The Bystander Effect Explains Why Some People Don't Help When Others Are In Danger-Here's How to Fight Against It

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The data is clear: Hate crimes against Asian Americans have skyrocketed since the pandemic began. Anti-violence organization Stop AAPI Hate reported nearly 3,800 incidents against Asian Americans and Pacific Islanders from March 2020 to February 2021, and New York City alone had an 867% increase in Asian hate crime victims in 2020 compared to the previous year.

What's most shocking? Some of these crimes have happened right in front of other people—who haven't stepped in to help. In a video that's now gone viral, a 65-year-old Asian American woman can be seen being thrown to the ground and repeatedly assaulted in full view of security guards in a building nearby. The security guards look out and clearly see what's going on, as one of them closes the door on her.

Plenty of people online have expressed shock and outrage that something like this could happen right in front of others, with no one rushing to help. But this kind of thing happens more often than you'd think. In fact, it's a social phenomenon with a name. It's called the bystander effect, and it's been well documented for decades. Here's what you need to know.

What exactly is the bystander effect?

The bystander effect is a social psychology theory that says that a person is less likely to offer help to a victim when more people are around, Todd Lucas, PhD, a social and health psychologist at Michigan State University, tells Health. "It's an irony of human behavior," he says.

The term was first coined in the 1960s by psychologists Bibb Latané and John Darley who analyzed the 1964 murder of a woman named Kitty Genovese in New York City. Genovese was stabbed to death outside of her apartment, but none of her neighbors reacted to help her, even though they were aware of what was going on.

"It's really a classic example of unhelpful behavior," Victoria Banyard, PhD, associate director for the Center on Violence Against Women and Children at the Rutgers School of Social Work, tells Health.

Why does the bystander effect happen?

There are a few possible reasons for this. One is what Lucas calls "diffusion of responsibility." Meaning, the more people there are around, the less any single person feels responsible for helping in any situation.

People are also "social creatures" and we tend to react to social cues from those around us, Banyard says. "We want to fit in and, if other people seem to think this isn't serious, we tend to react the same way," she says.

Experts say this is potentially damaging on so many levels. On a very basic—but important—level, the bystander effect increases the odds that someone will get hurt. "There may be a chance to keep something from escalating and prevent someone from being harmed if people actually intervene," Banyard says.

But the bystander effect isn't just harmful on a physical level—it's damaging on a mental level for the victim, too. "It sends a message to the victim that people don't think they're worth helping," Banyard says.

What you can do to stop the bystander effect

It's easy to think you wouldn't fall victim to the bystander effect, but it's a common social phenomenon that has impacted plenty of others. If you notice something seems off in a crowd but no one else is reacting, Lucas recommends listening to your gut. "Be confident in your values and assessment of the situation," he says. "If you think somebody needs help, recognize that might be correct. Even if no one else is acting, it may be appropriate to act."

One person taking action can create a domino effect, where others recognize that there is a problem and step in to help, too, Lucas says. "You don't need to be the person that fixes the situation entirely—you just need to be the person who starts the chain reaction," he says.

If you're a victim in a crowd and no one is helping you, Lucas recommends singling out a particular person or looking for someone who seems like they could be helpful and appealing directly to them. "You can better overcome a bystander effect that way," he says.

Even simply being aware that the bystander effect is a thing can be helpful, Banyard says. Organizations like Hollaback and Step Up also have courses you can take to learn more about the bystander effect and strategies for intervening in different situations.

And, of course, if you see someone being victimized, do your best to intervene. "Take action," Banyard says. "It's simple."

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22-Year-Old Surfer With Olympic Dreams Struck and Killed by Lightning While Training

surfer struck by lightning , olympic surfer struck by lightning , Female surfer riding ocean wave

A 22-year-old surfing standout was struck and killed by lightning as she was training in the waters of her home country, El Salvador, on March 19.

Katherine Diaz had been training for an upcoming surfing event—one that she hoped would qualify her for this summer's Olympics—when she was struck. According to CNN, Diaz was in the water at El Tunco beach in southwest El Salvador with her friend and uncle when the tragedy happened.

"Katherine came over to hug her [friend], as soon as she finished hugging her, the noise was heard," Diaz's uncle, Beto Diaz, told a newspaper in El Salvador, CNN reports. "She, the friend, was thrown by the force of the lightning strike too, the board threw me back. Katherine died instantly."

The lightning struck shortly after Diaz had entered the water. According to the Salvadoran Surf Federation, via the Olympic Channel, "the sky was clear and it was an unforeseen storm that did not seem to carry much electrical intensity either." After the unexpected strike, emergency services arrived, but they were unable to revive Diaz.

The International Surfing Association honored Diaz in a tweet, saying that "Katherine embodied the joy and energy that make surfing so special and dear to us all, as a global ambassador of the sport." According to the association, Diaz excelled at the international competition level and represented her country with pride.

"We send our heartfelt condolences to Katherine's family, the surfers of El Salvador, and to all those in the international surfing community whose lives she touched. We will never forget you," the International Surfing Association also tweeted.

