Compared with batch and vapor diffusion methods, counter diffusion can generate larger and higher-quality protein crystals yielding improved diffraction data and higher-resolution structures. Typically, counter-diffusion experiments are conducted in elongated chambers, such as glass capillaries, and the crystals are either directly measured in the capillary or extracted and mounted at the X-ray beamline. Despite the advantages of counter-diffusion protein crystallization, there are few fixed-target devices that utilize counter diffusion for crystallization. In this article, different designs of user-friendly counter-diffusion chambers are presented which can be used to grow large protein crystals in a 2D polymer microfluidic fixed-target chip. Methods for rapid chip fabrication using commercially available thin-film materials such as Mylar, propyl­ene and Kapton are also detailed. Rules of thumb are provided to tune the nucleation and crystal growth to meet users' needs while minimizing sample consumption. These designs provide a reliable approach to forming large crystals and maintaining their hydration for weeks and even months. This allows ample time to grow, select and preserve the best crystal batches before X-ray beam time. Importantly, the fixed-target microfluidic chip has a low background scatter and can be directly used at beamlines without any crystal handling, enabling crystal quality to be preserved. The approach is demonstrated with serial diffraction of photoactive yellow protein, yielding 1.32 Å resolution at room temperature. Fabrication of this standard microfluidic chip with commercially available thin films greatly simplifies fabrication and provides enhanced stability under vacuum. These advances will further broaden microfluidic fixed-target utilization by crystallographers.

Online courses and innovative teaching methods have triggered a trend in education, where the integration of multimedia, online resources and interactive tools is reshaping the view of both virtual and traditional classrooms. The use of interactive tools extends beyond the boundaries of the physical classroom, offering students the flexibility to access materials at their own speed and convenience and enhancing their learning experience. In the field of crystallography, there are a wide variety of free online resources such as web pages, interactive applets, databases and programs that can be implemented in fundamental crystallography courses for different academic levels and curricula. This paper discusses a variety of resources that can be helpful for crystallographic symmetry handling and visualization, discussing four specific resources in detail: the Bilbao Crystallographic Server, the Cambridge Structural Database, VESTA and Jmol. The utility of these resources is explained and shown by several illustrative examples.

High-pressure crystallographic data can be measured using a diamond anvil cell (DAC), which allows the sample to be viewed only along a cell vector which runs perpendicular to the diamond anvils. Although centring a sample perpendicular to this direction is straightforward, methods for centring along this direction often rely on sample focusing, measurements of the direct beam or short data collections followed by refinement of the crystal offsets. These methods may be inaccurate, difficult to apply or slow. Described here is a method based on precise measurement of the offset in this direction using a confocal optical device, whereby the cell centre is located at the mid-point of two measurements of the distance between a light source and the external faces of the diamond anvils viewed along the forward and reverse directions of the cell vector. It is shown that the method enables a DAC to be centred to within a few micrometres reproducibly and quickly.

Understanding the structure–property relationship in electrocatalysts under working conditions is crucial for the rational design of novel and improved catalytic materials. This paper presents the Aarhus University reactor for electrochemical studies using X-rays (AUREX) operando electrocatalytic flow cell, designed as an easy-to-use versatile setup with a minimal background contribution and a uniform flow field to limit concentration polarization and handle gas formation. The cell has been employed to measure operando total scattering, diffraction and absorption spectroscopy as well as simultaneous combinations thereof on a commercial silver electrocatalyst for proof of concept. This combination of operando techniques allows for monitoring of the short-, medium- and long-range structure under working conditions, including an applied potential, liquid electrolyte and local reaction environment. The structural transformations of the Ag electrocatalyst are monitored with non-negative matrix factorization, linear combination analysis, the Pearson correlation coefficient matrix, and refinements in both real and reciprocal space. Upon application of an oxidative potential in an Ar-saturated aqueous 0.1 M KHCO3/K2CO3 electrolyte, the face-centered cubic (f.c.c.) Ag gradually transforms first to a trigonal Ag2CO3 phase, followed by the formation of a monoclinic Ag2CO3 phase. A reducing potential immediately reverts the structure to the Ag (f.c.c.) phase. Following the electrochemical-reaction-induced phase transitions is of fundamental interest and necessary for understanding and improving the stability of electrocatalysts, and the operando cell proves a versatile setup for probing this. In addition, it is demonstrated that, when studying electrochemical reactions, a high energy or short exposure time is needed to circumvent beam-induced effects.

