July 22, 2019

Research Roundup Improving Colon Cancer Screening Disparities In Heart Care Medicaids Effect

first_imgEach week, KHN compiles a selection of recently released health policy studies and briefs.Urban Institute and Robert Wood Johnson Foundation: The ACA And America’s Cities: Fewer Uninsured And More Federal Dollars This report estimated the effect of the Affordable Care Act (ACA) on 14 large and diverse cities: Los Angeles, Chicago, Houston, Philadelphia, Phoenix, Indianapolis, Columbus, Charlotte, Detroit, Memphis, Seattle, Denver, Atlanta, and Miami. Among the seven cities in states that have expanded Medicaid, the ACA will likely decrease the number of uninsured by an average of 57 percent. … Among the seven cities in states not expanding Medicaid, the ACA will likely decrease the number of uninsured by an average of 30 percent. … If Medicaid eligibility were expanded in these cities, the number of uninsured would fall by an average of 52 percent (Buettgens and Dev, 6/19). JAMA Internal Medicine: Comparative Effectiveness Of A Multifaceted Intervention To Improve Adherence To Annual Colorectal Cancer Screening In Community Health Centers Colorectal cancer (CRC) screening rates are lower among Latinos and people living in poverty. … However, the ability of [fecal occult blood testing] to reduce CRC mortality depends on high rates of adherence to annual screening. … our multifaceted intervention [including computerized reminders, standing orders for medical assistants to give patients home fecal immunochemical tests (FIT), and clinician feedback on CRC screening rates] … greatly increased adherence to annual CRC screening; most screenings were achieved without personal calls. It is possible to improve annual CRC screening for vulnerable populations with relatively low-cost strategies that are facilitated by health information technologies (Baker et al., 6/16). Circulation: Early Results Of Massachusetts Healthcare Reform On Racial, Ethnic, And Socioeconomic Disparities In Cardiovascular Care Insured adults receive invasive cardiovascular procedures more frequently than uninsured adults. We examined the impact of healthcare reform in Massachusetts on use of coronary revascularization procedures and in-hospital and 1-year mortality by race/ethnicity, education, and sex. … Using hospital claims data, we compared differences in coronary revascularization rates (coronary artery bypass grafting or percutaneous coronary intervention) and in-hospital mortality …. Reducing insurance barriers to receipt of coronary revascularization procedures has not yet eliminated preexisting demographic and educational disparities in access to these procedures (Albert et al., 6/17). Employee Benefit Research Institute: Consumer Engagement Among HSA And HRA Enrollees HRAs [health reimbursement arrangements] and HSAs [health savings accounts] are very similar, though there are some key differences that may provide different incentives related to using health care services, and thus, different consumer engagement experiences. An HSA is owned by the individual with the high-deductible health plan and is completely portable. There is no annual use-it-or-lose-it rule associated with an HSA …. In contrast, an HRA is an employer-funded health plan that reimburses employees for qualified medical expenses. … Leftover funds at the end of each year can be carried over for future use (at the employer’s discretion) …. Adults with an HSA were more likely than those with an HRA to exhibit a number of cost-conscious behaviors related to use of health care services (Fronstin, 6/19). The Kaiser Family Foundation: Potential Supreme Court Decision: Who Will Bear The Coverage “Burdens?” The Supreme Court is expected to issue its decision [in the Hobby Lobby and Conestoga Wood Specialties cases] by the end of June 2014. … If the Court decides that Hobby Lobby must comply with the [health law] contraceptive coverage requirement, Hobby Lobby will likely choose to stop providing health insurance …. If, however, the Supreme Court exempts Hobby Lobby from the requirement that they include all prescribed FDA approved contraceptives as the ACA requires, some female employees and dependents … may either have to go without their preferred contraceptive method, pay out of pocket, or seek subsidized services at a government funded clinic. … it would be easy to envision that other corporations with religious objections to the full range of contraceptives would eliminate coverage (Sobel, Salganicoff and Nisha Kurani, 6/18). Here is a selection of news coverage of other recent research:AARP Blog: Diabetes, Alzheimer’s Top 2 Areas For Drug Research Diabetes, Alzheimer’s, arthritis and heart disease top the list for the most new drugs in development to treat the common chronic diseases of older Americans, according to a new drug- industry report. The report, by the Pharmaceutical Research and Manufacturers of America (PhRMA), an industry trade association, says 435 medicines that primarily target seniors are currently either in clinical trials or under review by the Food and Drug Administration (FDA) (Sagon, 6/16). Reuters:  Needle Biopsies May Be Underused For Breast Cancer PatientsMost women should undergo a needle biopsy for breast cancer diagnosis, but some surgeons opt for a more invasive procedure instead, according to a new study [in the Journal of Clinical Oncology]. The difference may be a matter of surgeon experience, researchers say, so many women could benefit if surgeons were trained and encouraged to opt for the needle method more often (Doyle, 6/15). Journal of the American Medical Association: Researchers Focus On Recovery In Schizophrenia The outlook for people diagnosed with schizophrenia, once considered a devastating illness that only worsens over time, has improved in the past several decades. Antipsychotic medications and psychosocial treatments have allowed many with the illness to achieve some degree of recovery, manage residual symptoms, and lead productive lives. Yet additional efforts are needed to consolidate these improvements and help more patients reach these goals. … These approaches are outlined in a new report, “Schizophrenia: Time to Commit to Policy Change,” drafted by [Stephen Marder, MD, professor of psychiatry at the University of California, Los Angeles] and others (Friedrich, 6/18). NewsWorks: Study: One In Five Inmates In Pa. Prisons Has Hepatitis CNearly one in five inmates entering Pennsylvania prisons has hepatitis C, according to a study published in the June issue of the American Journal of Public health. Since 2003, Pennsylvania has screened everyone entering prison for hepatitis C unless an inmate chooses to opt out of the test. Of the more than 100,000 people who were tested upon entry between 2004 and 2012, about 18 percent tested positive for the virus. “It’s an incredibly high rate,” said lead author, Sarah Larney, who’s a fellow at the National Drug and Alcohol Research Center at the University of New South Wales and a research associate at Brown University (Gordon, 6/16). MinnPost:  Few Doctors Discuss End-of-life Planning With Heart-Failure Patients, Mayo Study FindsAbout 5 million Americans have heart failure, a chronic condition in which the pumping action of the heart slowly weakens. There is no cure. Treatment — medications and lifestyle changes — can help people with the condition live longer and lead more active lives, but half of heart-failure patients die within five years of receiving their diagnosis. Yet, despite that prognosis, few doctors discuss end-of-life planning with heart-failure patients and their families, according to a recent study from researchers at the Mayo Clinic in Rochester (Perry, 6/18). Reuters: Shared Decision Making Still Lacking For Cancer Screening When it comes to cancer screening, doctors often do not adequately discuss the balance of pros and cons with their patients, a new study suggests. … Depending on the screening test in question, between 69 and 93 percent of study participants chose to get screened, and most said they would make the same decision again, the authors write in the American Journal of Preventive Medicine (Pittman, 6/19). MedPage Today: Racial Disparity In Stroke Grows In South Carolina In South Carolina, the rate of stroke hospitalization increased in recent years among young and middle-age blacks, but not other groups, resulting in a widening disparity, researchers found. In black individuals younger than 65, the rate per 100,000 rose from 121 in 2001 to 142 in 2010, a relative 17.3% increase, according to Wayne Feng, MD, of the Medical University of South Carolina Stroke Center in Charleston, and colleagues. In contrast, the stroke hospitalization rate declined in both black and white individuals 65 and older and remained stagnant in younger whites, they reported in the July issue of Stroke: Journal of the American Heart Association (Neale, 6/19). Modern Healthcare: Black, Hispanic Dialysis Patients Admitted More Often For Infections Black and Hispanic patients on dialysis for end-stage renal disease had markedly higher rates of infection-related hospitalizations and were less likely to have visited a specialist for pre-treatment care, a new study finds. Infection-related hospitalizations were about 20% higher for blacks of all ages, and about 30% higher for older Hispanics, compared with white patients, said study co-author Dr. Keith Norris of the David Geffen School of Medicine at UCLA (Rice, 6/19). This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription. Research Roundup: Improving Colon Cancer Screening; Disparities In Heart Care; Medicaid’s Effect On Citieslast_img read more

