FORGET STATEHOOD GO FOR INDPENDENCE

Supreme Court considers whether Puerto Ricans can be denied gov't benefits

"Puerto Ricans are citizens, and the Constitution applies to them," Supreme Court Justice Sonia Sotomayor said. File Pool Photo by Erin Schaff/UPI | License Photo

WASHINGTON, Nov. 10 (UPI) -- A dispute over $28,000 could have broad implications for the rights of Puerto Ricans and residents of other U.S. territories.

The U.S. Supreme Court heard oral arguments Tuesday on whether the exclusion of Puerto Rico from the Supplemental Security Income program violates the equal protection component of the Fifth Amendment's Due Process Clause.

The SSI program provides monthly payments to low-income Americans 65 or over or who are blind or disabled who live in one of the 50 states, the District of Columbia or the Mariana Islands.

In 2017, the federal government sued José Luis Vaello Madero, now 67, for repayment of $28,081 it claims he wrongly received as a resident of Puerto Rico.

Vaello Madero was living in New York state when he began receiving SSI payments in 2012. In 2013, he moved to Puerto Rico to care for his ailing wife. As a result, he lost his eligibility to receive SSI benefits, but he continued to receive them for several years because the Social Security Administration was unaware of his move.

Vaello Madero's lawyers argue the exclusion of Puerto Rican residents from the SSI program is unconstitutional because it denies them equal protection under the law, which the Supreme Court has held is implied by the Due Process Clause of the Fifth Amendment. A federal district judge and the 1st U.S. Circuit Court of Appeals sided with Vaello Madero

Hermann Ferré, an attorney for Vaello Madero, told the Supreme Court the Due Process Clause mandates that the federal government treat residents of Puerto Rico the same as other Americans in all circumstances.

In their brief, Vaello Madero's attorneys argue that denying Puerto Rican residents government benefits available to other Americans constitutes "singling out [Puerto Ricans] for second-class treatment that gives lie to their status as equal Americans."

The government's attorneys argue Puerto Rico's status as an unincorporated territory means the federal government is within its rights to deny Puerto Rican residents SSI benefits.

The government has a rational basis for excluding residents of Puerto Rico from the SSI program, as Puerto Ricans do not pay federal income taxes, Deputy Solicitor General Curtis Gannon told the justices.

"Congress has a legitimate interest in avoiding a one-sided fiscal relationship under which Puerto Rico shares the financial benefits but not the financial burdens of statehood," the government argued in its brief, "and declining to include Puerto Rico in the SSI program is a rational means of furthering that interest."

However, Justice Sonia Sotomayor pointed out that people who are eligible for SSI benefits would not pay federal income taxes regardless of where they live.

"Puerto Ricans are citizens, and the Constitution applies to them," Sotomayor said. "Their needy people are being treated different than the needy people in the 50 states."

Puerto Ricans have been U.S. citizens since 1917, when President Woodrow Wilson signed the Jones-Shafroth Act. However, beginning in 1901, the Supreme Court ruled in a series of cases, known as the Insular Cases, that residents of Puerto Rico and other unincorporated U.S. territories do not have the same constitutional rights as other Americans. The high court worried that extending full constitutional rights to the "uncivilized" people of Puerto Rico, who were of "alien races," would result in the "bestowal of citizenship on those absolutely unfit to receive it."

In an amicus brief, civil rights group LatinoJustice asked the Supreme Court to overturn the Insular Cases, saying they are "predicated on racist assumptions and rationales that indisputably have no place in modern American jurisprudence."

Before the oral arguments, the advocacy group Hispanic Federation held a news conference outside the Supreme Court.

Aurelius Aponte, a mother of two, said she returned to Puerto Rico from Florida to care for her sick mother and subsequently lost SSI benefits for her younger daughter, who suffers from several major heart conditions.


"Why would I stay in silence when someone wants to discriminate against my miracle baby?" Aponte asked.

American Airlines pilots reject holiday pay increase amid schedule concerns


An American Airlines flight is seen at St. Louis-Lambert International Airport in St. Louis, Mo. File Photo by Bill Greenblatt/UPI | License Photo

Nov. 10 (UPI) -- A union of American Airlines pilots has turned down an effort by the carrier to avoid trouble over the holiday travel season by offering to pay them as much as twice their normal rate.