This article presents a web-based framework to build a database without in-depth programming knowledge given a set of CIF dictionaries and a collection of CIFs. The framework consists of two main elements: the public site that displays the information contained in the CIFs in an ordered manner, and the restricted administrative site which defines how that information is stored, processed and, eventually, displayed. Thus, the web application allows users to easily explore, filter and access the data, download the original CIFs, and visualize the structures via JSmol. The modulated structures open database B-IncStrDB, the official International Union of Crystallography repository for this type of material and available through the Bilbao Crystallographic Server, has been re-implemented following the proposed framework.

SUBGROUPS is a free online program at the Bilbao Crystallographic Server (https://www.cryst.ehu.es/). It permits the exploration of all possible symmetries resulting from the distortion of a higher-symmetry parent structure, provided that the relation between the lattices of the distorted and parent structures is known. The program calculates all the subgroups of the parent space group which comply with this relation. The required minimal input is the space-group information of the parent structure and the relation of the unit cell of the distorted or pseudo-symmetric structure with that of the parent structure. Alternatively, the wavevector(s) observed in the diffraction data characterizing the distortion can be introduced. Additional conditions can be added, including filters related to space-group representations. The program provides very detailed information on all the subgroups, including group–subgroup hierarchy graphs. If a Crystallographic Information Framework (CIF) file of the parent high-symmetry structure is uploaded, the program generates CIF files of the parent structure described under each of the chosen lower symmetries. These CIF files may then be used as starting points for the refinement of the distorted structure under these possible symmetries. They can also be used for density functional theory calculations or for any other type of analysis. The power and efficiency of the program are illustrated with a few examples.

Here, a morphologically based approach is used for the in situ characterization of 3D growth rates of facetted crystals from the solution phase. Crystal images of single crystals of the β-form of l-glutamic acid are captured in situ during their growth at a relative supersaturation of 1.05 using transmission optical microscopy. The crystal growth rates estimated for both the {101} capping and {021} prismatic faces through image processing are consistent with those determined using reflection light mode [Jiang, Ma, Hazlehurst, Ilett, Jackson, Hogg & Roberts (2024). Cryst. Growth Des. 24, 3277–3288]. The growth rate in the {010} face is, for the first time, estimated from the shadow widths of the {021} prismatic faces and found to be typically about half that of the {021} prismatic faces. Analysis of the 3D shape during growth reveals that the initial needle-like crystal morphology develops during the growth process to become more tabular, associated with the Zingg factor evolving from 2.9 to 1.7 (>1). The change in relative solution supersaturation during the growth process is estimated from calculations of the crystal volume, offering an alternative approach to determine this dynamically from visual observations.

VMXm joins the suite of operational macromolecular crystallography beamlines at Diamond Light Source. It has been designed to optimize rotation data collections from protein crystals less than 10 µm and down to below 1 µm in size. The beamline has a fully focused beam of 0.3 × 2.3 µm (vertical × horizontal) with a tuneable energy range (6–28 keV) and high flux (1.6 × 1012 photons s−1 at 12.5 keV). The crystals are housed within a vacuum chamber to minimize background scatter from air. Crystals are plunge-cooled on cryo-electron microscopy grids, allowing much of the liquid surrounding the crystals to be removed. These factors improve the signal-to-noise during data collection and the lifetime of the microcrystals can be prolonged by exploiting photoelectron escape. A novel in vacuo sample environment has been designed which also houses a scanning electron microscope to aid with sample visualization. This combination of features at VMXm allows measurements at the physical limits of X-ray crystallography on biomacromolecules to be explored and exploited.

X-ray multi-projection imaging (XMPI) is an emerging experimental technique for the acquisition of rotation-free, time-resolved, volumetric information on stochastic processes. The technique is developed for high-brilliance light-source facilities, aiming to address known limitations of state-of-the-art imaging methods in the acquisition of 4D sample information, linked to their need for sample rotation. XMPI relies on a beam-splitting scheme, that illuminates a sample from multiple, angularly spaced viewpoints, and employs fast, indirect, X-ray imaging detectors for the collection of the data. This approach enables studies of previously inaccessible phenomena of industrial and societal relevance such as fractures in solids, propagation of shock waves, laser-based 3D printing, or even fast processes in the biological domain. In this work, we discuss in detail the beam-splitting scheme of XMPI. More specifically, we explore the relevant properties of X-ray splitter optics for their use in XMPI schemes, both at synchrotron insertion devices and XFEL facilities. Furthermore, we describe two distinct XMPI schemes, designed to faciliate large samples and complex sample environments. Finally, we present experimental proof of the feasibility of MHz-rate XMPI at the European XFEL. This detailed overview aims to state the challenges and the potential of XMPI and act as a stepping stone for future development of the technique.

