Teaching and safety-net hospitals show variations in quality and outcomes of care

Public release date: 17-Jun-2013
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Contact: Connie Hughes
connie.hughes@wolterskluwer.com
646-674-6348
Wolters Kluwer Health

Concerns about disproportionate impact of changes in hospital payment methods

Philadelphia, Pa. (June 17, 2013) Teaching hospitals with a higher intensity of physician-training activity achieve lower mortality rates, but higher hospitalization readmission rates for key medical diagnoses, reports a study in the July issue of Medical Care, published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The disparity in readmissions is greatest for "safety-net" hospitals serving low-income populations, according to the new research led by Dr Stephanie K. Mueller of Brigham and Women's Hospital, Boston. They write, "These findings suggest that high teaching intensity and safety-net institutions may be disproportionately affected by recent and upcoming changes in hospital payment models."

Variations in Outcomes at Higher-Intensity Teaching Hospitals

Using two nationally representative databases, the researchers evaluated the relationship between hospital teaching status, the quality of care provided, the patients outcomes achieved. Teaching hospitalsthose which train medical residentswere classified by teaching intensity, based on the ratio of residents to patient beds.

The study focused on three conditions widely used in assessing the quality and outcomes of hospital care: acute myocardial infarction (heart attack), congestive heart failure, and pneumonia. In addition to teaching status, the researchers looked for possible differences in quality of care at safety-net hospitalsthose treating a high proportion of Medicaid patients.

The study included data on 2,418 hospitals for the years 2007-08. Overall, 37 percent of hospitals were teaching hospitals. Five percent were medium-intensity and three percent were high-intensity teaching hospitals.

The teaching and nonteaching hospitals performed "uniformly well" on quality of care process measures. This meant that they had high rates of performing and reporting recommended care steps for all three diagnoses.

But there were some significant differences in patient outcomes by teaching hospital status. Medium- and high-intensity teaching hospitals had higher rates of repeat hospital admission for patients with all three conditions, compared to nonteaching hospitals.

In contrast, for myocardial infarction and heart failure, high-intensity teaching hospitals had lower mortality rates than nonteaching hospitals. The differences in outcomes remained significant after adjustment for patient risk factors.

Differences Are Most Pronounced at Safety-Net Hospitals

For the two heart disease diagnoses, there was a significant interaction between teaching intensity and safety net status. Among hospitals that served a higher percentage of Medicaid patients, higher-intensity teaching hospitals had persistently higher readmission rates for myocardial infarction and heart failure

Traditionally, teaching hospitals have been supported by a combination of patient revenues and government subsidies. Pressures to reduce government support for medical education pose a threat to the financial health of teaching institutions. Many teaching hospitals are also safety-net hospitals, which serve higher-risk patients. As a result they may also take a financial hit from new payment rules penalizing hospitals with higher readmission rates.

The new study suggests that teaching hospitalsespecially higher-intensity teaching hospitals that are also safety-net hospitalshave higher readmission rates for key diagnoses. This is despite the fact that they have lower mortality rates for major heart disease diagnoses.

How to explain this seeming contradiction? Lack of patient education at discharge may contribute to higher readmission rates at teaching hospitals. Another possibility is that patients with more complex conditions treated at teaching hospitals are more likely surviveand more likely to return for care requiring rehospitalization.

The study raises important questions about how changes in hospital payment based on quality and outcome measures may affect funding of teaching hospitals, Dr Mueller believes. She comments, "Financial incentives may disproportionately impact the financial health of higher teaching intensity hospitals and safety net hospitals, particularly with respect to penalties for higher readmission rates."

###

About Medical Care

Rated as one of the top ten journals in health care administration, Medical Care is devoted to all aspects of the administration and delivery of health care. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of health care. Medical Care provides timely reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services. In addition, numerous special supplementary issues that focus on specialized topics are produced with each volume. Medical Care is the official journal of the Medical Care Section of the American Public Health Association

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry.

Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2012 annual revenues of 3.6 billion ($4.6 billion).

---

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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.