The board of directors of the Allied Pilots Association, which represents about 15,000 AA pilots, voted against the proposal, which would have paid at least 150% of pilots' normal wages to pick up shifts around Thanksgiving, Christmas and New Year's.

Under the proposal, AA pilots would have received double pay to pick up open holiday trips.

"The board received a full briefing ... and thoroughly considered all aspects of the [proposal]," the union said in a statement on Tuesday, indicating that it's more interested in permanent changes to pilots' contracts.

"While understanding that its rejection creates a disparity among our fellow work groups that have accepted management's proffered incentives, the board concluded that the need to achieve meaningful permanent improvements in a new collective bargaining agreement must remain APA's focus."

Scheduling is an example of one issue that the pilots union wants to see addressed. American was forced to cancel more than 2,000 flights early this month and in late October due to bad weather and staffing shortages.

The airline has already addressed the shortages by making a deal with AA flight attendants that was similar to the one it offered the pilots.

"Management is failing to address the long-term solutions and is just trying to throw money at the problem," APA spokesman Dennis Tajer said, according to The Dallas Morning News.

"The problem is connecting pilots to the airplane and throwing money at it doesn't fix the structural problem that management has created."

AAA said this week that it expects about 4.2 million Americans will travel by airplane this Thanksgiving, an 80% increase over the same period in 2020 when many opted not to travel for the holidays due to the COVID-19 pandemic.

OLD BOYS CLUB
Study in Canada reveals possible gender bias in physician-to-surgeon referrals


A new study has uncovered potential gender bias in physician-to-surgeon referrals. 

Photo by Sasint/Pixabay


Nov. 10 (UPI) -- Male physicians are more likely to refer patients who need surgery to male surgeons, a study published Wednesday by JAMA Surgery found.

In the analysis of nearly 40 million physician-to-surgeon referrals made by roughly 45,000 physicians in Ontario, Canada, between 1997 and 2016, male physicians referred patients to male surgeons 87% of the time, the data showed.

In comparison, female physicians referred patients to male surgeons 79% of the time, the researchers said.

About 78% of surgeons practicing in Ontario, which includes major cities such as Toronto and Ottawa, at the time of the analysis were male, according to the researchers.

The numbers mean that male physicians were 32% more likely to refer patients to male surgeons than female ones, while female physicians were just under 2% more likely to refer patients to female surgeons.

"For surgeons, factors that should affect referrals should be related to ensuring patients have timely access to high quality of care -- things like experience, ability, patient satisfaction, etc.," study co-author Nancy Baxter told UPI in an email.

"What our study shows is that how referrals actually happen is in part influenced by the 'old boys club,' [meaning] male referring doctors preferentially refer to male surgeons," said Baxter, head of the School of Population and Global Health at the University of Melbourne in Australia.

In the United States, males make up 78% of all general surgeons, as well as 91% of all neurosurgeons and 94% of all sports medicine and orthopedic surgeons nationally, the Kaiser Family Foundation estimates.

Males also account for more than 80% of plastic surgeons, among other specialty surgeons, across the country, according to the foundation.

Previous research has suggested that gender plays a significant role in referral patterns in the United States as well, negatively impacting the practices of female physicians and potentially contributing to the gender-based pay gap nationally.

In addition, studies have shown that female surgeons perform procedures that generate lower compensation and reimbursement rates than their male peers.

"In the U.S. as in Canada, most practicing physicians are men," wrote the authors of a commentary published with the new study.

The new study focused on physician-to-surgeon referrals in Ontario, Canada, due to province's fee-for-service system in which referrals are "unrestricted by contracts, insurance schemes or employment."

As a result, physicians are free to refer patients to any specialist who accepts new patients, making it an "ideal setting to explore sex bias in referral networks," the researchers said.

In other words, if male physicians refer to male surgeons more frequently, it is possible that gender bias plays a role, given that there are no restrictions that limit their decisions, such as insurance requirements.

Females accounted for 77% of the patients referred to female surgeons and 55% of those referred to male surgeons, the data showed.

"Our study demonstrates that the bias male referring physicians have for male surgeons isn't limited to their male patients, so this isn't driven by patients themselves," Baxter said.

"Underutilizing one group -- female surgeons -- because of their gender means that patients will be more limited in terms of timely access to high-quality care [because] the best surgeon for your problem may be a woman, but you won't see her if you don't get referred to her," she said.