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July 22, 2019

State Highlights Mo Drops Many From Medicaid Mich Medicaid Shift Savings

first_imgA selection of health policy stories from Texas, Missouri, Illinois, Michigan, Florida, Pennsylvania, North Carolina and Minnesota.The Associated Press: Texas Sees Little Change Despite Insurance GainsHarris Health System — like other programs across the state — hasn’t enjoyed the expected savings from the Affordable Care Act because most of its 48,000 patients eligible for subsidized insurance instead chose to remain enrolled in the county’s cheaper taxpayer-funded medical care. Now, public entities from Houston to El Paso are scrambling to tweak rules to make those who qualify for subsidized insurance ineligible for the local programs (8/9).The Associated Press: Missouri Led Nation in Medicaid Roll ReductionsMissouri’s Medicaid program is leading the nation in the number of people dropped from its rolls. New figures from the U.S. Department of Health and Human Services show that Missouri’s Medicaid enrollment dropped by 37,260 people in June, compared with its average enrollment from July through September of last year. That was the largest numerical decrease of any state, though it ranked second behind Nebraska in terms of the percentage decline (8/11).Detroit News: Medicaid Shift Could Save Michigan Prisons $19MThe Michigan Department of Corrections expects to save at least $19 million on health care next year by enrolling inmates and parolees in the state’s expanded Medicaid health care program. Corrections officials and experts argue that providing uninsured ex-cons with treatment for the mental illness, substance abuse and chronic health conditions that otherwise can lead them to commit crimes again could reap future savings in the state’s $2 billion-a-year corrections budget (Bouffard, 8/11).USA Today: What Ails Appalachia Ails The NationDiabetes is slowly ravaging Alisha Blankenbeckler’s body — stealing her eyesight, impairing her kidneys and damaging her nerves so severely she can barely walk across a parking lot without help. And she’s only 48. … This week, U.S. Centers for Disease Control and Prevention Director Tom Frieden made a “house call” to find out more about the underlying causes of the region’s ills and how to treat them — and in the process gain traction against the rising burden of chronic disease that ails the nation. … Appalachia, like some blighted urban areas and Native American reservations, mixes several ingredients of poor health: doctor shortages and access-to-care problems; stressful, unhealthy lifestyles; low education levels; and insidious poverty (Ungar, 8/8).Chicago Tribune: Illinois Prison Hospice Offers Care, RedemptionRalph Pollock, in the ninth year of a 25-year sentence for a drunken driving crash that killed two children, bent forward in his chair, rested the book on the bed in front of him and quietly read to a man lying under a blanket. Propped up against a pillow, his eyes closed, the man listened as Pollock read from “The Purpose Driven Life.” Pollock, 55, is a volunteer in the hospice program for prisoners at Dixon Correctional Center, one of only about 20 prison hospices nationwide where the caregivers are inmates. Both patients and caregivers have been convicted of grievous crimes. But the hospice program is based on the belief that everyone deserves compassion as they are dying. And the program’s supporters say inmates who extend that compassion as volunteers can be transformed. The infirmary where the dying receive hospice care is in the prison’s health care unit (Brotman, 8/11).Health News Florida: No Documents? No Problem HereThe dirt road and lush tree canopy leading to the Catholic Charities medical clinic is in stark contrast to the bright lights surrounding the nearest hospital. Here, sirens would be drowned out by choruses of crickets and katydids. But this refurbished double-wide trailer off a rural highway in Dover is a medical refuge for some agricultural workers and their families. Dozens show up at the San Jose Mission medical clinic every Monday night, knowing Sister Sara Proctor and her team of volunteers won’t ask for what they don’t have: money or documentation. The Pew Research Center estimates that 825,000 immigrants in Florida today live here illegally. And regardless of any government policy or ongoing political debate, they sometimes get sick (Shedden, 8/8).Philadelphia Inquirer: Health System Forms Preferred Provider Network For Nursing Homes To Decrease ReadmissionsThe handoff of patients from hospitals to nursing homes has taken on increased significance now that Medicare penalizes hospitals if too many patients are readmitted unnecessarily within 30 days of discharge. To help prevent a breakdown in that transition and to generally improve care for its patients, Virtua, which bills itself as South Jersey’s biggest health system, has formed a preferred provider network for nursing homes and rehabilitation centers. The plan is part of an effort at Virtua to cast a wider net of care in the community it serves in preparation for a time when insurers will pay health systems for keeping people out of the hospital, not just for procedures and stays in the hospital. Starting about five months ago, Virtua signed contracts with 36 nursing-home operators in Burlington, Camden, Gloucester, and Mercer Counties. It’s not meant to be an exclusive list. It includes 29 of the 46 nursing homes in Burlington, Camden, and Gloucester Counties, which is where most of Virtua’s operations are located (Brubaker, 8/11).Raleigh News & Observer: DHHS Doubles Money Paid In No-Bid Medicaid Contract In doubling a no-bid contract to $6.8 million, the state Department of Health and Human Services has turned over the financial management of North Carolina’s $13 billion Medicaid program to a Washington-area consulting firm. Recently released contract documents spell out how Alvarez & Marsal is running the day-to-day financial operations of Medicaid, developing budgets, managing cash and contracts, and preparing reports for the legislature and governor. In addition, the department has tapped the consulting firm to reorganize the entire Medicaid division (Neff, 8/9).Minnesota Public Radio: Pharmacists Ready, Worry Over New Role: Medical Pot DispenserWhen medical cannabis becomes available next July, a pharmacist — not your doctor — will help you figure out your exact dosage. And that pharmacist will be one employed by the companies selected to manufacture the drug. Minnesota will be just the second state to use pharmacists to dispense medical cannabis. While some pharmacists say it makes sense to tap their expertise in handling medications, they also see many challenges in dispensing a drug that has a lot of variability and limited research to guide them (Benson, 8/10).  State Highlights: Mo. Drops Many From Medicaid; Mich. Medicaid Shift Savings This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.last_img read more

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July 21, 2019

Volkswagen ID R Electric To Go After Nürburgring Record

first_imgTime of 5 minutes and 30 seconds is possibleAccording to Autocar’s sources, Volkswagen Motorsport intends to take the Volkswagen I.D. R racer that set all-time record of Pikes Peak International Hill Climb to the Nürburgring. The track is exclusively booked for May 2019.Currently, the fastest EV at the Nürburgring Nordschleife was NIO EP9 (6:45.900 – six minutes, 45.900 seconds). The fastest car on the track ever was heavily modified Porsche 919 Hybrid Evo race car (5:19.55) at an average speed of 145.3 mph (233.79 km/h).Early simulations of I.D. R suggest times below 5:30 are possible, which gives it chance to beat not only EVs but also ICE cars.““We’re still at an early stage of preparation, but we’ve already seen lap times below 5min 30sec in the simulator,” an insider with knowledge of Volkswagen Motorsport’s Nürburgring plans told Autocar, adding: “There’s more to come, we’re sure”.” Source: Electric Vehicle News Setting a new record would be a great marketing asset ahead of the production launch of the Volkswagen I.D. model in late 2019.First, the I.D. R needs to be modified to handle higher speeds (new aerodynamic package, electric drive system, maybe gearing).See entire record-setting NIO EP9 Nurburgring lap here.The car will be driven by Romain Dumas, who was the driver also at Pikes Peak. Dumas is a four-time winner of the Nürburgring 24 Hours.Volkswagen I.D. R spec:0-100 km/h (62 mph) in 2.25 secondstwo electric motors with total of 500 kW of power and 650 Nm of torqueAWDcurb weight 1,100 kgSource: Autocar Volkswagen I.D. R news Volkswagen I.D. R Won’t Return To Pikes Peakcenter_img VW I.D. BUZZ CARGO, I.D. R & Cargo e-Bike Show Up In LA Volkswagen I.D. R Pikes Peak In The Eyes Of Fully Charged: Video Author Liberty Access TechnologiesPosted on December 6, 2018Categories Electric Vehicle Newslast_img read more

