Sunday, November 4, 2012

Stocks give up an early gain; storm sinks insurers

Enthusiasm about a solid October jobs report quickly faded on Wall Street Friday. Stocks drifted lower as companies began to assess the potential costs of Superstorm Sandy.

Insurers plunged on expectations that losses from the catastrophe will eat into their fourth-quarter earnings. AIG fell 5 percent, Genworth Financial and Arch Capital Group 4 percent and Hartford Financial Services Group 3 percent.

In the last big piece of economic news before Tuesday's presidential election, the Labor Department said employers added 171,000 jobs last month, while the unemployment rate ticked up to 7.9 percent. More jobs were added in the previous two months than was first reported, the government said.

The economy is the top issue in the election, but few expect the latest jobs numbers ? solid, but not great ? will sway many voters. Stocks in Europe rose after the report was released at 8:30 a.m. Eastern time, but fell back after the U.S. rally faded.

The Dow Jones industrial average rose as much as 57 points in the first minute of trading, then turned negative before a half-hour had passed.

The Dow was down 42 points at 13,191 at 12:15 p.m. Eastern time. The Standard & Poor's 500 index fell three to 1,425. The Nasdaq composite index dropped 9 to 3,010.

Insurers were not the only companies to suffer in Sandy's wake. Delta Air Lines said it lost $45 million in revenue last month because of flight cancellations during and after the storm. Shares fell 12 cents to $9.59.

And Verizon Communications Inc., whose downtown Manhattan facilities are still without power, said the storm would have a "significant" effect on its fourth-quarter earnings. Verizon said it could not yet estimate the cost of the storm, which downed cell towers across the region. Its stock fell a nickel to $45.09.

Stocks of consumer companies rose strongly, with Internet travel sites priceline.com and TripAdvisor Inc. leading the S&P 500. The companies surprised investors with better-than-expected third-quarter earnings after the market closed on Thursday. TripAdvisor rose $6.12, or 21 percent, to $35.53. Priceline added $61.24, or 10 percent, to $647.34.

Starbucks rounded out the S&P 500's top three gainers, adding $4.47, or 10 percent, to $51.09. The ubiquitous coffee vendor said late Thursday that global revenue at cafes open at least a year rose 6 percent during its fiscal fourth quarter, which runs from July through September.

Home decor retailer Restoration Hardware Holdings Inc. shot up $7.74, or 32 percent, to $31.74 in its first day of trading on the New York Stock Exchange.

___

Daniel Wagner can be reached at www.twitter.com/wagnerreports.

Source: http://news.yahoo.com/stocks-early-gain-storm-sinks-insurers-164215473--finance.html

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Video: More on November 2: Ohio, Ohio, Ohio

State elections decide health care's future

While the presidential race is the main focus of the election, the choices voters make to fill governor?s mansions and state legislatures may have just as big an effect on what kind of health coverage people like new mom Brandi DeFrank will have in coming years.

Source: http://www.msnbc.msn.com/id/3036697/vp/49666459#49666459

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When patient stories leave the hospital room

There are many ways a woman reacts as she pushes out her baby. One patient couldn?t stop laughing as the baby crowned. One screamed for ten minutes (no epidural). Another only grimaced and clenched her hands. I was particularly touched by a woman who cried tears of happiness throughout.

One patient, cervix fully dilated and about to start pushing, pulled me aside. ?I want to apologize for whatever happens next,? she told me. ?I?m a really nice person, I promise. But I don?t know what I?ll do or say once the baby starts coming out.?

?Don?t apologize,? I said, and reassured her that nothing she did would change the way I thought about her. Of course, no one else would hear about it. ?It?s like Vegas here. What happens in the delivery room stays in the delivery room.? I added.

It?s a comforting thing for me to say and for a patient to hear. But is it true?

Storytelling is part of a physician?s job. A doctor creates a narrative to communicate to a medical team. The prose is precise and the language is standardized, but the team wants to know what happens, in what order, what to do about it, and why.

The desire to share, however, sometimes extends beyond the confines of clinical care. During lunch, in the hallways, and in the elevators, my classmates and I trade snippets of what happened to our patients today. We know better, but we take the risk that even if strangers catch a few word here and there, not enough can be pieced together to violate confidentiality. It is part of the ?hidden curriculum??that is, being taught one thing in the classroom and practicing another in the workplace. None of this is new or news.

A major shift occurs when two things change: 1) the medium and 2) the audience. We go online and write what we have previously shared in hushed tones over hospital meals. Our intentions are usually good: to share, to connect, to explain, to teach. But we are no longer looking our audience in the eye. We cannot see who our words reach, and we cannot see their effect. How do our responsibilities change?

