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- Robert Wah, reproductive endocrinologist, and chairman of the board of trustees, American Medical Association

Wah says many physicians are also small businesses. So the uncertainty of knowing how much — or in some cases whether they’re going to be paid to see their Medicare patients, is more than just an inconvenience. “Because they have to continue to pay their rent and their insurance and their electric bill and the salaries of the people that work in their office,” he says.

Until now, the public hasn’t had a lot of sympathy for the plight of America’s doctors and their Medicare woes. Despite their complaints, doctors still earn a lot more than the average American. And surveys showed that most doctors continued to treat Medicare patients.

This problem with how Medicare pays doctors is the result of a funding formula enacted in 1997 that’s since gone awry. It affects many members of the military, too, because rates for the TRICARE health program are tied to those for Medicare.

But over time it has been gradually eroding what doctors earn to care for those patients. That’s because while Congress mostly hasn’t let the scheduled cuts take effect, it also hasn’t given doctors a raise, either. The result, says Wah, is “there’s now a 20 percent gap between… the cost of taking care of the folks in the Medicare and TRICARE system and the lack of increase in our fee schedule.”

Now that’s starting to have an impact on patients, says Paul Ginsburg, president of the Center for Studying Health System Change, a health research think tank. Ginsburg says most Medicare patients aren’t having trouble getting care because they’re not changing doctors. But with many doctors not taking new Medicare patients, there is starting to be an access problem.

“Someone who needs another doctor, either because they’ve moved, or their doctor is retired or they just don’t like their doctor anymore; those are the people bearing the brunt of whatever access limitation we have,” Ginsburg says.

But Ginsburg says he’s also worried about something else — the increasing gap in pay between primary care doctors, like family practitioners, and internists and specialists. Particularly now, he says.

“We really are looking to primary care physicians to play a bigger role, to coordinate care, to manage chronic disease, and not just to do piece work,” he says. But “at the same time we’re envisioning a changed role…we’re making primary care much less attractive.”

Those changes to the health delivery system are the result of the 2010 health overhaul. And it did include some payment increases for primary care doctors in Medicare. But it didn’t fix the overall doctor payment problem — largely because it cost too much.

And while there were a few hints that Congress might be getting ready to fix it using unspent funds from the wars in Iraq and Afghanistan, that didn’t happen. Which is why Wah and his colleagues are getting increasingly frustrated.

“Our organizations are committed to helping Congress develop better ways to pay physicians and deliver care to patients,” said a joint statement from the American Academy of Family Physicians, American College of Physicians, American College of Surgeone, and American Osteopathic Association. “(B)ut Congress must do its part and enact permanent repeal of the (current funding formula) —before 2012 comes to a close.”

Egypt is working "very diligently" to resolve the case of foreign workers facing charges, the country's military ruler has told US Senator John McCain.

Visiting Cairo, Mr McCain said Field Marshall Mohamed Hussein Tantawi had assured him Egypt was seeking to resolve the issue.

Mr McCain expressed "guarded optimism" the case could be brought to a close.

Egypt's ruling military council has accused foreign groups of funding street protests against them.

At least 43 NGO workers, including 19 Americans, are facing charges and have been banned from leaving Egypt.

Washington has warned it could review US aid to Egypt unless Cairo respects the rights of non-governmental organisation (NGOs).

Their trial is set to begin on 26 February.

Mr McCain is one of five US senators visiting Egypt, in a trip planned before the NGO workers were charged.

On Monday the senators met with representatives from the Muslim Brotherhood and its political party, the Freedom and Justice Party, which now holds the largest voting bloc in Egypt's parliament.

"The speaker informed us they are working on a new NGO law to update the Mubarak era's rather restrictive and repressive NGO law," Mr McCain said.

US state department officials warned previously that aid to Egypt, including military support from the US, could be under threat if charges against NGO workers were not dropped.