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July 21, 2019

Seasons Greetings And Merry Christmas Electric Car Fans

first_img We Go Behind-The-Scenes At A Certified Tesla Repair Center Above: A special thank you to Elon Musk and the entire staff at Tesla for making the best cars on — and for — the planet (Reddit: taure)Okay… what’s the ultimate Tesla gift? Maybe it’s time to head over to your local Tesla store and buy your loved one their own Tesla! Check out this classic Christmas ad from the “Electric Vehicle Association of America” that appeared in 1912. The ad says that the, “cost of an Electric is decidedly moderate when you consider its lasting, satisfactory service. Maintenance expense and cost of power is far lower than that for other types of cars. Before you buy any car – consider the Electric.” Indeed, some things never change. Big Oil Makes A New Attempt To Kill Electric Cars Author Liberty Access TechnologiesPosted on December 25, 2018Categories Electric Vehicle News MERRY CHRISTMAS TO THE TESLA FAMILY AROUND THE WORLD!Seasons greetings… and Merry Christmas to all those in the EV community! Hopefully, you’ve been treated to some great gifts under the Christmas tree this morning. Our Tesla family is gathered together as well enjoying a sunny holiday morning here in South Florida. Whether you received a nerdy Christmas sweater or a dorky dreidel (yeah, I got one) this holiday season, let’s face it — what you really wanted was something for your Tesla.More EV News *This article comes to us courtesy of EVANNEX (which also makes aftermarket Tesla accessories). Authored by Matt Pressman. The opinions expressed in these articles are not necessarily our own at InsideEVs.center_img Former Tesla Employees Open Used EV Dealership & Education Center Above: Christmas ad from the “Electric Vehicle Association of America” that ran in the American Journal of Surgery back in 1912 (Source: Plugin Sites)In any event, we wanted to send a message of peace and blessings to all those across the entire Tesla family worldwide. Thanks for your continuing support, we’re looking forward to an exciting 2019! Looking back at our amazing experience with the Model 3 already this year, we’re forecasting 2019 as the breakthrough year for Elon Musk and the team. We look forward to keeping you updated on all the exciting progress at Tesla.*Editor’s Note: EVANNEX, which also sells aftermarket gear for Teslas, has kindly allowed us to share some of its content with our readers, free of charge. Our thanks go out to EVANNEX. Check out the site here. Above: A Tesla holiday shout-out (Instagram: honey_fay)We know what you were really hoping for — a 2020 Tesla Roadster, now! Or, if you’re already a Tesla owner, a software update beamed to you with full self-driving capabilities. Or, even better — a new Supercharger station minutes from your house. But, no dice. Well… there are some merry things you can do to treat your Tesla. For one, you can spoil your Tesla with a soapy car wash. Then, snap some holiday family photos with your Model S, 3, or X afterwards — it is a member of your family after all. Or, perhaps… you can get a few fun accessories for it. Source: Electric Vehicle Newslast_img read more

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July 21, 2019

Honda unveils twoway wireless V2G energy management system

first_imgSource: Honda via Green Car Congress Honda unveiled its new Wireless Vehicle-to-Grid (V2G), a bi-directional energy management system, at CES 2019. Developed in partnership with WiTricity, the system creates a two-way energy flow between the grid and vehicles parked over WiTricity’s Drive 11 wireless charging pad, which can be used to power car batteries or help meet the grid’s energy demands during peak usage periods.WiTricity’s Drive 11 “park-and-charge” system is capable of charging vehicles at 3.6, 7.7 or 11 kW. Available in low-, mid-, and high-ground-clearance versions, the system is designed to accommodate passenger vehicles, SUVs and light trucks.Honda says its EV owners will be able to participate in the V2G program and receive compensation from utility operators. The company hopes to collaborate with energy companies to utilize the system.“Honda is seeking new partners who want to join us in the development and user testing of our technology concepts, and CES provides a vast B2B marketplace to explore collaboration opportunities,” said Honda Innovations CEO Nick Sugimoto. Source: Electric Vehicles Magazinelast_img read more

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July 21, 2019

Tesla revises pricing options reintroduces softwarelimited battery packs

first_imgModel S Performance 315 miles 3.0 seconds $112,000 Model X 270 miles 4.7 seconds $88,000 Model S 310 miles 4.1 seconds $85,000 Source: Electric Vehicles Magazine Model S Extended Range 335 miles 4.1 seconds $93,000 Model X Extended Range 295 miles 4.7 seconds $96,000 After Tesla recently discontinued the 75 kWh versions of Models S and X, some speculated that it was a precursor to replacing the battery pack used in those models with a redesigned pack based on the newer 2170 cells used in Model 3.However, that doesn’t seem to be in the cards for the moment – instead, the California carmaker has revised its lineup of S and X variants, reintroducing the option to buy a battery pack with software-limited range and unbundling Ludicrous Mode from the Performance variant.The news isn’t as momentous as a battery update would have been (although we’re pretty sure that will happen eventually), but as Electrek pointed out, it’s a good business move. It allows Tesla to streamline production by building only a single (100 kWh) battery pack for Models S and X, and also lets it offer a lower price to buyers who don’t feel the need to have the ultimate in range and performance.Tesla also lowered the price of the Extended Range (formerly known as 100) variants by $1,000, and dropped the previous numerical naming scheme. Here’s the new lineup: Model X Performance w/Ludicrous Mode 289 miles 2.8 seconds $137,000 Source: Electrek Range 0-60 mph Price Model S Performance w/Ludicrous Mode 315 miles 2.4 seconds $132,000 Model S and Model X owners can upgrade to the Extended Range version via an over-the-air update for $8,000. Model X Performance 289 miles 3.5 seconds $117,000last_img read more

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July 21, 2019

Tesla Model 3 Gets More Power Higher Top Speed With Software Update

first_imgSource: Electric Vehicle News Longest Range Electric Cars For Your Money: Model 3 For The Win Has Tesla Finally Opened Up The Full Potential Of Its Model 3 Battery? Watch Tesla Model 3 Performance Beat Ford Mustang GT: 40-100 MPH The slated update will increase the power of the vehicle by around 5% and its top speed by 7mph (10km/h). Furthermore, the Model 3 Long Range, equipped with the rear-wheel-drive system will get an increase in range from 310 miles to 325 miles (500 to 525 kilometers) per single charge.On the other hand, the Model 3 Performance will see an increase in top speed from 155 mph (250 km/h) to 162 mph (261 km/h) through a slew of upcoming firmware upgrades. And since the Model 3 is finally coming to Europe, the increased top speed will be a good thing to have on all those high-speed autobahn runs.“Firmware update coming later this month will increase power by ~5% & top speed by 10 km/h or 7mph. We’d electronically limited the Model 3 Performance to 155 mph. That was not a physical limit but an electronic limit. After a lot of testing, we now feel we can increase that limit by 10 km/h or 7 mph, and that just ends up being an rpm increase in the motors. The two motors just spin faster. I think they’re going somewhere along the lines of 19,000 rpm.”To conclude things, other Model 3 variants, including the Mid Range and the Dual Motor Long Range versions, will also be receiving the updated firmware, further boosting its performance. With approximately 450 horsepower and 471lb-ft of torque, it will be interesting to see how much of an impact this makes on the driving dynamics of the Model 3 Performance. After all, the roughly 5% increase in power (around 23 horsepower more) isn’t a number to trifle with.Meanwhile, check out a top speed test run of a Tesla Model 3, done on the autobahn..embed-container { position: relative; padding-bottom: 56.25%; height: 0; overflow: hidden; max-width: 100%; } .embed-container iframe, .embed-container object, .embed-container embed { position: absolute; top: 0; left: 0; width: 100%; height: 100%; }Source: Teslarati Author Liberty Access TechnologiesPosted on March 4, 2019Categories Electric Vehicle News The over-the-air updates will bring more power and top speed, but also, an improved range for certain models within the Model 3 rangeThe entire Tesla Model 3 fleet will see an over-the-air software update. It’s slated to be released sometime during this month, bringing several improvements to the EV. According to currently available information, the electric car will see an increase in both power and top speed, making it an even more performance-oriented machine. And in turn, that’s some really good news for all the current and would-be Model 3 owners out there.More Model 3 goodieslast_img read more

