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    Toyota Land Cruiser Earns High Marks in Consumer Reports Tests

    SUV lauded for comfort, while other brands get low grades

    The Toyota Land Cruiser earned a "Very Good" overall rating in tests of four luxury SUVs priced above $45,000 for the December issue of Consumer Reports. It ranks seventh overall in the category.

    Redesigned for 2008, the Land Cruiser drew praise from CR's engineers and editors for its comfortable ride, overall level of refinement, and excellent off-road capabilities.

    The Land Cruiser was tested against the Porsche Cayenne S, Land Rover Range Rover Sport HSE, and Hummer H2. The Cayenne S and Range Rover Sport both achieved "Good" overall scores. The H2 came in last in the category, with a "Fair" score. Prices ranged from $61,900 for the Land Rover to $71,985 for the Porsche.

    But in CR's testing, competitive models costing thousands less have earned higher overall scores.

    The best luxury SUV in Consumer Reports tests is the considerably less expensive Lexus RX 400h hybrid, which slightly outpointed the non-hybrid RX 350. Other top-scoring luxury SUVs are the Acura MDX, Mercedes-Benz GL450, Volvo XC90, and Audi Q7, in that order.

    None of the vehicles in this test group are recommended. The reliability of the Range Rover Sport and Cayenne is much worse than average, and the magazine doesn't have sufficient reliability data yet on the redesigned Land Cruiser, it said. The H2 scored too low in CR's testing.

    CR recommends only vehicles that have performed well in its tests, have at least average predicted reliability based on its Annual Car Reliability Survey of more than seven million print and web subscribers, and performed at least adequately if crash-tested or included in a government rollover test, according to Consumers' Union, which publishes the magazine.

    The Land Cruiser is quick, plush and refined. It has a composed, comfortable ride and quiet cabin. It's a capable off-roader, but it's fuel-thirsty and lacks agility. The third-row is cramped, especially given the SUVs rather large size.

    The vehicle, with a $67,707 Manufacturer's Suggested Retail Price as tested, is powered by a 381-hp, 5.7-liter V8 that provides effortless acceleration. CR averaged 14 mpg overall in its own fuel economy tests. Drivers will find plenty of room all around. The front seats are quite comfortable, and the second row can seat three adults with ease. The third row is cramped, low, uncomfortable, and difficult to reach.

    Despite its heft, the Cayenne is quick and sporty. It can tow a heavy trailer and has some off-road capability. Even for those who can afford it, the Cayenne is not to everyone's taste. The ride is stiff, and controls are complicated. The Cayenne ($71,985 MSRP as tested) is propelled by a smooth, muscular, 385-hp, 4.8-liter V8 that delivers excellent response and power. CR averaged 15 mpg overall in its tests on premium fuel. The interior has lots of padded trim, nicely stitched leather seats, and thick carpets. But that opulence is spoiled by oddly grained dash trim, wide panel gaps, and flimsy cup holders. The driver's space is roomy, front seats are very comfortable and supportive-if you fit them-but narrow and confining if you do not. The rear seats are firm but well shaped and easily accommodate three adults.

    The Range Rover Sport offers plenty of interior opulence. Though designed primarily for on-road driving, the Sport remains a competent off-roader like other Land Rovers. But its hefty weight takes a toll on both acceleration and fuel economy, and its controls can be frustrating to use. The Range Rover Sport HSE ($61,900 MSRP as tested) is powered by a 300-hp, 4.4-liter V8 mated to a smooth-shifting, six-speed automatic transmission. Together, they deliver just adequate acceleration and 14 mpg overall on premium fuel. The Range Rover Sport's interior has a very tasteful, high-end trim. Drivers get a high, commanding view of the road ahead. The front seats are well shaped and comfortable but a bit narrow. The rear seats are roomy and comfortable for three adults.

    The Hummer gets awful fuel economy, handling is ungainly, the brakes are subpar, and a terrible view out makes it difficult to judge the vehicle's position within a traffic lane and parking. The short list of good points includes a decent ride and good towing and off-roading capability. The base Hummer ($66,335 MSRP as tested) is powered by a 393-hp, 6.2-liter V8 engine that dishes out plenty of power. Fuel economy is the worst of the group by far, at 11 mpg overall with only 7 mpg in the city. Inside, CR found a mixture of some high-quality materials and cheap-looking panels and wide gaps around the center console. Even average-sized drivers feel a bit cramped and closed in. The front seats are wide and fairly comfortable. The rear seats easily hold three abreast, and the cushions are fairly comfortable.

    Toyota Land Cruiser Earns High Marks in Consumer Reports Tests...
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    Hospitals Score Low in Patient Survey

    Patients prefer higher quality of care than what they receive

    People don't much like what they find when they go the hospital.

    In a new study by Harvard School of Public Health (HSPH), researchers analyzed the first national data on patients' experiences in hospital settings and found that though patients are generally satisfied with their care, there is substantial room for improvement in a number of key areas, including pain management and discharge instructions.

    The study appears in the October 30, 2008 issue of The New England Journal of Medicine.

    "These data really represent a sea change for the health care system. Patient-centered care is at the heart of a high-performing system and until now, we have lacked information on how patients feel about their care. With this information now freely available, providers and policymakers can begin to focus on improving patients' experiences in the hospital," said lead author Ashish K. Jha, MD, MPH, and assistant professor of health policy at HSPH.

    The researchers analyzed data collected in the Hospital Consumer Assessment of Healthcare Providers and Systems survey, which asked patients questions about their hospital experiences and their demographic characteristics.

    Responses were grouped into six areas: communication with doctors, communication with nurses, communication about medications, quality of nursing services, how well hospitals prepared patients for discharge and pain management. More than 2,400 hospitals reported data.

    The results showed that, on average, about 67 percent of patients would definitely recommend the hospital at which they were treated. Patients were more satisfied with hospitals that had a greater ratio of nurses to patients, which wasn't surprising to the researchers. However, the HCAHPS survey provides the first national data to show the important role that nurses can play in providing patient-centered care.

    Another important finding of the study was that hospitals with more satisfied patients generally provided higher quality of care as measured by standard quality metrics. Hospitals in which patients rated their care highly were more likely to provide the appropriate care for heart attack, congestive heart failure, pneumonia and prevention of surgical complications.

    "Our study confirms that there need be no tradeoff between ensuring that care is technically superb and addressing the needs of the patients," said senior author Arnold Epstein, MD, MA, and chair of the Department of Health Policy and Management at HSPH.

    There were large variations in patient-satisfaction performance across the country. For example, 71.9 percent of hospital patients in Birmingham, AL, gave their care a high rating (9 or 10 on a 10-point scale); hospitals in Knoxville, TN and Charlotte, NC received the next-highest scores.

    On the other hand, patients gave hospitals in East Long Island, NY, Fort Lauderdale, FL and New York City the lowest marks.

    The researchers were surprised by some results. Pain management has been the target of both accreditation and quality-improvement initiatives for many years, but nearly a third of patients did not give high ratings in that area. Discharge instructions have similarly been targeted for quality initiatives, but about a fifth of patients did not rate communications in that area highly.

    "Given that we spend more than $2 trillion annually for health care in our country, we should expect that the basics are addressed, like always treating pain adequately," Jha said.



    Hospitals Score Low in Patient Survey...
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    In Times of Tight Credit, Retailers Revive Layaway

    "Buy now, pay later" becomes "Pay a bit at a time"

    Before there was VISA and Mastercard, there was layaway. Consumers who didn't have quite enough cash on hand to make a large purchase could put the item "on layaway."

    That meant the merchant would set the item aside for the consumer until they came in and paid for it. Often the consumer would come in weekly and put down small amounts until the item was paid for.

    In this new era of tight credit, retailers like Kmart and TJ Maxx have experienced a sharp increase in customer demand for their layaway programs, according to a report in the Wall Street Journal. Holiday consumers see layaway as a payment alternative at a time when credit card companies are reducing purchase limits and access to loans is tightening amid the country's ongoing financial crisis.

    "People are shying away from credit cards, because maybe their limits have been reduced or they simply don't want to carry any debt ahead of an economic recession," said Bob Robicheaux, Ph.D., chairman of the UAB Department of Marketing and Industrial Distribution. "And if a purchase can't be put on credit because it's restricted, then the best option is to use layaway and put $10 dollars down then make equal payments toward the purchase in the weeks before the holidays."

