Hanukkah 2024: Festival of Darkness and Light

Stephen F. Eisenman

 December 31, 2024
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Pietro Santi Bartoli, Judaicus Triumphus, from Giovanni Pietro Bellori, Veteres arcus augustorum triumphis insignes (Rome: Ad templum Sanctae Mariae de Pace, 1690).

Hanukkah v. Christmas

In liberal, Jewish households, Hanukkah has always been something of an embarrassment. First, there’s the unavoidable truth that Hannukah is no match for Christmas. Liturgically speaking, it’s a minor holiday; it ranks somewhere between Simchat Torah and Tu Bishvat, neither of which most Gentiles (and many Jews) have even heard of. So, efforts by assimilated Jews since the 19^th century, and especially the 1950s, to treat Hanukkah like Christmas are a stretch. The birthday of God (even if you are a non-believer) in 1 CE is objectively speaking a much bigger deal than the re-dedication by the victorious Maccabees (Judean rebels) of the second temple of Jerusalem (long since destroyed) in the 2^nd century BCE.

Second, there’s the matter of the name. “Hanukkah” — in Hebrew, “חנך‎”, meaning “to dedicate” — only gained its association with the ancient temple and Winter holiday in the 19^th century.  Prior to that, the commemoration was known as the Festival of Lights, according to the Roman chronicler, Titus Flavius Josephus. That term, (of obscure origin), may have prompted the legend – taught in every Hebrew school — that oil in the lamps of the newly rededicated temple miraculously lasted eight nights instead of the expected one. That’s why there are eight nights of Hanukkah and why the menorah holds eight candles plus the Shamash (“שֶׁמֶשׁ”) or “helper candle”.  It’s not exactly a loaves-and-fishes, or Santa Claes coming down the chimney miracle, but good enough. And it aided generations of Jewish parents teach their children a lesson in thrift: “Turn off the lights when you leave a room!”

There is much more to be said about the deficiency of Hannukah compared to Christmas (the music!), but this season, like the last one, there’s a third factor that far dominates the others: How can ekht Jews, in Yiddish Menschen, celebrate a holiday that honors an ancient victory when the Jewish military in Israel continues to rain death and destruction upon their Palestinian brothers and sisters?   What Jew with a moral compass can challenge the Catholic Pope’s recent chastisement of Israel, following an airstrike in Jabaliathat killed 12 members of one family, including  seven children: “Yesterday, children were bombed. This is cruelty, not war.”  After spokespersons for the Israeli government protested Francis’s words, the pope amplified his condemnation: “And with pain, I think of Gaza, of so much cruelty, of the children being machine-gunned, of the bombings of schools and hospitals. What cruelty!” Shade on any Jew – Israeli, American or other – who still supports Israel’s genocidal war against the Palestinians. May their Hanukkahs be dark!

A deliberate decision to kill civilians

We learned this week from an investigation by The New York Times, that in the days after the Oct. 7 Hamas outrages, Israeli leaders specifically changed military rules of engagement to allow up to 100 civilians to be killed for every high-ranking Hamas militant targeted, and 20 civilians for every rank-and-file militant. The latter weren’t necessarily armed or uniformed, billeted in barracks, or travelling in convoys. They might be seasonal fighters, recently mobilized, or even just lookouts or money changers – in effect, Hamas affiliated gofers. When killed, they might have been in bed with their wives, seated at family dinners, or playing with their children. A successful attack is one that kills the target and inevitably everyone near them – right up to the predetermined limit.

In practice, many more Palestinian civilians are killed than even the high number permitted by Israeli officials. The bomb that killed Ibrahim Biari, a senior Hamas commander in October 2023, according to the Times, also killed 125 others, including many small children. Israeli government war protocols mean that 25 of that number were innocents. Which 25?  The first or the last 25 dead? The youngest or the oldest 25 victims?

In addition to the deaths-per-strike ratio, the Israeli military established a civilian death cap of 500 per day, in effect a quota. If on Tuesday, 499 non-combatants are killed, medals may be awarded. If on Wednesday, the number is 501, an official expression of regret is due, like the following, issued by Netanyahu after the bombing of a tent camp at Tel al-Sultan in Rafah in southern Gaza in May 2024, setting it ablaze: “Despite our utmost efforts not to harm innocent civilians, last night, there was a tragic mistake. We are investigating the incident and will obtain a conclusion because this is our policy.” An IDF spokesman quickly walked back even that limited mea culpa, claiming without evidence, that the fire was caused by munitions stored in the tent camp. The more likely source of secondary explosions was cooking gas cylinders.

