Tetra­kis(μ-acetato-κ2O:O')bis­{[1,3-bis­(2,6-diiso­propyl­phen­yl)imidazol-2-yl­idene-κC2]chromium(II)} tetra­hydro­furan disolvate, [Cr2(C2H3O2)4(C27H36N4)2]·2C4H8O or [Cr2(OAc)4(IDipp)2]·2C4H8O (1), and tetra­kis­(μ-acetato-κ2O:O')bis­{[1,3-bis­(2,4,6-tri­methyl­phen­yl)imidazol-2-yl­idene-κC2]chromium(II)}, {Cr2(C2H3O2)4(C21H24N2)2] or [Cr2(OAc)4(IMes)2] (2), were synthesized from anhydrous chromium(II) acetate [Cr2(OAc)4] and the corresponding NHC (NHC = N-heterocyclic carbene) in toluene as solvent. Both complexes crystallize in the triclinic system, space group Poverline{1}. The mol­ecular structures consist of Cr2(OAc)4 paddle-wheels that carry two terminal NHC ligands. This leads to a square-pyramidal coordination of the chromium atoms.

In the title compound, C14H14O4, the dihedral angle between the coumarin ring system (r.m.s deviation = 0.016 Å) and the penta­noate ring is 36.26 (8)°. A short intra­molecular C—H⋯O contact of 2.40 Å is observed. Hirshfeld surface analysis reveals that 46.1% of the inter­molecular inter­actions are from H⋯H contacts, 28.6% are from H⋯O/O⋯H contacts and 14.7% are from H⋯C/C⋯H.

In the structure of the title salt, {[Ba(μ3-C3H2N3O2)2(μ-H2O)(H2O)]·H2O}n, the barium ion and all three oxygen atoms of the water mol­ecules reside on a mirror plane. The hydrogen atoms of the bridging water and the solvate water mol­ecules are arranged across a mirror plane whereas all atoms of the monodentate aqua ligand are situated on this mirror plane. The distorted ninefold coord­ination of the Ba ions is completed with four nitroso-, two carbonyl- and three aqua-O atoms at the distances of 2.763 (3)–2.961 (4) Å and it is best described as tricapped trigonal prism. The three-dimensional framework structure is formed by face-sharing of the trigonal prisms, via μ-nitroso- and μ-aqua-O atoms, and also by the bridging coordination of the anions via carbonyl-O atoms occupying two out of the three cap positions. The solvate water mol­ecules populate the crystal channels and facilitate a set of four directional hydrogen bonds. The principal Ba–carbamoyl­cyano­nitro­somethanido linkage reveals a rare example of the inherently polar binodal six- and three-coordinated bipartite topology (three-letter notation sit). It suggests that small resonance-stabilized cyano­nitroso anions can be utilized as bridging ligands for the supra­molecular synthesis of MOF solids. Such an outcome may be anti­cipated for a broader range of hard Lewis acidic alkaline earth metal ions, which perfectly match the coordination preferences of highly nucleophilic nitroso-O atoms. Thermal analysis reveals two-stage dehydration of the title compound (383 and 473 K) followed by decomposition with release of CO2, HCN and H2O at 558 K.