    Robicheaux said smaller retailers are more likely to offer layaway programs because those businesses know their customer personally, leading to a degree of trust between buyer and seller. Companies offering layaway this holiday season could see a competitive advantage over larger retailers that have done away with the service.

    "Companies with layaway programs are essentially offering their customers free credit, and many consumers are likely to take advantage of that in these economic times," Robicheaux said. "So I see a distinct advantage for some retailers to capitalize on."

    Layaway, as a practice, was mostly abandoned by many retailers as the popularity of credit cards surged in the 1990s.

    In Times of Tight Credit, Retailers Revive Layaway...
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      "Flawed" 401(k) Laws Putting Retirement at Risk

      Defined-contribution plans not meant to replace pensions

      Congress needs to reform flawed 401(k) laws that could push back retirement for millions of Americans whose savings have collapsed along with the stock market, a University of Illinois elder law expert says.

      Law professor Richard L. Kaplan says 401(k) accounts were meant to supplement traditional defined-benefit pensions, but have evolved into the sole nest egg for the bulk of U.S. workers whose employers offer any kind of savings program.

      The shift, he says, has left workers with the illusion of a company-funded pension when in fact it's largely their own money in investments that are generally tethered to the stock market, which has lost $8 trillion during an economic meltdown over the last year.

      "People mistakenly think they have an employer pension plan and don't understand that their retirement income, other than Social Security, is in very serious jeopardy right now," said Kaplan, who wrote a 2004 article on the risks of 401(k) plans that appeared in the Arizona Law Review.

      He argues that Congress should rewrite laws to allow 401(k) programs only in concert with defined-benefit pensions, even if it means more companies join the roughly half of U.S. employers that offer no retirement savings plan.

      "As matters stand currently, workers are being tricked," Kaplan said. "They think they have a pension plan at work when it's really their own money and every aspect of the 401(k) program -- participation, contribution level, investment allocation, withdrawal arrangement -- is problematic when it's the person's only savings plan."

      Even the lure of cashing in when employers offer matching contributions is "less than compelling," he said. Matches are typically small, and many employers have reduced or eliminated them in recent years. Beyond that, he says, workers who change jobs after just a few years often lose those employer contributions anyway.

      "If people want to save for their retirement, they can always set up an Individual Retirement Account at virtually any financial institution, including their neighborhood bank," Kaplan said. "The dollar limit on contributions is lower for IRAs than for employer-based plans, but the vast majority of 401(k) plan contributions are within current IRA limits and thus would not be impacted by this difference."

      When 401(k) laws were adopted in 1978, the new savings accounts were envisioned as part of a three-pronged plan for retirement, a supplement for monthly checks from Social Security and conventional defined-benefit plans, he said.

      But as 401(k) plans were being launched, Kaplan said, employers already were veering away from defined-benefit programs because of new costs created by the Employee Retirement Income Security Act, adopted four years earlier.

      The act, intended to make worker pensions more secure, also made defined-benefit plans more expensive through new regulations and insurance premiums to safeguard pension funds, he said.

      Only about half of employers offer any retirement savings program and, of those, nearly 60 percent offer just a 401(k) plan, Kaplan said. Many provide little or no company contribution, a trend he says has quickened in the last few years.

      "We're only now beginning to see a cohort of people on the cusp of retirement who have the bulk of their retirement funding coming from 401(k) plans," he said. "It's a relatively new phenomenon."

      Because the stock market plunge has withered savings, many of those workers may have to postpone retirement and keep working, Kaplan said. That, in turn, would reduce job openings for younger workers and boost employer health insurance costs due to an older workforce.

      "You might also just have more older people who are poor, which was the historical norm," Kaplan said. "Before Social Security, it was not unusual for older people to be poor or to move in with sons or daughters, not because they couldn't physically get around but because those were the people who had a significant source of income."

      In his 2004 law review article, Kaplan argued that flaws with 401(k) plans made a case against efforts afoot then to privatize Social Security, which he said would create the same risks and put future retirees in further financial peril. He doubts the move will resurface any time soon in the wake of the lingering turmoil on Wall Street.

      "The cause of Social Security privatization has been set back considerably," said Kaplan.

      ongress needs to reform flawed 401(k) laws that could push back retirement for millions of Americans whose savings have collapsed along with the stock mark...
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      More Pets Turned Over To Shelters in Ailing Economy

      Families give up cherished friends as costs rise and jobs disappear

      By Lisa Wade McCormick
      ConsumerAffairs.com

      October 28, 2008
      Leanne Potts can't shake the painful image.

      A distressed pet owner told Potts she'd lost her home and business and could no longer afford to take care of her beloved dog. The Chattanooga woman then asked Potts' organization to take her 8-year-old Basset Hound.

      The story is one her animal rescue group in Tennessee is encountering often during these tough economic times.

      "It was heartbreaking to take the dog from her," says Potts, president of Bellyrubs Basset Rescue, a non-profit group that finds homes for Bassett Hounds.

      "This was a middle class woman who lived in a nice part of Chattanooga. She and her husband owned a restaurant and had taken out a second mortgage to start the business. The business failed and they lost everything."

      Potts' group took the woman's Bassett Hound, but she had three other dogs. Another rescue group took one of the dogs.

      "But the other two were older dogs," Potts says, adding they were 10 and 12-years-old. "They were on a lot medication for arthritis. The woman told us she couldn't afford that medication and couldn't find anyone to take those dogs."

      That forced the woman to make a heart-wrenching decision.

      "She put the older dogs down," Potts says, unable to mask the sadness in her voice. "She said she would not take them to the pound, she couldn't keep them or couldn't find any rescue group to take them. And she didn't want them to suffer without their medication. So she had them put down."

      Potts worries that other pet owners in her area may soon be forced to make similar decisions.

      "We've been hit really hard (economically)," she says. "Tennessee is leading the nation in personal bankruptcies. We're getting a lot more calls from individuals who want to give us their dogs because they're losing their homes.

      "With all the foreclosures and job losses, the animals are the final victims," adds Potts, whose organization has rescued 71 dogs this year. That's a 50 percent increase since 2007. "They're the forgotten victims in all of this."

      Animal rescue groups and shelters across the country echo Potts' concerns. Many tell ConsumerAffairs.com they've seen an increase in the number of pet owners forced to give up their dogs and cats because of the ailing economy.

      "We've seen a lot of that," says Kathy Burkley, executive director of the Humane Society of Westmoreland County in Greensburg, Pennsylvania. "A lot of people are either losing their homes or can't afford their homes."

      Two people recently brought their dogs to Burkley's facility, which is a no-kill shelter. "They wanted to leave their two big dogs with us because they couldn't afford them anymore," Burkley says. "We asked them if they could give us a few days because we didn't have any space."

      The people walked out, but left their dogs in the shelter's parking lot.

      "We looked out the window and saw they had tied up those dogs to a telephone pole," Burkley says. "We couldn't get a license plate because they walked here."

      This particular story, however, has a happy ending. "Both those dogs were adopted," Burkley says.

      But some distraught pet owners simply leave their dogs and cats in their foreclosed homes when they're forced to move out.

      "Our humane agents have seen that happen several times," Burkley says. "People leave their dogs and cats and walk away.

      "Last week, we took in eight Jack Russell Terriers that were left in a house without food or water."

      Burkley's facility has seen the impact of the tough economy in other ways.

      "We run a clinic once a week where pet owners can bring in their animals for shots and check-ups," she said. "We've started to see people coming in with absolutely no money. When we ask them if they can afford to pay even $10, they say 'no.' Last Tuesday, we had two emergencies and the people had no money to give us."

      Problems across the country

      Across the country, the ailing economy is taking its toll on pet owners in central Oregon.

      ConsumerAffairs.com learned the Humane Society in that area has seen an increase in the number of people forced to give up their animals because of foreclosures and job losses.

      "Animals are the victims when finances are tight," says Lynne Ouchida, community outreach coordinator for the Humane Society of Central Oregon (HSCO). "Like all shelters across the nation, we have felt the impact of the economy on animals and witnessed the tears when people have to give up their animals due to foreclosure."

      Unlike other shelters, though, Ouchida's facility isn't seeing pet owners give up just one animal.

      "What we're getting is people turning in multiple dogs, cats, birds, and small animals. They're giving up all the animals in their homes. This is something we used to rarely--if ever--see. But now, we're seeing people give multiple animals at one time."

