The validation of structural models obtained by macromolecular X-ray crystallography against experimental diffraction data, whether before deposition into the PDB or after, is typically carried out exclusively against the merged data that are eventually archived along with the atomic coordinates. It is shown here that the availability of unmerged reflection data enables valuable additional analyses to be performed that yield improvements in the final models, and tools are presented to implement them, together with examples of the results to which they give access. The first example is the automatic identification and removal of image ranges affected by loss of crystal centering or by excessive decay of the diffraction pattern as a result of radiation damage. The second example is the `reflection-auditing' process, whereby individual merged data items showing especially poor agreement with model predictions during refinement are investigated thanks to the specific metadata (such as image number and detector position) that are available for the corresponding unmerged data, potentially revealing previously undiagnosed instrumental, experimental or processing problems. The third example is the calculation of so-called F(early) − F(late) maps from carefully selected subsets of unmerged amplitude data, which can not only highlight the location and extent of radiation damage but can also provide guidance towards suitable fine-grained parametrizations to model the localized effects of such damage.

Appreciating that the role of the solute–solvent and other outer-sphere interactions is essential for understanding chemistry and chemical dynamics in solution, experimental approaches are needed to address the structural consequences of these interactions, complementing condensed-matter simulations and coarse-grained theories. High-energy X-ray scattering (HEXS) combined with pair distribution function analysis presents the opportunity to probe these structures directly and to develop quantitative, atomistic models of molecular systems in situ in the solution phase. However, at concentrations relevant to solution-phase chemistry, the total scattering signal is dominated by the bulk solvent, prompting researchers to adopt a differential approach to eliminate this unwanted background. Though similar approaches are well established in quantitative structural studies of macromolecules in solution by small- and wide-angle X-ray scattering (SAXS/WAXS), analogous studies in the HEXS regime—where sub-ångström spatial resolution is achieved—remain underdeveloped, in part due to the lack of a rigorous theoretical description of the experiment. To address this, herein we develop a framework for differential solution scattering experiments conducted at high energies, which includes concepts of the solvent-excluded volume introduced to describe SAXS/WAXS data, as well as concepts from the time-resolved X-ray scattering community. Our theory is supported by numerical simulations and experiment and paves the way for establishing quantitative methods to determine the atomic structures of small molecules in solution with resolution approaching that of crystallography.

The success of experimental phasing in macromolecular crystallography relies primarily on the accurate locations of heavy atoms bound to the target crystal. To improve the process of substructure determination, a modified phase-retrieval algorithm built on the framework of the relaxed alternating averaged reflection (RAAR) algorithm has been developed. Importantly, the proposed algorithm features a combination of the π-half phase perturbation for weak reflections and enforces the direct-method-based tangent formula for strong reflections in reciprocal space. The proposed algorithm is extensively demonstrated on a total of 100 single-wavelength anomalous diffraction (SAD) experimental datasets, comprising both protein and nucleic acid structures of different qualities. Compared with the standard RAAR algorithm, the modified phase-retrieval algorithm exhibits significantly improved effectiveness and accuracy in SAD substructure determination, highlighting the importance of additional constraints for algorithmic performance. Furthermore, the proposed algorithm can be performed without human intervention under most conditions owing to the self-adaptive property of the input parameters, thus making it convenient to be integrated into the structural determination pipeline. In conjunction with the IPCAS software suite, we demonstrated experimentally that automatic de novo structure determination is possible on the basis of our proposed algorithm.

The advent of serial crystallography has rejuvenated and popularized room-temperature X-ray crystal structure determination. Structures determined at physiological temperature reveal protein flexibility and dynamics. In addition, challenging samples (e.g. large complexes, membrane proteins and viruses) form fragile crystals that are often difficult to harvest for cryo-crystallography. Moreover, a typical serial crystallography experiment requires a large number of microcrystals, mainly achievable through batch crystallization. Many medically relevant samples are expressed in mammalian cell lines, producing a meager quantity of protein that is incompatible with batch crystallization. This can limit the scope of serial crystallography approaches. Direct in situ data collection from a 96-well crystallization plate enables not only the identification of the best diffracting crystallization condition but also the possibility for structure determination under ambient conditions. Here, we describe an in situ serial crystallography (iSX) approach, facilitating direct measurement from crystallization plates mounted on a rapidly exchangeable universal plate holder deployed at a microfocus beamline, ID23-2, at the European Synchrotron Radiation Facility. We applied our iSX approach on a challenging project, autotaxin, a therapeutic target expressed in a stable human cell line, to determine the structure in the lowest-symmetry P1 space group at 3.0 Å resolution. Our in situ data collection strategy provided a complete dataset for structure determination while screening various crystallization conditions. Our data analysis reveals that the iSX approach is highly efficient at a microfocus beamline, improving throughput and demonstrating how crystallization plates can be routinely used as an alternative method of presenting samples for serial crystallography experiments at synchrotrons.

