Drug overdose deaths up for 11th consecutive year


CHICAGO (AP) — Drug overdose deaths rose for the 11th straight year, federal data show, and most of them were accidents involving addictive painkillers despite growing attention to risks from these medicines.


"The big picture is that this is a big problem that has gotten much worse quickly," said Dr. Thomas Frieden, head of the Centers for Disease Control and Prevention, which gathered and analyzed the data.


In 2010, the CDC reported, there were 38,329 drug overdose deaths nationwide. Medicines, mostly prescription drugs, were involved in nearly 60 percent of overdose deaths that year, overshadowing deaths from illicit narcotics.


The report appears in Tuesday's Journal of the American Medical Association.


It details which drugs were at play in most of the fatalities. As in previous recent years, opioid drugs — which include OxyContin and Vicodin — were the biggest problem, contributing to 3 out of 4 medication overdose deaths.


Frieden said many doctors and patients don't realize how addictive these drugs can be, and that they're too often prescribed for pain that can be managed with less risky drugs.


They're useful for cancer, "but if you've got terrible back pain or terrible migraines," using these addictive drugs can be dangerous, he said.


Medication-related deaths accounted for 22,134 of the drug overdose deaths in 2010.


Anti-anxiety drugs including Valium were among common causes of medication-related deaths, involved in almost 30 percent of them. Among the medication-related deaths, 17 percent were suicides.


The report's data came from death certificates, which aren't always clear on whether a death was a suicide or a tragic attempt at getting high. But it does seem like most serious painkiller overdoses were accidental, said Dr. Rich Zane, chair of emergency medicine at the University of Colorado School of Medicine.


The study's findings are no surprise, he added. "The results are consistent with what we experience" in ERs, he said, adding that the statistics no doubt have gotten worse since 2010.


Some experts believe these deaths will level off. "Right now, there's a general belief that because these are pharmaceutical drugs, they're safer than street drugs like heroin," said Don Des Jarlais, director of the chemical dependency institute at New York City's Beth Israel Medical Center.


"But at some point, people using these drugs are going to become more aware of the dangers," he said.


Frieden said the data show a need for more prescription drug monitoring programs at the state level, and more laws shutting down "pill mills" — doctor offices and pharmacies that over-prescribe addictive medicines.


Last month, a federal panel of drug safety specialists recommended that Vicodin and dozens of other medicines be subjected to the same restrictions as other narcotic drugs like oxycodone and morphine. Meanwhile, more and more hospitals have been establishing tougher restrictions on painkiller prescriptions and refills.


One example: The University of Colorado Hospital in Aurora is considering a rule that would ban emergency doctors from prescribing more medicine for patients who say they lost their pain meds, Zane said.


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Stobbe reported from Atlanta.


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Online:


JAMA: http://www.jama.ama-assn.org


CDC: http://www.cdc.gov


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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com


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Appeals court revives women inmates' bid for Wiccan chaplain















Central California Women's Facility


At the Central California Women's Facility in Chowchilla, shown, inmates are contending in a lawsuit that California prison policy favors mainstream religions in violation of the establishment clause of the 1st Amendment.
(Los Angeles Times)





































































A federal appeals court revived a lawsuit Tuesday by female prisoners who contend that the California prison system is violating their rights by refusing to hire a full-time Wiccan chaplain.


A district court rejected the inmates' suit, but a three-judge panel of the U.S. 9th Circuit Court of Appeals ruled that the inmates may have a valid claim.


The California Department of Corrections and Rehabilitation hires chaplains for five faiths: Protestant, Catholic, Jewish, Muslim and Native American. Inmates of other religions are permitted to worship with those chaplains or with volunteer chaplains.





In their lawsuits, inmates at the Central California Women's Facility in Chowchilla contend that the prison policy favors mainstream religions in violation of the establishment clause of the 1st Amendment. The inmates said there were more Wiccans at the women's prison than there were Jewish, Muslim or Catholic prisoners.


Wicca is a pagan religion that involves witchcraft. If the inmates' allegations are true, the appeals court said, "The prison administration has created staff chaplain positions for five conventional faiths, but fails to employ any neutral criteria in evaluating whether a growing membership in minority religions warrants a reallocation of resources."


The court stressed that it was not suggesting the lawsuit should succeed. A lower court must now evaluate the evidence, including a survey of the religious affiliations of inmates at the prison, the panel said.


maura.dolan@latimes.com






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Seeking Direction in Yemen

Yemenis gathered in Change Square in the capital, Sana, this month. Two years after the start of the country’s uprising, the square is almost empty of protesters. 