      Even horses in Ouchida's part of the country have become victims of the troubled economy. Many people in central Oregon own small ranches, and some of those ranchers are now abandoning their horses because of the high cost of hay and veterinary care, Ouchida says.

      "Often times they do not consider the long term costs, and during difficult financial time, horses are found abandoned on public lands. This can also happen to long time ranch folks."

      Some ranchers have even tried--unsuccessfully--to euthanize their horses because they can't afford to hire a veterinarian, Ouchida says.

      Ouchida's shelter has seen another sign of the sagging economy--more people are asking for pet food.

      "We provide pet food to the homeless, those needing assistance, and to seniors," she says. "These people need help with the food, but while we are receiving more requests for food--and our goal is to help people keep their animals--we are not getting the donations we need because of the downturn in the economy. In last year, we have seen huge drops in dog food and cat food donations."

      Thanks to one philanthropic young girl, though, Ouchida's facility now has enough pet food to feed its animals.

      In April, 12-year-old Mimi A. of Bend, Oregon, started the FreeKibble and FreeKibbleKat Web sites to help feed the hungry dogs at cats at Ouchida's shelter.

      Mimi donates ten pieces of kibble for every person who goes to those Web sites and plays a trivia game.

      She's partnered with pet food company Castor and Pollux. Their efforts have already provided over 49 million pieces of kibble to 11 shelters nationwide.

      "Freekibble is truly helping to feed the 4,000 animals cared for each year (at our facility)," Ouchida says. "But it also allows us to support our pet food program for those in need. We distribute pet food and treats to those in need via Meals on Wheels, VFW LaPine Community Kitchen and Pantry, and local soup kitchens.

      "We also help anyone who asks for pet food assistance via the phone or walks into our shelter."

      The Humane Society of the United States (HSUS) has also helped Ouchida's facility--and scores of other animal shelters and rescue groups nationwide--deal with the increasing number of animals they're seeing in this tight economy.

      Earlier this year, the HSUS started a special foreclosure fund to help "establish, expand, or publicize services or programs that assist families in caring for their pets during the current economic crisis."

      "We started seeing that pets were getting into trouble as people got into (financial) trouble," Nancy Peterson, manager of the HSUS's Feral Cat Program, told us. "I would say this is a national phenomenon. That doesn't mean every shelter in every community is effected to the same extent, but we know it's happening."

      Under the program, animal shelters and rescue groups can apply for grants of up to $2,000.

      "So far, we've given out about $80,000 to 46 organizations," Peterson says. "We seeded the grant with $15,000 and now have $105,000 thanks to the generosity of a lot of wonderful people. And we will continue to provide grants as long as we have money."

      Animal groups that have received the grants appreciate the HSUS's generosityand say it will help them care for distressed animals and their owners in these difficult times.

      "During this foreclosure and financial crisis we have noticed a marked increase in the number of people abandoning their pets," wrote Valerie Slamka, founder of A Purrfect World in New Jersey. Her organization received a $2,000 grant from the HSUS.

      "We intend to use the grant to help educate people about viable alternatives, to expand our foster network to accommodate those in need of temporary assistance and, if necessary, find suitable homes for pets from our list of potential adopters."

      The founder and president of the Community Partnership for Pets in North Carolina says her organization will use the $2,000 grant it received to help struggling pet owners.

      "We will be using this grant to provide emergency veterinary care to low income families," said Mary Cervini. "Just the thought of an animal dying in the back of a car while the family is trying to negotiate a payment plan with the veterinarian's office is a terrible situation."

      A pet owner in central Oregon, who recently received assistance from the humane society there, never forgot that act of kindness.

      "She had come upon some tough times and couldn't feed her dog," Ouchida told us. "We gave her some dog food. And now that she's back on her feet, she wants to do a fundraiser to help us."

      What you can do

      In the meantime, officials with animal shelters and rescue groups offer the following advice to pet owners faced with a financial crisis:

      Contact your local humane society or animal rescue group. "They probably have programs in place to assist people who come upon difficult times," Ouchida says. "Most have ways to help people. And the goal of animal welfare groups is to help people keep their animals...it's most stressful for animals to go home to home."

      Never leave your pets in a foreclosed home. -"It is irresponsible and cruel and most likely illegal to abandon a pet," says the HSUS's Peterson. "A pet could linger there for a long time and die a slow and painful death."

      Be proactive."If you're facing financial problems, deal with them," says Potts, president of the Bellyrubs Basset Rescue. "Talk to your lenders now, pay attention to these (presidential) candidates, and talk to your family and friends. And we tell people that if they take their pets to a shelter, the odds of their animals getting out are slim."

      Try to keep vaccinations and flea treatments current. "But I know that if people don't have the money, they don't have the money," says Burkley, with the Humane Society of Westmoreland County. "The wellness part is just so important because you don't want your pets to get sick. We have people who skip that and find themselves and their pets in a worse situation--something more life threatening and expensive."

      Don't be afraid to ask for help. "I have given some products free to people who don't have the money and say their dog is infested with fleas," Burkley says.

      Animal lovers can also help struggling pets--and their owners--during these tough economic times by:

      • Providing temporary housing for pets while their owners get settled;

      • Supporting their local animal shelters by donating food, money, or time. Some children across the country have asked their family and friends to make donations to animal organizations instead of giving them presents for their birthdays, Christmas, or other holidays;

      • Helping a pet owner in need by pay for their animals' food or veterinary bills;

      • Contacting local animal control officers if they know about a pet living in a house that is abandoned.

      More Pets Turned Over To Shelters in Ailing Economy...
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      Mars Recalls Cat Food Sold at Wal-Mart due to Salmonella

      15 states see recall of "Special Kitty" product


      Mars Petcare US has recalled a limited number of bags of its SPECIAL KITTY Gourmet Blend dry cat food sold at Wal-Mart stores in 15 states because of possible Salmonella contamination.

      The company said the potentially-tainted cat food was sold at Wal-Mart stores in Connecticut, Delaware, Massachusetts, Maryland, Maine, North Carolina, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, Virginia, Vermont, and West Virginia.

      "Mars Petcare has been working cooperatively with Wal-Mart to address this issue, and the affected product of this lot has already been removed from Wal-Mart's shelves," the company said in a statement released on Monday. "As a result, consumers can be assured that all SPECIAL KITTY Gourmet Blend products that remain on Wal-Mart's shelves are safe and not subject to this recall."

      The cat food involved in the recall include the 3.5 pound, 7 pound, and 18 pound bags with the following UPC codes: 81131 17546, 81131 17547, and 81131 17548. The recalled bags also have a Best if Used By date of August 11, 2009 and a lot code that starts with the numbers "50."

      The company said it is not aware of any illnesses in pets or humans linked to the recalled food. Cat owners, however, should immediately stop feeding the food to their pets, the company said.

      Salmonella can cause serious infections in dogs and cats, experts say. People can also be infected if they handle the tainted food. Children, the elderly, and those with compromised immune systems are especially vulnerable.

      Symptoms of Salmonella infection in humans include nausea, vomiting, diarrhea or bloody diarrhea, abdominal cramping and fever. Salmonella can, in rare cases, cause such serious illnesses as arterial infections, arthritis, muscle pain, and urinary tract symptoms.

      Pets infected with Salmonella may be lethargic and have diarrhea or bloody diarrhea, fever, and vomiting. Some pets, however, may only have decreased appetite, fever and abdominal pain.

      Pet owners whose cats ate the recalled food and have these symptoms should contact their veterinarian.

      For more information about the recall, pet owners can contact the company at 1-877-568-4463.

      More about pets ...



      Mars Recalls Cat Food Sold at Wal-Mart due to Salmonella...
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      ATV Injuries and Deaths Continue to Rise

      Consumer groups say hazards from all-terrain vehicles "unabated"


      For the eighth year in a row, serious injuries caused by all-terrain vehicles (ATVs) increased, and children under age 16 continued to suffer a significant portion of those injuries, according to a report released by the Consumer Product Safety Commission (CPSC). Estimated deaths on ATVs increased as well.

      "Every year, more and more families are devastated by deaths and injuries caused by ATVs. This tragic problem continues to be in dire need of an aggressive and immediate solution," stated Rachel Weintraub, Director of Product Safety for Consumer Federation of America. "Congress, CPSC, state legislatures, the ATV industry, and the consumer and health care community still have miles to go before we adequately reduce the hazards caused by ATVs."

