Tag: Supposed

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Health

Eye Drops Had been Speculated to Assist Her Imaginative and prescient. Why Did It Really feel Worse?

Eye Drops Were Supposed to Help Her Vision. Why Did It Feel Worse?

She immediately emailed Bicket informing the doctor that she would stop the medication and just take the others. Perhaps it was this drug that caused the photophobia, the dry eyes, and now the burning sensation.

“I am fine with any short-term IOP dropping experiment you choose to conduct,” Bicket wrote back. But the symptoms the patient was experiencing did not match the usual side effect profile of the medications she was taking. There is another possibility, added Bicket: Maybe it’s not a single drop, but all of them. They all contain a preservative called benzalkonium chloride (BAK). “If you don’t tolerate this,” Bicket wrote, “stopping one agent against another won’t help.”

The patient decided to stop them all, she wrote to Bicket. It was a risky move because the drops were important to keep pressure down and avoid further damage. But the pain and sensitivity to light were unbearable.

The patient had her answer three days later. Her eyes felt so much better without the drops. The gloomy feeling when she blinked was gone. Likewise the photophobia. It had to be the BAK. The patient turned to PubMed for information. There was a lot. Preservatives were essential in preventing bacteria from growing in medicine bottles that contained more than a single dose, and BAK was the most commonly used preservative in both over-the-counter and prescription eye drops.

She found that the patient’s complaints were not due to an allergy to the preservative, but to the way BAK worked. This compound kills germs by dissolving the lipid layer that forms their outer protective covering. Here’s the problem: the eyes are kept from drying out by a similar protective coat – from tears. Tears consist of a thin layer of fluid from the lacrimal gland (lacrimal gland), which in turn is covered by a layer of oil formed by the meibomian glands. BAK breaks down this outer protective lipid layer and exposes the salty liquid to the air. For many people with dry eyes, the unprotected fluid evaporates and the patient’s eyes become even drier. Eye drop users who produce enough tears are not affected, but many are not. Aging also reduces this protective layer, which puts older users of BAC-containing drugs at greater risk of eye drying. Eventually, the dryness can lead to permanent damage to the cornea, the clear outermost layer of the eye.

The patient immediately switched to single-dose bottles of the drops; these do not need any preservatives at all. With this change, her eyes began to heal. It’s been five years and she still can’t see well with her left eye, and she now has glaucoma in her right eye too. But she has figured out how to work with her vision and her glaucoma is well under control.

Bicket, now at the University of Michigan, was intrigued by the difference between real-world visual acuity and the patient’s own eyesight. Research she and her colleagues recently published shows that this can lag behind the visual acuity tested by weeks or sometimes months. The first question anyone undergoing eye surgery will ask themselves, Bicket told me, is how long it will take them to recover enough to go back to work, read, or drive. “The simple answer,” she says, “is, we just don’t know.” But Billet is working hard to find out.

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Business

Cyberpunk 2077 Was Imagined to Be the Largest Video Sport of the Yr. What Occurred?

Cyberpunk 2077 Was Supposed to Be the Biggest Video Game of the Year. What Happened?

The hype around Cyberpunk 2077 had been building for nearly a decade.

When CD Projekt Red, the Polish studio behind the video game, announced the title in 2012, it was billed as a gripping, free-flowing saga that would immerse players in a lifelike sci-fi universe. Since then, fans have been treated to impressive teaser trailers, buy-in from celebrities including Keanu Reeves, Grimes and ASAP Rocky, and headlines heralding it as the most anticipated title of the year, if not the century.

The game is set in a dystopian future where digital nomads navigate a high-stakes world of corporate espionage (with Mr. Reeves as their guide) and augment their bodies with high-tech weaponry. Players, especially those using next-generation consoles from Sony and Microsoft, were promised a revolutionary experience, with extensive character customization options and an expansive world to explore. Eight million people pre-ordered copies, sight unseen, ahead of its December release.

In July 2018, as anticipation for the game neared a crescendo across Twitter, one user tweeted at the official Cyberpunk 2077 account: “Will there be memes in the game?” The account responded: “Whole game is going to be a meme.”

