near Odessa, MN, photos by Ardith Gerber

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The number of Ebola cases in Liberia and Sierra Leone could rise to between 550,000 and 1.4 million by January if there are no “additional interventions or changes in community behavior,” the Centers for Disease Control and Prevention said in a report Tuesday. The estimate was derived from a new forecasting tool developed by the CDC.

The range of estimated cases to come — from 550,000 to 1.4 million …

see Morbidity and Mortality Weekly Report (MMWR)

http://www.cdc.gov/mmwr/preview/mmwrhtml/su63e0923a1.htm?s_cid=su63e0923a1_w

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Why Dogs Never Die.

Dogs never die. They don’t know how to. They get tired, and very old, and their bones hurt. Of course they don’t die. If they did they would not want to always go for a walk, even long after their old bones say: “No, no, not a good idea. Let’s not go for a walk.” Nope, dogs always want to go for a walk. They might get one step before their aging tendons collapse them into a heap on the floor, but that’s what dogs do. They walk.

It’s not that they dislike your company. On the contrary, a walk with you is all there is, and the cacophonic symphony of odor that the world is. Another dog’s mark, an old chicken bone, where the rabbit just passed by (exultation), and you. That’s what makes their world perfect, and in a perfect world death has no place.

However, dogs get very very sleepy. That’s the thing, you see. They don’t teach you that at the fancy university where they explain about quarks, gluons, and economics. They know so much they forget that dogs never die. It’s a shame, really. Dogs have so much to offer.

When you think your dog has died, it’s just fallen asleep in your heart. And by the way, it’s wagging its tail madly, you see, and that’s why your chest hurts so much and you cry all the time. Who wouldn’t cry with a happy dog wagging its tail in their chest?

Ouch! Wap wap wap wap wap, that hurts. But they only wag when they wake up. That’s when they say: “Thanks friend! Thanks for a warm place to sleep and keeping me always next to your heart, the best place.”

When they first fall asleep, they wake up all the time, and that’s why, of course, you cry all the time. Wap, wap, wap.

After a while they sleep more. Remember, a dog’s not a human, time is different for dogs. You take your dog for walk; it’s a day full of adventure in an hour. You come home from work and it’s like you’ve been gone a week – one of your days, but a week for your dog, really,

before the dog gets another walk. No WONDER they love walks.

Anyway, like I was saying, they fall asleep in your heart, and when they wake up, they wag their tail. After a few dog years, they sleep for longer naps, and you would too. They were a GOOD DOG all their life, and you both know it. It gets tiring being a good dog all the time, particularly when you get old and your bones hurt and you fall on your face and don’t want to go outside to pee when it’s raining but do anyway, because you are a good dog. So understand, after they’ve been sleeping in your heart for awhile, they’ll sleep longer and longer.

But don’t get fooled. They are not “dead.” There’s no such thing, really. They’re sleeping in your heart, and they’ll wake up, usually when you’re not expecting it. It’s just who they are.

I feel sorry for people who don’t have dogs sleeping in their heart. You miss so much.
Excuse me, I have to go cry now.

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BEWARE. . .not all Verizon stores are equal!

Do you know that if you buy a phone in one store another Verizon store can, and probably will, deny you service? Just because a store waves a Verizon flag doesnt mean the phone you buy will get service at another “Verizon” store. It is like buying a pair of jeans at an independent store and when you wash them the first time and the seams fall apart, you cant take the pants back to Macys

Heres proof. I was on vacation about six hours away from home when my cell phone stopped working. I saw the Verizon flag outside a store and made the assumption that because I was a Verizon customer I could get a new phone and all would be well with the world. Not true! After choosing a phone and getting it set up I left the store.

Another truth is that I am not a person with a computer brain and every time I get a new gadget I need help navigating.

When I got home, with more questions than answers, I stopped at our nearest store and asked for help. The guy behind the Verizon counter said, I cant help you. You didnt buy this at my store and I dont carry that phone. I suggest you go back to the place you bought it. Immediately I saw red and told him the place I bought it was six hours away. Sorry, he said, You should take that phone back, and I stormed out.