Subsequent investigations revealed that Israel knew full well that the camp was densely packed with refugees, and that its U.S. made GBU-39 bombs propelled lethal shrapnel and metal fragments as far as 600 meters. It’s also now clear that according to its revised rules of engagement, the deaths of as many as 200 civilians was considered a fair cost for whacking Yassin Rabia and Khaled Nagar, two senior Hamas officials, on May 26, 2024. In fact, the Israeli military and civilian leadership might have congratulated itself; that bomb killed only 150.

Hamas militants have been killed by munitions grossly disproportionate to their purpose. Unguided 2,000-pound bombs, supplied by the U.S., have leveled entire apartment buildings. The consequence is an average daily death rate in Gaza higher than any other conflict this century. At least 10% of the pre-war Gaza population of 2.3 million has been killed or wounded, or else is missing or detained by  Israeli security. Some detainees have been tortured. A third of the total casualties in Gaza are children. A report prepared by the EU representative for human rights Olof Skoog, (obtained by The Intercept) determined that because the Gaza death toll matches the regions demographic breakdown, indiscriminate attacks – war crimes — are occurring. If it were otherwise, a far greater percentage of young men than women and children would be dying.

 The Hanukkah blessing

This Hanukkah, my daughter Diane (aka Sarah, after the biblical matriarch) is visiting us from Pasadena, CA. We both recently fled in opposite directions; she west, to escape an abusive husband in Chicago; my wife Harriet and I east, to Norwich, U.K. to evade incipient American fascism.  We also left because we wanted to be closer to Harriet’s two daughters and her increasingly frail parents. On each night of Hanukkah – it commenced this year on December 25 — Sarah has lit the candles while I recited the single prayer I know:

בָּרוּךְ אַתָּה, יְיָ
אֱלֹהֵֽינוּ, מֶֽלֶךְ הָעוֹלָם,
אֲשֶׁר קִדְּשָֽׁנוּ בְּמִצְוֺתָיו
וְצִוָּֽנוּ לְהַדְלִיק נֵר שֶׁל חֲנֻכָּה.

Baruch atah, Adonai Eloheinu, Melech haolam, asher kid’shanu b’mitzvotav v’tsivanu l’hadlik ner shel Hanukkah.

The blessing starts, like most Jewish prayers, with an encomium to the master on high: “Blessed are You, Adonai our God, Sovereign of all…”  (I’ve always hated the bowing and scraping in Jewish prayers, but the blessing gets better) “…who honors us with moral action”.  Mitzvot ( מִצְוָה) is usually translated “commandments,” but my version isn’t wrong, and it allows us to embrace the righteous obligation to justice felt by generations of Jewish dissidents and activists. Hanukkah for me is a link between the past and a redeemed or post-revolutionary future.

The candles Sarah lights are the cheap kind I grew up with — corkscrewed and fragile, fast burning and messy. They leave droplets of green, blue, purple or orange wax on our steel and brass menorah and Formica countertop. After about 20 minutes, they flicker out. Each night, I’ve watched the last candle flame die. Sometimes, it’s the Shamash, the light that delivers light to the others.

It’s unclear now, when the Palestinians in Gaza will be delivered from their torment — their second Nakba — or who will help bring them the light of peace and justice. But given their resilience, they will in time recover and thrive as a community. The Jewish people also suffered a scourge – a Holocaust even greater in scale — and yet survived and prospered, both as a global diaspora and in eretz Israel, historic Palestine. But how will Israeli Jews and their supporters in the U.S. ever overcome the shame they must feel – if not now then soon — for what they have wrought in Gaza?

Stephen F. Eisenman is emeritus professor at Northwestern University. His latest book, with Sue Coe, is titled “The Young Person’s Guide to American Fascism,” and is forthcoming from OR Books. He can be reached at s-eisenman@northwestern.edu  

 

A special collection to address challenges and interdisciplinary frontiers in solar energy meteorology

Institute of Atmospheric Physics, Chinese Academy of Sciences

 

image: 

This special topic on Solar Energy Meteorology highlights the many variables, including cloudy conditions and energy conversion, that pose significant scientific challenges to solar energy efficiency.

