TIME Transportation

Golden Gate Bridge Closing for First Time in Decades

Exploring San Francisco & The Bay Area
George Rose—Getty Images The Golden Gate Bridge at Golden Gate National Park is viewed from a nearby hiking trail on April 2, 2014, in San Francisco, California. (Photo by George Rose--Getty Images)

Longest closure in the bridge's history

San Francisco’s Golden Gate Bridge is closing down for the weekend for the bridge’s longest shutdown ever and its first closure in more than 25 years.

The bridge will be closed from midnight Friday until 4 a.m. Monday morning so workers can install a moveable median barrier to prevent head-on collisions, according to a statement on the bridge’s website. Since 1970, there have been 128 head-on collisions that have resulted in 16 deaths, the Associated Press reports.

The bridge closed briefly in 1987 to celebrate its 50th anniversary, but the 52-hour closure this weekend will be the longest in the bridge’s history.

TIME food and drink

It’s O.K. to Sell Foie Gras in California Again

Foie Gras Ban
M. Spencer Green—AP In this Aug. 9, 2006, file photo, a serving of salt-cured fresh foie gras with herbs is displayed at chef Didier Durand's Cyrano's Bistrot & Wine Bar in Chicago

Chefs and foodies rejoice

A federal judge in Los Angeles on Wednesday overturned a state law banning the sale of foie gras in California, ending a two-year-long ban on the luxury food that had placated animal-rights groups but upset the state’s high-end restaurants and gourmands, the Los Angeles Times reports.

“It feels a little like December of 1933,” said chef Michael Cimarusti on Twitter, comparing the end of the ban to the time when alcohol became legal again in the U.S. after the Prohibition era.

Animal-rights groups, who had supported a ban on a product made by force-feeding ducks and geese and harvesting their abnormally fattened livers, vowed on Wednesday to protest outside any restaurants who reinstate foie gras on their menus — and there are plenty planning to do just that. One chef told the New York Times: “I’m just very excited to have some culinary freedom back.”

U.S. District Judge Stephen V. Wilson ruled that the ban unconstitutionally interfered with federal law regulating poultry products. Animal-rights groups said Wednesday they would ask the California attorney general to seek an appeal.

[Los Angles Times]

TIME Transportation

California Breaks Ground for $68 Billion Bullet Train

California Governor Jerry Brown Calls For Adding $2.8 Billion To Reserve Fund
Ken James—Bloomberg/Getty Images Jerry Brown, governor of California, speaks at the State Capitol in Sacramento, Ca., Jan. 5, 2015.

Political feuds, funding shortages and legal hurdles notwithstanding

California Governor Jerry Brown will hold a groundbreaking ceremony for the first stretch of a high-speed railway between San Francisco and Los Angeles this Tuesday, marking a symbolic victory for a project that still faces significant political opposition and funding shortfalls.

Tuesday’s groundbreaking ceremony in Fresno will kick off construction on the first 29-mile segment of the rail system, the Los Angeles Times reports. The project’s backers, primarily Democratic lawmakers, secured a number of legislative victories that cleared away legal challenges to land acquisitions and shored up additional funds for the $68 billion project.

Still, the project remains at least 50% short of the funds required to complete the railway by 2028, the L.A. Times reports, and continues to face staunch opposition from Republican lawmakers who criticize it as a fiscal boondoggle.

Read more at LA Times.

TIME Drugs

Meth Seizures at U.S.-Mexico Border Set New Records

President Obama to Announce Executive Action on Undocumented Immigration Issue
Sandy Huffaker—Getty Images A car drives along the U.S. - Mexico border wall in Calexico, Calif. on Nov. 19, 2014.

Figures show a 300% increase in methamphetamine seizures at California ports of entry from fiscal years 2009 to 2014

Methamphetamine seizures along the California-Mexico border soared to new highs in the fiscal year 2014, as narcotics smuggling cartels sought to benefit from the cost advantages of producing the drug south of the frontier.