      "This new report shows more of the same -- continued high death and injury rates among children on all-terrain vehicles," said American Academy of Pediatrics President David T. Tayloe, Jr., MD, FAAP. "ATVs continue to kill and seriously injure children at alarming rates. The CPSC's meager efforts to stem the tide have been entirely ineffective, and industry has done nothing to make these dangerous vehicles safer."

      Major findings in the CPSC's 2007 Annual Report on ATV-related Deaths and Injuries include:

      • Serious injuries requiring emergency room treatment rose from 146,000 in 2006 to 150,900 in 2007, an increase of less than one percent that was not statistically significant. Since 2001, there has been a statistically significant 37% increase in serious injuries.

      • The estimated number of ATV-related fatalities fell slightly from 948 in 2005 to 882 in 2006. To date, 542 reports of ATV-related fatalities have been identified for 2007, but this number is expected to increase as additional data are gathered. The states with the highest numbers of reported deaths identified in the period 2005-2007 were West Virginia (143), Florida (123) and Kentucky (114).

      • In 2007, at least 107 children younger than 16 were killed on ATVs. This accounts for 20 percent of fatalities.

      • Children under 16 suffered 40,000 serious injuries in 2007 -- or 27 percent of all injuries. This is a 2 percent increase from the 2006 estimate. CPSC found that this decrease was not statistically significant. Since 2001, there has been a statistically significant increase of 17% in the number of children under 16 seriously injured on ATVs.

      The CPSC data include a risk estimate of ATV injuries per 10,000 four-wheel ATVs. The risk estimate for 2007 is 153.9 compared with 163 in 2006. In making this determination, CPSC estimated that there were 9.5 million ATVs in use in 2007 and 8.6 million in use in 2006. In August 2006, CPSC denied a petition filed over six years ago by consumer and health groups demanding action on ATVs. Instead, the Commission moved forward with a rulemaking that would result in ATV standards. There is no timeline for the full rulemaking process and work on the rulemaking appears to have stalled.

      The CPSC's rulemaking, however, describes the development of a "transitional ATV" for children age 14 and older, which is of particular concern to consumer and public health advocates. These ATVs would likely have engines larger than those currently recommended for children under 16.

      The CPSC, the ATV industry, the Consumer Federation of America, and many other consumer advocates recommend that children ages 12 through 15 not ride ATVs with engines larger than 90 cc's.

      On August 14, 2008, the President signed into the law the Consumer Product Safety Improvement Act, which includes a provision focused on ATVs dealing primarily with protecting the economic interests of the largest ATV manufacturers.

      The provision makes the current ANSI/SVIA voluntary standard mandatory; requires that the manufacturer of any ATV imported into the U.S. be party to ATV Action Plans; requires that CPSC continue its rulemaking process and consider multiple factors when categorizing youth ATVs; and requires that CPSC consult with NHTSA to determine the safety of numerous aspects of ATV safety.

      The ANSI/SVIA standard sets forth a description of a transitional ATV, which contradicts that of CPSC's proposed rule. The speed limit for transitional ATVs in the ANSI/SVIA standard is considerably higher than that in CPSC's proposed rule.

      "The CPSC data show that the hazards posed by ATVs continue unabated. Children should not be riding adult-size ATVs, ATVs must be designed to eliminate hazards and enforcement must be effective at both the federal and state level," stated Weintraub.



      For the eighth year in a row, serious injuries caused by all-terrain vehicles (ATVs) increased, and children under age 16 continued to suffer a significant...
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      Checking Account Fees Hit Record Numbers in 2008

      ATM surcharges, bounced check fees, monthly service charges all up

      A new study finds that checking account fees have risen again this year to an all-time high. Bankrate's 2008 Checking Study details the average fees associated with using and maintaining an interest bearing account, including bounced check fees, ATM surcharges, and monthly service fees.

      Bankrate's survey of leading banks yielded the following data:

      • ATM surcharges moved to $1.97 while the cost of using an outside ATM reached $1.46, putting the total average cost of using an out-of-network ATM at $3.43. Additionally, bounced check fees rose 2.5 percent this year, up to $28.95.

      • With interest bearing accounts, monthly service fees hit a new high at an average of $11.97. Minimum balances also set a record with an average balance of $3,461.84 needed to keep an account open.

      • For non-interest bearing accounts, monthly service fees hit a new low at an average of $1.96. Minimum balances also hit a new low with an average balance of $109.26 required.

      To avoid some of the penalties associated with checking accounts, Bankrate's experts recommend taking the following steps:

      • Consumers should keep close tabs on their accounts by balancing their checkbooks regularly as well as checking their account balances regularly online. Furthermore, sign up for overdraft protection with a funded savings account to ensure that you don't bounce a check.

      • Use foresight when taking out money from your bank's ATM. Taking out $30 or $40 dollars from an out-of-network ATM is the same as paying 9 percent interest on your money.

      • Investigate online banks. Many reputable online banks have generous ATM fee reimbursement programs for frequent users.

      "In today's uncertain economic environment when every dollar counts, it is more important than ever for consumers to be vigilant about avoiding bank fees," said Bankrate Sr. Financial Analyst, Greg McBride. "Bankrate.com's annual Checking Study provides consumers with the tools and advice to find the best account and avoid unnecessary fees."

      Bankrate.com surveyed one interest checking account and one noninterest checking account at each of the largest banks and thrifts in each of 25 large markets to find the latest trends on checking account and ATM fees. There were 247 interest accounts and 226 noninterest accounts surveyed at 249 banks and thrifts in the top 25 metropolitan areas.

      The complete study is available online..

      Checking Account Fees Hit Record Numbers in 2008...
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      Personal Bankruptcies On the Rise

      Bankruptices on the rise but the choice can have serious consequences

      With two million people losing their homes to foreclosure this year and unemployment at a five year high, personal bankruptcies are on the rise again as well, up more than 28% over last year. Expectations are that bankruptcies will top 1.1 million for the year.

      That's according to the American Bankruptcy Institute which reports American families are now going bankrupt at the rate of 22,000 a week, a figure that is trending upward as the nation falls deeper and deeper into a recession.

      Some may see bankruptcy as a personal bailout, their individual version of the government bailout offered to banks. After all, wasn't it too much debt that drove our largest financial institutions into needing a $700 billion dollar bailout? Too much debt is one of the key reasons that more and more Americans are being driven into bankruptcy, along with rising unemployment and unpaid medical bills because of lost health benefits.

      But with laws tightening to make bankruptcy filings more difficult, not to mention more expensive, bankruptcies are nothing like bailouts. In fact, there are a few things you need to know if you are considering going down this rough and financially dangerous road.

      First and foremost, filing for bankruptcy destroys your credit rating and could make it extremely difficult to borrow money for many years thereafter. Typically, a bankruptcy will stay on a credit report for at least ten years.

      Steps you can take prior to bankruptcy

      Since bankruptcy is a very serious step with short and long-term consequences, make sure you have exhausted all other options before taking this route. One way to try to forestall it is to try to work out with as many of your creditors as possible partial payment options even if you both agree that it will take months or even years to finally repay the debts that are owed.

      Another option is to approach family or friends for monetary gifts or loans. If they turn you down, or if they are tapped out themselves, consider selling whatever valuables you have that might generate revenue such as gold, sterling silver, even heirlooms, art works, furs, bicycles, or cars.

      See if you can get a second or even a third job or ask a teen and young adult family members who are able to work, in addition to going to school full-or part-time, if they can contribute to your family household income needs. Renting out a room or part of your apartment or house, if it is allowed in your community, is another possible source of revenue.

      Bright spot

      If you have exhausted all possible avenues and bankruptcy still seems like the only alternative, there is a small bright side. Some experts say those who file for bankruptcy are already in such bad shape their credit scores are already very low. Therefore, wiping out their debts by filing for bankruptcy may even improve the chances for some people to eventually rebuild their credit ratings.

      So, if there are no viable alternatives to bankruptcy, the first step is for you to find a good lawyer who has expertise in bankruptcy filings. If you don't have one, the National Association of Consumer Bankruptcy Attorneys can provide you with a list of names in your area. They'll help you determine what kind of bankruptcy you should be filing because there re two main options. Most personal bankruptcies tend to be either Chapter 7 or Chapter 13.

