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Archive for September 21st, 2021

US Healthcare System: Their Baby Died in the Hospital. They Had Good Healthcare Insurance. Then Came the $257,000 Bill.

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Sarah Kliff reports in the NY Times (with no paywall on this article):

Brittany Giroux Lane gave birth to her daughter, Alexandra, a few days before Christmas in 2018. The baby had dark eyes and longish legs. She had also arrived about 13 weeks early, and weighed just two pounds.

Alexandra initially thrived in the neonatal intensive care unit at Mount Sinai West. Ms. Lane, 35, recalls the nurses describing her daughter as a “rock star” because she grew so quickly. But her condition rapidly worsened after an infection, and Alexandra died early on the morning of Jan. 15 at 25 days old.

A flurry of small medical bills from neonatologists and pediatricians quickly followed. Ms. Lane struggled to get her breast pump covered by insurance because, in the midst of a preterm birth, she hadn’t gone through the health plan’s prior approval process.

Last summer, Ms. Lane started receiving debt collection notices. The letters, sent by the health plan Cigna, said she owed the insurer over $257,000 for the bills it accidentally covered for Alexandra’s care after Ms. Lane switched health insurers.

Ms. Lane was flummoxed: It was Cigna that had received the initial bill for care and had paid Mount Sinai West. Now, Cigna was seeking the money it had overpaid the hospital by turning to the patient.

“For them, it’s just business, but for us it means constantly going through the trauma of reliving our daughter’s death,” said Clayton Lane, Alexandra’s father and Ms. Lane’s husband. “It means facing threats of financial ruin. It’s so unjust and infuriating.”

Medical billing experts who reviewed the case described it as a dispute between a large hospital and a large insurer, with the patient stuck in the middle. The experts say such cases are not frequent but speak to the wider lack of predictability in American medical billing, with patients often having little idea what their care will cost until a bill turns up in the mail months later.

Congress passed a ban on surprise medical bills last year, which will go into effect in 2022. It outlaws a certain type of surprise bill: those that patients receive from an out-of-network provider unexpectedly involved in their care. There are plenty of other types of bills that surprise patients, such as those received by the Lanes, that are likely to persist.

Continue reading. There’s much more, and there’s no paywall on this: gift article.

Written by Leisureguy

21 September 2021 at 8:03 pm

Where Do Species Come From?

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During the most recent ice age, glaciers divided an ancestral population of crows; one group became all-black carrion crows, the other hooded crows with gray breasts and bodies.Illustrations by François-Nicolas Martinet / Alamy

Ben Crair has a very interesting article in the New Yorker, which begins:

The evolutionary biologist Jochen Wolf was working from home when we first spoke, in April, 2020. Germany was under lockdown, and his lab, at Ludwig Maximilian University, in Munich, had been closed for weeks. Still, a reminder of his research had followed him from the office. “I have a crow nest right in front of me,” Wolf said, from his rooftop terrace. The nest was well hidden at the top of a tall spruce tree. Through the branches, Wolf could see a female crow sitting on her eggs.

Over the years, Wolf had climbed many similar trees to gather genetic material from crow nests. He had also collected samples from falconers whose goshawks hunt the birds. By comparing the genomes of European crows, Wolf wanted to bring fresh data to one of biology’s oldest and most intractable debates. Scientists have named more than a million different species, but they still argue over how any given species evolves into another and do not even agree on what, exactly, a “species” is. “I have just been comparing definitions of species,” Charles Darwin wrote to a friend, three years before he would publish “On the Origin of Species,” in 1859. “It is really laughable to see what different ideas are prominent in various naturalists’ minds.” To an extent, the same holds true today. It is difficult to find a definition of “species” that works for organisms as different as goshawks and spruce trees. Similarly, it can be hard to draw a line between organisms among whom there are only small differences, such as the goshawks in North America, Europe, and Siberia. Are they separate species, subspecies, or simply locally adapted populations of a single type?

Darwin thought that the blurriness of species boundaries was a clue that the living world was not a divine creation but actually changing over time. He encouraged biologists to treat species as “merely artificial combinations made for convenience,” which would never map perfectly onto nature. “We shall at least be freed from the vain search for the undiscovered and undiscoverable essence of the term species,” he wrote. His imprecision, however, did not sit well with all of his successors. One of the most influential evolutionary biologists of the twentieth century, a German-born ornithologist named Ernst Mayr, attacked Darwin for failing “to solve the problem indicated by the title of his work.” Darwin had shown how natural selection honed a species to its niche, but he’d “never seriously attempted a rigorous analysis of the problem of the multiplication of species, of the splitting of one species into two,” Mayr wrote, in 1963. Mayr, who spent much of his career at Harvard, called speciation “the most important single event in evolution,” and proposed reproductive isolation as an “objective yardstick” for understanding it: individuals of a sexually reproducing species could procreate with one another but not with individuals of other species.