When reacted in dry, degassed toluene, [Ir(COD)Cl]2 (COD = cyclo­octa-1,5-diene) and 2 equivalents of 2-(di-tert-butyl­phosphinito)anthra­quinone (tBuPOAQH) were found to form a unique tri-iridium compound consisting of one monoanionic dinuclear tri-μ-chlorido complex bearing one bidentate tBuPOAQ ligand per iridium, which was charge-balanced by an outer sphere [Ir(toluene)(COD)]+ ion, the structure of which has not previously been reported. This product, which is a toluene solvate, namely, (η2:η2-cyclo­octa-1,5-diene)(η6-toluene)­iridium(I) tri-μ-chlorido-bis­({3-[(di-tert-butyl­phosphan­yl)­oxy]-9,10-dioxoanthracen-2-yl}hydridoiridium(III)) toluene monosolvate, [Ir(C7H8)(C8H12)][Ir2H2(C22H24O3P)2Cl3]·C7H8 or [Ir(toluene)(COD)][Ir(κ-P,C-tBuPOAQ)(H)]2(μ-Cl)3]·toluene, formed as small orange platelets at room temperature, crystallizing in the triclinic space group Poverline{1}. The cation and anion are linked via weak C—H⋯O inter­actions. The stronger inter­molecular attractions are likely the offset parallel π–π inter­actions, which occur between the toluene ligands of pairs of inverted cations and between pairs of inverted anthra­quinone moieties, the latter of which are capped by toluene solvate mol­ecules, making for π-stacks of four mol­ecules each. The related ligand, 2-(di-tert-butyl­phosphinometh­yl)-anthra­quinone (tBuPCAQH), did not form crystals suitable for X-ray diffraction under analogous reaction conditions. However, when the reaction was conducted in chloro­form, yellow needles readily formed following addition of 1 atm of carbon monoxide. Diffraction studies revealed a neutral, dinuclear, di-μ-chlorido complex, di-μ-chlorido-bis­(carbon­yl{3-[(di-tert-butyl­phosphan­yl)­oxy]-9,10-dioxoanthracen-2-yl}hydridoiridium(I)), [Ir2H2(C23H26O2P)2Cl2(CO)2] or [Ir(κ-P,C-tBuPCAQ)(H)(CO)(μ-Cl)]2, Ir2C48H54Cl2O6P2, again crystallizing in space group Poverline{1}. Offset parallel π–π inter­actions between anthra­quinone groups of adjacent mol­ecules link the mol­ecules in one dimension.

The title compound, [Sn(C6H5)Cl3(C12H8N2)], which was obtained by the reaction between 1,10-phenanthroline and phenyl­tin trichloride in methanol, exhibits intra­molecular hydrogen-bonding inter­actions involving the chlorine and hydrogen atoms. Crystal cohesion is ensured by inter­molecular C—H⋯Cl hydrogen bonds, as well as Y—X⋯π and π-stacking inter­actions involving three different aromatic rings with centroid–centroid distances of 3.6605 (13), 3.9327 (14) and 3.6938 (12) Å]. Hirshfeld surface analysis and the associated two-dimensional fingerprint plots reveal significant contributions from H⋯H (30.7%), Cl⋯H/H⋯Cl (32.4%), and C⋯H/H⋯C (24.0%) contacts to the crystal packing while the C⋯C (6.2%), C⋯Cl/Cl⋯C (4.1%), and N⋯H/H⋯N (1.7%) inter­actions make smaller contributions.

The major principles and requirements of asymmetric and inclined double-crystal monochromators are re-examined and presented to guide their design and development for significantly reducing heat load density and gradient on the monochromators of fourth-generation synchrotron light sources and X-ray free-electron lasers.

In this work, we showed that the use of ethanol to increase image contrast when imaging cardiac tissue with synchrotron X-ray phase-contrast imaging (X-PCI) leads to heterogeneous tissue shrinkage, which has an impact on the 3D organization of the myocardium.

A systematic procedure is introduced for modeling charge-neutral non-polar surfaces of ionic minerals containing polyatomic anions. By integrating distance- and charge-based clustering to identify chemical species within the mineral bulk, our pipeline, PolyCleaver, renders a variety of theoretically viable surface terminations. As a demonstrative example, this approach was applied to forsterite (Mg2SiO4), unveiling a rich interface landscape based on interactions with formaldehyde, a relevant multifaceted molecule, and more particularly in prebiotic chemistry. This high-throughput method, going beyond techniques traditionally applied in the modeling of minerals, offers new insights into the potential catalytic properties of diverse surfaces, enabling a broader exploration of synthetic pathways in complex mineral systems.

BL19U1, an energy-tunable protein complex crystallography beamline at the Shanghai Synchrotron Radiation Facility, has emerged as one of the most productive MX beamlines since opening to the public in July 2015. As of October 2023, it has contributed to over 2000 protein structures deposited in the Protein Data Bank (PDB), resulting in the publication of more than 1000 scientific papers. In response to increasing interest in structure-based drug design utilizing X-ray crystallography for fragment library screening, enhancements have been implemented in both hardware and data collection systems on the beamline to optimize efficiency. Hardware upgrades include the transition from MD2 to MD2S for the diffractometer, alongside the installation of a humidity controller featuring a rapid nozzle exchanger. This allows users to opt for either low-temperature or room-temperature data collection modes. The control system has been upgraded from Blu-Ice to MXCuBE3, which supports website-mode data collection, providing enhanced compatibility and easy expansion with new features. An automated data processing pipeline has also been developed to offer users real-time feedback on data quality.

