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Which greeting is the cleanest? (NPR)

Fist Bumps Pass Along Fewer Germs Than Handshakes

by Michaeleen Doucleff
Jul 29, 2014

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A few weeks ago, we took a look at nonverbal greetings around the world. In Japan, they bow. Ethiopian men touch shoulders. And some in the Democratic Republic of the Congo do a type of head knock.

But the American fist bump stood apart from the rest.

Knocking knuckles was the only greeting we could find that signaled both victory and equality; neither bumper has the upper hand, so to speak.

But of many of our readers pointed out that bumping fists may have another superior quality: it's cleaner than a traditional handshake.

Now scientists in Wales have confirmed what these astute reader's already knew. You're much less likely to pass along bacteria when you bump fists than shake hands or high-five, biologists reported Monday in the American Journal of Infection Control.

The study was small. Only five pairs of people bumped, shook and slapped palms. But the findings were clear-cut. A moderately strong handshake transferred more than five times as much Escherichia coli bacteria onto a recipients hand than a fist bump, biologist David Whitworth and his colleague at Aberystwyth University found.

And that strong, sturdy handshake your grandpa taught you was even dirtier. It transferred nearly 10 times more bacteria than a fist bump.

The high-five fell between the two other greetings. Slapping palms, on average, passed along twice as much bacteria as the fist bump.

To quantify the cleanliness of each greeting, Whitworth and his colleague had volunteers put on a sterile glove and then dip their hands into a solution packed with bacteria. After the glove dried, each volunteer shook, bumped or high-fived another person wearing a clean glove. The scientists then measured the amount of E. coli on the recipient's hand.

In general, more microbes moved to the recipient when the greetings were longer, stronger and involved more skin-to-skin contact.

The bacteria used in the study were harmless. But Whitworth thinks the findings would also apply to pathogenic bacteria and viruses.

Many nasty microbes, such as Clostridium difficile and influenza, spread in clinics and hospitals through the hands of health care workers. And several infectious disease doctors have recently called for a ban on handshakes in hospitals.

But completely forbidding this classic greeting altogether at clinics may go too far, says Mary Lou Manning, of the Thomas Jefferson University School of Nursing in Philadelphia.

"We always have to take our cues from a patient," says Manning, who is the president-elect of the Association for Professionals in Infections Control. "If a patient extends his hand, I don't think I would refuse it. I would just wash my hands before and after."

And Manning definitely won't switch to bumping. "Fist bumping just seems more of an informal kind of greeting — a way to greet friends, not patients," she says. "I haven't been a fist bumper, and I don't intend to become one."

But she is a big fan of Whitworth's study. "I think it's fabulous," she says. "It's getting us all talking about the role of germ transmission from hands. I think awareness can potentially lead to behavior change and disease prevention."

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According to the Urban Institute report, the typical adult in trouble with bill collectors has a median debt of $1,350. (iStockphoto.com)

Chances Are Pretty Good That's A Bill Collector Calling

Jul 29, 2014

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In about one-third of U.S. households, the sound of a phone or door bell ringing may trigger a desire to duck.

That's because roughly 77 million adults with a credit file have at least one debt in the collection process, according to a study released by the Urban Institute, a research group. A credit file includes all of the raw data that a credit bureau can use to rank a borrower's creditworthiness.

Some of those debts can be quite small — perhaps just a $25 overdue water bill. But some are substantial and all can hurt a family's long-term economic prospects, the study found.

"In addition to creating difficulties today, delinquent debt can lower credit scores and result in serious future consequences. Credit scores are used to determine eligibility for jobs, access to rental housing and mortgages, insurance premiums, and access to (and the price of) credit in general," the study concluded.

The typical adult in trouble with bill collectors has a median debt of $1,350 in the collection process.

We aren't talking about home loans here. This report looks at non-mortgage debt, such as credit-card balances, stacked-up medical bills or past-due utility bills. These are debts that are more than 180 days past due, and have been placed in collections. The study didn't count personal debts, such as loans from family members, or pawnshop loans.

