Thursday, November 29, 2012

Worth Reading: On Parenting, TV, and Learning

I?ve written before about my recent experience in a parenting class based on Positive Discipline (rather than authoritative or permissive parenting). Apparently, this approach is really beneficial for kids with special needs. To read more, go to Parenting Style Has Big Impact on Kids with Disabilities.

And have I ever mentioned here how much I love David Simon?s HBO series The Wire and Treme (set in New Orleans)? Well, I found out why when I read Wired Magazine?s interview with Simon and he explained that he writes his shows for people who like to read stories in books (which is to say, stories that take 300-pages to relate rather than 40 minutes of TV). ?The interview is worth reading in its entirety for Simon?s thoughts on the significance of cities and the importance of telling stories over time.

I was also intrigued by NPR?s recent story about how kids learn in the east and in the west. Over here, we tend to think intelligence falls into our heads. Over there, they tend to think you work hard at it. Over here, we tend to value creativity. Over there, they score higher on science exams. We all have something to learn from one another.

And one more: Loving a Child on the Fringe, a wise (and critical) reflection on Andrew Solomon?s Far from the Tree by the mother of a child with Down syndrome. To leave you with one quote:

?The joy Eurydice takes in each detail of life is the most infectious quality I?ve ever known. When she flings her arms around my neck as she does every day, every night, my most recurrent fear is no longer relapsing cancer, no longer early dementia or heart disease or hearing loss?or even the fact that Eurydice is growing up too slowly. It is a testament to how radically this child has transformed me that my most recurrent fear may be that she?s growing up too fast?that one day she could be too mature to give me those massive, resplendent, full-body hugs.

Source: http://www.patheos.com/blogs/thinplaces/2012/11/worth-reading-on-parenting-tv-and-learning/

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Sixt Establishes Franchise Network in the USA

  • Two-pronged expansion strategy consisting of own rental stations and franchise partners
  • Important strategic step in international expansion plans
  • Intense interest from potential partners

Munich/Fort Lauderdale, 19 November 2012 ? Germany?s biggest car rental company Sixt has started implementing its plans to create a franchise network in the USA. The company will not only continue expanding Sixt?s own system of rental stations, but it now wants to acquire franchise partners in different states step by step so it can increase the pace of expansion in the car rental market in the USA, and reinforce the positioning of the Sixt brand. This step is part of its international expansion strategy, currently the focus of much of the company?s activities.

Over 100 potential franchisees have already contacted Sixt in the USA. They come from almost every state in the country with a clear geographical focus on economically important areas and prime tourist destinations. It?s possible that the first independent car rental companies with their own car fleets and with services which attain the requisite levels could start as Sixt franchisees before the end of this year.

Erich Sixt, CEO of Sixt AG: ?For many years now, cooperating with local franchise partners has been a cornerstone in our expansion overseas. Establishing a franchise network in the hugely important US market plays a key role in these plans. Due to our successful progress in the USA and the tremendous interest shown by potential franchisees we are able to start pursuing this strategic objective only one year after making our debut in the US market. Sixt has quickly made a name for itself in the USA.?

Craig A. Olson, Vice President Sixt Franchise USA: ?Independent car rental companies and growth-minded local entrepreneurs now have a unique opportunity to join the internationally successful Sixt Franchise system early in our drive to expand in the USA. By working with Sixt, they will be able to grow quickly as our company makes progress.?

Sixt started expanding in the USA in the spring of 2011 when it opened its first rental office in Florida. The company now has five rental offices throughout the state: they are located in Miami (2), Fort Lauderdale, West Palm Beach and Orlando. During the course of 2012, Sixt has established further important bases for its business in Atlanta (Georgia) and Phoenix (Arizona), both of which are key transport hubs in the USA.

Customers can book vehicles from Sixt?s US stations online at www.sixt.de or by calling the rental hotline at 01805 / 25 25 25. In the USA, Sixt can be contacted at www.sixt.com, via the company hotline at 001/ 888 /7498227 or using the Sixt smartphone app.