The structural characterization is reported of the supra­molecular complex between the tetra­quinoxaline-based cavitand 2,8,14,20-tetra­hexyl-6,10:12,16:18,22:24,4-O,O'-tetra­kis­(quinoxaline-2,3-di­yl)calix[4]resorcinarene (QxCav) with benzo­nitrile. The complex, of general formula C84H80N8O8·2C7H5N, crystallizes in the space group Poverline{1} with two independent mol­ecules in the asymmetric unit, displaying very similar geometrical parameters. For each complex, one of the benzo­nitrile mol­ecules is engulfed inside the cavity, while the other is located among the alkyl legs at the lower rim. The host and the guests mainly inter­act through weak C—H⋯π, C—H⋯N and dispersion inter­actions. These inter­actions help to consolidate the formation of supra­molecular chains running along the crystallographic b-axis direction.

X-ray diffraction from dislocation half-loops consisting of a misfit segment with two threading arms extending from it to the surface is calculated by the Monte Carlo method. The diffraction profiles and reciprocal space maps are controlled by the ratio of the total lengths of the misfit and the threading segments of the half-loops. A continuous transformation from the diffraction characteristic of misfit dislocations to that of threading dislocations with increasing thickness of epitaxial film is studied. Diffraction from dislocations with edge- and screw-type threading arms is considered and the contributions of the two types of dislocations are compared.

Recent developments in synchrotron radiation facilities have increased the amount of data generated during acquisitions considerably, requiring fast and efficient data processing techniques. Here, the application of dense neural networks (DNNs) to data treatment of X-ray diffraction computed tomography (XRD-CT) experiments is presented. Processing involves mapping the phases in a tomographic slice by predicting the phase fraction in each individual pixel. DNNs were trained on sets of calculated XRD patterns generated using a Python algorithm developed in-house. An initial Rietveld refinement of the tomographic slice sum pattern provides additional information (peak widths and integrated intensities for each phase) to improve the generation of simulated patterns and make them closer to real data. A grid search was used to optimize the network architecture and demonstrated that a single fully connected dense layer was sufficient to accurately determine phase proportions. This DNN was used on the XRD-CT acquisition of a mock-up and a historical sample of highly heterogeneous multi-layered decoration of a late medieval statue, called `applied brocade'. The phase maps predicted by the DNN were in good agreement with other methods, such as non-negative matrix factorization and serial Rietveld refinements performed with TOPAS, and outperformed them in terms of speed and efficiency. The method was evaluated by regenerating experimental patterns from predictions and using the R-weighted profile as the agreement factor. This assessment allowed us to confirm the accuracy of the results.

Small-angle scattering (SAS) is a key experimental technique for analyzing nanoscale structures in various materials. In SAS data analysis, selecting an appropriate mathematical model for the scattering intensity is critical, as it generates a hypothesis of the structure of the experimental sample. Traditional model selection methods either rely on qualitative approaches or are prone to overfitting. This paper introduces an analytical method that applies Bayesian model selection to SAS measurement data, enabling a quantitative evaluation of the validity of mathematical models. The performance of the method is assessed through numerical experiments using artificial data for multicomponent spherical materials, demonstrating that this proposed analysis approach yields highly accurate and interpretable results. The ability of the method to analyze a range of mixing ratios and particle size ratios for mixed components is also discussed, along with its precision in model evaluation by the degree of fitting. The proposed method effectively facilitates quantitative analysis of nanoscale sample structures in SAS, which has traditionally been challenging, and is expected to contribute significantly to advancements in a wide range of fields.

The two most abundant CaCO3 polymorphs, calcite and aragonite, are universally recognized for the richness of their morphology to which different twins make relevant contributions. The epitaxial transformation calcite ↔ aragonite has long been debated. While the twinning has been thoroughly treated, the homo-epitaxy occurring within each of these minerals has, inexplicably, been overlooked to date, both experimentally and theoretically. Twinning can be deceptive to the point where it can be mistaken for homo-epitaxy, thus making the proposed growth mechanism in the crystal aggregate wrong. Within the present work, the first aim is a theoretical investigation of the homo-epitaxies among the three {10.4}-cleavage, {01.2}-steep and {01.8}-flat rhombohedra of calcite. Accordingly, the specific adhesion energies were calculated between facing crystal forms, unequivocally showing that the {01.2}/{01.8} homo-epitaxy competes with the generation of both {01.2} and {01.8} contact twins. Secondly, the calculation of the specific adhesion energy was extended to consider homo-epitaxy for the {10.4} rhombohedron. The two-dimensional geometric lattice coincidence has been tried for the {00.1} pinacoidal form as well.