Diaz had worked as a chef and had opened her own business in El Tunco, USA Today reported. According to CBS, a funeral was held this past weekend, pictures of which can be seen on El Salvador's surfing federation's Facebook page. Tomorrow, a paddle-out ceremony will be held to honor her, per USA Today.

According to the National Weather Service (NWS), about 30 people in the US die from lightning each year. Another 240 are injured. Of those who are killed, about two thirds had been participating in outdoor recreational activities at the time of the strike.

It's estimated that the US has 20 million to 25 million cloud-to-ground lightning flashes per year. "Some of those flashes strike directly under the storm where it is raining, but some of the flashes reach out away from the storm where people perceive the lightning threat to be low or nonexistent, and catch people by surprise," the NWS reports.

Being in water at the time of a lightning strike may also make matters worse. According to the National Oceanic and Atmospheric Administration (NOAA), though lightning doesn't strike the ocean as much as land, when it does, it can spread out over the water, which acts like a conductor. When that happens, the lightning strike can affect boats that are nearby and any living creatures that are near the surface.

Generally, a significant lightning threat extends outward from the base of a thunderstorm cloud about 6 to 10 miles. With that in mind, the NWS suggests that you should stop your activity if you see lightning or hear thunder or if the sky looks threatening. "Thunderstorms can develop directly overhead and some storms may develop lightning just as they move into an area," according to the NWS. The NOAA also suggests that you get out of the water immediately if you're at the beach during a thunderstorm; and if you're at sea away from land, it's recommended you stay low in the boat or retreat to a cabin.

Once the storm has passed, the NWS suggests waiting at least 30 minutes after the last thunder before going back to your outdoor activity since electrical charges can still be in the clouds.

And if you or someone you know is struck by lightning, it's imperative to seek medical attention immediately, per the NWS. That means calling 911, performing CPR, or using an AED—all of which are crucial to keep the person alive until professional medical help can arrive to the scene.

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Why Men Are Buying Vibrators \u2014 and Keeping Them for Themselves

If you ask any man in America to define what a vibrator is, he’ll probably say something along the lines of, “Well, it’s a brightly-hued hunk of oblong plastic.” He’ll also probably note that vibrators are meant for women.

To an extent, this is true: historically, vibrators have been marketed to and used by women. Although an estimated 51% of men have copped to owning some sort of intimacy product (per a 2014 survey), they tend to be cock rings or Fleshlights—rarely, if ever, vibrators.

Part of the reason for this has to do with basic anatomical differences (and we probably don’t need to draw you a picture to explain why). But there’s also an undeniable stigma associated with guys using sex toys to get off.

“For men, any kind of [self-pleasure help] feels like a direct piercing of their masculinity,” says Alexandra Katehakis, clinical director of the Center For Healthy Sex. “The attitude is, ‘I can do this myself, and if I can’t there’s something wrong with me.'”

That attitude, however, might be changing. Sex tech companies are increasingly starting to market products like vibrators to dudes—and they’re into it.

While most sex toys for men are aimed at replicating the sensation of a penis going in and out of an orifice, the truth is that lots of guys find the sensation of vibrations on their penis (particularly around the frenulum, or the sensitive strip of skin underneath the head of the penis) incredibly pleasurable. In fact, according to one 2012 study, 44% of heterosexual men admitted that they’ve enjoyed using a vibrator at one point or another.

To that end, here are some of our favorite vibrating cock rings, sleeves, penile extenders, and other amazing toys that have been specifically marketed as vibrators for men.

Tenuto MysteryVibe

Design-wise, the Tenuto might throw you for a loop: it’s a small, black clip that attaches to the base of your penis, and it looks more like a tiny car seat than a sex toy. The device is controlled by an app, which powers six hyper-sensitive vibration motors that the company claims can help increase blood flow for stronger erections while also stimulating your pleasure centers. It can be used both solo and during intercourse.

According to Stephanie Alys, who has the (awesome) title of Chief Pleasure Officer at MysteryVibe, for too long men have been told that the pleasures of sex are largely fricative (i.e., through the friction produced by inserting a penis into a vagina). Most guys don’t even know how awesome vibrations can feel on their penises, particularly if they have trouble getting aroused in the first place.

“[For men, vibrations] provide such a distinct orgasm,” Alys says. “With Tenuto, we really target the entirety of the male sex organs, so it can be life-altering, particularly for guys who have had a harder time getting aroused.”

Hot Octopuss Pulse Solo Lux

In 2015, the sex toy company Hot Octopuss introduced the Pulse, a vibrating sheath that was marketed as “the world’s first guybrator.”

The inventor of the Pulse, Adam Lewis, told the Daily Dot that he actually adapted the Pulse’s design from a similar product used in the medical field, which used deep oscillations to to stimulate the frenulum of the penis and help victims of spinal cord injuries achieve orgasm. Lewis said he hoped the Pulse (which is now in its third incarnation) would kibosh the lingering stigma attached to male sex toys.

“There’s a hundred different ways to achieve orgasm,” he told the Daily Dot. “Why should us guys just have one?”