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Credit: Advances in Atmospheric Sciences

Solar energy has emerged as one of the most efficient and cost-effective renewable energy technologies capable of reducing the planet's dependence on fossil fuels. 

Solar energy efficiency isn't entirely trivial, however. In the past, most solar energy challenges were delegated solely to solar engineers. Today, an entire new field of meteorology, solar energy meteorology, has been developed specifically to address various challenges of converting solar energy into electricity.

One aspect of solar energy meteorology is to assess the long-term solar resource availability in various locations to develop solar electricity farms in the most efficient and cost-effective locations. On the other hand, solar energy meteorology must also address the second-to-second and day-to-day fluctuations in solar energy availability due to weather variations. This solar forecasting arm of solar energy meteorology helps energy providers efficiently schedule the use of different power systems in the shorter term.

Atmospheric scientists and solar energy engineers have approached the solar efficiency problem — understandably — from the perspective of their own disciplines and expertise. In order to effectively identify and address all of the challenges facing solar energy meteorology, however, the two fields must collaborate  to tackle issues from an interdisciplinary perspective.

To highlight the pressing nature of this dilemma and the most recent developments in the field, the journal Advances in Atmospheric Science recently published a special topic on solar energy meteorology. This issue consists of five invited articles featuring progress and challenges in satellite remote sensing, solar system modeling, photovoltaic power forecasting, thermal balance of solar panels and decarbonization strategy. 

“In the meteorological community, there is a common misconception that obtaining precise and accurate meteorological data will automatically lead to high-quality solar power estimates,” said Dazhi Yang, professor at the Harbin Institute of Technology and one of the guest editors of the special topic. 

The accuracy of meteorological data is only part of the solar energy efficiency hurdle that must be addressed by solar energy meteorology, however. “[In this special topic issue,] we stress that as an emerging interdisciplinary field, solar meteorology urgently requires both the atmospheric science and solar engineering communities to set aside disciplinary biases and gain a deeper understanding of the critical scientific and technical issues in interdisciplinary research,” said Yang.

“An additional aim of this special topic is to share expert perspectives and showcase the latest research advancements in solar meteorology, enabling atmospheric scientists to access relevant information when developing technologies and methods for solar energy applications,” said Xiang'ao Xia, from the Institute of Atmospheric Physics at the Chinese Academy of Sciences (IAP), also the guest editor of the special topic. 

The invited articles, contributed by established scientists from China, USA, Germany and Hungary, each feature a different aspect of solar energy meteorology, ranging from power forecasting to calculation:

• “Fengyun radiation services for solar energy meteorology: Status and perspective” written by Xia, Yang and Yanbo Shen summarizes the current surface solar irradiance information, or amount of radiant energy a specific area of the Earth receives from the sun, obtained by the Fengyun-4 satellites. The paper also analyzes how the coverage, timeliness and accessibility of this and future information from a new generation of satellites can be leveraged for future solar energy meteorology forecasting.
• “Strategic Global Deployment of Photovoltaic Technology: Balancing Economic Capacity and Decarbonization Potential”, a perspectives article written by Ian Marius Peters from the Forschungszentrum Jülich GmbH Helmholtz-Institute Erlangen-Nürnberg for Renewable Energies (HI ERN) in Erlangen, Germany stresses that the most effective means of global decarbonization may be counterintuitive. There is currently a mismatch worldwide between countries that can afford to install solar power panels and those where solar panel installation would maximize global decarbonization benefits. The paper argues that society must acknowledge this discrepancy and organize efforts to make capital and other resources available to less economically developed countries to increase global decarbonization efficiency.
• “A Second Tutorial Review of the Solar Power Curve: Applications in Energy Meteorology” focuses on the various applications of solar power curves, which are used to estimate the amount of electricity generated based on several meteorological variables. This comprehensive review is contributed by scientists from School of Electrical Engineering and Automation at the Harbin Institute of Technology, IAP/CAS, the Public Meteorological Service Centre at the China Meteorological Administration, and the Department of Energy Engineering and the Faculty of Mechanical Engineering at Budapest University of Technology and Economics in Budapest, Hungary
• “Improving Model Chain Approaches for Probabilistic Solar Energy Forecasting through Post-processing and Machine Learning” argues that post-processing steps that account for systemic errors in forecast models improve the accuracy of solar power production forecasts. The team used both machine-learning (ML) and statistical post-processing methods, and the ML strategy slightly outperformed the statistical strategy. It's written by Nina Horat and Sina Klerings from the Institute of Statistics at the Karlsruhe Institute of Technology in Karlsruhe, Germany and Sebastian Lerch from Institute of Statistics at the Karlsruhe Institute of Technology and the Heidelberg Institute for Theoretical Studies in Heidelberg, Germany
• “Energy Meteorology for the Evaluation of Solar Farm Thermal Impacts on Desert Habitats” focuses on the effects of large solar power plant impacts on the environment and how the environment can affect the power plant. While some of the variables, such as temperature, are easier to quantify, others, including dust concentration, ground condition and panel angle, are more difficult to assess. These factors, among others, contribute to the complexity of determining the impact of solar farms on their environment and vice versa. The article is written by Carlos F. M. Coimbra from the Department of Mechanical and Aerospace Engineering, Jacobs School of Engineering, Center of Excellence in Renewable Resource Integration and Center for Energy Research at the University of California San Diego in La Jolla, California.