About Sixt

Sixt AG, with its registered office in Pullach near Munich, is an international provider of integrated mobility services. Founded in 1912, the company, together with its franchisees and partners, is represented in more than 100 countries. Sixt is the market leader for car rentals in Germany and Austria and one of the biggest OEM-manufacturer-independent full-service leasing providers. The Sixt Group generated a turnover of ? 1.56 billion in 2011 and employs around 3,000 people worldwide (excluding franchisees).

www.sixt.de

SOURCE Sixt

Contact:

Sixt AG
Frank Elsner / Frank Paschen / Nicole Huss
Sixt Central Press Office
Tel.: +49 ? 5404 ? 91 92 0
Fax: +49 ? 5404 ? 91 92 29
Mail: pressrelations@sixt.com

###

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Source: http://www.franchising.com/news/20121129_sixt_establishes_franchise_network_in_the_usa.html

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Ignoring the Science on Mammograms - NYTimes.com

Last week The New England Journal of Medicine published a study with the potential to change both medical practice and public consciousness about mammograms.

Published on Thanksgiving Day, the research examined more than 30 years of United States health statistics to determine, through observation, if screening mammography has reduced breast cancer deaths. The researchers found that, as expected, the introduction of mammogram screening led to an increase in the number of breast cancers detected at an early stage.

But importantly, the number of cancers diagnosed at the advanced stage was essentially unchanged. If mammograms were really finding deadly cancers sooner (as suggested by the rise in early detection), then cases of advanced cancer should have been reduced in kind. But that didn?t happen. In other words, the researchers concluded, mammograms didn?t work.

This is a bold claim for an observational study. There are countless reasons why conclusions from such studies are commonly fraught with error. What if, for instance, the lion?s share of advanced cancers occurred among women without access to screening mammograms?a fact often not available in health statistics? Or what if mammography successfully prevented a major increase in advanced cancers, leaving the health statistics unchanged?

Hippocrates, the father of medicine, called experience ?delusive.? He recognized that uncontrolled observations may lead to faulty conclusions. For centuries the flawed logic of observational data seemed to validate bloodletting, an unhelpful and often harmful therapy. But most who were bled eventually improved?no thanks to the bloodletting?an observation that led medical authorities to believe in the practice.

Fortunately, we have learned something about bad logic. Today we seek studies designed to neutralize illusions. By enrolling people in a study and assigning them randomly to treatments, for instance, groups tend to be evenly balanced in every way except one: the treatment. Controlled studies led to the discovery that bloodletting is harmful rather than helpful, and randomized trials of screening mammography would therefore be a worthy gold standard to answer once and for all the question of whether the test saves lives.

It may be surprising, therefore, to learn that numerous trials of mammography have indeed randomly assigned nearly 600,000 women to undergo either regular mammography screening or no screening. The results of more than a decade of follow-up on such studies, published more than 10 years ago, show that women in the mammogram group were just as likely to die as women in the no-mammogram group. The women having mammograms were, however, more likely to be treated for cancer and have surgeries like a mastectomy. (Some of the studies include trials from Norway, the Netherlands, Sweden, and this major review of the data.)

In other words, mammograms increased diagnoses and surgeries, but didn?t save lives?exactly what the researchers behind last week?s observational study concluded.

It is affirming to see this newest study. But it raises an awkward question: why would a major medical journal publish an observational study about the effects of screening mammography years after randomized trials have answered the question? Perhaps it is because many doctors and patients continue to ignore the science on mammograms.

For years now, doctors like myself have known that screening mammography doesn?t save lives, or else saves so few that the harms far outweigh the benefits. Neither I nor my colleagues have a crystal ball, and we are not smarter than others who have looked at this issue. We simply read the results of the many mammography trials that have been conducted over the years. But the trial results were unpopular and did not fit with a broadly accepted ideology?early detection?which has, ironically, failed (ovarian, prostate cancer) as often as it has succeeded (cervical cancer, perhaps colon cancer).

More bluntly, the trial results threatened a mammogram economy, a marketplace sustained by invasive therapies to vanquish microscopic clumps of questionable threat, and by an endless parade of procedures and pictures to investigate the falsely positive results that more than half of women endure. And inexplicably, since the publication of these trial results challenging the value of screening mammograms, hundreds of millions of public dollars have been dedicated to ensuring mammogram access, and the test has become a war cry for cancer advocacy. Why? Because experience deludes: radiologists diagnose, surgeons cut, pathologists examine, oncologists treat, and women survive.

