NEW YORK/SAN FRANCISCO (Reuters) ? Groupon Inc is considering raising its IPO price range, as underwriters grow more confident about demand after completing the East Coast leg of a two-week roadshow to woo investors.
One of the most closely watched initial public offerings of the year, Groupon had previously filed with regulators to sell 30 million shares at $16 to $18 apiece, scaling back its aspirations amid weak market conditions and uncertainties over its long-term business outlook.
The company is now considering raising the price range and could file an amended IPO prospectus early next week, said a source familiar with the situation. Groupon declined to comment and no other details were immediately available.
Chief Executive Andrew Mason hosted a luncheon on Friday at the St. Regis hotel in Manhattan -- the biggest event on the roadshow, seen as crucial in helping Groupon's bankers decide how to price the shares.
Fund managers who attended the meeting told Reuters they were pleasantly surprised by how charming and composed Mason was, since he has a reputation of being volatile after he blasted Groupon's critics in a leaked staff memo this summer.
Nonetheless, quite a few investors said they were still undecided about buying into the IPO, noting that Groupon faces huge competition in the daily deals business. The company has also had to change its accounting twice under regulatory pressure and has lost two chief operating officers in the past year.
Mason "was a lot more likable, less arrogant in person than I expected," said a money manager at a firm with more than $15 billion under management, who attended the Friday meeting.
"It's intriguing. It's such a massive opportunity if they're the winner, so the question is, 'Do they become the winner?'" he said, speaking on condition of anonymity.
Despite lingering concerns, investors expect the IPO to be over-subscribed, partly because bankers have limited the float to just 4.7 percent of shares.
One investor who attended the event said the investor's hedge fund firm planned to ask for shares in the offer, but added that it was very unlikely to get an allocation.
The risk is that Groupon may be flipped by some investors on the first day. Later on, early-stage investors might want to cash out through secondary issues, putting downward pressure on the stock.
"It will probably be like LinkedIn, a huge moonshot," said a hedge fund manager with $500 million under management, who attended Friday's presentation.
"There hasn't been an IPO in a long time and everyone will clamor for it," he said, but added that he does not view Groupon as a long-term investment.
Fidelity Investments, Capital Group and T Rowe Price already own Groupon stock from private investment rounds and are planning on buying more shares in the IPO, according to two underwriting sources.
The three asset managers all declined to comment so it was not certain if they would follow through. Institutional investors typically do not show their hand until a day or two before the final pricing and stock market debut.
AHEAD OF AMAZON
Groupon scaled back its IPO to raise up to $540 million, from a previous target of up to $750 million, amid Wall Street concerns that the Chicago-based company faced well-funded rivals such as Google Inc and Amazon.com Inc. They have billions of dollars to put in play, while Groupon expects to have about $723 million in cash and equivalents after the IPO.
A private equity investor who attended the presentation on Friday said he thinks Groupon is big enough that it is here to stay, but he was still not sure how much the company is worth.
"People are questioning Groupon's business model but I think that's misplaced," said the investor, whose firm has more than $10 billion under management. "I don't know if it's worth $11 billion or $5 billion or $20 billion -- that's where the debate comes in -- but it's a real business."
Groupon, which is approaching three years old, stressed to potential investors on Friday that its financials compared favorably to those of Amazon in its early days.
Mason said Groupon is currently generating about $190 in gross billings per customer per year on average, compared with Amazon's $130 when it was at a comparable stage of development, according to a person who attended the presentation. Amazon now generates about $290 in gross billings per customer per year, Mason was quoted as saying.
"Given the past mistakes management has made, they sounded credible," Scott Sweet of research firm IPO Boutique said.
The one-hour presentation took place at a room atop the St. Regis, a luxury hotel off Fifth Avenue that sports red carpet stairways leading up from the sidewalk and staff in fancy overcoats and top hats.
Security was tight and investors who were not pre-registered and who tried to walk in were turned away. Those investors who made it inside were offered chicken salad, bread, chocolate chip cookies, and tea or coffee.
There were half a dozen questions after the presentation, of which two focused on one slide that showed Groupon spending roughly $14 to acquire each customer and generating a return on that investment, according to one investor.
Another question focused on Groupon's efforts to reduce marketing spending and how that will effect subscriber growth.
Executives and bankers are scheduled to meet with investors in San Francisco, Denver and Chicago next week.
Underwriters on the Groupon IPO are being lead by Morgan Stanley, Goldman Sachs & Co and Credit Suisse. The shares are expected to begin trading on the Nasdaq on November 4 under the ticker symbol "GRPN."
(Reporting by Clare Baldwin in New York and Alistair Barr in San Francisco; Additional reporting by Anthony Hughes in New York; Editing by Tiffany Wu, Gary Hill)
State Police arrest Occupy Nashville protestors early Friday morning Oct. 28, 2011 at the site where a few dozen Wall Street protesters have been encamped for about three weeks. Authorities began moving in early Friday using a newly enacted state policy that set a curfew for the grounds near the state Capitol, including Legislative Plaza where the protesters had been staying in tents. (AP Photo/JOHN PARTIPILO\ - THE TENNESSEAN)
State Police arrest Occupy Nashville protestors early Friday morning Oct. 28, 2011 at the site where a few dozen Wall Street protesters have been encamped for about three weeks. Authorities began moving in early Friday using a newly enacted state policy that set a curfew for the grounds near the state Capitol, including Legislative Plaza where the protesters had been staying in tents. (AP Photo/JOHN PARTIPILO\ - THE TENNESSEAN)
Occupy Nashville protestors who were arrested overnight at Legislative Plaza in downtown Nashville, hold up their citations after they were released from jail Friday, Oct. 28, 2011 in Nashville. Twenty-nine Wall Street protesters in Nashville have been issued misdemeanor citations for criminal trespassing after being arrested by state troopers overnight. (AP Photo/The Tennessean, John Partipilo) JOHN PARTIPILO/THE TENNESSEAN
Safety Commissioner Bill Gibbons, left, and Col. Tracy Trott, commander of the Tennessee Highway Patrol, hold a press conferences about clearing Wall Street protesters from the Legislative Plaza across from the state Capitol in Nashville, Tenn., on Friday, Oct. 28, 2011. Gibbons says Republican Gov. Bill Haslam's office approved a pre-dawn roundup of Wall Street protesters from the state Capitol grounds. Twenty-nine protesters were arrested overnight and issued misdemeanor citations for trespassing. (AP Photo/Erik Schelzig)
State Police arrest Occupy Nashville protestors early Friday morning at the site where a few dozen Wall Street protesters have been encamped for about three weeks. Authorities began moving in early Friday using a newly enacted state policy that set a curfew for the grounds near the state Capitol, including Legislative Plaza where the protesters had been staying in tents. (AP Photo/JOHN PARTIPILO\ - THE TENNESSEAN)
State Police arrest Occupy Nashville protestors early Friday morning Oct. 28, 2011 at the site where a few dozen Wall Street protesters have been encamped for about three weeks. Authorities began moving in early Friday using a newly enacted state policy that set a curfew for the grounds near the state Capitol, including Legislative Plaza where the protesters had been staying in tents. (AP Photo/JOHN PARTIPILO\ - THE TENNESSEAN)
NASHVILLE, Tenn. (AP) ? Tennessee state troopers for the second straight night arrested Wall Street protesters for defying a new nighttime curfew imposed by Republican Gov. Bill Haslam in an effort to disband an encampment near the state Capitol.