Another senator in the delegation, South Carolina Republican Lindsey Graham, told reporters it was still in US interests to help Egypt.

"It is in our interest economically, politically, and certainly from a national security point of view to help this young, struggling democracy, because if it turns out well, everything in this region changes for the better."

Mr Graham is a board member of one of the organisations facing censure, the International Republican Institute, and dismissed the charges.

"This was a politically motivated action," he said. "And as an American I'm offended that people would say things about these organisations."

The US groups deny they have done anything illegal and have accused Egypt's military rulers of derailing democracy.

Egypt's main accuser in the NGO case, cabinet minister Faiza Abul Naga, was appointed by former President Hosni Mubarak.

Dubai: Defending champion Shaker Hussain Al Ali finally hoisted himself at the top of the standings in the Open competition, qualifying on the seventh day of the 3rd Dubai International Bowling Tournament being held at the Dubai Bowling Centre.

Shaker Ali rolled a fantastic second series of 722 to compliment the opening one of 688 and third series of 760 for a total pin-fall of 2,170 and an average of 234.11.

In hot pursuit is Filipino Jordan Evan who climbed up from eighth to second with series rolls of 759, 696 and 707 for a total pin-fall of 2,030 and an average of 225.56, while third place was occupied by Ali Ahmad Al Saffar with series of 703, 699 and 744.

UAE national squad members Hussain Al Suwaidi and Syed Ebrahim Al Hashemi are in fourth and fifth places while former UAE national coach Patrick Healy saw his scores of 690, 714 and 713 slip him to sixth overall, with a few more days of qualifying still remaining.

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India's loss-making Kingfisher Airlines has told the aviation authorities that it hopes to restore flight schedules in the next five to seven days.

On Tuesday, the company's top officials met aviation regulators to discuss plans to end the large-scale flight disruptions over the past few days.

At least 30 more flights were cancelled on Tuesday and Kingfisher's shares fell by 20%.

The firm recently had its bank account frozen for non-payment of taxes.

It said it was now talking to banks to secure funding so it can continue operating.

Kingfisher executives were called by the Directorate General of Civil Aviation (DGCA) to explain why at least 130 flights were cancelled in recent days.

The airline has been given until Wednesday to come up with a revised, clear schedule for its operations, director general of civil aviation EK Bharat Bhushan told reporters after the meeting.

The airline, which flies on international as well as domestic routes, is currently operating 28 of its 64 planes, he said.

It flies to 46 destinations in India and eight overseas, including London, Hong Kong, Singapore and Dubai.

Earlier, the airline's billionaire owner Vijay Mallya said he was determined to keep the airline flying.

"Closing down is not an option. It will not happen," Mr Mallya said. "Government does not want it to happen. It is not in the national interest."

Meanwhile, India's government has ruled out any bailout for the carrier.

"As far as private airlines are concerned, they are talking to banks, and banks will lend them money only if they are confident that their business plans will succeed," said Ajit Singh, India's civil aviation minister.

The flight disruptions are the latest problem to hit Kingfisher Airlines.

Last week it reported that its losses widened 75% in the October to December quarter, raising fresh concerns about its future.

It made a loss of 4.44bn rupees ($90m; £57m) during the period, compared with 2.54bn rupees a year earlier.

Dubai: The UAE’s leading business personalities will once again engage in a keen contest for top golfing honours when the ninth edition of Dulsco Classic, the region’s premier golf championship, takes place on Thursday, February 23. This time, the Els Club at Dubai Sports City will be the venue for the tee-offs.

Dulsco Classic 2012, organised by Dulsco, is an annual golf championship that has been acknowledged not only for connecting the corporate fraternity but also encouraging businesspeople to take an active interest in the sport.

Prizes will be handed out to the top three individual performers of the competition, which will adopt an individual stableford format with a three-fourth handicap (under Divisions A & B). Participants are also allowed to form teams of four players to compete for the top three team prizes. The two best scores on each hole of each team will be counted for the team total. Special prizes will also be handed out for the ‘nearest to the pin’ and ‘longest drive’.