Medical authorities, physician and patient groups, and ?experts? everywhere ignore science, and instead repeat history. Wishful conviction over scientific rigor; delusion over truth; form over substance.

It is normally troubling to see an observational study posing questions asked and answered by higher science. But in this case the research may help society to emerge from a fog that has clouded not just the approach to data on screening mammography, but also the approach to health care in the United States. In a system drowning in costs, and at enormous expense, we have systematically ignored virtually identical data challenging the effectiveness of cardiac stents, robot surgeries, prostate cancer screening, back operations, countless prescription medicines, and more.

When Thomas Jefferson described his vision for the institution that would become the University of Virginia, he said:

This place will be based on the illimitable freedom of the human mind. For here we are not afraid to follow truth, wherever it may lead.

As we begin down the arduous path of health care reform, requisite to economic success, the question for policymakers and health care authorities is this: Are we ready to stop ignoring science? If so, the road may be smoother than we imagined for there is, and has been, much truth to follow.



Dr. David Newman is an emergency room physician in New York City and author of the book, ?Hippocrates Shadow: Secrets from the House of Medicine.?

Source: http://well.blogs.nytimes.com/2012/11/28/ignoring-the-science-on-mammograms/

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It's time to fix the charitable deduction - Fortune Finance: Hedge ...

By Mina Kimes

FORTUNE -- As elected officials in Washington struggle to find common ground on the deficit, it seems inevitable that tax breaks -- which, unlike tax rates, have been targeted by both parties -- will be on the chopping block. That includes the charitable deduction, which taxpayers can claim for donations to hospitals, colleges, churches, and other nonprofits. The Joint Committee on Taxation estimated that the tax break will cost the government $246 billion between 2010 and 2014.

The threat that lawmakers might eliminate -- or even curtail -- the charitable deduction has sent non-profits into a panic. The Charitable Giving Coalition, whose members include the United Way and the American Red Cross, recently announced plans to gather in the nation's capital on December 4th for a campaign called "Protect Giving - DC Days." The Independent Sector, a trade group for nonprofits, set up a website asking people to entreat their representatives to leave the deduction alone.

"We're seeing talk that we've never seen before, which suggests that we have a real issue here," says Diana Aviv, the head of the Independent Sector. Aviv says the tax break for donors should be protected because of its unique attributes. "The charitable deduction is not the same as other deductions," she says. "It doesn't benefit the individual."

Aviv is partially correct: the charitable tax break is different from many other tax breaks in so far as it clearly contributes to the public good. But the deduction does benefit individuals -- especially those in the upper class. According to a report by the Congressional Budget Office, taxpayers who make more than $100,000 a year took in 76% of the total charitable tax subsidy in 2006, despite contributing 57% of all donations. When wealthy people give money to charity, they reap outsized rewards.

Why the current deduction is unfair

There are several reasons for this discrepancy.?First, the tax break is a deduction, which means it can only be claimed by people who itemize their tax returns. That rules out the 70% of taxpayers who don't itemize. Second, because the expenditure is structured as a deduction, people in higher tax brackets can use it to net greater savings. Say a person in the 35% tax bracket donates $1000. If he or she deducts the contribution, his or her tax bill is reduced by 35% of $1000, or $350. Meanwhile, someone with a tax rate of 20% who donates the same amount of money will only save $200. As a result, it's cheaper for wealthy people to donate money.

MORE: Wall Street isn't backing Jack Lew for Treasury

By giving the rich a bigger incentive to donate, the government is effectively granting them greater control over the country's charitable giving. The subsidy is funded by all taxpayers, but the causes favored by the wealthy do not necessarily benefit everyone. PIMCO chief Bill Gross, himself a prominent philanthropist, told the New York Timesin 2007 that he thought wealthy donors were?over-compensated for giving money to "football stadiums and concert halls."?Gross added: "I don't think the public would vote for spending tax dollars on those things."

While lower-income taxpayers give 10% of their total donations to "basic needs organizations," according to the CBO, millionaires divert just 4% to such groups, preferring to donate to the arts and education sectors.?Some of those donations are used to pay for scholarships and charitable causes that benefit society at large, but other funds go to wealthy schools in high-income areas??In those cases, the government is essentially paying the rich to donate to their own communities.

Of course, many donations do go to worthy causes, none of which deserve to be starved of funding. But there's reason to believe that the charitable sector may be overstating the threat of a reduced tax break. Take, for example, the Charitable Giving Coalition's recent letter to President Obama, who proposed a couple of years ago that taxpayer deductions be limited to a rate of 28%. The Coalition argued that "any cap or limitation on charitable deductions" would undermine giving, with "long-lasting negative consequences." The Tax Policy Center has estimated that Obama's proposal would reduce private giving by about 2%.

That figure looks even smaller when you put it in the broader context of charities' revenue. In 2010, the nonprofit sector derived just 13% of its intake from private contributions. If you exclude hospitals and higher education organizations, which make most of their money from private payments and government sources, then the proportion of funding from private contributions increases to 24%.

Because the deduction has experienced little disruption since it was created in 1917, we cannot be absolutely sure what would happen if it were eliminated or cut. But there's reason to believe the effects would be smaller than previously thought. In recent years, several economists who have studied the price elasticity of giving, which is the percentage by which donations would decrease if the cost of giving were to go up, have found that the ratio is less than -1 -- meaning that, if the price went up by 1%, the level of giving would decline by less than 1%. A 2010 report by the Congressional Research Service points out that, historically, giving has not changed very much in response to changes in tax rates.

Many wealthy taxpayers say they would continue to donate if the deduction was reduced. In response to a recent survey conducted by the Center on Philanthropy at Indiana University, 50% of high-net-worth households said that they would give the same amount of money if the tax break were completely eliminated. "People tend to forget that some of the most significant giving in the U.S. dates back hundreds of years," says Rob Reich, an associate professor of political science at Stanford. "The Rockefellers and the Carnegies created foundations in the absence of any incentive whatsoever."

How to fix it: A floor and a credit

The charitable deduction is inequitable, costly, and inefficient. And yet, it should not be abolished altogether. For one, although economists have attempted to gauge the impact that eliminating the tax break would have on giving, the outcome is still uncertain; no one really knows what would happen (and which charities would suffer the most). Meanwhile, it's possible to reform the tax break and cut the subsidy while minimizing the impact on charitable giving.

Several politicians and think tanks have suggested that the tax break could be limited through the addition of a cap. An absolute dollar cap on deductions -- an idea promoted by Mitt Romney during his presidential campaign -- has been gaining steam. Such a proposal would effectively wipe out the charitable deduction, though,?because most people who itemize would first claim a deduction for their mortgage, which would consume most, if not all, of the allotted tax break.?President Obama's proposal for a 28% deduction cap -- described earlier -- would improve the structure of the tax break without hurting giving too badly, but it wouldn't raise very much money for the government.

MORE: Fiscal cliff: A modest proposal

A floor, which would force people to donate a certain amount of money to claim a tax break (and would exempt the money below the floor from the break, lowering the subsidy), offers a more elegant solution. The only people who would?who would donate less as a result of a floor would be those who contribute small amounts;?for others, there would be no reason to reduce giving at the margin. According to the Tax Policy Center, instituting a floor of 1.7% of adjusted gross income would raise $10-11 billion in annual revenue without affecting contributions at all. The CBO estimates that a floor of 2% of income would raise $15.7 billion while cutting donations by $3 billion.

The government could save even more money by converting the deduction into a tax credit, which would allow donors to claim a flat percentage of their donations. The CBO found that, if the charitable deduction were changed into a 25% credit with a floor of 2% of income, the government would cut the total subsidy by $11.9 billion a year, while donations would shrink by a mere $1 billion. A 15% credit would raise $24.6 billion, with donations falling by an estimated $10 billion, according to the CBO.

In the long-term, the savings would be significant. The Committee for a Responsible Federal Budget has estimated that changing the deduction to a 15% credit with a 2% floor would save the government $340 billion over the next decade, reducing the subsidy by 60%. Donations, meanwhile, would only decline by 4.9%. (The Bowles-Simpson commission proposed a similar, if slightly more draconian, 12% credit with a 2% floor.)

In addition to saving the government money, replacing the deduction with a credit would also make the system more equitable. All people would be equally compensated for giving to charity, regardless of their tax bracket. A credit would also reward the 70% of Americans who don't itemize their taxes, which might spur additional donations.

MORE: Wells Fargo CEO: Why Americans are saving so much

Such changes would inevitably change the profile of giving in this country, or at least the composition of donations that are subsidized by the government. People who make under $100,000 a year currently allot 67% of their donations to religious organizations, according to the CBO. Expanding the tax break to lower-income citizens would inevitably skew the subsidy toward churches.

This is a bad result. Not because it would compel taxpayers to fund widespread religious donations -- though many people would surely oppose such a large subsidy -- but because it would be wasteful. Studies have shown that the price elasticity of giving for religious donations is relatively low, which means that people would be unlikely to cut their gifts in response to a lowered tax break. Indeed, many religious donors do not currently claim a deduction.

If the government is serious about saving money, then it should consider exempting religious donations from the charitable tax break. Most people give to churches because they want to, not because they get a tax break for their generosity.

A massive subsidy would be not only controversial, but uneconomical.

Source: http://finance.fortune.cnn.com/2012/11/27/charitable-deduction-reform/

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Wednesday, November 28, 2012

Simple measures cut infections caught in hospitals

(AP) ? Preventing surgery-linked infections is a major concern for hospitals and it turns out some simple measures can make a big difference.

A project at seven big hospitals reduced infections after colorectal surgeries by nearly one-third. It prevented an estimated 135 infections, saving almost $4 million, the Joint Commission hospital regulating group and the American College of Surgeons announced Wednesday. The two groups directed the 2 1/2-year project.

Solutions included having patients shower with special germ-fighting soap before surgery, and having surgery teams change gowns, gloves and instruments during operations to prevent spreading germs picked up during the procedures.

Some hospitals used special wound-protecting devices on surgery openings to keep intestine germs from reaching the skin.

The average rate of infections linked with colorectal operations at the seven hospitals dropped from about 16 percent of patients during a 10-month phase when hospitals started adopting changes to almost 11 percent once all the changes had been made.

Hospital stays for patients who got infections dropped from an average of 15 days to 13 days, which helped cut costs.

"The improvements translate into safer patient care," said Dr. Mark Chassin, president of the Joint Commission. "Now it's our job to spread these effective interventions to all hospitals."

Almost 2 million health care-related infections occur each year nationwide; more than 90,000 of these are fatal.

Besides wanting to keep patients healthy, hospitals have a monetary incentive to prevent these infections. Medicare cuts payments to hospitals that have lots of certain health care-related infections, and those cuts are expected to increase under the new health care law.

The project involved surgeries for cancer and other colorectal problems. Infections linked with colorectal surgery are particularly common because intestinal tract bacteria are so abundant.

To succeed at reducing infection rates requires hospitals to commit to changing habits, "to really look in the mirror and identify these things," said Dr. Clifford Ko of the American College of Surgeons.

The hospitals involved were Cedars-Sinai Medical Center in Los Angeles; Cleveland Clinic in Ohio; Mayo Clinic-Rochester Methodist Hospital in Rochester, Minn.; North Shore-Long Island Jewish Health System in Great Neck, NY; Northwestern Memorial Hospital in Chicago; OSF Saint Francis Medical Center in Peoria, Ill.; and Stanford Hospital & Clinics in Palo Alto, Calif.

___

Online:

Joint Commission: http://www.jointcommission.org

American College of Surgeons: http://www.facs.org

___

AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/386c25518f464186bf7a2ac026580ce7/Article_2012-11-28-Hospital-Linked%20Infections/id-ca38651705e14125bc76f3764d7a7fe5

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ChannelAdvisor says eBay sales up 57 percent early on Cyber Monday

A Nutritional Supplemental Task Force made up of "prosecutors in Santa Cruz, Alameda, Marin, Monterey, Napa, Orange, Solano and Sonoma" as well as Santa Clara County have sued Southern California weight loss company Sensa. The parties agreed to settle the civil suit for $900,000 NBC San Diego reports.

Source: http://news.yahoo.com/channeladvisor-says-ebay-sales-57-percent-early-cyber-181431413--sector.html

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Tuesday, November 27, 2012

Obese flier turned away by airlines dies overseas

8 hrs.

An ailing, 425-pound woman who was turned away by three airlines as she tried to return to the U.S. from Europe has died overseas, prompting legal action from her family.