And for a second time, a Nashville night judge dismissed the protesters' arrest warrants.
The Tennessean newspaper reported early Saturday morning (http://tnne.ws/vE2PXN) that Magistrate Tom Nelson told troopers delivering the protesters to jail that he could "find no authority anywhere for anyone to authorize a curfew anywhere on Legislative Plaza."
Occupy Nashville protesters ? including many of the 29 arrested in a pre-dawn raid on Friday ? returned to the Legislative Plaza that evening and remained through the 10 p.m. curfew.
"To see it from the other side is even more infuriating," said Chip Allen, one of the protesters arrested in the first raid. "When you're in it, it's almost surreal. This takes on a whole 'nother flavor."
The arrests came after a week of police crackdowns around the country on Occupy Wall Street activists, who have been protesting economic inequality and what they call corporate greed.
In Oakland, Calif., an Iraq War veteran was seriously injured during a protest clash with police Tuesday night. In Atlanta early Wednesday, helicopters hovered overhead as officers in riot gear arrested more than 50 protesters at a downtown park. In San Diego, police arrested 51 people who occupied the Civic Center Plaza and Children's Park for three weeks.
In Nashville, more than 200 people came to Friday evening's meeting to discuss the first round of arrests and future plans, though those numbers had dwindled as the night wore on and temperatures dropped.
There was no noticeable law enforcement presence for nearly two hours after the curfew went into effect, while adjacent theaters let out and patrons filtered back through the plaza to their cars without being challenged for violating the restrictions.
"Nothing was done to them, they were not arrested," said protester Michael Custer, 46. "But we are arrested while we are expressing our constitutional right to free speech."
Once the theater traffic cleared, dozens of state troopers descended on the plaza and began arresting protesters and a journalist for the Nashville Scene, an alternative weekly newspaper.
Troopers wouldn't give any details other than that a press release would be issued later Saturday. After the arrested protesters were handcuffed, photographed and put on a bus, one trooper told another at the scene that 26 people had been apprehended.
Protesters remaining at the scene vowed to return Saturday, even if it means more arrests.
The 29 demonstrators arrested early Friday were taken to the Nashville jail, only to have Nelson, the night judge, rule the state had not given them enough time to comply with the new curfew. They were instead issued misdemeanor citations for trespassing, which carry a $50 fine if they are found guilty.
It was not immediately clear if other charges would be filed against those arrested Saturday morning.
The Haslam administration has cited what officials described as deteriorating security and sanitary conditions on the plaza, saying that acts of lewd behavior had been observed by workers in state office buildings.
Safety Commissioner Bill Gibbons said it was unrealistic to meet requests from protesters for a stronger law enforcement presence to help deter thefts and altercations often involving homeless people who had attached themselves to the encampment.
"We don't have the resources to go out and in effect babysit protesters 24-7 ... at the level that would have been necessary to address their concerns," Gibbons said during a press conference Friday.
Republican presidential hopeful Michele Bachmann is sinking in the polls. A prominent voice in the tea party movement says "It's time for Bachmann to go."
Is Michele Bachmann dragging down the tea party as a whole as she sinks in the polls?
Skip to next paragraph
Don?t look at us ? we?re not the first to raise this question. We?re just repunditing an idea from Ned Ryun, head of the tea party group American Majority.
On Thursday, Mr. Ryun posted a piece on the American Majority blog entitled, ?Bachmann?s Floundering Can Damage Tea Party.? In it, he argues that since Rep. Bachmann won the Ames, Iowa straw poll her campaign has been hampered by a loss of staff, poor fundraising, and an apparent lack of direction. He anticipates that she will shift even further right in coming weeks as she competes for votes in conservative Iowa, straying from the core tea party message of fiscal responsibility.
Election 101: Ten facts about Michele Bachmann and her presidential bid
Her campaign has become less about government reform and more about her personal effort to stay relevant and sell books, according to Ryun.
?It?s time for Michele Bachmann to go,? wrote Ryun.
First, props to Ryun for sampling the classic Dr. Seuss book, ?Marvin K. Mooney Will You Please Go Now!? We read that to our kids to try to get them to go to bed. Interestingly, Dr. Seuss himself apparently meant the book as a political allegory about Richard Nixon and Watergate.
OK, maybe Ryun didn?t link Bachmann with Nixon on purpose. But he?s right that her polls are sinking.
She?s fallen to 3.8 percent in national polls of prospective GOP voters, according to the RealClearPolitics rolling average. That puts her dangerously close to the Santorum Line ? the 2 percent threshold, from which a campaign teeters over the abyss.
She?s no longer doing well in Iowa, either, which for her might be even worse news than her national numbers. Her flavor-of-the-month period began after her win in the Ames straw poll. She was born in Iowa, comes from a nearby state, and has made Iowa the strategic focus of her campaign. But at the moment she?s in sixth place in Iowa, too, with only about 7 percent of the potential Iowa caucus vote.
