WASHINGTON ? House Republicans are proposing to spend about $260 billion over the next 4 1/2 years on transportation programs as a way to preserve jobs, according to a draft bill being introduced this week.
Rep. John Mica, R-Fla., who is chairman of the House Transportation and Infrastructure Committee, and other GOP leaders are expected to introduce the bill on Tuesday. Mica's committee is poised to approve the measure on Thursday.
The bill would maintain current spending on transportation despite declining gasoline and diesel fuel taxes, which historically have paid for highway and transit programs.
A separate committee will decide how to cover the gap between gas-tax revenues and the spending levels proposed in the bill. GOP leaders have said they plan to use revenue from expanded oil and natural gas drilling, but haven't provided details. However, congressional aides knowledgeable about the proposal said it would include drilling off the Virginia coast and in federal leases in the Arctic National Wildlife Refuge. The aides weren't authorized to speak publicly and asked not to be named.
The bill provides enough money to prevent the nation's roads, bridges and transit systems from falling further into disrepair, but not enough to significantly reduce the backlog of needed work on transportation infrastructure, transportation experts said. A congressionally mandated commission estimated in 2009 that it would require $200 billion a year to reduce the backlog while maintaining the current transportation system.
"Clearly this level of funding is inadequate to support our needs as a nation," said Joshua Schank, president of the Eno Center for Transportation, a Washington think tank that supports greater transportation investment.
But the bill is expected to save jobs in construction, bus manufacturing and other transportation-related industries in part because it allows state transportation departments to make long-term commitments of funds. Those kinds of commitments are usually necessary before companies can go forward with major new transportation projects.
Each $1 billion in transportation construction spending supports about 30,000 jobs, said Andy Herrmann, president of the American Society of Civil Engineers.
The GOP bill is "holding along the lines of what we've been doing in the past," he said.
But that may be enough to propel the bill through the House in an election year where voter regard for Congress is at rock bottom and lawmakers are eager to show off an accomplishment.
The last long-term transportation bill expired in 2009. Congress has kept transportation aid flowing to states through a series of short-term extensions. The current extension expires on March 31.
The Senate is working on its own bill, which would spend $109 billion over two years. Sen. Barbara Boxer, D-Calif., a co-author of the bill, says the bill's sponsors have a plan to pay for the measure, but hasn't detailed how that would happen.
Ultrasound male contraceptive, overlooked for decades, confirmed to workPublic release date: 29-Jan-2012 [ | E-mail | Share ]
Contact: Elaine Lissner 415-839-6304 Male Contraception Information Project
Imagine a contraceptive that could, with one or two painless 15-minute non-surgical treatments, provide months of protection from pregnancy. And imagine that the equipment needed were already in physical therapists' offices around the world.
Sound too good to be true? For years, scientists thought so too. But new research headed by Dr. James Tsuruta in the Department of Pediatrics at the University of North Carolina-Chapel Hill, published Monday in the journal Reproductive Biology and Endocrinology, is gaining the contraceptive method increased respect. The kicker: This treatment would be for mengiving them the first new option since condoms and vasectomy were introduced more than a century ago.
HOW IT WORKS
The testes need to be slightly cooler than the rest of the body to properly produce spermthe subject of countless jokes and warnings about hot tubs, laptops, and tight pants. But although hot tub or laptop use can push a man's sperm count over the edge if he's already low, it's not reliable enough for contraception. What if this heat effect could be enhanced?
That's where ultrasound comes in. Relatively inexpensive and already in use in physical therapists' offices around the world, therapeutic ultrasound (as opposed to diagnostic ultrasound) heats deeply and increases circulation to injured joints. The physical therapist applies lubricating gel to the joint, turns on the machine, and runs the wand back and forth over the joint for 5 or 10 minutes, creating a pleasant warming sensation.
It turns out, though, that ultrasound can be used on other body parts as well. That includes the testes, and it would be for contraception rather than healing. In the current study, researchers got more than 2 1/2 monthsand possibly long-lastingcontraception in rats with two 15-minute sessions of ultrasound, two days apart. And their study is the first to provide detailed insight into how ultrasound might be working, using modern equipment. But the published evidence that it works has been in plain sight for more than 35 yearsnot taken seriously until recently.
OVERLOOKED FOR DECADES
Dr. Mostafa Fahim of the University of Missouri, Columbia was the first to try therapeutic ultrasound for contraception. He and his team showed effect in rats, cats, dogs, monkeys, and even 8 men, publishing journal reports and book chapters in 1975-1982 and patents in 1977 and 1978. But it seemed too strange to be true. Were those effects really reproducible? Other researchers were suspicious enough that a site visit team was even sent to his lab.
Then in 1988 a more respected researcher, Ronald L. Urry of the University of Rochester, dealt what seemed like the death blow for ultrasound as contraception. In trying to repeat Dr. Fahim's experiments, he showed no significant effect on sperm production. Even when he turned it up so high that he saw burns, he still saw little to no effect.
Ultrasound was down, but not out. In the meantime, heat's impact on fertility was becoming more accepted. A landmark review article on the subject was co-authored by noted University of California, Los Angeles researcher Dr. Ronald Swerdloff, and a growing literature on occupational heat's impact on workers (such as welders) was emerging.
And one nonprofit organization continued to be intrigued. The Male Contraception Information Project pointed out that upon careful reading, several of Dr. Urry's techniques clearly differed from Dr. Fahim's earlier work. For example, Dr. Urry exposed the animal's whole tail end, not just the testes, to ultrasound. Not surprisingly, he could not find a power level that was effective without burning the bony, delicate tail structure!
"Nobody really took Dr. Fahim seriously. But it just seemed like too much data to be made up," explains Elaine Lissner, director of the Male Contraception Information Project (MCIP). "By the time I met him, he was pretty bitter about the whole thing, which didn't help."
The information on ultrasound languished for decades, available on MCIP's website but not pursued scientifically. During those decades, it became clear that many men were desperate for new options, with two advocacy sites springing up and thousands of men signing petitions for new methods at MaleContraceptives.org. Men in couples saw their partners suffering with female contraceptives and wanted to relieve them of burden; single men wanted a backup to condoms in a world of paternity tests and child support.
A NEW LOOK
Ultrasound's fortunes finally started to change in 2006, when the Parsemus Foundation, a small funder with roots in the male contraceptive advocacy movement, decided it was time to give ultrasound one more chance to prove itself. The newly formed foundation approached Dr. David Sokal of Family Health International (now called FHI360), known for his open mind and his knowledge of male methods. Dr. Sokal recruited James Tsuruta (UNC-Chapel Hill) and team, experts in evaluating sperm, to join the effort. Since Dr. Fahim had passed away in 1995, they even consulted with Dr. Fahim's only living colleague, Dr. Min Wang of the University of Missouri, to make sure nothing was missed. "There wasn't any more money where this came from," explains Lissner. "If this team of top-notch researchers couldn't pull it off, it would be ultrasound's last chance."
Things looked dicey at first. As Dr. Tsuruta explains, "The original ultrasound conditions from Dr. Fahim (1 MHz, 1 W/cm2, 10 minutes) that were reported to eliminate essentially all germ cells did not come close to achieving his reported result" in the first attempts. "The process of treating rat testes with ultrasound involves more variables than I imagined at the start of these studies."