The San Diego field office of U.S. Customs and Border Protection seized 14,732 pounds of methamphetamine during the fiscal year ending Sept. 30, The San Diego Union-Tribune reports. That accounts for 63% of all seizures of the drug at U.S. ports of entry nationwide.

Authorities have found the drug strapped to pedestrians or hidden in food cans, as well as in liquid form, passed off as windshield washer fluid.

Read more at The San Diego Union-Tribune

TIME California

Surfer Bitten By Shark in California

It's possible the shark was a great white

A man was recovering in hospital on Monday after he was attacked by an eight to 10-foot long young shark while surfing in Sand Spit Beach in Montana De Oro State Park in California.

The man, who remains unidentified, was attacked around 11:30 a.m on Sunday and bitten on his right hip. The size and appearance of the bite marks on the surf board, are indicative of a young great white shark, the Los Angeles Times reports.

Friends of the surfer say the shark appeared to swim up from depth and attack the board and then dragged the surfer under water. The man was able to paddle himself to shore with the help of friends who called 911.

Officials say the man is expected to survive the attack.

[Los Angeles Times]

TIME health

Changing the Face of Medical Education in the U.S.

surgeons-working
Getty Images

Zocalo Public Square is a not-for-profit Ideas Exchange that blends live events and humanities journalism.

We have a focus on wellness, prevention, chronic disease management, and finding ways to deliver health care in the most cost-effective setting

The United States spends more money on health care than any other country in the world. So how does Costa Rica outperform the United States in every measure of health of its population?

Costa Rica is healthier because its government spends more money than ours does on prevention and wellness.

In our country, we have left vast segments of the population without affordable care and we do not focus on wellness or chronic disease management. We don’t consistently control the glucose levels in diabetics and, consequently, too many go blind or lose a limb. Too often, hypertension goes untreated until the patient has a stroke or kidney disease. Then, all too often, these individuals go on medical disability with far more societal expense than the cost of the original health management.

Sadly, it has become the American way to leave many chronic diseases untreated until they become emergency situations at exorbitant cost to the U.S. healthcare system. For many patients, this care is too late to prevent life-changing disabilities and an early death.

When people ask me why we started the UC Riverside School of Medicine last year – the first new public medical school on the West Coast in more than four decades – I talk about the need for well-trained doctors here in inland Southern California. But we also wanted to demonstrate that a health care system that rewards keeping people healthy is better than one which rewards not treating people until they become terribly ill.

As we build this school, we have a focus on wellness, prevention, chronic disease management, and finding ways to deliver health care in the most cost-effective setting, which is what American health care needs.

We also teach a team approach to medicine—another necessary direction for our health care system. If you have a relatively minor problem, your doctor might refer you to a nurse practitioner or physician assistant for follow-up. This kind of team care makes financial and clinical sense, particularly since we have such a national shortage of primary care doctors. The good news: Even among physicians, the team approach, or medical home model, is gaining ground, with the Affordable Care Act accelerating change.

For all the talk about the lack of health insurance in this country, we don’t often discuss the other side of the problem – the fact that many Americans get more care than they need. You may have heard advertisements that you should have your wife or mother get a total body scan for Mother’s Day, because it will find cancer or heart disease. There is no evidence that this screening is a good idea. But in the U.S., we often encourage people to do things that have no proven benefit, and our churches or community centers sponsor these activities.

For all these reasons, we must shift the focus of health care to prevention. Two of the most profitable prescription drugs in the U.S., according to some sources, are those that reduce blood cholesterol and prevent blood clots—both symptoms of coronary heart disease, a largely preventable condition. Shouldn’t we be spending at least as much on prevention as we do on prescriptions? Closely connected to prevention is wellness. So many of our health problems in the United States are self-inflicted, because we smoke, eat too much, and don’t exercise. Doctors need to “prescribe” effective smoking cessation programs, proper diets and exercise as an integral part of care.