But is she hurting the tea party as a whole? There?s no evidence of that at all. Yes, she?s head of the House Tea Party Caucus, but do voters really look to her as the embodiment of the movement? We doubt it ? Rick Perry and Herman Cain have tea party links too. Cain?s doing great, to the point where he?s unofficially graduated from flavor-of-the-month to phenomenon-of-the-quarter. Would Ryun argue this boosts the tea party in total?
Let?s look at the polls. According to a Pew Research survey from October 24, 32 percent of the US public supports the tea party at least somewhat, while 44 percent oppose it.
Those aren?t great numbers ? Occupy Wall Street does a bit better in the same poll ? but they don?t appear to be reflective of a sinking trend line. A Pew survey from August came in with about the same results. And that?s when Bachmann was doing much better.
Bachmann herself thinks the American Majority slam was a Rick Perry plot.
?People have told us that these are Perry supporters and they went out with this and this was meant to be a stealth move and it was clumsy,? said Bachmann on CNN?s ?The Situation Room?.
Bachmann campaign officials point out that the tea party movement is highly decentralized and no one person or one organization can claim to speak for it. They say she won?t be getting out of the race just because one individual tells her to.
No, but unless her polls get better, Iowa Republicans might send her the same message in January. Given the focus she?s put on the Hawkeye State, it seems unlikely her campaign could survive a single-digit showing in the caucuses.
Election 101: Ten facts about Michele Bachmann and her presidential bid
LONDON ? The senior St. Paul's Cathedral priest who welcomed anti-capitalist demonstrators to camp outside the London landmark resigned Thursday, saying he feared moves to evict the protesters could end in violence.
Canon Chancellor Giles Fraser said on Twitter that "it is with great regret and sadness that I have handed in my notice at St. Paul's Cathedral."
He told The Guardian newspaper that he had resigned because he believed cathedral officials had "set on a course of action that could mean there will be violence in the name of the church."
Dean of St. Paul's Graeme Knowles confirmed Fraser had stepped down, saying officials were disappointed that he "is not able to continue to his work ... during these challenging days."
Protesters have been camped outside the building since Oct. 15. When police tried to move them the next day, Fraser said the demonstrators were welcome to stay and asked police officers to move instead.
Days later, cathedral officials shut the building to the public, saying the campsite was a health and safety hazard. It was the first time the 300-year-old church, one of London's best-known buildings, had closed since World War II.
Cathedral officials, and the bishop of London, have since asked the demonstrators to leave, but they are refusing to go.
Knowles said Wednesday the cathedral was considering all its options in response to the protest ? including legal action.
But in a victory for the protesters, he said the cathedral hoped to reopen Friday following changes to the layout of tents.
In a statement, the Occupy London protesters called Fraser a "man of great personal integrity."
The protesters said Fraser had "ensured that St. Paul's could be a sanctuary for us and that no violence could take place against peaceful protesters with a legitimate cause challenging and tackling social and economic injustice in London, the U.K. and beyond."
Fraser, 46, a high-profile and liberal Anglican clergyman, was appointed chancellor of the cathedral in 2009.
The role involves overseeing the work of the St. Paul's Institute, which "seeks to bring Christian ethics to bear on our understanding of finance and economics."
The cathedral and the protest tent city lie within London's traditional financial center, which is called the City.
Fraser, whose father came from a prominent London Jewish family, is well known through his newspaper and magazine columns and frequent appearances on BBC radio.
He has criticized the effects of the government's austerity measures.
"Should the church get stuck into the mucky world of politics? How ridiculous, of course it should," he wrote in the Guardian in June, going on to quote the late Brazilian bishop Helder Camara: "When I give to the poor, they call me a saint. When I ask why they are poor, they call me a communist."
____
Associated Press writer Robert Barr contributed to this report.
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Zoologger is our weekly column highlighting extraordinary animals ? and occasionally other organisms ? from around the world
Species: Over 70 species in the class Mixini Habitat: sea floors around the world, flipping the bird at sharks
Imagine you're a humble little red bandfish. To keep away from predators you hide in a burrow on the sea floor, occasionally poking your head out to see if it's safe to leave. It's not an exciting life, but you're doing OK.
Then one day, minding your own business, you suddenly find yourself drenched in sticky mucus. You can't breathe, because it has clogged your gills.
Your enemy is a hagfish. After you're dead it will drag you out of your burrow and devour you. But it's unlikely anyone will try to devour it in turn, because that slime it used to kill you also protects it from predators. Besides, why would anyone want to eat a creature that regularly eats decaying corpses from the inside out?
On the prowl
Hagfish are partway between fish and worms, with a spinal cord but no backbone. In this sense they resemble the common ancestor of all backboned animals, and have changed little in at least 300 million years.
Long thought to be scavengers, they have now been seen actively hunting for the first time. Vincent Zintzen of the Museum of New Zealand in Wellington and colleagues used underwater video cameras to catch them in the act. In December 2009 they saw a hagfish belonging to the genus Neomyxine go on the attack.
The hagfish began by searching the seabed and sticking its head into open burrows. Being blind, it probably relied on touch and smell, aided by the whisker-like barbels around its mouth.
When it found an inhabited burrow it went inside, its tail sticking out in the water. For the next minute, its muscles repeatedly went into spasm. Zintzen thinks it grabbed the prey fish in its mouth and began swallowing it. To swallow things, hagfish push out two plates covered with teeth, which clamp on and then retract, pulling the food into the hagfish's mouth (see photo).
The hagfish then spent a minute relaxing, its tail draped on the sea floor. It may have released slime, and then had to wait for the prey to suffocate. Finally, the hagfish tied its tail into a knot, anchoring itself on the sea floor. Braced, it pulled the dead fish out of the burrow and carried it away.
Shark repellent
Zintzen's cameras caught only one species of hagfish in the act of hunting, but it may be that they all do it. They can produce lots of slime quickly, which would certainly come in handy.