Yemen, having pulled back from the brink of war in 2011, is slowly embarking on a national dialogue aimed at reconciling its rancorous political factions, under the watchful eyes of Arab and Western monitors.

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Mindy McCready: Under Police Scrutiny at Time of Suicide?















02/18/2013 at 06:00 PM EST







Mindy McCready and David Wilson


Courtesy Mindy McCready


When Mindy McCready talked to police in recent weeks, her account of how her boyfriend came to be found with a fatal gunshot wound to the head concerned police, a law enforcement source tells PEOPLE.

"At first, she said she hadn't heard the gunshot because the TV was too loud. Then she said she had heard the gunshot," the source says. "So obviously there were a lot of questions, and the Sheriff was asking for clarification."

But before investigators could re-interview her, the long-troubled country singer also would die under eerily similar circumstances, her body discovered at the same Heber Springs, Ark., house just feet away from where David Wilson died.

McCready's death was blamed on what "appears to be a single self-inflicted gunshot wound," the Cleburne County Sheriff's Office said in a statement.

This differed from how the sheriff characterized Wilson's case. His cause and manner of death still have not been established by the coroner. It was McCready's publicist, and not a law enforcement official, who announced that Wilson had died of a self-inflicted gunshot wound.

After Wilson's death, McCready, 37, spoke to investigators three times, but they didn't feel as if they were through with her.

"At no point did [police] tell her she was a suspect, and she wasn't officially one," says the source. "But she knew that some of her answers didn't stand up to questioning. She was very cooperative, but she just wasn't making a lot of sense."


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Hip implants a bit more likely to fail in women


CHICAGO (AP) — Hip replacements are slightly more likely to fail in women than in men, according to one of the largest studies of its kind in U.S. patients. The risk of the implants failing is low, but women were 29 percent more likely than men to need a repeat surgery within the first three years.


The message for women considering hip replacement surgery remains unclear. It's not known which models of hip implants perform best in women, even though women make up the majority of the more than 400,000 Americans who have full or partial hip replacements each year to ease the pain and loss of mobility caused by arthritis or injuries.


"This is the first step in what has to be a much longer-term research strategy to figure out why women have worse experiences," said Diana Zuckerman, president of the nonprofit National Research Center for Women & Families. "Research in this area could save billions of dollars" and prevent patients from experiencing the pain and inconvenience of surgeries to fix hip implants that go wrong.


Researchers looked at more than 35,000 surgeries at 46 hospitals in the Kaiser Permanente health system. The research, published Monday in JAMA Internal Medicine, was funded by the U.S. Food and Drug Administration.


After an average of three years, 2.3 percent of the women and 1.9 percent of the men had undergone revision surgery to fix a problem with the original hip replacement. Problems included instability, infection, broken bones and loosening.


"There is an increased risk of failure in women compared to men," said lead author Maria Inacio, an epidemiologist at Southern California Permanente Medical Group in San Diego. "This is still a very small number of failures."


Women tend to have smaller joints and bones than men, and so they tend to need smaller artificial hips. Devices with smaller femoral heads — the ball-shaped part of the ball-and-socket joint in an artificial hip — are more likely to dislocate and require a surgical repair.


That explained some, but not all, of the difference between women and men in the study. It's not clear what else may have contributed to the gap. Co-author Dr. Monti Khatod, an orthopedic surgeon in Los Angeles, speculated that one factor may be a greater loss of bone density in women.


The failure of metal-on-metal hips was almost twice as high for women than in men. The once-popular models were promoted by manufacturers as being more durable than standard plastic or ceramic joints, but several high-profile recalls have led to a decrease in their use in recent years.


"Don't be fooled by hype about a new hip product," said Zuckerman, who wrote an accompanying commentary in the medical journal. "I would not choose the latest, greatest hip implant if I were a woman patient. ... At least if it's been for sale for a few years, there's more evidence for how well it's working."


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Online:


Journal: http://www.jamainternalmed.com


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State program to seize illegal guns gaining notice









CE: lraab 76090


lrh—ext 75886 / jlavally slotted


By law, Alexander Hernandez should have surrendered his gun to the state of California three years ago after a judge issued a restraining order against him for alleged domestic violence.





He didn't.


So one night recently , when the 26-year-old was at home in Whittier with his toddler, eight armed agents from the California Department of Justice banged on his door and took it from him.