Yet with persistence, the team finally found a combination that worked. The best results came from undergoing two sessions, each consisting of 15 minutes of ultrasound, two days apart. During the sessions, the testes were placed in a cup of saline to provide conduction between the ultrasound transducer and skin.
The researchers were not able to continue their study for long enough to see when, or whether, fertility would return. But they knew it was effective: microscopic examination showed dramatic changes after just two weeks. Normally, testes are full of many layers of cells developing into sperm, but now the tubes of the testis were almost empty. "Sperm production is very robust; this ensures the survival of a species. It's really difficult to find a way to turn off the production of sperm, but ultrasound seems to do the trick," Dr. Tsuruta continues. "There is something special about heating with ultrasoundit caused 10-times lower sperm counts than just applying heat."
CONFIRMED IN OTHER SPECIES
Encouraged by the preliminary results in rats, the foundation commissioned a small study in monkeys: the closest species to human. These researchers, working at the University of California-Davis, also had a tough time getting the ultrasound treatment to work. They tried many variations and did eventually get a shorter period of effect (six weeks) with a longer treatment (three 30-minute sessions two days apart). "We were pretty discouraged at first," says Dr. Catherine VandeVoort, lead researcher. "The monkeys didn't seem to mind the treatment a bit, but we were having a rough time of it. Thirty minutes of treatment three times a week is a lot of monkey testicular massage. We felt pretty silly, and it didn't help when the techs would come around and wonder what kind of research we were doing! We were relieved when we finally saw an effect."
Unbeknownst to either team, another researcher halfway around the world had also gotten intrigued. "A friend of mine works at an ultrasound company in Germany and had asked me whether I could think of any additional applications for ultrasound," says Dr. Raffaella Leoci, a veterinary researcher at the University of Bari in Italy. "I started poking around and found Dr. Fahim's publications. I was particularly intrigued by his mention that with two or more applications two days apart, permanent sterilization could be done. We have a big problem with stray dogs here; if it really worked, that might be a more humane and affordable way to sterilize them than surgery." She found the permanent effect she was hoping for, with Monday-Wednesday-Friday treatments of five minutes each, and published "Ultrasound as a Mechanical Method for Male Dog Contraception" in 2009.
Dr. Ted Tollner, a member of the UC-Davis team, points out that their struggles to show effect turn out to have a silver lining. "As luck has it, we're the only ones who can show that ultrasound can be reversible. The UNC team's rat study has the numbers, and they have beautiful histology data showing what's going on inside the testes. The Italian team was first to publish and showed ultrasound could be very effective in a large animal, not just rats. Together with our results showing the possibility of reversibility along with effectiveness in the closest animal to humans, it makes a pretty compelling package."
ALTERNATIVE TO VASECTOMY?
With permanent effect from three treatments in dogs and researchers not sure whether their rats would have gained fertility, ultrasound is beginning to look like a better permanent contraceptive than temporary one. But permanent contraception might not be such a bad thing. "I think one of the highest priorities in the area of new contraceptive development is nonsurgical sterilization, for men and for women," explains Jeff Spieler, Senior Technical Advisor for Science and Technology Office of Population and Reproductive Health Bureau for Global Health at the U.S. Agency for International Development. The agency works, among other priorities, to develop safe, effective and acceptable family planning methods to prevent unintended pregnancies, reduce maternal mortality and prevent the resort to abortion. "About 25% of couples worldwide rely on sterilization as their method, and I believe many more would choose permanent methods of contraception if they were nonsurgical. Of course, such methods would have to be easy to perform, including by non-physicians, highly acceptable and safe."
LIMITATIONS AND OPTIONS
He sees a limitation for ultrasound as a nonsurgical alternative to vasectomy, though, if it requires two visits. "Two visits is a concern. Ideally a method should be highly effective after one visit, because many people may not come back for the second treatment."
Two competing areas of research could get around the problem. They include RISUG(TM) long-acting vas deferens gel, which has been effective for more than a decade in studies in India ((now being modified and developed as Vasalgel(TM) for use outside India)), and a high-tech laser vasectomyusing light to seal off the vas deferens sperm tube without cutting the skinshowing promise in early studies at the University of North Carolina at Charlotte.
All three alternative methods are worth pursuing, says Lissner of the Male Contraception Information Project. "RISUG is far more advanced, but ultrasound and the laser vasectomy are the only ones that are completely nonsurgical. We try to keep in mind the concept of a 'contraceptive supermarket'the more options there are, the more likely there is to be something that's right for everybody."
COMPLIMENTS AND CAUTION
"This is an interesting development in a challenging indication," says regulatory consultant Gary Gamerman of Seraphim Life Sciences. Though much remains to be done, there's nothing inherent to the method that would make ultrasound dead in the water from a regulatory standpoint. "The only concern is proof of safety and durability of response. As long as it prevents fertile sperm, is overall safe and doesn't cause secondary safety or adverse sexual effects, there wouldn't necessarily be anything that would hold it back. You just have to do the studies."
But he seconds the concern over ultrasound use as a temporary contraceptive, rather than permanent sterilization. Unless they had sperm tests performed, couples would have no way of knowing when they became fertile as the method wore off. The method would have to be long-acting, or highly consistent from man to man, to get around this.
"Permanent is good, or it could be semi-permanent, or 12 months or longer. But two or three months is a bit short to ask people to come back for treatment, especially in the developing world," explains Gamerman.
And there's one more concern about a method that wears off over time: the quality of the first sperm that return. "I am convinced that any procedure which leads to
subfertility in males is likely to have effects on embryo development," explains Dr. Brian Setchell of the University of Adelaide, a pioneer in examining heat and environmental effects on sperm. "The effects are not only after heat. Sperm from obese males produce embryos that develop more slowly, and there is evidence for diabetes, various toxins and therapeutic agents having the same effects in males." These are all reasons for caution about short-term, rather than permanent, use. Dr. Tsuruta agrees: "Safety and efficacy are paramount. Studies in the rat are an excellent way to validate these methods without risk to humans."
EARLY ADOPTERS
But some men aren't waiting for the results of years of studies. They have a scientific backgroundthey know enough scientific jargon to read the papers and understand exactly what the risks areand are willing to take a chance.
In a long-term relationship and looking for an option other than condoms or vasectomy, Dr. Chris Jenks decided to give heat methods a try. Other men have tried heat methods and even posted their results to the online discussion group at the MaleContraceptives.org advocacy website. But with his chemistry background and skills with a microscope, Dr. Jenks decided to go one step further: he documented every sperm count and posted it on his website PuzzlePiece.org.
With a simple modification to his underwear (known as artificial cryptorchidism or the "suspensory method"), Dr. Jenks was able to keep his testes closer to his body, too warm to properly produce sperm. Reassuringly, in one- to two-year tests in France in the 1980's and 1990's the method had been both effective and reversible. Sure enough, within a month his sperm count dropped below the fertility cutoff. The method worked wellso well that he continued using it for nearly 12 years, giving his partner a 12-year break from pills and producing the first long-term data on the effect of heat.
But Dr. Jenks knew that being a pioneer, there might be surprises. In 2010 he discontinued the heating, wondering how his system was doing. By two months later the sperm numbers seemed to be climbing back up, and he thought he was regaining fertility as in the 2-year studies. But there was a catch: even a year later, most of the sperm were not swimming.
"Of course, my lack of return to fertility could have something to do with using the method for over 10 years," says Jenks. "And it isn't a problem for me, since we aren't trying to have a child. But it's something to know about. It's best to be really clear about the possible outcomes, and that you're okay with them, before trying something like this."