Nevada, a state hit hard by foreclosures, has the worst problem with overdue bills. There, just under half of the residents with credit files have debt in collections, according to the study. The Urban Institute based its report on a random sampling of 7 million people with 2013 credit bureau data from TransUnion, a major consumer-credit reporting agency.

While Nevada is a standout, problems with debt are concentrated mostly in the South, the study found. Of the 12 states besides Nevada with high levels of debt in collection, 11 are Southern states: Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Texas and West Virginia. The 12th state is New Mexico.

The states with the fewest troubled debtors are Minnesota, North Dakota and South Dakota.

About 22 million Americans have no credit file, which typically means they are too poor to have any credit at all. In other words, the study under-reports the financial troubles of the truly poor, and is more a reflection of the stresses on middle-class families in the U.S.

The report talks about the problems with "snowballing" debt. A lot of these overdue bills start out as relatively minor problems, such as past-due gym memberships or cell-phone contracts. But once those old bills get turned over to the collection industry, troubles mount for the debtors whose credit scores worsen.

Here's an odd twist to the debt story in the post-recession era: Most people are actually cleaning up their credit-card debt. The American Bankers Association said earlier this month that as a share of Americans' income, credit-card debt has slipped to the lowest level in more than a decade.

Today, about 2.44 percent of credit-card accounts are overdue by 30 days or more, compared with the 15-year average of 3.82 percent, according to the ABA Consumer Credit Delinquency Bulletin.

In other words, most people these days are more focused on paying off their bills. "More and more consumers are using their credit cards as a payment vehicle, paying off or paying down their balances each month," the ABA's chief economist, James Chessen, said in a statement.

Here's another peculiar point: The recession really hasn't done much to change the percentage of Americans dealing with debt collection. A decade ago, a study done by Federal Reserve economists concluded that just more than one-third of individuals with credit records had a debt in the collection process.

For the people who have fallen behind on an array of non-mortgage debts — from hospital bills to cellphone charges — being in the hole hurts because it undermines their long-term prospects.

"High levels of delinquent debt and its associated consequences, such as limited access to traditional credit, can harm both families and the communities in which they live," the Urban Institute study concludes.

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Proposed changes in medical training would shift money away from big teaching hospitals to clinics. (Erikona/iStockphoto)

Report Says Big Changes Are Needed In How Doctors Are Trained

by Julie Rovner
Jul 29, 2014 (Kaiser Health News)

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The way American doctors are trained needs to be overhauled, an expert panel recommended Tuesday, saying the current $15 billion system is failing to produce the medical workforce the nation needs.

"We recognize we are recommending substantial change," says health economist and former Medicare Administrator Gail Wilensky, co-chairwoman of the nonpartisan Institute of Medicine panel that produced the report. "We think it's key to justifying the continued use of public funds."

The federal government provides more than $11 billion a year in payments to support the training of doctors who have graduated medical school, mostly through the Medicare program. Most of that goes to the hospitals that sponsor interns and residents. States, through the Medicaid program, contribute nearly another $4 billion annually.

"The scale of government support for this phase of physician education is unlike that given to any other profession in the nation," said the report, which was funded by a dozen foundations with the support of a bipartisan group of members of Congress.

Even though the system has operated this way for decades, there is little data on how those funds are spent and how well they contribute to the preparation of a medical workforce needed for the 21st century, the panel found.

Despite a growing public investment in graduate medical education, there are persistent problems. They include uneven geographic distribution of physicians, too many specialists and not enough primary care providers, and a lack of cultural diversity in the physician workforce, the report found.

Not only that, the authors note, "a variety of surveys indicate that recently trained physicians in some specialties cannot perform simple procedures often required in office-based practice and lack sufficient training and experience in care coordination, team-based care and quality improvement."

The committee proposes a sweeping overhaul of the entire financing program for graduate medical education, with the goal of shifting the program "to a performance-based system," rather than one that merely funnels money to any facility with an accredited training program.

The current Medicare medical education payment system would be phased out over 10 years. At the end of the phase-out, policymakers would reassess whether Medicare should continue to subsidize doctor training at all, and if so, to what extent.

