New Taxes to Take Effect to Fund Health Care Law





WASHINGTON — For more than a year, politicians have been fighting over whether to raise taxes on high-income people. They rarely mention that affluent Americans will soon be hit with new taxes adopted as part of the 2010 health care law.




The new levies, which take effect in January, include an increase in the payroll tax on wages and a tax on investment income, including interest, dividends and capital gains. The Obama administration proposed rules to enforce both last week.


Affluent people are much more likely than low-income people to have health insurance, and now they will, in effect, help pay for coverage for many lower-income families. Among the most affluent fifth of households, those affected will see tax increases averaging $6,000 next year, economists estimate.


To help finance Medicare, employees and employers each now pay a hospital insurance tax equal to 1.45 percent on all wages. Starting in January, the health care law will require workers to pay an additional tax equal to 0.9 percent of any wages over $200,000 for single taxpayers and $250,000 for married couples filing jointly.


The new taxes on wages and investment income are expected to raise $318 billion over 10 years, or about half of all the new revenue collected under the health care law.


Ruth M. Wimer, a tax lawyer at McDermott Will & Emery, said the taxes came with “a shockingly inequitable marriage penalty.” If a single man and a single woman each earn $200,000, she said, neither would owe any additional Medicare payroll tax. But, she said, if they are married, they would owe $1,350. The extra tax is 0.9 percent of their earnings over the $250,000 threshold.


Since the creation of Social Security in the 1930s, payroll taxes have been levied on the wages of each worker as an individual. The new Medicare payroll is different. It will be imposed on the combined earnings of a married couple.


Employers are required to withhold Social Security and Medicare payroll taxes from wages paid to employees. But employers do not necessarily know how much a worker’s spouse earns and may not withhold enough to cover a couple’s Medicare tax liability. Indeed, the new rules say employers may disregard a spouse’s earnings in calculating how much to withhold.


Workers may thus owe more than the amounts withheld by their employers and may have to make up the difference when they file tax returns in April 2014. If they expect to owe additional tax, the government says, they should make estimated tax payments, starting in April 2013, or ask their employers to increase the amount withheld from each paycheck.


In the Affordable Care Act, the new tax on investment income is called an “unearned income Medicare contribution.” However, the law does not provide for the money to be deposited in a specific trust fund. It is added to the government’s general tax revenues and can be used for education, law enforcement, farm subsidies or other purposes.


Donald B. Marron Jr., the director of the Tax Policy Center, a joint venture of the Urban Institute and the Brookings Institution, said the burden of this tax would be borne by the most affluent taxpayers, with about 85 percent of the revenue coming from 1 percent of taxpayers. By contrast, the biggest potential beneficiaries of the law include people with modest incomes who will receive Medicaid coverage or federal subsidies to buy private insurance.


Wealthy people and their tax advisers are already looking for ways to minimize the impact of the investment tax — for example, by selling stocks and bonds this year to avoid the higher tax rates in 2013.


The new 3.8 percent tax applies to the net investment income of certain high-income taxpayers, those with modified adjusted gross incomes above $200,000 for single taxpayers and $250,000 for couples filing jointly.


David J. Kautter, the director of the Kogod Tax Center at American University, offered this example. In 2013, John earns $160,000, and his wife, Jane, earns $200,000. They have some investments, earn $5,000 in dividends and sell some long-held stock for a gain of $40,000, so their investment income is $45,000. They owe 3.8 percent of that amount, or $1,710, in the new investment tax. And they owe $990 in additional payroll tax.


The new tax on unearned income would come on top of other tax increases that might occur automatically next year if President Obama and Congress cannot reach an agreement in talks on the federal deficit and debt. If Congress does nothing, the tax rate on long-term capital gains, now 15 percent, will rise to 20 percent in January. Dividends will be treated as ordinary income and taxed at a maximum rate of 39.6 percent, up from the current 15 percent rate for most dividends.


Under another provision of the health care law, consumers may find it more difficult to obtain a tax break for medical expenses.


Taxpayers now can take an itemized deduction for unreimbursed medical expenses, to the extent that they exceed 7.5 percent of adjusted gross income. The health care law will increase the threshold for most taxpayers to 10 percent next year. The increase is delayed to 2017 for people 65 and older.