Agents found the loaded .45-caliber handgun in a safe by his bed. Hernandez, who told the agents he had forgotten that he was supposed to turn in the weapon, was arrested on suspicion of illegally possessing a handgun, records show.


After assuring that the child had a baby-sitter, the agents drove off into the night in search of more illegal guns. Their quest took them across the San Gabriel Valley, from a retirement home to a gated community to a small house with rosebushes in front. In the living room of that house, a mother wept as agents arrested her son. A conviction for misdemeanor battery made it illegal for him to continue possessing his four guns.


California has the nation's only program to confiscate guns from people who bought them legally but later became disqualified. During twice-weekly sweeps over the last five years, agents have collected more than 10,000 guns.


But there are still more than 19,700 people on the state's Armed Prohibited Persons database. Collectively, they own about 39,000 guns. About 3,000 people are added to the list each year.


Clearing the backlog would cost $40 million to $50 million, according to Atty. Gen. Kamala Harris. She estimated that once the backlog is cleared, fielding teams large enough to keep up with people added to the list would cost about $14 million a year.


"This is about prevention," Harris said. "This is about taking guns out of the hands of people who are prohibited from owning them, and are known to be potentially some of the most dangerous people walking around.... It's just common sense."


As gun control has moved to the forefront of national debate, California's program is being studied as a potential model.


The list of prohibited owners is compiled by analysts who track gun sales back to 1996 and match them against databases listing criminal convictions, restraining orders and mental health detentions.


Sometimes the guns are used in killings before the state can retrieve them, according to state Sen. Mark Leno (D-San Francisco), who last month introduced legislation that would provide funding for more agents to conduct sweeps.



For example, Roy Perez had been on the list for three years before he shot and killed his mother, his neighbor and his neighbor's 4-year-old in Baldwin Park in 2008, officials said.



Until recently, the gun apprehension teams had received little attention in the five years they have been sweeping through neighborhoods. But they suddenly have become a topic of intense interest — so much so that when agents rolled through Southern California earlier this month , their big, unmarked trucks were joined by two agents in a rented minivan large enough to carry journalists and camera crews.


The job requires a mixture of force and finesse. The agents show up in heavily armed teams, wearing black jumpsuits bulked up by bulletproof vests. But they don't have warrants and, unless their subject is on probation, they need permission to enter homes to search for guns. Obtaining a search warrant typically requires a reasonable suspicion that the gun would be on the premises, a difficult standard to meet based solely on information from a database, officials said.


Instead, they must talk their way in and coax gun owners into turning over their weapons.





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The Lede: Answering Readers’ Questions About the Meteorite Strike in Russia

You asked us great meteor questions, readers, ones that went beyond the mere fact of the seriously cool video coming from all over Russia. But we wanted to give you a deeper look at the science behind bombardments from space, so we called in a respected source to help.

Clark R. Chapman is a senior scientist at the Southwest Research Institute in San Antonio and a pioneer in the field of asteroid threat assessment. He is co-author of the 1989 book, “Cosmic Catastrophes,” with David Morrison, a senior scientist at the NASA Ames Research Center in Mountain View, Calif.

This is an unusual strike. It will take a while for analysis of the videos, and presumably of the seismic records of the explosion, before we can estimate the size of the projectile. I’m guessing it’s a once-in-a-decade kind of event.

Why unusual?

It’s unusual in the sense that it’s rare. It’s not the kind of event that happens very often. Also, they’re talking about maybe 1,000 people injured and some in the hospital. I’m not aware of a strike that has caused that much injury. That’s because it hit in a somewhat populated part of Russia, instead of the ocean or the desert or the middle of Siberia where relatively few people would have got hurt.

These things happen continually. This one was probably a few meters in diameter but they’re flying by the Earth all the time. And they hit – ones this big – maybe once in a decade. Things that would really devastate a city if they hit would occur maybe once every few centuries. It happens on a scale (of meteors small and large). Anyone living out in the countryside or a rural area, if the skies are clear, can look up at night and see apple-seed-size meteors hitting every few minutes, or at least every few hours.

Conceivably it could be part of a swarm, but it’s not associated with DA14 [the big asteroid that is to fly close by the Earth on Friday]. They’re on totally different trajectories. I don’t have the numbers in front of me, but their orbits are totally different. They both intersect the Earth, more or less, but the asteroid is moving maybe south to north and the Russian meteorite west to east. They’d have to be coming in the same direction to be part of a swarm. It’s a remarkable coincidence that what may be the most damaging meteor strike in modern history would happen on the same day as the closest passage of an asteroid as big as DA14.