Public release date: 17-Jun-2013
[ | E-mail | Share ]

Contact: Connie Hughes
connie.hughes@wolterskluwer.com
646-674-6348
Wolters Kluwer Health

Concerns about disproportionate impact of changes in hospital payment methods

Philadelphia, Pa. (June 17, 2013) Teaching hospitals with a higher intensity of physician-training activity achieve lower mortality rates, but higher hospitalization readmission rates for key medical diagnoses, reports a study in the July issue of Medical Care, published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The disparity in readmissions is greatest for "safety-net" hospitals serving low-income populations, according to the new research led by Dr Stephanie K. Mueller of Brigham and Women's Hospital, Boston. They write, "These findings suggest that high teaching intensity and safety-net institutions may be disproportionately affected by recent and upcoming changes in hospital payment models."

Variations in Outcomes at Higher-Intensity Teaching Hospitals

Using two nationally representative databases, the researchers evaluated the relationship between hospital teaching status, the quality of care provided, the patients outcomes achieved. Teaching hospitalsthose which train medical residentswere classified by teaching intensity, based on the ratio of residents to patient beds.

The study focused on three conditions widely used in assessing the quality and outcomes of hospital care: acute myocardial infarction (heart attack), congestive heart failure, and pneumonia. In addition to teaching status, the researchers looked for possible differences in quality of care at safety-net hospitalsthose treating a high proportion of Medicaid patients.

The study included data on 2,418 hospitals for the years 2007-08. Overall, 37 percent of hospitals were teaching hospitals. Five percent were medium-intensity and three percent were high-intensity teaching hospitals.

The teaching and nonteaching hospitals performed "uniformly well" on quality of care process measures. This meant that they had high rates of performing and reporting recommended care steps for all three diagnoses.

But there were some significant differences in patient outcomes by teaching hospital status. Medium- and high-intensity teaching hospitals had higher rates of repeat hospital admission for patients with all three conditions, compared to nonteaching hospitals.

In contrast, for myocardial infarction and heart failure, high-intensity teaching hospitals had lower mortality rates than nonteaching hospitals. The differences in outcomes remained significant after adjustment for patient risk factors.

Differences Are Most Pronounced at Safety-Net Hospitals

For the two heart disease diagnoses, there was a significant interaction between teaching intensity and safety net status. Among hospitals that served a higher percentage of Medicaid patients, higher-intensity teaching hospitals had persistently higher readmission rates for myocardial infarction and heart failure

Traditionally, teaching hospitals have been supported by a combination of patient revenues and government subsidies. Pressures to reduce government support for medical education pose a threat to the financial health of teaching institutions. Many teaching hospitals are also safety-net hospitals, which serve higher-risk patients. As a result they may also take a financial hit from new payment rules penalizing hospitals with higher readmission rates.

The new study suggests that teaching hospitalsespecially higher-intensity teaching hospitals that are also safety-net hospitalshave higher readmission rates for key diagnoses. This is despite the fact that they have lower mortality rates for major heart disease diagnoses.

How to explain this seeming contradiction? Lack of patient education at discharge may contribute to higher readmission rates at teaching hospitals. Another possibility is that patients with more complex conditions treated at teaching hospitals are more likely surviveand more likely to return for care requiring rehospitalization.

The study raises important questions about how changes in hospital payment based on quality and outcome measures may affect funding of teaching hospitals, Dr Mueller believes. She comments, "Financial incentives may disproportionately impact the financial health of higher teaching intensity hospitals and safety net hospitals, particularly with respect to penalties for higher readmission rates."

###

About Medical Care

Rated as one of the top ten journals in health care administration, Medical Care is devoted to all aspects of the administration and delivery of health care. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of health care. Medical Care provides timely reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services. In addition, numerous special supplementary issues that focus on specialized topics are produced with each volume. Medical Care is the official journal of the Medical Care Section of the American Public Health Association

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry.

Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2012 annual revenues of 3.6 billion ($4.6 billion).

---

[ | E-mail | Share ]

?

AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.

Source: http://www.eurekalert.org/pub_releases/2013-06/wkh-tas061713.php

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Anger in southern Egypt over Islamist governor

LUXOR, Egypt (AP) ? Angry tourism workers and activists in Luxor threatened Monday to block a newly appointed Islamist governor from his office because of his links to a former militant group that killed scores of people in a 1997 attack in the ancient city and devastated Egypt's sightseeing industry.