In addition, workers face a new $2,500 limit on the amount they can contribute to flexible spending accounts used to pay medical expenses. Such accounts can benefit workers by allowing them to pay out-of-pocket expenses with pretax money.


Taken together, this provision and the change in the medical expense deduction are expected to raise more than $40 billion of revenue over 10 years.


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Changes to Agriculture Highlight Cuba’s Problems





HAVANA — Cuba’s liveliest experiment with capitalism unfolds every night in a dirt lot on the edge of the capital, where Truman-era trucks lugging fresh produce meet up with hundreds of buyers on creaking bicycle carts clutching wads of cash.




“This place, it feeds all of Havana,” said Misael Toledo, 37, who owns three small food stores in the city. “Before, you could only buy or sell in the markets of Fidel.”


The agriculture exchange, which sprang up last year after the Cuban government legalized a broader range of small businesses, is a vivid sign of both how much the country has changed, and of all the political and practical limitations that continue to hold it back.


President Raúl Castro has made agriculture priority No. 1 in his attempt to remake the country. He used his first major presidential address in 2007 to zero in on farming, describing weeds conquering fallow fields and the need to ensure that “anyone who wants can drink a glass of milk.”


No other industry has seen as much liberalization, with a steady rollout of incentives for farmers. And Mr. Castro has been explicit about his reasoning: increasing efficiency and food production to replace imports that cost Cuba hundreds of millions of dollars a year is a matter “of national security.”


Yet at this point, by most measures, the project has failed. Because of waste, poor management, policy constraints, transportation limits, theft and other problems, overall efficiency has dropped: many Cubans are actually seeing less food at private markets. That is the case despite an increase in the number of farmers and production gains for certain items. A recent study from the University of Havana showed that market prices jumped by nearly 20 percent in 2011 alone. And food imports increased to an estimated $1.7 billion last year, up from $1.4 billion in 2006.


“It’s the first instance of Cuba’s leader not being able to get done what he said he would,” said Jorge I. Domínguez, vice provost for international affairs at Harvard, who left Cuba as a boy. “The published statistical results are really very discouraging.”


A major cause: poor transportation, as trucks are in short supply, and the aging ones that exist often break down.


In 2009, hundreds of tons of tomatoes, part of a bumper crop that year, rotted because of a lack of transportation by the government agency charged with bringing food to processing centers.


“It’s worse when it rains,” said Javier González, 27, a farmer in Artemisa Province who described often seeing crops wilt and rot because they were not picked up.


Behind him were the 33 fertile, rent-free acres he had been granted as part of a program Mr. Castro introduced in 2008 to encourage rural residents to work the land. After clearing it himself and planting a variety of crops, Mr. Gonzalez said, he was doing relatively well and earned more last year than his father, who is a doctor, did.


But Cuba’s inefficiencies gnawed at him. Smart, strong, and ambitious, he had expansion plans in mind, even as in his hand he held a wrench. He was repairing a tractor part meant to be grading land. It was broken. Again.


The 1980s Soviet model tractor he bought from another farmer was as about good as it gets in Cuba. The Cuban government maintains a monopoly on selling anything new, and there simply is not enough of anything — fertilizer, or sometimes even machetes — to go around.


Government economists are aware of the problem. “If you give people land and no resources, it doesn’t matter what happens on the land,” said Joaquin Infante of the Havana-based Cuban National Association of Economists.


But Mr. Castro has refused to allow what many farmers and experts see as an obvious solution to the shortages of transportation and equipment: Let people import supplies on their own. “It’s about control,” said Philip Peters, a Cuba analyst with the Lexington Institute, a Virginia-based research group.


Other analysts agree, noting that though the agricultural reforms have gone farther than other changes — like those that allow for self-employment — they remain constrained by politics.


“The government is not ready to let go,” said Ted Henken, a Latin American studies professor at Baruch College. “They are sending the message that they want to let go, or are trying to let go, but what they have is still a mechanism of control.”


For many farmers, that explains why land leases last for 10 years with a chance to renew, not indefinitely or the 99 years offered to foreign developers. It is also why many farmers say they will not build homes on the land they lease, despite a concession this year to allow doing so.


