 50-day moving average fell to $599.52 - below its 200-day moving average at $601.38. The weakness drove the S&P information technology sector <.gspt> lower. The index fell 0.6 percent and was the weakest of the S&P 500's 10 major industry sectors on Friday.

The Dow Jones industrial average <.dji> gained 81.09 points, or 0.62 percent, to 13,155.13 at the close. The Standard & Poor's 500 Index <.spx> rose 4.13 points, or 0.29 percent, to 1,418.07. The Nasdaq Composite Index <.ixic> slipped 11.23 points, or 0.38 percent, to close at 2,978.04.

For the week, the Nasdaq is down 1.1 percent, hurt largely by the decline in Apple.

The Dow, which does not count Apple as a component, rose 1 percent for its third straight week of gains. The S&P 500 is also up for three straight weeks, rising 4.3 percent over that period.

The equity market has regained most of the ground it lost following President Barack Obama's re-election as markets turned their focus to the coming "fiscal cliff." Market response to the macroeconomic data remained muted as negotiations continued to command investor attention.

U.S. House Speaker John Boehner said that talks this week with President Barack Obama produced no progress, and he renewed his demand that the president provide a new offer to avert the series of tax increases and spending cuts that are likely to hurt economic demand in 2013.

Material shares <.gspm> were the strongest performers of the day, with that index up 0.8 percent. Freeport-McMoRan Copper & Gold Co gained 2.9 percent to $31.70 while Dow Chemical added 2.2 percent to $30.30.

Amarin Corp fell 18.9 percent to $9.69 after the biopharmaceutical company raised $100 million in financing to help it launch its heart drug, Vascepa, but disappointed investors, who had hoped for a sale or partnership.

CombiMatrix Corp shares more than quadrupled, soaring 336.6 percent to $8.60 after the company said two studies published in a medical journal favored technology it uses for prenatal diagnosis of genetic abnormalities over traditional technologies.

About 52 percent of shares listed on the New York Stock Exchange closed higher while slightly more than 50 percent of Nasdaq-listed stocks closed lower.

Volume was light, with about 5.47 billion shares changing hands on the New York Stock Exchange, the Nasdaq and NYSE MKT, below the daily average so far this year of about 6.48 billion shares.

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Supreme Court could limit scope for class arbitration

(Reuters) - The Supreme Court  on Friday agreed to hear an appeal that gives the nine justices a chance to limit the ability of consumers and businesses to litigate disputes as a class.

At issue was whether doctors could collectively arbitrate a dispute over payments with Oxford Health Plans LLC even though the governing arbitration agreement did not mention class actions.

The court has in recent years made it harder for some parties to litigate or arbitrate their claims together, which could boost payouts and lower costs.

In the 2010 case Stolt-Nielsen v. AnimalFeeds International Corp, the court said it "cannot be presumed" that parties to a dispute agreed to accept class arbitration simply by having agreed to arbitrate in the first place.

And the next year, in AT&T Mobility v. Concepcion, the court gave businesses a big victory by upholding contracts that required customers to arbitrate disputes individually, and waive their right to pursue class-action litigation.

In the Oxford case, an arbitrator allowed class arbitration of a dispute over that company's alleged failure to properly reimburse doctors including John Sutter, who challenged how some 16,500 physicians in New Jersey were reimbursed.

The arbitrator allowed class arbitration despite the silence on that issue of the governing contractual clause, which said: "No civil action concerning any dispute arising under this agreement shall be instituted before any court, and all such disputes shall be submitted to final and binding arbitration."

The 3rd U.S. Circuit Court of Appeals in Philadelphia upheld the Oxford arbitrator's decision in April, saying the arbitrator simply "construed the text of the arbitration agreement to authorize and require class arbitration".

But Seth Waxman, a former U.S. solicitor general representing Oxford, said this effectively gave arbitrators unfettered discretion to decide whether there was an "implicit" understanding between parties to allow class arbitration.