The panel calls for spending the same overall amount from Medicare over the next decade, adjusted for inflation. But it would be distributed much differently, with a declining share providing direct subsidies to teaching programs. An increasing share would go instead to a "GME transformation fund" that would finance new ways to provide and pay for training, and to fund training positions "in priority disciplines and geographic areas."

The funds would still be distributed through the Medicare program, but a new "GME Policy Council" would be created under the office of the Secretary of Health and Human Services to oversee workforce issues and commission research on how well the federal dollars are being spent. The committee recommended that states impose similar requirements for Medicaid training funds.

Major teaching hospitals in the Northeast would be most immediately affected, since they account for a disproportionate amount of Medicare medical education funding and number of doctors-in-training. The panel called for an end to the current system of payments that favor those hospitals. Instead it said that Medicare should make a flat "per resident" payment to training sponsors based on the national per-resident amount, adjusted for location.

It's time to close the open checkbook for teaching hospitals, the panel said.

"The statutes governing Medicare's GME financing were developed at a time when hospitals were the central - if not exclusive - site for physician training," the report said. But by doing that, "the Medicare payment system discourages physician training outside the hospital, in clinical settings where most health care is delivered."

Members stopped short, however, of recommending that Medicare stop funding graduate medical education altogether, at least for the near future.

The rapid evolution of the health care sector, said Wilensky, "was an important rationale for potentially using the leverage provided by government funding to try to train the health-care workforce we needed for a 21st century delivery system."

But the panel also did not recommend lifting the current cap on the number of residencies that Medicare supports. That cap was imposed in the 1997 Balanced Budget Act.

"Increasing the number of physicians per se is not likely to solve important workforce issues," Wilensky said, "particularly with regard to specialty distribution or geography."

All of the changes proposed in the report would have to be made by Congress, because government support for graduate medical education is written into Medicare and other laws. The politics, however, are unclear because the changes would produce winners and losers among programs training interns and residents.

Copyright 2014 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.

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Andi gasps while accepting a proposal from Josh Murray (right, in the ill-fitting suit) on Monday night's finale of The Bachelorette. (ABC)

Sex And The Single Churl: Another 'Bachelorette' Finale Gets Weird

Jul 29, 2014 (Kaiser Health News)

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After the fact that it's a blatant and ridiculous fraud, the first thing you might notice about The Bachelor(ette) franchise is its prim, Victorian attitudes about sex. For a show that encourages 14-person dates and the temporary negotiation of a lifestyle that could be best described as G-rated swinging, the whole shebang is awfully precious when it comes to the fact that sometimes, some of these people have sex with each other.

The having of sex generally makes its official arrival in the narrative each season at the point where the Bachelor or Bachelorette (let's say Bacheloron) has three Strivers left to choose from. These are the ones who go on "overnight dates." At an overnight date — and the more you hear this explained, the more creepy and clinical it will sound — the couple opens a sealed note from host/procurer Chris Harrison, who instructs them that they may spend the night in separate rooms or together in the "fantasy suite." The fantasy suite is not filmed, meaning that it does give couples the chance to spend at least a little bit of time alone before they decide to get married (!), but the unspoken purpose of the fantasy suite is, unambiguously, that you can have sex in it before the final decisions get made.

It's always been clear that some Bachelorons are comfortable having sex with three people within a few days and others are not. Not everybody Does It. Not even everybody who goes to the fantasy suite Does It. Some people probably Do Stuff That Is Not It, or that is Not It Exactly. Generally, the show connotes the suggestion that sex at least may have been had by showing you the door to the suite closing on the couple. Generally — although I can blissfully admit I have not seen every episode of every season — this is not something they talk about directly after the fact. They do not say "the sex was great," even though you can tell sometimes that it was. They do not say "the sex was disappointing," even though you can tell sometimes that it was.

Instead, there is a sort of strange agreement that although everything else, including engagements and breakups, is entirely public, you have a right to secrecy when it comes to who did what with who. We will follow a sad person into a limo to cry and collapse, but whether you kept your underwear on is for you to take to the grave.

That's what made Monday night's finale and post-show live update so surprising.

