June 13, 2014
Thanks to AANA Members for Being Heard on Provider Nondiscrimination
Thanks to the dozens of state associations of nurse anesthetists and hundreds of individual AANA members who took the time to make their voices heard by legislators and the Medicare agency regarding equitable recognition and coverage of CRNA services by private health plans.
For years, the AANA has worked with coalition partners to enact and implement the provider nondiscrimination law supporting fair coverage of our members’ services. In response to a Centers for Medicare & Medicaid Services (CMS) Request for Information
(RFI) seeking comments from the public on how the law should be carried out, CRNAs and state associations of nurse anesthetists submitted comments in their own words by the June 10 deadline and contacted key members of Congress to support the law’s fair implementation. The provider nondiscrimination law, enacted in 2010 and taking effect this year, prohibits health plans from discriminating against qualified licensed healthcare professionals solely on the basis of their licensure, such as CRNAs. The help of AANA members was needed to ensure that this important provision has its intended effect of promoting fair market competition that helps patients obtain the quality healthcare that they need and deserve.
See all comments publicly posted to the provider nondiscrimination RFI here
(comments usually take a few days to post).
- The FTC Comments on Missouri APRN Legislation
- AANA Recertification Summit
- Upcoming Webinar: Defining Severe Maternal Morbidity
- Urgent Need in Uganda for CRNA Volunteers
- Additional Member Discounts on AANALearn
- Friends for Life Deadline: June 15
- Fundraising Events at Annual Congress -- Talent Show and Golf Tournament: Purchase Your Tickets Today
- Meet Your Educational Needs
- Save $50. Register Today for the 2014 Nurse Anesthesia Annual Congress
- There's Still Time to Save $50 on Your Registration for the AANA Business of Anesthesia Conference
- Save the Date for the AANA's Fall Leadership Academy
- CRNAs Share Their Stories in AANA Website's New "A Day in the Life" Section
- AANA Applauds CMS for Acknowledging the Important Issue of Surgical Fires in its Fire Safety Requirements
- Senate Confirms Burwell, Supported by AANA, as U.S. Secretary of Health and Human Services
- Rural Anesthesia Bills Reintroduced in Congress, with Mixed Impacts on CRNAs
- Congress Hears from CRNA-PAC – Will CRNA-PAC Hear from You?
- FEC REQUIRED LEGAL DISCLAIMER FOR CRNA-PAC
Healthcare HeadlinesHealthcare Headlines is for informational purposes, and its content should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.
Inside the Association
The FTC Comments on Missouri APRN Legislation
On May 9, the Federal Trade Commission (FTC) provided comments on Missouri House Bills 1481 and 1491, which would amend or remove requirements for “collaborative practice arrangements” between physicians and advanced practice registered nurses (APRNs).
AANA Recertification Summit
The AANA and President Dennis Bless, CRNA, MS, would like to invite all members and interested parties to join us June 27-28 in Rosemont, Ill., to engage in dialogue about the recently finalized National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) Continued Professional Certification (CPC) Program. Registration is free, and you can attend either in person or via webinar. Click here
to learn more and register.
Upcoming Webinar: Defining Severe Maternal Morbidity
On June 19, from noon to 1 p.m. ET, the Council on Patient Safety in Women's Health Care is presenting a free webinar titled, “Defining Severe Maternal Morbidity.” The webinar will discuss a standard definition of severe maternal morbidity; how to effectively identify cases of severe maternal morbidity; and how to use the Severe Maternal Morbidity Data Abstraction and Assessment Tool for reviewing the care of women who experienced a severe complication in pregnancy. More information and the registration link can be accessed here
Urgent Need in Uganda for CRNA Volunteers
Volunteer CRNAs needed for Mbarara, Uganda, July 27-Aug. 8. Funding is provided. For details, contact Andrea Moody
at Health Volunteers Overseas. See other volunteer opportunities
on the AANA website.
Additional Member Discounts on AANALearn through July, 31, 2014
AANA’s online continuing education resource, AANALearn
, is featuring the entire Clinical Topics catalog at an additional 30 percent discount
for AANA Members now through July 31:
for more information.
Friends for Life Deadline – June 15, 2014
Friends for Life help support the future of the nurse anesthesia profession through meaningful, lasting gifts. Contributions through Friends for Life help fund and sustain programs that further research and education in anesthesia.