Western boom cities see spike in harmful ozone

By Jim Robbins, Kaiser Health News

Trees explode in flames during the Caldor fire near Lower Echo Lake, Calif.,

 on August 30. 

File Photo by Peter DaSilva/UPI | License Photo

Nov. 10 (UPI) -- The reduction of harmful ground-level ozone across most of the United States over the past several decades has been an air pollution success story. But in some parts of the country, especially in the heavily populated mountain valleys of the West, the odorless, colorless gas has remained stubbornly difficult to reduce to safe levels.

Meanwhile, a growing body of research shows that the levels considered safe may still be too high and should be substantially lowered.

Cities with chronically hazardous levels of ozone include Salt Lake City, Phoenix and Albuquerque, N.M. But the levels in Colorado's Front Range, along the eastern edge of the Rockies, are among the highest in the country -- and this summer were the worst on record there.

The spike in ozone, a smoke-filled wildfire season and the ongoing COVID-19 pandemic created a no-win situation for people living within the Front Range, the most populated area of Colorado, which stretches more than 130 miles from Fort Collins through the Denver area and Colorado Springs. Exercising indoors with others is a high risk for COVID-19 transmission, while high levels of ozone and particulate matter outdoors are dangerous to human health.

"What should you do? We don't really know," said James Crooks, an air pollution researcher at National Jewish Health, a hospital specializing in respiratory disorders. "Unfortunately, there's not a great body of research to figure out what the trade-off is."

Along the Front Range, a place where you might expect fresh mountain breezes, this past summer the levels of ozone routinely spiked above the federal limit of 70 parts per billion -- a level that the Environmental Protection Agency lowered from 75 parts per billion in 2015. Officials issued "action alert" health warnings on 65 days there during the peak season from May 31 to Aug. 31, the highest since record-keeping began in 2011.

The World Health Organization suggests that, based on new research, the limit should be 60 parts per billion to better protect human health. The EPA said at the end of October it was reviewing the 70 ppb limit to see whether change was warranted.

Children, older adults and people with heart and lung problems and other pre-existing conditions are warned not to spend extended time outdoors. For much of the summer, the indoors was the only safe place for many people.

"The last two years, it has been really, really bad," said Crooks. Ozone is "the second-most dangerous widespread pollutant after particulate matter, and we know it impacts not just your lungs."

In some places, sporting events were canceled because of high levels of ozone and wildfire smoke. Schools in Provo, Utah, canceled football and soccer games in August because of ozone and other air pollution. The athletic department at the University of Utah in Salt Lake City has its own air-quality monitor for tracking particulate and ozone levels to know when to cancel practice or games.

Ozone, which is chemically similar to chlorine, though less toxic, may be most often thought of as a gas in the upper atmosphere, or stratosphere, where it acts to shield the Earth from the sun's ultraviolet rays. Ground-level, or tropospheric, ozone is created when auto exhaust and emissions from oil and gas production get baked by the sun. Cities at higher elevations get more solar irradiance than cities lower in altitude, and that increases the reactions that turn nitrous oxide and volatile organic compounds into ozone.

The gas is highly toxic to plants and animals, including humans. "Good up high, bad nearby" is the phrase some use to differentiate the protective, stratospheric ozone layer from ground-level ozone.

Ozone poses multiple serious threats to human health. "When our bodies breathe in ozone, it's like a sunburn of the lungs," said JoAnna Strother, senior director of advocacy for the American Lung Association. It can cause shortness of breath and stinging in the eyes, trigger asthma attacks and make people susceptible to pulmonary inflammation and coronary damage. It can increase the risk of other respiratory infections and trigger cardiac arrest. Exposure to ozone during pregnancy may result in lower birth weights.

It's also been shown to exacerbate COVID-19 symptoms and increase mortality from the disease and to increase the prevalence of Type 2 diabetes in people who spend time outdoors. In a study published last year, researchers in Colorado detected a reduction in bacterial diversity in the microbiome of the human gut from ozone, which could increase the risk of numerous chronic illnesses.

Smoke from fires in Northern California lowers visability in San Francico on October 2, 2020. File Photo by Terry Schmitt/UPI | License Photo

More than a million premature deaths are caused globally each year by ozone. Experts also say the burden of air pollution falls disproportionately on low-income, nonwhite and otherwise disenfranchised people who often lack the resources to move.

