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– Watch out for stars moving across galaxies or losing power—it could be aliens gathering energy before the lights go out. Dan Hooper, an astronomy and astrophysics professor at the University of Chicago, posted a paper in the preprint journal arXiv.org arguing that aliens in far-off galaxies may be sucking energy from stars to offset risks posed by an expanding universe, LiveScience reports. "The presence of dark energy in our universe is causing space to expand at an accelerating rate," writes Hooper. "As a result, over the next approximately 100 billion years, all stars residing beyond the Local Group [of galaxies including the Milky Way] will fall beyond the cosmic horizon and become not only unobservable, but entirely inaccessible, thus limiting how much energy could one day be extracted from them." Therefore, he argues, an advanced civilization may use something like "Dyson spheres"—an imagined solar-powered satellite dating back to 1930s science-fiction, notes LiveScience—to harvest a star's energy or use that energy to move it closer to home. Hooper hinges his case on the work of Russian astronomer Nikolai Kardashev, who argued in 1962 that technologically advanced civilizations would expand via three steps: harvesting resources of their planet, then the nearest star, then all stars in the galaxy and nearby galaxies. So how to spot energy-grabbing aliens? Massive stars emanate certain light wavelengths, which will appear in galaxies' light signatures if stars are drained energy—that is, when humans have powerful enough instruments to detect it.

How to dominate the universe in three easy steps …

 Step 1: Harvest all of your planet's resources.

 Step 2: Harvest all of your nearest star's energy.

 Step 3: Harvest all the energy from all the stars in your local galaxy; then move on to another galaxy.

 Congratulations! Your species now has all the elbow room it needs to grow into a universal superpower.

 That's one Russian astronomer's perspective, anyway. Astrophysicist Nikolai Kardashev first proposed these three phases (called Level I, II and III) of galactic expansion — which he referred to as the three "types" of technologically advanced civilizations — in 1962 as a way to measure the energy consumption of increasingly powerful societies. Recently, a paper posted June 13 to the preprint journal arXiv.org has revived Kardashev's model and added a new, apocalyptic twist. [13 Ways to Hunt Intelligent Aliens]

 According to the author of the paper, Dan Hooper — a senior scientist at the Fermi National Accelerator Laboratory in Illinois and a professor of astronomy and astrophysics at the University of Chicago — harvesting energy from distant stars isn't just the best way to increase a civilization's available resources. It's also the only way to prevent the ever-expanding universe from leaving that civilization totally alone in the vastness of space. (This study has yet to be peer-reviewed.)

 "The presence of dark energy in our universe is causing space to expand at an accelerating rate," Hooper wrote in the new paper. Over the next approximately 100 billion years, the stars beyond our Local Group, or a group of gravitationally bound galaxies that includes the Milky Way, will fall beyond the cosmic horizon, meaning an observer here could never retrieve information from them over the course of the age of the universe.

 At that point, "the stars become not only unobservable, but entirely inaccessible, thus limiting how much energy could one day be extracted from them," Hooper wrote in the paper.

 In other words, if humans hope to meet aliens in distant galaxies, it'll be a race against dark energy, that mysterious force thought to be uncontrollably stretching our universe farther and farther apart.

 That, of course, is how we'll find the aliens.

 Any advanced civilization worth their starships would understand the grim reality of universal expansion, Hooper wrote, and they wouldn't just sit around idly while the universe literally passed them by. Rather, they would capture stars from other galaxies, reel them in and harvest their energy first, before those stars (and their energy) became inaccessible forever. [12 Possible Reasons We Haven't Found Aliens]

 "Given the inevitability of the encroaching horizon, any sufficiently advanced civilization that is determined to maximize its ability to utilize energy will expand throughout the universe, attempting to secure as many stars as possible before they become permanently inaccessible," Hooper wrote.

 So, how do you lasso a star in the first place? Scientists and science-fiction authors alike have pondered this question for decades, and their favored answer is this: Throw a giant net around it, of course.

 This net wouldn't be made of twine or even metal, but of satellites — a swarm of millions of solar-powered satellites known as "Dyson spheres." Such a colossal cloud of harvesters could permanently hover around a star, beaming energy back to a nearby planet — or, as Hooper proposed in his new paper, actually use that star's energy to accelerate the whole ball of fire back toward the planet that wanted to use it.

 This may seem like a tall order for humans, who are still bumbling around Level I of Kardashev's scale. (Carl Sagan placed us at about a 0.7 in 1973). But some scientists think there could be alien civilizations thousands, or even millions, of years older than ours who are already well into their Level III, star-harvesting phase.

 And if another civilization has indeed begun rearranging the stars, it may not be long before Earthlings notice them, Hooper wrote.

 "Those stars that are currently en route to the central civilization could be visible as a result of the propulsion that they are currently undergoing," Hooper wrote. "Such acceleration would necessarily require large amounts of energy and likely produce significant fluxes of electromagnetic radiation."

 Beyond watching for those stars being dragged unceremoniously across distant galaxies, astronomers could also keep an eye out for the unusual galaxies that have had their prime stars ripped away from them, Hooper wrote.

 These hypothetical, star-harvesting aliens will probably be picky, Hooper noted: Teeny-tiny stars, hundreds of times smaller than Earth's sun, wouldn't produce enough radiation to be useful; significantly larger stars, on the other hand, would likely be too close to going supernova to be used as a viable battery. Only stars with a mass about 20 to 100 times the mass of our sun would be viable candidates for capturing and hauling back to the home galaxy, Hooper said. And because solar objects in that mass range radiate certain wavelengths of light more than others, alien star harvesting would show up in the light signatures from these galaxies.

 "The spectrum of starlight from a galaxy that has had its useful stars harvested by an advanced civilization would be dominated by massive stars and thus peak at longer wavelengths than otherwise would have been the case," Hooper said.

 Humans likely don't have precise enough instruments yet to detect these unusual light signatures beaming from the depths of the universe, Hooper wrote. Hopefully, astronomers will develop them before our sun becomes another flaming marble in some distant civilization's collection.

 Originally published on Live Science. ||||| WARCZone is a collection of outsider-uploaded WARCs, which are contributed to the Internet Archive but may or may not be ingested into the Wayback Machine. They are being kept in this location for reference and clarity for the Wayback Team, while also being accessible to the general public who are seeking any particular items they can regarding certain websites. ||||| Ancient extraterrestrial civilizations, millions of years older than humanity, would need enormous amounts of energy. By creating a swarm of satellites in a spherical shell, they could harness much of the power of their star.

 Science fiction author Olaf Stapledon described spherical, energy-trapping alien structures in his 1937 novel "Star Maker":

 "Not only was every solar system now surrounded by a gauze of light traps, which focused the escaping solar energy for intelligent use, so that the whole galaxy was dimmed, but many stars that were not suited to be suns were disintegrated, and rifled of their prodigious stores of sub-atomic energy."

 Incredible Technology: How to Search for Advanced Alien Civilizations

 Recalling Stapledon's description, physicist Freeman Dysonproposed similar structures in a scientific paper in 1960. Dyson realized that alien civilizations could be recognized by their waste heat, which would be detectable as infrared radiation. Dyson proposed that really advanced civilizations would re-engineer their solar systems, perhaps dismantling planets to form a shellof satellites around their star to capture its energy. [13 Ways to Hunt Intelligent Aliens]

 Astrophysicist Nikolai Kardashev proposed in 1962 that very old and advanced civilizations would be of three types:

 A Type I civilization harnesses all the resources of a planet. Carl Saganestimated that Earth rates about 0.7 on the scale.