Friends for Life receive a medallion at the AANA Annual Congress Opening Ceremonies, an engraved plaque in the AANA Park Ridge office, and an invitation to the Annual Awards and Recognition Event.
The minimum gift commitment to join Friends for Life is $25,000. Members may fulfill this commitment through a cash gift, but there are many other ways to meet the commitment through planned gifts. Some of the most popular planned gift options for becoming a Friend for Life include:
- A gift (bequest) in the will for a specific amount or a percentage of the total estate
- Gift of personal property or real estate
- Including the Foundation as a beneficiary on a retirement plan or a whole life insurance policy
For further information, please contact Nat Carmichael at (847) 655-1175 or email@example.com
. The Friends for Life
submission deadline for recognition at this year’s Annual Congress in Orlando, Fla., is June 15, 2014.
Fundraising Events at Annual Congress – Talent Show and Golf Tournament: Purchase Your Tickets Today
Orlando – The Stars Come Out Again
This fabulous and fun event will take place on Sunday, Sept. 14, 2014, and will feature talented CRNAs and SRNAs competing for fabulous prizes. There will also be dancing, dinner, drinks, and a DJ.
Sponsorships are available and include tickets and recognition. Please visit the Orlando – The Stars Come Out Again
webpage to learn more.
17th Annual Golf Tournament at Hawk’s Landing Golf Club
Plan to tee off at 1:30 p.m. at Hawk’s Landing Golf Club, an 18-hole championship golf course conveniently located on the lush grounds of the Orlando World Center Marriott Resort where the AANA 2014 Nurse Anesthesia Annual Congress will be held. Click here
to visit the golf tournament webpage for more details including information on club rental, sponsorships, contests, and photos from past Foundation golf tournaments.
We hope to see you at these events. If you have any questions, please contact Luanne Irvin, AANA Foundation Development Officer, at (847) 655-1173 or firstname.lastname@example.org
Meet Your Educational Needs
AANA has meetings and workshops designed to meet your educational needs. Click here
to find out more.
Save $50. Register Today for the 2014 Nurse Anesthesia Annual Congress
The AANA Nurse Anesthesia Annual Congress provides attendees with comprehensive sessions on pediatrics, pharmacology, crisis management, rare complications, adverse events, and more. Join your CRNA colleagues in Orlando
as we discuss our
patients’ best outcomes through evidence-based practice and quality improvement programs
. Register today
There’s Still Time to Save $50 on Your Registration for the AANA Business of Anesthesia Conference
Join your colleagues on July 12 in Chicago
for the AANA Business of Anesthesia Conference. The AANA’s Business of Anesthesia Conference, in the heart of downtown Chicago, will provide you with the knowledge you need to effectively address may of the business challenges that face an anesthesia practice. Register today
Save the Date for the AANA’s Fall Leadership Academy
Mark your calendars for AANA’s Fall Leadership Academy. The Fall Leadership Academy will be held November 7-9 in Rosemont, Ill
. Registration opens in July.
CRNAs Share Their Stories in AANA Website’s New “A Day in the Life” Section
Do you have a story to share with your peers and those interested in joining the profession? In “A Day in the Life,” a new section of the AANA website, members can share their day-to-day routines, extraordinary cases, senior projects, transitional periods, ease of/struggle with balancing personal and professional life, and experiences advocating for the profession or shadowing/being shadowed. Visit the Day in the Life
homepage for submission guidelines and to read the inaugural entry by Steve Wooden, CRNA, DNP
AANA Applauds CMS for Acknowledging the Important Issue of Surgical Fires in its Fire Safety Requirements
In a comment letter on June 2, the AANA applauded the Centers for Medicare & Medicaid Services (CMS) for acknowledging the issue of surgical fires in its proposed rule on fire safety requirements for certain healthcare facilities.
“The AANA takes the issue of fire safety in the operating room very seriously, as approximately 550 to 600 surgical fires occur each year,” states the AANA’s letter signed by AANA President Dennis Bless, CRNA, MS. “As such, the AANA is a collaborating partner of the Food and Drug Administration’s Preventing Surgical Fires Initiative. We applaud the Centers for Medicare & Medicaid Services (CMS) for putting first the health and safety of patients and providers alike by acknowledging the important issue of surgical fires and for retaining the current requirements regarding anesthetizing locations rather than applying the lower standard in the 2012 edition of the Life Safety Code (LSC). Therefore, we request that CMS adopt its proposal to retain the current hospital, critical access hospital, and ambulatory surgical center requirements regarding smoke control in anesthetizing locations.”