The neutralization of acidic solutions containing U (IV) and Ce (III) at room temperature in glove box atmosphere and in the presence of dithionite results in coprecipitation of these elements as amorphous solid solutions CexU1–xO2±y. The solubilities of the precipitates with different mole fractions (x) of Ce(OH)3 (x = 0.01 or 0.1) were determined in 1 M NaClO4 solutions between pH 2.2 and 12.8 under reducing conditions. The solids were investigated by a variety of methods (chemical analysis, SEM-EDX, XRD, XPS, XAS) to determine the nature of the solid solutions formed, their composition and the valence state of Ce and U. X-ray photoelectron spectroscopy confirmed the oxidation states of the solids both before and after the equilibration as Ce (III) and U (IV). The amorphous coprecipitates reached equilibrium relatively fast (∼1 week). The release of Ce from the coprecipitates was totally dominated by the release of uranium over the whole pH range. The Ce concentrations decrease slightly with the decrease of Ce content in the solid, suggesting that CexU1–xO2±y solids behave thermodynamically as solid solutions. The concentrations of U in equilibrium with the coprecipitate were in excellent agreement with the solubility of UO2(s) under reducing conditions reported in the literature. The conditional solubility product of Ce(OH)3 from the coprecipitate was several orders of magnitude (∼4 in the near neutral pH range and ∼18 in the acidic range) lower than that of pure Ce(OH)3(s). The activities and activity coefficients of Ce(OH)3(s) in the coprecipitate were also estimated. Activity coefficients are much less than 1, indicating that the mixing of Ce(OH)3 with UO2 is highly favorable.

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After 16 years of dedicated planning and engineering, scientists at the U.S. Department of Energy's (DOE) Brookhaven National Laboratory have completed a 3.2 gigapixel sensor array for the camera that will be used in the Large Synoptic Survey Telescope (LSST), a massive telescope that will observe the universe like never before. The digital sensor array is composed of about 200 16-megapixel sensors, divided into 21 modules called "rafts." Each raft can function on its own, but when combined, they will view an area of sky that can fit more than 40 full moons in a single image. Researchers will stitch these images together to create a time-lapse movie of the complete visible universe accessible from Chile. Currently under construction on a mountaintop in Chile, LSST is designed to capture the most complete images of our universe that have ever been achieved. The project to build the telescope facility and camera is a collaborative effort among more than 30 institutions from around the world, and it is primarily funded by DOE's Office of Science and the National Science Foundation.

Image credit: SLAC National Accelerator Laboratory

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Claire Lang-Ree was in a lab coat taking a college chemistry class remotely in the kitchen of her Colorado Springs, Colo., home, when a profound pain twisted into her lower abdomen. She called her mom, Jen Lang-Ree, a nurse practitioner who worried it was appendicitis and found a nearby hospital in the family's health insurance network.

After a long wait in the emergency room of Penrose Hospital, Claire received morphine and an anti-nausea medication delivered through an IV. She also underwent a CT scan of her abdomen and a series of tests.

Hospital staffers ruled out appendicitis and surmised Claire was suffering from a ruptured ovarian cyst, which can be a harmless part of the menstrual cycle but can also be problematic and painful. After a few days — and a chemistry exam taken through gritted teeth — the pain went away.

Then the bill came.

Patient: Claire Lang-Ree, a 21-year-old Stanford University student who was living in Colorado for a few months while taking classes remotely. She's insured by Anthem Blue Cross through her mom's work as a pediatric nurse practitioner in Northern California.

Total Bill: $18,735.93, including two $722.50 fees for a nurse to "push" drugs into her IV, a process that takes seconds. Anthem's negotiated charges were $6,999 for the total treatment. Anthem paid $5,578.30, and the Lang-Rees owed $1,270.45 to the hospital, plus additional bills for radiologists and other care. (Claire also anted up a $150 copay at the ER.)

Service Provider: Penrose Hospital in Colorado Springs, part of the regional health care network Centura Health.

What Gives: As hospitals disaggregate charges for services once included in an ER visit, a hospitalization or a surgical procedure, there has been a proliferation of newfangled fees to increase billing. In the health field, this is called "unbundling." It's analogous to the airlines now charging extra for each checked bag or for an exit row seat. Over time, in the medical industry, this has led to separate fees for ever-smaller components of care. A charge to put medicine into a patient's IV line — a "push fee" — is one of them.

Though the biggest charge on Claire's bill, $9,885.73, was for a CT scan, in many ways Claire and her mom found the push fees most galling. (Note to readers: Scans are frequently many times more expensive when ordered in an ER than in other settings.)