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Surgeon infected patients during heart procedure, Cedars-Sinai admits









A heart surgeon at Cedars-Sinai Medical Center unwittingly infected five patients during valve replacement surgeries earlier this year, causing four of the patients to need a second operation.


The infections occurred after tiny tears in the latex surgical gloves routinely worn by the doctor allowed bacteria from a skin inflammation on his hand to pass into the patients' hearts, according to the hospital. The patients survived the second operation and are still recovering, hospital officials said.


The outbreak led to investigations by the hospital and both the L.A. County and California departments of public health. The federal Centers for Disease Control and Prevention was also consulted.








Hospital officials called it a "very unusual occurrence" probably caused by an unfortunate confluence of events: the nature of the surgery, the microscopic rips in the gloves and the surgeon's skin condition. Valve replacement requires the surgeon to use thick sutures and tie more than 100 knots, which can cause extra stress on the gloves, they said.


Nevertheless, the hospital's goal is to have zero infections, said Harry Sax, vice chairman of the hospital's department of surgery. "Any hospital-acquired infection is unacceptable," he said.


The infections raise questions about what health conditions should prevent a surgeon from operating and how to get the best protection from surgical gloves. Surgeons with open sores or known infections aren't supposed to operate, but there is no national standard on what to do if they have skin inflammation, said Rekha Murthy, medical director of the hospital's epidemiology department. She added that there were also no national standards on types of gloves used, whether to wear double gloves or how many times surgeons should change those gloves during a procedure.


Healthcare-acquired infections are very common throughout the United States. Each year, infections cause 99,000 deaths in the country, including about 12,000 in California. Hospitals in the state are required to report certain infections to the California Department of Public Health. That reporting makes the public more aware of the quality of care provided at local hospitals and is an important tool for reducing infections, said Debby Rogers, deputy director of the department's Center for Health Care Quality.


Cedars-Sinai has low rates for hospital-acquired infections compared with the state and national average but has not performed as well on other surgical quality measures recently, according to the Leapfrog Group, an employer-backed nonprofit focused on healthcare quality. The organization gave the hospital a C rating last month on its national report card, down from an A in June, though it was not related to the infection outbreak.


"Clearly this hospital is making attempts to reduce infections, but they have more work to do," said Leah Binder, Leapfrog's chief executive.


Cedars-Sinai Medical Center conducts about 360 valve replacement surgeries each year and said infections occur in fewer than 1% of its cases — lower than the national average.


The hospital learned about the problem in June after three patients who had undergone valve replacement surgery showed signs of infection. Doctors diagnosed the patients with an infection called endocarditis. Concerned there might be a connection among the cases, epidemiologists analyzed the bacteria, staphylococcus epidermidis, and determined that it was an identical strain and therefore must have come from a single source. "It led to the question of gee, I wonder where it came from?" Murthy said.


Epidemiologists homed in on the surgeon with the skin inflammation. The bacteria matched, and then they made a surprising discovery: microscopic tears in the gloves typically worn by surgeons after performing valve replacement surgery. The surgeon, whose name was not released, was not allowed to operate again until he healed. He is still a member of the medical staff but no longer performs surgeries at the hospital.


The hospital soon found the same infection in two more patients. Officials also reached out to 67 patients who had heart valve replacements with the same surgeon but didn't find any other cases. One of the five infected patients was treated with antibiotics, and the other four had new valve replacement surgeries. Sax said the hospital apologized to the patients and has continued to monitor their health. The hospital has also covered the cost of their care, including follow-up treatment and all the related surgeries.


All surgeons doing valve replacements are now required to change gloves more frequently, officials said. Some surgeons are wearing double gloves during the operations, Sax said.


Following the outbreak, Cedars-Sinai did the proper follow-up to ensure the safety of their patients, said Dawn Terashita, a medical epidemiologist with L.A. County, who was notified in September. What occurred at Cedars-Sinai was an unintentional consequence of the surgery, she said.


"There is no way to keep a room entirely sterile and all the people in it sterile," she said. "You will always have risk of infection."


anna.gorman@latimes.com





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15 Agonizing Automotive Atrocities












Yugo.


There, we got it out of the way. When you read the headline, of course an image of a tiny Cold War-era hatchback popped into your head. We bet you also shuddered at the thought of a Pontiac Aztek.