We describe an ultra-compact setup for in situ X-ray diffraction on the inelastic X-ray scattering beamline ID20 at the European Synchrotron Radiation Facility. The main motivation for the design and construction of this setup is the increasing demand for on-the-fly sample characterization, as well as ease of navigation through a sample's phase diagram, for example subjected to high-pressure and/or high-temperature conditions. We provide technical details and demonstrate the performance of the setup.

The upgrade of the Swiss Light Source, called SLS 2.0, necessitates comprehensive updates to all 18 user front ends. This upgrade is driven by the increased power of the synchrotron beam, reduced floor space, changing source points, new safety regulations and enhanced beam properties, including a brightness increase by up to a factor of 40. While some existing front-end components are being thoroughly refurbished and upgraded for safety reasons, other components, especially those designed to tailor the new synchrotron beam, are being completely rebuilt. These new designs feature innovative and enhanced cooling systems to manage the high-power load and meet new requirements such as mechanical stability and compact footprints.

A novel in situ/operando method is introduced to measure the photon beam stability of synchrotron radiation based on orthogonal diffraction imaging of a Laue crystal/analyzer, which can decouple the energy/wavelength and Bragg angle of the photon beam using the dispersion effect in the diffraction process. The method was used to measure the energy jitter and drift of the photon beam on BL09B and BL16U at the Shanghai Synchrotron Radiation Facility. The experimental results show that this method can provide a fast way to measure the beam stability of different light sources including bending magnet and undulator with meV-level energy resolution and ms-level time response.

In synchrotron X-ray radiography, achieving high image resolution and an optimal signal-to-noise ratio (SNR) is crucial for the subsequent accurate image analysis. Traditional methods often struggle to balance these two parameters, especially in situ applications where rapid data acquisition is essential to capture specific dynamic processes. For quantitative image data analysis, using monochromatic X-rays is essential. A double multilayer monochromator (DMM) is successfully used for this aim at the BAMline, BESSY II (Helmholtz Zentrum Berlin, Germany). However, such DMMs are prone to producing an unstable horizontal stripe pattern. Such an unstable pattern renders proper signal normalization difficult and thereby causes a reduction of the SNR. We introduce a novel approach to enhance SNR while preserving resolution: dynamic tilting of the DMM. By adjusting the orientation of the DMM during the acquisition of radiographic projections, we optimize the X-ray imaging quality, thereby enhancing the SNR. The corresponding shift of the projection during this movement is corrected in post-processing. The latter correction allows a good resolution to be preserved. This dynamic tilting technique enables the homogenization of the beam profile and thereby effectively reduces noise while maintaining high resolution. We demonstrate that data captured using this proposed technique can be seamlessly integrated into the existing radiographic data workflow, as it does not need hardware modifications to classical X-ray imaging beamline setups. This facilitates further image analysis and processing using established methods.

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 Australian Synchrotron Imaging and Medical Beamline (IMBL) uses a superconducting multipole wiggler (SCMPW) source, dual crystal Laue monochromator and 135 m propagation distance to enable imaging and computed tomography (CT) studies of large samples with mono-energetic radiation. This study aimed to quantify two methods for CT dose reduction: wiggler source operation at reduced magnetic field strength, and beam modulation with spatial filters placed upstream from the sample. Transmission measurements with copper were used to indirectly quantify the influence of third harmonic radiation. Operation at lower wiggler magnetic field strength reduces dose rates by an order of magnitude, and suppresses the influence of harmonic radiation, which is of significance near 30 keV. Beam shaping filters modulate the incident beam profile for near constant transmitted signal, and offer protection to radio-sensitive surface organs: the eye lens, thyroid and female breast. Their effect is to reduce the peripheral dose and the dose to the scanned volume by about 10% for biological samples of 35–50 mm diameter and by 20–30% for samples of up to 160 mm diameter. CT dosimetry results are presented as in-air measurements that are specific to the IMBL, and as ratios to in-air measurements that may be applied to other beamlines. As CT dose calculators for small animals are yet to be developed, results presented here and in a previous study may be used to estimate absorbed dose to organs near the surface and the isocentre.