Hagfish also use their slime to get rid of predators. Zintzen filmed 14 cases of larger fish biting a hagfish only to get a mouthful of slime and beat a hasty retreat. The unlucky predators convulsed their gills to clear them of slime, like a human gagging. Even formidable predators like kitefin sharks were held off (see video, above).
That's impressive, because kitefins panic many fish. Zintzen's colleague Andrew Stewart once saw a group of spiny dogfish become so desperate to escape a kitefin that ? counterproductively ? they jumped out of their tank. In the observations made in the wild, the hagfish did nothing of the sort, and were remarkably blas? about predators. They ignored them unless they were bitten, and even if they were attacked they didn't appear to suffer injuries, and carried on feeding as if nothing had happened.
Feasting on decay
Hagfish also get food by scavenging. When they come across a big carcass, they burrow into it and then eat it from the inside. Uniquely for a vertebrate, as well as having a gut, they can absorb nutrients through their skin and gills.
That's all very well, but feeding inside a decaying corpse has its own problems, says Chris Glover of the University of Canterbury in Christchurch, New Zealand. There will be little oxygen in the water, and lots of toxic ammonia from the rotting flesh. But it seems the hagfish can cope with that too.
Glover captured Pacific hagfish (Eptatretus stoutii) off the coast of Vancouver, Canada, and studied how they responded to high ammonia and low oxygen. Many animals stop taking in nutrients under such conditions, because doing so uses up the scant oxygen and they must devote energy to battling the toxic effects of the ammonia.
Not the hagfish. Ammonia had no effect on their food uptake, and low-oxygen water actually increased it. Faced with hypoxia, the hagfish tripled the amount of the amino acid glycine that they took in through their gills, and absorbed six times as much through their guts. Much of this glycine ended up in their brains, possibly protecting neurons from damage.
This ability to shrug off oxygen deprivation and ammonia poisoning may have served the hagfish well over the years. "Without this tolerance, it might be less competitive for the limited food resources available to an animal that scavenges," Glover says. What's more, oxygen levels in the sea do crash sometimes, but hagfish seem happy in their low-oxygen hell.
Journal references: hagfish hunting video, Scientific Reports, DOI: 10.1038/srep00131; ammonia and anoxia, Physiological and Biochemical Zoology, DOI: 10.1086/662630
Read previous Zoologger columns: Female monkeys indulge in synchronised sex, The toad that's part clone, part love child, The first reptile with a true placenta, The fearsome jaws of a mini movie monster, Stealth millipede wears living camouflage, Dozy hamsters reverse the ageing process, World's nicest bird murders chicks, Architect mouse builds a food mansion, The amphibious fish that mates with itself, The world's smartest insect, The most athletic ape in the canopy, The monkey that really gets brotherly love.
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Virgin Galactic said its first passenger flights will not occur before 2013.
Sir Richard Branson's space tourism venture said it hopes to launch the service in two years time, but even that date is not fixed.
The firm's commercial director, Stephen Attenborough, told the BBC that its customers' safety is paramount.
Test flights are currently underway, with rocket-powered tests scheduled to start next year.
Almost 500 people have bought tickets.
Sir Richard had originally hoped the first commercial spacecraft, SpaceShip Two, would take off as early as 2007. However, Mr Attenborough stressed there never was an official date set for the inaugural launch.
Continue reading the main story
?Start Quote
[People] are willing to put a large amount of money upfront because they know we will only take them to space if it's safe to do so?
End QuoteStephen AttenboroughVirgin Galactic's commercial director
He criticised some press reports, notably an article in the Wall Street Journal, that described the 2013 goal as "yet another delay".
"This is a programme that can't have a hard-end date as safety is number one priority," Mr Attenborough said.
"Our foot is flat on the gas, we have proven technology, we have a spaceport that opened last week, and the test flight programme is well advanced - I don't think you can ask for a lot more from a programme like this. A delay is strange word, and there is no delay."
New pilot
Mr Attenborough also revealed that the venture's chief pilot, David Mackay, has recently been joined by a second pilot.
Keith Colmer, a former Air Force test pilot, was chosen from more than 500 applicants, among them a handful of astronauts.
The BBC's Richard Scott was the first journalist to be allowed inside the Virgin Galactic spaceship
Sir Richard dedicated the launchpad for the space tourism venture in the New Mexico desert on 18 October.
He plans to take the inaugural flight, accompanied by his children.
Mr Attenborough said that although all of the future tourists were eager to blast off to space, none were pushing for an early flight.
"They are willing to put a large amount of money up front because they trust us, because they know we will only take them to space if it's safe to do so," he said.
The 2.5-hour flights will offer five minutes of weightlessness. Tickets cost $200,000 (?127,000).
Former New Hampshire Gov. John H. Sununu is endorsing Mitt Romney tomorrow, in the latest sign of establishment Republicans starting to line up behind the frontrunner.
From the Union Leader:
I'm viewed as a good, solid conservative Republican and I'm supporting a good, solid conservative Republican,? Sununu said in disclosing his long-awaited endorsement.
Continue Reading
In exclusive interview, Sununu said he narrowed his choice to Romney and Texas Gov. Rick Perry, but was won over by what he views as Romney's conservative approach to pressing domestic and national security issues.
He said the final component that persuaded him to back Romney was the former Massachusetts governor's early October foreign policy speech at The Citadel in South Carolina.
?That showed me that he understands that the principal role of the President of the United States is the security of the country and participating in trying to stabilize the world,? Sununu said.
Perry's top strategist, the New Hampshire-based Dave Carney, began his career with Sununu.
Billions of dollars at stake as Canada comes to grips with soaring heart failure costsPublic release date: 23-Oct-2011 [ | E-mail | Share ]
Contact: Amanda Bates amanda@curvecommunications.com 604-306-0027 Heart and Stroke Foundation of Canada
Huge flow of heart failure patients place a big burden on the Canadian health care system, causing longer wait times for treatment and clogging emergency departments
Vancouver Heart failure (HF) costs are headed for the economic stratosphere, even as researchers come up with simple tests and strategies to bring them back to earth.
An assessment of the growing problem and a new initiative to curb costs and increase efficacy in dealing with heart failure patients when they present to emergency departments were the subject of two major studies presented at the Canadian Cardiovascular Congress 2011, co-hosted by the Heart and Stroke Foundation and the Canadian Cardiovascular Society.