We love to poke fun at failure, and no failure made a punchline better than the Yugo. We found that out while talking with Jason Vuic, author of The Yugo: The Rise and Fall of the Worst Car in History. Vuic was aware that the Yugo fell far short of being a good car, but what truly amazed him was how many people who had never driven a Yugo knew just how bad it was. In failure, it became a wild viral marketing success.


Not all cars rose to level of infamy embodied by the Yugo. To paraphrase Shakespeare, some cars were born awful while others had awfulness thrust upon them. Some automotive atrocities were the result of automakers trying something new and falling far short of the mark, while other cars failed from a lack of effort. Still others were perfectly adequate cars but came to represent a regrettable moment in time.


Here we display all three kinds of auto-trocities, highlighting famous failures and digging deep to dredge up detritus better off forgotten. Yes, we know there are many, many more automotive atrocities and this list only scratches the surface of the heap. You’ll have a chance to list your favorite heaps tomorrow, so stay tuned.


Above: Peel Trident 1965-1966


Famous from appearances on Top Gear and Monster Garage, the Peel Trident was a “shopping car” built on the Isle of Man. Along with the bubblelicious BMW Isetta and the fiberglass Reliant Robin, the Trident was ridiculed for its small size and three wheels.


Photo: Casaflamingo/Flickr


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Quentin Tarantino: if you think “Django Unchained” is violent, try slavery












LOS ANGELES (TheWrap.com) – If you think “Django Unchained” is violent, Quentin Tarantino has a historical reality check for you: Try slavery.


The “Pulp Fiction” auteur is back with an Antebellum revenge flick that according to early screenings pours on the blood and gore. Tarantino told an audience of British Academy of Film and Television Arts members on Thursday that if anything he spared the lash in his depiction of slavery, according to the Guardian.












“We all intellectually ‘know’ the brutality and inhumanity of slavery,” Tarantino said, “but after you do the research it’s no longer intellectual any more, no longer just historical record – you feel it in your bones. It makes you angry and want to do something … I’m here to tell you, that however bad things get in the movie, a lot worse shit actually happened.”


Tarantino’s comments indicate that he anticipates the irreverent “Django Unchained” – which opens on Christmas Day – will court controversy for setting its story against the backdrop of the slave trade.


The film centers on a bounty hunter (Christoph Waltz) who partners with a freed slave (Jamie Foxx) to take down a plantation owner, Calvin Candie (Leonardo DiCaprio) who controls his wife. Candie, who speaks with Magnolia-scented menace in the trailers, owns a mixed-race club in Greenville, Miss., and deals in slave-fights.


Perhaps because the film features Tarantino’s trademark sardonic humor, some early viewers have compared “Django Unchained” to the works of Mel Brooks.


“Just watched what was basically a three-hour homage to BLAZING SADDLES,”@LouLumenick tweeted.


But despite the humor, in an interview with Howard Stern this week, Tarantino indicated that he took the responsibility of depicting slavery very seriously. In particular, he said that shooting a scene where a female slave is brutalized brought him to tears and deeply impacted the crew.


“It was early on in the production, and it was the first time we started officially dealing with that kind of ugliness,” Tarantino said. “We later got used to dealing with that kind of ugliness. But that first – it was traumatizing to everybody, none less because of the fact that we were doing it in the real slave area of a real plantation where the slaves lived.


“This actually happened on the grounds,” he added. “There was blood in that ground. Those trees had memories of everything that happened there. We could feel the spirits of the old slaves on the property.”


Of course, Tarantino has taken on controversial subjects before. He turned an ultra-violent and satiric eye at the Nazis and an SD colonel nicknamed the “Jew Hunter” and turned it into “Inglourious Basterds.” Dealing with charges of insensitivity, it nonetheless collected over $ 300 million worldwide and was nominated for a Best Picture Oscar.


Movies News Headlines – Yahoo! News


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U.S. economy adds 146,000 jobs in November












The U.S. economy added 146,000 jobs in November and the unemployment rate fell to 7.7 percent, the lowest since December 2008. The government said Superstorm Sandy had only a minimal effect on the figures.

The Labor Department's report on Friday offered a mixed picture for the economy.

Hiring remained steady during the storm and in the face of looming tax increases. But the government said employers added 49,000 fewer jobs in October and September than initially estimated.