One man has even tried ultrasound; but without publications that list the best settings, he was not able to get it to work on the first try. Ryan, 34, of New Jersey, bought an ultrasound machine on eBay and posted his results to the online discussion group. "Honestly, I'd rather be able to have the ability to control my own fertility rather then permanently shut it off," he explains. "But I had no way to test that the machine was working right. Due to bills at the time, I couldn't afford to throw more money into testing ultrasound whereas I found out my insurance covers vasectomies. I feel I've waited long enough."
A NEW LEAD TO FOLLOW?
Ultrasound's future is uncertain. The 2010 Bill & Melinda Gates Foundation Grand Challenges Explorations grant that the UNC team won to complete their current study has run out, and Parsemus Foundation (the small funder that supported the preliminary tests) had only enough funds to support the proof of principle work. "We're very grateful to have received the Grand Challenges grant and be able to show that it actually works," says Tsuruta. "The quickest path to eliminating unwanted or mistimed pregnancies has men and women sharing responsibility together for family planning and it might take new male methods for this to happen regularly."
With men looking for options, ultrasound's new credibility may have arrived at the right moment. "There are a lot of 'me too' contraceptives being introducedpills with iron, pills with a few more days of estrogen, pill hormones in ring or patch formbut not a lot that is truly new," concludes Lissner. "This isn't as far along as RISUG; but it would be the first truly new male contraceptive in over a century, and would be one of the only contraceptive leads out there that has so few access issues, being based on equipment already in medical offices all over the world. We think it's worth giving it a chance."
###
Press resources and help for journalists writing about male contraceptive development are available from the nonprofit Male Contraception Information Project: http://www.NewMaleContraception.org .
Read the release from BioMed Central, Reproductive Biology and Endocrinology:
http://www.eurekalert.org/pub_releases/2012-01/bc-ss012712.php
To read more about ultrasound, see http://www.newmalecontraception.org/usound.htm .
ABOUT THE UNIVERSITY OF NORTH CAROLINA TEAM AND GRAND CHALLENGES EXPLORATIONS
Read the full UNC press release of grant award here: UNC researchers receive $100,000 Grand Challenges Explorations Grant to develop male contraceptive http://www.eurekalert.org/pub_releases/2010-05/uonc-urr051010.php
ABOUT THE MALE CONTRACEPTION INFORMATION PROJECT
The Male Contraception Information Project is entirely nonprofit and works in three areas:
raising public awareness of promising nonhormonal male contraceptives
advocating increased and expedited government research
serving as a resource for journalists who wish to write about the subject
Website: http://www.NewMaleContraception.org (or http://www.mcip.info) San Francisco, California
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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Ultrasound male contraceptive, overlooked for decades, confirmed to workPublic release date: 29-Jan-2012 [ | E-mail | Share ]
Contact: Elaine Lissner 415-839-6304 Male Contraception Information Project
Imagine a contraceptive that could, with one or two painless 15-minute non-surgical treatments, provide months of protection from pregnancy. And imagine that the equipment needed were already in physical therapists' offices around the world.
Sound too good to be true? For years, scientists thought so too. But new research headed by Dr. James Tsuruta in the Department of Pediatrics at the University of North Carolina-Chapel Hill, published Monday in the journal Reproductive Biology and Endocrinology, is gaining the contraceptive method increased respect. The kicker: This treatment would be for mengiving them the first new option since condoms and vasectomy were introduced more than a century ago.
HOW IT WORKS
The testes need to be slightly cooler than the rest of the body to properly produce spermthe subject of countless jokes and warnings about hot tubs, laptops, and tight pants. But although hot tub or laptop use can push a man's sperm count over the edge if he's already low, it's not reliable enough for contraception. What if this heat effect could be enhanced?
That's where ultrasound comes in. Relatively inexpensive and already in use in physical therapists' offices around the world, therapeutic ultrasound (as opposed to diagnostic ultrasound) heats deeply and increases circulation to injured joints. The physical therapist applies lubricating gel to the joint, turns on the machine, and runs the wand back and forth over the joint for 5 or 10 minutes, creating a pleasant warming sensation.
It turns out, though, that ultrasound can be used on other body parts as well. That includes the testes, and it would be for contraception rather than healing. In the current study, researchers got more than 2 1/2 monthsand possibly long-lastingcontraception in rats with two 15-minute sessions of ultrasound, two days apart. And their study is the first to provide detailed insight into how ultrasound might be working, using modern equipment. But the published evidence that it works has been in plain sight for more than 35 yearsnot taken seriously until recently.
OVERLOOKED FOR DECADES
Dr. Mostafa Fahim of the University of Missouri, Columbia was the first to try therapeutic ultrasound for contraception. He and his team showed effect in rats, cats, dogs, monkeys, and even 8 men, publishing journal reports and book chapters in 1975-1982 and patents in 1977 and 1978. But it seemed too strange to be true. Were those effects really reproducible? Other researchers were suspicious enough that a site visit team was even sent to his lab.
Then in 1988 a more respected researcher, Ronald L. Urry of the University of Rochester, dealt what seemed like the death blow for ultrasound as contraception. In trying to repeat Dr. Fahim's experiments, he showed no significant effect on sperm production. Even when he turned it up so high that he saw burns, he still saw little to no effect.
Ultrasound was down, but not out. In the meantime, heat's impact on fertility was becoming more accepted. A landmark review article on the subject was co-authored by noted University of California, Los Angeles researcher Dr. Ronald Swerdloff, and a growing literature on occupational heat's impact on workers (such as welders) was emerging.
And one nonprofit organization continued to be intrigued. The Male Contraception Information Project pointed out that upon careful reading, several of Dr. Urry's techniques clearly differed from Dr. Fahim's earlier work. For example, Dr. Urry exposed the animal's whole tail end, not just the testes, to ultrasound. Not surprisingly, he could not find a power level that was effective without burning the bony, delicate tail structure!
"Nobody really took Dr. Fahim seriously. But it just seemed like too much data to be made up," explains Elaine Lissner, director of the Male Contraception Information Project (MCIP). "By the time I met him, he was pretty bitter about the whole thing, which didn't help."
The information on ultrasound languished for decades, available on MCIP's website but not pursued scientifically. During those decades, it became clear that many men were desperate for new options, with two advocacy sites springing up and thousands of men signing petitions for new methods at MaleContraceptives.org. Men in couples saw their partners suffering with female contraceptives and wanted to relieve them of burden; single men wanted a backup to condoms in a world of paternity tests and child support.
A NEW LOOK
Ultrasound's fortunes finally started to change in 2006, when the Parsemus Foundation, a small funder with roots in the male contraceptive advocacy movement, decided it was time to give ultrasound one more chance to prove itself. The newly formed foundation approached Dr. David Sokal of Family Health International (now called FHI360), known for his open mind and his knowledge of male methods. Dr. Sokal recruited James Tsuruta (UNC-Chapel Hill) and team, experts in evaluating sperm, to join the effort. Since Dr. Fahim had passed away in 1995, they even consulted with Dr. Fahim's only living colleague, Dr. Min Wang of the University of Missouri, to make sure nothing was missed. "There wasn't any more money where this came from," explains Lissner. "If this team of top-notch researchers couldn't pull it off, it would be ultrasound's last chance."
Things looked dicey at first. As Dr. Tsuruta explains, "The original ultrasound conditions from Dr. Fahim (1 MHz, 1 W/cm2, 10 minutes) that were reported to eliminate essentially all germ cells did not come close to achieving his reported result" in the first attempts. "The process of treating rat testes with ultrasound involves more variables than I imagined at the start of these studies."
Yet with persistence, the team finally found a combination that worked. The best results came from undergoing two sessions, each consisting of 15 minutes of ultrasound, two days apart. During the sessions, the testes were placed in a cup of saline to provide conduction between the ultrasound transducer and skin.
The researchers were not able to continue their study for long enough to see when, or whether, fertility would return. But they knew it was effective: microscopic examination showed dramatic changes after just two weeks. Normally, testes are full of many layers of cells developing into sperm, but now the tubes of the testis were almost empty. "Sperm production is very robust; this ensures the survival of a species. It's really difficult to find a way to turn off the production of sperm, but ultrasound seems to do the trick," Dr. Tsuruta continues. "There is something special about heating with ultrasoundit caused 10-times lower sperm counts than just applying heat."
CONFIRMED IN OTHER SPECIES
Encouraged by the preliminary results in rats, the foundation commissioned a small study in monkeys: the closest species to human. These researchers, working at the University of California-Davis, also had a tough time getting the ultrasound treatment to work. They tried many variations and did eventually get a shorter period of effect (six weeks) with a longer treatment (three 30-minute sessions two days apart). "We were pretty discouraged at first," says Dr. Catherine VandeVoort, lead researcher. "The monkeys didn't seem to mind the treatment a bit, but we were having a rough time of it. Thirty minutes of treatment three times a week is a lot of monkey testicular massage. We felt pretty silly, and it didn't help when the techs would come around and wonder what kind of research we were doing! We were relieved when we finally saw an effect."
Unbeknownst to either team, another researcher halfway around the world had also gotten intrigued. "A friend of mine works at an ultrasound company in Germany and had asked me whether I could think of any additional applications for ultrasound," says Dr. Raffaella Leoci, a veterinary researcher at the University of Bari in Italy. "I started poking around and found Dr. Fahim's publications. I was particularly intrigued by his mention that with two or more applications two days apart, permanent sterilization could be done. We have a big problem with stray dogs here; if it really worked, that might be a more humane and affordable way to sterilize them than surgery." She found the permanent effect she was hoping for, with Monday-Wednesday-Friday treatments of five minutes each, and published "Ultrasound as a Mechanical Method for Male Dog Contraception" in 2009.
Dr. Ted Tollner, a member of the UC-Davis team, points out that their struggles to show effect turn out to have a silver lining. "As luck has it, we're the only ones who can show that ultrasound can be reversible. The UNC team's rat study has the numbers, and they have beautiful histology data showing what's going on inside the testes. The Italian team was first to publish and showed ultrasound could be very effective in a large animal, not just rats. Together with our results showing the possibility of reversibility along with effectiveness in the closest animal to humans, it makes a pretty compelling package."
ALTERNATIVE TO VASECTOMY?
With permanent effect from three treatments in dogs and researchers not sure whether their rats would have gained fertility, ultrasound is beginning to look like a better permanent contraceptive than temporary one. But permanent contraception might not be such a bad thing. "I think one of the highest priorities in the area of new contraceptive development is nonsurgical sterilization, for men and for women," explains Jeff Spieler, Senior Technical Advisor for Science and Technology Office of Population and Reproductive Health Bureau for Global Health at the U.S. Agency for International Development. The agency works, among other priorities, to develop safe, effective and acceptable family planning methods to prevent unintended pregnancies, reduce maternal mortality and prevent the resort to abortion. "About 25% of couples worldwide rely on sterilization as their method, and I believe many more would choose permanent methods of contraception if they were nonsurgical. Of course, such methods would have to be easy to perform, including by non-physicians, highly acceptable and safe."
LIMITATIONS AND OPTIONS
He sees a limitation for ultrasound as a nonsurgical alternative to vasectomy, though, if it requires two visits. "Two visits is a concern. Ideally a method should be highly effective after one visit, because many people may not come back for the second treatment."
Two competing areas of research could get around the problem. They include RISUG(TM) long-acting vas deferens gel, which has been effective for more than a decade in studies in India ((now being modified and developed as Vasalgel(TM) for use outside India)), and a high-tech laser vasectomyusing light to seal off the vas deferens sperm tube without cutting the skinshowing promise in early studies at the University of North Carolina at Charlotte.
All three alternative methods are worth pursuing, says Lissner of the Male Contraception Information Project. "RISUG is far more advanced, but ultrasound and the laser vasectomy are the only ones that are completely nonsurgical. We try to keep in mind the concept of a 'contraceptive supermarket'the more options there are, the more likely there is to be something that's right for everybody."
COMPLIMENTS AND CAUTION
"This is an interesting development in a challenging indication," says regulatory consultant Gary Gamerman of Seraphim Life Sciences. Though much remains to be done, there's nothing inherent to the method that would make ultrasound dead in the water from a regulatory standpoint. "The only concern is proof of safety and durability of response. As long as it prevents fertile sperm, is overall safe and doesn't cause secondary safety or adverse sexual effects, there wouldn't necessarily be anything that would hold it back. You just have to do the studies."
But he seconds the concern over ultrasound use as a temporary contraceptive, rather than permanent sterilization. Unless they had sperm tests performed, couples would have no way of knowing when they became fertile as the method wore off. The method would have to be long-acting, or highly consistent from man to man, to get around this.
"Permanent is good, or it could be semi-permanent, or 12 months or longer. But two or three months is a bit short to ask people to come back for treatment, especially in the developing world," explains Gamerman.
And there's one more concern about a method that wears off over time: the quality of the first sperm that return. "I am convinced that any procedure which leads to
subfertility in males is likely to have effects on embryo development," explains Dr. Brian Setchell of the University of Adelaide, a pioneer in examining heat and environmental effects on sperm. "The effects are not only after heat. Sperm from obese males produce embryos that develop more slowly, and there is evidence for diabetes, various toxins and therapeutic agents having the same effects in males." These are all reasons for caution about short-term, rather than permanent, use. Dr. Tsuruta agrees: "Safety and efficacy are paramount. Studies in the rat are an excellent way to validate these methods without risk to humans."
EARLY ADOPTERS
But some men aren't waiting for the results of years of studies. They have a scientific backgroundthey know enough scientific jargon to read the papers and understand exactly what the risks areand are willing to take a chance.
In a long-term relationship and looking for an option other than condoms or vasectomy, Dr. Chris Jenks decided to give heat methods a try. Other men have tried heat methods and even posted their results to the online discussion group at the MaleContraceptives.org advocacy website. But with his chemistry background and skills with a microscope, Dr. Jenks decided to go one step further: he documented every sperm count and posted it on his website PuzzlePiece.org.
With a simple modification to his underwear (known as artificial cryptorchidism or the "suspensory method"), Dr. Jenks was able to keep his testes closer to his body, too warm to properly produce sperm. Reassuringly, in one- to two-year tests in France in the 1980's and 1990's the method had been both effective and reversible. Sure enough, within a month his sperm count dropped below the fertility cutoff. The method worked wellso well that he continued using it for nearly 12 years, giving his partner a 12-year break from pills and producing the first long-term data on the effect of heat.
But Dr. Jenks knew that being a pioneer, there might be surprises. In 2010 he discontinued the heating, wondering how his system was doing. By two months later the sperm numbers seemed to be climbing back up, and he thought he was regaining fertility as in the 2-year studies. But there was a catch: even a year later, most of the sperm were not swimming.
"Of course, my lack of return to fertility could have something to do with using the method for over 10 years," says Jenks. "And it isn't a problem for me, since we aren't trying to have a child. But it's something to know about. It's best to be really clear about the possible outcomes, and that you're okay with them, before trying something like this."
One man has even tried ultrasound; but without publications that list the best settings, he was not able to get it to work on the first try. Ryan, 34, of New Jersey, bought an ultrasound machine on eBay and posted his results to the online discussion group. "Honestly, I'd rather be able to have the ability to control my own fertility rather then permanently shut it off," he explains. "But I had no way to test that the machine was working right. Due to bills at the time, I couldn't afford to throw more money into testing ultrasound whereas I found out my insurance covers vasectomies. I feel I've waited long enough."
A NEW LEAD TO FOLLOW?
Ultrasound's future is uncertain. The 2010 Bill & Melinda Gates Foundation Grand Challenges Explorations grant that the UNC team won to complete their current study has run out, and Parsemus Foundation (the small funder that supported the preliminary tests) had only enough funds to support the proof of principle work. "We're very grateful to have received the Grand Challenges grant and be able to show that it actually works," says Tsuruta. "The quickest path to eliminating unwanted or mistimed pregnancies has men and women sharing responsibility together for family planning and it might take new male methods for this to happen regularly."
With men looking for options, ultrasound's new credibility may have arrived at the right moment. "There are a lot of 'me too' contraceptives being introducedpills with iron, pills with a few more days of estrogen, pill hormones in ring or patch formbut not a lot that is truly new," concludes Lissner. "This isn't as far along as RISUG; but it would be the first truly new male contraceptive in over a century, and would be one of the only contraceptive leads out there that has so few access issues, being based on equipment already in medical offices all over the world. We think it's worth giving it a chance."
###
Press resources and help for journalists writing about male contraceptive development are available from the nonprofit Male Contraception Information Project: http://www.NewMaleContraception.org .
Read the release from BioMed Central, Reproductive Biology and Endocrinology:
http://www.eurekalert.org/pub_releases/2012-01/bc-ss012712.php
To read more about ultrasound, see http://www.newmalecontraception.org/usound.htm .
ABOUT THE UNIVERSITY OF NORTH CAROLINA TEAM AND GRAND CHALLENGES EXPLORATIONS
Read the full UNC press release of grant award here: UNC researchers receive $100,000 Grand Challenges Explorations Grant to develop male contraceptive http://www.eurekalert.org/pub_releases/2010-05/uonc-urr051010.php
ABOUT THE MALE CONTRACEPTION INFORMATION PROJECT
The Male Contraception Information Project is entirely nonprofit and works in three areas:
raising public awareness of promising nonhormonal male contraceptives
advocating increased and expedited government research
serving as a resource for journalists who wish to write about the subject
Website: http://www.NewMaleContraception.org (or http://www.mcip.info) San Francisco, California
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In this photo taken Saturday, Jan. 28, 2012, Myanmar pro-democracy leader Aung San Suu Kyi visits a photo exhibition at the Yangon Photo Festival in Yangon, Myanmar. (AP Photo/Khin Maung Win)
In this photo taken Saturday, Jan. 28, 2012, Myanmar pro-democracy leader Aung San Suu Kyi visits a photo exhibition at the Yangon Photo Festival in Yangon, Myanmar. (AP Photo/Khin Maung Win)
DAWEI, Myanmar (AP) ? Thousands of supporters in Myanmar's countryside cheered opposition leader Aung San Suu Kyi on Sunday as she made a political tour ahead of by-elections, highlighting how quickly and dramatically politics is changing in the long-repressed Southeast Asian nation.
Throngs of people lined the roads of several towns in the southern district of Dawei shouting, "Long Live Daw Aung San Suu Kyi!" ''Daw" is a title of respect in Myanmar.
Many waved bouquets of flowers, and some hoisted babies on their shoulders to glimpse the Nobel Peace Prize laureate and former political prisoner on her first political trip since announcing a bid for parliament.
"We will bring democracy to the country," Suu Kyi told an exuberant crowd of thousands. "We will work for development. We will bring rule of law to the country, and we will see to it that repressive laws are repealed."
"We can overcome any obstacle with unity and perseverance," she said from the second-story balcony of a provincial office for her National League for Democracy party.
Suu Kyi, 66, has devoted much of her life to a struggle against authoritarian rule, but spent 15 of the past 23 years under house arrest and has never held elected office. If she wins, she is likely to have limited power in the legislature, which remains dominated by the military and the ruling party, but victory would be highly symbolic and give her a voice in government for the first time.
The one-day trip to Dawei follows a series of unprecedented reforms enacted by the nominally civilian government that took over when a military junta ceded power last year. The government has released hundreds of political prisoners, reached cease-fire deals with ethnic rebels, increased media freedoms and eased censorship laws.
The April 1 by-election is being held to fill 48 seats in the lower house of parliament that were vacated after lawmakers were appointed to the Cabinet and other posts.
Suu Kyi's party boycotted the last vote in 2010, but registered earlier this month for the by-election after authorities amended electoral laws, enabling her party to legally participate.
The Election Commission must still accept Suu Kyi's candidacy. A ruling is expected in February.
Suu Kyi is hoping to run as a representative of the constituency of Kawhmu, a poor district just south of Yangon where villagers' livelihoods were devastated by Cyclone Nargis in 2008.
The vote is being closely watched because it is seen as a crucial test of the government's commitment to change.
Suu Kyi, who won the Nobel Peace Prize in 1991 for her nonviolent struggle for democracy, has rarely traveled outside Yangon, the country's main city, over the last two decades.
Although she conducted one successful day of rallies in two small towns north of Yangon last August, a previous political tour to greet supporters in 2003 sparked a bloody ambush of her convoy that saw her forcibly confined at her lakeside home.
Suu Kyi was finally released from house arrest in late 2010, just days after the country's military rulers held elections widely viewed as neither free nor fair.
In Dawei, a coastal district south of Yangon, Suu Kyi was garnering support for another candidate running for a parliament seat, party spokesman Nyan Win said.
She will make similar campaign trips to other areas, including the country's second-largest city, Mandalay, in early February before campaigning for her own seat, Nyan Win said.
Dawei is home to activists who recently helped persuade the government to ditch construction of a 4,000-megawatt coal-fired power plant over environmental concerns.
A 400-megawatt coal plant is still planned, however, because it will be needed to power a massive industrial complex project that includes construction of a deep sea port, a steel mill and a petrochemical plant. The project also includes railroads and highways that will connect Myanmar's coast directly to Thailand and the rest of Southeast Asia.
Banners with Suu Kyi's pictures decorated the area.
"People had been afraid to discuss politics for so long," said Aung Zaw Hein, an environmental activist whose Dawei Development Association helped stop the huge power plant. "Now that she's visiting the political spirit of people has been awakened."
January 27, 2012 6:30 AMText Size: A . A . A One basic thing can make the difference between a room looking cluttered or put-together: storage. Of course, getting rid of excess stuff also helps. But even after you've pared down your possessions, having an attractive place to stash essential items is key. Enter the two-door cabinet, a minimalist solution that's been around for centuries. Our take on the classic fits just about anywhere, and its panels can be made from a variety of materials?metal mesh, glass, or wallpapered plywood, for example?to suit your decorative palette. Like many PM projects, this one is simple; a reasonably skilled woodworker with a small table saw, cordless drill, and pocket-screw kit could build it over the course of two weekends, max. Here's how.
President Barack Obama speaks at the University of Michigan's Al Glick Field House, Friday, Jan. 27, 2012, in Ann Arbor, Mich. (AP Photo/Haraz N. Ghanbari)
President Barack Obama speaks at the University of Michigan's Al Glick Field House, Friday, Jan. 27, 2012, in Ann Arbor, Mich. (AP Photo/Haraz N. Ghanbari)
President Barack Obama greets supporters after his speech at the University of Michigan in Ann Arbor, Mich., Friday, Jan. 27, 2012. (AP Photo/Carlos Osorio)
President Barack Obama speaks at the University of Michigan's Al Glick Field House, Friday, Jan. 27, 2012, in Ann Arbor, Mich. (AP Photo/Carlos Osorio)
President Barack Obama speaks at the University of Michigan's Al Glick Field House, Friday, Jan. 27, 2012, in Ann Arbor, Mich. (AP Photo/Haraz N. Ghanbari)
President Barack Obama speaks at the University of Michigan's Al Glick Field House, Friday, Jan. 27, 2012, in Ann Arbor, Mich. (AP Photo/Carlos Osorio)
ANN ARBOR, Mich. (AP) ? President Barack Obama fired a warning at the nation's colleges and universities on Friday, threatening to strip their federal aid if they "jack up tuition" every year and to give the money instead to schools showing restraint and value.
Obama can't proceed, though, without the OK from Congress, where the reaction of Republican lawmakers ranged from muted to skeptical. Higher education leaders worried about the details and the threat of government overreach, and one dismissed it as mere election-year "political theater."
Average tuition and fees at public colleges rose 8.3 percent this year and, with room and board, now exceed $17,000 a year, according to the College Board.
Obama delivered his proposal with campaign flair, mounting a mainstream appeal to young voters and struggling families. He said higher education has become an imperative for success in America, but the cost has grown unrealistic for too many families, and the debt burden unbearable.
"We are putting colleges on notice," Obama told an arena packed with cheering students at the University of Michigan.
"You can't assume that you'll just jack up tuition every single year. If you can't stop tuition from going up, then the funding you get from taxpayers each year will go down."
Obama is targeting only a small part of the financial aid picture ? the $3 billion known as campus-based aid that flows through college administrators to students. He is proposing to increase that amount to $10 billion and change how it is distributed to reward schools that hold down costs and ensure that more poor students complete their education.
The bulk of the more than $140 billion in federal grants and loans goes directly to students and would not be affected.
Rising tuition costs have been attributed to a variety of factors, among them a decline in state dollars and competition for the best facilities and professors. Washington's leverage to take on the rising cost of college is limited because American higher education is decentralized, with most student aid following the student. And that's not counting the legislative gridlock.
"If you were a betting person, you would not bet on it getting done, simply because the political atmosphere in Washington is so poisonous," said Terry Hartle, senior vice president at the American Council on Education, an organization that represents colleges in Washington.
Rep. John Kline, R-Minn., chairman of the House Education and Workforce Committee, said Obama put forward "interesting ideas that deserve a careful review." But Rep. Virginia Foxx, R-N.C., who leads a House panel with jurisdiction over higher education, said Obama's plan should have tackled federal regulations that she said contribute to the problem.
The top Democrat on the House education committee, Rep. George Miller, D-Calif., said Congress has bipartisan concern about the rising costs of college and thinks the president's plan will open up a conversation about the problem. Some Republicans in the past, including Rep. Buck McKeon of California, have offered proposals similar to the president's.
Others were sharper in their critique.
Sen. Lamar Alexander, R-Tenn., a former education secretary, questioned whether Obama can enforce any plan that shifts federal aid away from colleges and universities without hurting the students it is meant to help. "The federal government has no business doing this," he said.
Enacted or not, Obama's plan may have the kind of popular appeal he can use in the campaign.
In Ann Arbor, he soaked up the cheers of students as he outlined the agenda from his State of the Union speech, and gave a shout out to the popular quarterback of the school's football team. And Obama used the college-aid matter to put the onus for action on Republicans, again painting them as obstructionists and himself as the fighter for the middle class.
Mary Sue Coleman, president of University of Michigan, said schools should be challenged to find ways to restrain costs, but they can't continue to make up for state cuts. Money for state universities in Michigan dropped by 15 percent in this year's state budget, and many ? including the University of Michigan ? raised tuition to help make up for the lost support.
Obama challenged states to be more responsible, too.
"He recognizes every part of it," Coleman said. "That's what was so powerful about the speech."
Kevin Carey, policy director at the independent Education Sector think tank, said higher education leaders will surely detest Obama's plan even if they do not say so directly.
"Instead, they'll work behind the scenes to kill it," Carey predicted.
University of Washington President Mike Young said Obama showed he did not understand how the budgets of public universities work. Young said the total cost to educate college students in Washington state, which is paid for by both tuition and state government dollars, has actually gone down because of efficiencies on campus. While universities are tightening costs, the state is cutting their subsidies and authorizing tuition increases to make up for the loss.
"They really should know better," Young said. "This really is political theater of the worst sort."
Obama also wants to create a "Race to the Top" competition in higher education similar to the one his administration used on lower grades. He wants to encourage states to make better use of higher education dollars in exchange for $1 billion in prize money. A second competition called "First in the World" would encourage innovation to boost productivity on campuses.
Obama is also pushing for the creation of more tools to help students determine which colleges and universities have the best value.
Michigan was Obama's last stop on a five-day trip to sell his State of the Union agenda in politically important states.
The White House has begun facing criticism from Republicans and daily questions from reporters about the blurring of Obama's governing and campaign-style events. Presidential spokesman Jay Carney said Obama went before Michigan students to promote a policy idea.
Said Carney: "We're not going to tell people not to applaud."
___
Associated Press writers Ben Feller and Julie Pace in Washington, David Runk in Ann Arbor, Mich., and Donna Gordon Blankinship in Seattle contributed to this story. Hefling contributed from Washington.
ALEXANDRIA, Va. ? An ex-Marine from Virginia pleaded guilty Thursday and has agreed to serve a 25-year prison sentence on charges that he fired a series of overnight pot shots in 2010 at the Pentagon, the Marine Corps museum in Quantico and other military targets as part of what prosecutors called a campaign to strike fear throughout the region.
Prosecutors also revealed Thursday new details about Yonathan Melaku's intended next target: Arlington National Cemetery, where he was arrested before he was able to carry out a plan to deface gravestones there.
As part of Thursday's plea deal, Melaku, 24, of Alexandria, pleaded guilty to destruction of U.S. property, use of a firearm in an act of violence and intention to injure a veterans' memorial, namely the cemetery. Prosecutors and Melaku's lawyer agreed to a 25-year sentence as part of the deal, and U.S. District Judge Gerald Bruce Lee said he would agree to the sentence as well.
Formal sentencing was delayed until April so a pre-sentence report can be prepared and Melaku's lawyer can request a mental-health evaluation for his client.
Prosecutors also released a video, made by Melaku, that was part of the evidence in the case, in which Melaku is seen firing shots at the National Museum of the Marine Corps as he drives by from I-95, where the museum is easily visible. In the video, Melaku shouts "God is Great!" in Arabic and talks about targeting the museum and "turning it off permanently."
The overnight shootings in October and November of 2010 twice targeted the Marine Corps museum and once each targeted the Pentagon and military recruiting stations in Woodbridge and Chantilly.
The shootings raised a high level of concerns, prompting authorities to suspect they were related and conducted by an individual with a grievance against the military in general or the Marines specifically.
But the shootings went unsolved until this summer, when Melaku ? a naturalized U.S. citizen from Ethiopia ? was spotted by police on Fort Myer and ran off, leaving a backpack behind. He was later caught and arrested at Arlington National Cemetery. The incident prompted a massive security scare in and around the Pentagon.
In the backpack police found spent shell casings; five pounds of ammonium nitrate, a common material in homemade explosives; two cans of spray paint; and a notebook in Arabic that contained references to Osama bin Laden, the Taliban and the "path to jihad."
Melaku eventually admitted to authorities that he planned to desecrate grave markers in the cemetery by spraying Arabic graffiti on them, and to deliberately leave the ammonium nitrate behind.
Nobody was hurt in any of the incidents, but Melaku has been ordered to make $111,000 in restitution for the damage he caused to the buildings, including the Pentagon.
Though no one was hurt, FBI spokeswoman Jacqueline Maguire called the case serious, and credited investigators for arresting Melaku before he did worse. She noted that a search of Melaku's home produced evidence that Melaku was looking to build a homemade timer.
The defense lawyer, Gregory English, said he has no doubt that his client is legally sane, but said a proper mental-health diagnosis may help his client become a better person while he serves his sentence.
English, himself a former Marine, said after the hearing that his personal experience suggests it's possible that some sort of post-traumatic stress or dispute with the Marines may have triggered Melaku's actions rather than any desire to support al-Qaida or the Taliban.
"The facts of the case and what his parents are saying to me about the young man suggests these actions are totally out of character," English said.
Dana Boente, the top assistant U.S. attorney for the Eastern District of Virginia, which prosecuted the case, said authorities have no evidence that Melaku suffers from any serious mental-health disorders or that his years in the Marine reserves provided a motive for the crime. He said Melaku never served overseas.
Boente called the crimes "a campaign of calculated and sustained attacks against military installations and memorials in northern Virginia."
Melaku did not speak during the hearing, except to answer a series of questions from the judge with a soft-spoken, "Yes, sir" and a final "guilty, sir" to formally enter his plea.
In the last years of Martin Privot?s life, his family had to start selling his assets to pay for his nursing home costs. ?He needed 24-hour care and couldn?t be left alone,? recalls his daughter Toni Footer. ?My biggest fear was we would run [through his money] and wouldn?t be able to provide the care that he needed.?
Privot died in 2008, from post-surgical complications and other ailments, before all his assets were depleted. Yet Footer, 61, says her dad?s experience ?reinforced my already strong feelings that long-term-care (insurance) is a necessity.? The Rockville, Md., resident says she pays about $2,500 every year for such coverage for herself. ?It?s expensive ? in fact, it?s gone up twice ? but it?s worth every penny. It provides a peace of mind that my family won?t have to struggle to find money to pay for my care.?
Mary McClelland came to the opposite conclusion after seeing how her mother?s expenses were often deemed exempt from coverage.
Her mother, Ruth Mezick, purchased long-term-care, or LTC, insurance in 1990 at age 78 when she was in fairly good health, paying an annual premium of $2,827 until she died 11 years later. In her mid-80s, her health began to deteriorate and she spent time in a nursing home, at home with help and in assisted living. But her policy ? which promised to pay $100 a day ? failed to cover much of those expenses because it kicked in only after she had been in one institution more than 100 days.
?She was never in one place long enough to qualify. She ended up getting about 10 days? coverage, worth about $1,000,? says McClelland, who lives in Arlington, Va. ?That was a lesson to me; I decided it doesn?t always pay off.?
The question of whether to get LTC insurance bedevils consumers and their advisers. Unlike medical insurance, it is intended primarily to cover people who need assistance with so-called activities of daily living ? for example, the care of a dementia patient or someone recovering from a broken hip. It can be expensive: Premiums range from $1,000 to $5,000 a year, depending on the age, sex and health of the purchaser as well as the extent of the coverage. And policy details can be confusing.
Even advocates acknowledge that it isn?t for everyone. Jesse Slome, executive director of the American Association for Long-Term Care Insurance, an industry group, sums it up well: ?Long-term care is a universal issue facing all Americans who are getting older. But long-term-care insurance is not a universal solution.?
So how great is the need for such coverage? It depends on how you look at the data. ?One in two Americans are likely to need long-term-care services sometime in their lives,? says Amy Pahl, a consulting actuary for Milliman Inc, a leading actuarial and consulting company. However, Pahl adds, of those who might need long-term care, about a third will not meet the most common deductible period of 90 days because they will either die or recover before then.
To determine if a long-term-care policy makes sense for you, it is important to understand how the coverage works and what?s available.
Medicare is not the answer
Most standard health insurance plans do not cover long-term care. Nor does Medicare or insurance policies that supplement Medicare.
Medicaid, however, is the largest source of coverage for long-term care. The program pays for more than two-thirds of nursing home residents, according to data from the Kaiser Family Foundation.
But Medicaid comes with significant limitations. The choice of facilities that accept Medicaid is narrow, and the program is restricted to people with extremely limited income and virtually no resources, which forces middle-income consumers to spend down their assets if they want to qualify.
?Medicaid is supposed to be a safety net, but unfortunately it rests just about a half-inch off the floor,? says Tom West, a Northern Virginia financial adviser and long-term-care expert.
Yet Kansas Insurance Commissioner Sandy Praeger cautions that LTC policies may not be a good investment for some people. ?It?s mostly a policy to protect your assets (so you don?t have to sell everything to pay for care) in case you get sick. If you don?t have assets to protect, then you shouldn?t be buying it.? Unfortunately, that can leave those consumers with limited flexibility if they do need long-term care.
How the coverage works
Typically, a policy pays a fixed daily benefit ($150 is common) for a certain period of time (often three to five years) starting at a specified time (90 days is common) after the beneficiary becomes disabled. The policy covers nursing home expenses, assisted living charges or less costly in-home-care bills.
Many policies also allow the initial fixed daily benefit to rise 3 or 5 percent annually to keep up with health-care costs. The policyholder agrees to a premium that can increase only if the change is approved by state regulators. Such increases have occurred frequently in recent years and, as a result, once-flat premiums have risen sharply. So have nursing home costs, which averaged about $214 a day ? or more than $78,000 annually ? for a semi-private room last year, according to a national survey by the insurer MetLife.
As people?s needs have changed, LTC policies have expanded to cover assisted living and home care; some new policies are flexible enough to anticipate technologies that don?t yet exist, such as robotic care.
?The policies have become very innovative,? says Slome. ?Today you can go in and design coverage for particular needs and desires; you can even buy long-term-care insurance to enable you to get your care on a cruise line if you want it ? and can afford it.?
Today?s policies can also allow couples to share benefits, so a husband and wife can each buy a shorter-term policy, for example three years of benefits. About 70 percent of coverage today is sold to couples, Slome said. If it turns out that the husband needs more than three years? coverage, he can tap into his wife?s benefit pool. And in some policies, if the husband completely exhausts the couple?s coverage, the wife may still receive some nominal benefits if she needs care, too.
At the end of 2010, about 7 million Americans had LTC insurance, according to LIMRA, an association of life insurance and financial service companies. About 422,000 new policies were written in 2010.
The 2010 health-care law has a provision creating a voluntary program of LTC insurance. However, in October, the Obama administration announced it would not implement the provision because it was financially unsustainable.
According to Slome, the average age of the buyer is 57, with three-quarters of the policies written when purchasers are between 45 and 64.
When buying insurance, the younger the consumer, the lower the annual premiums. Today, according to Slome?s association, a 55-year-old couple in generally good health can expect to pay $2,675 a year for $338,000 of benefits; that figure would grow to $800,000 by the time they reach 80 if the policy contained a 3 percent annual compounded escalation clause. If they are 65, however, that same policy would cost $4,660 a year and grow to only $527,000 in coverage when they are 80.
Steep rate increases
One of the key concerns among consumers is the rise of premiums.
?It?s probably the most frequent complaint I hear,? says Praeger, who heads the National Association of Insurance Commissioners? health and managed care committee. ?The problem is, the older policies weren?t priced right to begin with. Companies expected about 8 percent of customers to stop paying their premiums, when, in fact the lapse rate is closer to 2 percent.? That meant the insurers had to cover more beneficiaries than they expected at a time when the economic downturn has meant less return on their investments.
Praeger acknowledges that rate increase requests have posed a dilemma for insurance commissioners. ?If we don?t give them the rate increase they need, the insurance carriers could become financially impaired, and that doesn?t help people,? she says. In fact, in recent years, a number of companies have stopped selling policies. As a result, she adds, it?s hard to turn the increases down.
The policies can be very complicated, and Praeger advises consumers to consult with their accountant, attorney or other trusted financial adviser before purchasing a policy.
This article was produced in collaboration with Kaiser Health News. KHN is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente.
DEDHAM, Mass. ? An Alabama professor accused of killing three colleagues will ask a judge on Wednesday to keep a report into the 1986 killing of her brother secret.
The highest court in Massachusetts ruled last month that a judge's inquest report into the death of Amy Bishop's brother Seth can be released publicly.
But the court also said Amy Bishop's lawyer, prosecutors and others could go to court to argue that there is "good cause" why it should remain sealed. A hearing is scheduled Wednesday in Norfolk Superior Court on a request by Bishop's lawyer to keep the report sealed from public view.
Bishop, a former biology professor at the University of Alabama in Huntsville, was charged with opening fire on colleagues in 2010, killing three and wounding three others.
After the shootings, a Massachusetts judge conducted a closed-door inquest into the death of 18-year-old Seth Bishop. The shooting at the family's Braintree home had been ruled an accident after Amy Bishop told police she had accidentally shot her brother while trying to unload her father's shotgun.
But after the inquest, a grand jury indicted Bishop on murder charges in her brother's death.
Bishop's lawyer, Larry Tipton, has argued that releasing the inquest report and transcript could prejudice juries against her in both Massachusetts and in Alabama, where she faces a possible death sentence.
"That increment could make the difference that tips the balance toward death," Tipton argued in documents filed with the Supreme Judicial Court.
The Boston Globe challenged a judge's decision to keep the inquest records sealed, saying that release of the documents could shed some light on what led to authorities' decision not to prosecute Bishop in her brother's death decades ago.
In its decision last month, the Supreme Judicial Court sided with the Globe and outlined new rules for the release of inquest materials. The high court said the automatic impoundment of the records ends after the subject of the inquest is indicted by a grand jury or after prosecutors decide not to present the case to a grand jury.
Friday the 13th ended up being a very lucky day for a California man who videoed several UFOs flying near Los Angeles. The video, allegedly shot by a freelance photographer going by the name Nerdumb, shows several bright lights in the sky over Hermosa Beach that disappear as a helicopter crosses below them. It was posted to YouTube and is making the rounds in UFO circles.
Many people noted that the lights look very much like planes taking off from Los Angeles International Airport, a few miles north of Hermosa Beach. Could they simply be aircraft? Probably not, because the lights seem to be stationary, and there's no reason commercial airplanes would suddenly switch off their lights in that pattern.
Tracey Parece, a writer for Examiner.com, wrote, "The video shows six bright lights suspended across the sky at sunset in an almost perfect straight line. The unidentified flying objects were so bright that they are very easy to spot in the video. ... A close-up of one of the objects shows a UFO that emanated red rays of light from its body." Parece concluded that Nerdumb's video "looks very convincing."
While some seem convinced the video may represent the best evidence of UFOs in 2012, others smell a hoax. For someone who claims to be a professional photographer the videos are very poorly shot and composed. Nerdumb holds the camera unsteadily, and amateurishly zooms in and out. The camera movements are very suspicious, especially the way he pans left to right as the UFO lights go out one by one, also from left to right. Instead of holding the frame steady to see if the lights reappear, he just keeps panning right for no particular reason ? almost like he knows exactly what's going to happen.
Another red flag is that the anonymous photographer is a "repeater" ? someone who has made multiple UFO reports. In fact, his YouTube channel has several other similar videos featuring a series of approximately equidistant lights in the sky that appear and flicker out in more or less the same sequence as the newest video. The credibility of witnesses is suspect when they claim to see Bigfoot or UFOs over and over again, while most people never see them at all.
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This brings us to another curiosity: Why is Nerdumb apparently the only person seeing and videotaping these mysterious lights in the sky? For such a high-profile event in such a populated area, it's suspicious that there seem to be no reports or videos taken by anyone else of these UFOs. How does Nerdumb know where in the sky to look, and when to see the extraterrestrial craft? He claims it's not luck ? the aliens communicate with him in his dreams, telling him where to go. If his videos are real, Nerdumb would gain a lot of credibility by publicizing his alien meet-up information so that the public and other UFO researchers could be at the right place and time to see and record it for themselves.
Derek Serra, a Hollywood visual effects artist who analyzed previous UFO videos (including the infamous "Jerusalem UFO" hoax last year), told Life's Little Mysteries that the video was probably faked. "The video looks similar to a photograph, with the lights and helicopter added later as separate elements," Serra said. "The camera controls and hand-held feel would be added later to make it appear as recorded video. The software to do this is readily available, and it doesn't take an expert. The video has many qualities typical of amateur visual effects artists ... it lacks finesse. That finesse may not be obvious to the average viewer, but sticks out like a sore thumb to experienced artists."
Short of a confession from Nerdumb, it's impossible to know for certain whether this video is a hoax, but red flags abound. Maybe it's an ingenious double-deception, and aliens really are here but cleverly disguising their spacecraft to look exactly like faked video images.
7 Things That Create Convincing UFO Sightings
Russian Scientist's Claim of Life on Venus Debunked
Will We Really Find Alien Life in 20 Years?
Follow Life's Little Mysteries on Twitter @llmysteries, then join us on Facebook.
Benjamin Radford is deputy editor of Skeptical Inquirer science magazine and author of Scientific Paranormal Investigation: How to Solve Unexplained Mysteries. His Web site is www.BenjaminRadford.com.
? 2012 LifesLittleMysteries.com. All rights reserved. More from LifesLittleMysteries.com.
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