One way to accomplish this shift is to teach it to future doctors. At UC Riverside, we are supplementing the traditional medical school curriculum with training in the delivery of preventive care and in outpatient settings. Our approach is three-pronged..

First, we work with local schools and students to increase access to medical school through programs that stimulate an interest in medicine and help disadvantaged students become competitive applicants for admission to medical school or other professional health education programs. These activities start with students at even younger than middle school age, because that is when students begin to formulate ideas about what they want to be when they grow up. We focus on students from Inland Southern California because students who live here now will be among those best equipped to provide medical care to our increasingly diverse patient population. Doctors who share their patients’ cultural and economic backgrounds are better at influencing their health behaviors.

Second, we recruit our medical students specifically with a focus on increasing the number of physicians in Inland Southern California in primary care and short-supply specialties. Our region has just 40 primary care physicians per 100,000 people—far below the 60 to 80 recommended—and a shortage in nearly every kind of medical specialty. Students who have been heavily involved in service such as the Peace Corps, or who are engaged in community-based causes, are more likely to go into primary care specialties and practice in their hometowns.

Then, we teach our medical students an innovative curriculum. For instance, the Longitudinal Ambulatory Care Experience, called LACE for short, replaces the traditional “shadowing” preceptorship, where students follow around different physicians. Instead, our students participate in an a three-year continuity-of-care primary care experience that includes a sustained mentor-mentee relationship with a single community-based primary care physician. In this experience, they “follow” a panel of patients and gain an in-depth understanding of the importance of primary care, prevention and wellness. Our approach also includes community-based research that grounds medical students in public health issues such as the social determinants of health, smoking cessation, early identification of pre-diabetic patients, weight loss management and the use of mammograms to detect breast cancer.

We try to remove the powerful financial incentive for medical students to choose the highest paying specialties in order to pay off educational loans. We do this with “mission” scholarships that cover tuition in all four years of our medical school. This type of scholarship provides an incentive for students to go into primary care and the shortest-supply specialties and to remain in Inland Southern California for at least five years following medical school education and residency training. If the recipients practice outside of the region or go into another field of practice before the end of those five years, the scholarships become repayable loans.

Third, we are creating new residency training opportunities in our region to capitalize on the strong propensity for physicians to practice in the geographic location where they finish their post-M.D. training. Responding to our region’s most critical shortages, we are concentrating the programs on primary care specialties like family medicine, general internal medicine, and general pediatrics, as well as the short-supply specialties of general surgery, psychiatry, and OB/GYN. We are also developing a loan-repayment program for residents linked to practice in our region.

Ultimately, we hope our ideas for how to change health care will succeed and be adopted by others. It might take 30 years, but we believe what we are doing at the UC Riverside School of Medicine will change the face of medical education in the U.S.

G. Richard Olds is vice chancellor of health affairs and the founding dean of the UC Riverside School of Medicine. He wrote this for Zocalo Public Square. Zocalo Public Square is a not-for-profit Ideas Exchange that blends live events and humanities journalism.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME portfolio

Matt Black Is TIME’s Pick for Instagram Photographer of the Year 2014

The Californian photographer has spent the last year putting poverty on the map using Instagram

For many of his Instagram followers, Matt Black is a newcomer. He joined the photo-sharing app in December of 2013 to chart, through a series of gritty and deeply personal black-and-white photographs, the physical terrain of economic inequality in his native Central Valley of California, home to three of the five poorest metropolitan areas in the U.S.

“The Central Valley is this kind of vast unknown zone,” Black says. “These towns, these communities are right in the heart of the richest state in the richest country in the world. It’s halfway between Hollywood and Silicon Valley, and yet, you still have conditions like these,” where poor communities are left with bad roads, dirty water, crummy schools and polluted air.

Black’s work might be new to Instagram, but the 44-year-old photographer has spent more than 20 years exploring issues of migration, farming and the environment in the area. That was never his intention, though. “When I first started in photography, my goal was to get out of the Central Valley,” he says. “But it quickly became clear to me that if I had a significant thing to say, it would be about the place I’m from.”