And the unemployment rate fell to a four-year low in November from 7.9 percent in October mostly because more people stopped looking for work and weren't counted as unemployed.

There were signs that the storm disrupted economic activity. Construction employment dropped 20,000. And weather prevented 369,000 people from getting to work — the most in almost two years. They were still counted as employed.

Stock futures jumped after the report. Dow Jones industrial average futures were down 20 points in the minutes before the report came out at 8:30 a.m., and just after were up 70 points.

As money moved into stocks, it moved out of safer bonds. The yield on the benchmark 10-year U.S. Treasury note, which moves opposite the price, rose to 1.63 percent from 1.58 percent just before the report.

Since July, the economy has added an average of 158,000 jobs a month. That's a modest pickup from 146,000 in the first six months of the year.

The increase suggests employers are not yet delaying hiring decisions because of the “fiscal cliff.” That's the combination of sharp tax increases and spending cuts that are set to take effect next year without a budget deal.

Retailers added 53,000 positions while temporary help companies added 18,000 and education and healthcare also gained 18,000.

Auto manufacturers added nearly 10,000 jobs.

Still, overall manufacturing jobs fell 7,000. That was pushed down by a loss of 12,000 jobs in food manufacturing that likely reflects the layoff of workers at Hostess.

Sandy forced restaurants, retailers and other businesses to close in late October and early November in 24 states, particularly in the Northeast.

The U.S. grew at a solid 2.7 percent annual rate in the July-September quarter. But many economists say growth is slowing to a 1.5 percent rate in the October-December quarter, largely because of the storm and threat of the fiscal cliff. That's not enough growth to lower the unemployment rate.

The storm held back consumer spending and income, which drive economic growth. Consumer spending declined in October and work interruptions caused by Sandy reduced wages and salaries that month by about $18 billion at an annual rate, the government said.

Still, many say economic growth could accelerate next year if the fiscal cliff is avoided. The economy is also expected to get a boost from efforts to rebuild in the Northeast after the storm.

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YouTube Makeover Offers Larger Videos








After months of experimenting with YouTube’s interface and serving limited trials to willing users, Google has launched a new look for the web’s biggest video-sharing site.


The new YouTube is reminiscent of Flickr’s redesign earlier this year — putting the content, in this case the videos, front and center. The new YouTube offers larger videos closer to the top of the page; the title is now below the video, just above the various sharing options.


The left of the page is home to YouTube’s new “Guide,” a list of all the YouTube channels you’re subscribed to, along with your history and video playlists. The YouTube Guide now comes with you across devices, offering up new videos and suggestions on everything from Android phones to Google TV.


The other notable change is that the page is no longer centered, it’s aligned to the left edge of the browser window. The result is a slightly less cluttered page with more emphasis on the video, though the dead space to the right looks a bit strange if you’ve got a large monitor.








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Jackson’s Hobbit: the journey begins












WELLINGTON (Reuters) – Film maker Peter Jackson wants to scare children with his latest movie – and perhaps even a few grown ups.


The first of the Hobbit movie trilogy – “The Hobbit: An Unexpected Journey” – is about to hit theatres, and Jackson says he’s tried to hold true to its roots as a children’s fantasy story, with scary bits.












“If they’re scared of the trolls great, if they’re scared of the goblins great, they know there are no goblins, they know there are no trolls, it’s a safe kind of danger,” he says.


The film, produced by MGM and Time Warner Inc, is the fourth in the Oscar-winning Jackson’s blockbuster “Lord of the Rings” film franchise, based on the books of author J.R.R. Tolkien.


It follows the journey of hobbit Bilbo Baggins, reluctantly pushed into travelling with 13 dwarves to steal treasure from a dragon and regain their homeland. During his travels, he comes by the ring that he later passes onto kinsman Frodo Baggins, which was at the core of the “Rings” trilogy.


Jackson says he’s worked to keep distance between the Hobbit, published in 1937, and the much darker Lord of the Rings, which came out nearly 20 years later.


“The Lord of the Rings has an apocalyptic sort of heavy themic end-of-the world quality to it, which the Hobbit doesn’t, which is one of the delights of it,” he said.