Approximately half a million Canadians have heart failure. Ten per cent or 50,000 of those patients will have advanced heart failure with a 50 per cent chance of surviving one year. The number of patients living with heart failure is on the rise because more people are surviving heart attacks thanks to improved diagnosis and treatment.
According to Dr. Debbie Feldman of the faculty of medicine and the school of rehabilitation at the University of Montreal, the role played by the hospital emergency department (ED) is crucial in securing successful outcomes in HF treatment, both medically and economically.
In Dr. Feldman's study, which was carried out in eight Quebec hospitals, less than a third of patients who visited an emergency department for heart failure were followed up within two weeks the time period recommended by Canadian Cardiovascular Society (CCS) guidelines.
This is very troubling, says Dr. Feldman, whose study shows, for the first time, that lack of adherence to the CCS guidelines is associated with worse outcomes.
All 551 patients in Dr. Feldman's study had a diagnosis of heart failure confirmed when they presented to the ED. Their average age was 75 years; 51 per cent were males, and 49 per cent were females.
By four weeks following discharge from the ED, 51 per cent had consulted with a physician.
Over the six month follow-up period, 25 per cent returned to the ED, and 14 per cent died.
Patients who were seen within the two week period as recommended by the CCS had fewer adverse events: they were less likely to return to the ED, be hospitalized, or die, although the result was not statistically significant.
However, the tendency to have worse outcomes, which were deemed to be more deaths, more readmissions to hospital for heart failure, or a repeat visit to the emergency department, was significantly greater in patients who were not seen by a physician until four weeks after their visit to the ED. "Patients who do not receive prompt follow up (somewhere between 2 and 4 weeks) after their ED visit are at higher risk of dying, or being readmitted to the ED or to the hospital," Dr. Feldman said.
Dr. Feldman's study also found that by six weeks, 61 per cent of patients had been seen by a physician, and by three months, 95 per cent had been seen.
"It's urgent to ensure that there is appropriate follow up for these patients," says Dr. Blair O'Neill, president of the Canadian Cardiovascular Society. "We need to optimize adherence to these guidelines."
New simple risk score can guide admission vs. discharge decision-making
In another study, Dr. Douglas Lee, cardiologist at the Peter Munk Cardiac Centre and scientist at the Institute for Clinical Evaluative Sciences (ICES), told the meeting that it is only recently that tools have started to become available to allow physicians to make effective decisions based on acute prognosis of heart failure patients who present to the ED.
"Despite over one million visits to the ED in North America every year, we still have very little evidence to help us decide who could be discharged home and who should be admitted to hospital," Dr. Lee said.
Meanwhile, heart failure is on the rise as more people survive heart attacks and other cardiac conditions. People with heart disease are living longer and these are people who are susceptible to heart failure.
"We developed a risk score consisting of a set of simple questions and routinely available tests which we call the Emergency Heart Failure Mortality Risk Grade," Dr. Lee told the Congress.
"It is a score that can be calculated in any emergency department and could be employed anywhere around the world because it does not require any sophisticated tests," he said.
This simple clinical risk model can predict, with high accuracy, mortality among HF patients who present to the ED and may guide admission versus discharge decision-making, he said.
Dr. Lee and his team examined 12,591 patients with acute heart failure who presented to the ED between 2004 and 2007 in Ontario.
They developed a clinical risk score that would predict the chances of a patient dying within seven days after discharge from the ED, using readily available factors.
The factors that predicted greater risk of dying within seven days included greater acuity (i.e., need for emergency medical services), even slightly elevated troponin levels, increased serum creatinine, and either high or low serum potassium. If patients developed heart failure while using Metolazone a drug that sicker heart failure patients have to use they were also at higher risk.
Systolic blood pressure, heart rate, and oxygen saturation were also important predictors of mortality.
When all of these risk factors were combined, Dr. Lee and his team found that patients in the highest risk group had a seven-day mortality rate of about eight per cent, meaning that for every 12 patients in the highest risk group, one of them would die within seven days.
Patients in the lowest risk group on the contrary had a mortality rate of about 0.3 per cent, meaning that for every 350 patients who were discharged, there would be only one death.
"This is an ongoing area of study. We haven't solved the problem yet, but it's a big step towards more evidence-based decision-making in the emergency department care of heart failure," Dr. Lee said.
"In our next phase, we're working to develop a computerized system to calculate the score for physicians who work in the emergency department. We'd like to develop PDA and iPhone apps and other interactive technical tools in the future."
"This style of medicine is clearly going to be an important component in shaping future clinical practice," says Heart and Stroke Foundation spokesperson Dr. Beth Abramson, who adds that early diagnosis, lifestyle changes, and appropriate drug treatments can help those with heart failure lead normal and active lives and successfully manage their conditions and live longer.
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Statements and conclusions of study authors are solely those of the study authors and do not necessarily reflect Foundation or CCS policy or position. The Heart and Stroke Foundation of Canada and the Canadian Cardiovascular Society make no representation or warranty as to their accuracy or reliability.
The Canadian Cardiovascular Society (ccs.ca) is the national voice for cardiovascular physicians and scientists. Its mission is to promote cardiovascular health and care through knowledge translation, professional development, and leadership in health policy.
The Heart and Stroke Foundation (heartandstroke.ca), a volunteer-based health charity, leads in eliminating heart disease and stroke and reducing their impact through the advancement of research and its application, the promotion of healthy living, and advocacy.
Congress information and media registration is at www.cardiocongress.org
After October 26, 2011, contact:
Jane-Diane Fraser
Heart and Stroke Foundation of Canada
(613) 569-4361 ext 273, jfraser@hsf.ca
[ | E-mail | Share ]
?
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Billions of dollars at stake as Canada comes to grips with soaring heart failure costsPublic release date: 23-Oct-2011 [ | E-mail | Share ]
Contact: Amanda Bates amanda@curvecommunications.com 604-306-0027 Heart and Stroke Foundation of Canada
Huge flow of heart failure patients place a big burden on the Canadian health care system, causing longer wait times for treatment and clogging emergency departments
Vancouver Heart failure (HF) costs are headed for the economic stratosphere, even as researchers come up with simple tests and strategies to bring them back to earth.
An assessment of the growing problem and a new initiative to curb costs and increase efficacy in dealing with heart failure patients when they present to emergency departments were the subject of two major studies presented at the Canadian Cardiovascular Congress 2011, co-hosted by the Heart and Stroke Foundation and the Canadian Cardiovascular Society.
Approximately half a million Canadians have heart failure. Ten per cent or 50,000 of those patients will have advanced heart failure with a 50 per cent chance of surviving one year. The number of patients living with heart failure is on the rise because more people are surviving heart attacks thanks to improved diagnosis and treatment.
According to Dr. Debbie Feldman of the faculty of medicine and the school of rehabilitation at the University of Montreal, the role played by the hospital emergency department (ED) is crucial in securing successful outcomes in HF treatment, both medically and economically.
In Dr. Feldman's study, which was carried out in eight Quebec hospitals, less than a third of patients who visited an emergency department for heart failure were followed up within two weeks the time period recommended by Canadian Cardiovascular Society (CCS) guidelines.
This is very troubling, says Dr. Feldman, whose study shows, for the first time, that lack of adherence to the CCS guidelines is associated with worse outcomes.
All 551 patients in Dr. Feldman's study had a diagnosis of heart failure confirmed when they presented to the ED. Their average age was 75 years; 51 per cent were males, and 49 per cent were females.
By four weeks following discharge from the ED, 51 per cent had consulted with a physician.
Over the six month follow-up period, 25 per cent returned to the ED, and 14 per cent died.
Patients who were seen within the two week period as recommended by the CCS had fewer adverse events: they were less likely to return to the ED, be hospitalized, or die, although the result was not statistically significant.
However, the tendency to have worse outcomes, which were deemed to be more deaths, more readmissions to hospital for heart failure, or a repeat visit to the emergency department, was significantly greater in patients who were not seen by a physician until four weeks after their visit to the ED. "Patients who do not receive prompt follow up (somewhere between 2 and 4 weeks) after their ED visit are at higher risk of dying, or being readmitted to the ED or to the hospital," Dr. Feldman said.
Dr. Feldman's study also found that by six weeks, 61 per cent of patients had been seen by a physician, and by three months, 95 per cent had been seen.
"It's urgent to ensure that there is appropriate follow up for these patients," says Dr. Blair O'Neill, president of the Canadian Cardiovascular Society. "We need to optimize adherence to these guidelines."
New simple risk score can guide admission vs. discharge decision-making
In another study, Dr. Douglas Lee, cardiologist at the Peter Munk Cardiac Centre and scientist at the Institute for Clinical Evaluative Sciences (ICES), told the meeting that it is only recently that tools have started to become available to allow physicians to make effective decisions based on acute prognosis of heart failure patients who present to the ED.
"Despite over one million visits to the ED in North America every year, we still have very little evidence to help us decide who could be discharged home and who should be admitted to hospital," Dr. Lee said.
Meanwhile, heart failure is on the rise as more people survive heart attacks and other cardiac conditions. People with heart disease are living longer and these are people who are susceptible to heart failure.
"We developed a risk score consisting of a set of simple questions and routinely available tests which we call the Emergency Heart Failure Mortality Risk Grade," Dr. Lee told the Congress.
"It is a score that can be calculated in any emergency department and could be employed anywhere around the world because it does not require any sophisticated tests," he said.
This simple clinical risk model can predict, with high accuracy, mortality among HF patients who present to the ED and may guide admission versus discharge decision-making, he said.
Dr. Lee and his team examined 12,591 patients with acute heart failure who presented to the ED between 2004 and 2007 in Ontario.
They developed a clinical risk score that would predict the chances of a patient dying within seven days after discharge from the ED, using readily available factors.
The factors that predicted greater risk of dying within seven days included greater acuity (i.e., need for emergency medical services), even slightly elevated troponin levels, increased serum creatinine, and either high or low serum potassium. If patients developed heart failure while using Metolazone a drug that sicker heart failure patients have to use they were also at higher risk.
Systolic blood pressure, heart rate, and oxygen saturation were also important predictors of mortality.
When all of these risk factors were combined, Dr. Lee and his team found that patients in the highest risk group had a seven-day mortality rate of about eight per cent, meaning that for every 12 patients in the highest risk group, one of them would die within seven days.
Patients in the lowest risk group on the contrary had a mortality rate of about 0.3 per cent, meaning that for every 350 patients who were discharged, there would be only one death.
"This is an ongoing area of study. We haven't solved the problem yet, but it's a big step towards more evidence-based decision-making in the emergency department care of heart failure," Dr. Lee said.
"In our next phase, we're working to develop a computerized system to calculate the score for physicians who work in the emergency department. We'd like to develop PDA and iPhone apps and other interactive technical tools in the future."
"This style of medicine is clearly going to be an important component in shaping future clinical practice," says Heart and Stroke Foundation spokesperson Dr. Beth Abramson, who adds that early diagnosis, lifestyle changes, and appropriate drug treatments can help those with heart failure lead normal and active lives and successfully manage their conditions and live longer.
###
Statements and conclusions of study authors are solely those of the study authors and do not necessarily reflect Foundation or CCS policy or position. The Heart and Stroke Foundation of Canada and the Canadian Cardiovascular Society make no representation or warranty as to their accuracy or reliability.
The Canadian Cardiovascular Society (ccs.ca) is the national voice for cardiovascular physicians and scientists. Its mission is to promote cardiovascular health and care through knowledge translation, professional development, and leadership in health policy.
The Heart and Stroke Foundation (heartandstroke.ca), a volunteer-based health charity, leads in eliminating heart disease and stroke and reducing their impact through the advancement of research and its application, the promotion of healthy living, and advocacy.
Congress information and media registration is at www.cardiocongress.org
After October 26, 2011, contact:
Jane-Diane Fraser
Heart and Stroke Foundation of Canada
(613) 569-4361 ext 273, jfraser@hsf.ca
[ | E-mail | Share ]
?
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Undated artist rendering provided by EADS Astrium shows the scientific satellite Rosat. The German Aerospace Center said the retired satellite is hurtling toward the atmosphere and pieces could crash into the earth as early as Friday. Spokesman Andreas Schuetz told The Associated Press on Wednesday, Oct. 19, 2011 that most of the satellite named ROSAT, which is about the size of a minivan, will burn up during re-entry. (AP Photo/EADS Astrium)
Undated artist rendering provided by EADS Astrium shows the scientific satellite Rosat. The German Aerospace Center said the retired satellite is hurtling toward the atmosphere and pieces could crash into the earth as early as Friday. Spokesman Andreas Schuetz told The Associated Press on Wednesday, Oct. 19, 2011 that most of the satellite named ROSAT, which is about the size of a minivan, will burn up during re-entry. (AP Photo/EADS Astrium)
BERLIN (AP) ? A defunct German research satellite crashed into the Earth somewhere in Southeast Asia on Sunday, a U.S. scientist said ? but no one is still quite sure where.
Most parts of the minivan-sized ROSAT research satellite were expected to burn up as they hit the atmosphere at speeds up to 280 mph (450 kph), but up to 30 fragments weighing a total of 1.87 tons (1.7 metric tons) could have crashed, the German Aerospace Center said.
Jonathan McDowell of the Harvard-Smithsonian Center for Astrophysics in Cambridge, Massachusetts, said the satellite appears to have gone down over Southeast Asia. He said two Chinese cities with millions of inhabitants each, Chongqing and Chengdu, had been in the satellite's projected path during its re-entry time.
"But if it had come down over a populated area there probably would be reports by now," the astrophysicist, who tracks man-made space objects, told The Associated Press in a telephone interview.
Calculations based on U.S. military data indicate that satellite debris must have crashed somewhere east of Sri Lanka over the Indian Ocean, or over the Andaman Sea off the coast of Myanmar, or further inland in Myanmar or as far inland as China, he said.
The satellite entered the atmosphere between 0145 GMT to 0215 GMT Sunday (9:45 p.m. to 10:15 p.m. Saturday EDT) and would have taken 15 minutes or less to hit the ground, the German Aerospace Center said. Hours before the re-entry, the center said the satellite was not expected to land in Europe, Africa or Australia.
There were no immediate reports from Asian governments or space agencies about the fallen satellite.
The satellite used to circle the planet in about 90 minutes, and it may have traveled several thousand kilometers (miles) during its re-entry, rendering exact predictions of where it crashed difficult.
German space agency spokesman Andreas Schuetz said a falling satellite also can change its flight pattern or even its direction once it sinks to within 90 miles (150 kilometers) above the Earth.
Schuetz said the agency was waiting for data from scientific partners around the globe. He noted it took the U.S. space agency NASA several days to establish where one of its satellites had hit last month.
The 2.69-ton (2.4 metric ton) scientific ROSAT satellite was launched in Cape Canaveral, Florida, in 1990 and retired in 1999 after being used for research on black holes and neutron stars and performing the first all-sky survey of X-ray sources with an imaging telescope.
ROSAT's largest single fragment that could have hit is the telescope's heavy heat-resistant mirror.
"The impact would be similar to, say, an airliner having dropped an engine," said McDowell. "It would damage whatever it fell on, but it wouldn't have widespread consequences."
A dead NASA satellite fell into the southern Pacific Ocean last month, causing no damage but spreading debris over a 500-mile (800-kilometer) area.
Since 1991, space agencies have adopted new procedures to lessen space junk and having satellites falling back to Earth. NASA says it has no more large satellites that will fall back to Earth uncontrolled in the next 25 years.
___
Online:
The German space agency on ROSAT: http://bit.ly/papMAA
NEW YORK ? A slump in advertising showed no signs of easing for McClatchy Co. in its latest quarter.
The newspaper publisher cut expenses, partly through layoffs this year, but advertising and circulation revenue declined.
The economic downturn has exacerbated the newspaper industry's challenges making money off the Internet as print readership and ad dollars shrink. McClatchy has suffered more than some of its peers because two of its largest newspapers, The Miami Herald and The Sacramento Bee in California, are in markets that have been especially hit hard by a downturn in real estate. This, along with weak auto sales, has hurt advertising.
McClatchy earned $9.4 million, or 11 cents per share, in the quarter that ended Sept. 25. That's down 21 percent from $11.9 million, or 14 cents per share, a year earlier. Revenue fell 8 percent to $300 million from $328 million.
Advertising revenue declined 10 percent. Earlier this week, The New York Times Co. and USA Today publisher Gannett Co. reported smaller drops in third-quarter ad revenue.
McClatchy's circulation revenue fell 3 percent. Daily newspaper circulation declined 4 percent, but Sunday circulation grew 2 percent, the company said, adding that Sunday circulation drives more advertising revenue than any other day of the week.
Digital advertising revenue fell slightly ? less than half of a percent ? but that's because the company bundles some digital ads with print ads. Standalone digital revenue increased 9 percent. Digital advertising now represents 21 percent of McClatchy's total advertising revenue, up from 19 percent in the third quarter of 2010.
Shares of McClatchy, which is based in Sacramento, Calif., rose 9 cents, or 5.8 percent, to $1.64 in midday trading Friday. The stock has lost nearly two-thirds of its value since the start of the year.