"That was so ridiculous," says Claire, who adds she had previously taken the anti-nausea drug they gave her; it's available in tablet form for the price of a cup of coffee, no IV necessary. "It works really well. Why wasn't that an option?"

In Colorado, the average charge for the code corresponding to Claire's first IV push has nearly tripled since 2014, and the dollars hospitals actually get for the procedure has doubled. In Colorado Springs specifically, the cost for IV pushes rose even more sharply than it did statewide.

A typical nurse in Colorado Springs makes about $35 an hour. At that rate, it would take nearly 21 hours to earn the amount of money Penrose charged for a push of plunger that likely took seconds or at most minutes.

The hospital's charge for just one "IV push" was more than Claire's portion of the monthly rent in the home she shared with roommates. In the end, Anthem did not pay the push fees in its negotiated payment. But claims data shows that in 2020 Penrose typically received upward of $1,000 for the first IV push. And patients who didn't have an insurer to dismiss such charges would be stuck with them. Colorado hospitals on average received $723 for the same code, according to the claims database.

"It's insane the variation that we see in prices, and there's no rhyme or reason," says Cari Frank with the Center for Improving Value in Health Care, a Colorado nonprofit that runs a statewide health care claims database. "It's just that they've been able to negotiate those prices with the insurance company and the insurance company has decided to pay it."

To put the total cost in context, Penrose initially charged more money for Claire's visit than the typical Colorado hospital would have charged for helping someone give birth, according to data published by the Colorado Division of Insurance.

Even with the negotiated rate, "it was only $1,000 less than an average payment for having a baby," Frank says.

In an email statement, Centura said it "conducted a thorough review and determined all charges were accurate" and went on to explain that "an Emergency Room (ER) must be prepared for anything and everything that comes through the doors," requiring highly trained staff, plus equipment and supplies. "All of this adds up to large operating costs and can translate into patient responsibility."

As researchers have found, little stands in the way of hospitals charging through the roof, especially in a place like an emergency room, where a patient has few choices. A report from National Nurses United found that hospital markups have more than doubled since 1999, according to data from the United States Bureau of Labor Statistics. In an email, Anthem called the trend of increasing hospital prices "alarming" and "unsustainable."

But Ge Bai, an associate professor of accounting and health policy at Johns Hopkins University, says when patients see big bills it isn't only the hospital's doing — a lot depends on the insurer, too. For one, the negotiated price depends on the negotiating power of the payer, in this case, Anthem.

"Most insurance companies don't have comparable negotiating or bargaining power with the hospital," said Bai. Prices in a state like Michigan, where Bai said the UAW union covers a big proportion of Michigan patients, will look very different from those in Colorado.

Also, insurers are not the wallet defenders patients might assume them to be.

"In many cases, insurance companies don't negotiate as aggressively as they can, because they earn profit from the percentage of the claims," she says. The more expensive the actual payment is, the more money they get to extract.

Though Anthem negotiated away the push fees, it paid the hospital 30% more than the average Level IV emergency department visit in Colorado that year, and it paid quadruple what Medicare would allow for her CT scan.

Resolution: Claire and her mom decided to fight the bill, writing letters to the hospital and searching for information on what the procedures should have cost. The cost of the IV pushes and CT scan infuriated them — the hospital wanted more than double for a CT than what top-rated hospitals typically charged in 2019.

But the threat of collections wore them out and ultimately they paid their assigned share of the bill — $1,420.45, which was mostly coinsurance.

"Eventually it got to the point where I was like, 'I don't really want to go to collections, because this might ruin my credit score,'" says Claire, who didn't want to graduate from college with dinged credit.

Bai and Frank say the state of Maryland can provide a useful benchmark for medical bills, since it sets the prices that hospitals can charge for each procedure. Data provided by the Maryland Health Care Commission shows that Anthem and Claire paid seven times what she likely would have paid for the CT scan there, and nearly 10 times what they likely would have paid for the emergency department Level IV visit. In Maryland, intravenous pushes typically cost about $200 apiece in 2019. A typical Maryland hospital would have received only about $1,350 from a visit like Claire's, and the Lang-Rees would have been on the hook for about $270.

Claire's pain has come back a few times, but never as bad as that night in Colorado. She has avoided reentering an emergency room since then. After visiting multiple specialists back home in California, she learned she might have had a condition called ovarian torsion.

The Takeaway: Even at an in-network facility and with good insurance, patients can get hurt financially by visiting the ER. A few helpful documents can help guide the way to fighting such charges. The first is an itemized bill.

"I just think it's wrong in the U.S. to charge so much," says Jen Lang-Ree. "It's just a little side passion of mine to look at those and make sure I'm not being scammed."

Bai, of Johns Hopkins, suggests asking for an itemized explanation of benefits from the insurance company, too. That will show what the hospital actually received for each procedure.