While there is still much work to be done in the field of solar energy meteorology, Yang and Xia hope that highlighting current developments in the field will encourage atmospheric scientists and solar energy scientists to collaborate and overcome many of these challenges. “The current transition in the energy mix — from one dominated by fossil fuels to one primarily reliant on renewables — is not solely the responsibility of energy engineers. We want to take this opportunity to emphasize that understanding the mechanisms and uncertainties involved in solar energy harvesting, as well as how this energy is delivered to users via the electricity grid, is very crucial.”They said in the preface of the special topic. 

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Journal

Advances in Atmospheric Sciences

Article Publication Date

28-Dec-2024

Solar-powered charging! Korea’s first self-charging supercapacitors developed

DGIST (Daegu Gyeongbuk Institute of Science and Technology)

□ 

Jeongmin Kim, Senior Researcher at DGIST (President Kunwoo Lee), in joint research with Damin Lee, Researcher at the RLRC[1] of Kyungpook National University (President Young-woo Heo), has developed a high-performance self-charging energy storage device capable of efficiently storing solar energy. The research team has dramatically improved the performance of existing supercapacitor devices by utilizing transition metal-based electrode materials and proposed a new energy storage technology that combines supercapacitors with solar cells.

 

□ The research team designed the electrodes using a nickel-based carbonate and hydroxide composite material and maximized the conductivity and stability of the electrodes by adding transition metal ions such as Mn, Co, Cu, Fe, and Zn. This technology has greatly improved the performance of energy storage devices, demonstrating significant advancements in energy density, power density, and charge and discharge stability.

 

□ Particularly, the energy density achieved in this study is 35.5 Wh kg⁻¹, which is significantly higher than the energy storage per unit weight in previous studies (5-20 Wh kg⁻¹). The power density is 2555.6 W kg⁻¹, significantly exceeding the values from previous studies (- 1000 W kg⁻¹), demonstrating the ability to release higher power rapidly, enabling immediate energy supply even for high-power devices. Additionally, the performance showed minimal degradation during repeated charge and discharge cycles, confirming the long-term usability of the device.

 

□ Furthermore, the research team developed an energy storage device that combines silicon solar cells with supercapacitors, creating a system capable of storing solar energy and utilizing it in real time. This system achieved an energy storage efficiency of 63% and an overall efficiency of 5.17%, effectively validating the potential for commercializing the self-charging energy storage device.

 

□ Jeongmin Kim, Senior Researcher at the Nanotechnology Division of DGIST, states, “This study is a significant achievement, as it marks the development of Korea’s first self-charging energy storage device combining supercapacitors with solar cells. By utilizing transition metal-based composite materials, we have overcome the limitations of energy storage devices and presented a sustainable energy solution.” Damin Lee, a researcher at the RLRC of Kyungpook National University, stated, “We will continue to conduct follow-up research to further improve the efficiency of the self-charging device and enhance its potential for commercialization.”