The Takagi–Taupin equations are solved in their simplest form (zero deformation) to obtain the Bragg-diffracted and transmitted complex amplitudes. The case of plane-parallel crystal plates is discussed using a matrix model. The equations are implemented in an open-source Python library crystalpy adapted for numerical applications such as crystal reflectivity calculations and ray tracing.

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Tadanobu Asano (L) and Chin Han (R) in "Mortal Kombat."; Credit: Warner Bros. Pictures

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In this Saturday, Sept. 6, 2014 file photo, Paris Barclay attends the LA Premiere Screening of "Sons Of Anarchy" at TCL Chinese Theatre, in Los Angeles. A new guild study says that women and minorities were largely shut out of the ranks of TV directors again last season. In a Wednesday, Sept. 17, 2014 statement, Directors Guild President Barclay said it can be "shockingly difficult" to persuade those who control industry hiring to make even small improvements.; Credit: Paul A. Hebert/Paul A. Hebert/Invision/AP

A new guild study says women and minorities were largely shut out of the ranks of TV directors again last season.

The Directors Guild of America report released Wednesday said employers have made no significant improvement in diversity hiring for TV series in the last four years.

According to the study, white males directed the vast majority of the 3,500 cable, broadcast and high-budget online episodes made for the 2013-14 season.

The same holds true for the three previous years, according to guild findings.

In a statement, Directors Guild President Paris Barclay said it can be "shockingly difficult" to persuade those who control industry hiring to make even small improvements.

L-R Access Hollywood film critic Scott Mantz moderates a talk by Neil deGrasse Tyson at the Aero Theatre in Santa Monica, June 9, 2017. Courtesy of the American Cinematheque; Credit: Robert Enger

Neil deGrasse Tyson came onto the science-themed, late night talk show circuit with some clout. The "Cosmos" host, author, educator, and Hayden Planetarium director's first guest when StarTalk "jumped species" from podcast to television was Whoopi Goldberg. 

On Friday June 9, 2017, Tyson opened up a screening of "Star Trek II: The Wrath of Khan" at the American Cinematheque's Aero Theatre in Santa Monica with a talk on his career as an astrophysicist-turned-broadcaster. Access Hollywood's film critic, Scott Mantz, moderated the event and asked Tyson for his three favorite StarTalk guests.

1. Nichelle Nichols

While StarTalk was still just a podcast, Nichols appeared on StarTalk twice. Tyson learned that Star Trek had been a holdover gig for Nichols while paying her dues to land dancing parts on Broadway. Tyson didn't think being Lieutenant Uhura was anything to sneeze at. "She is actually in the chain of command to be captain of the ship," remarked Tyson.

Early on into the series, Nichols decided it was time to go back to New York and find her dream job, Tyson said. However, before leaving she attended a party where she bumped into Dr. Martin Luther King Jr. 

"And he says, 'Oh, my children! We line up at night, and you make us all proud.' And she said, 'Oh, thank you, but I'm going back to New York,' and he said, 'You can't do that. There are no other black people on television. Much less, what there are, they're not in any kind of role of responsibility, and integrity, and dignity.' And he convinced her to stay with the series." - Neil deGrasse Tyson

Tyson teared up, searched for tissues, and said he opened up a bottle of wine at eleven in the morning during the taping with Nichols. "And then, I think it was only one and a half glasses of wine," Tyson said, before he asked Nichols about her and William Shatner's interracial kiss on Star Trek, one of the first interracial kisses on television. Tyson said Nichols told him that the producers of the show wanted to film a version of the scene without the kiss, but that she and Shatner purposefully kept messing up the non-kiss until they ran out of filming time so that the editors of the show wouldn't have any such scene to work with.

Nichols then asked Tyson if he wanted to see what a "racial kiss" was, and then she kissed him.

Tyson also recognized Nichols for her role in recruiting women and people of color for NASA space missions from engineering schools across the United States. Tyson said Nichols was able to find these recruits by looking where NASA had not been looking.

"You were only looking at the U.S. Naval Academy and not Tuskegee Institute where they have a huge engineering group. So she laid out this recipe, and that first astronaut class: it had black people, it had Asians, it had women. And they were at the top of their class when they came out of college and graduate school, so she shaped the modern view of NASA."

2. Biz Stone

"The name doesn't even sound real," said Tyson, referring to the co-founder of Twitter. Tyson counts Stone among the great entrepreneurs who never finished college: Bill Gates, Michael Dell, Mark Zuckerberg.