      Chapter 7

      Chapter 7 is the simplest and least expensive personal bankruptcy alternative. It's what you do if you can't pay your unsecured debt, such as credit card payments. The process, which takes only a few months, will wipe off your credit card balances. Bankruptcy lawyers say the primary reason people chose Chapter 7 is so they can protect their car and home.

      Some assets, such as pension plan, qualified retirement plans like IRAs or 401(k)s, are exempt from Chapter 7 bankruptcy, which means you can keep them. So if you find yourself falling into financial trouble, the one thing you don't want to do is to cut back on pension or retirement contributions.

      Chapter 13

      The more complicated version is Chapter 13 which is a court-supervised three-to-five year repayment plan that lets you keep more of your assets. It can also help to reduce car or mortgage payments that aren't covered under Chapter 7. In a Chapter 13 filing, your debts are not wiped clean. Instead, during repayment plan, you pay back some of your debts. After that, most of the rest of your debts are forgiven.

      Also with Chapter 13, you may be able to alter a car loan or catch up on back mortgage payments. As for other types of assets you may want to keep that aren't protected under Chapter 7, Chapter 13 may apply. But again, this will vary from state to state and there are a number of rules governing how much you have to repay each creditor.

      There are other types of bankruptcies, such as Chapter 11, which is corporations use but usually is too expensive for most individuals. Then there is Chapter 12, which works like Chapter 13 but is designed for family farms.

      Keep in mind that there are some things no type of bankruptcy will help you with such as student loans, child support, alimony and back taxes.

      How bankruptcies work

      Declaring bankruptcy can be a long and painful process. Once you find an attorney, you then set up a meeting where you bring your past tax returns, pay stubs, bank statements, and documents showing any assets and debts. You also have to agree to go through credit counseling.

      You then file with the bankruptcy court which should issue an automatic stay that stops creditors from harassing you or trying to seize your assets. Shortly thereafter, within four weeks, you may have to meet with what's known as a creditor's trustee to review your situation. Following this, the court may wait another two months to see if any objections are filed to your bankruptcy petition. You'll also need to enroll in a credit education course. Finally, if the court rules in your favor, you will receive an order that discharges you from most of your debts.

      Perhaps the most important asset that may be protected from creditors in bankruptcy is your home, provided it is your primary residence. The amount you can protect varies from state to state. Florida and Texas have what's called "homestead exemptions" which means your home is protected. Some states have rules governing occupancy and that you have to actually own the property. Other states only allow you to keep a home, provided you have a certain amount of equity invested in the property.

      There also are other assets such as your car and some personal effects that may be protected, but the limits will vary from state to state.

      Nobody likes bankruptcies but in these difficult times they are becoming an ever-growing part of American life. One Richmond, VA-based counseling agency, Clearpoint Financial Solutions, recently told the Richmond Times Dispatch that it has seen a 10 percent increase in the number of people seeking help over last year, along with other signs of hardship, including:

      • A 25 percent increase in the amount of debt people are placing in debt-management programs, indicating a rise in delinquency rates with consumer credit.

      • A 22 percent increase in monthly housing expenses among people seeking counseling.

      • A 23 percent increase in the number of clients who are now living with friends or relatives because they can't afford to rent or own a home.

      You and any of your family members may be having a hard time dealing with the emotional ramifications of declaring bankruptcy, such as feeling guilty about telling those who performed work for you that you will not be able to pay them, or how your self-esteem is impacted by your grave financial situation. If so, consider seeking out a therapist who can help you deal with those emotions and provide the kind of help you probably won't get from a credit counselor.

      Just remember that these are very hard times and you are not alone in having to go down the personal bankruptcy road. It's becoming one crowded highway.

      Personal Bankruptcies On the Rise...
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      How to Appeal Your Property Tax Bill

      Make sure you're not paying more than your house is worth

      When home values fall, so can property tax bills, but sometimes not before you initiate the tedious process to prove your home's assessed value warrants a tax reduction.

      Pay close attention to your next property tax bill.

      Your home may be worth less than the local tax assessor believes and that could mean a smaller property tax bill.

      However, unless the assessor takes it upon himself or herself to update property values, against which taxes are typically levied, it's up to you to appeal your tax bill.

      Pay particular attention to the fact that property tax systems vary widely from jurisdiction to jurisdiction.

      • Property taxes are typically based on some assessed value of your property, but that's where the similarity ends.

      • How property values are actually assessed, how that assessed value is taxed, the length of time between assessments, the process to appeal the assessment and the laws that govern it all, are all as local as your real estate market.

      • You must visit your local jurisdiction to learn the local system, its rules and your rights to appeal. Don't assume the assessor isn't already at work for you, but also don't assume he or she is.

      The Federation of Tax Administrators can point you to your property tax assessor or administrator where you can get all the details you need for appealing your property tax.

      Right now is a good time to take stock of your property tax bill.

      Generally, when home prices rise, so do property taxes. The opposite is also true, when home values fall, so do property taxes.

      Today's increased incidence of foreclosures, slow sales and lender reluctance to finance the full value of a home make it obvious that home values are down in many locations.

      The previous housing boom frenzy caused many buyers to bid up the price of the property and artificially inflate the value. In some markets, sellers who purchased homes at the height of the boom and must now sell, are finding they have to price their home to move. That causes home value declines.

      The National Taxpayers Union (NTU) reported that as many as 60 percent of all homes are over-assessed and not in line with their actual value -- and that was during boom times.

      Also many errors are clerical mistakes according to the American Homeowners Association (AHA).

      The vast majority of homeowners who find errors and contest their bill enjoy a lower property tax, says the AHA, which offers a quiz that points to signals your home could be over assessed.

      Tell-tale signs include:

      • Errors in the description of your property on the tax bill.

      • Compatible homes in the area that have sold for less than your appraised value.

      • Neighbors with lower assessments on similar houses. Some homes retain the same assessed value for years and assessed values often don't rise in step with market values or home sale prices.

      • Value reducers in your home or area, including drainage problems, easements, re-zoning, heavy traffic, nearby railroad tracks, freeways, industry or toxic waste.

      • Depreciation factors, including age, the quality of materials, inefficient heating, structural cracks, deterioration, or chronic defects.

      The AHA's kit is a good deal because it's an informative package that is free. NTU's costs $7, but likewise remains a bargain from an independent non-commercial source. However, your local jurisdiction has all the information you need to appeal your property tax assessment and it's a good bet that information and the process is free.

      Watch out for private, sometimes questionable property tax reduction operations charging larger fees and promises. Avoid official-looking mailings and email come-ons that offer to do the work for you -- for a fee -- with "guarantees." Some are out right scams appealing to your sense of dread at going it alone. They want only your money and have no plans to appeal your property tax assessment.

      In any event, you can wait until your assessment arrives or visit your property tax assessor's office to examine your account.

      When you do, consider the following questions:

      • Did you buy your home in a bidding war? Yesterday's over-valued property is today's over-assessed property.

      • Are there errors in your tax records? Look closely at your records and make sure there aren't reporting errors. A condo listed as a single-family home, an incorrect age, square footage that's off, too many rooms and other descriptive factors could falsely boost assessed value.

      • Do the math. Some tax laws put a cap on how much above the market value an assessment can be and how much it can rise each year. An appeal that results in a reduced assessed value, may not be permanent. You could quickly return to your higher value, market conditions permitting.

      To appeal the assessed value and related property tax, prepare yourself for a tough row. You may even have to appeal an initial rejection.

      First, pay close attention to your local rules' period of time when you must complete the appeals process.

      Even if the process is free if you go it alone, you may need the help of a real estate agent, realty attorney or other licensed professional to assist you gathering some of the evidence you'll need to make your case.

      You'll have to look at comparable homes in your community to determine how much the owners are paying for property taxes. The information is largely public and available from your tax assessor's office.

      You'll typically have to find at least three other comparable homes in your neighborhood that have lower assessments. Obviously, the lower, the better.

      A real estate agent or other professional who has access to the multiple listing service can do a comparable market analysis of homes recently sold and in escrow to hone in on your home's true value -- something you may not be able to accomplish with older public records.

      An appraiser with multiple listing service access can do the same, as well as perform an appraisal of your home.

      In either case, you could be out a few hundred dollars for professional assistance. Don't make a case if you don't think it's worth the cost to appeal.