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July 21, 2019

Tesla completes acquisition of Maxwell officially takes over the battery technology

first_imgAfter a few months of formalities, Tesla announced today that it has finally completed its acquisition of Maxwell and it will officially be able to take over its battery technology. more…Subscribe to Electrek on YouTube for exclusive videos and subscribe to the podcast.https://youtu.be/ee5nKd7zjWoThe post Tesla completes acquisition of Maxwell, officially takes over the battery technology appeared first on Electrek. Source: Charge Forwardlast_img

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July 21, 2019

Five Years Since The Senates FCPA Hearing

first_imgFive years ago today, the Senate held a hearing titled “Examining Enforcement of the Foreign Corrupt Practices Act.”(See here for the full hearing transcript, here for the video).It was the first congressional hearing on the FCPA during its new era of enforcement (to be followed by a June 2011 FCPA hearing in the House) and the first FCPA hearing in Congress since the FCPA was amended in 1998.In opening the hearing, Senator Arlen Specter (who passed away in October 2012) noted that “oversight is a major function of Congress,” but that Congress does “not do very much of it.”During the hearing:Greg Andres (then the DOJ’s Acting Deputy Assistant Attorney General, Criminal Division) provided an overview of the DOJ’s FCPA enforcement program;I provided a critique of the DOJ’s charging decisions in the most egregious cases of corporate bribery as well as the DOJ’s prosecution (or lack thereof) of individuals;Andrew Weissmann (then with Jenner & Block, appearing on behalf of the U.S. Chamber of Commerce) suggested potential reforms to the FCPA, including an affirmative compliance defense and clarification of the “foreign official” element; andMichael Volkov (then with Mayer Brown) proposed a more balanced enforcement approach and suggested a limited amnesty program for corporations.During the hearing, Senator Amy Klobuchar (D-Minn.) noted, among other things, that “one of the basic principles of due process is that people in companies have to be able to know what the law is in order to comply with it” and she further stated that “many very good standing companies [in her state of Minnesota] … do not always know what behavior will trigger an enforcement action.”Senator Christopher Coons (D-Del.) stated, among other things, that he “would welcome [the] opportunity” to work on “potential amendments to the [FCPA] that would allow clarification on the definition of foreign official and the creation of a compliance defense.”Five years have passed since the Senate’s FCPA hearing and certain things have changed.Most interestingly, Weissmann, who advocated for FCPA reform at the hearing, is now the current DOJ Fraud Section Chief (see this prior post for additional discussion) and Andres, who defended the DOJ’s FCPA enforcement program, is now in private practice and as highlighted in this prior post has largely abandoned many of the positions he articulated on behalf of the DOJ at the hearing. (For more on this general issue, see this prior post “In the FCPA Space, Who Speaks for Whom?”).Other things have not changed, including my FCPA views (see here for my written testimony).I went to Capitol Hill five years ago today without an agenda and on behalf of no one but myself.My testimony represented my genuine beliefs and I was proud of what I said then and I remain proud today.last_img read more

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July 21, 2019

Issues To Consider From The Las Vegas Sands Enforcement Action

first_imgThis recent post went in-depth into the recent $9 million Foreign Corrupt Practices Act books and records and internal controls enforcement action against Las Vegas Sands (LVS).This post continues the analysis by highlighting various issues to consider.Is Your Company In Violation of the Books and Records and Internal Controls Provisions?LVS is not a “normal” company in that its Chairman and CEO Sheldon Adelson (or his family) own a majority of company shares.Moreover, Adelson is very active in his support of Republican candidates and causes, an issue that has been well-documented. (See here for instance). As a result, some have suggested that LVS was targeted by the Democratic administration.I have no insight or opinion about this.But I will say the following.If every issuer undertook an internal investigation of its world-wide business operations like LVS did, every issuer would find conduct generally consistent, albeit perhaps not to the extent or magnitude addressed in the SEC’s LVS order, with what the SEC found to be books and records and internal controls violations in the LVS action.In determining whether your company is violating the books and records and internal controls provisions (as found by the SEC in the LVS action) ask yourself:Has any transaction in the company been pursued with perhaps secondary ulterior motives? Here, the SEC found as follows regarding the “Adelson Center.” “No research and or analysis was done to determine whether a need existed for such a business center, the amount of any profit or loss it was likely to generate, or whether it would do anything to improve LVSC’s image in China. Numerous employees were concerned that the purchase of the real estate was solely for political purposes.”When engaging service providers, does the company always engage in pre-hiring due diligence?Does your company always have original backup documentation prior to paying invoices?Does your company (particularly if in the entertainment and hospitality industry) occasionally provide complimentary items or services such as restaurant meals and hotel stays to actual and potential customers and business contacts? If so, do your employees always record the comp recipients’ names and otherwise follow the internal comp approval rules?See this prior post which addresses similar issues.What To Call It?For starters, what to call the LVS enforcement action?As noted in the original post, while there are a few sentences in the administrative order that touch upon issues relevant to the anti-bribery provisions, the enforcement action was on balance a pure books and records and internal controls action.Since the FCPA’s enactment, there have been over 1,200 books and records and internal controls enforcement actions, but actions that are not otherwise termed “FCPA” enforcement actions.My recent article proposing an “FCPA common language,” states:“Enforcement actions charging or referencing books and records and internal controls violations should be included in FCPA enforcement statistics to the extent the underlying allegations concern foreign bribery. A suitable guidepost in this regard is whether an enforcement action is included on the DOJ or SEC website of FCPA enforcement matters.”The LVS action (unlike the vast, vast majority of the above referenced 1,200 books and records and internal controls actions) is indeed listed on the SEC’s FCPA website.Thus, it is proper to call it an FCPA enforcement.TimelineLVS’s FCPA scrutiny began, at least informally, in November 2010 with the”noisy exit” civil lawsuit by Steven Jacobs (the former President of Macau Operations) from the company. (See here for the original post). Formally, the company’s FCPA scrutiny began with the SEC’s February 2011 subpoena to the company.Thus, from start to finish the scrutiny lasted 5 years and two months.Again (and has been stated several times recently given the robust FCPA enforcement activity thus far this year), if the SEC wants the public to have confidence in its FCPA enforcement program, it must resolve instances of FCPA scrutiny much quicker.Root CausesExamining the root cause of an enforcement action is not to excuse the alleged conduct, but to understand the circumstances which gave rise to the enforcement action in the first place.As highlighted many times on these pages, trade barriers and distortions are often the root causes of bribery and a reduction in bribery will not be achieved without a reduction in trade barriers and distortions.So why did the LVS action happen?It probably had a lot to do with various barriers and restrictions concerning doing business in China that had, as a common thread, the need for a Chinese intermediary – in the words of the enforcement action a “beard.”Would the enforcement action have resulted if LVS could have directly purchased the China basketball team or if LVS could have directly purchased a building in China?last_img read more