The tweet was somewhat prescient — but not in the way developers had hoped.

Since the release of Cyberpunk 2077 on Dec. 10, thousands of gamers have created viral videos featuring a multitude of glitches and bugs — many hilarious — that mar the game. They include tiny trees covering the floors of buildings, tanks falling from the sky and characters standing up, inexplicably pantless, while riding motorcycles.

These videos depict a game that is virtually unplayable: rife with errors, populated by characters running on barely functional artificial intelligence, and largely incompatible with the older gaming consoles meant to support it. Fans are livid.

So many gamers demanded refunds from distributors this week that they overwhelmed Sony’s customer service representatives and even briefly took down one of its corporate sites. In response, Sony and Microsoft said they would offer full refunds to anyone who purchased Cyberpunk 2077 through their online stores; Sony even pulled the title.

Cyberpunk’s rollout is one of the most visible disasters in the history of video games — a high-profile flameout in the midst of the holiday shopping season by a studio widely considered an industry darling. It shows the pitfalls gaming studios can face when building so-called Triple-A games, titles backed by years of development and hundreds of millions of dollars.

But it is also a tale that insiders said they saw coming for months, based on CD Projekt Red’s history of game development and warning signs that Cyberpunk 2077 might not live up to its sky-high expectations.

CD Projekt Red was founded in Warsaw in the 1990s by two high school friends, Marcin Iwiński and Michał Kiciński, during a time of transformation and growth in the gaming industry. (CD-ROM discs were a novel innovation back then.) The two began importing games from the United States, and essentially repackaging and republishing them in Poland.

“By the time school was out we had both become truants, skipping classes to play games,” Mr. Iwiński said in an oral history of the studio.

Early employees who spoke to The New York Times described the company’s leaders as deft marketers, storytellers and artistic visionaries. They said that their enthusiasm for their games often ran ahead of their engineering and technical prowess. The employees spoke on condition of anonymity for fear of reprisal.

The company’s ambitions were astronomical early on, as were some of its failures. In the early aughts, CD Projekt Red made a play to develop The Witcher, a popular series of books by the Polish writer Andrzej Sapkowski, into an immersive video game franchise.

But the first Witcher game, released in 2007, was buggy and stuffed with more features than it could support. Former employees who worked on the game said it would take three to five minutes to load basic screens.

Employees said that often, much of the game development took place in-house, bucking the common industry practice of contracting out such tasks to other, more experienced studios. As a result, the developers created worse versions of features that had been perfected by other companies.

Still, the Witcher series gained the studio an early following and fan base. The studio received the most acclaim for The Witcher 3, which won awards for its detailed universe and rich storytelling. Like earlier titles, it was buggy from the outset, frustrating players. But most fans accepted what they saw as a kind of test-and-release culture around CD Projekt Red games: a willingness to put out projects that were not yet problem-free.

Then came Cyberpunk 2077. First announced in 2012 and based loosely on a tabletop role-playing game created in 1988, the title was CD Projekt Red’s first attempt at creating a new, futuristic world.

It was to be set in Night City, a darkly dystopian megacity where humans and machines were fused together and repackaged as mercenaries, carrying out sabotage missions against evil corporations. The game would combine elements from some of sci-fi’s greatest hits: Strange Days meets Blade Runner meshed with The Matrix.

To hammer that point home, CD Projekt Red cast a familiar famous face in the game: Keanu Reeves. At a development conference in 2019, the actor burst onto the stage in a cloud of smoke after a video revealed his character.

“Let me tell you, the feeling of being there, of walking the streets of the future, is really going to be breathtaking,” Mr. Reeves said at the event. (A spokeswoman for Mr. Reeves did not respond to a request for comment.)

Inside CD Projekt Red, it was a very different story. Developers were increasingly concerned with some of the grand promises being made by management on the promotional marketing tour. Far into the game’s development, former employees said, the hyper-customizable and endlessly explorable world being sold to players was nowhere close to manifesting.