      The AARP also says some states have programs for property tax deferrals and other programs that let certain home owners postpone payment of some or all property taxes. There are also some tax rebates and exemptions.

      Don't forget, property taxes are also one of many home ownership related expenses that qualify for a deduction on your income tax returns. The smaller the tax, the smaller the deduction.

      ---
      Broderick Perkins parlayed 30 years of old-school journalism into a digital real estate news service, the DeadlineNews Group, offering "News that really hits home!"™. The Silicon Valley bootstrap includes the Web site DeadlineNews.Com and the back shop Deadline Newsroom. Contact him at news@deadlinenews.com.

      How to Appeal Your Property Tax Bill...
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      Brits Get Treats, Yanks Get Tricks From Food Companies

      American products use food dyes, while UK equivalents go all-natural

      While British consumers enjoy products made by General Mills, Kellogg, Kraft and McDonald's that are free of synthetic food dyes, American customers lack such royal treatment, according to the October issue of Nutrition Action Healthletter.

      Despite evidence linking food dyes to hyperactivity and other behavior problems in children, companies continue to use the controversial dyes in American product lines. But interestingly enough, they substitute natural colorings in the United Kingdom.

      In the U.K., Fanta orange soft drink gets its bright color from pumpkin and carrot extract, but in the U.S. it comes from Red 40 and Yellow 6. Starburst Chews and Skittles, which are both Mars products, also contain synthetic food dyes in the U.S. but not in the U.K. Similarly, in the U.S., McDonald's strawberry sundaes are colored with Red 40 but --amazing as it might sound --real strawberries in the U.K.

      "British candy has all the sugar of American candy, and it's certainly not health food," said Michael F. Jacobson, executive director of the nonprofit Center for Science in the Public Interest (CSPI), Nutrition Action's publisher. "But as Halloween approaches, it's a shame that American kids trick-or-treat for candy dyed with discredited chemicals while British families have many of the same foods, minus the dyes."

      Americans consume five times as much food dye as they did 30 years ago, according to data from the Food and Drug Administration. But in the wake of two British studies that found food dyes (and possibly the preservative sodium benzoate) impair the behavior of many children, the British government pressured companies to switch to safer, natural colorings and the European Parliament approved a warning label for foods that still contain the dyes.

      In June CSPI urged the FDA to ban Red 40, Yellow 5 and six other synthetic dyes. The group wants parents of children sensitive to the chemicals to file reports online, which CSPI will then forward to the FDA.



      Brits Get Treats, Yanks Get Tricks From Food Companies...
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      Can Coffee Offset Liver Damage from Alcohol?

      The Healthy Geezer



      Q. I'm a social drinker who has several glasses of wine every evening, but I'm told I can avoid any liver damage if I drink plenty of coffee. Sounds ridiculous. What do you think?

      There was a study of more than 125,000 people who drank coffee. The study, published recently, showed that one cup of coffee a day cut the risk of alcoholic cirrhosis of the liver by 20 percent. Four cups a day reduced the risk by 80 percent. It's not known yet why coffee protected livers in this study.

      Even "social drinkers" can develop cirrhosis, a condition that causes irreversible damage to the liver. Whether you get cirrhosis depends upon the amount of alcohol you drink and a predisposition for the condition.

      If you drink a lot of alcohol, you will hurt your liver. However, you will not necessarily get cirrhosis. You have a one-in-three chance of getting cirrhosis if you drink 8 to 16 ounces of liquor a day (or the equivalent in other alcoholic drinks) for 15 years or more.

      More men than women get cirrhosis. There is a theory that more men get cirrhosis because they're heavier drinkers.

      Women can't tolerate as much alcohol as men can. Studies show that a much higher percentage of women, consuming less alcohol than men, suffer from cirrhosis.

      In the United States, excessive alcohol consumption is the single greatest risk factor for cirrhosis. Chronic infection with the hepatitis C virus is the second leading cause of cirrhosis.

      The liver, which is located in the upper right side of the abdomen, is the largest organ in the human body. It weighs about three pounds and is--believe it or not--about the size of a football. You cannot live without a liver.

      The liver is a multipurpose organ that performs hundreds of tasks. Among its functions are the digestion of fats, removal of harmful substances from blood, production of cholesterol, control of infections and the coagulation of blood.

      In cirrhosis of the liver, scar tissue replaces healthy tissue; this blocks blood flow through the liver and prevents it from working efficiently.

      At the onset of cirrhosis, there may be no symptoms. As the liver deteriorates, the following may occur: internal bleeding, fluid retention in the legs and feet, bruising, yellow skin and eyes, fluid in the abdomen, itchy hands and feet, dark urine, loss of appetite and weight, nausea, fatigue, and red spider veins.

      Although liver damage from cirrhosis is irreversible, treatment can help prevent more damage and reduce complications. Giving up alcohol is the primary treatment. Improving nutrition is often part of treatment, too.

      A doctor can diagnose cirrhosis through symptoms, a medical history, a physical exam, and tests.

      Tests that are often used in diagnosis include a computerized axial tomography (CAT) scan, ultrasound, magnetic resonance imaging (MRI), or a scan using a radioactive substance that highlights the liver. A doctor might look at the liver using an instrument that is inserted into the abdomen. A liver biopsy can confirm a diagnosis.

      All Rights Reserved © 2008 by Fred Cicetti



      There was a study of more than 125,000 people who drank coffee. The study, showed that one cup of coffee a day cut the risk of alcoholic cirrhosis of the l...
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      West Virginia Wipes Out Credit Card Debt for 1,451 Citizens

      Attorney General cleans the slate for victims of shady debt collector

      As thousands of consumers discover each year, shady companies that promise to get rid of your credit card debt always fail to deliver. It turns out that getting rid of that debt is a lot harder than they say.

      Your state attorney general, on the other hand, can sometimes wipe the slate clean, especially if there is something about the debt, or the way it is being collected, that bends or breaks the rules.

      In West Virginia, for example, Attorney General Darrell McGraw has entered into a settlement agreement with Financial Credit Services ("FCS"), a debt purchaser based in Palatine, Illinois, that purchased canceled debts of $6,675,474.64 for 1,451 West Virginia consumers.

      According to FCS, the defaulted credit card accounts in question were originally owed to numerous mainstream credit card banks, including Bank One, Citifinancial, Chase, GE Capital, Household, MNBA, and Providian.

      McGraw began an investigation of FCS in January, 2007 after receiving consumer complaints disclosing that it was collecting debts in West Virginia without a license. The complaints also disclosed that FCS threatened to file suit and report debts to credit bureaus when it did not intend to take these actions. The attorney general also alleged that FCS did not have any verifiable proof of the debts that it sought to collect other than computer spreadsheets.

      In addition to relieving consumers of the alleged indebtedness, FCS also agreed to refund all payments it collected, which so far amounts to only $2,481.00. The amount actually collected was likely small because FCS said it only contacted three per cent of the consumers.

      "My office remains concerned about the debt purchasing industry, which typically purchases accounts for pennies on the dollar and rarely obtains any proof of the debt that would be admissible as evidence in a court, McGraw said. "This practice is troublesome because state and federal laws require that collection agencies be able to verify a debt when disputed by consumers, an important obligation to consumers that debt purchasers can rarely meet."

      More Scam Alerts ...

      West Virginia Wipes Out Credit Card Debt for 1,451 Citizens...
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      Shimano Dura Ace Bicycle Wheels Recalled

      October 23, 2008
      Shimano American Corp. is recalling Dura Ace carbon clincher wheels for bicycles. Rim surface and spoke hole plugs on the wheel can cause a puncture to the inner tube, resulting in a flat tire. This can cause the rider to lose control and fall.

      This recall involves the Shimano Dura Ace Carbon Clincher Wheel Sets with model number WH-7850 C24CL sold for road racing bicycles. The rim has labels that read 'Shimano WH-7850', 'Dura Ace', and 'Carbon 1380.' These wheels are intended for use with high-end adult road-racing bicycles.

      The wheels, made in Malaysia, were sold at bicycle specialty stores and dealers nationwide from April 2008 through August 2008 for about $1,300.

      Consumers should stop using the bicycles with the recalled wheels, remove the wheels, and return them to their local bike dealer or retailer for a free inspection and repair.

      For more information, contact Shimano American Corp. at (800) 353-4719 between 8 a.m. and 5 p.m. PT Monday through Friday, or visit the firm's web site at bike.shimano.com.