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July 21, 2019

A Preview Of Sengs Appeal

first_imgForeign Corrupt Practices Act appeals are not as rare as Halley’s Comet, but nevertheless rare. Thus, when an FCPA appeal occurs and an appellate court is presented with the opportunity to construe the law, almost be definition, it is a big deal.As highlighted in this prior post, in July 2017 after a long trial a federal jury convicted Ng Lap Seng of two counts of violating the FCPA, one count of paying bribes and gratuities, one count of money laundering and two counts of conspiracy “for his role in a scheme to bribe United Nations ambassadors to obtain support to build a conference center in Macau that would host, among other events, the annual United Nations Global South-South Development Expo.”Thereafter, Seng was sentenced to 48 months in prison and three years of supervised release. In addition, Seng was ordered to pay a $1 million fine, $302,977 in restitution to the United Nations and the judge also ordered a forfeiture money judgment of $1.5 million.Recent filings by Seng and the DOJ in connection with Seng’s bail application (which was denied by the court) provide a glimpse of the issues that will likely be before the Second Circuit. (Speaking of the Second Circuit and FCPA appeals, the Hoskins matter is still before the Second Circuit and despite oral arguments occurring over 16 months ago there is no decision).Seng’s bail motion stated:“This appeal arises out of an extraordinary and unprecedented invocation of U.S. anti-corruption statutes to prosecute a foreign national for allegedly bribing foreign ambassadors to the United Nations, in an effort to persuade them to support his plans to build the UN a new convention center for free. According to the government, these actions violated the prohibition on bribing agents of an “organization” that receives federal funds, 18 U.S.C. §666, and the Foreign Corrupt Practices Act (FCPA), 15 U.S.C. §§78dd-2, 78dd-3, and served as the predicate for money laundering violations as well, 18 U.S.C. §1956. Unsurprisingly, there are substantial questions as to whether this novel prosecution can be squared with the statutes, governing Supreme Court precedent, and the strong constitutional avoidance concerns this case presents.First, there is a substantial question whether §666 applies to the UN. On its face, the statute specifies the government organizations to which it applies—namely, “State, local or Indian tribal government[s].” Particularly given the obligation to interpret statutes to avoid unreasonable interference with the sovereign authority of other nations, §666 should not be read to reach foreign and international government agents and agencies, which raise wholly different considerations and sensitivities.Second, there is a substantial question whether the government proved, or the jury found, that any payments were made in exchange for an “official act.” The Supreme Court considerably narrowed the concept of “official acts” in McDonnell v. United States, 136 S. Ct. 2355 (2016), in large part because of constitutional concerns that apply with full force here. Indeed, if anything, concerns about fair notice, arbitrary enforcement, chilling of political discourse, and undue interference with other sovereigns apply with even greater force to this case, as it is far from clear what actions by the UN or its ambassadors even qualify as “official acts,” or what kinds of payments are impermissible in this unique context. Yet the government repeatedly urged the jury to treat as “official acts” things that plainly do not qualify under McDonnell—actions as innocuous as attending a meeting in an “official” capacity and circulating to the UN a letter on “official” UN letterhead.Third, there is a substantial question whether the FCPA, a statute enacted to penalize bribing foreign officials to obtain or retain business, applies to the unusual allegations of this case. Ng was not accused of paying bribes to obtain a UN contract, or to secure a permit, license, or other UN prerequisite to doing business with a third party. He was accused of bribing UN ambassadors to support his effort to build the UN a convention center for free. The FCPA was never intended to reach actions of foreign governments or international organizations that do not award or directly impact “business.”As to the FCPA specific issue, the motion stated:“The government’s reliance on the pro bono agreement raises the additional substantial question whether the FCPA even reaches the conduct alleged here. The FCPA prohibits payments made to foreign officials for the purpose of “obtaining or retaining business for or with, or directing business to, any person.” 15 U.S.C. §78dd-2(a)(1); 15 U.S.C. §78dd-3(a)(1). That limitation was deliberate; in enacting the FCPA, Congress specifically chose to criminalize only “commercial bribery,” and rejected a competing House proposal that “contained no limiting ‘business nexus’ element.” United States v. Kay, 359 F.3d 738, 746-47 (5th Cir. 2004).The government never sought to prove that the purported bribes were intended to obtain any paying government contract or other commercial business from the UN. Nor did the government allege that they were paid to obtain a permit, license, or other prerequisite from the UN to doing commercial business with a third party. Instead, the government asserted an exceedingly tenuous relation to commercial business: that Ng paid the alleged bribes because if the UN agreed to support the convention center that Ng hoped to build at no cost to the UN, and to hold its annual exposition there at no cost to the UN, then Ng might obtain business from third parties for as-yet unbuilt shops, restaurants, and apartments that would be located around the center. That chain of inferences stretches far beyond what the FCPA was enacted to prohibit. Even if such a remote connection to commercial business could suffice, moreover, the jury was not instructed—over Ng’s objection—that any connection to commercial business was required.  The jury thus had no way to know whether “business” referred to commercial business, or what kind of nexus to commercial business the statute requires.”As to the FCPA specific issue, the DOJ’s opposition brief stated:“Ng claims that he warrants bail pending appeal because he intends to argue that there is insufficient evidence that he paid bribes with the intent to “obtain[] or retain[] business,” as required under the FCPA. This claim, which only concerns two counts, was not presented by Ng in seeking bail pending appeal before the District Court. This Court could therefore choose to remand this portion of Ng’s motion. But there is no need to do so. A jury verdict must be upheld if “any rational trier of fact could have found the essential elements of the crime beyond a reasonable doubt.” The jury here was presented with overwhelming evidence that the bribes Ng paid were intended to advance his business interests. This evidence included, among other things, a promotional video for the Macau Conference Center that highlighted that the project would be developed by Ng’s for-profit real estate company, and would include a hotel, a shopping center, residences, and a marina. And rather than bring Ashe, Lorenzo, and others from the UN to a project that might deemed “philanthropic”, when they came to Macau, Ng took them to another for-profit, luxury project developed by his company, with marble floors, gold statues, and a clubhouse with a cigar lounge and wine storage.Ng suggests that while the evidence might otherwise have been sufficient, the District Court erred by not instructing the jury that “business” means “commercial business.”  This suggestion should be rejected out of hand. The District Court’s instruction was taken directly from the statute. Ng does not explain on what basis this Court should conclude that a jury does not know what a commonsense term like “business” means, and there is no likelihood whatsoever that it would have made any difference had the District Court said “commercial business” rather than “business,” in a case where the only business discussed by anyone, including Ng, as the beneficiary of Ng’s bribes was his for-profit real estate development company.”Seng’s reply brief stated:“The only connection between the charged conduct and commercial business that the government asserts in its opposition is the same attenuated theory it asserted at trial: that if the UN supported the convention center that Ng planned to build the UN for free, then Ng might someday obtain additional business from third parties for future shops, restaurants, and apartments in the area. The government cites not one case holding that this build-it-for-free-and-others-will-come-and-pay theory is enough to satisfy the FCPA, and there is a substantial question as to whether it should be. See United States v. Kay, 359 F.3d 738, 746-47 (5th Cir. 2004) (explaining that FCPA criminalizes only “commercial bribery”).The government downplays the district court’s refusal to instruct the jury that “business” under the FCPA means “commercial business.” But that error easily could have misled the jury, as the court repeatedly used “business” elsewhere in its instructions to refer more broadly to either commercial or noncommercial transactions. And the point was critical since Ng’s defense turned heavily on his philanthropic motives.”In denying Seng’s bail request, the court did expedite the appeal.Seng is represented by Kirkland & Ellis attorneys Paul Clement, Viet Dinh, Erin Murphy and Harker Rhodes. FCPA Institute – Boston (Oct. 3-4) A unique two-day learning experience ideal for a diverse group of professionals seeking to elevate their FCPA knowledge and practical skills through active learning. Learn more, spend less. CLE credit is available. Learn More & Registerlast_img read more

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July 21, 2019

VE Advises Noble in Marcellus Exit

first_imgHouston-based Noble Energy said Thursday that it will exit the Marcellus Shale by divesting its midstream assets in the Marcellus Shale to a portfolio company of Quantum Energy Partners for $765 million. Noble will now focus its efforts on the DJ Basin and Delaware Basin, two areas that are hot trends in the oil & gas industry . . .You must be a subscriber to The Texas Lawbook to access this content. Username Lost your password? Passwordcenter_img Remember me Not a subscriber? Sign up for The Texas Lawbook.last_img

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July 20, 2019

EU Elections

first_img Categories: European Union, Politics « EU Elections with Exit Polls Greek Prime Minister Alexis Tsipras has called a snap election after disappointing results from his party in the European Elections. His Syriza party was estimated to have received just 23.94% of votes in the elections, trailing behind its main opposition party New Democracy, which received 33.28%. A far-right party in Italy’s of Deputy Prime Minister Matteo Salvini has come out on top in Italy’s European parliamentary elections based on the exit polls. It certainly appears that Nigel Farage will come out on top in the UK. So far, we are looking at truly a sea-change in Europe.Nevertheless, the European People’s Party in the European Parliament has influence in all the EU’s institutions and it will most likely remain with the greatest number of seats probably around 23%. It has been the largest political group in the European Parliament since 1999. In the European Council, 9 out of 28 Heads of State and Government belong to the EPP family and in the European Commission, 13 out of 27 Commissioners come from EPP parties. The EPP looks to be losing more than 40 seats.The parties who seem to want reform should combine about 200 seats against about 540 seats. The question that will rise is how will Brussels react? Ignore it and push on or reform? It appears that there will not be a reform movement and Brussels will most likely try to paint this as a temporary populace fluke as did Washington Republicans with Trump.center_img The Shift from Public to Private Assets in Europe »last_img read more