 

□ This research was conducted with support from DGIST’s Institutional Core Projects, the Early Career Researcher Projects, and the Kyungpook National University’s Regional Leading Research Center for Carbon-Neutral Intelligent Energy System. The research findings were published in the prestigious journal Energy (ranked in the top 3.2% of JCR) in December.

 - Corresponding Author E-mail Address : jkim@dgist.ac.kr
 

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[1] RLRC of Kyungpook National University: Regional Leading Research Center for Carbon-Neutral Intelligent Energy System

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Journal

Energy

DOI

10.1016/j.energy.2024.133593 

Article Title

Design of high-performance binary carbonate/hydroxide Ni-based supercapacitors for photo-storage systems

Article Publication Date

30-Dec-2024

 

DGIST created a triple-layer battery resistant to fire and explosion

DGIST (Daegu Gyeongbuk Institute of Science and Technology)

 A research team from DGIST's (President Kunwoo Lee) Division of Energy & Environmental Technology, led by Principal Researcher Kim Jae-hyun, has developed a lithium metal battery using a “triple-layer solid polymer electrolyte” that offers greatly enhanced fire safety and an extended lifespan. This research holds promise for diverse applications, including in electric vehicles and large-scale energy storage systems.

 

□ Conventional solid polymer electrolyte batteries perform poorly due to structural limitations which hinder an optimal electrode contact. This could not eliminate the issue of “dendrites” either, where lithium grows in tree-like structures during repeated charging and discharging cycles. Dendrites are a critical issue, as an irregular lithium growth can disrupt battery connections, potentially causing fires and explosions.

 

□ The research team, therefore, developed a triple-layer structure for the electrolyte to address such issues. Each layer serves a distinct function, significantly enhancing the battery’s safety and efficiency. This electrolyte incorporates “decabromodiphenyl ethane (DBDPE)” to prevent fires, “zeolite” to enhance the electrolyte's strength, and a high concentration of a lithium salt, “lithium bis (trifluoromethanesulfonyl) imide) (LiTFSI),” to facilitate a rapid movement of lithium ions.

 

□ The triple-layer solid electrolyte features a robust middle layer that boosts the battery's mechanical strength, while its soft outer surface ensures an excellent electrode contact, facilitating an easy movement of lithium ions. This enables a faster movement of lithium ions, enhancing energy transfer rates and preventing dendrite formation effectively.

 

□ The experiment showed that the battery developed by the research team retained about 87.9% of its performance after 1,000 charging and discharging cycles, demonstrating a notable improvement in durability compared with traditional batteries, which typically maintain 70–80% of their performance. It can also extinguish itself in a fire, thus significantly reducing the fire risk. This battery is expected to be applicable across various sectors, ranging from small devices like smartphones and wearables to electric vehicles and large-scale energy storage systems.

 

□ Dr. Kim stated, "This research is anticipated to make a significant contribution to the commercialization of lithium metal batteries using [solid polymer] electrolytes, while providing enhanced stability and efficiency [to] energy storage devices."

 

□ This study was supported by the Future Materials Discovery Project (led by Professor Lee Jung-ho of Hanyang University) and the Mid-Career Researcher Program (led by Dr. Kim Jae-hyun) of the National Research Foundation of Korea. The findings were published as the cover article in an international academic journal, Small, published by Wiley.

 

- Corresponding Author E-mail Address : jaehyun@dgist.ac.kr

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Journal

Small

DOI

10.1002/smll.202406200 

Article Title

Triple-Layered Noncombustible PEO-Based Solid Electrolyte for Highly Safe Lithium-Metal Batteries

 FOR PROFIT HEALTHCARE U$A

Improved health care value cannot be achieved by hospital mergers and acquisitions alone

New study finds that only about one in five health care integrations leads to improved value of care delivery

American College of Surgeons

Key Takeaways

• A new study finds little evidence that hospital mergers and acquisitions reduce costs or improve quality of care.

• More strategic quality improvement efforts are needed for patients to benefit from health care integration.

CHICAGO (December 30, 2024) — Mergers and acquisitions of U.S. hospitals and health systems rarely improve the quality of care delivered or result in lower health care costs and prices, according to a study published in the Journal of the American College of Surgeons (JACS).

The study, a systematic review of hundreds of published studies, comes amid accelerating health care integration, sometimes called consolidation. Nearly 70 percent of U.S. hospitals are now affiliated with a health system.

