Saturday, July 9, 2011

UN Authorizes Peacekeepers as South Sudan Celebrates Independence

South Sudan became the world's newest country on Saturday (local time) as it declared its independence.In anticipation of an uneasy transition to statehood, the United Nations authorized sent 7,000 troops and 900 police on Friday to help establish peace for the war-ravaged new nation. The U.N. resolution was drafted by the United States and approved by the U.N. Security Council by a 15-0 vote.

Southern Sudan has been in a civil war with its northern counterpart, its second since Sudan became a nation, since the mid-1980s. The split has partly been along religious lines. North Sudan is mostly Muslim while those in the South are mostly Christian and Animist. South Sudan sought independence, in part, over its objections to being governed by Sharia law.

Christian groups and celebrities, such as Bono and George Clooney, have been influential in bringing international attention to Sudan's civil war, especially over the last decade. Samaritan's Purse, a Christian relief organization, has been one of the organizations heavily involved in helping to relieve suffering caused by the war. Franklin Graham, president of Samaritan's Purse, made note of the unusual coalitions involved in helping southern Sudan in an interview with Foreign Policy magazine.

“I'm very grateful for George Clooney and what many of the Hollywood types have done. It's been extremely valuable in keeping Sudan in the center of attention,” said Graham. Graham also made clear that the work of relief agencies is far from over, even with South Sudan's independence.

When asked if South Sudan was ready to govern on its own, Graham replied, “No, it's going to have to have a lot of help. The United States, no question, has to get into that situation knee deep because if we just pull back, I don't see how they make it. Europe has to be involved. The United Nations has to be involved. The border has to be protected. China has to get involved. They have the oil leases. They are going to have to invest in the south. It's going to take a few years for this to function. Look how far they've come in such a short time, though.”

Mini-stim IVF, Mini-IF and Micro-IVF

There is an increased awareness of the availability of minimal stimulation IVF procedures, equivalently referred to as Mini-stim IVF, Mini-IVF and Micro-IVF procedures, as an alternative to conventional IVF primarily because of its decreased cost compared to conventional IVF. Although there are many differences in the approaches taken by programs which use these labels to describe the procedures they perform, there is limited awareness of these differences by patients seeking these procedures. In this paper, we will review some of these differences and reasons that patients may or may not wish to utilize a procedure incorporating them.

The first and most important issue is to be clear about the program’s objective for the ovulation induction. Is the objective to produce as many eggs as possible for the given ovulation induction (as is commonly the objective for conventional IVF, or is it to produce the one or two best eggs that the patient is able to produce? Producing more eggs leads to using more medications both for greater stimulation and to avoid an “LH surge”. How to optimize egg quality is less understood, but appears to be achieved at times with low dose stimulation protocols. Faucer showed that the same numbers of chromosomally normal eggs were obtained using both gentle and more aggressive ovulation inductions. The primary financial saving of a Mini-stim IVF cycle is achieved by decreased medication use and less need of intensive monitoring. Thus gentler ovulation induction protocols will save the patient money. At times, a gentler ovulation induction regimen will also lead to a cancelled cycle that could have been rescued by a higher dose or longer ovulation induction. This may increase patient costs in having to do extra cycles.

ICSI is a powerful technique that bypasses the need for the sperm to be able to enter the egg on its own and thus solves almost all (recognized and unrecognized) male factor problems. We use ICSI routinely as a component of Mini-stim IVF which makes it a powerful alternative to conventional IVF for the young couple with isolated male factor infertility. ICSI enables us to more accurately assess the quality of eggs than if ICSI is not used because the multi-layer of granulosa cells that are found around the egg are removed for ICSI, whereas they need to be left on if ICSI is not used. ICSI is used with conventional IVF in 20-90% of patients depending on the program (with an average use > 50%). Medical coding enables separate billing for ICSI and thus some programs add it to the cost of their Mini-stim IVF program. In our program ICSI (and assisted hatching if needed) are included in the cost of the package price for Mini-stim IVF.

Eggs are identified by the lab in the follicular fluid that is aspirated in conjunction with transvaginal ultrasound. We routinely flush the follicles until the lab finds an egg. Follicle flushing is currently done in a minority of conventional IVF programs for complex reasons. However, if you only have one or two follicles to work with you need to find an egg in each of them. Sometimes we find it in the first aspirate and most of the time by the second flush, but occasionally it is not found until the tenth flush. This is an aspect of Mini-stim IVF that is more difficult than conventional IVF. Follicle flushing increases the amount of time that a case requires.

Some form of anesthesia, usually deep IV sedation, is used in almost all conventional IVF cases. In order to save costs, some programs do not use IV sedation for Mini-stim IVF. The thinking is that since only a few needle punctures are required, patients are willing to trade off the discomfort for the cost savings. We don’t view this as appropriate. In addition to the humanist aspects of providing anesthesia, anesthesia enables the physician to spend the time required for follicular flushing without patient discomfort which enhances the effectiveness of egg retrieval. Also the ovaries frequently are situated in the abdomen in positions that make aspiration more difficult (or even impossible), but they can be pushed to positions to optimize retrieval. However, moving the ovaries around is uncomfortable without some anesthesia. Again anesthesia optimizes egg retrieval which is especially important if only a small number of follicles are available.