"Until he described how he envisioned Twitter, I had not fully appreciated what it was," said Tyson. Stone asked Tyson if he had ever seen birds suddenly take flight and flock together after behaving independently, and then, just as swiftly as they started, return to their posts and be "individuals again."

"Twitter is a flocking mechanism for humans," Tyson said. "I live near Ground Zero in New York City," Tyson recalled what could be described as a Twitter moment from 2011. "I'm watching TV, all of a sudden I heard noises in the street. Crowds were developing. I said, 'What's going on?'" While Tyson was sitting in his home, it had been announced that Osama Bin Laden had been killed.

Tyson got on the internet and read the news. "I missed all that, but all these people got the tweet, and everyone gathered back at Ground Zero." That realization of the nature of social media made Biz Stone Tyson's number two guest.

3. Kareem Abdul-Jabbar

Jabbar's appearance on StarTalk is from the upcoming season, so Tyson did not want to reveal the topics of the episode, but he could not resist including Jabbar because of his numerous qualifications.

• He has written a novel about Sherlock Holmes' older brother, Mycroft Holmes (which Jabbar talked with Off-Ramp about in 2015)
• He had a column in Time Magazine
• His high scores on Celebrity Jeopardy
• He's the highest scorer ever for the NBA, with 38,387 career points (Kobe Bryan is third with 33,643 points)
• He played in the All-Star Game 19 times out of his 20 NBA seasons
• He has six NBA Championship rings
• And he was in "Airplane!" and Bruce Lee's "Game of Death"

Tyson gives us one giveaway though, from Jabbar's interview. The one film role that Jabbar is disappointed about never being cast in was Chewbacca in "Star Wars."

Neil deGrasse Tyson's new book is Astrophysics for People in a Hurry. Thanks to him and the American Cinematheque for allowing us to excerpt their presentation on Off-Ramp.

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

L-R: Three Southern California retro fanatics, John Rabe, Chris Nichols, and Charles Phoenix; Credit: John Rabe/KPCC

Is it possible that the two titans of retro Southern California - Charles Phoenix and Charles Nichols - have never been on Off-Ramp at the same time? But maybe that brings up a larger question. Is it even possible for them to exist in the same place, at the same time, or would their meeting cause a cosmic singularity, an undarnable rending of the time-space continuum?

The answers are, stupidly, yes; and thankfully, yes.

Over the 11 years of Off-Ramp, "God Bless Americana" author Charles Phoenix and Los Angeles Magazine's Chris Nichols have played a large part in bringing interesting and endangered places to our listeners. From Pomona to Chatsworth to Bellflower to Anaheim, both men have made careers of highlighting and preserving things that in their day were seen as expendable, flavor-of-the-month, mass marketed creations. Like programmatic architecture (buildings that look like what they're selling or making, i.e. the Donut Hole in La Puente, the Idle Hour - a giant wine cask - in NoHo).

Yet, with hindsight, we've been able to see them as archetypal and important touchstones of our region.

For their final appearances on the show, they got in the Mercedes and shared their love of getting lost in Southern California.

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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.

Emerita Resources Corp. (EMO:TSX.V; EMOTF:OTCQB; LLJA:FSE) announces results from a metallurgical testing program at its wholly-owned Iberian Belt West (IBW) project in Spain. Read why one expert says the company is in "the right place to be."

This Buy-rated Canadian explorer-developer is working to achieve first mover status in this emerging clean energy space. Find out what all it has done and is doing.

Full Text:

A National Science Foundation-funded research has discovered the root cause of why lithium metal batteries fail -- bits of lithium metal deposits break off from the surface of the anode during discharging and are trapped as "dead" or inactive lithium that the battery can no longer access. The discovery challenges the conventional belief that lithium metal batteries fail because of the growth of a layer, called the solid electrolyte interphase (SEI), between the lithium anode and the electrolyte. The researchers made their discovery by developing a technique to measure the amounts of inactive lithium species on the anode -- a first in the field of battery research -- and studying their micro- and nanostructures. The findings could pave the way for bringing rechargeable lithium metal batteries from the lab to the market.

Image credit: University of California - San Diego

This Buy-rated Canadian explorer-developer is working to achieve first mover status in this emerging clean energy space. Find out what all it has done and is doing.

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.

Florida Gov. Ron DeSantis speaks to the media about the cruise industry during a press conference at PortMiami in April. DeSantis faces criticism for failing to do all he could on Florida's biggest environmental threat: climate change.; Credit: Joe Raedle/Getty Images

Brick by brick, the stucco shell of a new flood-resilient public works building is taking shape blocks from the beach, the most visible sign yet of a small community's enormous task staving off the rising sea.