A new type of research into the impacts of air pollution at the single-cell level has found that exposure to ozone and fine-particle pollution may cause lifelong health problems. In a study of predominantly Hispanic children 6 to 8 years old in California's ozone-plagued Central Valley, air pollution was found to impair the expression of genes that regulate the immune system and can lead to increased levels of heart disease and other problems. These changes may even be passed on to offspring.

"It looks like even brief air pollution exposure can actually change the regulation and expression of children's genes and perhaps alter blood pressure, potentially laying the foundation for increased risk of disease later in life," said Dr. Mary Prunicki, director of air pollution and health research at Stanford University's Sean N. Parker Center for Allergy and Asthma Research.

Ground-level ozone is primarily human-caused. The smoke from wildfires, which plague Colorado and the West every summer but were especially bad this year, add much to the problem of both ozone and fine-particle pollution. Ozone from Asia also crosses the Pacific and adds to the burden.

"We are not nearly as strict as other states -- for example, California -- and not nearly as strict as Europe for vehicle emissions," said Frank Flocke, an atmospheric chemist at the National Center for Atmospheric Research in Boulder, Colo., who studies air pollution.

The other major factor is volatile organic compounds -- methane, ethane, benzene and other substances -- emitted by the burning and production of natural gas and oil and gas operations, he said.

"The meteorology here is also part of the problem," said Flocke. "You have prolonged high-pressure systems, and the air gets really stagnant and the effects get amplified."

Climate change is a major contributor. "If you are under polluted conditions as the climate warms, you get more ozone," said Daniel Jacob, a professor of atmospheric chemistry at Harvard University.

While the air quality on the Front Range improved through the past decade, it grew worse the past two years. State officials say they are moving to address sources of pollution; critics say they are not taking it seriously enough as the Front Range continues to boom, adding people and pollution.


"I don't think there's an easy fix," said Flocke. "We need more aggressive regulation and shifting of our habits. We need to try to get people to use public transit."

Increasing the use of electric vehicles and renewable energy is key to the strategy in Denver and other ozone-plagued cities, he and others said. "The things that we do to address climate change are the things that would clean up our air immediately," said Crooks. "We'd get two birds for one stone."

Research for this article was supported by the Bill Lane Center for the American West at Stanford University.

Study: Rising greenhouse gases, ice melt caused by humans drive climate change


Researchers say that rising ice melt -- melt ponds and smaller floes are pictured in northern Greenland in August 2017 -- and greenhouse gases on Earth, caused by humans, are driving climate change. 

File Photo by Nathan Kurtz/NASA | License Photo

Nov. 10 (UPI) -- Rising greenhouse gas concentrations in the atmosphere and the melting of the polar ice sheets are the main drivers of climate change, according to an analysis published Wednesday by the journal Nature.

There has been a general warming trend over the past 10,000 years, and the magnitude and rate of warming over the past 150 years far surpasses the magnitude and rate of changes over the past 24,000 years, the data showed.

The findings, which are based on reconstructions of the Earth's climate since the last ice age, about 24,000 years ago, also show the adverse effects of human activity on the climate, given that the past 150 years coincides with the rise of large-scale industry globally, the researchers said.

"This reconstruction suggests that current temperatures are unprecedented in 24,000 years," study co-author Jessica Tierney said in a press release.

"[It] also suggests that the speed of human-caused global warming is faster than anything we've seen in that same time," said Tierney, an associate professor of geosciences at the University of Arizona in Tucson.

A study published earlier this year noted that rising greenhouse gas concentrations in the Artic are threatening the ozone layer in the region and contributing to ice sheet melt.

For this study, the researchers created maps of global temperature changes for every 200-year interval going back 24,000 years by combining two independent datasets -- temperature data from marine sediments and computer simulations of climate.

The researchers analyzed the chemical signatures of marine sediments to get information about past temperatures.

Because temperature changes over time can affect the chemistry of a long-dead animal's shell, scientists can use those measurements to estimate temperature in an area.

It's not a perfect thermometer, but it's a starting point, the researchers said.

In addition, the computer-simulated climate models provided temperature data based on the researchers' best understanding of the physics of the climate system, which also isn't perfect, they said.