Tranglo, a global cross-border payments company, has expanded...

Housing activists erect a sign in front of Massachusetts Gov. Charlie Baker's house in Swampscott, Mass., on Oct. 14, 2020. The Centers for Disease Control and Prevention has extended a moratorium on evictions until the end of July.; Credit: Michael Dwyer/AP

The Centers for Disease Control and Prevention has extended a moratorium on evictions until the end of July. The ban had been set to expire next week, raising concerns that there could be a flood of evictions with some seven million tenants currently behind on their rent.

The Biden administration says the extension is for "one final month" and will allow time for it to take other steps to stabilize housing for those facing eviction and foreclosure. The White House says it is encouraging state and local courts to adopt anti-eviction diversion programs to help delinquent tenants stay housed and avoid legal action.

The federal government will also try to speed up distribution of tens of billions of dollars in emergency rental assistance that's available but has yet to be spent. In addition, a moratorium on foreclosures involving federally backed mortgages has been extended for "a final month," until July 31.

In announcing the extension of the eviction moratorium, the CDC said that the COVID-19 "pandemic has presented a historic threat to the nation's public health. Keeping people in their homes and out of crowded or congregate settings — like homeless shelters — by preventing evictions is a key step in helping to stop the spread of COVID-19."

The CDC first issued the moratorium last September. It was extended once already in March, until June 30.

But landlords have been pushing back, arguing that they've taken a huge financial hit over the past year, losing billions of dollars a month in rent. Several business groups have sued the CDC and won, though court decisions to lift the moratorium have been stayed pending appeal.

The Alabama Association of Realtors, which brought one of the cases, argued that the CDC exceeded its authority in issuing the ban. The group is seeking relief from the U.S. Supreme Court, but the justices have yet to respond.

In its petition, the Realtors association called the CDC's "continued insistence that public-health concerns necessitate that landlords continue to provide free housing for tenants who have received vaccines (or passed up the chance to get them)...sheer doublespeak."

Housing advocates have argued that the moratorium is still very much needed. They note that $46 billion in emergency rental assistance approved by Congress has been slow getting into the hands of those it was intended to help. The money is supposed to cover rent that tenants currently owe.

The National Low Income Housing Coalition reports that in some states, less than five percent of the funds have been distributed so far. The group pushed the administration to extend the ban to give states and localities more time to get the money out.

Despite the moratorium, thousands of renters have still faced the threat of eviction because of loopholes in the law. Many are the lowest income tenants and disproportionately people of color. A new study by the Eviction Lab at Princeton University has found that communities with the lowest vaccination rates tend to have the highest eviction filings, raising additional health concerns.

"Allowing the moratorium to expire before vaccination rates increase in marginalized communities could lead to increased spread of, and deaths from, COVID-19," a group of more than 40 House lawmakers wrote in a letter this week to President Biden and CDC Director Rochelle Walensky, urging them to extend the moratorium.

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

Patrick Doherty volunteered for a new medical intervention of gene-editor infusions for the treatment of genetically-based diseases.; Credit: /Patrick Doherty

Patrick Doherty had always been very active. He trekked the Himalayas and hiked trails in Spain.

But about a year and a half ago, he noticed pins and needles in his fingers and toes. His feet got cold. And then he started getting out of breath any time he walked his dog up the hills of County Donegal in Ireland where he lives.

"I noticed on some of the larger hill climbs I was getting a bit breathless," says Doherty, 65. "So I realized something was wrong."

Doherty found out he had a rare, but devastating inherited disease — known as transthyretin amyloidosis — that had killed his father. A misshapen protein was building up in his body, destroying important tissues, such as nerves in his hands and feet and his heart.

Doherty had watched others get crippled and die difficult deaths from amyloidosis.

"It's terrible prognosis," Doherty says. "This is a condition that deteriorates very rapidly. It's just dreadful."

