Women Better Educated Than Men

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Girls rule, boys drool—in the Ivory Tower at least. New Census figures show that more American women than men have completed college and hold advanced degrees. It’s the first time in history that women have outnumbered men in key educational metrics, but it’s also the culmination of a decades-long trend toward better women’s education and workplace equality. Among adults over 25, women barely edge out men as holders of advanced degrees, but still lag in business, science, and engineering. For bachelor’s degrees, though, the difference is greater: The U.S. has 1.5 million more female degree-holders than male ones.

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Rachel Maddow OBLITERATES John McCain, Joe Lieberman, And Lindsay Graham's Libyan HypocrisyIn recent days, John McCain, Joe Lieberman, and Lindsay Graham have all advocated different variations of the "cut the head of the snake off" approach in regard to Colonel Muammar Gaddafi.

The Senators criticized President Barack Obama's dealings with the Libyan leader, arguing that the United States needs to do more to eliminate Gaddafi.

Which might be the correct opinion, but -- as Rachel Maddow pointed out -- the trio visited Libya 20 months ago and could not say enough nice things about the Colonel they are now calling an enemy of the American state.

Back in a 2009 democratic cable, "Lieberman called Libya an important ally in the war on terrorism" while McCain said the country's relationship with the US had taken a "remarkable and positive turn in recent years."

Now, however, the Senator from Arizona is comparing Gaddafi to another former dictator.

"I don't think we worried too much when we wanted to get rid of Hitler who would take his place," McCain told an interviewer.

Maddow, understandably, thought the three men's about-face was rather absurd, but also -- sadly -- rather just another day in Washington.

"Inviting these Senators to opine on the war and to chest bump about how if they were in charge, Gaddafi would be a dead man because only they have moral clarity about what a bad guy Gaddafi is," she said. "Having these Senators opine on this war, after they've just crawled out of Gaddafi's tent themselves? That is a political science case study in 'getting away with it.' In a just world, this would be embarrassing, but in the Beltway, it's just Sunday morning."

Video below.

See Also: Glenn Beck And Bill O'Reilly: MSNBC Only Exists To Humiliate Conservatives CHRIS MATTHEWS: The Majority Of Republicans As Birthers RACHEL MADDOW: The Media Is Ignoring Town Halls Against Republicans

Anderson Cooper Left Stunned By Donald Trump's Total Refusal To Be Swayed By Actual Facts

Beyond his tenacious ability to spectacularly drop himself into international breaking news stories the other thing Anderson Cooper does really well is confront crazy people on TV.

Now, Donald Trump is not crazy, per se (and his willingness to engage with any and all media is actually rather winning) but his birther claims are looney and last night Cooper devoted his show to a) disproving them and b) confronting Trump (alas by phone).

In regards to the former Cooper and CNN actually sent people to Hawaii to investigate whether Trump really does have investigators there.  They came up empty-handed.  Though the fact CNN footed the bill to discover that in and of itself is really a testament to Trump's media savvy.  (Also, probably, CNN's struggling ratings.)

With regards to the latter, Trump called into Cooper last night so the exchange lacked some of the sparks former similar interviews have boasted. 

But even still, Cooper did a reasonably good job of holding Trump's birther feet to the fire.  Not that it mattered.   Who needs facts when you've got ratings.  Video below.

SHEP SMITH: "Fox News Can Confirm That The President Of The United States Is A Citizen Of the United States. Period"

Shep Smith appears to be losing patience with the crazies. (This is not the first time.)

Said Shep on his show Fox Report last night: "Fox News can confirm that the President of the United States is a citizen of the United States.  Period."

In a perfect media world Donald Trump will see this, take some time away from his regular segment on Fox & Friends, and go on Shep's afternoon Studio B show wherein Shep will take him to the woodshed. Dare to dream. 

Shep, long considered the voice of reason at Fox, is one of a handful of on-air personalities at the network (Chris Wallace is another, Bret Baier wants to be) that allow Fox News reporters to hold their heads up in actual news situations.  

So while it's great when he speaks his minds on TV, and he is just generally better than anyone else on TV at what he does, don't think that Roger Ailes doesn't rely on him to issue declarations like this from time to time.  It's part of what he gets paid the big bucks to do.  Which isn't to say it doesn't rock when it happens.

Video below.

Football's Future If the Players Win

There would be no draft. Incoming players would sell their services to the richest teams.