Adel el-Khayat was named to the provincial governor's post Sunday by President Mohammed Morsi, causing the outrage. El-Khayat is a member of the Construction and Development party, the political arm of Gamaa Islamiya, which waged an armed insurgency against the state starting in 1992 and attacked police, Coptic Christians and tourists.

In November 1997, gunmen from the group attacked tourists at Luxor's 3,400-year-old Hatshepsut Temple, killing 58. More than 1,200 people died in the campaign of violence by the group and another militant organization, Islamic Jihad.

Tourism is the lifeblood of Luxor, home to some of Egypt's most dramatic ancient temples and pharaonic tombs, including that of King Tutankhamun. The city has been hit hard by the downturn in foreign visitors since the Arab Spring unleashed political turmoil since 2011.

Hundreds of people protested outside the governor's office Monday night. The tourism workers, opposition politicians and activists in the crowd said they would consider sealing off the site with locks and chains, and sending el-Kayat back to Luxor's airport.

"When I heard about the appointment, I remembered the whole scene," said Tharwat Agamy, the head of Luxor's Tourism Chamber who witnessed the 1997 attack.

"With my own arms, I carried the blooded bodies of the women, children and men," Agamy said, recalling that the victims' corpses were mutilated.

"I still remember the ... newlywed Japanese couple hugging each other and both dead," he added. "Are these human beings? Do they have mercy inside their hearts?"

Not only are the horrific memories of what has been dubbed the "Luxor Massacre" still fresh in the minds of many residents, but they also worry about the impact of a hard-line Islamist running the southern city and surrounding province.

El-Khayat's party calls for strict implementation of Islamic Shariah law, which includes imposing an Islamic dress code for women, banning alcohol, and preventing the mixing of the sexes. Workers in a city as heavily dependent on tourism as Luxor worried that such policies would further hurt their business.

His appointment was also seen as a move aimed at solidifying Morsi's support among hard-liners ahead of protests planned for later this month by the liberal opposition and youth activists. The Gamaa's party has threatened to counter opposition demonstrations with an "Islamic revolution."

Both the Gamaa and Islamic Jihad renounced violence in the 2000s amid a crackdown by then-President Hosni Mubarak. Since Mubarak's ouster in 2011, both have launched political parties, and the Gamaa's is allied to Morsi, a member of the Muslim Brotherhood.

El-Khayat, who was among 17 new governors appointed by Morsi, said he would not be influenced by his political affiliation.

"I am honored to belong to the Islamist current, but now as a governor, I am in the service of the nation," he said in comments emailed to The Associated Press by the group's media representative. "It is not fair to judge someone just because of affiliation but by evaluating their work, performance and skills."

He said the Gamaa also suffered under Mubarak, that the group didn't order the Hatshepsut Temple attack, was not aware of it, and condemned it afterward.

At the time of the attack, however, the group claimed responsibility for it. Two years later, one of the top group's leaders, Rifai Ahmed Taha, warned the government that there could be another such attack if Egypt did not change its hostile policy toward the Islamic movement.

One of the founders of Gamaa Islamiya, Nageh Ibrahim, said that el-Khayat split from the group when it diverted to militancy and worked for 30 years as an engineer in an agency of the Ministry of Housing.

Ibrahim said the group is short of members who are qualified to hold a senior government post so it nominated el-Khayat.

"He didn't participate in any violence. He has nothing to do with the attacks," Ibrahim said.

But many residents of Luxor still found Morsi's move shocking. Tourism is the main employer in the province of about 1 million people, and practically the only industry besides farming and a sole factory processing the region's sugar cane crop.

"Does the president and his advisers know that Luxor is a tourist province? Do they know the culture background and the black history of the affiliates of the Islamic group?" asked poet Hussein al-Kabahi.

Driver Ahmed Gahlan wondered how a hard-line Islamist who belongs to a conservative group could even be considered for the leadership of a city and province where tourism has such a high priority.

"Is he going to shake hands with foreigners, whom they consider as devils? They even refuse to shake hands with Muslim women, so what about foreigners?" he asked.

Boat operator El-Nadi el-Rawi said the appointment of el-Khayat would have a "disastrous" impact on European sightseers.

"They want to kill tourism," the 26-year-old added. "Why Luxor? There are many other provinces where the governor can serve."