So Doherty was thrilled when he found out that doctors were testing a new way to try to treat amyloidosis. The approach used a revolutionary gene-editing technique called CRISPR, which allows scientists to make very precise changes in DNA.

"I thought: Fantastic. I jumped at the opportunity," Doherty says.

On Saturday, researchers reported the first data indicating that the experimental treatment worked, causing levels of the destructive protein to plummet in Doherty's body and the bodies of five other patients treated with the approach.

"I feel fantastic," Doherty says. "It's just phenomenal."

The advance is being hailed not just for amyloidosis patients but also as a proof-of-concept that CRISPR could be used to treat many other, much more common diseases. It's a new way of using the innovative technology.

"This is a major milestone for patients," says Jennifer Doudna of the University of California, Berkeley, who shared a Nobel Prize for her work helping develop CRISPR.

"While these are early data, they show us that we can overcome one of the biggest challenges with applying CRISPR clinically so far, which is being able to deliver it systemically and get it to the right place," Doudna says.

CRISPR has already been shown to help patients suffering from the devastating blood disorders sickle cell disease and beta thalassemia. And doctors are trying to use it to treat cancer and to restore vision to people blinded by a rare genetic disorder.

But those experiments involve taking cells out of the body, editing them in the lab, and infusing them back in or injecting CRISPR directly into cells that need fixing.

The study Doherty volunteered for is the first in which doctors are simply infusing the gene-editor directly into patients and letting it find its own way to the right gene in the right cells. In this case, it's cells in the liver making the destructive protein.

"This is the first example in which CRISPR-Cas9 is injected directly into the bloodstream — in other words systemic administration — where we use it as a way to reach a tissue that's far away from the site of injection and very specifically use it to edit disease-causing genes," says John Leonard, the CEO of Intellia Therapeutics, which is sponsoring the study.

Doctors infused billions of microscopic structures known as nanoparticles carrying genetic instructions for the CRISPR gene-editor into four patients in London and two in New Zealand. The nanoparticles were absorbed by their livers, where they unleashed armies of CRISPR gene-editors. The CRISPR editor honed in on the target gene in the liver and sliced it, disabling production of the destructive protein.

Within weeks, the levels of protein causing the disease plummeted. Researchers reported at the Peripheral Nerve Society Annual Meeting and in a paper published in The New England Journal of Medicine.

"It really is exciting," says Dr. Julian Gillmore, who is leading the study at the University College London, Royal Free Hospital.

"This has the potential to completely revolutionize the outcome for these patients who have lived with this disease in their family for many generations. It's decimated some families that I've been looking after. So this is amazing," Gillmore says.

The patients will have to be followed longer, and more patients will have to be treated, to make sure the treatment's safe, and determine how much it's helping, Gillmore stresses. But the approach could help those struck by amyloidosis that isn't inherited, which is a far more common version of the disease, he says.

Moreover, the promising results potentially open the door for using the same approach to treatment of many other, more common diseases for which taking cells out of the body or directly injecting CRISPR isn't realistic, including heart disease, muscular dystrophy and brain diseases such as Alzheimer's.

"This is really opening a new era as we think about gene-editing where we can begin to think about accessing all kinds of different tissue in the body via systemic administration," Leonard says.

Other scientists who are not involved in the research agree.

"This is a wonderful day for the future of gene-editing as a medicine,"
agree Fyodor Urnov, a professor of genetics at the University of California, Berkeley. "We as a species are watching this remarkable new show called: our gene-edited future."

Doherty says he started feeling better within weeks of the treatment and has continued to improve in the weeks since then.

"I definitely feel better," he told NPR. "I'm speaking to you from upstairs in our house. I climbed stairs to get up here. I would have been feeling breathless. I'm thrilled."

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

; Credit: /Rose Wong for NPR/KHN

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.

Mauna Loa summit webcams have been down for several months due to wind damage at the radio telemetry site. On November 7, 2024, HVO staff visited the site and performed a partial fix that brought the webcams back online.