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July 20, 2019

Entrepreneurs Attend WVCChelanDouglas Unemployment Rate Drops to 33Forum on Proposed Charter School

first_imgThe Wenatchee Valley College has launched a start up program … Audio Playerhttps://www.kpq.com/wp-content/uploads/2018/11/wvc-11a.wav00:0000:0000:00Use Up/Down Arrow keys to increase or decrease volume.Stacy Luckesmeyer, business & industry liaison with the Center for Entrepreneurship at WVC … says if you have the mind of an entrepreneur you should begin your investigation of the new program online at wvc dot edu …last_img

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July 20, 2019

Seattle Cancer Care Alliance wins Employer of Excellence award

first_img Source:https://www.seattlecca.org/ May 28 2018Seattle Cancer Care Alliance (SCCA) announced today that it is one of eight national recipients of an Employer of Excellence award from the American Academy of Physician Assistants (PA’s) Center for Healthcare Leadership and Management. SCCA accepted the award during the American Academy of PAs’ (AAPA) Annual Conference, earlier this week in New Orleans, LA.”This award reinforces that Seattle Cancer Care Alliance is a top place to work for APPs, and their invaluable commitment to our organization and patients,” said F. Marc Stewart, Medical Director and senior vice president at Seattle Cancer Care Alliance.The award program is designed to showcase hospitals and health systems that have implemented practices that create positive work environments for PAs (physician assistants) and encourage collaborative provider teams. The program is the first and only PA-specific award program available to hospitals and health systems.”This award demonstrates the incredible engagement of our APP workforce, and the impressive organizational leadership team who appreciate the skills and contributions of our APP’s,” said Gabrielle Zecha, Director, Advanced Practice Providers at Seattle Cancer Care Alliance.The 2018-2019 winners are: Establishing a positive and supportive PA work environment. Providing opportunities for PAs to provide meaningful input that leads to positive organizational change. Keeping PAs informed about organizational activity and decisions. Involving PAs in leadership efforts to improve the quality of patient care. Creating processes for effective conflict management. “These hospitals and health systems have earned designation as Employers of Excellence by taking specific steps to empower their PAs and promote mutual respect and effective communication among all of their healthcare providers,” said Jennifer Broderick, managing director of CHLM. “We’re thrilled to be able to recognize organizations that are going the extra mile to ensure their PAs get the opportunity to work in engaging environments and achieve the best patient outcomes.”Each awardee will be showcased as a top place to work for PAs, which will enhance recruitment of highly-qualified PAs, increase retention rates, and showcase the awardees as pioneers in the healthcare industry. Awardees will retain their designation as an Employer of Excellence for two years, and then must re-apply to maintain the designation.Any hospital or health system in the United States that employs PAs was eligible to apply for the award. The next online application period opens in fall 2018.center_img “These eight hospitals and health systems have unlocked some important secrets to maximize the value of PAs to their organizations and their patients,” said Jenna Dorn, CEO of AAPA. “PA-positive environments create a win-win situation for PAs and for employers.”Related StoriesEmbrace your natural skin tone to prevent skin cancer, say expertsStudy reveals link between inflammatory diet and colorectal cancer riskLiving with advanced breast cancerTo determine the criteria for recognition, CHLM partnered with HealthStream, a leading provider of workforce, patient experience, and provider solutions for the healthcare industry, to gain an understanding of what PAs value in their place of employment. Based on the survey findings, criteria for the Employer of Excellence Awards focused on five key drivers: Brigham and Women’s Hospital – Boston The Cleveland Clinic – Cleveland El Centro Family Health – Taos, New Mexico Hospital for Special Surgery – New York MidMichigan Health – Midland, Michigan NYU Langone Health – New York Seattle Cancer Care Alliance – Seattle Wake Forest Baptist Health – Winston-Salem, North Carolinalast_img read more

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July 20, 2019

Anything goes the shape of your vulva is unique and normal say

first_img Source:https://www.ncbi.nlm.nih.gov/pubmed/29940085 Image Credit: JpegPhotographer / Shutterstock By Dr. Ananya Mandal, MDJul 2 2018There are few women who have checked out their vulva using a hand-held mirror and liked what they saw. In the largest ever study conducted on vaginas and vulvas of women, researchers have said that there is nothing called a “normal vagina”. This study was published in the latest issue of the journal BJOG.center_img Related StoriesStudy: Two-thirds of pneumonia patients receive more antibiotics than they probably needBordeaux University Hospital uses 3D printing to improve kidney tumor removal surgeryRaw meat can act as reservoir for bacteria associated with hospital infectionsA team of researchers from Lucern Cantonal Hospital in Switzerland looked at 657 women aged between 15 and 84. Lead author Anne Kreklau and her colleagues meticulously measured the inner and outer labia, vaginal opening, clitoris and the perineum of the women. When they compiled their results, a wide variation was noted. No average size or shape could be deduced from the results that could fit most of the women the researchers explain.The two lips or the labia varied widely, they write. The outer labia or the labia majora was between 12mm and 180mm in length among the women. Similarly the inner labia or the labia minora varied between 5mm to 100mm in length. The clitoris was between 1mm and 22mm and its length varied between 0.5mm to 34mm. The vaginal opening size varied between 6 to 75mm.The researchers explain that this wide variation in size shows biological differences and emphasize those entirely healthy vaginas and vulvae can look entirely different from each other and that is normal. They explain that no vagina is “wrong or weird”. All the women measured were Caucasians in this study and the authors plan a more detailed study with women of different ethnicities.There is a major surge in labiaplasties or plastic surgery procedures to correct the shape and size of the vaginas and vulvae. In a 2016 survey 443 Australian GPs were interviewed. Of these 97 percent had reported that they cared for patients who were anxious over the appearance of their genitalia and if their vulva looked normal. A report released in 2017 by the International Society of Aesthetic Plastic Surgery said that there was a 39 percent increase in women who went under the knife between 2015 and 2016 for a vulval plastic surgery or labiaplasty. For most of these women the common complaint was that their vulvas were asymmetrical or too large.The labia and the vulva that are shown on screen, in anatomical illustrations and in porn are not the standard, the experts add, and women should stop trying to make their vulvae look like what they consider “beautiful”.last_img read more

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July 20, 2019

Tobacco products more aggressively marketed in Milwaukees minority neighborhoods

first_imgAug 3 2018Tobacco products in Milwaukee are more aggressively marketed in stores in African-American and Latino neighborhoods than in white ones, according to a study led by a public health researcher at the University of Wisconsin-Milwaukee.Results are similar to other studies showing that communities with lower incomes, lower educational attainment and more minority residents are targeted with significantly more tobacco promotion. This study is the first to document the trend in Milwaukee, said Linnea Laestadius, assistant professor in the Zilber School of Public Health.In addition to the disparity, the researchers have identified a state policy obstacle that keeps local governments from enacting more stringent regulation of tobacco advertising. The results were published Aug. 2 in the journal Tobacco Regulatory Science and were presented to the Milwaukee Common Council earlier this year.The study involved multiple stakeholder organizations, who conducted an audit of promotion and advertising practices at stores in three demographically distinct ZIP code clusters, with a random sample of tobacco retailers drawn from each.Compared to retailers in the predominantly white ZIP code cluster, stores in the African-American and Hispanic areas are more likely to engage in tactics like placing tobacco next to candy, placing ads in the line of sight of children and offering price promotions such as selling small cigars individually and for less than $1, said Laestadius.”The evidence is increasingly clear that children who are exposed to tobacco marketing in stores are more likely to start smoking,” she added.While it’s legal for retailers to market tobacco products, she said, these practices are not used to the same degree in the white ZIP code cluster. The tobacco industry spends over $8 billion annually on cigarette advertising and promotion.Related StoriesLow rates of recommended treatment for tobacco dependence in patients hospitalized with SUDsStudies show no evidence of fall in cigarette consumption due to WHO’s FCTCSmoking ban in prisons reduces levels of second-hand smokeLaestadius sees this as the industry cultivating the next generation of smokers by targeting susceptible populations. “Addressing point-of-sale advertising would ultimately help us reduce the disparities we see in smoking-related diseases,” she said.In Wisconsin, African-American adults and lower income adults have particularly high smoking rates, according to data from the Wisconsin Department of Health Services. Promotion of menthol cigarettes, which have higher carbon monoxide concentrations than regular cigarettes, was most common in the African-American ZIP code cluster.The study team also pointed to a state level policy, called preemption, that bars local governments from establishing regulations that are stricter than Wisconsin legislation on advertising, licensing and youth access. For example, the rule means Milwaukee couldn’t adopt a ban on menthol cigarettes, which have long been targeted at African American communities. Changing state law would give cities a better chance to protect their residents and promote health.Store audits were conducted by public health workers and volunteers at 195 tobacco retailers during three months of 2016. The auditors used the Standardized Tobacco Assessment for Retail Settings form co-developed by the Centers for Disease Control and Prevention, specifically designed to help community groups collect data to inform policy change.Source: https://uwm.edulast_img read more