“Proponents of health care integration have claimed it controls costs and enhances care quality,” said lead study author Bhagwan Satiani, MD, MBA, FACS, professor of surgery emeritus at The Ohio State University Wexner Medical Center, Columbus, Ohio. “But we found that evidence is lacking that integration alone is an effective strategy for improving the value of health care delivery.”

The study results send a clear message to health care leaders, Dr. Satiani said.

“These findings provide an opportunity to better define value with a focus on benefiting patients while balancing the financial stability of the health care industry,” he said. “Quality improvement in health care cannot be achieved by mergers and acquisitions alone.”

Effects of Health Care Integration

The authors’ systematic review included studies published from 2000-2024. Of these, 37 met inclusion criteria. Among the 26 studies that measured quality of care, nearly 77 percent (20 studies) showed reduced quality or no change due to integration, the investigators reported. Only 23 percent (six studies) showed improved quality, primarily due to better care management processes rather than outcomes. Just one study found fewer patient deaths after integration.

Hospital charges increased with integration 93 percent of the time, according to 13 of 14 studies measuring price changes. Of 16 studies assessing health care spending, 81 percent (13 studies) showed higher costs or no change.

The researchers also reported the net impact of integration on quality, price, and spending:

• Only eight of 37 studies (22 percent) showed that health care integration had a positive (improved) net impact.
• More than half (54 percent, 20 studies) showed a negative (worse) net impact.

In noting limitations of their review, Dr. Satiani said none of the reviewed studies used standard measures of quality, price, or spending. Also, most studies did not explore reasons for a lack of change in health care value after integration.

How this Study Differs from Previous Research

Although other researchers have reached similar conclusions, Dr. Satiani said their study differed in two ways. First, most studies of health care integration appear in health policy and economics publications and do not reach many surgeons, he noted. Yet, surgical services affect health organizations’ bottom line, accounting for about one third of U.S. health care expenditures.

“Surgical outcomes also have a direct impact on overall health care quality,” he said.

Second, Dr. Satiani said few of the published studies were systematic reviews, which are intended to reduce bias.

In this study, after screening 1,297 U.S. articles published from 1990 to 2024, the investigators systematically reviewed 384 of them that discussed either horizontal or vertical health care integration. They defined horizontal integration as two or more hospitals merging and vertical integration as hospitals acquiring independent physician practices.

To be included in the review, articles must have reported at least one of three measures of value: quality, price, and spending. Quality referred both to patient outcomes, such as the number of 30-day readmissions or deaths, and to care management processes. Such processes included staffing levels and use of nurse care managers. Price denoted the amount the organization charges the consumer per hospitalization, and spending was the organization’s costs per patient.

Focus on Quality Improvement

Dr. Satiani said health care leaders should delineate organizational resources and infrastructure to quality improvement efforts and standardize quality metrics. As a model for quality improvement, he suggested the American College of Surgeons Quality Verification Program as a model improving surgical quality.

Study coauthors are David Way, MEd; David Hoyt, MD, FACS; and E. Christopher Ellison, MD, FACS.

The study authors have no relevant disclosures.

This study is published as an article in press on the JACS website.

Citation: Satiani B, Way DP, Hoyt DE, Ellison EC. A Systematic Review of Integration Strategies Across the U.S. Healthcare System Shows No Consistent Improvement in Price, Cost Reduction, or Quality of Care. Journal of the American College of Surgeons. DOI: 10.1097/XCS.0000000000001229

# # #

About the American College of Surgeons

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has approximately 90,000 members and is the largest organization of surgeons in the world. "FACS" designates that a surgeon is a Fellow of the American College of Surgeons.

Follow the ACS on social media: X | Instagram | YouTube | LinkedIn | Facebook

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Journal

Journal of the American College of Surgeons

DOI

10.1097/XCS.0000000000001229 

Article Title

A Systematic Review of Integration Strategies Across the U.S. Healthcare System Shows No Consistent Improvement in Price, Cost Reduction, or Quality of Care

Article Publication Date

30-Dec-2024

Billing patients for portal messages could decrease message volume and ease physician workload

Peer-Reviewed Publication

American College of Physicians

Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.          
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1. Billing patients for portal messages could decrease message volume and ease physician workload  

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-01711  

URL goes live when the embargo lifts            

A retrospective observational study found that a program that enabled billing patients for portal messages slightly decreased the volume of patient-initiated messages. The results suggest portal message billing could help to reduce portal message burden, which contributes to provider burnout. The study is published in Annals of Internal Medicine.  