Hotel manager Gamal Ahmed Mahmoud, 49, said that the decision was another setback for his livelihood.

"Hotel managers are about to close their hotels because of heavy debts," he said.

Tourism in all of Egypt has been struggling since Mubarak's ouster and the breakdown in security in the country.

The number of tourists coming to Egypt fell to 9.8 million in 2011 from 14.7 million the year before, and revenues plunged 30 percent to $8.8 billion. Last year, the numbers climbed up to slightly more than 10 million, but most visitors go to the beach resorts of the Red Sea, staying away from Nile Valley sites like Luxor.

___

Michael reported from Cairo.

Source: http://news.yahoo.com/anger-southern-egypt-over-islamist-governor-171520264.html

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With Samsung, Jay-Z's business continues to boom

FILE - This May 1, 2013 file photo shows Jay-Z at "The Great Gatsby" world premiere at Avery Fisher Hall in New York. Jay-Z is teaming up with Samsung to release his new album, unveiling a three-minute commercial during the NBA Finals and announcing a deal that will give the music to 1 million users of Galaxy mobile phones. The new album, called ?Magna Carta Holy Grail,? will be free for the first 1 million android phone owners who download an app for the album. Those who do so will get the album on July 4, three days before its official release. (Photo by Evan Agostini/Invision/AP, file )

FILE - This May 1, 2013 file photo shows Jay-Z at "The Great Gatsby" world premiere at Avery Fisher Hall in New York. Jay-Z is teaming up with Samsung to release his new album, unveiling a three-minute commercial during the NBA Finals and announcing a deal that will give the music to 1 million users of Galaxy mobile phones. The new album, called ?Magna Carta Holy Grail,? will be free for the first 1 million android phone owners who download an app for the album. Those who do so will get the album on July 4, three days before its official release. (Photo by Evan Agostini/Invision/AP, file )

NEW YORK (AP) ? He really is more than a businessman.

Jay-Z's partnership with Samsung for his new album, "Magna Carta Holy Grail," is another sign of how musicians are finding new ways to push, sell and promote their music, and how the multiplatinum performer ? who famously rapped "I'm not a businessman, I'm a business, man" ? continues to leverage his enduring popularity into a successful brand.

Jay-Z will give his new album to 1 million users of Galaxy mobile phones on July 4, three days before the album's official release date. The 43-year-old broke the news about his twelfth album in a three-minute commercial during the NBA Finals.

Details about the Samsung-Jay-Z deal, announced Sunday, weren't disclosed and both parties did not grant interviews.

But Jay-Z's partnership is just another way artists are promoting their music at a time when album sales are low and the digital market has taken the lead in the music industry.

Jim Donio, president of the National Association of Recording Merchandisers (NARM), said top level acts like Jay-Z and Taylor Swift have the power to launch new albums in spectacular ways with various partners.

"For an artist whose album release is an event in itself ... they carry with them a much wider profile in the marketplace that they speak to, so their audience and all the things that they do affords these unique opportunities," he said.

In 2011, Lady Gaga sold 440,000 copies of her "Born This Way" album on Amazon for just 99 cents when it was on sale for two days, helping the album sell 1.1 million in its debut week. Others have also used that trend to sell albums, though not in its debut week: Last year, Phil Collins' greatest hits jumped into the Top 10 at No. 6 ? its peak ? when it was sold for 99 cents for a day. And Bruno Mars' "Doo-Wop & Hooligans" and Demi Lovato's "Unbroken" both jumped about 100 spots on the Billboard chart when they were on sale for 99 cents months after they were released.

Taylor Swift, one of the top sellers in music, had her second platinum-debut week with "Red" last year. Her partnerships for the album included Target, Walgreens and Papa John's (you could order a pizza and a Swift album at the same time).

"Even if you didn't purchase the CD, her face was still on the pizza box," Donio said.

And Prince released his "20Ten" album in 2010 via the Daily Mirror newspaper in United Kingdom.

Jay-Z's new partnership is one of his many business deals. His Roc Nation agency, which manages Rihanna, Shakira and other musicians, recently expanded into the sports world, and he now is helping the careers of New York Yankee Robinson Cano, New York Jets rookie Geno Smith and others. Jay-Z has launched fashion lines, has a string of 40/40 nightclubs, was also the president of Def Jam and owned part of 1 percent of the Brooklyn Nets.