Vilma Soltesz and her husband traveled to Hungary in September to spend a month in their former homeland ? a trek the Bronx residents made every year to visit family.

They flew from New York to Budapest on KLM without any problems, with Soltesz purchasing two seats for herself because of her size, said Holly Ostrov Ronai, the family?s attorney.

But when the couple tried to return to New York in October, the problems began.

?They were sent from airline to airline, they were sent driving around, they were just treated completely inhumanely,? Ronai told NBC News. ?(The airlines) had a duty to get her home to her doctors.?

Soltesz, 56, and her husband came on board their scheduled KLM flight to New York on Oct. 15 with the help of a Skylift elevator, but the captain told them to disembark because of an issue with the seatback and because the airline didn?t have a seatbelt extender, Ronai said.

KLM countered that it was not physically possible for Soltesz to board the aircraft, despite every effort made by the airline.

?A seat or belt extender did not offer a solution either,? said KLM spokeswoman Ellen van Ginkel, in a statement to NBC News.

?Subsequently, KLM and its partners Delta and Air France did its utmost to find an alternative in the two days that followed. The passenger also took the initiative herself to approach her ticket agent to look for alternatives with other airlines.?

The couple spent five hours at the airport and then drove through the night to Prague, where they were told a bigger Delta Air Lines plane could take them home the next day. But that attempt was also unsuccessful because Delta only had a plastic wheelchair that was not able to hold Soltesz's weight, Ronai said.

Delta did not respond to a request for comment, but a spokesman for the airline told The New York Post that ?despite a determined good-faith effort by Delta in Prague, we were also physically unable to board her on our aircraft.?

Finally, the couple tried to return to New York on a Lufthansa flight on Oct. 22. They boarded the plane, but the captain asked them to disembark because he thought Soltesz could not fasten herself in properly, Ronai said.

Lufthansa said the decision was unavoidable.

?Lufthansa, together with its local partners, fire brigade and technical experts at Budapest Airport tried its utmost to accommodate Mrs. Vilma Soltesz on board our flight from Budapest,? said spokeswoman Christina Semmel.

?After several, time consuming attempts it was decided that for the safety of this passenger and the over 140 fellow passengers, Lufthansa had to deny transportation of the passenger.?

Hungarian television footage of the couple after the incident showed Soltesz???an amputee who suffered from kidney disease and diabetes???with a severely distended belly. She died two days later.

Ronai, who plans to sue the three airlines involved for $6 million in federal court next week, said they violated the Air Carrier Access Act by not providing Soltesz with proper assistance or making the proper accommodations for her to be able to fly home and seek medical care from her doctors. This ultimately caused her death, Ronai said.

Under the Air Carrier Access Act, airlines may not refuse to fly people because of their disability, but they may exclude anyone from a flight ?if carrying the person would be inimical to the safety of the flight.??

?Airlines are responsible for determining whether or not they can carry passengers safely, and that includes those with disabilities. They may decline boarding if they believe they?re not able to do so,? said DOT spokesman Bill Mosley.

A carrier that excludes a person with a disability on safety grounds must provide a written explanation, but the Soltesz family never received any such document, Ronai said.

Meanwhile, the European Union, which includes Hungary, mandates that air travelers with ?reduced mobility? can't be denied boarding, unless the aircraft is physically too small or there are security concerns.

Obesity in itself is not considered a disability and it?s up to each airline to decide how to deal with large passengers, Mosley said.

There is also no specific rule that requires airlines to carry seatbelt extenders, said Les Dorr, an FAA spokesman. Planes must be equipped with an approved safety belt for each passenger, but the only way to meet the "approved" requirement for large fliers is for the airline to furnish the extenders, Dorr said.

With more than one-third of U.S. adults now obese, airlines continue to grapple with how to accommodate those fliers. Most now have policies addressing ?customers of size? ? usually asking them to buy two seats if they can?t lower their armrests or overflow into a neighbor?s seat.

Airfarewatchdog.com recently put together a guide listing each carrier?s approach and was surprised by the lack of uniformity.

Meanwhile, Soltesz?s family is grieving their loss.

?This should not have happened at all and it should never happen to anyone else, ever,? Ronai said.

Source: http://www.nbcnews.com/travel/obese-flier-turned-away-airlines-dies-overseas-1C7277987

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