Senate Confirms Burwell, Supported by AANA, as U.S. Secretary of Health and Human Services
Six weeks after the AANA expressed support for the president’s nomination
of Office of Management and Budget Director Sylvia Mathews Burwell to serve as Secretary of the U.S. Department of Health and Human Services, the U.S. Senate on a bipartisan 78-17 vote
confirmed the president’s nomination June 5. Burwell is scheduled to be sworn in and to start her new job Mon., June 9, overseeing the agency that runs several major programs critical to CRNAs, including Medicare and Medicaid, the Affordable Care Act, nurse workforce development initiatives, and the National Institutes of Health.
Rural Anesthesia Bills Reintroduced in Congress, with Mixed Impacts on CRNAs
Two perennial provisions newly reintroduced as legislation in Congress address rural anesthesia issues familiar to CRNAs—one proposing to add “on-call” CRNA services to authorized charges under the Medicare reasonable-cost pass-through program for anesthesia services in rural critical access hospitals (CAHs), and another adding anesthesiologists as eligible providers under the pass-through program.
The “Craig Thomas Rural Hospital and Provider Equity Act” (S. 2359), introduced by Sens. Al Franken (D-MN) and Pat Roberts (R-KS), includes AANA-backed language restoring “on-call” payment for CRNAs in the Medicare rural anesthesia pass-through program. The legislation compiles several policy provisions of interest to rural hospitals, including further postponement of Medicare policy requiring physician supervision of outpatient therapeutic services such as dialysis and chemotherapy. The bill has been referred to the Senate Finance Committee.
Language adding anesthesiologists as providers to the rural pass-through program is among the provisions incorporated into S. 2359, and has also been introduced as separate legislation by Reps. Lynn Jenkins (R-KS) and Emanuel Cleaver (D-MO) as the “Medicare Access to Rural Anesthesiology Act” (H.R. 4781) with the support of the American Society of Anesthesiologists. The AANA and CRNAs have expressed concerns about such legislation in that it threatens to increase healthcare costs without improving quality or access—including possibly making Medicare liable for remote “supervision” charges. The bill has been referred to the House Ways and Means Committee.
Congress Hears from CRNA-PAC – Will CRNA-PAC Hear from You?
On June 4 in Washington, five key members of Congress serving on the Appropriations, Finance, Health Education Labor and Pensions, and Veterans Affairs Committees and in the Senate leadership heard directly about CRNAs and the issues important to our profession—thanks to the contributions AANA members have made to the CRNA-PAC.
Without the voluntary contributions AANA members make to CRNA-PAC, those contacts would not have taken place. In fact, over 350 times a year, AANA Federal Government Affairs staff team members and AANA members around the country attend political events supporting CRNA-friendly legislators and the campaigns of federal lawmakers influential to CRNA reimbursement and practice, building relationships that make a difference.
With Medicare funding, veterans healthcare and nurse workforce development legislation pending in Congress and sure to affect the patients, practice, and reimbursement of CRNAs, ensuring that our voice is heard, is more important than ever before. If you are one of the 8 percent of AANA members who gave to the CRNA-PAC in 2013, or one of the thousands who have renewed in 2014, thank you! If you have not yet given, or you would like to increase your contribution this election year, the time is now—just click www.crna-pac.com
, enter your AANA member login and password, and support your profession today!
See your 2013 CRNA-PAC Annual Report
… just click here
The following is an FEC required legal notification for CRNA-PAC: Gifts to political action committees are not tax deductible. Contributions to CRNA-PAC are for political purposes. All contributions to CRNA-PAC are voluntary. You may refuse to contribute without reprisal. The guidelines are merely suggestions. You are free to contribute more or less than the guidelines suggest and the association will not favor or disadvantage you by reason of the amount contributed or the decision not to contribute. Federal law requires CRNA-PAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. Each contributor must be a US Citizen.