He said that while the federal appeals court in New York has taken a similar approach, the federal appeals court in New Orleans required more of a contractual or legal basis.

"A party's right not to be dragooned into class arbitration proceedings that it never agreed to authorize should not depend on which federal court is asked to enforce the ... basic precept that arbitration is a matter of consent, not coercion," Waxman wrote.

The doctors, while noting that the agreement was "atypical", urged the Supreme Court not to take the case.

They said the appellate court split appeared based more on the facts of the particular cases, and that the issue will become less important as more parties use agreements with explicit language about class arbitration.

A decision is expected by the end of June.

The case is Oxford Health Plans LLC v. Sutter, U.S. Supreme Court, No. 12-135.

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Should breast cancer patients skip the pre-op MRI?

NEW YORK (Reuters Health) - A new review of existing evidence suggests that using magnetic resonance imaging to "stage" a woman's breast cancer before surgery might do more harm than good.

MRI produces a much clearer image than X-rays and ultrasound, and is recommended for detecting early tumors in women at increased risk for breast cancer. But routinely using the technology once any woman is diagnosed with a tumor may lead to more radical surgery without any benefits, says a team of Australian and U.S. researchers.

They found that about 26 percent of women who had a pre-operative MRI to help determine the extent and severity of their tumor ended up having their entire breast removed, compared to about 18 percent of those whose surgeons only used traditional methods of characterizing the cancer.

"I wasn't surprised by the results at all. What I am surprised by was the strength of the data," said Dr. Monica Morrow, the study's senior author and the chief of breast service at Memorial Sloan-Kettering Cancer Center in New York.

Because MRIs are more sensitive than mammograms, some doctors think they are a good tool for identifying the precise outlines of cancerous tissue. Others, however, have begun to question whether the imaging led surgeons to remove more breast tissue than necessary.

Moreover, women who have MRIs before breast surgery seem to be no less likely to need a second surgery to remove additional cancerous tissue.

A study published in September, for instance, found that among more than 300 women who underwent breast cancer surgery, just as many of those who had an MRI before the first surgery ended up having a repeat operation. (see Reuters Health article of September 25, 2012 here: http://reut.rs/Oogm3c)

An MRI can also add more than $1,000 to a patient's bill.

"I think more surgeons are starting to question this because they're seeing the outcomes," Morrow said.

For the new study, she and her colleagues pulled together data from nine previous studies to see if MRIs influenced the number of women who had their breast removed or who had a second surgery to remove additional cancer.

From the nine studies, the researchers had information on 3,112 women who had breast cancer surgery.

Overall, the team found that about 16 percent of the women who had an MRI ended up having the entire cancerous breast removed, known as a mastectomy, during their first surgery. That's compared to about 8 percent of women who did not have an MRI.

They also found that having an MRI before surgery did not influence whether women would need additional surgery to remove more tissue. In each group, between 11 percent and 12 percent had to go back under the knife.

After taking into account the women's initial surgery and the second operations, the researchers calculated that about 26 percent of those who had an MRI ended up having their entire breast removed, compared to 18 percent in the no-MRI group.

"It causes more mastectomies to start with, but it doesn't decrease the number of women who started out wanting a lumpectomy and needing a mastectomy," said Morrow of preoperative MRIs.

The study did not look at long term outcomes, including how many women survived beyond five years. Nor did it examine the use of MRI to screen the opposite breast for signs that cancer had spread, the researchers note in their report, which is published in the Annals of Surgery.

These results do not apply to certain subgroups of patients, they add, including women with genetic mutations that predispose them to cancer and those whose other diagnostic tests produced conflicting results.

But based on the short term measures of how many surgeries women got and how much tissue surgeons removed from them, Morrow told Reuters Health that MRIs do not seem to have a place in breast cancer surgery.

"There may be select circumstances where we'd use it to solve a problem, but for most women with breast cancer they don't need an MRI for their evaluation," she said.

SOURCE: http://bit.ly/RdZNIw Annals of Surgery, online November 26, 2012.

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