German Chancellor Angela Merkel, left. arrives for an EU summit in Brussels on Sunday, Oct. 23, 2011. Big banks find themselves under pressure in Europe's debt crisis with finance chiefs pushing to raise billions of euros in capital and accept huge losses on Greek bonds they hold. (AP Photo/Geert Vanden Wijngaert)
German Chancellor Angela Merkel, left. arrives for an EU summit in Brussels on Sunday, Oct. 23, 2011. Big banks find themselves under pressure in Europe's debt crisis with finance chiefs pushing to raise billions of euros in capital and accept huge losses on Greek bonds they hold. (AP Photo/Geert Vanden Wijngaert)
German Chancellor Angela Merkel arrives for an EU summit in Brussels on Sunday, Oct. 23, 2011. Big banks find themselves under pressure in Europe's debt crisis with finance chiefs pushing to raise billions of euros in capital and accept huge losses on Greek bonds they hold. (AP Photo/Geert Vanden Wijngaert)
Greek Prime Minister George Papandreou, left, speaks with Latvian Prime Minister Valdis Dombrovskis during a round table meeting at an EU summit in Brussels on Sunday, Oct. 23, 2011. Greece's prime minister is pleading with European leaders in Brussels to act decisively to solve the continent's debt crisis. At a summit Sunday, the leaders are expected to ask banks to accept huge losses on Greek bonds to ease the pressure on the country, and to raise billions more in capital to weather those losses. (AP Photo/Yves Logghe)
Greek Prime Minister George Papandreou, left, speaks with Luxembourg's Prime Minister Jean-Claude Juncker during a round table meeting at an EU summit in Brussels on Sunday, Oct. 23, 2011. Greece's prime minister is pleading with European leaders in Brussels to act decisively to solve the continent's debt crisis. At a summit Sunday, the leaders are expected to ask banks to accept huge losses on Greek bonds to ease the pressure on the country, and to raise billions more in capital to weather those losses. (AP Photo/Yves Logghe)
German Chancellor Angela Merkel, left, speaks with Dutch Prime Minister Mark Rutte during a round table meeting at an EU summit in Brussels on Sunday, Oct. 23, 2011. Greece's prime minister is pleading with European leaders in Brussels to act decisively to solve the continent's debt crisis. At a summit Sunday, the leaders are expected to ask banks to accept huge losses on Greek bonds to ease the pressure on the country, and to raise billions more in capital to weather those losses. (AP Photo/Yves Logghe)
BRUSSELS (AP) ? Greece's prime minister pleaded Sunday for a comprehensive solution to the European debt crisis that has swallowed his country and is threatening to suck in larger economies, but the continent's leaders warned the world may have to wait a few more days.
The search for a comprehensive solution to its escalating debt troubles has divided the continent. Increasingly it is pitting not only the poorer countries in the eurozone against their richer neighbors that are tired of bailing them out, but also sparking anger from governments outside the 17-state currency union, who fear being dragged into the mess.
"The crisis in the eurozone is having a chilling effect on all our economies, Britain included. ... We have to deal with this issue," British Prime Minister David Cameron said on his way into the meeting of the 27-country EU. Britain does not use the euro. Later in the day, the leaders of countries the 17 that use the euro will meet on their own.
Cameron's eurozone counterparts, meanwhile, tried to lower expectations for Sunday's meetings, saying the real decisions will be made Wednesday at another emergency summit.
"Let's put the expectations in context: Don't count on decisions today," German Chancellor Angela Merkel said.
Leaders are in the difficult position of not being able to decide on anything until everything is in place, since each piece of the crisis puzzle affects the others.
The biggest sticking point is how to most effectively use Europe's bailout fund to make sure Italy and Spain don't see their borrowing costs spiral out of control as happened with Greece, Portugal and Ireland. Europe doesn't have enough money to rescue Italy and Spain as it did the other three countries; analysts say it must act now to eliminate the possibility of their collapse.
Merkel and French President Nicolas Sarkozy urged Italian Prime Minister Silvio Berlusconi at a meeting on Sunday morning to reform the country's economy before it's too late, according to a German official. He spoke on condition of anonymity to describe private discussions.
While the German and French leaders presented a united front to Italy, their disagreements over how best to use the bailout fund, which is called the European Financial Stability Facility, are causing delays.
France wants the fund to be allowed to tap the massive cash reserves of the European Central Bank ? an option Germany rejects. And weaker economies are wary of agreeing to the other two parts of the grand plan ? bigger bank capital and cuts to Greece's debt ? without assurance that the bailout fund is ready to provide support.
Until it does, the continuing uncertainty will roil markets and slow growth across Europe and even the world.
Worst off, of course, is Greece, which reeling from several rounds of budget cuts that have sparked a series of strikes and riots.
"Greece has proven again and again that we are making the necessary decisions to make our economy sustainable, and make our economy more just," Greek Prime Minister George Papandreou told reporters as he headed into Sunday's meetings. "We are doing what we need from our side ... but it's been proven now that the crisis is not a Greek crisis. The crisis is a European crisis, so now is the time that we as Europeans need to act decisively and effectively."
To ease the pressure on the country, banks will be asked to accept much bigger losses on the country's bonds.
Austria's chancellor said the cut in the value of Greek government bond will likely be raised "in the direction of 40 to 50 percent."
"A cut in the debt is the right step," Werner Faymann told Austrian newspaper Wiener Kurier. The comments were confirmed by one of his aides.
Despite massive budget cuts and reforms, a new report has said that Greece's economic situation is still dire and that worsening economic conditions mean it could take the country decades to emerge from the crisis.
The report from debt inspectors said the eurozone and the International Monetary Fund would likely have to lend Athens more money unless the banks accept a 60 percent writedown of the bonds they hold. That would be on top of the euro110 billion ($300 billion) in rescue loans that have been propping up with country since May 2010.
Another rescue of a similar size was agreed to in July, but it's now clear that deal did not go far enough. For instance, it called for only a 21 percent cut in Greek bond holdings; leaders are now discussing a much more significant reduction, though an exact percentage has not yet emerged.
The near-consensus among eurozone countries that Greece's debt will have to be slashed is one of the reasons banks across Europe ? not only in the 17-country eurozone ? will be forced to shore up their capital buffers in the coming months.
A European official said Saturday that new rules agreed by EU finance ministers would see banks having to raise just over euro100 billion ($140 billion). The official was speaking on condition of anonymity because the rules were pending approval from EU leaders.
However, on Sunday it was uncertain whether EU leaders would even be able to sign off on the bank capital rules before a second summit Wednesday. A draft of summit conclusions from Sunday morning only welcomed the progress made by finance ministers, adding that the final decision would be made by yet another finance ministers' meeting on Wednesday ahead of the second summit.
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Associated Press writers Raf Casert, Elena Becatoros, Slobodan Lekic and Don Melvin contributed to this report.
sometimes, but hagfish seem happy in their low-oxygen hell.
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Public release date: 23-Oct-2011
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