I have found that the biggest challenge of writing as a medical student is the balance between confidentiality and honesty. During the first few days of medical school, I asked the higher-ups at my medical school for advice about boundaries in writing. Admitting it was a gray area that made heavy use of common sense, one of my advisers told me, ?People aren?t going to trust you enough to talk to you if they think you?ll have no restraint in writing what they say. The classroom would no longer be a safe place.?

Similarly, sometimes you meet a patient with an extraordinary story that you wish you could share, but it is too challenging to anonymize the details without losing the message. Here is where the specifics become even more confusing and peculiar. Sometimes I change identifying details (gender, age, location, temporality, or disease) or use a conglomeration of patients instead of just one. But doing this is inherently dishonest: even with a disclaimer, my story is partly fictional and it is impossible to know which part. It becomes a representation of my perception rather than reality. If I want to make a specific point, what is stopping me from tweaking a detail or two to fit my worldview? Are my quotations verbatim, or are they close enough? Do I become a screenwriter rather than a physician if I change five details? Ten? Twenty?

Additionally, different rules surface depending on the outlet or story type. One major newspaper, for example, lets you omit details but not create them. It is also possible to seek the permission of the patient to tell a story. However, giving that person discretion over what smaller details are shared may change the story on a more macro level. It seems as though honesty and confidentiality lie on two opposing ends of a seesaw, but the audience is never sure which side is up.

As an employee of my hospital, I have access to every patient?s online medical records. Each time I look up a patient, a box pops up. ?Reason for looking up this patient?? My cursor hovers over the possible options: ?Clinical care,? ?Teaching,? ?Research,? ?Admin,? ?Quality assurance??it goes on. I instinctively head for the first or the second, because it?s how I want to see myself. What I am doing is in the patient?s best interest, or in my colleagues? best interest, or in the public?s best interest.

But there is one option at the very end of the list that stands out: ?Other.? If you click ?Other,? you must explain why, on the record.