I drove to the store where Ive always done business and told them my story. They too repeated the other guys advice, but because of our history together they helped me get over the immediate hurdle. I went home and struggled with the new phone. Then on the 12th day of this fiasco the new phone would not even turn on. I called the store where I bought the phone and after trying everything and the phone not responding they suggested I contact Verizons 800 number. I did that and again we could not get the phone to work. The Verizon guy said, Return that phone to where you bought it and then he reinstated the service on an old phone so at least I could receive and make calls although the email and texting didnt work.

As soon as we could my husband and I hopped in our car and drove six hours to take the phone back. When I entered the store I spoke with the man Id talked with days earlier and reminded him of the situation. He remembered. I presented the non-functioning phone and asked for my money back. The store manager refused because it was day fifteen and the contract was that I had to return the phone in fourteen days. I told them of the actions of Verizon headquarters and they offered me a replacement phone. Seeing only red, I left the phone on the counter and walked out of the store with the manager repeating that I could not do that.

Immediately I called Verizon and demanded they record my story. Days later I went to an official, authorized Verizon dealer and again told this story. With a bill of several hundred dollars, a charge for a phone that I dont want and didnt work, double bills for installation of service, transfer fees and more, I left the official store with a phone that I can get serviced at any Authorized dealership.

Lessons learnednever, ever buy a phone when away from home and only buy from an authorized dealership so you can get the help you need when you need it.

I suggested to the store manager that it would be oh-so-helpful if consumers would know how the stores differ. I suggested that the official sites (or unofficial ones) had another color in their banner to give the customer a clue to what kind of store they were dealing with.

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Two separate vaccines are now being recommended

By Peter Loftus Sept. 1, 2014 4:55 p.m. ET

The U.S. Centers for Disease Control and Prevention recommends that older adults now get two different pneumonia vaccines, versus only a single shot under the old guidelines. WSJ’s Peter Loftus joins Tanya Rivero on Lunch Break to explain the rationale. Photo: Getty

People age 65 and older should get two separate vaccines to protect against pneumonia and other infections starting this fall, a change of decades-old advice, according to new health guidelines.

An advisory panel to the U.S. Centers for Disease Control and Prevention recently recommended that people get a second vaccine, called Prevnar 13, because of limitations with the older shot, called Pneumovax 23.

Both vaccines, which are usually administered once in older adults, are designed to protect against infections of the bacterium Streptococcus pneumoniae, but they work in different ways. Prevnar 13 has been used by itself to vaccinate children since 2010 and has proven effective.

An estimated 900,000 people in the U.S. a year get pneumococcal pneumoniaa lung infection whose symptoms include fever, cough and chest painand 5% to 7% of patients die from it, according to the CDC. It is typically treated with antibiotics, but some strains have developed resistance to those drugs.

Pneumococcal bacteria also can cause so-called invasive diseases, including bacteremia, a bloodstream infection, and meningitis, which affects the brain and spinal cord. The CDC estimated there were about 3,300 deaths in the U.S. from these two diseases in 2012.

A Pneumonia Diagnosis

Some basics on the lung infection

• Pneumococcal pneumonia is a form of lung infection caused by the bacterium Streptococcus pneumoniae. Pneumonia can also be caused by viruses and fungi.
• Symptoms include high fever, cough, shortness of breath and chest pains.
• The bacteria also can cause bloodstream infections and meningitis.
• Infections are treated with antibiotics but some strains have developed resistance to antibiotics.
• New U.S. guidelines recommend adults 65 and older receive two vaccines to protect against pneumococcal disease: Prevnar 13 and Pneumovax 23. Previously, only Pneumovax 23 was recommended for routine vaccination of adults 65 and older.
• Prevnar 13 has a list price of $135 per dose. Pneumovax 23 costs $68 per dose.

Pneumococcal infections are more likely to cause illness in older people, children younger than 2 years old and those with conditions that weaken the immune system, such as diabetes, according to the CDC. The bacteria are transmitted by contact with saliva or mucus. Children are carriers, harboring the bug in their noses or throats, and the bacteria are a common cause of middle-ear infections in kids.