ArcWave Ion

From Men’s Health sex columnist Zachary Zane’s review: “The sensation was novel—I’ll give it that much. I like the fact that you can pretty much put your dick in there, not do anything except strengthen your grip so there’s more pressure, and you’ll orgasm. Whether on purpose or not, the toy edges you because it’s only focusing on one section of your penis. Since it edges you, you end up orgasming hard. That’s a definite pro.

“Really, the Ion is a clit sucker except for the head of your penis. If you have a sensitive head and really like to focus on just your head when masturbating, then the Ion is a solid option.”

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Countless Homebound Patients Still Wait for Covid Vaccine Despite Seniors’ Priority

Opening another front in the nation’s response to the pandemic, medical centers and other health organizations have begun sending doctors and nurses to apartment buildings and private homes to vaccinate homebound seniors.

Boston Medical Center, which runs the oldest in-home medical service in the country, started doing this Feb. 1. Wake Forest Baptist Health, a North Carolina health system, followed a week later.

In Miami Beach, Florida, fire department paramedics are delivering vaccines to frail seniors in their own homes. In East St. Louis, Missouri, a visiting nurse service is offering at-home vaccines to low-income, sick older adults who receive food from Meals on Wheels.

In central and northern Pennsylvania, Geisinger Health, a large health system, has identified 500 older homebound adults and is bringing vaccines to them. Nationally, the Department of Veterans Affairs has provided more than 11,000 vaccines to veterans who receive primary medical care at home.

These efforts and others like them recognize a compelling need: Between 2 million and 4.4 million older adults are homebound. Most are in their 80s and have multiple medical conditions, such as heart failure, cancer, and chronic lung disease, and many are cognitively impaired. They cannot leave their homes or can do so only with considerable difficulty.

By virtue of their age and medical status, these seniors are at extremely high risk of becoming seriously ill and dying if they get covid-19. Yet, unlike similarly frail nursing home patients, they haven’t been recognized as a priority group for vaccines, and the Centers for Disease Control and Prevention only recently offered guidance on serving them.

“This is a hidden group that’s going to be overlooked if we don’t step up efforts to reach them,” said Dr. Steven Landers, president and CEO of Visiting Nurse Association Health Group, which provides home health and hospice care to over 10,000 people in New Jersey, northeastern Ohio and southeastern Florida. His organization plans to launch a pilot home vaccination program for frail patients this week.

Jane Gerechoff, 91, of Ocean Township, New Jersey, is waiting for the group to vaccinate her. She had a stroke more than a year ago and has difficulty breathing because of a serious lung disease. “I can’t walk; I’m in a wheelchair. There’s no way in the world I could get the vaccine if they didn’t come out to me,” she said in a phone interview.

Although Gerechoff doesn’t go out, she lives with an adult son who interacts with people outside the house and she receives help from physical and occupational therapists at home. Any one of them could bring in the virus.

Reaching homebound seniors presents many challenges. At the top of the list: Home care agencies and hospice organizations don’t have access to covid vaccines either for their staff or patients.

“There is no distribution of vaccines to our members, and there has been no planning surrounding meeting the needs of the people we serve,” said William Dombi, president of the National Association for Home Care & Hospice.

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Organizations that administer vaccines also complain they’re not being paid enough by Medicare to cover their costs — primarily staff time and effort. (The shots are free because the federal government is paying for them.) Making a vaccine house call requires about an hour on average, including travel, time interacting with patients and post-vaccination monitoring of people for potential side effects, according to program leaders.

Medicare reimbursement for the first shot is $16.94; for a second shot, it’s $28.39, according to Shawna Ramey, a consultant who presented the data at a recent American Academy of Home Care Medicine webinar. “The actual cost of these visits is closer to $150 or $160,” Dombi said.

Then, there are issues with cold storage and transportation for the Pfizer-BioNTech and Moderna vaccines. Both vaccines are fragile after being thawed and need to be handled carefully, according to the new CDC guidance on vaccinating homebound adults.. Once vaccine vials are opened, shots need to be delivered within six hours, according to instructions from Pfizer and Moderna.

Those requirements have proved too burdensome for Prospero Health, which serves 9,000 seriously ill patients in their homes in 20 states, including nearly 2,000 homebound patients. Fewer than 10% have been vaccinated, said Dr. Dave Moen, Prospero’s medical group president.

Things will become easier if vaccines from Johnson & Johnson and AstraZeneca receive approval, as expected, he suggested. Both of those vaccine candidates are more stable than the Pfizer and Moderna vaccines and would be easier to administer in the home, Moen said.

Palmer Kloster, 84, of Bradley, Illinois, receives care from Prospero under a contract with his Medicare Advantage insurer, UnitedHealthcare. He’s a largely immobile polio survivor who has undergone open-heart surgery and receives care from paid helpers for four hours a day.

“I really need someone to come here and give me a shot,” he told me in a phone conversation. “I don’t want that disease [covid-19]. At my age, it would be very detrimental.”