      The recall is being conducted in cooperation with the U.S. Consumer Product Safety Commission (CPSC).

      Shimano Dura Ace Bicycle Wheels Recalled...
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      Uninsured Aren't Primary Cause of Crowds in Emergency Rooms

      New study challenges assumptions about health care crisis

      The 47 million Americans who lack health insurance are the reason emergency rooms are crowded all the time -- right? And only the uninsured visit the emergency department for minor complaints, because it's easier than going to a doctor -- right?

      Not so fast. According to a new study by a University of Michigan team, published in the Journal of the American Medical Association, the reality of what causes ER overcrowding is a lot more complicated. And some widely repeated perceptions about the uninsured and emergency care may be rooted more in assumptions than in solid fact.

      Those faulty perceptions, they conclude, may be getting in the way of real efforts to solve both the uninsurance problem and the problem in American ERs.

      In truth, the uninsured do not make up a disproportionate share of ER patients, because they are the only group that faces the full cost of care, the study shows. It also demonstrates that people who have insurance are more likely to contribute to ER overcrowding and to use the ER for minor complaints or in place of a primary care doctor's visit, because primary care offices are also overcrowded.

      The study is based on an exhaustive review of 127 medical research papers, and on detective work to find out whether often-repeated statements about the uninsured and emergency care were actually based in fact.

      Most of the papers were published in the last decade, when both the plight of the uninsured and the state of the nation's ERs captured the national spotlight.

      Although it challenges some of the most-repeated mantras about the uninsured and ER care, the study does confirm that solid evidence exists for many of the things that Americans have come to believe about the uninsured and emergency care.

      For instance, the study shows, the number of people without insurance visiting American ERs is rising -- but less quickly than the numbers of uninsured are rising. Meanwhile, patients with insurance are going to the ER more frequently.

      There is also solid evidence that caring for patients -- insured and uninsured -- in an ER is more expensive than treating the same complaint in a doctor's office. Uninsured people definitely have a hard time finding primary care doctors who will see them as outpatients, but even insured patients have difficulty finding primary care.

      "What we found is that there is a perception that -- because one of the roles of the emergency room is a safety net for the uninsured -- it is the uninsured who must be causing all the problems in ER care," says first author and emergency physician Manya Newton, M.D., MPH, M.S., a Robert Wood Johnson Clinical Scholar at the U-M Medical School.

      "The crisis in emergency medicine and the problems of the growing uninsured population have been conflated," she said. "While there's excellent research out there on both issues, the myths about how the uninsured use the emergency department threaten to interfere with the policy-making process. The rise in ER use has much more to do with the aging of the population, the increase in chronic diseases, and the decrease in available primary care than with the uninsured. Policies based on false assumptions risk diverting energy and money from confronting the true drivers of emergency department crowding."

      At the least, Newton and her co-authors conclude from their review, ER policy solutions will need to address the lack of timely access to primary care by the uninsured and insured alike.

      The uninsured have a nearly impossible task in finding primary care. But both insured and uninsured have trouble getting appointments in less than two to three weeks, or finding primary care after regular business hours and on weekends -- which leads them to the always-open ER.

      A reluctance by some physicians to take on the legal liability of counseling a patient over the phone, instead of instructing them to go to the ER, may also contribute, Newton says.

      Meanwhile, Newton says the evidence is very strong that the overall cause of ER overcrowding is an "input-throughput-output" problem at American hospitals.

      Patients come to the ER for treatment, and under federal law the ER cannot turn them away. Some of them need at least an overnight stay in one of the hospital beds upstairs from the ER. But those beds are often full because of a lack of safe and appropriate places to discharge current patients to -- so patients get backed up down in the ER, making it more crowded.

      The closure of hospitals, ERs, and long-term skilled nursing facilities around the country makes the situation worse and worse, the researchers say. Fewer beds plus more patients equals an ER calamity.

      Newton and her colleagues began the study after noting a curious phenomenon in the medical literature: many papers whose introductory passages included phrases like "It is well understood that..." and other statements of conventional wisdom about the uninsured and ERs. They often appeared without direct citations of studies that could support such statements.



      Uninsured Aren't Primary Cause of Crowds in Emergency Rooms...
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      Budgeting to Play Big Role in Holiday Shopping

      Price is the chief factor in deciding where to spend

      If retailers need yet another reminder that this Christmas shopping season will be challenging, consumers are happy to oblige.

      According to the National Retail Federation's 2008 Holiday Consumer Intentions and Actions Survey, conducted by BIGresearch, U.S. consumers plan to spend an average of $832.36 on holiday-related shopping an increase of less than 2 percent from year's $816.69. This represents the lowest increase in planned consumer spending since the survey began in 2002.

      Though shoppers choose to visit stores for different reasons, consumers say one factor will play the biggest role in buying decisions this year: price. According to the survey, 40.0 percent of shoppers say that sales or promotions is the largest factor when determining where to shop, while another 12.6 percent state that everyday low prices are most important.

      Other consumers rated selection and merchandise quality as the primary factor. Only a handful of consumers said they are making buying decisions based on a convenient location or helpful customer service this year.

      "Retailers are going into this holiday season with their eyes wide open, knowing that savings and promotions will be the main incentive for shoppers," said NRF President and CEO Tracy Mullin. "No one is canceling Christmas because money is tight, but consumers will be sticking to their budgets and looking for good deals when deciding where to spend this holiday season."

      As in previous years, gift giving is the largest component of shoppers' budgets. This year, the average person will spend $466.13 on gifts for family, $94.52 on friends, $26.70 on co-workers, and $43.50 on other gifts.

      For the first time in the survey's history, people say they plan to spend less on gifts for family members ($466.13 in 2008 vs. $469.14 last year). Spending is expected to be particularly weak among young adults, as 18-24 year-olds plan to spend $50 less on gifts than one year ago.

      "It might not be easy to pull back on small gifts for a co-worker or a child's teacher, but consumers feel like their family understands their current situation," said Phil Rist, Vice President of Strategy for BIGresearch. "Americans might eliminate an extended family gift exchange or buy one big present for all of the kids to compensate for a budget-friendly Christmas this year."

      According to the survey, 40.2 percent of consumers will start their shopping before Halloween. This figure is consistent with numbers from previous years and demonstrates that bargain hunters are looking for ways to spread out spending over a period of time.

      With sales and promotions the theme of the 2008 holiday season, it's no surprise that most consumers plan to do some shopping at discount stores. Additionally, more than half of American adults plan to shop at department stores, while more than one-third of shoppers plan to shop at clothing and electronics stores.

      As the Internet becomes more of a mainstay in the retail landscape, Americans are heading online to compare prices, research retail locations, and look for gift ideas before heading to stores. Although the number of people buying gifts online is expected to remain flat over last year, shoppers will rely on the Internet more than ever to browse for holiday gifts and research products. According to the survey, the Internet will influence 33.6 percent of holiday purchases, up from 30.2 percent last year and 28.9 percent in 2006.

      Though most consumers plan to stick to a budget this season, many are padding it with a little something extra. Knowing that the holidays often abound with good deals, more than half of shoppers are planning to make additional non-gift purchases for themselves or their families this holiday.

      Some may have even been holding back on personal purchases for the last few months to take advantage of holiday pricing. Shoppers will spend an average of $119.83 on these purchases, up from $106.67 last year.

      NRF continues to expect holiday sales to increase 2.2 percent to $470.4 billion.

      Budgeting to Play Big Role in Holiday Shopping...
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      Chevy Volt Gets a Jolt with Mixed Review

      Car And Driver praises and buries electric car equally


      General Motors, which recently celebrated its 100th birthday, has staked a large part of its future on a little car called the GM Unveils Chevy Volt The carmaker hopes that consumers will embrace this next-generation hybrid when it goes into production in 2010.

      And how has the automotive press received GM's offering? Praise is not universal.

      "Proud as we are of GM for getting by for a century, we're not piling on the presents in the form of unqualified praise and optimism about the Volt, which will start rolling down GM's Hamtramck, Michigan, assembly line in November, 2010, Car And Driver said in its October 2008 review. "After all, we remember the 1996 GM EV1, an electric car that proved only that electric propulsion wasn't ready for prime time."

      In terms of style and design, the magazine gives the Volt relatively high marks, saying photographs don't really do it justice. Up close and personal, the writers say, the Volt is well proportioned and "convincingly cool."