Generally, the way a Bachelorette season works is that each of the final two men has a private moment with the Bachelorette in which they propose to her, and she says yes or no. The analog in a Bachelor season is that each woman goes to find out whether he's going to propose or not. (If you have noticed that you commit a final act of either acquiescence or decisiveness depending on whether you are a boy or a girl, you win $20,000 in imaginary Bachelor Bucks in the Spot The Freakazoid Gender Politics Up In Here Sweepstakes.)

This year, however — and she was not the first to do this — Bachelorette Andi decided that since she already knew she wanted to marry giant-toothed former baseball player Josh, she would spare Wisconsin native Nick the trouble of picking out a ring and putting on a suit. So she went to see him and told him that it wasn't him, he was not the guy, and she would be giving her final rose (...never mind) to Josh.

Nick, who had been feeling pretty confident, looked devastated. He kept struggling like he was trying to say something to Andi, and as I watched him squirm and seemingly bite his tongue, I came up with a stone-cold guess regarding what his deal was.

Finally, after way too much pointless dumpsplaining on Andi's part, she left. She went off to see Josh, they got engaged, they kissed with such lip-smacking ferocity that it sounded like somebody was climbing the Empire State Building with suction cups on his hands and feet, and it was over.

Buuuuuuut it wasn't, quite, because there's always the hour they call After The Final Rose, presumably because Brand Extension and Just Leave It On This Channel And Rest Your Fingers, Baby seemed tacky. During that hour, we typically get to catch up with the couple to see whether they're still together (sometimes they're not) and happy (sometimes they're not), but we also check in with the runner-up to see whether he or she has recovered (sometimes s/he has not). This time, there was lots of buildup about the fact that Nick had tried to get Andi to meet with him in person earlier to ... maybe explain the breakup more? ... and she'd declined. So Nick had given Chris Harrison a letter to hand to her, which was written on notebook paper, because apparently he wrote it during homeroom. This would be Nick's big chance to confront Andi.

For a brief moment, it seemed like Nick was going to think better of all this confrontation. Rather than demanding answers, he thanked her for opening him up to the idea that he could feel love. She encouraged him to stick with that idea.

It was not to be. Nick had more to say. Many of those at home hoped he would not say it, whatever it was. STOP, NICK, we thought. STOP WHILE YOU CAN STILL STOP.

"Knowing how in love with you I was, if you weren't in love with me, I'm just not sure why, like, why you made love with me."

[Please note that as I rewatched the clip to add that quote, my shoulders involuntarily hunched up to my ears.]

Andi bristled at this, saying that seemed "below the belt" and like something that should be private, which is both kind of crazy and perfectly logical. In a way, they're less far apart here than they seem: Nick thinks he's arguing an old-fashioned view in which sex means something, at least when one person has declared himself to be in love, so one doesn't play with someone else's feelings by engaging in it when to do so might be misleading. Andi thinks she's arguing an old-fashioned view in which one does not kiss and tell, particularly about a relationship that's over, particularly during something that is mostly supposed to be a happy celebration of a new relationship. They both would claim that they're arguing simple sexual ethics — simple good bedroom manners.

The problem is that this is not a simple situation. This is a situation massively complicated by the fact that — oh, right — it took place within a completely artificial environment in which people have already waived all kinds of expectations they would normally have when it comes to sexual ethics. Andi has already agreed to reveal far more about her romantic and sexual life than she would if she weren't doing all this on television. Nick has already agreed that he will participate in a contest in which there will be, at the end, a loser — someone in precisely his position, who is in love and is essentially strung along until the very end and then dumped. She's already waived, up to a point, "what's private is private," and he's already waived, up to a point, "don't mislead me."

But because sex has always lived in such a bizarre part of Bachelor World, both used for titillation and withheld from view as part of a respectful pantomime of romance, it affects the dynamic in unexpected ways. It was hard to avoid the feeling that while Nick might have been justified in feeling icky about having had sex with her when he didn't realize she intended to dump him, bringing it up on live television was more about embarrassing her; otherwise, why break the unwritten rule that what happens in the fantasy suite is only vaguely alluded to outside the fantasy suite?