Rescue workers move a stretcher containing recovered remains at the site of the collapsed Champlain Towers South condo building in Surfside, Fla., on Monday. Rescuers have recovered three more bodies and officials say the demolition of the building will accelerate search efforts.; Credit: Lynne Sladky/AP

Miami-Dade County mayor Daniella Levine Cava said on Monday morning that three more victims have been recovered from the ruins of the collapsed condo tower in Surfside, Fl., bringing the total death toll so far to 27.

Cava added that the demolition of the rest of Champlain Towers South "was executed exactly as planned" the previous evening, and that it would now allow rescue teams to work on a section of the collapsed building that was previously inaccessible. She noted that 118 individuals remain unaccounted for.

"Truly, we could not continue without bringing this building down," Cava said. "The area closest to the building was not accessible, due to the enormous risk to the team of first responders, because of the instability of the building."

According to Florida Governor Ron DeSantis, the newly accessible section of rubble is also from a part of the building where many bedrooms were located, and may contain the remains of many victims. The building collapsed in the middle of the night.

Authorities had been concerned that an approaching tropical storm might topple the standing part of the building onto the section that had already collapsed. That would have been a massive setback in the search for victims and for clues to the cause of the disaster.

Tropical Storm Elsa now appears to be tracking further to the west, and is more likely to hit the west coast of Florida, rather than the site of the disaster. But officials at the National Weather Service say the storm's course still could change.

Cava acknowledged that demolishing people's homes "is a devastating decision" and said that "our teams are doing everything possible to help those who lost their home begin to rebuild."

She said that authorities are working with insurance companies and the Federal Emergency Management Agency to streamline claims and help those who've lost homes and property.

One animal rescue volunteer had gone to court to stop the demolition of the rest of the tower, asking the court to allow more time to rescue pets that might still be trapped inside. The judge denied the motion.

Cava said in her Monday briefing that Miami-Dade rescue teams had already gone through parts of the building that were still accessible, "searching in closets and under beds" to find missing pets.

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

Help shape the future of greenways and trails in Catawba County! Catawba County and the Carolina Thread Trail planners ask citizens to help with planning for the trail by taking an online survey.

County programs which developed QR (Quick Response) codes for building permits; reach families affected by economic distress, and serve as an ongoing, immediate source of food for students during weekends and extended breaks from school; and promote healthy, sustainable policies that improve physical activity and nutrition in schools were honored.

Catawba County Home Health is empowering older adults to lower their risk of falling through a new service called Smart Moves.

County employees in the first Leadership Academy recently helped families in transition through a Family Care Center project.

Catawba County Board of Commissioners adopts resolution supporting citizen participation in government through elections in Catawba County.

Students work on a classroom exercise at a school in Kibera, a poor neighborhood in Nairobi, Kenya.; Credit: Tony Karumba/AFP via Getty Images

You'd think the best way to get girls to succeed in school would to be design programs specifically for them — offer them mental health support or free menstrual pads.

But a new study, published in May in the journal World Bank Economic Review, begs to differ. Researchers David Evans and Fei Yuan reviewed 267 studies of education programs from 54 low- and middle-income countries to find the most effective ways to get more girls in school and improve their learning. Globally, more than 130 million girls remain out of school, according to the World Bank, due to poverty, child marriage and violence.

Instead of only examining girls' education programs, they looked at all kinds of programs. To measure access, they analyzed enrollment rates, attendance, drop-out, graduation and completion rates, and to measure performance, they looked at test scores.

Their biggest finding is that gender-neutral programs — such as handing out cash aid to families of school-aged children — can be just as effective at improving girls' education as programs designed just for girls.

The study is among the first to look both at ways to boost girls' access to school as well as their classroom performance, says Markus Goldstein, lead economist at the World Bank's Africa Gender Innovation Lab, who did not work on the report.

We spoke with Evans, a senior fellow at the Center for Global Development, and Yuan, a doctoral candidate in education policy and program evaluation at Harvard University, to discuss the best ways to boost education for girls in low- and middle-income countries. This interview has been edited for length and clarity.

What inspired you to conduct this study?

Evans: A lot of the previous work that examined this issue have focused on programs targeted to needs that are unique to girls, such as menstrual health. Those are worthy interventions, but if we only focus on programs that target girls, we might miss programs that benefit girls a lot but happen to help boys as well.