With online storytelling, I suspect there is a lot of ?Other.? But will we label it as such? Will we articulate why we need to share and who benefits from it? The rules are ambiguous enough today that I can push off the question, at least in medical records. It lingers in my mind though, as the details of what happens in Vegas slowly leak their way out.

~~~

This piece will appear in the book Establishing, Managing and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices by Kevin Pho, MD and Susan Gay, in January 2013.

Images: Nmadhubala on Flickr and Tsca on Flickr

Source: http://rss.sciam.com/click.phdo?i=12deb98dff5453ad8b1d6d15c3fbff4d

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Saturday, November 3, 2012

Study: Romney, Obama both get negative coverage

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San Francisco Chiropractor Review: Neck and Back Pain - Dr Davis ...

Thomas HarwoodThe Executive Express Chiropractic? "Patient of the Week" is Thomas Harwood.

Thomas presented to our clinic with symptoms of neck and lower back pain. The pain was interfering with his active lifestyle and was affecting his work, home life. Thomas drives all over the SF Bay Area for work and was having difficulty performing his heavy work load? due to the back and neck pain.

Since his first treatment, Thomas has felt a significant amount of improvement. He notices a decrease in neck and back pain levels, better range of motion, and overall functional improvement. His adjustments are holding longer and longer and Thomas is excited to be active again.

Thomas appreciates the personal treatment plan he has received at Executive Express Chiropractic and has improved greatly with prescribed home care. He has finally found a natural and holistic approach to health and wellness.

Source: http://www.sfbackpaindoctor.com/2012/11/san-francisco-chiropractor-review-neck-and-back-pain-.html

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Venice hit by worst flooding in two years

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Benghazi questions fuel fierce partisan debate

FILE - In this Wednesday, Sept. 12, 2012 file photo, a man looks at documents at the U.S. consulate in Benghazi, Libya, after an attack that killed four Americans, including Ambassador Chris Stevens. The graffiti reads, "no God but God," " God is great," and "Muhammad is the Prophet." CIA security officers went to the aid of State Department staff less than 25 minutes after they got the first call for help during the attack on the U.S. Consulate in Benghazi, Libya, U.S. intelligence officials said Thursday, Nov. 1, 2012, as they laid out a detailed timeline of the CIA's immediate response to the attack from its annex less than a mile from the diplomatic mission.(AP Photo/Ibrahim Alaguri)

FILE - In this Wednesday, Sept. 12, 2012 file photo, a man looks at documents at the U.S. consulate in Benghazi, Libya, after an attack that killed four Americans, including Ambassador Chris Stevens. The graffiti reads, "no God but God," " God is great," and "Muhammad is the Prophet." CIA security officers went to the aid of State Department staff less than 25 minutes after they got the first call for help during the attack on the U.S. Consulate in Benghazi, Libya, U.S. intelligence officials said Thursday, Nov. 1, 2012, as they laid out a detailed timeline of the CIA's immediate response to the attack from its annex less than a mile from the diplomatic mission.(AP Photo/Ibrahim Alaguri)

(AP) ? The deadly military-style assault on the U.S. Consulate in Benghazi, Libya, has raised numerous foreign policy and national security questions and fueled a fierce, partisan election debate over the Obama administration's handling of the attack.

The strike that killed U.S. Ambassador Chris Stevens and three other Americans is either proof of President Barack Obama's leadership failures or a tragic event that occurred despite the administration's best efforts to protect the compound and respond in the aftermath of the attack, according to highly charged arguments on both sides.

Administration officials have warned against drawing conclusions from individual documents that have leaked into the public sphere. They maintain that a full picture of what happened and any assessment of blame can only be determined after a complete review of all the evidence. But as documents continue to surface in the final days of the presidential campaign, the intensity of allegations of administration impropriety or incompetence has risen.

A look at what is known, what is still unanswered and who is investigating the incident that has called into doubt Washington's ability to predict such events, secure American personnel in dangerous places and track down those responsible.

THE UNDISPUTED FACTS:

At 9:40 p.m. local time on Sept. 11, the 11th anniversary of the terrorist attacks in the United States, organized, well-armed attackers stormed the U.S. Consulate in Benghazi. The attack occurred within hours of demonstrators in neighboring Egypt scaling the walls of the U.S. Embassy in Cairo to protest an American-made, anti-Islam film. Those protests spread in the following days across the Muslim world from Morocco to India, with 50 people killed.

The attackers breached the Benghazi consulate's perimeter and set fire to parts of the compound, including the building where Stevens, his security guard and State Department information officer Sean Smith, took refuge in a safe room. Diplomatic security agents on the site notified Washington, the U.S. Embassy in Tripoli and a nearby CIA office of the attack. They tried, unsuccessfully, to repel the assault. Reinforcements arrived from the CIA annex to evacuate those on the compound, but Smith was already dead and Stevens could not be found. The group fell back to the CIA annex, which later came under well-aimed mortar fire, killing CIA contractors Tyrone Woods and Glen Doherty, both former Navy SEALs. The bodies of the victims and the survivors of the attack were evacuated from Benghazi.

National Security Adviser Tom Donilon advised Obama of the attack at about 5 p.m. in Washington (11 p.m. in Libya) while he was meeting with Defense Secretary Leon Panetta and the chairman of the Joint Chiefs of Staff, Gen. Martin Dempsey. Obama ordered that the U.S. begin moving military assets into the region to prepare for a range of contingencies. Those didn't arrive until the fighting was over at 4 a.m. Libya time, or 10 p.m. in Washington.

THE UNANSWERED QUESTIONS:

Q: Was there an intelligence failure? Did the Obama administration know about threats to the Benghazi consulate that could have allowed it to either prevent or turn back the attack?

A: Multiple senior administration officials have said there was no specific, credible threat information about a planned attack on the consulate on Sept. 11 or any other date. U.S. officials have said that while they now believe the attack was planned, it appears that it was planned a few hours in advance, not days or weeks.

However, those officials also have noted a serious deterioration in the security situation in Benghazi in the months leading up to the attack, including several previous incidents at the consulate itself, the office of the International Red Cross and an attempt on the life of the British ambassador to Libya.