"This is actually the highest point in the city," Satellite Beach City Manager Courtney Barker said, adding that right next door to the new public works building will be a new fire station.

It's a close-knit community established by rocket scientists south of Kennedy Space Center, on a low-slung barrier island between the Atlantic Ocean and Indian River Lagoon.

By 2040, community leaders expect significant impacts associated with climate change. Already flooding is a problem, and beach-front homes perch precariously atop a sand dune left exposed after a series of storms and hurricanes washed away a sea wall.

The needs are great, and in Gov. Ron DeSantis, Barker sees a potential ally.

"At least he talks about climate change as actually being real, so that's good," she said. "And he's putting money toward it so that's encouraging."

But Barker also feels DeSantis is doing only part of the job.

"We desperately need to grow up as a state and realize that we need to get our emissions down," Barker said.

Since his election in November 2018, DeSantis is making good on some of his environmental promises, including what he likes to call "resilience," a new buzzword for climate adaptation. But as the governor prepares for a reelection bid in 2022, and is seen as a potential Republican frontrunner for the presidency in 2024, DeSantis faces criticism for failing to do all he could on Florida's biggest environmental threat: climate change.

Some of his critics acknowledge that the $1 billion Resilient Florida plan he announced in January could be a first step toward helping some communities pay for adaptation. But critics also point out that DeSantis has done almost nothing to put Florida on a path to scaling back the state's heavy reliance on fossil fuels.

"I would give him probably a C-minus," said former Republican Gov. Charlie Crist, who served from 2007 to 2011, and now represents St. Petersburg in the U.S. House of Representatives as a Democrat.

Crist still gets plaudits from environmentalists for his administration's climate initiatives, including a cap-and-trade system to curb carbon emissions and an executive order that was intended to put the state on a path to reducing its greenhouse gas emissions 80% by 2050. But those were basically abandoned by Gov. Rick Scott, the Republican now serving in the U.S. Senate.

Crist, who switched parties and this week announced he is running for governor in 2022, said DeSantis should be "encouraging renewables such as wind energy, solar energy, and particularly solar. I mean, my goodness, we're the Sunshine State."

DeSantis' press office declined to make the governor available for an interview and did not respond to written questions.

In comments at two press conferences earlier this year, the governor cited his support for spending hundreds of millions of dollars on water projects and Everglades restoration as evidence of his environmental credentials, while promising to double down on funding for coastal resilience.

Florida needs "to tackle the challenges posed by flooding, intensified storm events [and] sea level rise," he said. "When you look at how an insurance market would view property insurance, and to see that Florida is leading and trying to get ahead of some of these impacts, we think it'll be a very smart thing to do."

Lawmakers have had their own ideas on how to handle climate threats, and have passed two bills that, when taken together, are similar to DeSantis' Resilient Florida proposal.

"It's not exactly as he said he wanted it, but it's close," said Jonathan Webber, deputy director of Florida Conservation Voters. "These are policies that need to happen. It would have been better if they happened 20 years ago."

"I am not a global warming person"

In his 2018 campaign, DeSantis appealed directly to supporters of former President Donald Trump, such as in this ad where he tells one of his children to "build the wall" with toy blocks. The environment was a major issue in that election.

Residents were grappling with a toxic red tide and blue-green algae crisis that made beaches and waterways unsafe, and left marine-life belly-up.

In recent years Floridians have also experienced deadly, devastating consequences of back-to-back major hurricanes.

All the while, advocates were highlighting likely links between the state's environmental woes and global warming.

Florida's climate challenges are among the biggest in the country. Beyond those related to hurricanes intensified by climate change, they include sea level rise, extreme heat, drought and increasing health threats from mosquito-borne diseases.

By its own numbers, the DeSantis administration predicts that with sea level rise, $26 billion in residential property statewide will be at risk of chronic flooding by 2045.

But in 2018, DeSantis let voters know that he had clear limits when it came to climate change.

"I am not in the pews of the church of the global warming leftists," DeSantis told reporters at one 2018 campaign stop. "I am not a global warming person. I don't want that label on me."

Early plaudits from environmentalists

Once in office, DeSantis won early plaudits for directives aimed at cleaning up water and helping Florida adapt to climate change. He appointed the first state resilience officer and the first chief scientist, and ordered Florida's Department of Environmental Protection to make sure its decisions were based on the best available science.