POMPOUS AND SMALL MINDED


The pointy eared, hairy footed hobbit Bilbo is played by British actor Martin Freeman, who says he’s tried to make Bilbo his own creation, a character audiences can root for despite his initial pomposity and small mindedness.


“You have to be able to follow him for the duration of the film, but I wanted him to be open and changeable and ready to be surprised,” Freeman said.


A key scene is an encounter in a cave between Bilbo and the creature Gollum, reprised in full computer generated splendor by Andy Serkis with the distinctive throaty whisper.


“It was a very rich experience,” he said, adding that playing Gollum again was “an absolute thrill”.


Such is the affection for the creature, who calls the magic ring “Precious”, that a 13 meter (42 feet) sculpture of Gollum hangs in the airport terminal at Wellington, which regards itself as the spiritual home of the Tolkien films and terms itself the “Middle of Middle Earth”.


Returning actors from the Rings trilogy, many of whom have only passing mention in the book, were no less enthusiastic. Ian McKellen returns for a leading role as the wispy-haired, grey bearded wizard, Gandalf, while Cate Blanchett is the elven queen Galadriel and Elijah Wood appears as Frodo Baggins.


“You couldn’t not come back, you had to come back,” says Hugo Weaving, the leader of the elves, Elrond.


HOBBIT – A FRAUGHT JOURNEY


The Hobbit film journey has not been without its setbacks.


Metro-Goldwyn-Mayer, owners of the film rights to the Tolkien books, had financial woes, prompting original director Guillermo del Toro to pull out and Jackson, already script writer and executive producer, to step in.


A major labor dispute prompted threats to move production out of New Zealand, and was solved by changing labor laws, while Jackson suffered a perforated ulcer and underwent surgery, delaying the film still further.


Though only two films were planned originally, Jackson has tapped Tolkien’s appendices to the Rings to make it into three.


Audiences are also getting more visual bangs for their buck, with the movies filmed in 3D and at 48 frames per second (fps), double the industry standard.


This delivers clearer pictures, but opinion is divided, with some critics calling it cartoon-like and jarring.


Jackson says he wants to drag the iPad generation back into theatres and the romance, excitement and mystery they offer.


“It’s more realistic, it’s more immersive. I almost feel a responsibility as a film maker to try to do my part at encouraging people to come to the movies, to watch the film in a cinema,” he said.


The second film “The Hobbit: The Desolation of Smaug” will be released in December next year, with the third “The Hobbit: There and Back Again” is due in mid-July 2014.


(Reporting by Gyles Beckford, editing by Elaine Lies)


Movies News Headlines – Yahoo! News


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America waits for Powerball jackpot winners to reveal themselves

Powerball officials confirmed that there are two winning tickets in the second-biggest lottery in history, sold in Arizona and Missouri.









Someone missing at work on Thursday? For many in Arizona and Missouri, that was just one more reason to speculate on who won the record Powerball lottery whose golden tickets were sold in those states.

And while America was waiting to learn who will share in the estimated $587.5-million jackpot, lottery officials prepared to hold news conferences Thursday to highlight the establishments where the winning tickets were sold. Everybody loves a winner, but in the lottery world, the sellers of winning tickets get to share the lucky spotlight.

On Wednesday night, officials drew the winning numbers -- 5, 16, 22, 23, 29, and 6 as the powerball. Two winning tickets will split the jackpot, the largest in Powerball history and the second-largest lottery prize in U.S. history.


QUIZ: Test your knowledge of Powerball


All that is known so far is that one of the winning tickets was sold in the Kansas City area and the other was in Arizona. The winners have 180 days to claim their prize.

Like many forms of gambling, the lottery runs on selling the dream of instant riches, mainly to people who most likely will never have a chance to earn any amount close to a major jackpot.

That the odds of winning are almost one in 176 million rarely serves as a damper on the frenzy, designed to up the drama and the eventual net proceeds that go to the states who are sponsors. (About $1 of each $2 ticket goes to fund the prizes, with the rest going to the states -- minus the administrative costs to run the lottery.)

The record Powerball lottery was no different. At its peak, tickets were selling at a rate of about 130,000 a minute -- the equivalent of a small city picking numerical combinations (or more likely allowing a machine to randomly choose them). That surge is partly responsible for driving up the jackpot to astronomical heights.