      The "coolness" extends to the vehicle's interior, according to the writers. But they also point out that only two passengers will fit in the back seat.

      The Volt will be powered with GM's new E-flex architecture, the T-shaped lithium-ion battery. It should deliver the equivalent of 150 horsepower and 273 pounds per foot of torque to the drive train. At that rate, GM expects the batteries to deliver about 40 miles of city-type driving before the batteries are drained.

      Once that happens, a 1.4 liter E85-powered engine kicks on to recharge the batteries, extending the range up to 250 miles or so. After that, the car will need to be plugged into house current to recharge the battery pack.

      As any consumer who has a cell phone or other electronic device knows, lithium ion batteries lose their capacity to hold a full charge over time. How much life can motorists expect from the Volt's battery engine?

      Car And Driver quotes GM officials as saying the batteries will last 10 years or 150,000 miles, but the battery pack hasn't faced that real world test yet.

      Which brings the reviewers to the real question about the Volt it's price tag. While GM says the car will probably sell for around the mid $30,000 range, the reviewers point out it will probably be closer to $40,000 before a consumer can drive it off the lot.

      The bottom line?

      "Cost isn't the only thing that will limit the Volt's appeal," the magazine concludes. "It will be compact, and its limited seating capacity and practicality may render it ill-suited as primary transportation for folks with large families. Further, its limited range also eliminates its usefulness to people that live in rural areas."

      Chevy Volt Gets a Jolt with Mixed Review...
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      Pfizer Pays $894 Million to Settle NSAID Claims

      Allegations involve Bextra and Celebrex

      Drug maker Pfizer Inc., says it will pay $894 million to settle lawsuits filed over safety concerns over some of its painkiller products. Similar concerns forced rival Merck to withdraw Vioxx in 2004.

      At issue are claims involving Pfizer's non-steroidal anti-inflammatory medicine Bextra, which is similar to Vioxx. It also settles litigation filed in response to Celebrex, another pain killer in the same class that remains on the market.

      The settlement resolves substantially all of the personal injury cases, consumer fraud cases and state attorneys general claims, the company said.

      "We are pleased by the favorable rulings we have achieved in this litigation and believe that now is the right time to resolve these matters," said Amy W. Schulman, senior vice president and general counsel of Pfizer. "Inevitably, litigation can be distracting and putting these matters behind us helps our shareholders and, most importantly, patients and doctors."

      Though claims against Celebrex are among those covered by the settlement, Pfizer said the agreement should in no way diminish the drug's integrity.

      "Pfizer stands by the safety and efficacy profile of Celebrex. It is one of the most rigorously- and continuously-studied drugs in the world, as evidenced by its approval and use in 111 countries during the past 10 years across several different pain indications," said Joseph M. Feczko, chief medical officer for Pfizer. "We believe that putting these matters substantially behind us should better enable physicians to consider Celebrex purely on the strength of its clinical data, and its ability to meet the diverse needs of patients in pain."

      The announcement follows favorable rulings in which federal and New York state court judges overseeing a majority of the personal injury cases ruled that the plaintiffs' lawyers failed to present reliable scientific evidence to prove Celebrex can cause heart attacks or strokes at its most commonly prescribed dose.

      Pfizer said it believes these rulings would have likely limited the scope of these cases had the litigation continued. By settling these matters now, the parties are minimizing the future cost and disruption inevitably associated with litigation.

      These rulings within the past year are consistent with the conclusion reached by the U.S. Food and Drug Administration (FDA) in 2005 that, based on the available data, the benefits of Celebrex outweigh its risks for appropriate patients at approved doses. The FDA requires that all prescription NSAIDs carry the same cardiovascular boxed warnings.

      The personal injury settlements will resolve more than 90 percent of the known personal injury claims brought by law firms representing persons who allege that Pfizer's NSAID pain medications were the cause of a heart attack, stroke or other injury. Pfizer said it will work to finalize agreements with each of the law firms with which it has agreements in principle before the end of the year.

      Pfizer said it has also has reached an agreement in principle to settle payor class action consumer fraud cases involving Bextra and Celebrex in which plaintiffs allege economic loss relating to the promotion of these medications. The settlement will resolve these cases on a nationwide basis and is subject to approval by the appropriate courts.

      In addition, Pfizer has reached agreements in principle to resolve claims brought by 33 states and the District of Columbia, primarily relating to alleged Bextra promotional practices. Under these settlements, Pfizer will make a total payment of $60 million to the states and adopt compliance measures that complement policies and procedures previously established by the company.



      Pfizer Pays $894 Million to Settle NSAID Claims...
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      Internet Gaming Addiction May Be Growing Health Problem

      Can online virtual worlds cause loss of grip on reality?

      The positive or negative impact of video games on children can usually be counted on to spark a lively debate, but it's not just kids who are playing games and in some cases causing mental health experts to worry.

      Researchers and educators at The University of Texas Health Science Center at Houston are examining the virtual world of an online game called Second Life, for both its addictive and educational potential.

      In Second Life, created by Linden Lab in 2003, users are able to create an image called an "avatar" by right-clicking and selecting everything from hair color to chin length to muscle tone. The basic level of membership is free and includes training for the avatar to learn how to walk, talk and fly.

      This virtual world is populated by islands, created and inhabited by avatars of other users. Clothes, houses and furniture, even body parts, can be purchased using Linden dollars, which can be bought with real money. Avatars can also "marry" other avatars.

      Cindy Burkhardt Freeman, assistant professor of clinical nursing at the UT Health Science Center at Houston School of Nursing, has written about massively multiplayer online role playing games (MMORPG) and virtual worlds such as Second Life. She said users should proceed with caution.

      "Patients started coming in affected by it," said Freeman, who sees patients in her private practice in The Woodlands. "They didn't come in for thatno one came in for that problembut it would come out in talking."

      In her article for the January 2008 issue of The Journal of Nurse Practitioners, Freeman said one of her patients was suffering from depression brought on in part by his wife's addiction to Second Life.

      "She was carrying on an affair with a guy on another continent through the game," Freeman said. "It ruined the family. She just got sucked into it. She was away from her family even if she was in the house."

      Freeman's story, "Internet Gaming Addiction," was later named No. 1 on the list of the journal's "Top 25 Hottest Articles."

      "Work, relationships, responsibilities, and even personal health and hygiene may be neglected by persons who are unable to control the amount of time spent in on-line activities," Freeman wrote. "They may get restless or irritable if they are unable to play. They may sacrifice time from family, friends and work. They may spend increasing amounts of time playing and may totally lose track of the time."

      According to a 2006 Stanford study led by Nick Yee, Ph.D., 39 percent of male players and 53 percent of female players said the quality of friendships with their online friends was comparable or better than their real-life friends.

      "You can become someone totally different from who you are. If you don't like yourself, you can change that," Freeman said.

      The American Medical Association has called for more research on gaming and addictive behaviors. Directives ordered at the 2007 AMA annual meeting included encouraging organizations such as the Centers for Disease Control and Prevention, the National Science Foundation and the National Institutes of Health to fund quality research on the long-term effects of video games.

      "This is something that is just coming to be recognized as a problem," Freeman said.

      But universities, Fortune 500 companies and nonprofit organizations see a totally different side of Second Life. They are so committed to the virtual world and its possibilities that they have purchased property (with real money) and created buildings.

      Cynthia Phelps, Ph.D., assistant professor of Health Informatics at The School of Health Information Sciences at the UT Health Science Center at Houston, studies Second Life as part of her class on "Emerging Technologies for Teaching, Learning and Research." The class is taught in Second Life.

      "We're looking at how you can use Second Life for education," Phelps said. "If you needed to teach a class to people in different parts of the world, you could teach it in Second Life, where everyone can show up."

      Phelps said the ability to create things in the 3-D space is one of its attractions. On a recent day, her avatar was checking out the Palomar Pomerado West Health campus on Second Life, a virtual copy of the real-life center that will open in 2011 in San Diego.

      Second Life can host educational meetings where instructors from around the world come together; virtual emergency rooms where nursing school students can train and retreats for people with disabilities, among many other opportunities.

      Mental health experts, meanwhile, will likely continue their debate over whether online gaming's potential for addiction outweigh its positive benefits.

      Internet Gaming Addiction May Be Growing Health Problem...
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