However, by combining the methods -- a process called data assimilation that is also used frequently in weather forecasting -- they were able to harness the strengths of both.

"To forecast the weather, meteorologists start with a model that reflects current weather," said Tierney, who also contributed to the Intergovernmental Panel on Climate Change, released in October.

"[They] then add in observations such as temperature, pressure, humidity, wind direction and so on to create an updated forecast," she said.

In future studies, the researchers plan to apply their method to investigate climate changes even farther in the past, they said.

"With this method, we are able to leverage the relative merits of each of these unique datasets to generate observationally constrained, dynamically consistent and spatially complete reconstructions of past climate change," study co-author Matthew Osman said in a press release.

"The fact that we're today so far out of bounds of what we might consider normal is cause for alarm and should be surprising to everybody," said Osman, a geosciences postdoctoral researcher at the University of Arizona.

Israeli archaeologists find ring believed to ward off hangovers in ancient winery

The gold ring contained a purple semiprecious stone likely to be an amethyst.

 Photo courtesy of the Israel Antiquities Authority

Nov. 9 (UPI) -- Israeli archaeologists have discovered a ring in the ruins of an ancient wine factory that they believe was likely used to prevent hangovers.

The Israel Antiquities Authority said the ring is gold with a purple semiprecious gem, probably an amethyst.

People from the region believe amethysts were the 12th stone in the foundation of New Jerusalem, and the ancient Greeks believed that it counteracted the effects of wine.

"Many virtues have been attached to this gem, including the prevention of the side effect of drinking, the hangover" IAA representative Amir Golan said in a statement.

The authority said the ring likely belonged to a wealthy person and they may have wore the ring to ward off a hangover, or as a symbol of status. Photo courtesy of the Israel Antiquities Authority

Archaeologists discovered the ring in Yavne, Israel, at a size dating to the Byzantine era, between the 3rd century and 7th century.

The winery is considered to be largest known in the Byzantine world and the section where the ring was found dates to around the 7th century.

"Gold rings inlaid with amethyst stone are known in the Roman world, and it is possible that the ring's find belongs to the elites who lived in the city as early as the 3rd century CE," the IAA added.

The authority said the ring likely belonged to a wealthy person and they may have wore the ring to ward off a hangover, or as a symbol of status.

Experts say the winery was known for bottling a white wine known as Gaza wine and likely produced more than 500,000 gallons per year.

Study: Ban on menthol cigarettes in Canada had more people quit smoking

By Amy Norton, HealthDay News

A ban on menthol cigarettes in Canada led an increase in the overall number of people who quit smoking, according to new research.

 File Photo by underworld/Shutterstock

If the U.S. Food and Drug Administration wants to know whether it should follow through on its proposed menthol cigarette ban, it need only look to Canada for an answer.

A new study finds that Canada's ban on menthol cigarettes seemed to drive more smokers to quit, with overall cigarette sales dipping after the law took hold.

Researchers found that after menthol ban went into effect, sales of those cigarettes took an unsurprising plunge. But there was also a reduction in overall cigarette sales, of just under 5%.

The findings suggest that the ban is having its intended effect, said lead researcher Michael Chaiton, of the Ontario Tobacco Research Unit and the University of Toronto.

In the United States, where menthol cigarettes are far more popular, a similar ban could have an even greater impact, Chaiton noted.

Last April, the U.S. Food and Drug Administration said it would seek to ban menthol cigarettes, though no effective date was given and no action has yet been taken. Other flavored cigarettes were banned in 2009.

Tobacco companies add menthol to cigarettes because it has cooling properties and takes the edge off cigarette smoke's harshness.

"It makes the poison go down easier," explained Erika Sward, assistant vice president of national advocacy for the American Lung Association.

Public health advocates have long pushed for a menthol ban, citing the products as particularly insidious.

That's partly because they appeal to kids, and act as a "starter product," Sward said. And in the United States, she added, cigarette companies have spent decades targeting people of color in their menthol product marketing.

Sward, who was not involved in the new study, said it "provides valuable information" on what could happen if the United States follows through on a menthol cigarette ban.

"Cigarette sales went down across the board, and that's important," she said.

The findings were published Tuesday in the journal JAMA Network Open.