That's why we decided to look at all of the interventions we know of to identify the ones that are most effective at improving outcomes for girls, regardless of whether they're specifically for girls or not.

You found that the most effective programs for getting more girls into school cut the cost of education for students, regardless of gender, and their families. What are some examples of programs that worked well?

Evans: A lot of the most effective programs are ones that either eliminate school fees, provide scholarships or provide families a cash transfer to cover the other costs of having their daughter in school.

For example, in Ghana, lots of girls and boys pass their secondary school entrance exam, but they don't have the money to pay school fees. So, a program there provided scholarships to students who had already passed the entrance exam. It dramatically increased the high-school graduation rate of girls by 66%.

But the most effective interventions are those that address costs related to specific obstacles that girls face in a particular setting. In Afghanistan, for example, a [non-gendered] program built schools in rural communities. It decreased [the cost of] travel to school for both girls and boys and led to a more than 50% increase in girls' participation in primary school. That's dramatic.

Which programs were the most helpful for improving a girl's school performance, as opposed to just getting them into the classroom?

Evans: The most effective interventions to increase learning were programs that improved the quality of teaching. But it's not just throwing teachers into a conference room and giving them some lecture. It's also not about throwing fancy technology, like laptops or tablets, at classrooms. Hardware doesn't work. It's distracting for teachers and students.

Instead, a literacy program – which included coaching teachers, providing them with detailed teachers' guides and providing students with books – had a big impact on girls' education [in terms of test scores] in Kenya. So did another program in Kenya that helped teachers to teach children in a language they spoke at home (rather than English).

Were there any other types of programs that helped girls learn better in the classroom?

Yuan: Another intervention worth mentioning is called Teaching at the Right Level, based in India. The idea is that students in the same classroom may have many different reading levels. But because of constraints like large class sizes, teachers may not be able to tailor their teaching to the right level for every student. This leaves some students behind.

Teaching at the Right Level facilitated summer camps in which children were grouped by reading level, instead of age or grade. This allowed teachers to target their teaching to the specific levels of these students. In one region, after 50 days of focused teaching in these camps, children at the lowest achievement levels in India were able to catch up to the learning level of the third-highest achieving state in the country.

Many of the high-impact interventions you're referencing don't target girls specifically. Are you saying that girls' programs aren't necessary?

Evans: Not at all! We particularly focused on how to increase access to education and improve quality of learning. Some [girl-focused] programs have other goals – such as reducing violence against girls, improving girls' psychological and emotional wellbeing, reducing adolescent pregnancy or helping girls to transition from school to the workforce.

But when teaching is of bad quality, we just need to help schools improve the teaching. That's not necessarily a gender-specific problem.

Wouldn't it be more cost-effective to just offer scholarships or cash transfers to girls only instead of both genders, especially if far fewer girls are attending school than boys?

Evans: Sure, if you don't have the budget to waive school fees for everyone, eliminating school fees for girls is an effective way to do a girl-targeted program. That's what The Gambia did. But sometimes general, non-targeted interventions are more politically palatable for governments, since constituents have both daughters and sons.

Were you concerned that some of the gender-neutral programs might benefit boys more than girls?

Evans: That was something we were worried about – increasing inequality. But we found that overall, the impact of gender-neutral programs tends to be slightly larger on girls than boys both in terms of access and learning. These differences, for the most part, were not statistically significant. They were small. But it does mean that these general, non-targeted interventions are not increasing inequality between boys and girls. If anything, they're likely to decrease it.

What changes do you hope to see in how we work on girls' education around the world?

Evans: We want to make sure that people who care about girls' education draw on the full toolbox of programs that can improve girls' education. That includes girl-targeted programs. It also includes general programs.

We don't anyone to walk away from this and say, 'Oh, we don't need to worry about girls.' Instead, it means that if we are worried about girls, we have a broader array of tools to help them.

Joanne Lu is a freelance journalist who covers global poverty and inequity. Her work has appeared in Humanosphere, The Guardian, Global Washington and War is Boring. Follow her on Twitter: @joannelu

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

Insufficient evidence exists to support claims that taking megadoses of dietary antioxidants, such as selenium and vitamins C and E, or carotenoids, including beta-carotene, can prevent chronic diseases, says the latest report on Dietary Reference Intakes (DRIs) from the Institute of Medicine of the National Academies.