By 2019, chatter began to circulate in Polish game development circles that CD Projekt Red was way behind schedule with Cyberpunk 2077, even with a release date set for the following April. Some saw the departure of top executives — including key board members — as major warning signs.

On Glassdoor, a site where people can rate their previous employers, current and former CD Projekt Red workers said there was chaos behind the scenes: Office rumors spreading on Discord servers, misleading deadlines set by managers, infighting among the company’s top brass, and incompetence and poor planning leading to unnecessary “crunch,” a term for overworking employees to produce games under a tight deadline. Longtime engineering staff left the company as a result of overwork.

“The owners treat the company as a machine to earn money, and do not see employees as people but more like data in the table,” one former employee wrote on the site.

This January, CD Projekt Red tweeted that the game’s release had been delayed until Sept. 17, because there was “still work to be done.” Then, in March, the coronavirus pandemic caused CD Projekt Red to send its work force home.

Though the company said remote work would not hurt Cyberpunk’s chances of a September release, executives eventually announced further delays. The game was pushed to Nov. 19 in order to “fix a lot of bugs.” It was the same story in October, when the game’s release date was pushed to Dec. 10, at the height of the holiday shopping season.

Inside CD Projekt Red, as executives and communications staff geared up for a wide release, the problems were evident. While developers had created a functioning game for PC users, Cyberpunk was glitchy and crashed frequently on next-generation consoles like the PlayStation 5 and the new Xbox devices. Even worse, the game barely ran on older consoles like the PlayStation 4 and Xbox One.

Typically, game developers send early copies of new titles to reviewers with ample lead time. But CD Projekt Red kept Cyberpunk 2077 under wraps for as long as it could. The company only shared advance copies of the PC version with gaming publications and news organizations, previewing the best possible version of Cyberpunk to reviewers who would post their ratings online just days before the game’s release.

For months, reviewers, including those at The New York Times, tried to obtain review copies for the new game consoles released by Sony and Microsoft this year. Stephanie Bayer, a spokeswoman for CD Projekt Red, said in a previous email correspondence that the company would “hold off sending our console codes until close to launch” so that they could “send them securely.” That never happened.

Early reviews mentioned some issues with bugs, but the impressions were largely positive. Excitement continued to build until the game was released on Thursday, Dec. 10.

Eager fans were thrilled to finally be playing the game for the first time. Ashley Shoate, a D.J. in Northville, Mich., said she was amazed at the detail on her PlayStation 5, and loved the ability to customize her character, literally, to the teeth.

Then came the bugs. Ms. Shoate said it was impossible for her character to complete basic tasks like running, dodging and picking up weapons. Steering a car was so challenging that she felt like she was “drunk driving.” On one mission, Ms. Shoate had to sneak up and kill an enemy with a katana sword.

“I’m bringing a knife to a gunfight, so I’ve got to be on my P’s and Q’s. I can’t even do that,” she said. “It’s almost unplayable.” For the time being, she’s shelved the game.

“I really thought it was going to be to that level of top-three game ever on a new console,” she said. “It’s very disappointing.”

Billy Marte, an account executive at a software company in Austin, Texas, said he bought into the high expectations and the commercials with Mr. Reeves. Playing on his PC, he loved the story line and missions, but was often frustrated by glitches that made his character stand up while riding a motorcycle, or forced him to backtrack to an earlier saved game. Some of his friends, he said, had decided to return Cyberpunk.

“There was so much there, but they just didn’t pay attention to the details,” he said. “It’s evident that this game was rushed.”

Almost as soon as the game arrived, players began posting screenshots of the most glaring glitches on social media. Entire subreddits are now devoted to the frequent, nonsensical bugs users observed as they traversed deeper into Night City.

One frequent glitch includes characters going into “T-Pose” — standing with their arms raised to either side — and suddenly losing their pants. Users on Reddit described the phenomenon as “straight Donald Duckin’ it.”

Other bloopers include characters being flung through buildings seemingly out of nowhere and cars exploding for no reason. The non-player characters, or N.P.C.s, act so unnaturally that they can ruin the gaming experience.

One Reddit user posted a video of him throwing a grenade into the middle of a freeway at rush hour, only to see every N.P.C. open their car doors, leave their vehicles and crouch for cover simultaneously, as if choreographed by a professional dance troupe. (Someone else quickly edited the video to mimic the opening scene from “La La Land,” in which drivers abandon their vehicles to dance in the middle of the freeway.)

“I don’t think I’ve ever seen a game have this many gaffes, this often, this early into a release,” said Chris Person, a video producer who runs Highlight Reel, a YouTube show dedicated to video game bloopers and glitches. “Broken games can be super charming when they’re funny, like you’re seeing the strings on a puppet in a bad movie.” Two of Mr. Person’s most recent shows have been dedicated almost entirely to Cyberpunk glitches.

Most players, though, are pretty unhappy. On Thursday, Sony said it would refund players who wanted to return the game and pulled Cyberpunk from the company’s digital storefront. A PlayStation spokesman said the company had nothing further to add beyond its decision. Microsoft also said on Friday that it would issue refunds, but did not remove the game from its online store.

CD Projekt Red said Friday that it would refund disappointed players “out of our own pocket if necessary.” The company’s stock has dropped 41 percent since early December. Ms. Bayer, the company spokeswoman, declined to comment on a detailed list of questions provided by The Times.

Inside the studio, there has been infighting and finger-pointing. In a contentious meeting with board members on Thursday, CD Projekt Red staffers pressed executives on the game’s unrealistic deadlines and false promises. Management was tight-lipped about its tense discussions with Sony, Bloomberg reported on Friday, though people at Sony are upset at CD Projekt Red’s initial handling of the situation, people close to the company said.

The immediate future looks dark for Cyberpunk’s makers — perhaps even darker than the future they built in Night City. Refund requests are pouring in by the thousands. Lawyers and investors in Warsaw are circling the situation, contemplating a class-action lawsuit against the company for what one attorney described as potential criminal “misrepresentation in order to receive financial benefits.” Many gamers are swearing off playing Cyberpunk entirely until the company fixes all of the problems.

The coming weeks will determine whether CD Projekt Red can make good on a promise it made back in 2017, when players wondered whether the title would ever come out. “Worry not,” the company tweeted, assuring fans that Cyberpunk 2077 would be “huge” and “story-driven.”

“No hidden catch, you get what you pay for.”

Categories
Health

The Vaccines Are Purported to Be Free. Shock Payments Might Occur Anyway.

The Vaccines Are Supposed to Be Free. Surprise Bills Could Happen Anyway.

Federal regulations say that if Americans get a coronavirus vaccine, they shouldn’t have to pay anything out of their own pocket.

Congress passed law this spring banning insurers from applying cost-sharing such as a co-payment or deductible. It consisted of extra safeguards that prevented pharmacies, doctors, and hospitals from charging patients.

For consumer advocates, the rules seem almost ironic – nonetheless, they fear surprise vaccine bills will find their way to patients, just as coronavirus tests and treatments did earlier this year.

“It’s the American healthcare system, so inevitably there are gaps that we can’t foresee right now,” said Sabrina Corlette, co-director of the Center for Health Insurance Reforms at Georgetown University.

[Have you received a coronavirus vaccine? Tell us about it here.]

Americans vaccinated this year and next typically don’t pay for the vaccine themselves, as the federal government bought hundreds of millions of doses on behalf of patients. It has agreed to buy 100 million doses from Pfizer-BioNTech – and is negotiating for more – and 200 million from Moderna, enough to vaccinate 150 million Americans (the vaccines require two shots). It also has orders to purchase additional vaccines that are still being tested.

The Affordable Care Act provides additional protection as most health insurers are required to fully cover all federally recommended preventative measures. The CARES bill, passed this spring, has tightened these Obamacare rules.

Typically, insurers have around two years to cover a newly approved prevention service. The CARES Act provided coverage for 15 days following a recommendation by the Federal Advisory Board on Immunization Practices.

Some insurers, including Aetna and certain Blue Cross Blue Shield plans, have already announced that they will not charge patients for the vaccine or its administration.

“The health insurance companies pay the administration fees for the administration of the Covid-19 vaccine,” said David Allen, a spokesman for the American health insurance plans. “The administration fee covers doctors who provide the vaccine to patients, report to the public health and answer patient questions.”

The federal government has used other levers to cut the bills for surprise vaccines. When it offered improved Medicaid payment rates this spring, states had to fully cover coronavirus vaccines as a condition of receipt for all of their participants. All 50 states have accepted the additional funding and are now subject to these requirements.

Updated

Dec. 17, 2020, 6:13 p.m. ET

Elsewhere, the Centers for Disease Control and Prevention require vaccine providers to sign a contract stating not to bill patients for the vaccine and the cost of giving it. Doctors outside the network who do not have a contract with a patient’s private insurance must accept Medicare’s rate for administering the vaccine – $ 16.94 for the first dose and $ 28.39 for the second, according to those released in October Regulate. For uninsured patients, healthcare providers must send these fees to a provider assistance fund for reimbursement.

This is different from the rules for coronavirus treatment, which governed cost-sharing by insurers but did not take steps to restrict medical and hospitals billing. This meant that some patients were getting bills they weren’t expecting.

“What makes vaccination protection unique is that there are requirements for both insurers and providers,” said Karyn Schwartz, Senior Fellow at the Kaiser Family Foundation. “It’s a belt-and-suspender approach that makes consumer protection a lot stronger.”

Despite this protection, experts see some weak points. It has to do with the type of health insurance Americans have. Millions are still covered by “grandfather’s” health insurances that existed before and are exempt from the rules on Affordable Care. Hence, these plans are not required to fully cover the coronavirus vaccine or any other preventive service.

Experts also worry about uninsured Americans. The United States does not have a national program to cover vaccination costs. For the coronavirus, healthcare providers are instructed to submit vaccination-related costs to a $ 175 billion Provider Relief Fund set up last spring.

The fund had $ 30 billion left as of November 10. There is no substitute source of funding for the uninsured that could be covered when it is used up.

“The question marks for me are the uninsured and the people who are in the unregulated plans,” Ms. Corlette said.

Additional fees can accompany a vaccine. Some providers are used to charging a visit fee for all personal patients. Most emergency rooms charge “set-up fees,” the price of going in the door and finding care, as do some doctors in hospitals. Some patients who received coronavirus tests in emergency rooms faced setup fees in excess of $ 1,000, according to billing records presented to the New York Times. These fees are typically not incurred in retail pharmacies, where many Americans may be vaccinated.

Federal law makes it very clear that patients do not have to pay for the vaccine and its administration. However, there is no language that defines what qualifies as “vaccine administration” and whether the attendance fee causes the reduction.

“The question that I’m still not clear about is what happens if someone walks into an ambulance that charges a facility and receives a vaccine,” said Kao-Ping Chua, an assistant professor of pediatrics at the University of Michigan Coronavirus Medical Billing. “Is there any way that they can be charged? I think the answer is yes. “

When patients experience side effects from the vaccine and require medical attention – as a health care worker in Alaska did earlier this week – they have no special protection against those allegations. If a vaccine visit addresses other medical issues – such as having a patient’s blood drawn or pre-existing medical conditions discussed with a provider – this can also mean regular fees for care.

Then there is the prospect of Obamacare repeal. Last month the Supreme Court held an oral argument in a case involving the termination of the Affordable Care Act. If the challenge is successful, Obamacare’s mandate for prevention services like the coronavirus vaccine will be void.

Insurers can still choose to insure the vaccine – and find it inexpensive if it avoids hospitalization – but they could ask for a co-payment, just like they do with doctor visits and prescription drugs.

“All vaccine coverage depends on the Affordable Care Act,” said Ms. Corlette. “If that goes away, that’s another very big problem.”