Over 100 years, migration, farm labor and poverty have shaped the region, he says. “These are the places that actually produce what feeds the nation, and the irony is that we’re so dependent on these communities for food and yet rarely do people take time to actually look at them and understand what the challenges are, what these folks are facing — what their lives are like.”

Black’s Geography of Poverty project is designed to address these issues. “People should care because we’re all implicated in this system,” he says. “What we pay at the supermarket is what eventually goes to the farms and goes to the farm laborers. We’re all connected. So, [if] I can lift that veil and make that connection between what we eat, the choices we make, and how that impacts real people — communities — that’s the role I can play.”

The best way to do so, Black explains, was by using the unlikeliest of platforms for a photographer who developed his visual identity at a regional newspaper where black-and-white fiber paper prints were the norm.

There’s no doubt that Black is an unconventional choice for Instagram Photographer of the Year. For one thing, he doesn’t always uses an iPhone to shoot the images he posts on his feed – “It’s a mixture of iPhone and a Sony RX 100 camera,” he says, “but it seems like the convention is: if you’re upfront about it, then you’re not cheating, so I’ve been upfront about it.” Second, he’s not a prolific user. In the year since he joined the photo-sharing network, he’s posted 73 images – an average of one photograph every five days. That’s because he doesn’t look at Instagram as a daily journal. “I want each image to contribute and advance this portrait that I’m building, and if I feel like the images that I shot don’t meet that standard, then I don’t publish that day. I’ll wait until the next time.”

For him, Instagram’s appeal resides in its mapping feature – which allows photographers to add geographic coordinates to their images. “Maps are fantastic,” says Black. “They [offer] a complementary augmentation of reality. Photography and maps are similar: they’re born out of the same idea of describing a place for another person to engage with. And, they are right there, together, on that same platform. Without this map, I would not be on Instagram.”

The mapping feature might have attracted Black to Instagram, but the newfound freedom and sense of community is what kept him on the photo-sharing app. “I started Geography of Poverty with 20 followers. I had no clue if people would even understand what this was, and [I didn’t know] whether or not people would want to engage with me over these issues.”

To his surprise, Black found that Instagram users valued substance, engaging with the photographer and his work. “That’s reflected in the comments,” he says. “It’s interesting because in my other work, which are long-term photo essays, I’d spend one or two years trying to tell a story, and people wouldn’t have an opportunity to respond. It was top-down. On Instagram, it’s an unfolding, ongoing narrative, and people engage with that in a new way. It’s something they choose to receive. People take it in. People receive the work in a more intimate way. It’s right there, close to them. You don’t get that same reaction from a gallery show or from a book.”

This, he adds, offers “a fantastic opportunity for photographers to have an independent voice. There are hundreds of millions of people on Instagram wanting to engage with photography. If you’re a photographer working on these issues for so long, how can you not want to reach those people?”

Matt Black is a freelance photographer based in California. Follow him on Instagram @mattblack_blackmatt. In 2013, David Guttenfelder was TIME’s Instagram Photographer of the Year.

Phil Bicker, who edited this photo essay, is a Senior Photo Editor at TIME.

Olivier Laurent is the editor of TIME LightBox. Follow him on Twitter and Instagram @olivierclaurent

TIME motherhood

YouTube CEO: America Needs Paid Maternity Leave

Vanity Fair New Establishment Summit - Day 2
Kimberly White—Getty Images for Vanity Fair Youtube CEO Susan Wojcicki speak onstage during "Who Owns Your Screen?" at the Vanity Fair New Establishment Summit on October 9, 2014 in San Francisco, California. (Kimberly White--Getty Images for Vanity Fair)

It's not just good for women, it's good for business

YouTube CEO Susan Wojcicki wrote an op-ed in the Wall Street Journal Wednesday reminding everyone that paid maternity leave isn’t just good for women, it’s good for business.