How big is DA14?

It’s about 100 feet across.

Should we be scared? What can we do?

The estimated danger from a large impact has dropped in recent decades because of telescopic observations and sky surveys. We should continue to monitor the skies for undiscovered large asteroids and for very much smaller ones that could still be quite dangerous, depending on where they hit. We should continue to look.

No space telescope now searches for such threats. Would such a device help?

That kind of project wouldn’t find what hit Russia (as the asteroid was too small) but it would find ones that are much more dangerous. And once they were detected, we could warn people. We could say, “It’s going to hit such an area at a certain time on a certain day and you should stay away from the windows.” You could provide warning of impacts that could be dangerous.

Could we divert a planetary threat?

If it’s found early enough – quite a few years in advance of its hitting – then NASA and the European Space Agency and other space agencies have the technology to divert the asteroid so it would miss the Earth.

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Mindy McCready Is Dead in Apparent Suicide






Breaking News








02/17/2013 at 09:30 PM EST



Country singer Mindy McCready has committed suicide, multiple sources close to her tell PEOPLE. She was 37.

Professionally, McCready was best known for her multi-platinum debut album Ten Thousand Angels. In recent years, it's been the singer's personal troubles making headlines, though she was attempting to reestablish her music career. In 2010, McCready released a new album titled I'm Still Here.

She is survived by her son Zander, 6, with ex Billy McKnight, and Zayne, 10 months.

In January, McCready's life partner and Zayne's father, singer-songwriter David Wilson died of a self-inflicted gunshot wound. Just three weeks later, a judge ordered McCready to be committed to a treatment facility to cope with mental health and alcohol issues and her sons were placed in foster care.

Story developing …

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UN warns risk of hepatitis E in S. Sudan grows


GENEVA (AP) — The United Nations says an outbreak of hepatitis E has killed 111 refugees in camps in South Sudan since July, and has become endemic in the region.


U.N. refugee agency spokesman Adrian Edwards says the influx of people to the camps from neighboring Sudan is believed to be one of the factors in the rapid spread of the contagious, life-threatening inflammatory viral disease of the liver.


Edwards said Friday that the camps have been hit by 6,017 cases of hepatitis E, which is spread through contaminated food and water.


He says the largest number of cases and suspected cases is in the Yusuf Batil camp in Upper Nile state, which houses 37,229 refugees fleeing fighting between rebels and the Sudanese government.


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Seawater desalination plant might be just a drop in the bucket









CARLSBAD, Calif. — Dreamers have long looked to the Pacific Ocean as the ultimate answer to California's water needs: an inexhaustible, drought-proof reservoir in the state's backyard. In the last decade, proposals for about 20 desalting plants have been discussed up and down the coast.


But even with construction about to begin on the nation's largest seawater desalination facility, 35 miles north of San Diego, experts say it is doubtful that dream will ever be fully realized.


"While this Poseidon adventure may work out, I don't look for a lot of that," said Henry Vaux Jr., a UC Berkeley professor emeritus of resource economics who contributed to a 2008 National Research Council report on desalination.





The reasons boil down to money and energy. It takes a lot of both to turn ocean water into drinking water, driving the average price of desalinated supplies well above most other sources.


The purified water produced by the Poseidon Resources plant will cost the San Diego County Water Authority more than twice what it now pays the Metropolitan Water District of Southern California for supplies from Northern California and the Colorado River. Over the authority's 30-year contract with Poseidon, San Diego County ratepayers will pay between $3 billion and $4 billion for the desalted water, which is expected to provide no more than a tenth of their overall supply.


Seawater desalination is not new to California. There are number of small coastal plants, used mostly for research or industrial purposes, and a few, such as one on Catalina Island, that provide municipal supplies.


For reasons unique to the region, San Diego County will be the first to stick a big straw into the Pacific. It is at the end of the line for imported water, doesn't have much local groundwater and is perennially battling with Metropolitan, Southern California's wholesaler of imported supplies.


"I do believe it is worth it," said Tom Wornham, board chairman of the county water authority. "I would rather be apologizing to people in 10 years for the rate than the fact they would have no water."


Up the coast, other places have taken a pass on the Pacific. Los Angeles and Long Beach recently shelved seawater desalting plans after concluding that other water sources, such as conservation or recycling, are cheaper and easier to pursue.