In 2019, they approved of DeSantis' order to his environmental regulators to oppose fracking, but he since has failed to get his Republican colleagues in the legislature to pass a statewide fracking ban, something he advocated for during his campaign. The state's oil and gas industry does not currently use fracking as a drilling method, but environmentalists are worried it might start doing so, resulting in water pollution.

Environmental groups also praised DeSantis in 2020 when the governor announced the state was backing a plan to buy 20,000 acres of the Everglades to prevent oil development there.

And they did the same when DeSantis backed spending $166 million in settlement money Florida received from Volkswagen on electric vehicle charging stations and cleaner electric buses. The money, part of a larger $14.7 billion settlement, came after the German automaker was caught lying about its cars' diesel emissions.

"Everyone was optimistic," said Susan Glickman, the Florida director for the Southern Alliance for Clean Energy. "I kept hearing an opening on climate."

Two years later, though, Glickman and other advocates are assessing DeSantis' climate record much like this: He's done more than previous Governor Scott, but that's not saying much.

DeSantis quietly replaced his chief science officer in March with Mark Rains, a professor, and chair and director of the School of Geosciences at the University of South Florida. But he never has replaced his chief resilience officer after she left for the Trump administration after only a few months in the position.

"Missing in action" on renewables

In many ways, it's what DeSantis hasn't done that defines his climate record. He has chosen not to use his bully pulpit to advocate for a clean-energy future, like his Democratic Party counterparts in the Southeast states of North Carolina and Virginia, or like the mayors of Orlando and Tampa.

DeSantis has also been "missing in action" in debate over bills this year in the Florida legislature that would undermine local government efforts to transition to clean energy, said Webber, with the Florida Conservation Voters group.

One such bill, that has passed the House and Senate and awaits DeSantis' consideration, would ban local governments from restricting fuel sources. The oil and gas industry has supported such measures around the country. They aim to block the push by climate activists to ban natural gas hook-ups in new buildings, and electrify them instead to reduce carbon emissions.

Of course, electrification only reduces emissions if it's powered by renewable energy. But Florida has no requirement that utilities provide a certain amount of that. Solar power accounts for only about 2.5% of the electricity produced by utilities, while they rely on fossil fuels for about 84%.

When DeSantis had a chance to appoint someone to the state's powerful Florida Public Service Commission, a regulatory body with a big say in state energy policy, he chose the Florida chairman of the American Legislative Exchange Council, a group known for its support of fossil fuels.

"We are very frustrated by the messaging, and the lack of acknowledgement of the root of the problem of all these issues," said Yoca Arditi-Rocha, executive director of The CLEO Institute, a nonprofit that focuses on climate science education.

"We need to acknowledge the warming temperatures and the rising seas are a result of our warming climate," she said. "We cannot adapt our way out of it. We need to aggressively tackle mitigation."

"What places can we not save?"

In Satellite Beach, Courtney Barker, the city manager who welcomes the governor's help with adapting to climate change, also wants to see him tackle the emissions side of the equation.

Besides moving the public works building and fire station to higher ground, the community is fortifying its system of flood control. Barker said the community needs more funding opportunities from the state.

"We're looking for assistance in helping us engineer our way out of it," she said.

Marine and climate scientist Jeff Chanton, of Florida State University, thinks there's too much emphasis on sea walls, which can cause beach erosion and destroy tidal zones vital to marine life, including crabs and turtles.

"An ideal governor would try to lessen the impacts of growth in this state, especially along our coastlines," he said.

Before her departure, Julia Nesheiwat, DeSantis' chief resilience officer, characterized the state's infrastructure as "outdated" in a report, and called its resilience strategy "disjointed."

For Thomas Ruppert, an attorney and coastal planning specialist with Florida Sea Grant, DeSantis' emphasis on hardening infrastructure ignores that — for some communities — the investments will be futile in staving off the inevitable.

"Ultimately, what we really need is to start talking seriously [about] what places can we not save? And what is an exit strategy? Because we have no idea," Ruppert said.

Barker hopes it doesn't come to that in Satellite Beach, where she grew up.

"It's personal to all of us, because I think everyone can look at their own hometown, and you can't imagine being anywhere else."

This story is a collaboration between Inside Climate News and WMFE Orlando, a member of ICN's National Reporting Network-Southeast.

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

Gloria Majiga-Kamoto, an activist from Malawi, is one of six recipients of the 2021 Goldman Environmental Prize. Majiga-Kamoto has been instrumental in implementing Malawi's ban on thin plastics.; Credit: /Goldman Environmental Prize

For Gloria Majiga-Kamoto, her great awakening to plastic pollution started with goats.