• By ROGER GOODELL

Late Monday afternoon, U.S. District Court Judge Susan Richard Nelson issued a ruling that may significantly alter professional football as we know it.
For six weeks, there has been a work stoppage in the National Football League as the league has sought to negotiate a new collective-bargaining agreement with the players. But Judge Nelson ordered the end of the stoppage and recognized the players' right to dissolve their union. By blessing this negotiating tactic, the decision may endanger one of the most popular and successful sports leagues in history.
What would the NFL look like without a collectively bargained compromise? For many years, the collectively bargained system—which has given the players union enhanced free agency and capped the amount that owners spend on salaries—has worked enormously well for the NFL, for NFL players, and for NFL fans.
For players, the system allowed player compensation to skyrocket—pay and benefits doubled in the last 10 years alone. The system also offered players comparable economic opportunities throughout the league, from Green Bay and New Orleans to San Francisco and New York. In addition, it fostered conditions that allowed the NFL to expand by four teams, extending careers and creating jobs for hundreds of additional players.
For clubs and fans, the trade-off afforded each team a genuine opportunity to compete for the Super Bowl, greater cost certainty, and incentives to invest in the game. Those incentives translated into two dozen new and renovated stadiums and technological innovations such as the NFL Network and nfl.com.
Under the union lawyers' plan, reflected in the complaint that they filed in federal court, the NFL would be forced to operate in a dramatically different way. To be sure, their approach would benefit some star players and their agents (and, of course, the lawyers themselves). But virtually everyone else—including the vast majority of players as well as the fans—would suffer.

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Small-market teams like the Buffalo Bills would suffer.

Rather than address the challenge of improving the collective-bargaining agreement for the benefit of the game, the union-financed lawsuit attacks virtually every aspect of the current system including the draft, the salary cap and free-agency rules, which collectively have been responsible for the quality and popularity of the game for nearly two decades. A union victory threatens to overturn the carefully constructed system of competitive balance that makes NFL games and championship races so unpredictable and exciting.
In the union lawyers' world, every player would enter the league as an unrestricted free agent, an independent contractor free to sell his services to any team. Every player would again become an unrestricted free agent each time his contract expired. And each team would be free to spend as much or as little as it wanted on player payroll or on an individual player's compensation.
Any league-wide rule relating to terms of player employment would be subject to antitrust challenge in courts throughout the country. Any player could sue—on his own behalf or representing a class—to challenge any league rule that he believes unreasonably restricts the "market" for his services.
Under this vision, players and fans would have none of the protections or benefits that only a union (through a collective-bargaining agreement) can deliver. What are the potential ramifications for players, teams, and fans? Here are some examples:
• No draft. "Why should there even be a draft?" said player agent Brian Ayrault. "Players should be able to choose who they work for. Markets should determine the value of all contracts. Competitive balance is a fallacy."
• No minimum team payroll. Some teams could have $200 million payrolls while others spend $50 million or less.
• No minimum player salary. Many players could earn substantially less than today's minimums.
• No standard guarantee to compensate players who suffer season- or career-ending injuries. Players would instead negotiate whatever compensation they could.
• No league-wide agreements on benefits. The generous benefit programs now available to players throughout the league would become a matter of individual club choice and individual player negotiation.
• No limits on free agency. Players and agents would team up to direct top players to a handful of elite teams. Other teams, perpetually out of the running for the playoffs, would serve essentially as farm teams for the elites.
• No league-wide rule limiting the length of training camp or required off-season workout obligations. Each club would have its own policies.
• No league-wide testing program for drugs of abuse or performance enhancing substances. Each club could have its own program—or not.
Any league-wide agreement on these subjects would be the subject of antitrust challenge by any player who asserted that he had been "injured" by the policy or whose lawyer perceived an opportunity to bring attention to his client or himself. Some such agreements might survive antitrust scrutiny, but the prospect of litigation would inhibit league-wide agreements with respect to most, if not all, of these subjects.
In an environment where they are essentially independent contractors, many players would likely lose significant benefits and other protections previously provided on a collective basis as part of the union-negotiated collective-bargaining agreement. And the prospect of improved benefits for retired players would be nil.
Is this the NFL that players want? A league where elite players attract enormous compensation and benefits while other players—those lacking the glamour and bargaining power of the stars—play for less money, fewer benefits and shorter careers than they have today? A league where the competitive ability of teams in smaller communities (Buffalo, New Orleans, Green Bay and others) is forever cast into doubt by blind adherence to free-market principles that favor teams in larger, better-situated markets?
Prior to filing their litigation, players and their representatives publicly praised the current system and argued for extending the status quo. Now they are singing a far different tune, attacking in the courts the very arrangements they said were working just fine.
Is this the NFL that fans want? A league where carefully constructed rules proven to generate competitive balance—close and exciting games every Sunday and close and exciting divisional and championship contests—are cast aside? Do the players and their lawyers have so little regard for the fans that they think this really serves their interests?
These outcomes are inevitable under any approach other than a comprehensive collective-bargaining agreement. That is especially true of an approach that depends on litigation settlements negotiated by lawyers. But that is what the players' attorneys are fighting for in court. And that is what will be at stake as the NFL appeals Judge Nelson's ruling to the Eighth Circuit Court of Appeals.
Mr. Goodell is commissioner of the National Football League.