Last year, more than 82 golfers participated in Dulsco Classic. Top winners last year were Bharat Godkhindi and Jamal Barghouti, who won the Division A and Division B respectively.

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Release Date: 12/16/2011Contact Information: John Martin (212) 637- 3662, martin.johnj@epa.gov

(San Juan, P.R.) The U.S. Environmental Protection Agency announced a legal settlement with the developers of the Vanderbilt and La Concha Hotels of San Juan for discharging pollutants into the San Juan stormwater sewer system, which is connected to the Condado Lagoon. The settlement requires the payment of a $472,240 civil penalty and the expansion of an existing artificial habitat for fish in the Condado Lagoon. Under the agreement’s terms, the hotel’s developer, International Hospitality Associates S. en C. por A. (IHA-SE) and its managing partner, International Hospitality Associates, Inc. (IHA-INC), will construct 30 units of reef modules at an estimated cost of $32,000.

“Pollutants, whether carried by uncontrolled stormwater runoff or discharged into waterways, can seriously damage ecosystems," said EPA Regional Administrator Judith A. Enck. "I encourage all developers in Puerto Rico to take the necessary precautions to protect rivers, streams and other water bodies from contamination.”

Under the federal Clean Water Act, pollutants may not be discharged into navigable waters of the United States without the proper permit. Developers of sites one acre or larger are required to implement stormwater pollution prevention plans to keep soil and contaminants from running off into nearby waterways. The rate at which water carries soil and contaminants off of construction sites is typically 10 to 20 times greater than that from agricultural lands, and 1,000 to 2,000 times greater than those of forested lands.

EPA inspected the Vanderbilt Hotel and the La Concha Hotels in April and August 2006, and discovered that they had discharged stormwater into the San Juan stormwater sewer system from the construction sites without first applying for the required permit. EPA also found that the developers had discharged water used in the construction into the stormwater sewer system without the proper permit. These discharges led to increased turbidity (water cloudiness) and bacteria in the adjacent Condado Lagoon.

The Condado Lagoon Taino Coral Trail and Reef Enhancement Project is a habitat restoration project consisting of 44 artificial reef modules that was constructed following the Morris J. Berman oil spill of 1994. Since the first phase of the Reef Enhancement Project, the number of fish and other species within the lagoon has increased. The additional 30 reef modules IHA-SE and IHA-INC will construct will further enhance the wildlife and fisheries value of the Condado Lagoon.

The artificial reef construction funded by IHA-SE and IHA-INC is considered by EPA to be a supplemental environmental project, which is an environmentally-beneficial project that a violator voluntarily agrees to undertake in partial settlement of violations, and it must be a project that a violator would not otherwise be required to perform.

For more information about requirements of the Clean Water Act and how EPA protects the nation’s water, visit http://www.water.epa.gov/

Follow EPA Region 2 on Twitter at http://www.twitter.com/eparegion2 and visit our Facebook page, http://www.facebook.com/eparegion2

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Scientists in Russia have grown plants from fruit stored away in permafrost by squirrels over 30,000 years ago.

The fruit was found in the banks of the Kolmya River in Siberia, a top site for people looking for mammoth bones.

The Institute of Cell Biophysics team raised plants of Silene stenophylla – of the campion family – from the fruit.

Writing in Proceedings of the National Academy of Sciences (PNAS), they note this is the oldest plant material by far to have been brought to life.

Prior to this, the record lay with date palm seeds stored for 2,000 years at Masada in Israel.

The leader of the research team, Professor David Gilichinsky, died a few days before his paper was published.

In it, he and his colleagues describe finding about 70 squirrel hibernation burrows in the river bank.

"All burrows were found at depths of 20-40m from the present day surface and located in layers containing bones of large mammals such as mammoth, woolly rhinoceros, bison, horse, deer, and other representatives of fauna from the age of mammoths, as well as plant remains," they write.