She was working for a local environmental NGO in her native Malawi with a program that gave goats to rural farmers. The farmers would use the goat's dung to produce low-cost, high-quality organic fertilizer.

The problem? The thin plastic bags covering the Malawian countryside.

"We have this very common street food, it's called chiwaya, and it's just really potato fried on the side of the road and it's served in these little blue plastics," Majiga-Kamoto says. "So because it's salty, once the goats get a taste of the salt, they just eat the plastic because they can't really tell that it's inedible. And they die because it blocks the ingestion system — there's no way to survive."

The goats were supposed to reproduce for the program, with the goat kids going on to new farmers. But because of plastic deaths the whole goat chain started falling apart.

"It was a lot of expectation from the farmers waiting to benefit. So you had this farmer who had this one goat and then they lost it. And that means that in that chain of farmers, that's obviously affected quite a number of farmers who won't get their turn."

For Majiga-Kamoto, her experience at the NGO with the plastic-eating goats was the moment it all changed. All of a sudden she started noticing how plastics were everywhere in the Malawian environment and food system — affecting people's livelihoods and health.

The fish in Lake Malawi were eating plastic trash. The country's cows were eating plastic. Researchers found that in one Malawi town 40% of the livestock had plastic in their intestines.

"We're choking in plastics," Majiga-Kamoto says, "And so what it means is that in one way or the other, we as humans are consuming these plastics."

Majiga-Kamoto was also seeing how plastics contributed to the growth of disease. Huge piles of plastic trash were blocking off Malawi's many waterways, creating pungent breeding grounds for mosquitoes that carry malaria and for bacteria that cause cholera.

The 30-year-old says she remembers a time when Malawians didn't rely so much on thin, single-use plastic. "I remember back in the day when we'd go to the market and buy things like fish, like dried fish, you'd get it in newspapers."

But thin plastics have taken off in the last decade or so as new manufacturers sprung up in Malawi, selling products like thin plastic bags at cheap prices that made them affordable and accessible even in the most undeveloped parts of the country. A 2019 UNDP funded report found that Malawi produces an estimated 75,000 tonnes of plastic a year, with 80% reportedly single-use plastic. Single-use plastic refers to bags, straws and bottles that can't be recycled, and thin plastic refers to plastic that's under 60 microns in thickness.

The proliferation of this thin plastic waste led to the Malawian government's 2015 decision to ban the production, distribution and importation of single-use thin plastic. But before the ban could go into full effect, Malawi's plastics manufacturing industry filed an injunction at the country's High Court. The ban stalled.

When Majiga-Kamoto and a group of her fellow environmental NGO-workers and activists heard about the injunction they were angry and frustrated. "It sort of caught our interest to say, 'Wait a minute, you mean that there's actually people in our society who think that this is not a problem and that we should actually continue to live this way?'"

Galvanized, Majiga-Kamoto led a group of local environmental activists and NGOs to actually implement the single-use plastics ban, organizing marches on the judiciary where the decision would be decided. She kept her job at her NGO, the Centre for Environmental Policy and Advocacy, and did this work on her own time.

She rejected the plastic industry's argument that the ban would hurt Malawi's economy — and even debated an industry lobbyist on TV.

Finally in 2019, after multiple injunctions filed by the plastics industry, the High Court ruled in favor of the single-use thin plastic ban. The following year the Malawian government began closing down illegal plastic manufacturers.

Last week Majiga-Kamoto was named one of the six winners of the 2021 Goldman Environmental Prize for her work on this issue. Michael Sutton, executive director of the Goldman Environmental Foundation, says Majiga-Kamoto's fight with the plastic lobby epitomizes the spirit of the prize. "She mustered the troops, the grassroots communities, to take on the government and big industry and won several times," Sutton says, "She not only won the ban in law, but is now holding the government's feet to the fire to enforce it."

And Majiga-Kamoto isn't letting up her pressure to uphold the single-use plastic ban anytime soon. Although she is trying to get some summer vacation time with her family — that is, if she isn't interrupted.

"I was just at the lake a couple of weeks ago and we were there just enjoying the beautiful lake and along come these pieces of plastic." Three plastic bags floated up closer to her, her son and her niece as they played in the water.

Majiga-Kamoto grabbed for the bags.

"My family was laughing to say, 'You shouldn't be working! You're at the lake!' And I'm like, 'But I can't just leave them in there!'"

Julia Simon is a regular contributor to NPR's podcasts and news desks focusing on climate change, energy, and business news.