 A Type II civilization harnesses all the radiation of a star. Humans might reach Type II in a few thousand years.

 A Type III civilization harnesses all the resources of a galaxy. Humans might reach Type III in a few hundred thousand to a million years.

 A solid shell around a star would be gravitationally unstable, and would probably require more material than all of the planets of a solar system could provide. Instead, practical Dyson sphereswould be made from millions of individual solar-collecting satellites.

 Solar sails could remain in place by balancing against the pressure of light from the sun. The satellite would not be in orbit, it would actually hover in space. Such a satellite is called a "statite." Rings of statites would form a cloud around the star, collecting its energy and beaming it back to the home planet.

 Dyson spheres and other mega-structures appear frequently in science fiction. In his 1970 novel "Ringworld," Larry Niven features a ring-shaped artificial structure girdling an alien star. In the 1992 “Star Trek: The Next Generation” episode "Relics," the starship Enterpriseencounters a Dyson sphere in the form of a rigid shell surrounding a star.

 · The Top 10 Mad Scientists

 · The Most Famous Astronomers of All Time

 · The Top 10 Star Trek Technologies

 Follow us @Spacedotcom, Facebook or Google+. |||||


Daybreakers

 'Daybeakers': It's draining men in latest vampire flick

 Handout Ethan Hawke, Claudia Karvan, Willem Dafoe in 'Daybreakers,' the lastest take on the booming vampire genre.

 The fact that "Daybreakers" was filmed over two years ago can't detract from one haunting revelation: This action-horror thriller's depiction of a world lousy with vampires has come true — at least in pop culture.

 Writer-directors Michael and Peter Spierig couldn't have predicted a TV/movie landscape thirsting for twilight romances and true blood.

 But there are twists here, and while inspiration eventually runs dry, "Daybreakers" does add vamp-mobiles to the usual mythology.

 Those are the anti-sunlight cars the undead drive in 2019, 10 years after a plague gives almost everyone red eyes and a fear of wooden stakes. There's also a ghoul military force and baristas serving blood-spiked coffee, except the hemoglobin drained from hunted humans is running low.

 That's where vamp hematologist Edward Dalton (Ethan Hawke) comes in with his Van Helsing trench coat. Edward hates his supernatural diet and is working on an ineffective blood substitute for his evil boss (Sam Neill), since "infected" blood turns vamps into man-bats.

 Edward finds a group of renegade humans led by sexy Audrey (Claudia Karvan) and raspy-voiced Elvis (Willem Dafoe), crossbow-wielding saviors with a cure, and Edward defangs himself for the greater good.

 Despite the Spierig brothers' punchy visual style and satiric tone, "Daybreakers" eventually devolves, though Dafoe and his Southern drawl goose things up and Hawke has a greasy romanticism.

 (It remains unclear if Edward Dalton would win a brood-off against "Twilight's" Edward Cullen.)

 But all the mirror-world bits get tiresome, and the Spierigs seem to lose interest in what they've created, a feeling that's infectious. In a vampire movie, that's truly the deadliest thing imaginable.

 jneumaier@nydailynews.com ||||| After all the toothless, limp-dick vampire posturing in the Twilight chick flicks, it's a kick to see a balls-out, R-rated movie about bloodsuckers that doesn't spare the gore so little girls won't cry into their Twitpics of Rob Pattinson. Such a movie is Daybreakers, a nifty genre piece from Aussie twins Michael and Peter Spierig (Undead) who put some oomph into an overworked theme. Don't get me wrong. Daybreakers, despite the star presence of Ethan Hawke and Willem Dafoe, is a B movie, with all the disreputable low rent, lowbrow pleasures that implies. I'll take that over pompous any day.

 Peter Travers reviews Daybreakers in his weekly video podcast, "At the Movies With Peter Travers."

 As the Spierigs see the future — it's 2019 — vampires have taken over the world. Hilariously, they're all a bunch of tie-and-suited corporate workslaves who commute at night and appreciate Starbucks for adding a few shots of blood to their daily caffeine fix. The plot coagulates when bossman Charles Bromley (Sam Neill) puts pressure on his employees to come up with a blood substitute (what, he's never heard of Tru Blood?). Enter the hero of the piece, a vampire named Edward (aren't they all?). This Edward, played with style and bruised grace by Hawke, is a hematologist with such a sympathy for humans that he's also switched to drinking animal blood. When he meets Elvis (Willem Dafoe having a blast), a vampire who has managed — I'll never tell how — to become human again, Edward believes he's found a cure.

 Get more news, reviews and interviews from Peter Travers on The Travers Take.

 But is he too late? The shortage of blood (read: oil or any metaphor you like) has resulted in mass panic. The havenots of this new society, called subsiders, have begun feeding on themselves and morphing into scary bat-like creatures. The script has holes big enough to fall through, but as Bromley sniffs a glass of real human blood like the finest Shiraz — he likes the scent of fear in the nose — or Elvis hums a few bars of the King's immortal "Burning Love" before lifting his crossbow in battle, Daybreakers brims over with fierce retro fun. Highbrows will condescend to this movie like nobody's business. But there are a few of us left out there — junkies for smart exploitation — who will relish this stuff. You know who you are. ||||| In the unnamed metropolis of Daybreakers, downtown bustles at midnight but lies quiet at noon. Sunlight is a little harsh on its denizens, who seem kind of on edge anyway, and not just because of their yellow eyes and pointy teeth. Ten years into an outbreak of vampirism, society has become a dark mirror of what it was before, with one looming problem: The blood farms have started to run dry. The coffee stands have signs boasting “Still Serving 20% Blood.” But it looks like the signs will soon have to come down. What’s a hungry vampire supposed to do?

 Even more confounding, what’s a vampire with a conscience supposed to do? Ethan Hawke plays one such tortured creature, a hematologist turned bloodsucker against his will, now working to create a blood substitute for a many-tentacled corporation led by Sam Neill, an executive whose concern for the future never stretches past the edges of his profit margins. The work, to put it mildly, isn’t going well, and the consequences of failure surround the city in the form of “subsiders,” the feral, violent creatures into which vampires evolve without blood. (Think Max Schreck in Nosferatu, only less dapper.) After one particularly trying day, Hawke runs into the human resistance, an encounter that makes his loyalties even less sure.

 Written and directed with considerable visual flair by Australian siblings Peter and Michael Spierig (Undead), Daybreakers bursts with clever ideas and resonant concepts, from the tiny video camera in Hawke’s car that allows him to see himself without a mirror to the eerie parallels between their world of diminishing resources and ours, which comes complete with a neglected underclass of our own. It begins well, too, balancing the black comedy of the vampire world with some unsettling, well-staged thrills. But after a while, Daybreakers settles into the lulling rhythms of too many horror movies, as the characters ponder what to do in darkened rooms instead of doing much of anything. As the action diminishes, the plot digs into a rut, hobbling toward a climactic showdown that doesn’t feel all that climactic. The Spierigs get a lot of points for inventiveness, but their cleverly constructed, uncomfortably familiar world makes a deeper impression than much of what happens within it. ||||| Vampires are popping up so often these days, and in such a trendy sympathetic light, that it's getting hard to remember when they were the vicious and spooky ''other.'' You could argue that Daybreakers takes the new commonality of vampires to its logical extreme. The movie is set in 2019, 10 years after vampires have taken over the earth and established an undead society that looks a lot like the human one they wiped out. Yes, they've still got big incisors and golden eyes, but they also stand on subway platforms in Willy Loman overcoats, waiting glumly for the next train, and in line at fast-food outlets that serve coffee and ''20 percent'' blood. That would be human blood, and the reason for the scant percentage figure is that the world is fast running out of it. (It's a thin metaphor for our situation with oil.)

 Edward Dalton (Ethan Hawke), a vampire hematologist, works for a corporation that farms the blood of human cattle, who hang naked and unconscious with syringes holstered into their necks. Portrayed by Hawke as a sulky silent renegade, Edward lives in a cobalt blue modernist apartment that looks like it could be the vampire version of Mickey Rourke's lair in 9 1/2 Weeks (talk about crypts!). He is working on a plan to create synthetic blood, a crusade that would rescue the vampire world (and save a few humans, too). The only thing that stands in the way is  you guessed it  bloodsucking corporate greed. The sibling writer-director team of Michael and Peter Spierig gather the promising elements of a socio-satirical horror movie. But when Edward joins a roving band of human renegades, led by Willem Dafoe as a guy named Elvis, Daybreakers turns into a ponderous apocalyptic chase film  it's like Children of Men with exploding-plasma shock effects. The best thing you can say about the movie is that it pours some very old blood into a new plastic bottle. C

 See all of this week's reviews |||||

Write a summary.

– Critics agree that Daybreakers is visually inventive, but the B-movie charms of this vampire/oil allegory don't snare everyone. Some opinions: Willem Dafoe "and his Southern drawl goose things up," Joe Neumaier writes for the New York Daily News, and Ethan Hawke "has a greasy romanticism." But directors the Spierig brothers "seem to lose interest in what they've created, a feeling that's infectious." The film "bursts with clever ideas and resonant concepts," Keith Phipps writes at the Onion AV Club. But the "plot digs into a rut," and the "cleverly constructed, uncomfortably familiar world makes a deeper impression than much of what happens within it." "After all the toothless, limp-dick vampire posturing in the Twilight chick flicks, it's a kick to see a balls-out, R-rated movie about bloodsuckers that doesn't spare the gore so little girls won't cry into their Twitpics of Rob Pattinson," Peter Travers writes in Rolling Stone. Yeah, it's a B movie. "I'll take that over pompous any day." The "thin metaphor for our situation with oil" has "promising elements of a socio-satirical horror movie," Owen Gleiberman writes in Entertainment Weekly. But it devolves into a "ponderous apocalyptic chase film," like "Children of Men with exploding-plasma shock effects."


Write an article based on this summary:

– It was initially reported that the first same-sex couples to wed after Australia legalized gay marriage last year did so on Dec. 16—but it has now been revealed that Jo Grant and Jill Kindt were actually the first couple to marry under the new legislation, on Dec. 15. Grant was receiving palliative care for cancer at the time, and Queensland's state attorney general says officials went to "extraordinary lengths" to make sure the couple was granted a waiver to skip the official 30-day waiting period most couples in the country had to undergo, with one official staffer driving 60 miles to deliver necessary paperwork to the couple. Their marriage was approved, they were married in their garden, and registered all within a day; it was just six days after same-sex marriage became legal. Grant died Jan. 30, the BBC reports. "Jo and I got to be legally married for 48 days—I'll take that," says Kindt. The couple had been together eight years, and considered themselves married ever since a 2013 commitment ceremony. "I know there are other couples that were married that weekend, and for different reasons. They are among the first … and the reason we did is a tremendously sad one, and I'd trade everything for not having to stand here and talk about this story," said the attorney general when revealing the historic marriage to Queensland's parliament, per ABC. "I'm glad the story's been told for Jo, and I loved hearing her name being said in Parliament today," said Kindt, adding that the wedding "was great, it was really good. It was legal … Jo very much wanted it to happen, as I did."

Image copyright Marion Jonkers Image caption Jill Kindt (L) and Jo Grant were married on 15 December

 A dying woman and her partner were the first same-sex couple to legally marry in Australia, it has been revealed.

 After the nation redefined its marriage law in December, Jo Grant and Jill Kindt obtained an exemption from an official waiting period.

 Ms Grant died from cancer on 30 January, less than seven weeks after marrying Ms Kindt. They had been together for eight years.

 "Jo and I got to be legally married for 48 days - I'll take that," Ms Kindt.

 Image copyright Marion Jonkers

 Their historic marriage was made public in Queensland's parliament by state Attorney-General Yvette D'Ath.

 "I am honoured to reveal today that on December the 15th last year, despite what you may have seen reported in the media, Australia's first same-sex marriage was in fact actually held in Queensland," she said.

 Laws allowing same-sex couples to register for marriage had come into effect six days earlier, following a decisive public vote and approval by parliament.

 Some other same-sex couples, including others where one partner had a terminal illness, were also allowed to skip the waiting period and a handful of well-reported midnight celebrations took place.

 But the Queensland couple were married privately in their garden on the Sunshine Coast, surrounded by friends and family. Ms D'Ath said the marriage had been revealed now to parliament with family permission.

 She said officials went to "extraordinary lengths" to make Ms Grant and Ms Kindt's wedding happen quickly.

 Media playback is unsupported on your device Media caption First same-sex wedding on Sydney's Harbour Bridge

 The ceremony took place within 24 hours of the marriage being approved.

 Ms D'Ath said staff from Queensland Births, Deaths and Marriages drove about 100km (60 miles) to deliver paperwork to the marriage celebrant.

 Ms Grant had a "rare cancer" and had been receiving palliative care. She and Ms Kindt had held a commitment ceremony in 2013.

 "We considered ourselves married [in 2013], but in a legal sense we weren't," said Ms Kindt, according to the Australian Broadcasting Corp. ||||| The first same-sex couple to wed in Australia were only married for 48 days before death parted them

 Updated

 The extraordinary efforts behind the scenes of Australia's first same-sex marriage, allowing a Queensland woman to wed her partner before she died from cancer, have been revealed.

 Jill Kindt and Jo Grant had been together for eight years but only legally married for 48 days, after they tied the knot in their garden on December 15.

 It was a week after same-sex marriage became legal in Australia, and it has now been revealed to be the country's first.

 It was allowed to proceed without the 30-day waiting period because Ms Grant was terminally ill with a rare cancer.

 She died on January 30, 2018, just over six weeks from her wedding.

 The behind-the-scenes details, and the people who helped make their wedding possible, were mentioned in Queensland Parliament.

 Attorney-General Yvette D'Ath said Ms Kindt and Ms Grant were approved, married, and registered all in one day, after the Registrar ruled exceptional circumstances.

 Staff from Births, Death and Marriages also played an important role — with one staff member even driving from Brisbane to a roadside service station on the way to the Sunshine Coast to meet the celebrant and deliver the paperwork necessary for the marriage to take place.

 "I know there are other couples that were married that weekend, and for different reasons. They are among the first … and the reason we did is a tremendously sad one, and I'd trade everything for not having to stand here and talk about this story," Ms Kindt said.

 In 2013, Ms Kindt and Ms Grant held a commitment ceremony, or a "promise day" as they called it, and considered themselves to be each others' spouses ever since.

 Their 2017 wedding made their marriage legal.

 "It was great, it was really good. It was legal … Jo very much wanted it to happen, as I did," Ms Kindt said.

 "It's very hard to describe. We considered ourselves married, but in a legal sense we weren't."

 Ms Kindt said she and her wife were humbled by those behind the scenes who moved heaven and earth to make sure they had as much time possible together legally married.

 "But we were overwhelmed by the fact the people who did not know us made something that we wanted happen and gave us a whole heap of joy. That's the story," Ms Kindt said.

 "But I'm glad the story's been told for Jo, and I loved hearing her name being said in Parliament today.

 "Jo and I got to be legally married for 48 days. I'll take that."

 Ms D'Ath called it an "inspiring story".

 "It's a story of hope that reframes Queensland as a modern, trailblazing state which recognises equal rights and the most fundamental principle — that love is love," Ms D'Ath said.

 Australia's first same-sex weddings occurred from January 9 but some couples, such as Ms Kindt and Ms Grant, were eligible for exemptions allowing them to wed earlier.

 Lauren Price and Amy Laker, from Sydney, also exchanged vows on December 16 after they too obtained a waiver exempting them from the one-month waiting period because their families were travelling from Wales to be there.

 Ms Grant and Ms Kindt were one of 159 same sex couples who have been married in Queensland since the marriage equality laws were passed.

 Topics: community-and-society, family-and-children, marriage, lgbt, state-parliament, parliament, government-and-politics, maroochydore-4558, qld, brisbane-4000

 First posted |||||


News article:

NEW YORK ( MainStreet) -- Jerks in the American media would have you believe all of America's iconic products are made elsewhere and American manufacturing is circling the wide, stinky drain to irrelevance.

 As the American media outlet that suggested just such a thing this year, we feel inclined to tell you that it's not exactly true.

 No,Chuck Taylors,Jeans,dolls and eventools aren't strictly "Made In The U.S.A." anymore, despite 61% of Americans tellingand Harris they'd pay more for American-made products. Yes, the University of Michigan says American manufacturers make only 75% of the items America consumes and may make less if manufacturing continues to be neglected. That doesn't mean there aren't still great items being produced on our shores each day under brand names Americans have loved for generations.

 1 of 11

 In fact, the U.S. is even encroaching on the turf of some of its biggest rivals. We took a look around the market and found 10 items that are still proudly Made in the U.S.A.: ||||| NEW YORK ( NEW YORK ( MainStreet ) -- What does being "American" mean in the marketplace? If you're a U.S. consumer, it's apparently a huge incentive. According to a 2010 survey by Adweek Media and Harris, 61% of Americans say they are more likely to buy a product when an ad says it's "Made in America." That includes 75% of Americans 55 and over, 66% of those 45 to 54 and 61% of those 35 to 44. If you're a U.S. consumer, it's apparently a huge incentive. According to a 2010 survey by Adweek Media and Harris, 61% of Americans say they are more likely to buy a product when an ad says it's "Made in America." That includes 75% of Americans 55 and over, 66% of those 45 to 54 and 61% of those 35 to 44. It also indicates a premium those same Americans are willing to pay for those products. After toys from China entered the country in 2007 laden with toxic levels of lead, pesticides and chemicals, a Gallup poll found that 82% of Americans would rather spend more money on a toy if it were made in the United States. That percentage jumped to 94% when survey participants were asked if they'd pay extra for food produced in the U.S. to avoid Chinese imports. It also indicates a premium those same Americans are willing to pay for those products. After toys from China entered the country in 2007 laden with toxic levels of lead, pesticides and chemicals, a Gallup poll found that 82% of Americans would rather spend more money on a toy if it were made in the United States. That percentage jumped to 94% when survey participants were asked if they'd pay extra for food produced in the U.S. to avoid Chinese imports. That consumer patriotism is great and all, but does it do any good when buyers are given conflicting messages about what is and isn't made in this country? Does a beer can draped in the colors of the American flag necessarily indicate an American brewer? Does a truck rambling through the rugged American landscape as a song about "our country" plays in the background necessarily indicate an "American-made" vehicle? That consumer patriotism is great and all, but does it do any good when buyers are given conflicting messages about what is and isn't made in this country? Does a beer can draped in the colors of the American flag necessarily indicate an American brewer? Does a truck rambling through the rugged American landscape as a song about "our country" plays in the background necessarily indicate an "American-made" vehicle? Does the presence of the word "American" in the product's name or in its producer's core marketing agenda make that product "American"? Does the presence of the word "American" in the product's name or in its producer's core marketing agenda make that product "American"? Any good, American skeptic knows the answer. Putting on a topcoat of red, white and blue and hiding behind a heavy layer of jingoism can't hide a product's true identity. That made it pretty easy to put together this checklist of 10 "American" products that have dual citizenship at best or are hiding their true colors at worst: Any good, American skeptic knows the answer. Putting on a topcoat of red, white and blue and hiding behind a heavy layer of jingoism can't hide a product's true identity. That made it pretty easy to put together this checklist of 10 "American" products that have dual citizenship at best or are hiding their true colors at worst:

 Budweiser

 Anheuser-Busch InBev ( BUD ) really wants you to believe that the only way to get something more American into a beer can is to brew it with grain grown on the battlefields at Lexington and Concord and water piped from the Reflecting Pool on the National Mall. The company spent more than $1 billion on its NFL sponsorship alone and has plowed $239 million more into Super Bowl ads over the past decade. Its Clydesdales are American commercial icons and Budweiser's red, white and blue cans send a not-so-subtle message that despite the brewery's German roots, it's American to the last drop. The company spent more than $1 billion on its NFL sponsorship alone and has plowed $239 million more into Super Bowl ads over the past decade. Its Clydesdales are American commercial icons and Budweiser's red, white and blue cans send a not-so-subtle message that despite the brewery's German roots, it's American to the last drop. That facade came crashing down in 2008, when Brazilian-Belgian brewing company InBev took over Anheuser-Busch for $52 billion. Though the company still has a dozen breweries in the U.S., there have been a whole lot of layoffs stateside in an attempt to make the brewer a leaner, more cosmopolitan international player. That facade came crashing down in 2008, when Brazilian-Belgian brewing company InBev took over Anheuser-Busch for $52 billion. Though the company still has a dozen breweries in the U.S., there have been a whole lot of layoffs stateside in an attempt to make the brewer a leaner, more cosmopolitan international player. Budweiser, Bud Light and Michelob are still feature players in the stable, but now they're sharing shelf space with brewery mates such as Boddington's, Lowenbrau, Hoegaarden, Spaten and Labatt. Budweiser, Bud Light and Michelob are still feature players in the stable, but now they're sharing shelf space with brewery mates such as Boddington's, Lowenbrau, Hoegaarden, Spaten and Labatt. Bud's not even the brewer's only big gun anymore, as it made clear by airing a Bud's not even the brewer's only big gun anymore, as it made clear by airing a Stella Artois ad featuring Adrien Brody during the Super Bowl a few years ago. It still throws around that "King of Beers" title here in the states, but its recent relegation to third place among U.S. beer brands indicates that crown is slipping. Don't blame Bud for talking tough and acting aggressively on football Sundays; when the game's over, it goes home to multinational masters that consider it their American Beck's.

 Coors

 What is the only thing worse that playing "American" while not being produced by an American company anymore? Putting on that costume while being produced by two foreign brewing juggernauts. What is the only thing worse that playing "American" while not being produced by an American company anymore? Putting on that costume while being produced byforeign brewing juggernauts. Such is the case for Coors, which stopped being solely a Rocky Mountain resident in 2005 when it merged with Canadian megabrewer Molson. That lumped the Coors brands in with a stable that includes the Molson products, England's Carling and Dutch-derived Grolsch. Still, it needed a little something extra to compete in the American marketplace. Such is the case for Coors, which stopped being solely a Rocky Mountain resident in 2005 when it merged with Canadian megabrewer Molson. That lumped the Coors brands in with a stable that includes the Molson products, England's Carling and Dutch-derived Grolsch. Still, it needed a little something extra to compete in the American marketplace. This is where Coors' branches on the family tree get complicated. SABMiller -- formed in 2002 when South African Breweries bought U.S.-based Miller Brewing -- teamed with MolsonCoors ( This is where Coors' branches on the family tree get complicated. SABMiller -- formed in 2002 when South African Breweries bought U.S.-based Miller Brewing -- teamed with TAP ) to market both companies' beers in the U.S. under the MillerCoors joint venture. While it's nice that Coors Light recently took the No. 2 spot in the American market from Budweiser, saying it's the No. 2 American beer brand is a bit of an oversimplification. At this point, Coors in the U.S. is equal parts American, Canadian, British and South African. You'd have to dig down through the beer ranks to Yuengling or Boston Brewing ( While it's nice that Coors Light recently took the No. 2 spot in the American market from Budweiser, saying it's the No. 2 American beer brand is a bit of an oversimplification. At this point, Coors in the U.S. is equal parts American, Canadian, British and South African. You'd have to dig down through the beer ranks to Yuengling or SAM ) -- with a combined U.S. market share of little more than 2% to MillerCoors' 29% -- before you found a truly "American" beer.

 Chevrolet Silverado

 You're right, John Mellencamp, You're right, John Mellencamp, this is our country . Just make sure you're including all of North America in that grouping. The Chevy Silverado and its doppelganger, the GMC Sierra, have all the makings of a big, durable, contractor-friendly, all-American truck. It's just that last adjective that General Motors ( The Chevy Silverado and its doppelganger, the GMC Sierra, have all the makings of a big, durable, contractor-friendly, all-American truck. It's just that last adjective that GM ) still has a bit of trouble with. Sure, some of the trucks are assembled at plants in Flint, Mich., and Fort Wayne, Ind., but a sizable number are also made in Silao, Mexico. Even those made north of the border aren't quite "American." Auto pricing site Cars.com booted the Silverado and Sierra out of the Top 10 of its American-Made Index after its pieces slipped below the list's cutoff of 75% domestically produced content to only 61%. Even those made north of the border aren't quite "American." Auto pricing site Cars.com booted the Silverado and Sierra out of the Top 10 of itsafter its pieces slipped below the list's cutoff of 75% domestically produced content to only 61%. That's no knock on the Silverado's quality, just a reminder that it takes a global village to raise a Chevy pickup. That's no knock on the Silverado's quality, just a reminder that it takes a global village to raise a Chevy pickup.

 Ford F-150

 Didn't think you were going to get away that easily, did you, Ford ( Didn't think you were going to get away that easily, did you, F )? No, Ford didn't take any of the U.S. government's bailout money and doesn't assemble any of its U.S.-sold F-150s beyond U.S. borders. That doesn't mean that a big chunk of the F-150 isn't made elsewhere. No, Ford didn't take any of the U.S. government's bailout money and doesn't assemble any of its U.S.-sold F-150s beyond U.S. borders. That doesn't mean that a big chunk of the F-150 isn't made elsewhere. The F-150 may roll off the lines in Kansas City, Mo., and Dearborn, Mich., but only 60% of its parts are made in the U.S. That's actually a great statement on the F-150's quality and demand, considering that 90% of its parts were made in the U.S. before volume increased nearly 11% in the past year alone. Unfortunately, the F-150's popularity forced Ford to outsource parts and cut costs. The F-150 may roll off the lines in Kansas City, Mo., and Dearborn, Mich., but only 60% of its parts are made in the U.S. That's actually a great statement on the F-150's quality and demand, considering that 90% of its parts were made in the U.S. before volume increased nearly 11% in the past year alone. Unfortunately, the F-150's popularity forced Ford to outsource parts and cut costs. If you're looking for something a bit more American, however, Cars.com says the San Antonio, Texas-built Toyota ( If you're looking for something a bit more American, however, Cars.com says the San Antonio, Texas-built TM ) Tundra has the most American-made parts of any truck on the market while keeping assembly line jobs in-house.

 Rawlings baseballs

 As American as mom, baseball and apple pie? Not so fast, baseball. As American as mom, baseball and apple pie? Not so fast, baseball. St. Louis, Mo.-based Rawlings has been the official baseball supplier of Major League Baseball since 1977, but hasn't sewn a single stitch into cowhide stateside during that time. Well before Rawlings was called up to the majors, the company had outsourced its production to other spots in the northern hemisphere. St. Louis, Mo.-based Rawlings has been the official baseball supplier of Major League Baseball since 1977, but hasn't sewn a single stitch into cowhide stateside during that time. Well before Rawlings was called up to the majors, the company had outsourced its production to other spots in the northern hemisphere. Though founded in St. Louis all the way back in 1887, Rawlings moved its baseball manufacturing plant to Puerto Rico in 1969. That was followed by a move to Haiti shortly thereafter. Finally, the company settled down in Costa Rica, where it has been sending its cowhide, cores and twine ever since. Now part of Jarden ( Though founded in St. Louis all the way back in 1887, Rawlings moved its baseball manufacturing plant to Puerto Rico in 1969. That was followed by a move to Haiti shortly thereafter. Finally, the company settled down in Costa Rica, where it has been sending its cowhide, cores and twine ever since. Now part of JAH ) -- the same folks who own the Crock-Pot, Mr. Coffee, Oster, Rival and Sunbeam brands -- Rawlings is just a small cog in a really big conglomerate. It just happens to have the misfortune of providing a key element of the national pastime from the warm tropical confines of another nation entirely. It just happens to have the misfortune of providing a key element of the national pastime from the warm tropical confines of another nation entirely.

 Levi's

 Wear them to the fall of your totalitarian government, name drop them in your protest songs, but just don't call Levi's blue jeans Yankee made. Nothing could be further from the truth. Wear them to the fall of your totalitarian government, name drop them in your protest songs, but just don't call Levi's blue jeans Yankee made. Nothing could be further from the truth. The Levi Strauss & Co. bears little resemblance to the little outfit that cropped up in San Francisco during the late 1800s, outfitted the American counterculture in the mid-20th century and became the symbol of all things American by the time the Berlin Wall came down in 1989. By that time, the company itself was crumbling under pressure from cheaper overseas manufacturers and started shutting down its U.S. manufacturing operations. The Levi Strauss & Co. bears little resemblance to the little outfit that cropped up in San Francisco during the late 1800s, outfitted the American counterculture in the mid-20th century and became the symbol of all things American by the time the Berlin Wall came down in 1989. By that time, the company itself was crumbling under pressure from cheaper overseas manufacturers and started shutting down its U.S. manufacturing operations. Those "American" blue jeans started coming with "made in" tags as diverse as a soul-searching exchange student's passport stamps. They're made it Japan, Lesotho, Mexico, Cambodia, Turkmenistan, the Philippines and a whole lot of other places far beyond U.S. borders. Those "American" blue jeans started coming with "made in" tags as diverse as a soul-searching exchange student's passport stamps. They're made it Japan, Lesotho, Mexico, Cambodia, Turkmenistan, the Philippines and a whole lot of other places far beyond U.S. borders. The company still maintains a headquarters in San Francisco, but other outposts in Belgium and Singapore as well as manufacturing facilities spread throughout the globe indicate Levi's American identity hangs by a thread, if it hasn't frayed away completely. The company still maintains a headquarters in San Francisco, but other outposts in Belgium and Singapore as well as manufacturing facilities spread throughout the globe indicate Levi's American identity hangs by a thread, if it hasn't frayed away completely.

 American Girl dolls

 Hey kid, wanna buy a $100 doll? Hey kid, wanna buy a $100 doll? Don't worry, they're totally educational, have huge boutique stores and restaurants that you can spend hundreds more dollars in and are nothing like that morally reprehensible Barbie. Mattel ( Don't worry, they're totally educational, have huge boutique stores and restaurants that you can spend hundreds more dollars in and are nothing like that morally reprehensible Barbie. MAT ) should know, as it's owned American Girl since 1998 and has made American Girl and Barbie products in China since roughly that time. Not that American Girl dolls were all that American before Mattel got involved. The original dolls were made in Germany and weren't made any less pricey by the switch. But quibbling over the doll's price or manufacturing location is of little interest to American Girl, which views its mission as retelling American history through the eyes of pieces of plastic molded into the shape of 9-year-old girls and outfitted like audio-animatronic rejects from Walt Disney World's Hall of Presidents. Not that American Girl dolls were all that American before Mattel got involved. The original dolls were made in Germany and weren't made any less pricey by the switch. But quibbling over the doll's price or manufacturing location is of little interest to American Girl, which views its mission as retelling American history through the eyes of pieces of plastic molded into the shape of 9-year-old girls and outfitted like audio-animatronic rejects from Walt Disney World's Hall of Presidents. Actual American girls should consider themselves fortunate for the experience. After all, who can give a less biased view of the messy intricacies of American history than a smiling, disconnected friend from a foreign country? Actual American girls should consider themselves fortunate for the experience. After all, who can give a less biased view of the messy intricacies of American history than a smiling, disconnected friend from a foreign country?

 Craftsman tools

 Sears ( SHLD ) may be in trouble now with hundreds of stores facing closure and the fate of the entire company very much in doubt, but it's been through bad times before. Consider the case of its trademark Craftsman tool brand. Before you could just snap them up at any Ace Hardware, Craftsman was one of Sears' big draws and its finest example of durable American products. Consider the case of its trademark Craftsman tool brand. Before you could just snap them up at any, Craftsman was one of Sears' big draws and its finest example of durable American products. That little fable was all well and good until 2004, when a class-action suit accused Craftsman of not living up to its "Made in the USA" label. The suit accused Sears of using metal parts from Austria, Denmark, China, India and Mexico in its Craftsman products. That's a big no-no when the Federal Trade Commission says goods can be called American-made only if they're made entirely in the U.S. or made in the U.S. with an overwhelming majority of U.S.-made parts. That little fable was all well and good until 2004, when a class-action suit accused Craftsman of not living up to its "Made in the USA" label. The suit accused Sears of using metal parts from Austria, Denmark, China, India and Mexico in its Craftsman products. That's a big no-no when the Federal Trade Commission says goods can be called American-made only if they're made entirely in the U.S. or made in the U.S. with an overwhelming majority of U.S.-made parts. The claimants lost not because they were wrong, but because they failed to prove any injury from the mislabeling. While a whole lot of Craftsman products are still made in the U.S., some Craftsman products are now labeled "Made in China." The claimants lost not because they were wrong, but because they failed to prove any injury from the mislabeling. While a whole lot of Craftsman products are still made in the U.S., some Craftsman products are now labeled "Made in China."

 Schwinn bicycles

 Whether it's the classic beach cruiser or the traditional 10-speed, that Schwinn you're seeing at Wal-Mart ( Target ( Whether it's the classic beach cruiser or the traditional 10-speed, that Schwinn you're seeing at WMT ) or TGT ) hasn't been a consistent American classic for more than 20 years. After feeling the pinch from competitors such as Trek and Specialized and losing the ability to make bikes at a competitive cost, Schwinn originally sent all its manufacturing overseas in 1991. It went bankrupt a year later, but resurfaced in 1993 as a boutique outfit making lightweight bikes. After feeling the pinch from competitors such asandand losing the ability to make bikes at a competitive cost, Schwinn originally sent all its manufacturing overseas in 1991. It went bankrupt a year later, but resurfaced in 1993 as a boutique outfit making lightweight bikes. Schwinn's last bankruptcy in 2001 sealed its fate in the U.S. Schwinn was sold to Pacific Cycle. Pacific, in turn, was bought by Dorel Industries, a Canadian company that also makes furniture and baby products. The Schwinn bikes consumers see today are built in Taiwan and China and have little in common with the company's history -- besides a nameplate. Schwinn's last bankruptcy in 2001 sealed its fate in the U.S. Schwinn was sold to Pacific Cycle. Pacific, in turn, was bought by, a Canadian company that also makes furniture and baby products. The Schwinn bikes consumers see today are built in Taiwan and China and have little in common with the company's history -- besides a nameplate. In today's bicycle industry, though, being foreign-made is about the most American thing a large bicycle manufacturer can do. The National Bicycle Dealers Association says 99.5% of bikes sold in the United States are mass-market imports from Asian countries. In today's bicycle industry, though, being foreign-made is about the most American thing a large bicycle manufacturer can do. The National Bicycle Dealers Association says 99.5% of bikes sold in the United States are mass-market imports from Asian countries. ||||| KitchenAid mixers

 The old story goes that a Hobart Manufacturing executive's wife coined the name in 1915, telling the exec, "I don't care what you call it, this is the best kitchen aid I ever had." The KitchenAid brand appeared four years later, but didn't pick up steam until it appeared in multiple colors in 1955. Now more than 40 colors are produced by 700 workers at the KitchenAid factory in Greenville, Ohio. They're still a wedding industry staple and easily the heaviest, most durable appliance in most American kitchens. The company, now a Whirlpool (WHR) brand, has since branched into other areas of the kitchen, but the familiar outline of its popular mixer is still what springs to mind when someone asks for a KitchenAid.

 Next> |||||
What is a shorter version of the above article?

– Who says America is losing its touch? Well TheStreet did earlier this year, listing 10 iconic American brands now made overseas—like Levi's Jeans, Converse sneakers, and even American Girl dolls. But things aren't all bad, and it is Independence Day. So in the spirit of patriotism, TheStreet decided to list some iconic brands still made in the US of A. Like: Louisville Slugger: As the name implies, MLB's most popular bats still hail from Kentucky. Indian Motorcycles: This century-old company recently moved its factory—from North Carolina to Iowa. Slinky: Still ambling down out of Pennsylvania, as it has been since 1945. Gibson Guitars: The original Kalamazoo plant closed in 1984, but Les Paul is still all-American. The guitars are hand-crafted in Nashville. Kohler Fixtures: Did you know the name "Kohler" refers to Kohler, Wisconsin? Or that the company's products have been made there since 1912? Now you do. Weber Grills: While Weber's gas models are made overseas, its classic black-domed charcoal grills are still made in Palatine, Illinois. For the full list, click here, or to jump to where we've left off, click here.


Article:

To Austin Tice, From your family

 Austin Tice was captured while reporting on the civil war in Syria on August 12, 2012. Since then, Marc, Debra and the Tice family have endured three consecutive Christmases without their son and brother. This will be the fourth. The Tices hope t ||||| The families of four American hostages who were killed while in Islamic State custody issued a joint letter Wednesday imploring the Obama administration to “use all appropriate means” to find and return missing U.S. journalist Austin Tice.

 Tice is the last unaccounted-for American reporter in the Syrian civil war; he was abducted by unknown gunmen in August 2012 and has been incommunicado ever since. Tice’s parents have asked the White House to step up search efforts, with their calls sounding increasingly urgent as the clock runs out on the Obama administration’s final term.

 State Department spokesman John Kirby said U.S. officials are working through the Czech government, the U.S. protecting power because the U.S. embassy in Damascus is shuttered, to find information on Tice’s “welfare and whereabouts.” Kirby said officials are in regular contact with families of U.S. detainees overseas, but that privacy considerations prevented him from saying more about Tice.

 “We are deeply concerned about the well-being of Austin Tice,” Kirby said. “His case has the attention of the highest levels in the U.S. government and the administration.”

 The letter the Tices released Wednesday bore the names of the slain hostages’ parents – a raw reminder of search efforts that didn’t find captives in time. They represented journalists James Foley and Steven Sotloff, and humanitarian aid workers Abdul-Rahman Peter Kassig and Kayla Mueller.

 The Islamic State beheaded Foley, Sotloff and Kassig in gruesome propaganda videos. Mueller, who reportedly was enslaved and assaulted for months by Islamic State leader Abu Bakr al Baghdadi, died in a coalition strike, apparently an inadvertent casualty of the U.S.-led campaign targeting the Islamic State’s so-called caliphate in Iraq and Syria.

 We are four families bonded together by tragedy and terror. . . . But there is something that still can be done: Bring Austin Tice safely home. Open letter to President Obama

 The Tices got to know the other families when they united to lobby for changes in hostage policy – they were at the White House together a year ago this week when President Barack Obama announced a revamped process based on the families’ recommendations.

 “We are four families bonded together by tragedy and terror. We will never fully recover from the horrific outcome of our own hostage crisis,” the families of the slain captives wrote in the joint letter. “But there is something that still can be done: Bring Austin Tice safely home.”

 Neither the Tices nor the other families named specific steps the Obama administration could take to find Tice and win his release. They alluded to diplomatic efforts and urged officials not “to hesitate in leveraging all appropriate means.” The parents also chided Obama for failing to mention Tice – the only U.S. journalist in captivity in the world – during his high-profile speech at the annual White House Correspondents Association dinner April 30.

 Austin Tice is the only American journalist being held captive in the world.

 “We are not asking the White House to put anyone in harm’s way, nor compromise national security,” the families wrote. “We are asking the president, fully within the responsibilities and obligations of his office, to put aside any personal or election year concern, to engage boldly and to use all appropriate means to bring Austin Tice safely home as soon as possible.”

 The families gave wrenching testimonials about having a loved one held hostage in Syria.

 Mueller’s parents and brother, Carl, Marsha and Eric, wrote that they are “haunted every day” and urged the government not to repeat what they deemed as missed opportunities and “the deadly silence that cost all the hostages their lives.”

 Foley’s parents, Diane and John, told Obama that they’re counting on him to keep the promises he made “after the horrific execution of our son.” Kassig’s parents, Ed and Paula, said they’re “devastated by the loss of our son, but the pain will be slightly lessened” if his death spurred the government to act urgently to bring Tice home.

 Shirley and Arthur Sotloff were even more direct.

 “We, the family of the late journalist Steven Sotloff, remind President Obama of the following: You told us in person that if it were your daughters, you would do anything in your power to bring them home,” they wrote. “We implore you: Bring Austin Tice home.”

 EDITORS: STORY CAN END HERE

 Tice, now 34, a U.S. Marine-turned-journalist who reported for outlets including McClatchy and The Washington Post, vanished in Syria in mid-August 2012. Apart from a video clip showing him in the custody of unknown gunmen shortly after his disappearance, there’s been no confirmed sighting of Tice since.

 Unlike the other American captives, Tice is widely believed to have been seized by loyalists of the Syrian regime – not by the Islamic State. Damascus denies any knowledge of his whereabouts. This August will mark his fourth year in apparent detention.

 The parents of the hostages closed their letter of support by recognizing the Tice family’s anguish. They, too, know how “it requires mountain-moving faith to maintain hope as the crisis continues.”

 “With unwavering hope, Austin’s parents do not give up,” the families wrote. “The United States government must not give up.” ||||| Fresno Democratic Congressman Jim Costa voted twice to support Saudi Arabia’s war in Yemen while taking campaign cash from oil and gas companies. He has said he will take a stronger stand early next year. Hold him to account. |||||
What is a summary?

– American journalist Austin Tice—believed to be the only US reporter held hostage anywhere in the world—was captured in Syria in August 2012. Since then, US hostages James Foley, Peter Kassig, Kayla Mueller, and Steven Sotloff have been killed, and their families fear Tice's parents will soon have to share in their heartbreak. "We are four families bonded together by tragedy and terror," they write in an open letter to Obama at McClatchy. "But there is something that still can be done: Bring Austin Tice safely home." The letter comes a year after Obama promised the US would improve on how it dealt with hostages. "You told us in person that if it were your daughters, you would do anything in your power to bring them home," says the letter. "We are not asking the White House to put anyone in harm's way, nor compromise national security," but to "engage boldly and use all appropriate means to bring Austin Tice safely home as soon as possible." The editorial board of the Sacramento Bee is backing the families. "The US military has a solemn creed: No soldier left behind," it writes. "The same should hold true for Austin Tice." A State Department rep tells McClatchy that Tice's case "has the attention of the highest levels in the US government and the administration."


Write a summary based on this article:

Study Population

 Using the Centers for Medicare and Medicaid Services carrier files for a 20% random sample of beneficiaries from January 1, 2008, through December 31, 2011, we identified index emergency department visits at acute care hospitals by Medicare beneficiaries. We defined an index visit as the earliest visit at which a beneficiary had an evaluation and a management claim by an emergency medicine physician with a place-of-service designation in the emergency department. Emergency medicine physicians were defined as physicians with an emergency medicine specialty who billed 90% or more of claims with an emergency department place of service. We included only one index visit to the emergency department per beneficiary and excluded all visits to the emergency department that resulted in a hospital admission.

 We limited our analyses to beneficiaries who had been continuously enrolled in Medicare Part D for 18 months or more, including at least the period from 6 months before the index visit to 12 months afterward. We included only beneficiaries who had not had an opioid prescription filled in the 6 months before the index visit. In addition, we excluded beneficiaries with hospice claims or a cancer diagnosis between 2008 and 2012.

 We assigned each index emergency department visit to a physician according to the billing National Provider Identifier (NPI) and then linked each visit to a hospital by matching to facility claims in the outpatient department file according to the date and beneficiary. To ensure that we had an adequate sample size at the physician and hospital level, we excluded physicians with fewer than five emergency department visits and hospitals with fewer than five physicians billing for emergency department visits in our sample. If physicians practiced in more than one hospital, they were assigned to the hospital at which they had the most visits, and any visits at other facilities were excluded.

 This study was approved by the institutional review board at Harvard Medical School, which waived the requirement for informed consent since the data were deidentified and only aggregate results would be reported.

 Definitions of Opioid Prescriptions and Intensity of Physicians’ Prescribing

 We identified prescription claims corresponding to an opioid (excluding methadone) according to the National Drug Code in the Medicare Part D database.16 We attributed an opioid prescription to an index emergency department visit and the associated physician if it was filled by the patient within 7 days after the date of the emergency department visit; in a sensitivity analysis, we restricted this duration to 3 days. This attribution method was necessary because prescriber NPI information is not available in the Part D database (see the Methods and Results section in the Supplementary Appendix, available with the full text of this article at NEJM.org). For this and subsequent opioid prescriptions, we extracted the number of days for which opiates were supplied and calculated the morphine equivalents dispensed, using standard conversion tables.21

 We defined the main exposure as treatment by a “high-intensity” or “low-intensity” opioid prescribing physician within the same hospital. For each physician, we first calculated the proportion of all emergency department visits after which an opioid prescription was filled. We then grouped physicians into quartiles of rates of opioid prescribing within each hospital and classified physicians as being in the top (high-intensity) or bottom (low-intensity) quartile of prescribing rates. In 93 hospitals, because of a high number of prescribers who did not prescribe opioids, there were fewer than four separate groups of prescribers to assign to quartiles; therefore, the highest and lowest prescribers in a hospital were assigned to the high-intensity and low-intensity groups. We also defined an alternative exposure, classifying physicians according to the median dose (in morphine equivalents) of prescriptions filled after an emergency department visit (“high-dose intensity” and “low-dose intensity”).

 Outcomes

 Our primary outcome was long-term opioid use, which we defined as 180 days or more of opioids supplied in the 12 months after an index emergency department visit, excluding prescriptions within 30 days after the index visit. We applied this exclusion because otherwise this outcome, by design, would be correlated with our definition of the main exposure. We chose 180 days as a specific marker for clinically significant long-term opioid use beyond the common duration of 90 days described in previous literature.16,22,23 Therefore, this outcome captures the extent to which other physicians prescribe opioids for the subsequent 12 months after a patient’s index emergency department visit.

 Secondary outcomes were rates of hospital encounters (emergency department visits, hospitalizations, or both), including those potentially related to adverse effects of opioids and those associated with a selection of medical conditions that were unlikely to be influenced by opioid use, in the 12 months after an index emergency department visit (definitions are provided in the Methods and Results section in the Supplementary Appendix).8-10,24 To assess for possible undertreatment of pain by low-intensity prescribers that could have led to repeat emergency care, we also measured rates of repeat emergency department visits at 14 and 30 days that resulted in the same primary diagnosis as the initial emergency department visit, classified according to Clinical Classifications Software (CCS) groups (categorizations of codes in the International Classification of Diseases, 9th Revision).25

 Patient Covariates

 Table 1. Table 1. Characteristics of the Patients, According to Opioid Prescribing Intensity of Physician Seen.

 We collected information on the patients’ age, sex, race or ethnic group, dual eligibility for Medicaid and Medicare coverage, and disability status.26 Using the Chronic Conditions Warehouse database, we also captured the presence of any of 11 chronic conditions (Table 1) as well as the number of coexisting chronic conditions that a patient had at the time of an index emergency department visit.

 Statistical Analysis

 Our strategy to reduce selection bias relied on the assumption that within the same hospital, patients do not choose specific emergency physicians, and therefore patients treated by physicians of varying opioid prescribing intensity may be similar with respect to both observable and unobservable characteristics. To assess this approach, we compared the characteristics of patients who saw high-intensity prescribers with those who saw low-intensity prescribers. We assessed balance in the case mix by comparing rates of visits classified according to the top 25 CCS groups, as well as by plotting the cumulative distribution of the primary-diagnosis CCS group between high-intensity and low-intensity prescribers. Differences in distributions between groups were assessed with the use of the Kolmogorov–Smirnov test.27

 Table 2. Table 2. Rate of Filling a Prescription for Opioids within 7 Days after Emergency Department Visit and Rate of Long-Term Use, According to Opioid Prescribing Intensity of Physician Seen.

 We then computed unadjusted rates and odds ratios for each outcome, stratified according to treatment by a high-intensity or low-intensity opioid prescriber. To account for residual differences between patient populations, we estimated adjusted odds ratios with patient-level multivariable logistic regression. Dependent variables were the occurrence of primary or secondary outcomes. The key explanatory variable was a binary indicator for whether a patient was treated by a high-intensity or low-intensity prescriber (the middle two quartiles of prescribers were not included in these models). Other covariates included the patients’ age, sex, race or ethnic group, Medicaid eligibility, and disability status, as well as the presence of 11 different chronic conditions. We prespecified several subgroup analyses to assess for heterogeneity (Table 2). All models accounted for grouping of patients within hospitals with the use of robust standard errors clustered at the hospital level.28

 The hypothetical long-term effect of filling an initial opioid prescription after an emergency department visit versus not filling a prescription was estimated to approximate the number of patients who would need to be prescribed an initial opioid for one patient to become a long-term user. A definition of “number needed to harm” is provided in the Methods section in the Supplementary Appendix.29

 We performed additional sensitivity analyses to address the possibility of selection bias and sensitivity to design assumptions (details are provided in the Methods section in the Supplementary Appendix). These analyses included an alternative exposure in which intensity was defined according to the median dose of opioid prescription filled after an emergency department visit, as described above. Replicating our results with an alternative definition of exposure that operates through a similar causal pathway (increased opioid exposure) could argue against selection bias, particularly if the two exposures (dose and frequency of opioid prescribing) are minimally correlated.

 All analyses were performed with the use of Stata software, version 14.1 (StataCorp). The 95% confidence intervals around reported estimates reflect 0.025 in each tail, or P values no higher than 0.05. ||||| Some emergency room doctors are far more likely than others even within their own department to prescribe opioids to treat pain in older people, and their patients are at greater risk of using the powerful drugs chronically than those who saw doctors who prescribe them less frequently, according to a large new study.

 The research was published Wednesday in The New England Journal of Medicine.

 As the opioid epidemic continues to devastate communities around the country, the study was the latest attempt to identify a starting point on the path to excessive use.

 “This is the analysis we have been looking for to show the risk of a single exposure of a patient in an emergency room to an opioid,” said Dr. Lewis S. Nelson, the chairman of emergency medicine at Rutgers New Jersey Medical School and University Hospital, who was not involved in the study.

 The study tracked about 375,000 Medicare patients with a similar range of complaints in several thousand hospital emergency rooms from 2008 to 2011, as well as the frequency of opioid prescriptions written by the doctors who treated them. It found that the prescribing patterns of whichever physician they encountered were an important factor in their future opioid use. |||||

– Scientists trying to better understand the nation's rising opioid addictions have uncovered an interesting wrinkle: A patient's risk of getting hooked might depend on which ER doctor they happen to get. In a New England Journal of Medicine study, researchers found that patients whose ER doctors are more likely to prescribe opioids are more likely to develop an addiction compared to the patients of ER doctors who prescribe less frequently. It may sound like an obvious chain of events, but it remains unclear why two patients given the same opioid prescription after similar complaints have different addiction risks depending on their ER doc. The takeaway is "not that high-intensity prescribers are necessarily irresponsible in prescribing opioids to certain patients," the lead author tells the New York Times. But "their patients have worse outcomes that we weren’t aware of before." After tracking 375,000 Medicare patients in ERs between 2008 and 2011, researchers found that one in every 48 patients prescribed opioids ends up using them long-term, or more than half a year. But when comparing "high-intensity" prescribing docs (who gave opioids to one in four patients) to "low-intensity" prescribers (one in 14), patients of the first group had a 30% greater risk of turning into long-time users. It may be a simple numbers game, as observed in a post at Pacific Standard: "The more prescriptions doctors give out, the more likely they'll end up handing a script to someone who will have a serious problem later." But one doctor sees a larger issue: Among ER doctors, there's no consensus "about when to prescribe opioids and what dose to give." (This is how long it takes to become dependent.)