He's still a consistent hit maker and a superstar who transcends music ? which is why Samsung likely partnered with him on his new album. Samsung has chipped away at Apple's share of the mobile market with its Galaxy phones, and companies are relying more on music to lure new customers (Apple last week announced it will debut iRadio, its streaming music service, in the fall).

One of the many questions about the Samsung deal still unanswered: Will the 1 million downloads count toward first-week sales of the album, giving it elite status of debuting with platinum sales, an accomplishment few artists have achieved? Billboard, which tracks album sales and chart information for the industry, did not return emails seeking comment. Samsung reportedly purchased the albums though it's unclear what the price-point was.

Jay-Z made it clear Monday what he felt the trade publication should do.

"If 1 Million records gets SOLD and billboard doesn't report it, did it happen? Ha," Jay-Z tweeted, adding: "Platinum!!!"

Donio said he thinks more deals like Samsung-Jay-Z are on the horizon.

"The record labels that are putting out the music and partnering with a variety of types of commerce outlets are going to look at just anything and everything that may work with that particular artist and that particular album release," he said.

____

Online:

http://www.magnacartaholygrail.com/

____

Follow Mesfin Fekadu on Twitter: twitter.com/MusicMesfin

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/495d344a0d10421e9baa8ee77029cfbd/Article_2013-06-18-Music-Jay-Z/id-b748a6b5a1cb4691908ee9cf26356412

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ToughWriter prototype brings color printing to the cockpit, we go hands-on

You might be surprised to hear that many current aircraft already have the ability to print documents at 30,000 feet. Long-haul airliners like the Boeing Dreamliner and Airbus A340 ship with a ToughWriter flight deck printer installed and ready to go, but the device has been limited to black and white output, which can be a bit restrictive when it comes to spitting out charts and weather information. Astro-Med, the company behind the cockpit printer currently churning out reports in thousands of commercial, business and military planes, has a spiffy new model on the way. We spotted an early prototype on display at the Paris Air Show this week, and while it's still a ways off from being cockpit-ready, the device works quite well, printing to ZINK paper at about 30 seconds per page, compared to 5 seconds for the monochrome version.

Unlike the printers we're accustomed to using on the ground, a ToughWriter must be installed before an aircraft is certified, so it's really something you need to factor in before the FAA signs off on your plane. In other words, don't expect to simply swap in this new color model once it hits the market. It's also an expensive acquisition -- it wouldn't be unreasonable to expect pricing in the $25,000 range, though that detail has yet to be announced. The version we saw in Paris is very much a work in progress -- it far exceeds the maximum size allowed, and it's heavier than the targeted 10 pounds, too. It does print quite nicely, though, and once engineers manage to squeeze the printer into a smaller housing, it'll likely include AirPrint so pilots can print from their iPads, and possibly Android wireless support, too. Astro-Med reps weren't able to tell us when the color ToughWriter will take to the skies, and considering the certification involved, it could be a few years out. Catch it in action in the gallery below.

Gallery: Astro-Med ToughWriter color cockpit printer hands-on

Filed under: Peripherals, Transportation

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Source: http://www.engadget.com/2013/06/18/toughwriter-color-cockpit-printer/?utm_medium=feed&utm_source=Feed_Classic&utm_campaign=Engadget

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Green Chemists Synthesise Vanillin From Sawdust

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Living Walls: How They Can Improve Your Home and Your Health

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A living wall, or a green wall, ?is a garden that grows vertically, as opposed to horizontally, which can exist inside or outside the home. Any well lit place inside your home, would make a suitable environment. Indoor herb gardens are growing in popularity and thrive well in sunny kitchens. Conversely any outside wall would do as well. Green, or living walls, are beneficial to us in so very many ways. Below I discuss, in simple terms, how these vertical gardens can protect your home and environment, save you energy, and benefit your health.

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How living walls can improve indoor air quality

Pollutants exist all around us, both outdoors and indoors. Toxic fumes infiltrate the air we breathe through our air systems and ductwork and can cause what we commonly call ?Sick Building Syndrome.? Green, or living walls, can significantly clear up the toxins. While all plants absorb pollutants, there are certain plants that do so with much more efficiency. While even one plant can remove toxins from your home or building, the more plants that are added, the more toxins are absorbed.