USA Today 1A, "Poll: Trump is fired up but he likely won't be hired," by Susan Page: "Fifty percent of Americans, including 31% of Republicans, say Trump would make a 'poor' or 'terrible' president.

Better Hand-Washing Through Technology

By TINA ROSENBERG

Why can’t hospitals get health care workers to wash their hands?
Hospitals in the United States enjoy access to running water. Virtually all of them have alcohol-rub dispensers, hundreds of them, in the hallways. Using one takes a few seconds. Yet health care workers fail to wash hands a good percentage of the times they should. Doctors are particularly bad.
A health care worker’s hands are the main route infections take to move from one patient to another. One recent study of several intensive care units — where the patients most vulnerable to infection reside — showed that hands were washed on only one quarter of the necessary occasions.
It’s not that hospitals are ignoring the problem — indeed, they are implementing all kinds of strategies to promote hand-washing. Nevertheless, it is rare to find a hospital that has been able to keep the hand-washing rate above 50 percent.
Readers of Fixes know our skepticism about relying on things that beep in health care. In general, the American health care system depends too much on technology and not enough on human connection. But in the case of hand-washing, the opposite may be true. Improving hand-washing rates is not simple – if it were, we wouldn’t have a problem. It requires many steps that take into account human foibles. But for measuring compliance — one of the most important and difficult steps — we may have been relying too much on people to do a machine’s job. There is a new technological fix available that — when accompanied by other changes — may be key to reducing dangerous infections.
Why is this even a problem at all? There cannot be a single trained health care worker, anywhere in the world, who is unaware of the importance of hand-washing. Yet 2 million patients in America acquire an infection in the hospital every year — about one in 20 patients — and 100,000 people die of them. This is the fourth leading cause of death in America. Few families don’t have some horror story that started with a hospital-acquired infection. And hand-washing rates in other wealthy countries are not much different.
Hospital-acquired infections cost the American health care system between $30 and $40 billion annually. Simple division puts the rough average cost of treating of a hospital-acquired infection at $15,000 to $20,000. One study that gathered data from other studies found the average cost of treating an infection with MRSA, a staph bacteria resistant to many antibiotics, is $47,000.
There are several reasons, however, that hospital hand-washing rates may be about to improve. One reason is that hospitals have a strong financial incentive to reduce infections. In 2008, hospitals were told that Medicare would no longer reimburse them for the cost of treating preventable hospital-acquired conditions it calls “never events,” which includes many kinds of hospital-acquired infections. The new health care reform bill instructs states to do the same with Medicaid. Many insurance companies also now refuse to pay for never events. This tends to concentrate the minds of hospital executives.
Another powerful incentive to prevent infection is the rise of superbugs, like MRSA, that are increasingly resistant to our arsenal of antibiotics. Infections are getting more and more deadly. No one is more aware of this than the people most in contact with these bugs. Hand-washing is not only protective for patients.
Patients are also more knowledgeable about hospital infections and more empowered. Hospitals are increasingly required to report their incidence of hospital-acquired infections, and those results will be posted online. Patients can use this information to help them choose a hospital.
Many people have studied why hand-washing rates are so dismal. On Friday I will write about the reasons, and what has helped — although not enough — to fix the problems. The most important reason is probably that health care workers are so busy; stressed-out people with too much to do often forget to wash their hands, or it just gets skipped.
Using alcohol rub takes only a few seconds, but many nurses should be doing this dozens of times a day — in some intensive care wards, 100 times a day for each patient.
It will be very difficult to improve compliance unless hospitals can tell who is and isn’t cleaning hands, and in what circumstances. Individual doctors and nurses need to know their own hand-washing rates.
“Data really helps us work backwards,” said Katherine Ellingson, an epidemiologist at the Centers for Disease Control in the Division of Healthcare Quality Promotion. “If hospitals can identify wards that have problems or wards that are doing very well, they can learn where the gaps are or how people have found a way to get adherence up. And when people have data, they pay attention. The CEO may pay attention. The health workers themselves will pay attention if you provide data on their performance.”
Until now, hospitals have had two ways to measure hand-washing. One is by monitoring how often each soap or alcohol gel dispenser needs to be refilled. By tracking how much product a unit uses, you can get a rough idea of how much hand-washing is going on. The limits here are obvious: there is no way to tell who is washing hands and when.
The method currently considered the gold standard is using human observers: nurses or other health care workers who roam halls and patient rooms with a clipboard, recording who does and doesn’t wash hands. Sometimes they’re like secret shoppers and sometimes they’re announced.
This system, too, is woeful. Spending health care workers’ time in observing is expensive. And they can monitor only a small sample of health care workers. A recent study at the University of Iowa to test whether observers should stand still or move around found that moving more was better, but the real news was this: “All observation schedules capture at best 3.5% and at worst 1.2% of all daily opportunities” for handwashing.
When the monitors are announced, it’s bound to inflate compliance, in part because their presence reminds workers to wash hands. Their data may be entered into a computer and analyzed only weeks or months later. It isn’t enough. Hospitals need accurate information about who is and isn’t washing hands, and they need to be able to remind people to do so in real time.
Enter technology. In the last year or two, several new ways to promote hand-washing – all things that beep – have made their debut: HyGreen, BioVigil, Patient Care Technology System’s Amelior 360 and Proventix’s nGage are some of them, but there are others. Some are spinoffs of systems widely used to track hospital equipment (this is how hospitals can find a wheelchair when it is needed). All employ new technology that can detect alcohol — which in hospitals is a component not only of rubbing gel but also soap.
They work like this: every health care worker wears an electronic badge. When she washes her hands or uses alcohol rub, a sensor at the sink or dispenser or her own badge smells the alcohol and registers that she has washed her hands. Another sensor near the patient detects when her badge enters a room or the perimeter around a patient that the hospital sets. If that badge shows that her hands were recently washed, it displays a green light or something else the patient can see. If she hasn’t washed, her hands, the badge says so and emits a signal to remind her to do so. The sensor also sends this information to a central data base. Information about the hand-washing practices of a particular unit, shift or individual is instantly available.
Do they work? It is early yet — these systems are largely in the pilot phase or in use in only a handful of hospitals. But several different studies have shown that they greatly improve hand-washing compliance. There is some evidence that the systems are associated with a drop in infections. Proventix claims its nGage system saw a 22 percent drop in infection in the units where it was used in a seven-month trial, while elsewhere in the hospital the drop during that time was only 4 percent.
Miami Children’s Hospital said that during the time it used the HyGreen system in its oncology unit, the unit had a whopping 89 percent drop in infections. Deise Granado-Villar, chief medical officer, said that the gains have been maintained eight months later. These studies should be read cautiously; they are very small – Granado-Villar would not say how many infections were being counted – and not peer–reviewed.
The drawback to these systems is that they are much more expensive than other measures hospitals have tried. This is the “hand hygiene-industrial complex,” as Philip Polgreen, an infectious-disease specialist at the University of Iowa Carver College of Medicine, calls it. These systems are brand new and their price is likely to drop substantially, but right now they are expensive — Amelior, for example, costs $1,500 to $2,000 per hospital bed to install. Most offer hospitals the option to buy a system or lease it.
Hospital-acquired infections are so expensive, however, that a system that proves effective will pay for itself in the first year. “It paid for itself with the avoidance of one infection,” Granado-Villar said of the HyGreen system. “It cost $50,000 to implement, which can be the cost of one infection today.” An article in the journal Infection Control and Hospital Epidemiology found that if a hospital improved hand-washing rates by 5 percent, it would save $1,000 per bed each year in averted MRSA infections alone – and MRSA infections make up only 8 percent of all hospital-acquired infections.