The CDC is expected to formally adopt the advisory panel’s recommendations in coming weeks.

The addition of Prevnar 13 to the guidelines continues a campaign by vaccine manufacturers and public-health authorities to expand routine vaccinations to adults from children. In recent years the CDC has urged more adults to receive seasonal influenza vaccines, and recommended adults 60 and older get a shot to reduce their risk of shingles.

In an unusual move, the CDC panel said it would revisit its decision in 2018 and might remove its Prevnar 13 recommendation if the number of people getting sick declines sufficiently. The routine use of Prevnar 13 in children since 2010 has had what scientists call a herd effect, which occurs when vaccination of one part of the population also reduces the transmission of a disease to unvaccinated people. If the herd effect continues to rise, it could lessen the need for Prevnar 13 in adults.

Some members of the CDC panel said the relatively high cost of Prevnar 13 also factored into their recommendation to revisit the guidelines. Prevnar 13 costs about $135 a dose versus $68 for Pneumovax 23. The federal Medicare program, which currently pays for one pneumococcal vaccine per older adult in most cases, might not begin covering a second shot until 2016.

A magnified image of Streptococcus pneumoniae bacteria grown from a blood culture. The bug can cause pneumonia, bloodstream infections and meningitis. U.S. Centers for Disease Control and Prevention

Because of Prevnar 13’s price, “we want to use it as long as we need to use it to provide protection, but we probably don’t want to use it beyond that time period,” said Ruth Karron, a member of the CDC advisory panel an immunization researcher at Johns Hopkins Bloomberg School of Public Health.

Prevnar 13 replaced an older shotPrevnar 7that came out in 2000 and was also recommended mainly for children. Its manufacturer, Pfizer Inc., PFE -0.59% later gathered enough evidence to support its use in adults.

People 65 and older who haven’t received any pneumococcal vaccine are now recommended to receive Prevnar 13 first, followed by Pneumovax 23 at least six to 12 months later. Those already vaccinated with Pneumovax 23 should get Prevnar 13 at least one year later, the panel voted.

Clinical results show that even receiving the two vaccinations can’t guarantee protection against pneumococcal disease in everyone, nor do they protect against infections caused by viruses and fungi.

More than 60% of older people have received at least one shot of Pneumovax 23, according to the CDC. The vaccine, introduced by Merck & Co. in 1983, is designed to protect against 23 serotypes, or strains, of Streptococcus pneumoniae. It is known as a polysaccharide vaccine because it incorporates sugar coatings of the bacteria, which trigger the body’s immune system to make antibodies to fight the bacteria.

Those who receive Pneumovax 23 at or after age 65 should only get a single dose, while people who have gotten it before age 65if they had a chronic disease, for instanceshould get another dose if at least five years have passed. The CDC says the vaccine is effective against invasive disease, including bacteremia and meningitis, but less effective in preventing pneumococcal pneumonia.

John Grabenstein, an executive director of health and medical affairs in Merck’s vaccines unit, said there is some evidence Pneumovax 23 can help ward off pneumonia. He said a 2010 study published in the British Medical Journal found the vaccine reduced the incidence of pneumonia among residents in Japanese nursing homes compared with a placebo.

Prevnar 13 is designed to protect against 13 strains of the bacteria, including 12 types also targeted by Pneumovax 23. But Prevnar 13 is designed differently than Pneumovax 23. It contains polysaccharides that are fused to proteins, forming a so-called conjugate, which is believed to help trigger a stronger immune response against certain bacteria strains.

In 2011, the Food and Drug Administration approved the use of Prevnar 13 in adults age 50 and older. But the CDC’s advisory panel delayed its recommendation until it received results of a large clinical study testing whether a vaccine-induced immune response actually translated into reduced risk for disease.

The study, presented at a medical conference in March, found that Prevnar 13 reduced by about 45% the risk of a first case of pneumonia caused by the targeted 13 bacterial strains compared with a placebo. The vaccine also reduced by 75% the risk of a first case of an invasive disease caused by the targeted strains.