Find out if the hospital massively overcharged. The Medicare price lookup tool can be useful for getting a benchmark. And publicly available data on health claims in Colorado and at least 17 other states can help, too.

Vincent Plymell with the Colorado Division of Insurance encourages patients to reach out if something on a bill looks sketchy. "Even if it's not a plan we regulate," he wrote in an email, departments such as his "can always arm the consumer with info."

Finally, make scrutinizing such charges fun. Claire and Jen made bill-fighting their mother-daughter hobby for the winter. They recommend pretzel chips and cocktails to boost the mood.

Bill of the Month is a crowdsourced investigation by KHN and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

This content is from Southern California Public Radio. View the original story at SCPR.org.

Many hospitals around the country, including Medstar Washington Hospital in Washington DC., have started sharing their prices online in compliance with a recent federal rule.; Credit: DANIEL SLIM/AFP via Getty Images

A colonoscopy might cost you or your insurer a few hundred dollars — or several thousand, depending on which hospital or insurer you use.

Long hidden, such price variations are supposed to be available in stark black and white under a Trump administration price transparency rule that took effect at the start of this year. It requires hospitals to post a range of actual prices — everything from the rates they offer cash-paying customers to costs negotiated with insurers.

Many have complied.

But some hospitals bury the data deep on their websites or have not included all the categories of prices required, according to industry analysts. A sizable minority of hospitals have not disclosed the information at all.

While imperfect and potentially of limited use right now to the average consumer, the disclosures that are available illustrate the huge differences in prices — nationally, regionally and within the same hospital. But they're challenging for consumers and employers to use, giving a boost to a cottage industry that analyzes the data.

While it's still an unanswered question whether price transparency will lead to overall lower prices, KHN took a dive into the initial trove of data to see what it reveals. Here are five takeaways from the newly public data and tips for how you might be able to use it to your benefit

1) As expected, prices are all over the map

The idea behind the requirement to release prices is that the transparency may prompt consumers to shop around, weighing cost and quality. Perhaps they could save a few hundred dollars by getting their surgery or imaging test across town instead of at the nearby clinic or hospital.

Under the Trump-era rule, hospitals must post what they accept from all insurers for thousands of line items, including each drug, procedure or treatment they provide. In addition, hospitals must present this in a format easily readable by computers and include a consumer-friendly separate listing of 300 "shoppable" services, bundling the full price a hospital accepts for a given treatment, such as having a baby or getting a hip replacement.

The negotiated rates now being posted publicly often show an individual hospital accepting a wide range of prices for the same service, depending on the insurer, often based on how much negotiating power each has in a market.

In some cases, the cash-only price is less than what insurers pay. And prices may vary widely within the same city or region.

In Virginia, for example, the average price of a diagnostic colonoscopy is $2,763, but the range across the state is from $208 to $10,563, according to a database aggregated by San Diego-based Turquoise Health, one of the new firms looking to market the data to businesses, while offering some information free of charge to patients.

2) Patients can look up the information, but it's incomplete

Patients can try to find the price information themselves by searching hospital websites, but even locating the correct tab on a hospital's website is tricky.

Typically, consumers don't comparison-shop, preferring to choose convenience or the provider their doctor recommends. A recent Peterson-KFF Health System Tracker brief, for instance, found that 85% of adults said they had not researched online the price of a hospital treatment.

And hospitals say the transparency push alone won't help consumers much, because each patient's situation is different and may vary from the average— and individual deductibles and insurance plans complicate matters.

But if you do want to try, here's one tip: "You can Google the hospital name and the words 'price transparency' and see where that takes you," says Caitlin Sheetz, director and head of analytics at the consulting firm ADVI Health in the Washington, D.C., metro area.

Typing in "MedStar Health hospital transparency," for example, likely points to the MedStar Washington Hospital Center's "price transparency disclosure" page, with a link to its full list of prices, as well as its separate list of 300 shoppable services.

By clicking on the list of shoppable services, consumers can download an Excel file. Searching it for "colonoscopy" pulls up several variations of the procedure, along with prices for different insurers, such as Aetna and Cigna, but a "not available" designation for the cash-only price. The file explains that MedStar does not have a standard cash price but makes determinations case by case.

Performing the same Google search for the nearby Inova health system results in less useful information.

Inova's website links to a long list of thousands of charges, which are not the discounts negotiated by insurers, and the list is not easily searchable. The website advises those who are not Inova patients or who would like to create their own estimate to log into the hospitals' "My Chart" system, but a search on that for "colonoscopy" failed to produce any data.

3) Third-party firms are trying to make searching prices simpler – and cash in

Because of the difficulty of navigating these websites — or locating the negotiated prices once there — some consumers may turn to sites like Turquoise. Another such firm is Health Cost Labs, which will have pricing information for 2,300 hospitals in its database when it goes live July 1.

Doing a similar search for "colonoscopy" on Turquoise shows the prices at MedStar by insurer, but the process is still complicated. First, a consumer must select the "health system" button from the website's menu of options, click on "surgical procedures," then click again on "digestive" to get to it.

There is no similar information for Inova because the hospital has not yet made its data accessible in a computer-friendly format, said Chris Severn, CEO of Turquoise.

Inova spokesperson Tracy Connell said in a written statement that the health system will create personalized estimates for patients and is "currently working to post information on negotiated prices and discounts on services."

Firms like Turquoise and Health Cost Labs aim to sell the data gathered from hospitals nationally to insurers, employers and others. In turn, those groups may use it in negotiations with hospitals over future prices. While that may drive down prices in areas with a lot of competition, it might do the opposite where there are few hospitals to choose from, or in situations where a hospital raises its prices to match competitors.

4) Consumers could use this data to negotiate, especially if they're paying cash

For consumers who go the distance and can find price data from their hospitals, it may prove helpful in certain situations:

• Patients who are paying cash or who have unmet deductibles may want to compare prices among hospitals to see if driving farther could save them money.
• Uninsured patients could ask the hospital for the cash price or attempt to negotiate for the lowest amount the facility accepts from insurers.
• Insured patients who get a bill for out-of-network care may find the information helpful because it could empower them to negotiate a discount off the hospitals' gross charges for that care.

While there's no guarantee of success, "if you are uninsured or out of network, you could point to some of those prices and say, 'That's what I want,'" says Barak Richman, a contract law expert and professor of law at Duke University School of Law.

But the data may not help insured patients who notice their prices are higher than those negotiated by other insurers.

In those cases, legal experts say the insured patients are unlikely to get a bill changed because they have a contract with that insurer, which has negotiated the price with their contracted hospitals.

"Legally, a contract is a contract," says Mark Hall, a health law professor at Wake Forest University.

Richman agrees.

"You can't say, 'Well, you charged that person less,'" he notes, but neither can they say they'll charge you more.

Getting the data, however, relies on the hospital having posted it.

5) Hospitals still aren't really on board

When it comes to compliance, "we're seeing the range of the spectrum," says Jeffrey Leibach, a partner at the consulting firm Guidehouse, which found earlier this year that about 60% of 1,000 hospitals surveyed had posted at least some data, but 30% had reported nothing at all.

Many in the hospital industry have long fought transparency efforts, even filing a lawsuit seeking to block the new rule. The suit was dismissed by a federal judge last year.

They argue the rule is unclear and overly burdensome. Additionally, hospitals haven't wanted their prices exposed, knowing that competitors might then adjust theirs, or health plans could demand lower rates. Conversely, lower-cost hospitals might decide to raise prices to match competitors.

The rule stems from requirements in the Affordable Care Act. The Obama administration required hospitals to post their chargemaster rates, which are less useful because they are generally inflated, hospital-set amounts that are almost never what is actually paid.

Insurers and hospitals are also bracing for next year when even more data is set to come online. Insurers will be required to post negotiated prices for medical care across a broader range of facilities, including clinics and doctors' offices.

In May, the Centers for Medicare & Medicaid Services sent letters to some of the hospitals that have not complied, giving them 90 days to do so or potentially face penalties, including a $300-a-day fine.

"A lot of members say until hospitals are fully compliant, our ability to use the data is limited," says Shawn Gremminger, director of health policy at the Purchaser Business Group on Health, a coalition of large employers.

His group and others have called for increasing the penalty for noncomplying hospitals from $300 a day to $300 a bed per day, so "the fine would be bigger as the hospital gets bigger," Gremminger says. "That's the kind of thing they take seriously."

Already, though, employers or insurers are eyeing the hospital data as leverage in negotiations, says Severn, Turquoise's CEO. Conversely, some employers may use it to fire their insurers if the rates they're paying are substantially more than those agreed to by other carriers.

"It will piss off anyone who is overpaying for health care, which happens for various reasons," he says.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation).

This content is from Southern California Public Radio. View the original story at SCPR.org.

Rita Moreno, as seen in the documentary “Rita Moreno: Just a Girl Who Decided to Go for It.”

Guest host John Horn and KPCC film critics Claudia Puig, Peter Rainer, Lael Loewenstein and Charles Solomon review this weekend’s new movie releases on streaming and on demand platforms.

• "Rita Moreno: Just a Girl Who Decided to Go for It," at Laemmle’s theaters (Newhall, Town Center 5, NoHo 7, Claremont 5, Playhouse 7) and other select theaters 

• "Les Nôtres," at Laemmle’s Royal and Laemmle’s Virtual Cinema 

• "Rise Again: Tulsa And The Red Summer," premieres on National Geographic June 18 at 6pm PT & on Hulu June 19

• "Luca," at the El Capitan Theater (Hollywood) & Disney+

• "The Sparks Brothers," in wide release 

• "Sisters on Track," on Netflix June 24

• "Fatherhood," on Netflix

• "Truman & Tennessee: An Intimate Conversation," at Landmark’s Nuart Theater & Virtual cinemas 

• "Sweet Thing," Laemmle’s Royal and Laemmle’s Virtual Cinema

• "Summer of 85," at Laemmle’s theaters (Playhouse 7, Royal and Town Center 5) 

• "12 Mighty Orphans" in wide release

Our FilmWeek critics have been curating personal lists of their favorite TV shows and movies to binge-watch during self-quarantine. You can see recommendations from each of the critics and where you can watch them here.

With guest host John Horn 

Guests:

Claudia Puig, film critic for KPCC and president of the Los Angeles Film Critics Association (LAFCA); she tweets @ClaudiaPuig

Lael Loewenstein, film critic for KPCC and film columnist for the Santa Monica Daily Press; she tweets @LAELLO

Peter Rainer, film critic for KPCC and the Christian Science Monitor

Charles Solomon, film critic for KPCC, Animation Scoop and Animation Magazine

This content is from Southern California Public Radio. View the original story at SCPR.org.

Are you digitally prepared for the winter? Seems easy until you have no power and your battery in your mobile device is dead. Don't be caught digitally unprepared.

Rescuers search for bodies from the site where a Philippine military C-130 plane crashed in Patikul town, Sulu province, southern Philippines on Sunday, July 4, 2021.; Credit: /Joint Task Force-Sulu via AP

MANILA, Philippines — A Philippine air force C-130 aircraft carrying combat troops crashed in a southern province while landing Sunday, killing at least 29 army soldiers on board and two civilians on the ground, while at least 50 were rescued from the burning wreckage, officials said.

Some soldiers were seen jumping off the aircraft before it crashed and exploded around noon in the periphery of the Jolo airport in Sulu province, military officials said. Two of six villagers who were hit on the ground have died.

Defense Secretary Delfin Lorenzana said rescue and recovery efforts were ongoing. The aircraft had 96 people on board, including three pilots and five crew and the rest were army personnel, the military said, adding 17 soldiers remained unaccounted for by nightfall. The pilots survived but were seriously injured, officials said.

The Lockheed C-130 Hercules was one of two ex-U.S. Air Force aircraft handed over to the Philippines as part of military assistance this year. It crashed while landing shortly before noon Sunday in Bangkal village in the mountainous town of Patikul, military chief of staff Gen. Cirilito Sobejana said.

Military officials said at least 50 people on board were brought to a hospital in Sulu or flown to nearby Zamboanga city and troops were trying to search for the rest. "Per eyewitnesses, a number of soldiers were seen jumping out of the aircraft before it hit the ground, sparing them from the explosion caused by the crash," a military statement said.

Initial pictures released by the military showed the tail section of the cargo plane relatively intact. The other parts of the plane were burned or scattered in pieces in a clearing surrounded by coconut trees. Soldiers and other rescuers with stretchers were seen dashing to and from the smoke-shrouded crash site.

The plane was transporting troops, many of them new soldiers who had just undergone basic training, from the southern Cagayan de Oro city for deployment in Sulu, officials said.

"They were supposed to join us in our fight against terrorism," Sulu military commander Maj. Gen. William Gonzales said. Government forces have been battling Abu Sayyaf militants in the predominantly Muslim province of Sulu for decades.

It was not immediately clear what caused the crash. Regional military commander Lt. Gen. Corleto Vinluan said it was unlikely that the aircraft took hostile fire, and cited witnesses as saying that it appeared to have overshot the runway then crashed in the periphery of the airport.

"It's very unfortunate," Sobejana told reporters. "The plane missed the runway and it was trying to regain power but failed and crashed."

An air force official told The Associated Press that the Jolo runway is shorter than most others in the country, making it more difficult for pilots to adjust if an aircraft misses the landing spot. The official, who has flown military aircraft to and from Jolo several times, spoke on condition of anonymity because of a lack of authority to speak publicly.

Initial pictures showed that the weather was apparently fine in Sulu although other parts of the Philippines were experiencing rains due to an approaching tropical depression. The airport in Sulu's main town of Jolo is located a few kilometers (miles) from a mountainous area where troops have battled Abu Sayyaf militants. Some militants have aligned themselves with the Islamic State group.

The U.S. and the Philippines have separately blacklisted Abu Sayyaf as a terrorist organization for bombings, ransom kidnappings and beheadings. It has been considerably weakened by years of government offensives but remains a threat.