To meet the bodys daily energy and nutritional needs while minimizing risk for chronic disease, adults should get 45 percent to 65 percent of their calories from carbohydrates, 20 percent to 35 percent from fat, and 10 percent to 35 percent from protein.

High schools that successfully engage students in learning have many things in common.

The vast majority of healthy people adequately meet their daily hydration needs by letting thirst be their guide, says the newest report on nutrient recommendations from the Institute of Medicine of the National Academies.

Good morning. I am Dr. Alice Gast and I am here today with Dr. David Relman as the chair and vice chair of the Committee on the Review of the Scientific Approaches Used During the FBI’s Investigation of the 2001 Bacillus anthracis Mailings.

A National Research Council committee asked to examine the scientific approaches used and conclusions reached by the Federal Bureau of Investigation during its investigation of the 2001 Bacillus anthracis mailings has determined that it is not possible to reach a definitive conclusion about the origins of the anthrax in letters mailed to New York City and Washington, D.C., based solely on the available scientific evidence.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome -- commonly referred to as ME/CFS -- is a legitimate, serious, and complex systemic disease that frequently and dramatically limits the activities of affected individuals, says a new report from the Institute of Medicine.

Cognitive training, blood pressure management for people with hypertension, and increased physical activity all show modest but inconclusive evidence that they can help prevent cognitive decline and dementia, but there is insufficient evidence to support a public health campaign encouraging their adoption, says a new report from the National Academies of Sciences, Engineering, and Medicine.

A new report from the National Academies of Sciences, Engineering, and Medicine outlines how to examine whether specific levels of nutrients or other food substances (NOFSs) can ameliorate the risk of chronic disease and recommends ways to develop dietary reference intakes (DRI) based on chronic disease outcomes.

Policymakers’ efforts to reduce threats from improvised explosive devices (IEDs) should include greater oversight of precursor chemicals sold at the retail level – especially over the Internet – that terrorists, violent extremists, or criminals use to make homemade explosives, says a new report from the National Academies of Sciences, Engineering, and Medicine.

The emergence of inexpensive small unmanned aircraft systems (sUASs) that operate without a human pilot, commonly known as drones, has led to adversarial groups threatening deployed U.S. forces, especially infantry units.

A single breakthrough discovery for managing citrus greening in Florida in the future is unlikely, says a new report by the National Academies of Sciences, Engineering, and Medicine.

Improved understanding of the coupled natural-human coastal system will help promote resilience of coastal communities and ecosystems under rapidly changing environmental conditions and support informed decision-making, says a new report from the National Academies of Sciences, Engineering, and Medicine.

A new report from the National Academies of Sciences, Engineering, and Medicine identifies the most promising scientific breakthroughs that are possible to achieve in the next decade to increase the U.S. food and agriculture system’s sustainability, competitiveness, and resilience.

A new report from the National Academies of Sciences, Engineering, and Medicine highlights the dynamic process of learning throughout the life span and identifies frontiers in which more research is needed to pursue an even deeper understanding of human learning.

The National Academy of Medicine (NAM) honored three members today at its annual meeting for their outstanding service.

The National Academy of Medicine (NAM) has selected three outstanding health professionals for the class of 2018 NAM Fellowships.

A new report from the National Academies of Sciences, Engineering, and Medicine recommends changes in the way that the U.S. Department of Energy manages science and technology (S&T) development in order to accelerate the cleanup of radioactive waste and contaminated soil, groundwater, and facilities at U.S. nuclear weapons sites.

Representatives from the national academies of sciences of the G20 countries handed over recommendations for improving marine conservation to the Japanese Prime Minister Shinzo Abe.

The National Academy of Medicine today announced Daniel Weinberger is the recipient of the 2019 Rhoda and Bernard Sarnat International Prize in Mental Health, for his fundamental role in elucidating the biological origins and genetic expressions of schizophrenia, and for transforming how clinicians, researchers, and the public understand mental illness.

WASHINGTON — In response to the COVID-19 outbreak, the White House Office of Science and Technology Policy has asked the National Academies of Sciences, Engineering, and Medicine to establish a Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats.