New Business Marketing is launching for the first time, its flagship free newsletter ?Business Marketing Edge? for business owners. As a result, they are also given away 2000 copies of their highly acclaimed lead generation training video course ?40 Ways To Get Leads?.
Individuals starting to market online and advance marketers and marketing department representatives are facing the same challenge ? information overload and the difficulty in being able to differentiate between what works and what doesn?t.
The main objective of ?Business Marketing Edge? newsletter is to provide small business owners and marketers with the knowledge and solutions to enable them run their business more successfully.
The weekly newsletter features motivational quotes, productivity tips, business building techniques including internet and offline marketing strategies for business owners. With every issue subscribers will also get access to free weekly downloadable reports, audio or video program.
One of the most popular sections of Business Marketing Edge newsletter is the ?Tools To Help Build Your Business Fast!? section. This section list very useful marketing and business building software and other resources online for growing businesses.
A satisfied subscriber, Kenvil Williams, the Director of salads-recipes.org, shares his story: ?The motivation, strategies and resources we receive weekly through Business Marketing Edge are having great impact on our bottom-line. I will recommend everyone who wishes to build their business fast to subscribe to the newsletter?
According to Jeffrey Benson, Managing Director of New Business Marketing ? ?With so much junks small business owners and marketers are being bombarded with every day, it?s hard to tell what really works from what doesn?t. The purpose of Business Marketing Edge newsletter is to first determine what works and then only deliver that to our readers. We believe this will save people time, money and frustrations. Every week subscribers will receive in their inbox, profitable marketing strategies, tips, tools and useful resources to help them build their business fast?
Early subscribers of the newsletter will get a copy of their highly rated lead generation training video course ?40 Ways To Get Leads? normally valued at $97 per piece. It?s only available to the first 2000 subscribers and the course reveals 40 low or no cost profitable lead generation strategies people can easily implement in their business to start generating more leads.
About Company:
New Business Marketing provides internet business marketing services to local businesses. Their main goal is to deliver unrivalled quality internet marketing services to local business owners and marketers that will help them increase their profit fast.
If you are looking to quickly boost your business profits go to: http://nbmuk.com/newsletter/signup.html to join the newsletter and your 7 part video course for free.
Contact Info:
New Business Marketing Jeffrey Benson 3 The Quadrant Coventry West Midlands CV1 2DY United Kingdom Tel: +44 844 588 6113 Website: http://nbmuk.com
I wrote earlier this week about two new animal emergency rooms in west Bradenton. Veterinary Emergency Center and Bradenton Veterinary Emergency join Animal ER of University Park in offering emergency care for pet families.
If you've ever had a pet suffer a sudden illness or injury and had to rely on your vet's after-hours answering service, you realize how vital these services are to the community.
Five years ago this past Wednesday, my hound Jethro got bloat. He had been sick for three weeks and wasn't eating, and I had resorted to hand-feeding him ground chicken and rice mixed with baby food to get some nutrition in him while his doctor ran tests to find out what was wrong.
About a half-hour after he ate his scant half-cup of food that night, he was in distress. I knew what it was, but was astounded because he had not overeaten or drank too much water, and he was hardly doing acrobatics in the yard that would have caused his stomach to "flip."
I called my vet's office, and Dr. Jim Beamer (bless him) called me right back. He told me to get Jethro to the Animal ER as soon as possible because it was staffed and equipped to handle this life-threatening condition.
Somehow, I managed to get my old hound in the car and make the trip to Interstate 75 and University Parkway. And yes, I broke the speed limit to get there, but not enough to get us both killed in an accident.
Along the way, I called the Animal ER. I had their number in my cell phone, even though I had never needed to call them ... until then. I told them Dr. Beamer was sending us and advised them of Jethro's condition.
I felt almost like an EMT calling in from the field: "I have a hound, almost 15 years old. He's about 38 pounds, and he has bloat. We're about 20 minutes out."
They were ready for us when we got there and whisked Jethro back to the treatment area. The prognosis was grim, as I knew it would be. He would need surgery, and he probably would not survive it at his age.
I left the ER that night with his collar, tags and leash; tangible reminders of a well-loved dog. I left with memories of a handsome, loyal, sweet,
stubborn hound. I left with trepidation, wondering how Reba was going to handle not having her big brother around after 10 1/2 years.
But I also left with much more than those things.
I left knowing that I had done the best I could for him. I left knowing that he had gotten the best care available at that particular time.
I left with a feeling of gratitude to the folks at Animal ER, especially Dr. McGuinness, for being there when we needed them and for treating us with such compassion and respect.
The ride home was somber (and slower). The 30-minute drive there had been hectic, and the drive home seemed to be in slow motion.
It won't be that way from now on. If I ever need an animal ER again, Veterinary Emergency Center on Cortez Road is three minutes from my house (four if I have to stop at the light by the Shell station).
We are lucky, indeed, to have not one, but two new animal ERs in Manatee County. Is this community big enough to support three animal ERs? I believe it is.
Animal ER serves the communities of east Manatee and is a stone's throw from I-75.
Veterinary Emergency Center on Cortez Road is there for pet families in south county, Cortez and south Anna Maria Island.
Bradenton Veterinary Emergency is closer for folks in Palmetto, northwest Bradenton and north Anna Maria Island.
So far, both the new ER directors advise it has been going well. They've been open only four weeks and three months, respectively, and have yet to survive a season without snowbirds.
But in listening to them, I could hear the passion in their voices for helping people and their pets.
Dr. Ilonka Ambros at Veterinary Emergency Center has worked in animal ERs before and designed her clinic for one purpose only: emergency care. She has invested in state-of-the-art equipment and has designed VEC to be welcoming and comfortable for her clients and their pets.
We sat and talked in the "comfort room," a space designed for those times when your pet won't ever be going home with you. It has low lighting and a comfortable couch, an ideal place to sit and hold him while skilled hands help him on his way to the Rainbow Bridge.
Dr. Ashley Kanzler was full of energy and optimism when we spoke on the phone. Her clinic, Bradenton Veterinary Emergency, works in partnership with Sarasota Veterinary Clinic, which serves south Sarasota County from its position on South Tamiami Trail.
She decided to start small by renting space at De Soto Animal Clinic, but is confident enough in BVE's success that she's ordered a new sign for Manatee Avenue so folks can find her clinic more easily.
You might be wondering: Aren't these two clinics in competition with each other?
The answer would be, "Technically, yes." But both directors expressed that their first priority is people's pets and they are not above referring people to the closest ER. If either one of them got a call from Lakewood Ranch, I would bet Reba and Ella's bag of kibble that they would not hesitate for a second to send that caller to the Animal ER.
And you might be wondering: Isn't an animal ER expensive?
And the answer to that would be, "Technically, yes." But when you consider you are paying for the doctor's expertise, for state-of-the-art equipment, and for peace of mind knowing you are doing the absolute best you can do for your pet when they need you the most, my answer would be, "Technically, no. It's worth every nickel."
Here's wishing both Dr. Ambros and Dr. Kanzler much success in their endeavors. Manatee County needs you both, and I for one am really grateful you are here.
Not only can these have as many calories as a meal, (sometimes upwards of 400) their carb count can be on par with a pre-marathon pasta binge; some have 60-80g of carbs per serving. Add in sugars, saturated fats in whipped cream and chocolate flavorings, and you've got dessert in a very large plastic cup. More from Shape.com: 10 Must-Follow Food Boards on Pinterest 13 Foods Fit People Love Quick and Easy Chia Seed Recipes Flickr photo by CarbonNYC
Plus-size fliers have a slim new tool to help them get from here to there.
A downloadable, four-page brochure titled ?Travel Tips for People of Size??offers tips for packing, booking flights, choosing seats, traveling to and through airports and getting on and off airplanes. A description of each airline's passengers-of-size policy is included, along with recommendations for ways that travel agents can help a passenger of size have a comfortable flying experience.
?Airline travel, in particular, is such a hot topic for fat people,? said Peggy Howell, spokeswoman for the National Association to Advance Fat Acceptance (NAAFA). ?Some have mobility issues and the trip from the curb to the gate is daunting. Some people are concerned that they may not be able to move quickly enough to make connecting flights. And we often get questions about which airlines have policies regarding?the purchase of?two seats.?
Howell said the brochure, which was created with input from the Association for Airline Passenger Rights (AAPR), will help passengers of size make informed travel decisions and avoid some uncomfortable situations, such as being publicly humiliated by being called out of line to buy a second seat.
?The reality is that purchasing a second coach seat, sharing a third seat with a fellow traveler of size, or considering an upgrade to business or first class may be the most appropriate choice,? said Tony Harrell, owner of Abundant Travel, based in Alexandria, Va.
The brochure recommends that passengers of size book a second seat when flying Southwest, American and Jet Blue. United may require passengers of size to purchase a second seat if they are unable to fit in a single seat with both armrests down. The brochure also suggests that travelers check their airline's policy at the time of flying.
?Air travel these days is not a pleasant experience, but as passengers we?re all in this together,? said AAPR executive director Brandon?Macsata. ?So if traveling can be easier and more pleasant for people of size, it will be more pleasant for people of all sizes.?
In addition to urging travelers to choose airlines that are ?people-of-size friendly,? the brochure also offers these tips:
A window seat will give you a little more shoulder room but hip room remains the same. The average seat is (approximately) 18 inches wide.
While you can discreetly ask your flight attendant for a seat belt extender as you board, you may find it more convenient to carry your own. (A list of sites that sell seatbelt extenders is included.) ?
Smile and say hello to your seat mates. It is harder to be annoyed with someone if they are being nice.
Washroom size may?be an issue. Try to plan accordingly
?I?m going to print out the brochure and take it with me when I travel,? said Carole Cullum, a Minnesota resident who usually purchases a second airline seat.
?Society thinks people of size want special accommodations on airplanes, without respect for others,? said Janie Oyakawa, a 34-year-old person of size from McKinney, Texas. ?But we just want to know exactly what the deal is, and this brochure removes a lot of the guesswork.
?My hips might be wider,? she said, ?but my money is just as green as the next person's and I want to travel and see the world.??
Find more by Harriet Baskas on StuckatTheAirport.com and follow her on Twitter.?
This story is just sad! Amandla Stenberg, the actress who plays Rue in the Hunger Games is now getting attacked on twitter with some racist crap from haters that have no life. They also posted hateful comments about Lenny Kravitz and Dayo Okeniyi questioning filmmakers’ casting choices. In the book District 11 is largely a black-majority district, so why wouldn?t Rue and Thresh be black? And in any case, who cares? Why is it so important. I loved Rue in the movies. She did a great job and questioning any of the cast never crossed my mind. I enjoyed every second o the movie! This kind of behavior is disgusting, and I just don?t understand it. It is shameful. There are much bigger issues in the world ? like I don?t know ? cancer, aids, war, hunger, even genetically modified foods for the love of gawd! Amandla Stenberg has tactfully responded to the comments saying, ?As a fan of the books, I feel fortunate to be part of The Hunger Games family. It was an amazing experience; I am proud of the film and my performance. I want to thank all of my fans and the entire [...]
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What You Must Do To Succeed In Home Based Network Marketing Opportunity
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Revealed: How to generate Endless Leads and instant cash for any MLM! free presentation?. Also published at Network Marketing From Home: Earning From MLM Home Based Business Opportunities.
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Roll that spliff phatly, pack some fresh ice into the binger, and set the Volcano to "toastify." It's time for tonight's Stoner Channel. We've collected our best high-times material for the discerning pothead so sit back, relax, and pass that shit on the left, yo. More »
By : Meghnath Kumar ?? Submitted 2012-03-25 05:56:25
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Author Resource: The company is famous for its wide range of services including custom interior, custom furniture, custom woodworking, custom cabinetry, kitchen and bath remodelling, house additions, home improvement , interior remodelling New York, apartment remodelling, apartment renovation , built in bookcases and other renovation services.
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SES (Paris:SESG)(LuxX:SESG) announced at the Samsung Africa Forum in Cape Town, South Africa, that it is collaborating with Samsung to drive digital broadcasting via satellite in sub-Saharan Africa. Samsung will introduce an LED television with an integrated free-to-air satellite receiver, the Samsung LED TV Free Satellite that will be distributed in Nigeria, Ghana, Cote D?Ivoire, Senegal, Democratic Republic of Congo and Cameroon in August 2012. Distribution in additional countries will follow.
The integrated satellite receiver will allow consumers to receive free-to-air television channels without the need for an additional set top box as the LED TV will be directly connected with the satellite dish. In preparation for the launch, SES and Samsung will jointly arrange training sessions with distribution partners and installers to ensure the proper connection of the TV device to the satellite dish. Both partners will also run a joint marketing campaign in June 2012.
As a leader in the free-to-air TV market, SES delivers more than 60 free-to-air channels in more than 40 African countries. The launch of the new Samsung LED TV Free Satellite coincides with more channels becoming available in Africa.
"This collaboration is the first of its kind and will drive digitalization in Africa," said Christoph Limmer, SES?s Senior Director of Marketing Development and Marketing in Africa. "Today, one out of three households in Africa has a TV set but less than 10 million homes receive content in digital format. Our cooperation will not only help to improve access to digital content for African consumers but it will also encourage African broadcasters to launch more content. In servicing more than 40 African countries, we are well aware of the huge demand for more and higher quality TV services. The opportunity lies in providing an increasingly sophisticated African viewership with a significantly increased number of TV channels ? a first for many African countries.?
?The Samsung LED TV Free Satellite is our contribution to the continent?s efforts to ?go digital?, providing African consumers with greater choice and broadcasters with the opportunity to grow the region?s media industry,? says Dae Hee Kim, Regional Product Manager at Samsung Africa.
SES is a world-leading satellite operator with a fleet of 50 geostationary satellites. The company provides satellite communications services to broadcasters, content and internet service providers, mobile and fixed network operators and business and governmental organisations worldwide.
SES stands for long-lasting business relationships, high-quality service and excellence in the broadcasting industry. The culturally diverse regional teams of SES are located around the globe and work closely with customers to meet their specific satellite bandwidth and service requirements.
SES (Paris:SESG)(LuxX:SESG) holds participations in Ciel in Canada and QuetzSat in Mexico, as well as a strategic participation in satellite infrastructure start-up O3b Networks. Further information under: www.ses.com.
Markus Payer SES Tel + 352 710 725 500 markus.payer@ses.com or Kirstin Steffen SES Tel + 352 710 725 329 kirstin.steffen@ses.com
When the MP3 revolution hit its stride, the coolest thing about it was how much control we were given over our music. Weightless files and tiny players let you carry your entire library around with you, all the time. Anything you wanted to listen to - so long as you had already hunted it down - was available instantaneously with a swipe of the finger. No longer would we be limited by what we could physically carry, or what a radio network chose to play. More »
Contact: Michael M. Webber webberm4@unlv.nevada.edu Pensoft Publishers
An elusive new scorpion species from California lives underground
Even in places as seemly well-studied as the national parks of North America, new species are still being discovered. Using ultraviolet light that cause scorpions to fluoresce a ghostly glow, researchers from the University of Nevada, Las Vegas (UNLV) have discovered an intriguing new scorpion in Death Valley National Park. They named the species Wernerius inyoensis, after the Inyo Mountains where it was found. The study was published in the open access journal ZooKeys.
This new species is small, only 16 mm in length. "We almost overlooked this one during the survey" said Matthew Graham, a PhD Candidate with the School of Life Sciences at UNLV. Matt discovered the scorpion along with his father who was volunteering that night. "Only a single male individual was found, but the physical uniqueness was enough to identify it as a new species", said Michael Webber, another PhD Candidate from UNLV who described the specimen. This new scorpion appears to be closely related to two other species found over 400 kilometers away at Joshua Tree National Park and along the lower Colorado River. This group of scorpions is most easily identified by the presence of a conspicuous spine at the base of the stinger, the function of which, if any, is unknown.
The previously known species are also rarely observed in the wild, and this elusive nature has led to speculation that these scorpions occur at very low densities or have only sporadic surface activity. However, the rocky terrain in which the previous species were found and the discovery of the new species at the base of a talus slope, hint at the possibility that these scorpions are subterrestrial, spending their lives deep in rock crevices or in the interstitial spaces among piles of loose rock.
Scorpions are quite common within arid regions where they can comprise a large component of biological diversity. The new species was discovered during field surveys funded by the National Park Service as part of efforts to develop better inventories for all organisms occurring within the parks.
"In North America, inventories for mammals, birds, reptiles and amphibians are pretty well developed, and we have a good handle on higher-order plants, but for many groups of smaller organisms taxonomic inventories will no doubt lead to numerous new discoveries" said Dr. Jef Jaeger, a Research Assistant Professor at UNLV who initiated and oversaw the scorpion surveys.
In the face of regional environmental changes brought about by human actions and the potential for larger changes that global warming may bring, many scientists and resource managers place new importance on efforts to document and catalog species diversity.
###
Original source:
Webber MM, Graham MR, Jaeger JR (2012) Wernerius inyoensis, an elusive new scorpion from the Inyo Mountains of California (Scorpiones, Vaejovidae). ZooKeys 177: 1-13. doi: 10.3897/zookeys.177.2562
Posted by Pensoft Publishers.
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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.
Contact: Michael M. Webber webberm4@unlv.nevada.edu Pensoft Publishers
An elusive new scorpion species from California lives underground
Even in places as seemly well-studied as the national parks of North America, new species are still being discovered. Using ultraviolet light that cause scorpions to fluoresce a ghostly glow, researchers from the University of Nevada, Las Vegas (UNLV) have discovered an intriguing new scorpion in Death Valley National Park. They named the species Wernerius inyoensis, after the Inyo Mountains where it was found. The study was published in the open access journal ZooKeys.
This new species is small, only 16 mm in length. "We almost overlooked this one during the survey" said Matthew Graham, a PhD Candidate with the School of Life Sciences at UNLV. Matt discovered the scorpion along with his father who was volunteering that night. "Only a single male individual was found, but the physical uniqueness was enough to identify it as a new species", said Michael Webber, another PhD Candidate from UNLV who described the specimen. This new scorpion appears to be closely related to two other species found over 400 kilometers away at Joshua Tree National Park and along the lower Colorado River. This group of scorpions is most easily identified by the presence of a conspicuous spine at the base of the stinger, the function of which, if any, is unknown.
The previously known species are also rarely observed in the wild, and this elusive nature has led to speculation that these scorpions occur at very low densities or have only sporadic surface activity. However, the rocky terrain in which the previous species were found and the discovery of the new species at the base of a talus slope, hint at the possibility that these scorpions are subterrestrial, spending their lives deep in rock crevices or in the interstitial spaces among piles of loose rock.
Scorpions are quite common within arid regions where they can comprise a large component of biological diversity. The new species was discovered during field surveys funded by the National Park Service as part of efforts to develop better inventories for all organisms occurring within the parks.
"In North America, inventories for mammals, birds, reptiles and amphibians are pretty well developed, and we have a good handle on higher-order plants, but for many groups of smaller organisms taxonomic inventories will no doubt lead to numerous new discoveries" said Dr. Jef Jaeger, a Research Assistant Professor at UNLV who initiated and oversaw the scorpion surveys.
In the face of regional environmental changes brought about by human actions and the potential for larger changes that global warming may bring, many scientists and resource managers place new importance on efforts to document and catalog species diversity.
###
Original source:
Webber MM, Graham MR, Jaeger JR (2012) Wernerius inyoensis, an elusive new scorpion from the Inyo Mountains of California (Scorpiones, Vaejovidae). ZooKeys 177: 1-13. doi: 10.3897/zookeys.177.2562
Posted by Pensoft Publishers.
[ | E-mail | Share ]
?
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.
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(Reuters) - Chancellor George Osborne cut personal income taxes but aimed new levies on the wealthy on Wednesday, taking a political gamble while pledging to stick to his government's tough austerity plan.
He also said that economy was improving, although growth is set to remain very modest this year.
In a move that will please his own Conservative party, he cut a 50 percent income tax band for the highest earners to 45 percent, from next year on. The Conservatives say that high a levy is a barrier to aspiration. The Labour opposition say it is a fair way to spread the pain.
In a nod to the Liberal Democrats, the junior coalition partner, Osborne raised the income tax threshold by more than previously announced to 9,205 pounds ($14,300), taking more poorly paid people out of the tax net.
Osborne also introduced a new 7 percent stamp duty rate on sales of property worth more than 2 million pounds. But he cut corporation tax 2 pence to 24 pence in April.
"We'll be gettng five times more money each and every year from the wealthiest in our society," he said, in a statement opponents are likely to challenge.
Mindful of the risk that heavily indebted Britain could lose its prized top-notch credit rating, Osborne said there was no room to soften the plan of unprecedented spending cuts and tax increases, aimed at reducing sky-high debts.
A shock jump in public sector borrowing to a new record in February, released ahead of the budget statement, provided a stark reminder that the chancellor of the exchequer had no money to provide the fragile economy with a significant boost.
"This budget reaffirms our unwavering commitment to deal with Britain's record debts," Osborne said in his budget speech to parliament.
Despite the ongoing risks from the euro zone debt crisis, Britain's economy was set to avoid a renewed recession and growth is expected to pick up in coming years, Osborne said.
The coalition government of Conservatives and Liberal Democrats also remained on track to meet its fiscal targets to erase the budget deficit - which topped 11 percent before it took office - within the next five years.
In November, the ongoing economic weakness had forced Osborne to add two more years of austerity after the 2015 election and pointing to a much slower recovery than they expected when they took power in 2010.
Ratings agencies have warned Britain that it could be downgraded, with apparently only Osborne's unwavering determination to cut the deficit keeping them onside for now.
AUSTERITY
Britain has been hit hard by the 2007-2009 financial crisis and had to spend tens of billions to bailout major banks.
The recovery from the steep slump has been very weak, with the economy still running well below its precrisis peak and the unemployment rate at its highest in 16 years.
Many Britons have experienced the worst squeeze on their living standards in at least a generation as price rises outpaced meagre wage growth and the government's tax increases and austerity measures are eating into households budgets.
But in recent weeks, the overall mood among businesses is slowly improving after taking a severe knock from the euro zone crisis at the end of last year.
The government's Office for Budget Responsibility forecast that growth should pick up from the 0.8 percent predicted for 2012 to 2.0 percent next year and 2.7 percent in 2014, leaving its November predictions largely unchanged.
The government's Office for Budget Responsibility forecast predicted that net borrowing would fall from 126 billion pounds in 2011/2012 to 21 billion in 2016/2017.
Overall Britain's public sector debt as share of gross domestic product (GDP) will peak at 76.3 percent in 2014/15 before falling, fulfilling the second part of the fiscal target.
Any hopes for stimulus still rest squarely with the central bank and Wednesday's minutes suggested those chances of more money printing are receding.
Minutes from the Bank of England's latest meeting, also released on Wednesday, showed rising concerns about oil prices and future wage inflation, in a sign that the central bankers may be reluctant to extend quantitative easing beyond the current target of 325 billion pounds.
(Additional reporting by Fiona Shaikh, David Milliken, Olesya Dmitracova, and UK bureau; Editing by Mike Peacock/Jeremy Gaunt)
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No evidence that higher regional health care costs indicate inappropriate care, study shows Public release date: 20-Mar-2012 [ | E-mail | Share ]
Contact: Steve Tokar steve.tokar@ncire.org 415-221-4810 x5202 University of California - San Francisco
There is no solid evidence to support the widely held belief that regions of the United States that spend more on health care and have higher rates of health care use deliver more unnecessary care to patients, or that low-cost areas deliver higher quality and more efficient care, according to a study led by Salomeh Keyhani, MD, a physician at the San Francisco VA Medical Center and an assistant professor of medicine at the University of California, San Francisco.
The study authors called for national health care policies designed to discourage inappropriate care, regardless of region.
"Geographic variations in health care have captured the attention of researchers for the past 30 years, especially during the recent health care reform debate," said Keyhani. "The assumption is that areas that spend more are delivering more inappropriate care in the form of unnecessary tests and procedures." In turn, she said, "this has led policy makers to hold up low-cost areas as models of high-quality health care, and to propose policies that cap spending."
That assumption is unwarranted, according to Keyhani and her co-authors. "The literature is so limited that you cannot either support or refute such an assertion. There is just not enough data," said Keyhani.
In their study, the scientists reviewed 114,830 peer-reviewed articles, published between January 1, 1978 and January 1, 2009. They found only five that analyzed detailed clinical data in relation to geographic region, and concluded that the results of those papers "did not lend support" to the idea that higher cost regions deliver more inappropriate care. Their literature review was published in the March issue of the journal Medical Care.
"Do we have any evidence to say that the differences in cost of care in different localities are actually related to inappropriate care? No," asserted Keyhani.
She concluded that "instead of focusing on geographic variations, more of our efforts should be directed at designing policies that will reduce inappropriate care in general, regardless of region."
However, said Keyhani, "you need good scientific evidence to design such policies, and right now, that evidence is lacking." In a related literature review based on the same 30-year data base, published on January 23 in the Archives of Internal Medicine, Keyhani and her colleagues found only 172 peer-reviewed articles that addressed the general topic of health care overuse.
One reason for the dearth of such literature, Keyhani said, is an overall lack of patient care guidelines by which researchers might judge overuse of tests and procedures: "There are not enough guidelines, and most of those that do exist don't address inappropriate care. Guidelines state when you should give a diagnostic test, for example, but they don't say when you shouldn't. And if you have no standards, how can you say when care is inappropriate?"
Creating guidelines is "expensive and very labor intensive," acknowledged Keyhani. "And it's not something one health system can do by itself. There needs to be a national investment."
Nonetheless, she said, the long-term benefits of such guidelines for the U.S. health care system would be considerable. "Overuse isn't just a matter of unnecessary expense, but of patient safety," she noted. "People assume that more care is better. In fact, we know that unwarranted procedures can add to health risks and lead to poor outcomes."
###
Co-authors of the Medical Care paper are Raphael Falk, MD, MPH, of UCSF, Tara Bishop, MD, MPH, of Weill Cornell Medical College and Elizabeth A. Howell, MD, MPP, and Deborah Korenstein, MD, of Mount Sinai School of Medicine. The study was supported by funds from the Commonwealth Fund and the Department of Veterans Affairs.
Co-authors of the Archives paper are Deborah Korenstein, MD, Raphael Falk, MD, Elizabeth A. Howell, MD and Tara Bishop, MD, MPH. The study was supported by funds from the Commonwealth Fund and the Department of Veterans Affairs.
SFVAMC has the largest medical research program in the national VA system, with more than 200 research scientists, all of whom are faculty members at UCSF.
UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.
[ | E-mail | Share ]
?
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.
No evidence that higher regional health care costs indicate inappropriate care, study shows Public release date: 20-Mar-2012 [ | E-mail | Share ]
Contact: Steve Tokar steve.tokar@ncire.org 415-221-4810 x5202 University of California - San Francisco
There is no solid evidence to support the widely held belief that regions of the United States that spend more on health care and have higher rates of health care use deliver more unnecessary care to patients, or that low-cost areas deliver higher quality and more efficient care, according to a study led by Salomeh Keyhani, MD, a physician at the San Francisco VA Medical Center and an assistant professor of medicine at the University of California, San Francisco.
The study authors called for national health care policies designed to discourage inappropriate care, regardless of region.
"Geographic variations in health care have captured the attention of researchers for the past 30 years, especially during the recent health care reform debate," said Keyhani. "The assumption is that areas that spend more are delivering more inappropriate care in the form of unnecessary tests and procedures." In turn, she said, "this has led policy makers to hold up low-cost areas as models of high-quality health care, and to propose policies that cap spending."
That assumption is unwarranted, according to Keyhani and her co-authors. "The literature is so limited that you cannot either support or refute such an assertion. There is just not enough data," said Keyhani.
In their study, the scientists reviewed 114,830 peer-reviewed articles, published between January 1, 1978 and January 1, 2009. They found only five that analyzed detailed clinical data in relation to geographic region, and concluded that the results of those papers "did not lend support" to the idea that higher cost regions deliver more inappropriate care. Their literature review was published in the March issue of the journal Medical Care.
"Do we have any evidence to say that the differences in cost of care in different localities are actually related to inappropriate care? No," asserted Keyhani.
She concluded that "instead of focusing on geographic variations, more of our efforts should be directed at designing policies that will reduce inappropriate care in general, regardless of region."
However, said Keyhani, "you need good scientific evidence to design such policies, and right now, that evidence is lacking." In a related literature review based on the same 30-year data base, published on January 23 in the Archives of Internal Medicine, Keyhani and her colleagues found only 172 peer-reviewed articles that addressed the general topic of health care overuse.
One reason for the dearth of such literature, Keyhani said, is an overall lack of patient care guidelines by which researchers might judge overuse of tests and procedures: "There are not enough guidelines, and most of those that do exist don't address inappropriate care. Guidelines state when you should give a diagnostic test, for example, but they don't say when you shouldn't. And if you have no standards, how can you say when care is inappropriate?"
Creating guidelines is "expensive and very labor intensive," acknowledged Keyhani. "And it's not something one health system can do by itself. There needs to be a national investment."
Nonetheless, she said, the long-term benefits of such guidelines for the U.S. health care system would be considerable. "Overuse isn't just a matter of unnecessary expense, but of patient safety," she noted. "People assume that more care is better. In fact, we know that unwarranted procedures can add to health risks and lead to poor outcomes."
###
Co-authors of the Medical Care paper are Raphael Falk, MD, MPH, of UCSF, Tara Bishop, MD, MPH, of Weill Cornell Medical College and Elizabeth A. Howell, MD, MPP, and Deborah Korenstein, MD, of Mount Sinai School of Medicine. The study was supported by funds from the Commonwealth Fund and the Department of Veterans Affairs.
Co-authors of the Archives paper are Deborah Korenstein, MD, Raphael Falk, MD, Elizabeth A. Howell, MD and Tara Bishop, MD, MPH. The study was supported by funds from the Commonwealth Fund and the Department of Veterans Affairs.
SFVAMC has the largest medical research program in the national VA system, with more than 200 research scientists, all of whom are faculty members at UCSF.
UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.
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Public release date: 23-Mar-2012
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