Former Libya-based security officials have said the threat environment was extremely dangerous and Stevens himself had written cables back to Washington stressing the worsening conditions and heightened extremist activity. And documents found at the site six weeks after the attack indicate that consulate employees noticed a local Libyan police officer taking photos of the consulate from a building across the street on the morning of Sept. 11, according to Foreign Policy magazine.

The White House was aware of a growing terrorist threat in the region. It signed off a year ago on a new counterterrorism task force in North Africa to combat what it believes is a growing threat from al-Qaida-linked militants in northern Mali, Libya and elsewhere in the region. An elite Delta Force team has been in the region for six months, beginning to set up its intelligence and targeting network.

Q: Should the administration have increased security at the consulate based on the danger in Benghazi? Would it have made a difference?

A: State Department officials have testified to Congress that security at the compound was adequate for the assessed threat level. Those same officials have acknowledged that the security was clearly inadequate for the size and scale of the Sept. 11 attack. Fox News has reported, citing a classified cable, that consulate security staffers warned a month before the attack that the Benghazi compound was vulnerable. Appeals for additional manpower from the former regional security officer at the U.S. Embassy in Tripoli and the commander of a Tripoli-based military team were denied. But officials insist there is no guarantee that the requested extra support would have been enough to deter or defend against such a sustained attack. The consulate was lightly guarded compared with other diplomatic missions of its size in volatile locations.

Q: Was the immediate response to the attack inadequate? Did officials in Washington turn down urgent appeals for assistance from the intelligence community, and the military and did authorities on the ground tell would-be responders to "stand down" as the assault was happening?

A: Senior intelligence officials have denied reports that officials in Washington rejected requests for CIA agents at the nearby annex to respond to the consulate attack. These officials insist that a half-dozen security forces from the CIA annex responded within 25 minutes of the first call for help from the consulate. Armed with the small arms they normally carry ? and with no response from Libyan officials who were asked to provide heavy weaponry ? they helped rescue some State Department personnel and repel the militants. An unarmed Defense Department drone aircraft was quickly moved overhead to provide surveillance video for the CIA on the ground during the night. Two military members were with the CIA team that flew from Tripoli to Benghazi during the night to provide assistance. Panetta, meanwhile, ordered two teams of special operations forces from Fort Bragg, N.C., and central Europe to head to the area, and sent a Marine Fleet Antiterrorism Security Team to Libya. The Marine team got to Tripoli, but by then the Americans had already been flown out of Libya. The commando teams got to Sigonella Naval Air Station in Sicily, Italy, but arrived after the fight was over. Two of the CIA security officers, Woods and Doherty, died in a mortar attack just before dawn when insurgents assaulted the CIA annex, where the Americans had taken refuge.

Q: Did the administration intentionally downplay the attack by initially describing it as a response to the anti-Islam movie and not specifically an "act of terrorism"? Is the administration trying to cover up al-Qaida links to the attack to benefit Obama politically in his re-election campaign?

A: It's unclear what motivations, if any, were behind the administration's messaging, but Obama heatedly denied any political motivation in one of his debates with GOP presidential nominee Mitt Romney.

In public statements, administration officials did link the Benghazi attack to the anti-Islam film by saying it appeared to have sprung from the same anger that sparked the violent protests elsewhere. Those statements, though, such as widely criticized comments by U.S. Ambassador to the United Nations Susan Rice, were couched as preliminary findings based on the best available evidence at the time.

Intelligence officials say their assessment ? from a protest gone bad to an orchestrated attack ? evolved as more information became available. They say that while early reports indicated extremists were involved in the assault, initial public statements were deliberately cautious and limited since they involved classified intelligence. While it has become clear that information was coming in in real time during the attack, there are still questions about how quickly conflicting reports were sorted out and how high up the chain of command the information went.

State Department officials have said they never concluded the attack began as a spontaneous demonstration against the movie and said further that there was no protest outside the consulate before the assault occurred. However, they also stress that they made no immediate conclusions about the origins or impetus for the attack. Eyewitnesses have told various news organizations, including The New York Times, that some of the attackers said they were angered by the film, but there is no evidence yet to suggest that that was their motivation to storm the compound.

Q: Who did it?

A: That is still unclear. The Tunisian government is holding as a suspect a Tunisian man named Ali Harzi, who was arrested in Turkey and may have some ties to the attack. Emails sent from the State Department to the White House and other government agencies on the evening of the attack reported that the militant group Ansar al-Sharia had claimed responsibility, leading to charges that the administration knew it was a terror attack and not protesters. However, the group subsequently denied responsibility for the attack and there are questions about whether the initial claim was credible. U.S. intelligence also intercepted phone calls in which al-Sharia members were bragging about pulling off the attack to members of Al-Qaida in the Islamic Mahgreb, an offshoot of al-Qaida.

Q: Who is investigating the incident?

A: In addition to an FBI investigation, which is required when an American official is killed in the line of duty overseas, there are at least four congressional investigations and several State Department probes now under way. The FBI will try to determine who actually committed the attack and killed the four Americans with an eye toward potential prosecution or other action. The House Oversight and Government Reform Committee is looking into possible administration negligence related to security at the consulate and the response to attack. The House and Senate Intelligence and Foreign Affairs committees are also seeking answers to the questions. Secretary of State Hillary Rodham Clinton has appointed an independent accountability review board to examine any State Department failures and make recommendations on diplomatic security. The State Department's inspector general has informed Congress that his office will be making its own inquiries.

___

Associated Press writer Lolita C. Baldor contributed to this report.

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/386c25518f464186bf7a2ac026580ce7/Article_2012-11-02-US-Libya-QandA/id-9ac946135db74396984faf165696e28e

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