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July 20, 2019

One more question Dr Frieden Eleven things wed like to know about

first_imgQ: What training, specifically, did health care workers receive prior to treating Mr. Duncan? Who provided the training and how long did it last? Q: You have repeatedly assured the United States that we know how to stop Ebola. Are you concerned about the impact the two cases have on your credibility? Q: Nurses at the Dallas hospital have specified shortcomings in the way their hospital has handled Duncan’s case. Has your investigation confirmed these mistakes? Email Q: In West Africa, some health care workers have been afraid to care for Ebola patients, and some have not shown up for work or even left their homes. Has anyone at Texas Presbyterian refused to take care of Ebola patients? Country * Afghanistan Aland Islands Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia, Plurinational State of Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Cote d’Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People’s Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People’s Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia, the former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Martinique Mauritania Mauritius Mayotte Mexico Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Norway Oman Pakistan Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Qatar Reunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela, Bolivarian Republic of Vietnam Virgin Islands, British Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Q: What Ebola-specific training is provided now at Texas Presbyterian and at other hospitals around the country? Q: Do you think the media are paying too much attention to the U.S. outbreak and too little to the epidemic in West Africa?*The Ebola Files: Given the current Ebola outbreak, unprecedented in terms of number of people killed and rapid geographic spread, Science and Science Translational Medicine have made a collection of research and news articles on the viral disease freely available to researchers and the general public. Q: Why is the second case being moved to Emory? Are you concerned about the level of care at Texas Presbyterian, further infections, or both? Q: Should all future patients be moved to one of the four Ebola-specialized treatment centers in the United States if their condition allows it? Q: At CDC’s Ebola training course in Anniston, Alabama, health care workers are told to strictly limit shifts in Ebola treatment units, starting with 1-hour rotations. Is Texas Presbyterian using a similar strategy? Are Emory and the other dedicated centers? Click to view the privacy policy. Required fields are indicated by an asterisk (*) Q: You said that about 50 health care workers entered Duncan’s room and that you want to limit the number of people exposed to Ebola patients. How do you do this? What is the minimum number needed for a single patient? Q: Are people taking care of Ebola patients allowed to help other patients? Frieden vowed that this lapse would not happen again. “We will ensure from this moment forward that no other individual who is being monitored for exposure undergoes travel in any way other than controlled movement,” he said, which can include chartered planes or cars but puts restrictions on the use of public transport. The new patient will be transferred to Emory University Hospital in Atlanta, which has a specialized unit to provide Ebola care, later today.From now on, CDC will send a rapid response “go” team to any health care facility that has an Ebola patient. CDC has also sent staff to Dallas and two Ebola-experienced nurses from Emory will provide training and supervision of the Texas Presbyterian health care workers.As often happens with major breaking news stories, CDC could not answer all the questions of the reporters who attended the press conference or joined by telephone. ScienceInsider had two reporters on the call who were not selected. They were left with the following questions.Q: You said that the two health care workers may have been particularly vulnerable between 28 September, when Duncan was admitted to the hospital and isolated, and 30 September, when he received his diagnosis. Was infection control inadequate during those days—and how so? Why is it less likely that they became infected after his diagnosis? Sign up for our daily newsletter Get more great content like this delivered right to you! Country A second health care worker at Texas Presbyterian Hospital in Dallas has tested positive for the Ebola virus. Today, the U.S. Centers for Disease Control and Prevention (CDC) said that its investigations “increasingly suggest” that she and a colleague diagnosed with Ebola on 14 October were at highest risk of infection between 28 and 30 September, when Thomas Eric Duncan had been admitted to the hospital but had yet to receive confirmation that he was infected.“These two health care workers both worked on those days, and both had extensive contact with the patient when the patient had extensive production of body fluids because of vomiting and diarrhea,” said CDC Director Thomas Frieden at a press conference today.The second health care worker flew from Cleveland, Ohio, to Dallas on 13 October, the day before she developed symptoms, leading CDC to try to contact the 132 passengers and the crew on that flight. (The woman had an “elevated” temperature of 99.5°F, or 37.5°C; that’s below the threshold for a fever, which is at 100.4°F, or 38.0°C.) Frieden said the woman, whose job he did not specify, “should not have traveled on a commercial airline” but stressed she did not vomit and was not bleeding during the trip. “The level of risk of people around her would be extremely low,” he said.last_img read more