CRNAs - Infinity HealthCare
Infinity HealthCare is actively recruiting CRNAs to join our growing physician- and employee-owned group practice in the Milwaukee area.
Anesthesia Linked to Effects on Children's Memory
While animal research has previously demonstrated that anesthesia affects parts of the brain that deal with memory, it is uncertain whether the human experience is the same. Now, investigators reporting in Neuropsychopharmacology
offer evidence that undergoing anesthesia as an infant may hamper recollection of details or events as one ages. Their study compared the memory of 28 children between the ages of six and 11 who were administered anesthesia as babies against the memory of 28 children of the same age who were not. The findings, parallel to the results from a small study on rats, determined that early exposure to anesthesia impairs the ability to remember details later in life but does not appear to hurt a child's familiarity with objects and events or impact their IQ.
From "Anesthesia Linked to Effects on Children's Memory"
Science News (06/09/14) Yeager, Ashley
Parental Presence During Anesthesia Induction Improves Quality of Anesthesia for Children
Children experience better quality of anesthesia if a parent is present when they receive the anesthesia, new research shows. Researchers conducted a randomized controlled trial to evaluate the impact of parental presence on parent and children anxiety during the perioperative period as well as on the perceived quality of anesthesia. The study included 60 children scheduled for tonsillectomy, with half randomly allocated to have a parent present during induction of anesthesia, and the other half separated from their parents at the entrance to the operating room. The researchers found that children's anxiety scores were much lower in the group that had a parent present compared to the control group. Overall anesthesia quality was rated much higher in the group with the parent as well. In the control group, 87 percent of parents said they would have preferred to stay with their child during anesthesia. The findings were reported at this year's Euroanaesthesia meeting in Stockholm.
From "Parental Presence During Anesthesia Induction Improves Quality of Anesthesia for Children"
Pain After Surgery Differed Between the Sexes
A team of Austrian researchers found that in a study of more than 10,000 patients, there was no overall difference between men and women in terms of degree of pain experienced after surgery. However, a disparity emerged when the researchers looked at the pain reports according to type of surgery performed. Men were 27 percent more likely to report postoperative pain following a major surgery, such as a bone or vascular procedure; while women were 34 percent more likely than men to report pain after minor procedures like biopsies or diagnostic tests. Lead researcher Helmar Bornemann-Cimenti, MD, speculated that the differences could have biological origins—citing different levels of hormones and different distribution for opioid receptors—or even psychosocial ones—expectations the two sexes may have regarding how much pain they should feel after surgery, for example.
From "Pain After Surgery Differed Between the Sexes"
Daily Rx (06/02/14) Maleki, Nancy
Cost-Effectiveness Analysis of Stocking Dantrolene in Ambulatory Surgery Centers for the Treatment of Malignant Hyperthermia
Dantrolene is, at present, the only treatment for malignant hyperthermia (MH), a rare hypermetabolic syndrome of the skeletal muscle and potentially fatal complication of general anesthesia. The Malignant Hyperthermia Association of the United States recommends that 36 vials of dantrolene (20 mg per vial) remain in stock at every ambulatory surgery center (ASC). To assess the cost-effectiveness of doing so, researchers used a decision-tree model to compare treatment with dantrolene to a supportive care-only strategy. Researchers estimated that 47 MH events occur annually in U.S. ASCs and that the incremental cost-effectiveness ratio was $196,320 in 2010 dollars per life saved compared with a supportive care strategy. The researchers found that the Malignant Hyperthermia Association's recommendation for stocking dantrolene is cost-effective when compared with U.S. regulatory agencies' estimated values of statistical life.
From "Cost-Effectiveness Analysis of Stocking Dantrolene in Ambulatory Surgery Centers for the Treatment of Malignant Hyperthermia"
Anesthesiology (06/14) Vol. 120, No. 6, P. 1333 Aderibigbe, Taiwo; Lang, Barbara H.; Rosenberg, Henry; et al
Children Exposed to Secondhand Tobacco or Cooking Smoke Have Very High Rates of Pain and Complications After Tonsillectomy
Children who have been exposed to indoor coal-burning stoves or second-hand tobacco smoke are more likely to experience complications and high levels of pain after tonsillectomies, according to new research. Nearly half of the world's population uses solid fuel for heating and cooking, and the stoves may release pollutants into household air. Children are also exposed to carbon monoxide from second-hand tobacco smoke. This exposure to carbon monoxide results in carboxyhemoglobin, which may trigger postoperative complications and increase pain sensitivity. For their study, researchers looked at 100 Turkish children who were scheduled for elective tonsillectomy and divided into low and high carbon monoxide exposure groups. Forty-seven percent of children in the high-carboxyhemoglobin group experienced complications following surgery, compared to 14 percent in the low group. The researchers presented their findings at this year's Euroanaesthesia meeting in Stockholm.
From "Children Exposed to Secondhand Tobacco or Cooking Smoke Have Very High Rates of Pain and Complications After Tonsillectomy"
Science Codex (06/01/14)
Reduce Costs With Selective Pre-Op Testing
The appropriate use of preoperative testing was the focus of an interdisciplinary panel of physicians that recently convened at the New York Academy of Medicine. The session was scheduled after the American Board of Internal Medicine Foundation listed five medical services of dubious value, including preoperative testing for patients undergoing routine surgery. Panelist Deborah Korenstein, editor of ACP Smart Medicine, said: "There is strong evidence that pre-op testing does not change outcomes or surgery cancellation rates for patients undergoing minor procedures like cataract surgery," and she noted that testing can have both physical and non-physical effects, such as bleeding and false-positive results that trigger anxiety or surgical delays. Meanwhile, panelist Tomas Heimann at James J. Peters VA Medical Center in New York City said the problem is not that pre-op testing is useless, but that unneeded tests are often performed, so it is important that the tests are of clinical benefit.
From "Reduce Costs With Selective Pre-Op Testing"
Anesthesiology News (06/01/14) Vol. 40, No. 6 Bufano, Paul
Risk of Death Following Surgery Is Highest on Weekends, in the Afternoons, and February
The risk of death following surgery is highest on weekends, in the afternoons, and in February, according to new research. The findings, reported at this year's Euroanesthesia conference, were based on a retrospective analysis of more than 218,000 patients who underwent surgery between 2006 and 2011 at two hospitals in Berlin. The researchers found that surgery performed in the afternoon was linked to a 21 percent higher risk of death compared with surgery performed at other times of day, while surgery on the weekend had a 22 percent higher risk of death compared with surgery on weekdays. In addition, surgery performed in February had a 16 percent greater risk of death compared to surgery in other months. The researchers noted that several factors may have affected the outcomes, but their findings reinforce the need "to further improve patient safety."
From "Risk of Death Following Surgery Is Highest on Weekends, in the Afternoons, and February"
Surgeons Report Fewer Postoperative Blood Clots Using Risk-Based Preventive Measures
Researchers from Boston Medical Center report that two years after introducing preventative treatment based on each patient's individual clotting risk, study participants recorded an 84 percent reduction in the frequency of deep venous thromboses. The condition can cause debilitating swelling and chronic pain in the affected limb. In addition to a decline in blood clots in a deep vein, the occurrence of pulmonary emboli—or blood clots that travel to the lungs—decreased by 55 percent. The results indicate that implementation of a multi-faceted prevention program within the surgical department was able to steadily curb the frequency of these postoperative complications. The researchers used national practice guidelines and scientific evidence to develop a program that would calculate the individual risk factors for each patient. They then determined individualized prophylaxis for each patient and tested the program on all patients at the hospital undergoing general and vascular surgery. Based on the positive results, the researchers believe their approach to venous thromboembolism could serve as a model for other medical centers. The research was published in the June issue of the Journal of the American College of Surgeons.
From "Surgeons Report Fewer Postoperative Blood Clots Using Risk-Based Preventive Measures"
Medical Xpress (06/02/14)
Epidural Steroid Injection Associated With Increased Spinal Fractures
In a retrospective study published in the June 5 issue of the Journal of Bone and Joint Surgery, researchers looked at one type of treatment for back pain—lumbar epidural steroid injection (LESI)—and whether or not it had any connection to bone fragility and fractures of the spine. The findings showed that LESIs may result in increased bone fragility over time and noted that a higher number of these injections were linked to an increased risk of fragility and fracture. The authors concluded that because of this association, injection therapy should be approached cautiously as a treatment for back pain in individuals at risk of experiencing fractures related to osteoporosis—including older women, smokers, those who are underweight, and those who have had previous fractures. Lead researcher Shlomo Mandel, MD, MPH, said, "Through careful screening and monitoring steroid exposure, the risk of a fracture can be minimized." He noted that there is a place for injection therapy in treating back pain, provided it is administered safely. "In the appropriate setting, and for the right patient, LESI provides effective symptomatic relief and improved level of function," he remarked.