In Boston, Mary Gareffa, 84, is grateful that a physician she knows and trusts, Dr. Won Lee, came to her house in early February to vaccinate her. “I haven’t been out of the house in about eight years, except by ambulance,” said Gareffa, who has stomach cancer, weighs 73 pounds and broke her hip this summer after a bad fall.

It’s essential to reach out to patients like Gareffa, said Lee, a geriatrician who works with the Boston Medical Center’s home-based program. “It’s worth providing quality of life and reducing suffering, and covid-19 causes nothing but suffering,” she said. The Boston program has vaccinated 84 people as of Feb. 12.

The vaccines come from the medical center’s supply. Before going out, staff members call patients and address any concerns they might have about getting the shots. Most are African American and many families want to know whether the vaccine will make their frail parents or grandparents sick. “They need to hear that it’s safe to get a shot from someone who knows their medical issues,” Lee said.

Wake Forest’s house call program is sending out a doctor, nurse or physician assistant paired with a pharmacy resident to deliver vaccines. About 200 people are served through the program, most of them in their late 70s or early 80s with five or more medical conditions, said Dr. Mia Yang, the program’s director.

Wake Forest’s goal is to provide vaccine house calls to up to 40 patients a week and include family caregivers if there’s adequate supply, Yang said.

Robert Pursel, 69, who has severe osteoporosis and fluid retention in his feet and legs, and his wife Gail, 72, who has serious back problems, both received Pfizer vaccines in late January from Geisinger at their home in Millville, Pennsylvania. At first, Robert said he was skeptical, but now he’s glad he said yes. If a Geisinger nurse hadn’t come to them, he wouldn’t have been able to get out on his own.

Because of his swelling, “I can’t get my shoes on,” Robert said, and “I’d have to walk barefoot through the snow and ice out there.”

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Under a Boil Water Advisory? Here’s What You Need to Know—Including What You Can (and Can’t) Do

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Millions of Texans remain under a boil-water advisory following a week of freezing temperatures and storms that have pushed state water supplies beyond their limits. More than 700 water supply systems were affected by leaks caused by frozen pipes, reported CNN.

During a press conference on Thursday, Austin Water Director Greg Meszaros said the state capital's water supply lost 325 million gallons of water due to burst pipes. "We know that there are tens of thousands of leaks," he said. "As the fire department indicated they have responded to thousands upon thousands of burst pipes. That is an incredible amount of water. Nothing I've ever seen before."

Lights and heat came back on Friday morning, but some 187,000 customers remain without power and millions still have no water at all or are being told to boil their water to make it safe to drink, reported NPR. According to Houston Mayor Sylvester Turner, the city's residents will probably have to boil water until Sunday or Monday. If you're not familiar with a boil-water advisory, here are some answers to the most common questions.

First: Why are boil water advisories issued?

According to the Centers for Disease Control and Prevention (CDC), local health authorities issue boil water advisories when the community water supply is (or could be) contaminated with germs that can make you sick.

These boil water advisories often result from unplanned events like water line breaks, treatment disruptions, power outages, and floods, per the New York State Department of Health.

How long do you need to boil water during an advisory?

Boiling is the safest method for making water safe for drinking or cooking. "In a large clean pot or kettle, the water should be brought to a rolling boil for one full minute," Tamika Sims, PhD, senior director in food technology communications at the International Food Information Council, tells Health. "Before you drink or expose your skin to the water, be sure to let it cool down to a safe temperature."

Do you have to boil water if you have a filter?

Water filters remove bacteria, hardness, and unwanted impurities from water, such as sediment, taste, and odor, to improve its quality. But a filter can't remove microorganisms or other contaminants from contaminated water, so you should still boil the water, Sims says.

Can you shower during a boil water advisory?

You can, but it's extremely important you but take care not to swallow any of the water. "During times of inclement weather, there can be low water pressure in the pipes. With this, the groundwater, which is generally not treated against harmful bacteria, viruses, and parasites, can seep into older pipes that have cracks in them," Vidya Mony, MD, infectious disease expert at Santa Clara Valley Medical Center in Fruitdale, California, tells Health.

"These harmful pathogens can then be swallowed when the bath or shower is turned on and make you sick," Dr. Mony adds. "This is why it's very important to not swallow any water while taking a bath or shower. It is also important that for children and people with disabilities [to be] supervised during their bath, to ensure that water is not swallowed and to limit the amount of time bathing."

If you need to bathe infants or young children during a boil-water advisory, the CDC suggests giving them a sponge bath to reduce the chance of them swallowing water.

Can you brush your teeth during a boil water advisory?

Not with your tap water, per the CDC. You should use bottled or boiled water for this, since it's so easy to swallow water while brushing your teeth.

Can you wash dishes during a boil water advisory?

The CDC recommends using disposable plates, cups, and utensils whenever possible during a boil-water advisory. If washing dishes is a priority during a boil-water advisory, you can use treated (boiled) water, Sims says. In fact, she adds that all water of uncertain quality should be treated before using it for any purpose where you have the potential of ingesting it, including washing dishes, drinking, food washing/preparation, brushing teeth, or making ice.