The study involved about 85,000 people in the Netherlands, where Pneumovax 23 isn’t routinely administered to older adults. Pfizer, which conducted the study, wanted to demonstrate Prevnar 13’s effectiveness in an unvaccinated population, said Rosalind Hollingsworth, senior director of Pfizer’s vaccines unit.

The addition of Prevnar 13 in older adults “will change the landscape if it goes into full recommendation,” said Kenneth Schmader, head of the geriatrics division at Duke University Medical Center and an American Geriatrics Society liaison to the CDC’s vaccine advisory panel. “They both should be given.”

Write to Peter Loftus at peter.loftus

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bottom line, PreferredOne’s policies were loss-leaders to sucker people in, they didn’t have the business competence to service their policies plus their actuarial projections sucked… so of course it’s Dayton’s / Obama’s fault… fkers
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Insurers leaving the Exchanges Posted by Richard Mayhew at 10:18 am Sep 182014

Some drop-outs are more important than others.

Weve seen some insurance companies drop out of the Exchanges this year. My take on a New York drop-out was that it was good news as the enrollment was miniscule and the products were not reasonably priced. The insurer was just too small to compete and there was minimial hope for significant membership gains to cover their back end costs:

384 people are too few people for an insurance company to offer a commercial or commercial like product for two significant reasons. Either reason is a good enough reason for a company to get out of this market segment.
From a policy point of view, unpopular and comparatively expensive plans exiting the marketplace is a good thing in states with deep markets and significant participation. It sucks that 384 people will need to find new policies next but they are highly likely to get better and cheaper policies instead.

This is not the case in Minnesota. A major insurer is dropping its participation from the Exchange on both the individual and SHOP side of the equation.

The insurer with the lowest rates and most customers on Minnesotas health care exchange is pulling out
According to a company statement, MNsure policies make up only a small percentage of PreferredOnes entire enrollment but take up a significant amount of resources to support.
PreferredOne had 59 percent of the individual market for MNsure enrollees as of Aug. 6.

This is a significant disruption to the Minnesota market. It is not shocking though.

I am eyeballing the pricing for a 35 year old non-smoker in the Twin Cities on Health Sherpa and platinum plans without subsidy are cheaper from this provider than most baesline Silver plans. I think a few things are happening.

PreferredOne either was amazingly over optimistic on their acturial modeling or had decided to engage in an extremely aggressive loss leader pricing strategy to build membership. If this was a loss leader strategy, than it may have been too effective as the low cost platinum planss would have been very attractive to people with significant pre-exisiting medical conditions or known medical risk. People with high utilization and high complexity of cases are expensive on the medical side as they go to doctors/hospitals a lot AND they are administratively costly as they are calling in for help and care coordination on a frequent basis.

Secondly, the back-end infrastructure to support Exchange is extensive, especially as the risk spreading mechanisms such as risk adjustment require significant technical support. Building that type of infrastructure from scratch is painful and expensive. PreferredOneseems to have been only a commercial group insurer with a small staff before it decided to dip its toes into the water for individual Exchange. It had no pre-exisiting model it could rip off to modify for Exchange.

It had aggressive pricing, a population that is higher need than normal, and not a lot of administrative/technical depth. On a quick glance at these basic facts, dropping Exchange makes sense. It sucks for the people who have to re-enroll in new plans at higher price points but 2014 was always a beta test year, and we know that companies would be entering and leaving different markets which is why the markets were never expected to stabilize until the 2016 open enrollment period. Preferred One is not the only significant exit, as Hawaii lost a large provider for the SHOP exchanges for the same basic reason

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Certain gut bacteria may induce metabolic changes following exposure to artificial sweeteners

Date: September 17, 2014 Source: Weizmann Institute of Science

This image depicts gut microbiota.

Credit: Weizmann Institute of Science

Artificial sweeteners — promoted as aids to weight loss and diabetes prevention — could actually hasten the development of glucose intolerance and metabolic disease, and they do so in a surprising way: by changing the composition and function of the gut microbiota

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