President Rodrigo Duterte expanded the military presence in Sulu into a full division in late 2018, deploying hundreds of additional troops, air force aircraft and other combat equipment after vowing to wipe out the Abu Sayyaf and allied foreign and local gunmen.

Government forces at the time were running after Muslim armed groups a year after quelling the five-month siege of southern Marawi city by hundreds of militants linked to the Islamic State group. More than 1,000 people, mostly militants and long-elusive Abu Sayyaf commanders, were killed in months of intense air and ground assaults.

Sunday's crash comes as the limited number of military aircraft has been further strained, as the air force helped transport medical supplies, vaccines and protective equipment to far-flung island provinces amid spikes in COVID-19 infections.

The Philippine government has struggled for years to modernize its military, one of Asia's least equipped, as it dealt with decades-long Muslim and communist insurgencies and territorial rifts with China and other claimant countries in the South China Sea.

This content is from Southern California Public Radio. View the original story at SCPR.org.

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Police tape blocks access from a street leading to the building complex where the Capital Gazette is located on June 29, 2018, in Annapolis, Md. The suspect barricaded a back door in an effort to "kill as many people as he could kill," police said.; Credit: Mandel Ngan/AFP via Getty Images

Jury selection in the trial of the gunman who fatally shot five employees at the Capital Gazette newspaper in Annapolis, Md., on June 28, 2018 gets underway on Wednesday.

Jarrod Ramos, 41, has pleaded guilty — but not criminally responsible for reason of insanity — in the killings of John McNamara, Rob Hiaasen, Gerald Fischman, Wendi Winters and Rebecca Smith. The mass shooting was one of the deadliest attacks on journalists in modern U.S. history.

"There is a sense that you don't want this to be the thing that makes your life change," Phil Davis, the paper's former criminal justice reporter who now works at the Baltimore Sun, told NPR.

Davis was hiding under his desk while live tweeting the shooting that day. Later, he was part of the Pulitzer Prize-winning team that put out a paper the very next day.

"That's kind of what drove me to continue as a criminal justice reporter. Once I got the feeling of like, 'no we're going to get back to exactly what we do. We're going to tackle this how we would even if it wasn't us and try to go at it from the perspective of a local community newspaper,'" Davis said.

Bruce Shapiro, the executive director of the Columbia University's Dart Center for Journalism and Trauma, said what made this shooting reverberate in newsrooms across the U.S. was "the idea of a newsroom full of colleagues being murdered just because they are journalists. It's an identity based attack."

Attacks on journalists in the U.S. haven't stopped there. During his time in office, President Donald Trump tweeted that the news media is the enemy of the people. Associated Press journalists were threatened and had their equipment damaged by supporters of Trump during the Capitol insurrection on Jan. 6. And last year, during the protests in Minneapolis over the murder of George Floyd by police, the U.S. Press Freedom Tracker reported at least 160 threats to journalists across the country in one week--mostly by police.

Shapiro says the trial is a reminder to the public of the risks and costs local reporters take daily.

"The reality is that local newsrooms all over the country cover extraordinarily difficult events affecting their own families, neighbors, kids, schools whether that is wildfires, whether that is mass shooting, whether that is COVID-19," Shapiro said.

The Capital Gazette trial has been delayed several times due to COVID-19, turnover in the public defender and state's attorney's offices, and rounds of court hearings. Davis says he hopes the long-awaited trial brings some closure.

"Certainly for the families of the victims themselves, I look forward to being on the other end of this trial," he said. "And whatever the outcome is, being able to embrace them and support them just to bring them some sort of closure."

Today, less than a week before the third anniversary of the shooting, the judge has called a pool of 300 people to determine the 12 that will sit as jurors. They will then determine Ramos's mental sanity during the attack.

Steve Mercer, a former Maryland public defender, said the defense has the burden to prove Ramos's sanity. He said that in cases like these, the defense will look at motive and intent. One possible motive, Mercer says, is Ramos' "long-simmering feud with the paper."

Ramos sued the paper for defamation in 2012 after reporters wrote about his guilty plea on charges of criminal harassment and 90-day suspended jail sentence. But that motive might not hold up.

"I think there's a big gap between sort of being upset about a story that's published ... and then going in and committing a mass shooting," Mercer said.

Mercer adds what presents a challenge to both the defense and prosecution is Ramos's conduct after the shooting. He was found by police under a desk at the scene of the shooting with a pump-action shotgun which was purchased legally a few years before.

"The defense may point to it and say that it shows just a disconnect from reality and a lack of awareness of what was going on," Mercer said.

Circuit Court Judge Judge Michael Wachs will ultimately decide if he ends up in prison or a state psychiatric hospital.

This content is from Southern California Public Radio. View the original story at SCPR.org.

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