Poseidon, a small, privately held company based in Stamford, Conn., started talking about developing a desalination plant in Carlsbad in late 1998. The road to construction has been so long and twisting that Global Water Intelligence, which covers the international water industry, last year listed the project among the "Top 10 Desalination Disasters" of all time.


It took years for the company to get the necessary state and local permits. Environmentalists filed multiple legal challenges, the last of which was only recently resolved in Poseidon's favor. A deal with a number of local water agencies in San Diego County fell apart.


In the end, the Poseidon supplies — up to 56,000 acre-feet a year — will sell for roughly $2,000 an acre-foot, more than double the company's 2004 estimate. (One acre-foot is enough to supply two average homes for a year.) The price will rise with inflation; if energy costs go up, so will the price of water.


On the other side of the Pacific, Australia offers a sobering lesson in the perils of diving too deeply into desalination.


When years of withering drought emptied the country's reservoirs, Australia commissioned six big coastal desalting plants, including some of the world's largest. Then the rains returned. Just as some of the operations were coming on line, they were no longer needed.


Four of the six plants are being idled because cheaper water is available. Australian politicians are bemoaning the desalination binge, complaining that it saddled ratepayers with "hyper-expensive" white elephants they have to pay for regardless of whether the plants are used.


"That's certainly the risk — that we build them when they're not necessary or we build them, frankly, too soon," said Heather Cooley of the Pacific Institute, an Oakland think tank.


Santa Barbara had a similar experience in the early 1990s, when it built a desalination plant during a severe statewide drought that ended before the facility was finished. The $34-million plant, with a tenth of the capacity of the Carlsbad facility, was never used beyond the testing phase, though it could still be brought into service in an emergency.


The $954-million Carlsbad project is being financed with $781 million in tax-exempt construction bonds sold by Poseidon and the water authority. The balance is coming from investors who anticipate a return of about 13%. IDE Americas Inc., the subsidiary of an Israeli firm that runs some of the world's largest coastal desalination facilities in the Middle East, has been hired to design and operate the plant, slated for completion in 2016.


The fresh water will be produced through reverse osmosis, an energy-intensive process that separates salts and contaminants from seawater by forcing it through sand filters and tightly coiled, synthetic membranes peppered with billions of tiny holes a fraction of the width of a human hair. The water will then be pumped inland for distribution — the opposite direction that drinking supplies are usually moved — requiring construction of a 10-mile underground pipeline that the water authority will own and operate.


Poseidon chose the Carlsbad location, next to the Encina Power Station, so it could draw from the power plant's cooling water discharge — thus avoiding the environmental harm of operating its own ocean intake.


But new federal and state environmental regulations are pushing coastal power plants to phase out the use of huge volumes of ocean water for cooling, thwarting that strategy. Poseidon expects the Encina station to be replaced within the decade with a new generating facility employing a different cooling system.


That will mean the desalter will have to pump directly from the ocean, sucking 300 million gallons a day. Of that, 100 million gallons will go through the reverse osmosis process, with half converted to fresh water and half to a concentrated brine. The brine, twice as salty as the sea, will be diluted in a mixing pool with the other 200 million gallons of intake and discharged to the ocean.


Destruction of marine life is a major environmental concern of ocean desalination. Raw seawater is full of tiny organisms, including plankton that form a critical part of the food chain and the young stages of fish and invertebrates. When the water they live in is pumped into a plant, they die.


The Coastal Commission is requiring Poseidon to restore 55 acres of marine wetlands in south San Diego Bay to compensate for the plant's projected effects. The State Water Resources Control Board is also developing new seawater desalination regulations that could force Poseidon to change its intake and discharge systems.


"They took a big risk in building this before the rules are finalized," said Joe Geever of the Surfrider Foundation, which tenaciously fought the Carlsbad proposal in court and argues that water agencies should turn to the ocean only as a last resort — after more environmentally benign sources such as recycling and storm-water capture have been aggressively pursued.


Poseidon, which is trying to line up customers for a similar-size desal plant proposed in Huntington Beach, says it is peddling more than water. "What we're selling is ... a reliability premium that's locally controlled, drought-proof," said Carlos Riva, the company's chief executive.


But even Poseidon doesn't predict that the Pacific will become California's dominant water supply. The state has too many other sources.


"We have quite a bit of water to move around," said Peter MacLaggan, the Poseidon executive who is overseeing the Carlsbad project. "I don't think it's ever going to be a majority of supply or anywhere close to that."


bettina.boxall@latimes.com





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