Can you wash clothes during a boil water advisory?

Good news here: It's still safe to wash clothes as normal during a boil-water notice, per the CDC—but you have to make sure they're completely dry before you wear them. If you're under a 'Do Not Use' advisory, however, you should not use water for anything, including washing clothes.

I accidentally drank some water that wasn’t boiled—what should I do?

First of all, don't panic. "Generally, the chance of becoming ill after accidentally drinking contaminated water is quite low," Dr. Mony says. However, people who have chronic illnesses, recent skin infections or wounds, or are immunocompromised are at high risk of infection.

"The most frequent signs of an infection after drinking contaminated water are those of the gastrointestinal system," Dr. Mony explains. "You can have abdominal pain, vomiting, diarrhea, and abdominal cramps, with or without fevers. Should you have these types of symptoms, it is important to seek medical care."

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Medicare Cuts Payment to 774 Hospitals Over Patient Complications

The federal government has penalized 774 hospitals for having the highest rates of patient infections or other potentially avoidable medical complications. Those hospitals, which include some of the nation’s marquee medical centers, will lose 1% of their Medicare payments over 12 months.

The penalties, based on patients who stayed in the hospitals anytime between mid-2017 and 2019, before the pandemic, are not related to covid-19. They were levied under a program created by the Affordable Care Act that uses the threat of losing Medicare money to motivate hospitals to protect patients from harm.

On any given day, one in every 31 hospital patients has an infection that was contracted during their stay, according to the Centers for Disease Control and Prevention. Infections and other complications can prolong hospital stays, complicate treatments and, in the worst instances, kill patients.

“Although significant progress has been made in preventing some healthcare-associated infection types, there is much more work to be done,” the CDC says.

Now in its seventh year, the Hospital-Acquired Condition Reduction Program has been greeted with disapproval and resignation by hospitals, which argue that penalties are meted out arbitrarily. Under the law, Medicare each year must punish the quarter of general care hospitals with the highest rates of patient safety issues. The government assesses the rates of infections, blood clots, sepsis cases, bedsores, hip fractures and other complications that occur in hospitals and might have been prevented. The total penalty amount is based on how much Medicare pays each hospital during the federal fiscal year — from last October through September.

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Hospitals can be punished even if they have improved over past years — and some have. At times, the difference in infection and complication rates between the hospitals that get punished and those that escape punishment is negligible, but the requirement to penalize one-quarter of hospitals is unbending under the law. Akin Demehin, director of policy at the American Hospital Association, said the penalties were “a game of chance” based on “badly flawed” measures.

Some hospitals insist they received penalties because they were more thorough than others in finding and reporting infections and other complications to the federal Centers for Medicare & Medicaid Services and the CDC.

“The all-or-none penalty is unlike any other in Medicare’s programs,” said Dr. Karl Bilimoria, vice president for quality at Northwestern Medicine, whose flagship Northwestern Memorial Hospital in Chicago was penalized this year. He said Northwestern takes the penalty seriously because of the amount of money at stake, “but, at the same time, we know that we will have some trouble with some of the measures because we do a really good job identifying” complications.

Other renowned hospitals penalized this year include Ronald Reagan UCLA Medical Center and Cedars-Sinai Medical Center in Los Angeles; UCSF Medical Center in San Francisco; Beth Israel Deaconess Medical Center and Tufts Medical Center in Boston; NewYork-Presbyterian Hospital in New York; UPMC Presbyterian Shadyside in Pittsburgh; and Vanderbilt University Medical Center in Nashville, Tennessee.

There were 2,430 hospitals not penalized because their patient complication rates were not among the top quarter. An additional 2,057 hospitals were automatically excluded from the program, either because they solely served children, veterans or psychiatric patients, or because they have special status as a “critical access hospital” for lack of nearby alternatives for people needing inpatient care.

The penalties were not distributed evenly across states, according to a KHN analysis of Medicare data that included all categories of hospitals. Half of Rhode Island’s hospitals were penalized, as were 30% of Nevada’s.

All of Delaware’s hospitals escaped punishment. Medicare excludes all Maryland hospitals from the program because it pays them through a different arrangement than in other states.

Over the course of the program, 1,978 hospitals have been penalized at least once, KHN’s analysis found. Of those, 1,360 hospitals have been punished multiple times and 77 hospitals have been penalized in all seven years, including UPMC Presbyterian Shadyside.

The Medicare Payment Advisory Commission, which reports to Congress, said in a 2019 report that “it is important to drive quality improvement by tying infection rates to payment.” But the commission criticized the program’s use of a “tournament” model comparing hospitals to one another. Instead, it recommended fixed targets that let hospitals know what is expected of them and that don’t artificially limit how many hospitals can succeed.

Although federal officials have altered other ACA-created penalty programs in response to hospital complaints and independent critiques — such as one focused on patient readmissions — they have not made substantial changes to this program because the key elements are embedded in the statute and would require a change by Congress.