From "Epidural Steroid Injection Associated With Increased Spinal Fractures"
CDA Press (05/28/14) Fitcher, Wayne
Could Carbon Monoxide Protect Against Anesthesia-Induced Neuroapoptosis?
According to a report in the June issue of Anesthesia & Analgesia
, subclinical carbon monoxide (CO) inhalation may protect against developmental neurotoxicity triggered by anesthesia. Drs. Ying Cheng and Richard Levy of Children's National Medical Center wrote in their paper that low concentrations of CO were able to limit brain-cell apoptosis in immature mice following isoflurane exposure. The researchers discovered that isoflurane caused an increase in apoptosis in baby mice but also that concomitant exposure to 100 ppm of inhaled CO significantly reduced the increase in apoptosis without causing carboxyhemoglobin levels that are known to be harmful. Although a higher concentration of CO provided a greater decrease in isoflurane-induced apoptosis, it also resulted in higher carboxyhemoglobin levels. The findings could have implications for research that aims to identify ways to protect developing brains from the potential negative impacts of anesthetics. In an accompanying editorial, Dr. Vesna Jevtovic-Todorovic of University of Virginia Health System discussed the prospect of protecting the brains of infants and children during anesthesia by using a potentially lethal gas. She noted that having a full understanding of anesthetic-induced neurodegeneration has given physicians the ability to attempt to create "clinically attainable methods to protect against anesthesia-induced developmental neurotoxicity." She also wrote that while the use of carbon monoxide as a protective agent might be considered "extreme," and while the scientific evidence has some key limitations, it does address an important issue and "moves us a step closer to understanding the pathways responsible for anesthesia-induced neuroapoptosis."
From "Could Carbon Monoxide Protect Against Anesthesia-Induced Neuroapoptosis?"
NIH Announces the Launch of a Huge Database for Pain Research
The National Institutes of Health has unveiled the Interagency Pain Research Portfolio (IPRP), which will give users access to more than 1,200 projects supported across the federal government. The two-tiered database will feature basic, clinical, and translational research in the first tier; while the second tier will include studies covering 29 different areas of pain. The product of a collaborative effort by six federal agencies, including the Centers for Disease Control and Prevention and the Food and Drug Administration, the database is intended to allow the research community and public to learn more about pain research. Additionally, it will provide researchers with a single location where they can source information, identify research gaps to guide future pain studies, and/or identify potential collaborators.
From "NIH Announces the Launch of a Huge Database for Pain Research"
Medical Daily (05/27/14) Rivas, Anthony
Doctors Split on Zohydro, A Longer-Lasting Painkiller
Doctors are embroiled in a controversy regarding whether or not to prescribe the new painkiller Zohydro, a long-acting version of hydrocodone. Though some doctors welcome it because it offers long-lasting pain relief, others fret that its use will feed the growing epidemic of narcotic abuse. Zohydro contains a higher dose of hydrocodone than the widely used but short-acting formulations of hydrocodone, like Vicodin; and its capsules were not designed to make it difficult for addicts to crush or dissolve them in order to get a high. Zogenix, the maker of Zohydro, has said it is working on developing two abuse-deterrent formulations of the drug—one of which is expected to be ready for approval in 2016. Despite a recommendation against approval from a Food and Drug Administration advisory board that cited concerns about safety and the drug's potential to cause dependence, the FDA approved Zohydro in the fall of 2013. Late last year, attorneys general from 28 states petitioned the FDA to reconsider its approval; but the agency has said that it believes Zohydro's benefits outweigh the risks. The FDA required Zogenix to conduct additional studies to gauge the risks of addiction, death, and overdose associated with long-term use of the drug before approving it; and required the company to educate doctors and patients on safe storage and use of Zohydro.
From "Doctors Split on Zohydro, A Longer-Lasting Painkiller"
Wall Street Journal (05/26/14) Loftus, Peter