For decades, Mayr’s arguments dominated evolutionary thought. But consensus was crumbling by the two-thousands, when Wolf confronted the species problem. Wolf had learned Mayr’s “biological species concept” as a student, but he’d also discovered dozens of competing species concepts with alternative criteria, such as an animal’s form, ecology, evolutionary history, and ability to recognize potential mates. (Philosophers had joined the debate, too, with head-scratching questions about the ontological status of a species.) “The more you looked into it, the more confused you got,” Wolf said. Mayr had written that “the process of speciation could not be understood until after the nature of species and of geographic variation had been clarified.” But, in time, Wolf had come to believe the opposite: the nature of species could not be understood until the process of speciation—the ebb and flow of genetic differences between populations, and the evolution of reproductive isolation—had been clarified. . . 

Continue reading.

Later in the article:

. . . Beginning in the nineteen-eighties, Tautz had spent his career sequencing DNA, focussing on only a few hundred base pairs at a time. He was looking to see whether DNA might solve the species puzzle. Decades earlier, Mayr had argued that reproductive isolation can only develop in geographic isolation, after an impassable physical barrier, such as a mountain range or a river, divides a population in two; without migration the two populations would evolve into different species that could remain separate even when the barrier dried up or crumbled. This model, which Mayr called allopatric, or other-place, speciation, became the textbook standard of speciation, even though plenty of organisms appeared to have evolved without a geographic barrier. Some African lakes, for example, contain hundreds of species of colorful fish called cichlids; it was hard to imagine each species evolving in isolation, but Mayr and other mid-century leaders of evolutionary biology were dismissive of alternative ideas. (“These species have come into contact only after they had evolved,” Mayr wrote, of the fish.) For Tautz, the question was not whether allopatric speciation was valid—everyone agreed it was—but whether it was the only way species could diversify. “The allopatric paradigm was based on a few facts, a lot of faith, and on paradigmatic despots ruling the field,” he wrote.

In the early nineties, one of Tautz’s students, Ulrich Schliewen, brought him samples of cichlids he had collected from two small crater lakes in Cameroon. There were no barriers in either crater lake, and also no fertile hybrid forms. Either each species had evolved somewhere else and invaded the lake before its source population went extinct, as Mayr claimed, or they had all evolved together in their lake, through a process of sympatric, or same-place, speciation. Schliewen and Tautz sequenced a short snippet of mitochondrial DNA from each fish. By comparing the sequences, they could work their way backward to calculate the time of the organisms’ most recent common ancestor. The results indicated that the two ancestors of the twenty different species had lived and diversified within each lake. It was solid evidence of sympatric speciation. . .

And later:

Beginning in the nineteen-eighties, Tautz had spent his career sequencing DNA, focussing on only a few hundred base pairs at a time. He was looking to see whether DNA might solve the species puzzle. Decades earlier, Mayr had argued that reproductive isolation can only develop in geographic isolation, after an impassable physical barrier, such as a mountain range or a river, divides a population in two; without migration the two populations would evolve into different species that could remain separate even when the barrier dried up or crumbled. This model, which Mayr called allopatric, or other-place, speciation, became the textbook standard of speciation, even though plenty of organisms appeared to have evolved without a geographic barrier. Some African lakes, for example, contain hundreds of species of colorful fish called cichlids; it was hard to imagine each species evolving in isolation, but Mayr and other mid-century leaders of evolutionary biology were dismissive of alternative ideas. (“These species have come into contact only after they had evolved,” Mayr wrote, of the fish.) For Tautz, the question was not whether allopatric speciation was valid—everyone agreed it was—but whether it was the only way species could diversify. “The allopatric paradigm was based on a few facts, a lot of faith, and on paradigmatic despots ruling the field,” he wrote.

In the early nineties, one of Tautz’s students, Ulrich Schliewen, brought him samples of cichlids he had collected from two small crater lakes in Cameroon. There were no barriers in either crater lake, and also no fertile hybrid forms. Either each species had evolved somewhere else and invaded the lake before its source population went extinct, as Mayr claimed, or they had all evolved together in their lake, through a process of sympatric, or same-place, speciation. Schliewen and Tautz sequenced a short snippet of mitochondrial DNA from each fish. By comparing the sequences, they could work their way backward to calculate the time of the organisms’ most recent common ancestor. The results indicated that the two ancestors of the twenty different species had lived and diversified within each lake. It was solid evidence of sympatric speciation.

And later:

Konrad Lorenz, a Nobel Prize-winning biologist from Austria, formalized the study of animal behavior, or ethology, in the middle of the twentieth century. Lorenz’s most famous insight came when he hatched and raised a clutch of goslings. Not only did the young birds treat him as their mother, but, when they matured, they sought out human mates. Lorenz realized the geese had no innate sexual preference; rather, they learned to recognize appropriate mates by imprinting on their parents in the first days of their lives.