Boston’s Beth Israel Deaconess said in a statement that “we employ a broad range of patient care quality efforts and use reports such as those from the Centers for Medicare & Medicaid Services to identify and address opportunities for improvement.”

UCSF Health said its hospital has made “significant improvements” since the period Medicare measured in assessing the penalty.

“UCSF Health believes that many of the measures listed in the report are meaningful to patients, and are also valid standards for health systems to improve upon,” the hospital-health system said in a statement to KHN. “Some of the categories, however, are not risk-adjusted, which results in misleading and inaccurate comparisons.”

Cedars-Sinai said the penalty program disproportionally punishes academic medical centers due to the “high acuity and complexity” of their patients, details that aren’t captured in the Medicare billing data.

“These claims data were not designed for this purpose and are typically not specific enough to reflect the nuances of complex clinical care,” the hospital said. “Cedars-Sinai continually tracks and monitors rates of complications and infections, and updates processes to improve the care we deliver to our patients.”

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This Teenage Girl Developed a Massive Hairball in Her Stomach After Eating Her Own Hair

Rapunzel syndrome , eating hair, Trichotillomania disorder
rapunzel syndrome hair ball

The researchers explained in the report that hair is "resistant to digestive enzymes" and "unaffected" by the normal contractions of the stomach "owing to its slippery nature." As a result, they wrote, the hair fibers can become trapped in the stomach, stick together, and form a trichobezoar, aka a mass made of hair, or a hairball.

The teen was diagnosed with a condition called Rapunzel syndrome and doctors performed emergency laparoscopic surgery to remove the hairball. They found "multiple pockets of pus" and an oval-shaped mass of hair that was nearly 19 inches long. She was also given intravenous antibiotics for abdominal sepsis.

Rapunzel syndrome is a term that's been used to describe a solid mass of indigestible material that forms in the stomach. Most of the time this happens in children, the mass is usually made of swallowed hair from their head, dolls, or brushes. The condition is linked to trichotillomania and trichophagia, which are both rare. Up to 3% of the population will experience trichotillomania at some point in their life, according to the National Organization for Rare Diseases, and trichophagia is even more rare. The exact cause of trichotillomania isn't known, but it's characterized as an obsessive-compulsive related disorder in the Diagnostic and Statistical Manual of Mental Disorders Version 5.

Even in people who have those (already rare) conditions, Rapunzel syndrome isn't common. One study estimates that just 1% of people who struggle with both conditions will form a hairball in their GI tract. While it's rare, Rapunzel syndrome can be deadly. In 2017, a 16-year-old girl died from the disorder after an infected ulcer formed in her stomach that burst, causing her vital organs to fail.

Despite her health ordeal, the teen featured in the latest case report is now doing OK. She was admitted to the intensive care unit, and given a psychiatric evaluation. Seven days after her surgery, she was discharged. The researchers also noted that, during a 30 day follow-up, the teen was "progressing well" with dietary advice and the help of a psychologist.

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Cote named a National Academy of Inventors senior member

Pathologist Richard J. Cote, MD, the Edward Mallinckrodt Professor and head of the Department of Pathology & Immunology at Washington University School of Medicine in St. Louis, has been elected a senior member of the National Academy of Inventors (NAI). A cancer specialist, Cote has developed tools for analyzing tumor cells and predicting disease progression and response to therapy.

The distinction honors people who have demonstrated remarkable innovation, producing technologies that have had, or aspire to have, real impact on the welfare of society. Senior members also must have demonstrated substantial training and mentoring of the next generation of inventors, and have provided leadership to advance inventorship within their academic institutions.

Cote led three of the largest clinical trials in breast, lung and bladder cancer, which were based on research from his laboratory. With the help of funding from the National Cancer Institute, Cote and his colleagues are developing a tool to detect early-stage breast cancer and predict how the disease will progress by analyzing tumor cells in the bloodstream. He and his colleagues also have developed tools based on nanotechnology that may one day lead to a liquid biopsy blood test to detect early, treatable cancer.

Cote holds numerous patents and is the founder of several biotech companies, including Impath, Clarient, Filtini, Sensitini and Circulogix. One of the first companies to bring specialty testing for cancer analysis to market, Impath was acquired by Genzyme in 2004. Clarient, an image analysis company co-founded by Cote under the name Chromavision, brought high-tech diagnostic capabilities to practicing pathologists and oncologists. Clarient was acquired by GE in 2009.

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The ACA Marketplace Is Open Again for Insurance Sign-Ups. Here’s What You Need to Know.

For people who’ve been without health insurance during the pandemic, relief is in sight.

In January, President Joe Biden signed an executive order to open up the federal health insurance marketplace for three months as of Monday so uninsured people can buy a plan and those who want to change their marketplace coverage can do so.

Consumer advocates applauded the directive. Since 2016, the number of Americans without health insurance has been on the rise, reaching 30 million in 2019. The economic upheaval caused by the novel coronavirus has made a bad situation worse, throwing millions off their insurance plans.