"The presence of vertical ice wedges demonstrates that it has been continuously frozen and never thawed.

"Accordingly, the fossil burrows and their content have never been defrosted since burial and simultaneous freezing."

The squirrels appear to have stashed their store in the coldest part of their burrow, which subsequently froze permanently, presumably due to a cooling of the local climate.

Back in the lab, near Moscow, the team's attempts to germinate mature seeds failed.

Eventually they found success using elements of the fruit itself, which they refer to as "placental tissue" and propagated in laboratory dishes.

"This is by far the most extraordinary example of extreme longevity for material from higher plants," commented Robin Probert, head of conservation and technology at the UK's Millennium Seed Bank.

"I'm not surprised that it's been possible to find living material as old as this, and this is exactly where we would go looking, in permafrost and these fossilised rodent burrows with their caches of seeds.

"But it is a surprise to me that they're finding viable material from this placental tissue rather than mature seeds."

The Russian team's theory is that the tissue cells are full of sucrose that would have formed food for the growing plants.

Sugars are preservatives; they are even being researched as a way of keeping vaccines fresh in the hot climates of Africa without the need for refrigeration.

So it may be that the sugar-rich cells were able to survive in a potentially viable state for so long.

Silene stenophylla still grows on the Siberian tundra; and when the researchers compared modern-day plants against their resurrected cousins, they found subtle differences in the shape of petals and the sex of flowers, for reasons that are not evident.

The scientists suggest in their PNAS paper that research of this kind can help in studies of evolution, and shed light on environmental conditions in past millennia.

But perhaps the most enticing suggestion is that it might be possible, using the same techniques, to raise plants that are now extinct – provided that Arctic ground squirrels or some other creatures secreted away the fruit and seeds.

"We'd predict that seeds would stay viable for thousands, possibly tens of thousands of years – I don't think anyone would expect hundreds of thousands of years," said Dr Probert.

"[So] there is an opportunity to resurrect flowering plants that have gone extinct in the same way that we talk about bringing mammoths back to life, the Jurassic Park kind of idea."

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As Pakistan's civilian leadership falters under the weight of challenges from the army and the judiciary, a resurgent hard-line movement is making a noisy comeback.

But Maulana Khalil is eager to point to the legitimacy of these groups, saying: "All parties here including the Ansar-ul-Umma are legitimate bodies with no bans on them."

And after Osama Bin Laden's death the US media reported that recovered data from his hideout indicated the al-Qaeda chief was still in contact with Maulana Khalil.

Maulana Khalil, however, laughs it off: "All I can say is if a list was made of those making such accusations on me – America would always be on top."

He does not deny having a close relationship with al-Qaeda's leader, but says they were last in contact at the end of the Afghan jihad.

"We say that if they have clear proof that we are terrorists – that we have killed innocent people – we are willing to suffer whatever punishment," he says.

Public support

The crucial question is the level of public support this movement has. The leaders are clearly keen to present themselves as a legitimate voice and insist their new groups operate within the law. They have a website and even have a presence on Twitter and are trying to gather funds on the ground.

But they mostly hope to capitalise on Pakistanis' growing disillusionment with mainstream political parties. This is also felt in the government's perceived inability to stand up to the US, which in the eyes of some Pakistanis, is responsible for the deaths of Pakistani civilians in drone strikes.

Such feelings are driving support for people like Maulana Khalil.

While he talks flanked by his followers, young madrassa students peer into the glass windows of the restaurant to catch a glimpse of their beloved leaders.

"I just want to do their ziarat," says one wide-eyed boy not more than 10 years old. Ziarat means pilgrimage and for those young men meeting Maulana Khalil is nothing less than that.

Religious parties did poorly in Pakistan's last election. It is not yet clear how and when Difa-e-Pakistan plans to put itself to the public popularity test. For the moment, it appears content to gather momentum.