Part of the weird appeal of this show, admittedly, is its tendency to stumble, entirely unwittingly, entirely without sophistication, into actual brambles involving sex and gender. Little conversations about who would move to be with whom, little exchanges with parents, little turns of phrase (Josh's repeated use of the expression "make her my wife" made me feel like I was watching a 1950s western) — it's all so fake, and yet it blunders into these wee little bursts of honesty.

The irony of the entire thing was that the bursting of this particular bubble, the abrupt abandonment of the unwritten rules about fantasy suite nondisclosure, might have seemed like an intrusion of modern vulgarity on the surface. But what Nick introduced was actually an extremely traditional cultural idea within our sense of how men and women relate to each other: the spurned partner who regrets having had sex when it turns out the feelings weren't reciprocated.

What's different is that in the traditional version of this narrative, this comes from the woman. Maybe Nick was trying to embarrass or shame her, maybe he was trying to make her uncomfortable. But if this had been the other way around — a woman complaining that a guy shouldn't have had sex with her if he didn't love her — there'd be no assumption that the revelation of sex itself was supposed to reflect poorly on him. It would be about false pretenses only.

It's almost impossible to imagine a man who chose to be the Bachelor setting his jaw and saying what Andi did about how revealing that they'd had sex was hitting below the belt. That's not because Andi is necessarily wrong or that her reaction is necessarily female; it's because within popular entertainment, there's almost no such thing as casting aspersions on men for the sex they're having, particularly within the confines of an arrangement like this, where everyone is on board voluntarily.

It's just ... strange. It's all strange. It's a prim undertaking with lots of bikini shots. It's an 8:00 p.m. show that sends people off to what might as well be called the Sex Lounge. It throws all kinds of stereotypes and nonsense into a blender and produces a simulacrum of traditional courtship with ten people at once.

And it almost never gets anybody married.

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Chronixx onstage on Saturday at LargeUp's SummerStage event in New York City's Central Park. (Courtesy of LargeUp)

Chronixx: 'I'm Not A Perfectionist With Music'

by Baz Dreisinger
Jul 29, 2014 (Kaiser Health News)

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Summertime bodes well for reggae music. The genre's biggest crossover moves — from Sean Paul to I Wayne — have been made during the balmier months, when Americans relax enough to stretch the geographical limits of our soundtracks. This year's case in point: Chronixx, Jamaica's current it-artist, steadily making strides on international shores. The 21-year-old Rastafarian singer — his sweet, sincere tunes and old-school-yet-not-overly-nostalgic sound are welcome antidotes to an irony-laden culture — released his debut EP, performed on Jimmy Fallon's show and, this weekend, took the stage before a filled-to-capacity crowd for a free concert at Central Park SummerStage. That venue holds 5,500 people and an estimated 2,000 more stayed outside the gates, listening. It was a LargeUp event with New York's iconic Rice and Peas sound system DJing throughout. Backstage, Chronixx reasoned with Baz Dreisinger about music-making, Rasta and the state of reggae.

BAZ DREISINGER: What a show! The crowd hit capacity almost right after the gates opened. Even Mick Jagger came out. What does it mean to you to be at SummerStage — one of few current reggae artists to perform at this venue in recent years?

CHRONIXX: Central Park was definitely, officially one of my most exciting shows ever. New York City is home to a lot of Jamaicans and Caribbean people — I think there are more Jamaicans here than in Jamaica. It's home. So it feels like getting accepted at home.

And performing on Jimmy Fallon — again as one of few reggae artists to ever do so?

It was wonderful, but frightening, because I knew that everyone in Jamaica was watching, and if you mess up, you mess up in front of your whole family. My mother was watching, my grandmother was watching — it was scary. But other than that, it's just music — it's living. The stage becomes insignificant, the setting becomes insignificant, and you fall in love with the music and get in that state of relaxation and from there, the interaction and performance come to be.

How did it, literally, come to be — that Fallon performance?