Related More From Fixes

Read previous contributions to this series.

The technological approach is expensive enough that hospitals struggling with raising hand-washing rates will likely first want to make sure they are getting other things right — creating a culture of accountability, redesigning hand hygiene systems to make hand-washing easy and automatic, and other strategies. These improvements are necessary whether or not hospitals add the technological piece. “I come back to: what do you pair it with?” said Lisa McGiffert, campaign director for Consumer Union’s Safe Patient Project. “When you implement something like this technology you also have to do some culture change.”
On Friday, I’ll look at how some hospitals are changing hand-washing culture, and what we can learn from an absurdly simple idea that has already brought a deadly type of hospital infection down to near zero in Michigan.

Donald Trump: Obama Too Dumb for Ivies

Katsumi Kasahara / AP Photo

Donald Trump is trying out a new, racist dog whistle about President Obama: Saying he was a “terrible” student and wondering how he got into Columbia and Harvard. "I heard he was a terrible student, terrible. How does a bad student go to Columbia and then to Harvard?" Trump asks the Associated Press. "I have friends who have smart sons with great marks, great boards, great everything and they can't get into Harvard. We don't know a thing about this guy. There are a lot of questions that are unanswered about our president.” Obama graduated magna cum laude in 1991 from Harvard Law School, where he was president of the Harvard Law Review.

Read it at Associated Press