Canada's national menthol ban went into effect in October 2017, though some provinces instituted their own prior to that.

The hope is that such measures will push more menthol smokers to finally quit. And previous research has suggested that's the case. However, a ban could also simply cause menthol smokers to switch to non-menthol cigarettes.

"That's the main question we were trying to address in this study," Chaiton said.

The researchers focused on the ban's impact on cigarette sales, using wholesale data reported by manufacturers to Canada's national health institute between 2010 and 2018.

They found that nationally, overall cigarette sales declined by 4.6% post-ban, versus the prior year. There were also sales declines within each province, though the figures varied widely.

Sward said she'd like to know more about the reasons for the variance among provinces. Were some taking additional measures that others were not?

"Removing menthol cigarettes from the market is a huge step forward," Sward said.

But it's also vital, she added, to ensure that smokers know how to access help to end their nicotine addiction. It's not clear from this study, Sward noted, what drove the decline in overall sales: Was it because menthol smokers were quitting?

A study earlier this year did find evidence of that. It found that after Canada's national ban took hold, more menthol smokers said they'd attempted to quit, versus non-menthol smokers.

The researchers on that study estimated that in the United States, where there are about 19 million menthol smokers, a ban could spur over 900,000 people to quit. That would include over 200,000 Black Americans.

"That would be a truly massive intervention," Chaiton said.

Sward said that smokers who want to quit can get free help from the government "quitlines" that operate in every U.S. state. It often takes several attempts before a smoker successfully quits.

But they stand the best chance, Sward said, if they use the quitlines, or other counseling, along with one of the medications that are approved by the U.S. Food and Drug Administration for smoking cessation.

More information

The American Lung Association has help for people who want to quit smoking.

Copyright © 2021 HealthDay. All rights reserved.

US Justice Dept. sues Uber for over charging customers with disabilities

The Justice Department on Wednesday sued Uber over allegations of charging passengers with disabilities for taking too long to enter vehicles. 

File Photo by John Angelillo/UPI | License Photo

Nov. 11 (UPI) -- The Justice Department has filed a lawsuit against ride-share company Uber, accusing it of overcharging customers with disabilities.

The complaint filed Wednesday in the U.S. District Court for the Northern District of California says the company's practice of charging a wait time fee that kicks in two minutes after an Uber driver arrives at the pickup location and stops when the trip begins discriminates against those with disabilities as they often require more than two minutes to enter the vehicle.

The practice, according to the lawsuit, has been active since at least 2016, and violates the Americans with Disabilities Act, which prohibits discrimination by private companies.

"Many passengers with disabilities require more than two minutes to board or load into a vehicle for various reasons, including because they may use mobility aids and devices such as wheelchairs and walkers that need to be broken down and stored in the vehicles or because they simply need additional time to board the vehicle," it said, adding that they are charged regardless of the reason for the wait time.

The lawsuit points to a 52-year-old woman who suffers from quadriplegia due to a spinal cord injury sustained in 2012.

This woman, identified as Passenger A in the court document, uses a manual wheelchair, and starting in May of last year required an Uber for 10 trips a week to and from her residence and a rehabilitation center.

In August of that year, she noticed she was being charged daily wait time fees despite taking much effort to lessen the wait time of her Uber vehicle. When she learned of the wait time fees she requested a refund but was informed they were automatic and the company couldn't do anything to prevent them from incurring.

"Uber's refusal to refund her money or to change its wait time fee policy makes Passenger A feel like a second-class citizen," the complaint states.

The lawsuit seeks relief from the court including ordering Uber to end its discrimination of those with disabilities as well as to modify its wait time fee policy to comply with ADA, train its drivers on ADA and pay monetary damages to those impacted and a civil penalty.

"Uber's wait time fees take a significant toll on people with disabilities," Acting U.S. Attorney Stephanie Hinds for the Northern District of California said in a statement. "Passengers with disabilities who need additional boarding time are entitled to access ride-sharing services without discrimination."

The lawsuit states that upon request Uber has refunded wait time charges to some passengers with disabilities while also denying the requests of others.

In a statement emailed to CNN, Uber spokesman Noah Edwardson said it is the company's policy to refund those charges when alerted to them and following a change made last week any rider certified they are disabled will have the fees automatically waived.