The move is in stark contrast to the Trump administration’s approach. As covid-19 took hold last spring and the economy imploded, health experts pleaded with the Trump administration to open up the federal marketplace so people could buy insurance to protect themselves during the worst public health emergency in a century. The administration declined, noting that people who suddenly found themselves without coverage because they lost their jobs were able to sign up on the marketplace under ordinary rules. They also cited concerns that sick people who had resisted buying insurance before would buy coverage and drive up premiums.

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The Biden administration is promising to spend $50 million on outreach and education to get the word out about the new special enrollment period. That’s critical, experts said. Although the number of people signing up for Affordable Care Act plans has generally remained robust, the number of new consumers enrolling in the federal marketplace has dropped every year since 2016, according to KFF, corresponding to funding cuts in marketing and outreach. (KHN is an editorially independent program of KFF.)

“There are a lot of uninsured people who even before covid were eligible for either hefty marketplace subsidies or for Medicaid and not aware of it,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. A marketing blitz can reach a broad swath of people and hopefully draw them in, regardless of whether they’re uninsured because of covid or not, she said.

Here are answers to questions about the new enrollment option.

Q: When can consumers sign up, and in which states?

The sign-up window will be open for three months, from Monday through May 15. Uninsured residents of any of the 36 states that use the federal healthcare.gov platform can look for plans during that time and enroll.

Most of the states and the District of Columbia that operate their own marketplaces are establishing special enrollment periods similar to the new federal one, though they may have somewhat different time frames or eligibility rules. In Massachusetts, for example, the sign-up window remains open until May 23, while in Connecticut, it closes March 15. Meanwhile, Colorado has reopened enrollment in its marketplace for residents who lack insurance, but anyone already enrolled in one of the state’s marketplace plans won’t be allowed to switch to a different plan until the regular open enrollment period in the fall.

At this point, only Idaho has not announced plans to open their marketplaces, said Corlette. It may still do so, however.

Q: Can people who lost their jobs and health insurance many months ago sign up during the new enrollment period?

Yes. The enrollment window is open to anyone who is uninsured and would normally be eligible to buy coverage on the exchange (people who are serving prison or jail terms and those who are in the country without legal permission aren’t allowed to enroll).

People with incomes up to 400% of the federal poverty level (about $51,500 for one person or $106,000 for a family of four) are eligible for premium tax credits that may substantially reduce their costs.

Typically, people can buy a marketplace plan only during the annual open enrollment period in the fall or if a major life event gives them another opportunity to sign up, called a special enrollment period. Losing job-based health coverage is one event that creates a special sign-up opportunity; so is getting married or having a baby. But usually people must sign up with the marketplace within 60 days of the event.

With the new special enrollment period, how long someone has been uninsured isn’t relevant, nor do people have to provide documentation that they’ve lost job-based coverage.

“The message is quite simple: Come and apply,” said Sarah Lueck, a senior policy analyst at the Center on Budget and Policy Priorities.

Q: What about people who are already enrolled in a marketplace plan? Can they switch their coverage during this new enrollment period?

Yes, as long as their coverage is through the federal marketplace. If, for example, someone is enrolled in a gold plan now but wants to switch to a cheaper bronze plan with a higher deductible, that’s allowed. As mentioned above, however, some state-operated marketplaces may not make that option available.

Q: Many people have lost significant income during the pandemic. How do they decide whether a marketplace plan with premium subsidies is a better buy for them than Medicaid?

They don’t have to decide. During the application process, the marketplace asks people for income information. If their annual income is below the Medicaid threshold (for many adults in most states, 138% of the federal poverty level, or about $18,000 for an individual), they will be directed to that program for coverage. If people are eligible for Medicaid, they can’t get subsidized coverage on the exchange.

People can sign up for Medicaid anytime; there’s no need to wait for an annual or special enrollment period.

Those already enrolled in a marketplace plan whose income changes should go back into the marketplace and update their income information as soon as possible. They may be eligible for larger premium subsidies for their marketplace plan or, if their income has dropped significantly, for Medicaid. (Likewise, if their income has increased and they don’t adjust their marketplace income estimates, they could be on the hook for overpayments of their subsidies when they file their taxes.)

Q: What about people who signed up under the federal COBRA law to continue their employer coverage after losing their job? Can they drop it and sign up for a marketplace plan?

Yes people in federal marketplace states can take that step, health experts say. Under COBRA, people can be required to pay the full amount of the premium plus a 2% administrative fee. Marketplace coverage is almost certainly cheaper.

Normally, if people have COBRA coverage and they drop it midyear, they can’t sign up for a marketplace plan until the annual fall open enrollment period. But this special enrollment period will give people that option.

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At Colorado’s Rural Edges, Vaccines Help Assisted Living Homes Crack Open the Doors

Bingo is back in the dining room. In-person visits have returned, too, though with masks and plexiglass. The Haven Assisted Living Facility’s residents are even planning a field trip for a private movie screening once they’ve all gotten their second round of covid-19 vaccines.

Such changes are small but meaningful to residents in the Hayden, Colorado, long-term care home, and they’re due mostly to the arrival of the vaccine.