It was also fueled by the lack of a winner in earlier rounds. Wednesday’s jackpot had been increased by 16 consecutive failures to pick a winner, rolling over the pot.

One reason for a delay in winners coming forward may be their need to figure out a financial strategy. Winners can be paid over time, for the full $587.5 million, or all at once, for a cash value of $384.7 million.

There are also tax and investment issues that can require some expertise. For example, with the federal government weighing increased taxation on the rich as one way to solve the issues connected to the so-called fiscal cliff, some people may want to pull the income into this year instead of next.

And of course, if the winning ticket was bought by a group such as an office pool, it may take some time to round up the winners and figure out the next step.



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A Step Toward a Universal Cancer Blood Test



By Jocelyn Kaiser, ScienceNOW


People usually find out that they have cancer after developing symptoms or through a screening test such as a mammogram—signs that may appear only after the cancer has grown or spread so much that it can’t be cured. But what if you could find out from a simple, highly accurate blood test that you had an incipient tumor? By sequencing the abnormal DNA that a tumor releases into a person’s bloodstream, researchers are now one step closer to a universal cancer test. Although the technique is now only sensitive enough to detect advanced cancers, that may be a matter of money: As sequencing costs decrease, the developers of the method say, the test could eventually pick up early tumors as well.


The new work is part of a wave of research on using either cells shed into the blood by tumors or free-floating tumor DNA in blood to track the growth and spread of tumors and tailor treatments. The free tumor DNA tests generally rely on looking for known alterations in cancer genes to distinguish cancerous DNA from normal DNA. Seeking a way to detect tumor DNA without knowing its genetic makeup beforehand, postdoctoral researcher Rebecca Leary and others in the labs of Victor Velculescu and Luis Diaz at the Johns Hopkins University School of Medicine in Baltimore, Maryland, and collaborators at other institutions took advantage of an observation they and others have made: No matter the type of cancer, tumor cells almost invariably have substantially altered chromosomes, such as swapped pieces and extra copies of certain genes. This suggests that a test that could detect any chromosomal abnormalities in a person’s blood could serve as a general test for cancer.


Now, the researchers have shown that their idea has promise. First, they isolated the free DNA in blood samples from 10 people with advanced colon or breast cancer. Then, using next-generation DNA sequencing methods, they read the entire genome of the DNA in the blood. (The approach was similar to a new test that can detect Down syndrome in a fetus from a pregnant woman’s blood sample by looking for just an extra copy of chromosome 21.) The cancer patients all had DNA with chromosomal alterations in their blood, whereas none of 10 healthy controls tested positive, according to the team’s report today in Science Translational Medicine.



“There are multiple uses of this approach,” Velculescu says. His group initially hopes to track whether a patient’s tumor is responding to treatment or regrows after surgery. The test could also be used to decide what drug a patient should get without biopsying her tumor—in some patients, the Hopkins team detected extra copies of two genes known to drive cancer, ERBB2 and CDK6, which can be targeted with existing drugs.


The test isn’t that cheap or quick at the moment: Each of the 10 patients’ tests in the study cost several thousand dollars just for sequencing and took a month, including the time for analysis. And early detection is still a ways off. The technique has to sift through large amounts of DNA from normal cells that is also floating in blood to find tumor-associated sequences; the portion of DNA in the cancer patients’ blood that came from tumors ranged from 47.9% to as low as 1.4%. The test might have to work on blood samples with less than 0.1% tumor DNA to detect small, curable tumors, the researchers suggest. But that is just a matter of doing more sequencing, Velculescu says. And as sequencing costs continue to drop, “in the very near future, this could end up being extremely cheap,” he adds.


“The approach has tremendous promise and, should the sequencing strategy become economical, it could have important applications in early cancer detection,” says Daniel Haber of Massachusetts General Hospital in Boston who works on using circulating tumor cells to detect and monitor cancer.


Carlos Caldas of the Cancer Research UK Cambridge Research Institute, who, like the Hopkins group, is working on sequencing free tumor DNA in blood, says the new study is the latest showing “that circulating tumor DNA is going to have a great future in all aspects of cancer management. … This is an exploding field.” He thinks such tests could reach the clinic within 5 to 10 years.


This story provided by ScienceNOW, the daily online news service of the journal Science.


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