"Wait time fees are charged to all riders to compensate drivers after two minutes of waiting, but were never intended for riders who are ready at their designated pickup location but need more time to get into the car," he said.

"We recognize that many riders with disabilities depend on Uber for their transportation needs, which is why we had been in active discussions with the DOJH about how to address any concerns or confusion before this surprising and disappointing lawsuit."

COVID-19 pandemic puts spotlight on 'outdated' infection control practices
By Amy Norton, HealthDay News

The COVID-19 pandemic has forced hospital staff and medical professionals to readdress infection control methods, some of which are "outdated," according to new research. 

File Photo by John Angelillo/UPI | License Photo

The COVID-19 pandemic has offered some lessons on respiratory disease transmission, and now a new review suggests that hospitals could use those insights to create even smarter infection-control policies.

The review, published Tuesday in the Annals of Internal Medicine, suggests that some longstanding infection-control tactics at hospitals are "outdated."

And certain changes, like greater use of N95 masks, might be in order.

Current infection-control measures are based, in part, on a "false simplification" of respiratory virus transmission, said lead review author Dr. Michael Klompas.

RELATED Many vaccinated health workers who get COVID-19 are exposed at home, study finds

The traditional teaching was that most respiratory viruses, like the flu and common cold, are mainly transmitted by respiratory "droplets" -- relatively heavy particles that people expel when they exhale. Droplets fall to the ground within feet of the infected person, and they're adequately blocked by a surgical mask.

But some other viruses, like measles and tuberculosis, have traditionally been labeled "airborne." That means they can be transmitted among people via tiny "aerosol" particles that remain suspended in the air for a longer time, and those particles can accumulate in a poorly ventilated space.

Surgical masks block some of those minute particles, but not all.

That droplet/aerosol premise has helped guide policies at hospitals. For example, N95 masks are generally reserved for procedures considered "aerosol-generating," like inserting a ventilator tube.

But recent research shows the droplet/aerosol divide to be a dubious one, said Klompas, an infectious disease specialist at Brigham and Women's Hospital in Boston.

"Most of what we exhale is aerosol," he said. And in reality, all respiratory viruses can, to some degree, be transmitted by those tiny airborne particles.

Where did the droplet/airborne distinction come from? It was based on observations regarding proximity. Most respiratory viruses, including the flu, are usually passed among people in relatively close contact.

But then there are pathogens like the measles virus, which can also infect people at greater distances: A U.S. measles outbreak in the 1990s, for example, happened at an international sports event held in a domed stadium.

The droplet-borne/airborne categories emerged to explain those differences in viral transmission.

However, Klompas said, it's really other factors that are key -- such as ventilation. Even airborne pathogens rapidly become "diluted" in a well-ventilated area, which lowers the risk of infection.

In a pandemic-era study of train passengers, people seated next to someone with an asymptomatic COVID-19 infection were 10 times as likely to become infected as passengers who were three seats away.

Poor ventilation, though, lowers the protection afforded by distance, Klompas said.

Duration of exposure matters, too, he explained, even in reasonably well-ventilated places. In that same train passenger study, travelers on long journeys were at greater risk of infection than those on fairly short trips.

Plus, there are differences among respiratory viruses themselves that influence transmission, and differences among the people infected. If, for instance, they have a high "viral load" -- the amount of virus in their bodies -- they are more contagious.

To Klompas and his colleagues, it all means that infection-control policies based on the droplet/airborne premise deserve a review.

Some specifics they suggest: Consider using N95 masks in the care of all patients with a respiratory infection, and not only during aerosol-generating procedures.

Recent research, Klompas said, suggests those procedures carry no extra risk. Allocate airborne-infection isolation rooms for patients with respiratory infections and a high viral load.

Review minimum ventilation standards, and consider increasing standards for non-clinical areas of the hospital and those outside of patient care. Dr. David Henderson, of the U.S. National Institutes of Health Clinical Center in Bethesda, Md., cowrote an editorial published with the review.

He called it a "great paper" that highlights the point that there is no strict dichotomy between droplet and aerosol.

As for the practical implications, that's more complicated, according to Henderson. He said that surgical masks, along with eye protection, have worked "extraordinarily well" in preventing COVID-19 outbreaks among U.S. health care workers.

What's more, Henderson noted, other respiratory infections that can spread in hospitals have basically disappeared.