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

; Credit: /Courtesy of TED

Part 3 of TED Radio Hour episode: An SOS From The Ocean

In 1998, Alasdair Harris went to Madagascar to research coral reefs. He's worked there ever since. He explains the true meaning of conservation he learned from the island's Indigenous communities.

About Alasdair Harris

Alasdair Harris is a marine biologist and the founder of the organization Blue Ventures. His organization seeks to catalyze and sustain locally-led marine conservation in coastal communities around the world.

His work focuses on rebuilding tropical fisheries and working with coastal people to increase their sources of income.

Harris holds a PhD in tropical marine ecology, and an honorary doctorate of science from the University of Edinburgh.

This segment of TED Radio Hour was produced by Matthew Cloutier and edited by Sanaz Meshkinpour. You can follow us on Twitter @TEDRadioHour and email us at TEDRadio@npr.org.

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

Three applied research centers at the Charlotte Research Institute will install instrumentation and conduct experiments at the Eco-Complex, an expansion of innovative waste reduction and waste processing technology already underway at the Complex.

Proper dental care and routine trips to the dentist help to guarantee that children and adults not only have a healthy smile, but a healthy body as well. To help ensure that every child in Catawba County has access to dental care, Catawba County Public Health Dental Practice serves as a resource for children ages 4 to 17.

The expansion will more than double clinic space. It will allow the clinic to provide routine dental services, such as cleanings, fillings, sealants, and extractions, to an additional 1,500 children and young adults. During the renovation, the current dental practice will remain open and operate under current hours

The Catawba County Public Health Dental Practice celebrated a �grand re-opening� on May 31 by welcoming visitors to an open house at its new space inside the Public Health building. Located just down the hall from its former location, the practice has doubled in size and capacity in order to provide a comprehensive dental home for children ages 1-21 in Catawba County.

Catawba County has been ranked #1 nationally in its population group in the 2013 Digital Counties Survey by Gov Tech Magazine.

Dental care was recently provided for hundreds of children by Catawba County Public Health.

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.

Focused attention by world leaders is needed to address the substantial challenges posed by disposal of spent nuclear fuel from reactors and high-level radioactive waste from processing such fuel for military or energy purposes.

To ensure that minority students who are poorly prepared for school are not assigned to special education for that reason, educators should be required to first provide them with high-quality instruction and social support in a general education classroom before making a determination that special education is needed.

As part of the $4 billion settlement announced today between the federal government and BP concerning the 2010 Deepwater Horizon disaster, the National Academy of Sciences has been asked to establish a new $350 million, 30-year program on human health and environmental protection in the Gulf of Mexico.

Cardiac arrest strikes almost 600,000 people each year, killing the vast majority of those individuals, says a new report from the Institute of Medicine. Every year in the U.S., approximately 395,000 cases of cardiac arrest occur outside of a hospital setting, in which less than 6 percent survive.

Weather and environmental forecasts made several weeks to months in advance can someday be as widely used and essential as current predictions of tomorrow’s weather are, but first more research and sustained investment are needed, says a new report from the National Academies of Sciences, Engineering, and Medicine.

The U.S. Department of Health and Human Services (HHS) should lead efforts among federal partners and stakeholders to design, implement, and evaluate a multipronged, evidence-based national strategy to reduce stigma toward people with mental and substance use disorders, says a new report from the National Academies of Sciences, Engineering, and Medicine.

During the National Academy of Sciences Annual Meeting, the CHR held a breakfast briefing to highlight issues surrounding digital security and human rights. The meeting featured John Scott-Railton of The Citizen Lab, who spoke about the use of digital surveillance and technologies to target members of civil society worldwide.

The Gulf Research Program (GRP) of the National Academies of Sciences, Engineering, and Medicine today announced grant awards for seven new projects totaling $5.3 million.

While the U.S. Department of Veterans Affairs (VA) provides mental health care of comparable or superior quality to care provided in private and non-VA public sectors, accessibility and quality of services vary across the VA health system, leaving a substantial unmet need for mental health services among veterans of the recent wars in Afghanistan and Iraq, says a new congressionally mandated report from the National Academies of Sciences, Engineering, and Medicine.

The National Academies of Sciences, Engineering, and Medicine are launching an Academies-wide initiative to transform how the nation addresses the complex issues associated with environmental health—a field that examines how the environment affects human health.

Joint statements from the national science academies of the G7 nations were released today in advance of the G7 Summit to be held in La Malbaie, Canada, on June 8 and 9, 2018.

The Gulf Research Program (GRP) of the National Academies of Sciences, Engineering, and Medicine today announced a new grant opportunity focused on enhancing coastal community resilience and well-being in the Gulf of Mexico region.