  

Researchers from the Mayo Clinic studied data between 18 August 2023 through 18 February 2024 to determine the effects of the implementation of billing for patient-initiated portal messages on patients and physicians and advanced practice providers at Mayo Clinic sites in four U.S. states. The researchers compared the results with electronic health record (EHR) data from the same period between 2022 and 2023. Portal messages eligible for e-billing met the following criteria: patient-initiated, established patient, new or multiple symptoms or concerns, and requiring 5 minutes or more to assess and respond. Before sending a portal message, a pop-up screen notified the patient of the potential to be billed for a response to the message. The researchers identified all instances where a patient initiated a message and viewed the billing disclaimer. They then compared the use of Mayo Clinic facilities, including emergency departments and outpatient office visits, in the seven days after viewing the billing disclaimer and proceeding to send a message versus those who did not. Finally, the researchers conducted an online survey to assess providers’ perceptions of billing for patient portal messages. The results found that implementation of e-visit billing was associated with an 8.8% decrease in patient-initiated medical advice messages between the two time periods. Only 0.3% of medical advice messages were ultimately billed, and there was no difference in 7-day use of emergency services in patients who sent a message versus those who did not after viewing the billing disclaimer. Providers with experience using e-visit billing reported overall acceptance of the process, however, 66.1% of providers did not perceive an effect on the volume of messages received. These findings suggest that billing for portal messages is both feasible and acceptable to providers and has potential to decrease provider workload.  

 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Shannon M. Dunlay, MD, MS please email Vincent Jacobbi at Jacobbi.Vincent@mayo.edu.  

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2. ACP develops framework to standardize approach, use of economic evidence for clinical guidelines 

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-02149 

URL goes live when the embargo lifts          

The American College of Physicians (ACP), in recognition of accelerating health care spending and the impact on patients, has developed a framework that aligns with ACP principles of promoting high-value care, to standardize its approach to identifying, appraising, and considering economic evidence in the development of ACP clinical guidelines. The framework is published in Annals of Internal Medicine. 

 

The framework presents and explains the process that ACP’s Clinical Guidelines Committee (CGC) utilizes for incorporating economic evidence into clinical recommendations. Eligible economic evidence includes cost-effectiveness analyses, economic outcomes in randomized controlled trials, and resource utilization (intervention cost) data. To develop a clinical recommendation, the committee first and foremost assesses the best available evidence for the clinical net benefit of interventions, weighing the benefits and harms. In addition, patient values and preferences play a major role in formulating the recommendations.  After assessing if an intervention has clinical net benefit, economic evidence may be considered in prioritizing among recommended interventions of equal effectiveness or modifying the strength of recommendations. The committee’s goal is to always inform clinicians about intervention cost to enhance awareness about the burden on our patients and support shared cost-conscious prescribing in real-life settings. 

 

ACP has been a global leader in the development of clinical guidelines and advancing science and methods. This framework represents a new advancement in guideline development that will continue to ensure that clinical recommendations consider factors important for physician, patient, public, and health system decision-making to deliver and receive high-value, sustainable health care. 

 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with someone from ACP, please contact Andrew Hachadorian at ahachadorian@acponline.org. 

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Also new in this issue: 

The Nuances of Performance Measurement and Clinical Guidelines 

Amir Qaseem, MD, PhD, MHA et al. 

Ideas and Opinions 

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-02092 

 

Medical Reference Tools and Pharmaceutical Promotion: A History of Entanglement 

Andrew S. Lea, MD, DPhil; Jai Krishan Khurana, AB, AM 

History of Medicine 

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-01959 

 

Misinformation, Identity, and the Basis of Belief 

Dhruv Khullar, MD, MPP; Dannagal G. Young, PhD 

Ideas and Opinions 

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-02844 

 

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Journal

Annals of Internal Medicine

DOI

10.7326/ANNALS-24-01711 

Method of Research

News article

Subject of Research

People

Article Title

Implementation of Billing for Patient Portal Messages as e-Visits in a Large Integrated Health System

Article Publication Date

31-Dec-2024

 

Trends of violence in movies during the past half century

JAMA Network

About The Study: 

The results of this study suggest that speech about committing murder in movies is increasing over time, even in non-crime movies, regardless of character gender. These results are consistent with previous findings that highlighted increasing trends of violence using smaller datasets.