It's not clear that N95 masks would have significant added value, according to Henderson. And they would be challenging to wear. "Over an eight-hour shift, you could feel like you're suffocating," he noted.

That's not to say there's no room for improvement. New masking options that offer better filtration, along with wearability, would be welcome, according to Henderson.

At this point, he said a key lesson he's learned from the pandemic is that "source-control masking" -- masking the infected person -- "really works."

The editorial suggests a "reasonable" approach going forward, once seasonal respiratory infections return to their normal patterns: Have "universal" masking in hospitals each fall through spring, when viruses like the flu are highly active.

More information

Harvard Medical School has more on curbing the spread of COVID-19.

Copyright © 2021 HealthDay. All rights reserved.

Judge OKs $626 million settlement in Flint water litigation

By ED WHITE

1 of 5

FILE - This Jan. 26, 2016, file photo, shows the Flint River in Flint, Mich. A judge on Wednesday, Nov. 10, 2021, approved a $626 million settlement for Flint residents and others who were exposed to lead-contaminated water. (AP Photo/Carlos Osorio, File)


DETROIT (AP) — A judge on Wednesday approved a $626 million deal to settle lawsuits filed by Flint residents who found their tap water contaminated by lead following disastrous decisions to switch the city’s water source and a failure to swiftly acknowledge the problem.

Most of the money — $600 million — is coming from the state of Michigan, which was accused of repeatedly overlooking the risks of using the Flint River without properly treating the water.

“The settlement reached here is a remarkable achievement for many reasons, not the least of which is that it sets forth a comprehensive compensation program and timeline that is consistent for every qualifying participant,” U.S. District Judge Judith Levy said in a 178-page opinion.

Attorneys are seeking as much as $200 million in legal fees from the overall settlement. Levy left that issue for another day.

The deal makes money available to Flint children who were exposed to the water, adults who can show an injury, certain business owners and anyone who paid water bills. About 80% of what’s left after legal fees is earmarked for children.

“This is a historic and momentous day for the residents of Flint, who will finally begin to see justice served,” said Ted Leopold, one of the lead attorneys in the litigation.

Corey Stern, another key lawyer in the case, said he represented “many brave kids who did not deserve the tragedy put on them.”

In a money-saving move, Flint managers appointed by then-Gov. Rick Snyder and regulators in his administration allowed the city to use the Flint River in 2014-15 while another pipeline was being built from Lake Huron. But the river water wasn’t treated to reduce corrosion. Lead in old pipes broke off and flowed to homes as a result.

There is no safe level of lead. It can harm a child’s brain development and cause attention and behavior problems.

Flint switched back to a Detroit regional water agency in fall 2015 after Dr. Mona Hanna-Attisha publicly reported elevated lead levels in children.

Some critics said the disaster in the predominantly Black city was an example of environmental racism.

Flint is paying $20 million toward the settlement, while McLaren Health is paying $5 million and an engineering firm, Rowe Professional Services, is paying $1.25 million. Lawsuits still are pending against the U.S. Environmental Protection Agency, McLaren and other engineering firms.

The deal was announced in August 2020 by Attorney General Dana Nessel and Gov. Gretchen Whitmer, both Democrats, who were elected in 2018 while the litigation was in state and federal courts.

The judge said it was “remarkable” that more than half of Flint’s 81,000 residents have signed up for a share of the settlement. It’s not clear just how much each child will receive. A claims process is next with families required to show records, such as blood tests or neurological results, and other evidence of injury.

Flint resident Melissa Mays, a 43-year-old social worker, said her three sons have had medical problems and learning challenges due to lead.

“Hopefully it’ll be enough to help kids with tutors and getting the medical care they need to help them recover from this,” Mays said. “A lot of this isn’t covered by insurance. These additional needs, they cost money.”

She considers the settlement a “win.”

“We’ve made history,” Mays said, “and hopefully it sets a precedent to maybe don’t poison people. It costs more in the long run.”

The Flint saga isn’t over. Nine people, including Snyder, have been charged with crimes. They’ve pleaded not guilty and their cases are pending.

The state last week agreed to pay $300,000 to the former head of the drinking water division. An arbitrator said Liane Shekter Smith was wrongly fired for what happened in Flint.

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AP reporter David Eggert in Lansing, Michigan, contributed to this story.

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