Crows and most other birds also imprint. Wolf has come to think that this might be the mechanism of their speciation. If carrion crows imprint on carrion crows and hooded crows imprint on hooded crows, then the occasional hybrid, who looks like neither, will be disadvantaged when it comes to finding mates. This process of “social marginalization,” Wolf believes, may be enough to create effective reproductive isolation, even though the birds’ genomes are perfectly compatible. (In genetic terms, the crows’ imprinting ends up putting divergent selection pressure on chromosome eighteen and nowhere else, allowing the rest of the genome to homogenize.) He now wants to find out just how long this mechanism has been operating. Crow bones are common in ancient human trash piles—“eating crow” used to be more than just a figure of speech—and, by sequencing the DNA from these bones, Wolf hopes to determine whether cavemen ate hooded crows in Eastern Europe and carrion crows in Western Europe, reconstructing the birds’ speciation continuum with data points stretching back thousands of years.

The entire article is worth reading.

Written by Leisureguy

21 September 2021 at 5:52 pm

Calvin, Man of Action

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Written by Leisureguy

21 September 2021 at 11:36 am

How Farming with Horses Makes Better Wine

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Sophia McDonald writes in SevenFifty Daily:

As a child growing up in Champagne, Christophe Baron would ride his bike down a dirt road to visit his grandparents and pass a lush green field where a woman regularly rode a large white horse. That animal made a big impression on a small boy, and he vowed that someday, he would live and work with animals, too.

Baron went on to found Cayuse Vineyards in Washington’s Walla Walla Valley, followed by a project he calls Horsepower Vineyards, where much of the vineyard work is done with teams of Percheron and Belgian draft horses. After harvest, the horses pull the cultivators that cover the vines’ crowns with soil to keep them warm. In the spring, they power the plows that pull the soil back, aerate the ground, and cut down weeds.

Using horses at his biodynamic vineyard produces higher-quality wines, Baron believes, and he’s not the only one. Domaine de la Romanée-Conti recently reintroduced horses at its vineyards to help decrease soil compaction as well.

Beyond the practical reasons for driving horse teams through vineyards, there is also a desire among some to keep the craft and tradition of horse viticulture alive. “There’s something irreplaceable and really authentic about using horses,” says Horsepower’s equine and vineyard manager Joel Sokoloff. “We do it because it’s a choice to farm in a much more artisanal and ancestral way.”

Working with animals instead of machines means treading more gently on the earth and farming at a less frenetic, more traditional pace. “We live in a world where everything is the same, where everything goes fast,” Baron says. “It’s always more, more, more.”

But farming with horses is not just slower—it’s more time-consuming and expensive. “It makes no economic sense to farm with horses,” says Charline Drappier, the deputy director of Champagne Drappier, whose family started using Ardennais horses on its 71-acre organic vineyard to till, remove weeds, and aerate the soil about 15 years ago. “It’s a real investment, but it’s pure investment for very little productivity.”

Horses can also be a dangerous liability to owners who don’t understand how to work them. “Sometimes people see this very romantic picture of horses as gentle giants,” says Stephen Hagen, the owner of Antiquum Farm at the southern end of Oregon’s Willamette Valley, who previously farmed his vineyards with horses for several years and has been working with them since he was a teenager. “The truth is there’s nothing more dangerous you can do—besides maybe bull riding—than hooking farming implements to the back of two 2,000-pound horses and farming with them. That’s especially true when you’re working horses in the physical constraints of a vineyard. There’s a high degree of caution and skill that’s necessary.”

What Horses Do that Machines Can’t

Cultivators drawn by four-legged critters rather than steel-and-rubber farm equipment make for a much more tactile, gentle experience for the ground and the vine, says Sokoloff. “You can feel through your hands and through the cultivator every stone you hit and every soil change.” If a tractor snags a vine, the driver will never feel it. Someone driving a team of horses is more likely to, and can stop before they tear the plant from the ground.

Even passing through the vineyard 14 times a year, horses put less . . .

Continue reading.

Written by Leisureguy

21 September 2021 at 11:05 am

Fall spices and Cinnawood Boroka

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Phoenix Artisan’s Star Craft Brought forth a fall-fragrant lather from Seifenglatt’s Pumpkin Pie shaving soap, a seasonal issue of some years back. The marvellous Baby Smooth did its usual perfect job, and a small splash of Cinnawood Boroka from a Chiseled Face sample I’ve had on hand finished the job. The entire shave was a quick and pleasant way to start the new day.

Written by Leisureguy

21 September 2021 at 8:06 am

Posted in Shaving

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