Jimmy Fallon came to Jamaica and was staying at Goldeneye [the boutique hotel owned by Island Records founder Chris Blackwell]. He was on vacation, and he heard my music and liked it. So it was that simple: on vacation in Jamaica, hear some reggae, like the reggae — and here I am.

After the Fallon performance you posted something on your Facebook page about not having to water down one's Rasta identity in order to achieve crossover success. Explain what you meant.

Rasta is our platform, that's where we stand. And if you remove that platform, you're not standing on anything. As a Rasta, as a Jamaican youth, that is my culture, that is who I am. So regardless of the music, the instrumentation, which show I am at — I'm going to be a Jamaican Rasta. When you look at the music charts, there's reggae there but you don't see nothing about Rastafari — and that doesn't matter to me. There are a lot of youths out there who want to hear what I have to say as a Rasta, and I can't brush those billions of youths under the carpet, just for a mainstream audience.

Is a mainstream audience something you think about? Current reggae has a kind of boom-and-bust history with American audiences: moments of great crossover success, but little lasting presence.

That's because for us, as Jamaican youth with our morals, we are only willing to go a certain distance to please the mainstream. For me, unless people respect my morals and my culture, I can't go too far. The industry doesn't respect our culture; they try to give it a pop image. That's what the celebrity thing is in America: You're talented and then they refine it to suit everybody. You can reach to a level but then you're asked to do and be things that are not acceptable. Dem say America is the land of the free, but except for the Rastaman — the respect is not there. I think that's it with the mainstream thing: Celebrity life can't work for a person like me; as Rasta you deal with the earth, you deal with farming, with meditation, health — and a celebrity life doesn't facilitate any of those.

So how do you plan to navigate that celebrity world, considering?

My plan is just to live and do what I can, until I can't do it anymore.

Last time Jamaican music was seriously on America's radar it was dancehall: Sean Paul, Elephant Man, back in the early 2000s. Do you think roots reggae, your music, is more marketable?

Americans are marketing geniuses. They can market fridge to Eskimo people. Dem can market anything. You ever hear some song that's number one in America and you're like — this? So they can market dancehall, roots — whatever.

Your album Dread & Terrible is independently released. What made you go that route?

Just how a woman say she want to remain single for a while, you know, and see whaa gwaan? That's why. You get signed too young and you get signed for less than your potential. It's actually my EP, but everyone called it an album, which it's not. It's a project that captured a vibe I was feeling, not a full album.

You're identified — along with other young artists like Protoje and Jesse Royal — as part of Jamaica's "new roots movement," which blends old-school roots music with a kind of new-age hipster aesthetic. Does this label annoy you?

Not at all. We are a movement, with a lot of youths — a whole heap o we shouting at the same time, very loud and very vibrant.

Your father was a reggae artist named Chronicle, so you practically grew up in the studio. How old were you when you first started making music?

Professionally, 15.

And unprofessionally?

From ever since.

Who are you listening to these days?

Enya. Her vocal abilities, her elasticity, ability to replicate strings and percussions — amazing.

Your song "Smile Jamaica" is the perfect replacement for Bob Marley's "One Love" in all the tourism ads. Would you be up for having that song used in those ads featuring happy tourists?

That song is for the people and if it will ultimately benefit the people of Jamaica, by all means.

What is your songwriting process like? How do you make music?

It can come from a memory, a color, a feeling. From there, it becomes a word or a phrase or a sound. I meditate a lot with my thoughts. I spend half an hour every day just thinking, and that's really how I make music. Melodies for me are more like a mechanical thing — you know what kind of melodies will drive certain feelings — that's the technical part. When you meditate so much, the songs are already there, so you go in the studio it flows.

See, I'm not a perfectionist with music. I like it raw; I don't like to polish it too much. If so God give it to me I'm not going to use my human brain to replace heavenly things with human things. A lot of things that don't make sense to our brains make sense to our souls. So the grammar not right — the grammar is not correct. Some of the "ares" could be taken out; some of the "is" could be "are"; you didn't pronounce the "t" properly — but it's feelings. When you think, you don't think in complete sentences. And when you feel, you don't feel in perfect grammar.

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