She cited a 2011 survey from California’s Center for Economic and Policy Research that found that, after California implemented paid leave, 91% of businesses said the policy had either a positive effect on profitability, or no effect at all. Wojcicki, who was the first Google employee to go on maternity leave and now runs YouTube, which is owned by Google, says she’s seen this firsthand:

That last point is one we’ve seen at Google. When we increased paid maternity leave to 18 from 12 weeks in 2007, the rate at which new moms left Google fell by 50%. (We also increased paternity leave to 12 weeks from seven, as we know that also has a positive effect on families and our business.) Mothers were able to take the time they needed to bond with their babies and return to their jobs feeling confident and ready. And it’s much better for Google’s bottom line—to avoid costly turnover, and to retain the valued expertise, skills and perspective of our employees who are mothers.

Best of all, mothers come back to the workforce with new insights. I know from experience that being a mother gave me a broader sense of purpose, more compassion and a better ability to prioritize and get things done efficiently. It also helped me understand the specific needs and concerns of mothers, who make most household spending decisions and control more than $2 trillion of purchasing power in the U.S.

As Wojcicki notes, paid maternity leave can reduce risk of post-partum depression, keep babies healthy, and encourage mothers to stay in the workplace, yet only 12% of private workers and 5% of low-income workers in the U.S. have access to these benefits. Every other developed nation in the world has government-mandated paid maternity leave, and when the UN‘s International Labor Organization surveyed the maternity leave policies of 185 nations, the U.S. was one of two countries that don’t guarantee paid maternity leave. Papua New Guinea is the other.

She wants America to get cracking on paid maternity leave, stat.

[WSJ]

TIME health

How Obamacare Has Changed My Hospital

stethoscope
Getty Images

So far in 2014, we have brought almost 7,500 new patients into primary care facilitating better preventative health and chronic disease management

The holidays are a convenient time to take stock of our blessings and opportunities, and to consider the challenges we have overcome in the previous year. As I reflect back, I have many things to be thankful for: good health, a supportive, healthy family, colleagues I enjoy and respect, and a job that I love.

This year, the Affordable Care Act (ACA) had a profound and rapid change on my professional life as a physician who works in an institution that forms part of California’s safety net for those in need. I’m the chief medical officer for San Mateo Medical Center, the county hospital and affiliated clinics in San Mateo County. I also provide primary care in one of our outpatient clinics.

As a result of the ACA, many patients we serve in our county became newly eligible for Medi-Cal, California’s Medicaid program. With this transition, they were offered far more choices: They had access to services that were previously unavailable, such as dental services and expanded mental health services. And, instead of having to travel to our specialty clinic in the middle of the county, they could be referred to “private” specialists in their own communities. Far from luxuries, these new choices will help promote preventative care and early disease intervention; patients who in the past might have delayed a gallbladder or hernia surgery (and ended up in the emergency department with pain) can get prompt treatment with their new Medi-Cal coverage.

Before the ACA, most of our patients were either uninsured or were enrolled in a county program that only covered services at our institution; they could not seek care elsewhere. So more choice for patients means more pressure on us; as patients become eligible for Medi-Cal, they may now choose to leave our organization to seek care elsewhere. I will try to avoid clichés as I write this, but there is one that is especially appropriate here: “pressure makes diamonds.” I am seeing a spectacular gem being built around me here in San Mateo, far from flawless but beautiful nonetheless.

Competition has forced us to confront some difficult questions, such as: What is the role of the safety net in this new era when many more people are insured? Why should we, as an institution, continue to exist? Thankfully the answers to these questions came fairly easily.

As an integrated health system, we offer a range of services from outpatient to emergency services to inpatient to long-term care; we offer a distinct advantage over the traditional fragmented health care system. Embedded in the San Mateo County Health System, we can work with our colleagues in Adult and Aging Services, Family Health Services, and Public Health to better meet all the psychosocial needs of our patients. For example, our partnership with the county’s Behavioral Health and Recovery Services has allowed us to embed behavioral health experts in our primary care clinics so that they can better address the mental health needs of our patients; this partnership also expands our ability to refer patients with drug and alcohol problems.

As our patients have moved to Medi-Cal, the ACA has brought our institution some new funding. But we realize that this will be short-lived; many of the new programs of the ACA are funded by reductions to other parts of the safety net. Such pressure is not new; safety net programs are often short of resources, forcing adjustments and redesigns. But the ACA ramps up this pressure on us to innovate, to find ways to do things cheaper and more efficiently.

Fortunately, we had a head start. We began almost a decade ago by redesigning our primary care services and establishing team based care. The county implemented an electronic health record in our clinics long before there was a mandate to do so. The ACA, through its resetting of priorities and funding mechanisms, offers us an opportunity to build on this foundation. We have repurposed some staff roles and brought in new staff members with new skill sets. For example, we have staffers who are specially trained to extract information from electronic records to better manage chronic disease, and pharmacists have been added to some primary care teams to assist with medication management.

The ACA has facilitated new partnerships with other community provider, allowing us to focus on those services that we provide well while partnering to provide services that are best delivered by others. This is a transition from the past, when we were the provider of last resort, forced to provide as much as we could and living without the services we could not provide by ourselves.

One of our biggest investments has been in what we call our Lean transformation. Lean, based on the Toyota Production System, is a proven performance improvement methodology. Lean healthcare principles focus on increasing value by constantly improving quality and reducing defects and other wastes. Within the San Mateo County Health System, this transformation is being organized through our LEAP Institute. LEAP stands for Learn, Engage, Aspire, and Perfect (as a verb). As part of LEAP, we bring together teams that include line staff to observe and analyze our core processes – and then design new improved approaches that reduce waste and improve outcomes.

There is much work ahead, but much has already been accomplished. So far in 2014, we have brought almost 7,500 new patients into primary care facilitating better preventative health and chronic disease management. The majority of these patients are newly eligible for Medi-Cal. We have also seen a reduction of more than 20 percent in the number of patients leaving our Emergency Department without being seen due to long waits. We have seen an improvement in our performance on patient satisfaction surveys in a variety of areas including the Emergency and Inpatient Departments. And our pharmacy has reduced the time patients must wait for their prescriptions by about 75 percent. These are just a few of the gains. We look forward to many more.

Dr. Chester Kunnappilly is chief medical officer for San Mateo Medical Center, the county hospital and affiliated clinics in San Mateo County. He is board certified in Internal Medicine and also serves the organization as a primary care physician. He is a graduate of Dartmouth College and the University of Pennsylvania Perelman School of Medicine. He wrote this for Zocalo Public Square. Zocalo Public Square is a not-for-profit Ideas Exchange that blends live events and humanities journalism.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Know Right Now

Know Right Now: From California’s Pineapple Express to Another Shutdown Drama

Watch this week's #KnowRightNow to catch up on all the latest stories

The House passed a $1.1 trillion spending package late Thursday to ensure that the government will avoid another damaging shutdown. “This compromise proposal merits bipartisan support on Capitol Hill and hopefully will arrive on the President’s desk in the next few days, and if it does, he will sign it,” stated White House Press Secretary Josh Earnest.

A tropical storm called the Pineapple Express pummeled the Pacific Northwest on Thursday. In drought-stricken California, flooding and mudslides prompted rare school closures in the north of the state. Powerful winds knocked out power to more than 150,000 homes in Washington.

Gas prices hit a 4-year low this week, with the average price of gas in the United States sinking to $2.72 per gallon. That’s the lowest gas prices have been since November 2010. Prices are dropping due to higher North American oil production and less demand. New Mexico has the lowest gas prices at $2.38 per gallon, and San Francisco has the highest gas prices at $3.04 per gallon.

And lastly, on Wednesday, TIME Magazine chose the Ebola fighters as 2014’s Person of the Year. “They risked and persisted, sacrificed, and saved,” TIME editor Nancy Gibbs wrote.

Your browser is out of date. Please update your browser at http://update.microsoft.com