Mini-IVF is a great technique which could replace a significant proportion of conventional IVF procedures without decreasing the pregnancy rate. The benefits to the patient are a much easier ovulation induction, fewer side effects from the medications and significant cost savings (1/2 to 2/3rds in our program). Mini- IVF, Mini-stim IVF and Micro-IVF are still evolving as procedures. We feel that the above components are important for a good program.
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Federal Bank Regulators Scrutinizing Mortgage Lawsuits Against Banks, Opening New Worry For Investors, Bankers

WASHINGTON -- Federal bank regulators are scrutinizing more than 150 home loan-related lawsuits directed at lenders and mortgage companies, a top official at the Federal Deposit Insurance Corporation plans to say Thursday, underscoring the threat the largest U.S. banks face from faulty and improper mortgage and foreclosure practices.

The revelation will likely add to large banks' woes, as the five biggest servicers -- Bank of America, JPMorgan Chase, Wells Fargo, Citigroup and Ally Financial -- currently face up to $30 billion in penalties from state attorneys general and federal agencies for wrongful foreclosures and other mortgage-related misdeeds.

Lenders and servicers, which collect borrowers' monthly payments and foreclose on them when they fall behind, face 67 pending class-action suits in more than 20 states that challenge foreclosures based on so-called "robo-signing" and other poor documentation practices, according to FDIC Director of Depositor and Consumer Protection Mark Pearce's prepared remarks for a Thursday congressional panel.

The companies face 57 additional suits in 25 states over alleged improprieties resulting from loan modifications in the Obama administration's signature foreclosure-prevention initiative, known as HAMP, and 24 lawsuits over non-HAMP modifications, according to the remarks. Further, investors in mortgage securities have filed 21 suits that allege misconduct and seek to force banks to buy back the loans at face value, an outcome that could cost banks hundreds of billions of dollars.

The FDIC is also tracking separate suits launched by state attorneys general in Ohio, Nevada and Arizona against Ally and Bank of America.

Regulators sanctioned the banks in April, saying at the time that they expected the firms to improve their procedures and compensate abused homeowners.

But those findings were based on bank-provided information and their own limited review of less than 3,000 loan files. And in that case, regulators didn't act until reports emerged of banks' shoddy practices. Private litigation -- and the discoveries they could produce -- could yield nuggets about poor behavior that regulators missed.

Regulators guide banks in deciding how much money to put aside to guard against losses -- cash that otherwise could be used to pad their profits -- and approve requests to pay dividends to shareholders or buy back shares to drive up the company's stock price. Concerns over lawsuits -- and the merit of plaintiffs' claims -- could derail banks' financial plans.

Bank of America shares are down 22 percent over the last three months in New York Stock Exchange composite trading. JPMorgan has slid 15 percent, while Wells Fargo has declined 13 percent. Citigroup has dropped 8 percent.

"Servicing problems continue to present significant operational and litigation risk to servicers and originating banks," Pearce plans to say, according to a copy of his prepared remarks.

For the larger economy, the lawsuits represent potential pitfalls that could delay a broader recovery.

"The housing market cannot heal and recover until mortgage servicing and foreclosure problems are resolved and systems are adequate to the task at hand going forward," according to Pearce's prepared remarks. "A comprehensive resolution for past servicing errors is essential to the recovery of the housing market and greater economy."

The five largest servicers, which collect payments for three out of every five home loans, are engaged in discussions with state and federal authorities to settle accusations of defective and sometimes-illegal foreclosure practices.

"Poor mortgage servicing practices have both contributed to the creation of the housing crisis and acted as an impediment to its resolution," Pearce plans to say, according to his prepared remarks.

A recent Treasury Department audit of the 10 largest servicers in the HAMP program found that four of them needed "substantial improvement." The remainder were found to need "moderate improvement." None passed with flying colors.

Pearce says in his prepared remarks that about 90,000 homeowners are contesting their foreclosures in court, an indication of poor mortgage and foreclosure practices. As a result, the average foreclosure took nearly nine months to procesas of December, according to Pearce's remarks. It took just four months as of 2007.

Navy tests bacteria-powered hydrogen fuel cell, could start monitoring your underwater fight club

Microbial fuel cells aren't exactly new, but microbial fuel cells scouring the ocean floor? Now that's an initiative we can get behind. The Naval Research Laboratory is currently toying around with a so-called Zero Power Ballast Control off the coast of Thailand, presumably looking for treasures dropped from the speedboat of one "Alan Garner." Purportedly, the newfangled hydrogen fuel cell relies on bacteria to provide variable buoyancy, which allows an autonomous ocean sensor to move up and down water columns with little to no effort. Furthermore, it's able to get its energy from microbial metabolism (yeah, we're talking about hot air), and while it's mostly being used to measure things like temperature and pressure, it could be repurposed for more seirous tasks -- like mine detection. There's no clear word yet on when America's Navy will have access to this stuff, but if we had to guess, they've probably be using it behind our backs for the better part of a score.