A green wall can contain as many as thousands of plants. These living walls can help to remove formaldehyde, VOCs, Carbon Monoxide and many other harmful pollutants. ? NASA (The National Aeronautic and Space Administration) has identified the 15 best plants for living walls. For the list, visit Ecologic Design Lab.

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?How green walls can protect your home or building

Outdoor living walls offer your building ?protection by acting as a climate control. The plantings prevent dramatic temperature fluctuations which then prevents the building from corrosion that results from expanding and contracting which occurs during extreme temperatures. These plants act as a natural insulation, keeping air inside the buildings cooler in the summer months and warmer during the winter months. The manner in which these vertical gardens are constructed allows the building to breathe, shields the walls from precipitation, wind, harmful UV rays and corrosive rain. ?Living walls and green roofs help to provide a natural environment for birds, butterflies and bees.

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How vertical gardens save energy

Simply put, the plants on the building?s exterior keep the building protected by the heat of the sun, therefore keeping the building itself cooler meaning less energy is utilized when cooling the building. Interior green walls also greatly help to reduce energy by helping to keep the interior cool. With each additional plant, energy consumption is reduced, therefore a room with hundreds of plants can see a temperature reduction of as much as 7 degrees celsius or 44 degrees fahrenheit. This is indeed significant! Conversely, during the cold winter months these green walls have the opposite effect and act as insulation from the bitter temperatures. The additional layer prevents heat from escaping thus dramatically lowering your gas or heating oil consumption.

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?The health benefits of living walls

Plants offer instant stress relief by softening the environment around us. They reduce noise and eliminate pollution. ?Gardens have an instant calming effect. In workplaces plants have been shown to increase productivity, in the home they increase tranquility. They ease stress and fatigue, and offer energy rich oxygen. Gardens are strategically placed in hospitals to for their calming benefits which can lead to a patient?s shortened stay. ?Try doubling the health benefits by building an edible living wall in your kitchen. Not only will these greens relax you and purify the air you breathe, but edible plants such as herbs and lettuces have their own health benefits.

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How to build your own living wall

First decide whether you would like your wall to be indoors or outdoors. It may be wise, when starting out, to start with an indoor wall which is both easier to build and to maintain. You may want to meet with a garden or vertical wall specialist to get advice based on your needs and lifestyle. A garden specialist will help you decide which plants would be best for you. Specific plants such as bamboo palm, azalea, chrysanthemums, spider plants and aloe vera, ivy and peace lilies are among many of those that are especially good at removing toxins. You?ll need to consider which wall to use and whether that wall receives much direct sunlight or not. You?ll also need to think about humidity levels and water availability.

There are several ways in which vertical gardens can be constructed. Before you do so you may want to consult with someone who is well versed in these types of gardens, or go to a designated site such as Clean Air Gardening. ?Generally speaking, these walls are vertical and comprised of shelves or plant containers that attach themselves directly onto the walls. Some containers may hang from ceilings and more complicated configurations may contain both vertical and horizontal structures. Most important is to ensure that each plant gets the proper amount of light needed and can easily be watered. Plants require air, and therefore the plants should be set up in such a way that air can freely flow around the plants themselves.

Source: http://freshome.com/2013/06/17/living-walls-how-they-can-improve-your-home-health/

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Pro-Obama group airing health ads

WASHINGTON (AP) ? An outside group supporting President Barack Obama's agenda plans to air a series of ads this summer promoting Obama's health care overhaul.

Organizing for Action intends to spend at least $1 million this summer on ads to draw attention to the implementation of the health care law, including its quality of care and coverage of uninsured Americans.

The move comes as the White House works to implement the law. People without access to health coverage through their jobs can start shopping for subsidized private insurance in new state markets beginning Oct. 1. Those benefits will kick in Jan. 1.

The organization's first ad touts benefits for consumers, including preventive care, average rebate checks of $150 last year and tax credits for small businesses to pay for part of their workers' coverage.

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/89ae8247abe8493fae24405546e9a1aa/Article_2013-06-17-Health%20Overhaul-Ads/id-bd5d505a36314d62af5b1adf2bbcadd9

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