Corresponding Author: To contact the corresponding author, Brad J. Bushman, PhD, email bushman.20@osu.edu.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamapediatrics.2024.5741)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

 https://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2024.5741?guestAccessKey=329c32c0-4782-4216-9860-573fb07343a2&utm_source=for_the_media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=123024

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Journal

JAMA Pediatrics

A rising trend of 'murderous verbs' in movies over 50 years

Study finds all types of movies contain more violence

Ohio State University

The amount of murdering and killing in movies has increased overall over the past 50 years, according to a new study that analyzed a massive database of film dialogue.

 

Researchers used machine learning to search a database of subtitles from more than 160,000 English-language movies produced from 1970 to 2000.  They calculated the amount of dialogue from characters using variations of the words “murder” or “kill” in each of the films.

 

While the total use of these “murderous verbs” varied widely from year to year, there was a clear increasing trend over the five-decade period, said Brad Bushman, corresponding author of the study and professor of communication at The Ohio State University.

 

And not just in crime movies, where violence might be expected.

 

“Characters in noncrime movies are also talking more about killing and murdering today than they did 50 years ago,” Bushman said.

 

“Not as much as characters in crime movies, and the increase hasn’t been as steep. But it is still happening. We found increases in violence cross all genres.”

 

The study was published online today (Dec. 30, 2024) as a research letter in the journal JAMA Pediatrics.

 

Another notable finding was that violent language increased for both male and female characters, said Babak Fotouhi, lead author of the study and adjunct assistant research professor in the College of Information at the University of Maryland.

 

Women generally didn’t have as much violent dialogue as men, but they also did show increases over time.

 

“Our findings suggest that references to killing and murder in movie dialogue not only occur far more frequently than in real life but are also increasing over time,” Fotouhi said.

 

“This is more evidence that violence is a bigger part of the movies we watch than ever before.”

 

For the study, the researchers used movie subtitles from opensubtitles.org to extract dialogue referring to actions committed by characters in 166,534 movies.

The researchers computed the percentage of what they called murderous verbs – the number of verbs from the roots “kill” and “murder” – divided by the total number of verbs in the dialogue. They tracked changes year by year. Overall, about 7% of movies had murderous verbs in dialogue over the period studied.

 

The study counted only murderous verbs used in active construction (such as “She killed X.”). They didn’t count passive constructions (“He was killed by X.”) or negations (“She didn’t kill X.”) or questions (“Did she murder X?”).

 

“We designed this to be a conservative estimate,” Fotouhi said. “It is likely there was more violence in the movies than what we calculated in terms of the dialogue.”

 

One reason this can be considered a conservative estimate is the narrow focus of the study, said co-author Amir Tohidi, a postdoctoral researcher at the University of Pennsylvania.

 

“We focused exclusively on murderous verbs in our analysis to establish a lower bound in our reporting,” Tohidi said. “Including less extreme forms of violence would result in a higher overall count of violence. “

 

While other studies have shown increases in movie violence, the value of this analysis was the huge dataset, the researchers said. No other study has examined such a massive number of films.

 

What’s not clear is how long the trend of increasing violence will continue, Bushman said.

 

“The evidence suggests that it is highly unlikely we’ve reached a tipping point,”

he said.

 

Added Fotouhi: “Movies are trying to compete for the audience’s attention and research shows that violence is one of the elements that most effectively hooks audiences.”

 

That means we need to promote “mindful consumption and media literacy to protect vulnerable populations, especially children,” the researchers wrote in the study.

 

Rouzbeh Touserkani of the Institute for Research in Fundamental Sciences in Tehran, Iran was also a co-author.

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Journal

JAMA Pediatrics

DOI

10.1001/jamapediatrics.2024.5741 

Method of Research

Data/statistical analysis

Subject of Research

Not applicable

Article Title

Trends of Violence in Movies During the Past Half Century

Article Publication Date

30-Dec-2024