While the vaccine rollout has hit snags across the U.S., including in many large urban areas, some rural counties — with their smaller populations and well-connected communities — have gotten creative about getting the doses out quickly to long-term care facilities. They are circumventing bogged-down Walgreens and CVS, the pharmacy chains contracted for the campaign, and instead are inoculating their older residents with the counties’ shares of doses.

It’s clear why the counties are trying their own path. Federal data provided by the state of Colorado shows that, as of Jan. 21, dozens of long-term care facilities in Colorado were enrolled to receive vaccines from Walgreens or CVS but still did not have any vaccination dates scheduled. Among assisted living facilities in particular, rural locations tended to have later start dates than non-rural ones. By mid-January, over 90 facilities had opted out of the program that has been beset by cumbersome paperwork and corporate policies.

When Roberta Smith, who directs the Routt County Public Health Department, learned in December that The Haven and another facility in the county hadn’t gotten any dates from Walgreens for their shots, she diverted about 100 doses from the county’s allotment. The vaccines would likely have gone to health care workers, she said, but she couldn’t let the most vulnerable in the county wait.

Fourteen of the 19 people who died of covid in the county, after all, had been residents of those two long-term care facilities.

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The county received a shipment of Moderna vaccines the following week to continue with its health care workers, Smith said.

The health department ensured that all able and willing residents of the county’s two long-term care facilities received their first doses before 2021 began. Smith suspects such reprioritization and fast deployment — despite the department’s reliance on spreadsheets and sticky notes to schedule visits — is easier in small communities.

“There is a sense of community in our smaller, rural counties that we’re all kind of looking out for each other. And when you tell someone, ‘Hey, we need to vaccinate these folks first,’ they’re quick to say, ‘Oh, yeah,’” Smith said.

Hayden, a town of about 2,000 in northwestern Colorado, is the kind of place where, within hours of Haven staffers posting online that they were looking for a grill, workers from the hardware store delivered one at no charge. It’s the kind of town where locals have come throughout the pandemic to serenade Haven residents with guitar, flute and violin performances outside the windows. When the virus hit The Haven, eventually killing two of its 15 residents, locals paraded past the facility in their cars, taped with balloons and signs that said “We love you” and “Get well soon.”

After all the heartache, isolation and waiting, newly vaccinated resident Rosa Lawton, 70, is ready to bust out of The Haven. She said she expected to get her second vaccine dose Jan. 28.

“I hope to be able to go shopping at Walmart and City Market and go to the bank, the library, the senior center. … I won’t stop,” she said, laughing. “Right now, we’re restricted to the building.”

Even after getting everyone vaccinated, though, assisted living locations won’t be able to fling open the doors quite yet. State and federal officials need to give the OK, said Doug Farmer, president and CEO of the Colorado Health Care Association, which represents long-term care facilities in the state. Still, the combination of vaccines, repeated negative covid tests and a lower level of virus spread in the community is allowing some facilities the peace of mind to crack the doors open just a bit in the meantime.

Until recently, Lawton and others at The Haven were playing bingo perched in their doorways, with a staff member moving down the hallway calling out numbers. Lawton said she could see about four others from her door, but not her friends Sally, Ruth or Louise. Now, they’re back in the dining room, with one person to a table and playing with sanitized chips.

“We can see each other and we’re closer together and we can hear the caller better,” said Lawton. “It’s just more of a group experience.”

Residents can now gather in the common areas, wearing masks, to play the piano and do target practice with foam dart guns. And the excursion to a movie theater next month will be the first field trip in nearly a year. (Lawton is rooting for watching “The Sound of Music.”)

“It just feels overall lighter,” said Adrienne Idsal, director of The Haven, hours before receiving her second vaccine dose.

Fraser Engerman, a spokesperson with Walgreens, confirmed that some counties moved ahead with vaccinations before the company received its allocation, and said the company is on track to complete vaccinations at all Colorado long-term care facilities that they were responsible for by the end of January. Monica Prinzing, a CVS Health spokesperson, said that her company has completed first doses for all 119 skilled-nursing facilities in Colorado and more than half the assisted living sites it partnered with, adding that their team is working closely with facilities to “remain on track to meet our program commitments.”

Along the state’s eastern edge, where Colorado meets Kansas, a pair of counties is already done vaccinating long-term care residents, according to Meagan Hillman, the public health director for Prowers and Kiowa counties.

In December, Hillman and her colleagues started to wonder just how Walgreens was going to get the shots to their four local long-term care facilities.

“Out here, I’m two-plus hours from the closest Walgreens, and I don’t even know where a CVS is,” she said. “It’s such a huge operation and we just were worried, you know. Oftentimes the little guy gets left out or left for last.”

Hillman said she and her colleagues managed to secure Pfizer vaccines from a local hospital.

“We have been so beat down in public health that I actually went and did the vaccination clinic,” said Hillman, who is also a physician assistant. “We just needed that — a good, heart-swelling thing to do.”

She said it indeed helped boost her spirits to give the shots herself. “Finally, I feel like the light at the end of the tunnel is not a train,” she said.

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