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July 20, 2019

Critics assail paper claiming harm from cancer vaccine

first_img Sign up for our daily newsletter Get more great content like this delivered right to you! Country The tussle is the latest salvo in a widen
ing global battle over the HPV vaccine. Originally licensed in 2006, the vaccine is now approved for use in more than 
120 countries. Studies show it is already starting to reduce HPV infections, which are blamed for 528,000 cervical cancer cases and 266,000 deaths each year, with the greatest burden in developing countries. (Boys are also now getting vaccinated, as HPV can cause genital warts and various cancers.) But in several countries, girls have complained of debilitating symptoms, reminiscent of chronic fatigue syndrome, 
after vaccination. Email By Dennis NormileDec. 21, 2016 , 9:30 AM Alarmed by “pseudoscience” that may bring “devastating” health consequences, two groups of researchers have asked the journal Scientific Reports to retract a paper that they claim undermines confidence in the human papillomavirus (HPV) vaccine, given to girls to prevent cervical cancer.The 11 November paper describes impaired mobility and brain damage in mice given an HPV vaccine. The mice received doses that were proportionally a thousand times greater than that given to people, along with a toxin that makes the blood-brain barrier leaky. That protocol, critics contend, does not mimic what happens in the human body.“Basically, this is an utterly useless paper, a waste of precious animals,” David Gorski, a surgical oncologist at the Barbara Ann Karmanos Cancer Institute in Detroit, Michigan, wrote on his Orac blog at scienceblogs.com. In an email to Science, the paper’s corresponding author, Toshihiro Nakajima of Tokyo Medical University, defended the work, stating: “Our manuscript was formally published after an intensive scientific review done by reviewers and by the editorial board of Scientific Reports.” Critics assail paper claiming harm from cancer vaccine Country * Afghanistan Aland Islands Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia, Plurinational State of Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Cote d’Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People’s Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People’s Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia, the former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Martinique Mauritania Mauritius Mayotte Mexico Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Norway Oman Pakistan Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Qatar Reunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela, Bolivarian Republic of Vietnam Virgin Islands, British Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe The Yomiuri Shimbun via AP Images Off the cliff After claims arose that the human papillomavirus vaccine could cause debilitating side effects, the vaccine rate among women in Japan plummeted. Click to view the privacy policy. Required fields are indicated by an asterisk (*) Last July, women claiming side effects from the cervical cancer vaccine sued Japan’s government. (Graphic) J. You/Science; (Data) S. Hanley et al., The Lancet (27 JUNE 2015) © The Lancet These claims have attracted media attention, spawned antivaccination campaigns, and cut vaccination rates. More than 90% of Danish girls born in 2000 received at least one vaccine dose, but that rate has dropped year by year. Ireland also saw a drop in vaccination rates in 2015 and 2016. The trend is “alarming,” says Heidi Larson, who heads the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine.Japan is the prime battleground. As in many countries, the HPV vaccine got off to a promising start there. The first vaccine was licensed in 2009; in April 2013, the ministry added the vaccine to its recommended list and offered it for free. Uptake was robust. Sharon Hanley, a cancer epidemiologist at Hokkaido University in Sapporo, Japan, and colleagues reported in The Lancet in 2015 that roughly 70% of girls born between 1994 and 1998 completed the three-dose vaccination course.In spring 2013, however, a number of media outlets in Japan reported on alleged side effects. These include difficulty walking, headache, fatigue, poor concentration, and pain. That June, the health ministry suspended its “proactive recommendation” for vaccination, pending an investigation.The following January a ministry panel concluded that there is no evidence for a causal association between the HPV vaccine and the reported adverse events. The European Medicines Agency and the U.S. Centers for Disease Control and Prevention have come to similar conclusions. Epidemiological studies indicate that the symptoms reported by the vaccinated girls are found at equal rates in nonvaccinated populations. Yet Japan’s health ministry has never restored its proactive recommendation, which means that although the government pays for the shots, it has stopped urging local authorities to promote vaccination.Vaccination rates have plummeted in Japan. Hanley says that in the city of Sapporo, the vaccination rate fell to just 0.6% of eligible girls, and she believes that nationwide, the rate is close to zero. (In a sign of growing trouble for vaccination, 63 women in July filed a class-action lawsuit against the government and vaccinemakers, seeking $125,000 each in compensation for the alleged side effects.) Larson notes that health ministries in other countries aggressively promoted vaccine safety after claims of side effects surfaced, keeping vaccination rates high. An official at Japan’s health ministry says a decision on restoring the proactive recommendation is under review.Nakajima’s study is sure to inflame the debate. His group gave mice large doses of the HPV vaccine along with a pertussis toxin to help the vaccine slip into the central nervous system. The treatment, they found, impaired tail movement and locomotion. A postmortem revealed structural damage, increased cell death, and other abnormalities in the mice’s brains.Critics assail the study in a pair of letters to Scientific Reports and its publisher, the Nature Publishing Group. One, signed by 
20 members of the HPV Prevention and Control Board at the University of Antwerp in Belgium, asserts: “This experimental setup in no way mimics the immunization with HPV vaccines but is gross over dosage and manipulation of membrane permeability.” A second letter, from David Hawkes, a viro
logist at the University of Melbourne in Australia, and two colleagues argues that the paper “lacks a clear methodology, adequate controls to control for bias, descriptions of results consistent with the data presented, or enough information for this study to 
be reproduced.”Nakajima defends his group’s methodo
logy, stating that they adopted a strategy similar to that commonly used in studying autoimmune encephalitis in mice. As for the dose, he wrote, “This is just the first paper and dose-dependency could be one of the interesting experiments in the future.” He added that they are now preparing a detailed response to criticisms of their paper.Vaccine proponents worry that the paper will embolden vaccine opponents. Nearly 200 tweets have mentioned it, with several mistakenly assuming it appeared in Nature. Both letters call on Scientific Reports to withdraw it. In an email to Science, a journal spokesperson confirmed having received the letters, and wrote, “We investigate every concern that is raised with us carefully and will take action where appropriate.”Even as opposition to the HPV vaccine gains momentum, evidence of its efficacy is accumulating. But with its paltry vaccination rate, Japan is unlikely to see any reduction in its current 9000-plus cases of cervical cancer and 3000 deaths each year. Worse, says Larson, Japan’s suspension of the proactive recommendation “has been particularly applauded” by vaccine-critical groups in other countries. For women in Asian nations with weaker health infrastructure, Hanley adds, “The vaccine may be their only hope of prevention.”last_img read more

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July 20, 2019

How HIVAIDS ended up in Trumps State of the Union speech

first_img How HIV/AIDS ended up in Trump’s State of the Union speech President Donald Trump announced an initiative to end HIV/AIDS in the United States during his State of the Union address. Sign up for our daily newsletter Get more great content like this delivered right to you! Country By Jon CohenFeb. 6, 2019 , 5:05 PM Trump devoted 63 words to the topic in his speech, which left many unanswered questions about what, exactly, the administration plans to do, how much it will cost, and where the money will come from. But this morning, Fauci, Redfield, Giroir, and other health officials took part in a press briefing to better explain their vision.The push to end AIDS in the United States will concentrate on improving diagnosis, treatment, and prevention efforts in 48 counties; Washington, D.C.; and one municipality in Puerto Rico; those locations account for more than half of the nearly 40,000 new HIV diagnoses each year. “When we originally did this [analysis] and I saw the map of those counties I was shocked that it was only 48 counties out of over 3000 counties in the United States,” said Redfield, who described the new program as “laser focused.” They also will target seven states that account for the majority of infections in rural populations, including Native American communities that have had sharp increases in HIV diagnoses in men who have sex with men.Fauci acknowledges that even before he met with Redfield, many of the specifics of the plan “were floating around in a very similar way.” Indeed, a similar vision is spelled out in detail in National HIV/AIDS Strategy reports issued during the administration of former President Barack Obama. CDC reports have also documented the hot spots for years. And those maps have helped clarify the problem, Fauci notes. “There’s nothing like, ‘Holy mackerel, there are a lot of infections in this district!’” he says. But he says there’s never been “a concerted, multiagency effort” to address gaps in the federal response with a target date to “end the epidemic as we know it.”The goal of the new program is to reduce new infections by 75% in 5 years, and by 90% in 10 years. “HIV has cost America too much for too long,” says Giroir, HHS’s assistant secretary of health, who noted that 700,000 Americans have died from AIDS.Girior won’t specify how much money the initiative would cost, but says Trump’s budget request, expected next month, will ask Congress for new funding. They do not plan to take it from existing HHS programs. “We are very confident we will have the sufficient resources provided in the 2020 budget for us to begin this very aggressive plan,” he says. (Congress will have the final say on any spending.)Fauci said a key part of the plan is to better coordinate the contributions of 19 Centers for AIDS Research (CFARs) that together receive $45 million a year from the National Institutes of Health. The CFARs, mainly based at universities, conduct multidisciplinary studies on everything from epidemiology to behavioral research and “implementation” science that looks at how best to keep HIV-infected people in care and help uninfected access proven interventions. “The location of the 19 CFARs beautifully overlap—although not completely—with the hot spots,” Fauci says. The CFARs have strong ties to their communities, he says, and they can better coordinate how they work together.Michael Saag, director of the CFAR at the University of Alabama in Birmingham, welcomes the new initiative and says his counterparts around the country have much to learn from one another and from international efforts. “The CFARs are beginning to form a larger, national group effort to share best practices and ways forward,” Saag says. Douglas Richman, who leads the CFAR at the University of California, San Diego, notes that clinics at CFAR sites often do a good job of providing testing and access to convenient care, but says the “practical issue” is how to reach vulnerable and uninsured people who now are outside the system.Several advocacy groups have welcomed the push to end AIDS by 2030 in the United States, but they also have raised serious concerns about the Trump administration’s treatment of many of the communities most vulnerable to HIV infection. As the International AIDS Society in Geneva, Switzerland, cautioned in a statement: “We must also acknowledge that this announcement is inconsistent with the policies and rhetoric that directly attack trans people and the larger LGBTQ [lesbian, gay, bisexual, transgender, and questioning] community, people who inject drugs, people of colour, refugees, sex workers and women’s rights.”Redfield stresses that leaders recognize the epidemic is concentrated in vulnerable communities. “Stigma is the enemy of public health,” says Redfield, adding that transgender people and injecting drug users, in particular, have suffered. “We need to be able to address in a comprehensive way how to destigmatize HIV infection.”The new plan will put much emphasis on offering anti-HIV drugs to uninfected people as part of a proven strategy called pre-exposure prophylaxis, or PrEP. Giroir says 1.2 million Americans are at high risk of HIV infection and candidates for PrEP, but only 10% receive it. “It’s an astounding and shocking figure that so few are getting an indicated medication, but [it’s] a tremendous opportunity for us to expand the program,” Giroir says. And he says models show that if 60% of these people use PrEP, new infections will drop by 90%.Giroir urges Congress to support the plan. “This is a public health issue,” he says. “Everybody should be behind this.” Click to view the privacy policy. Required fields are indicated by an asterisk (*)center_img Doug Mills/picture-alliance/dpa/AP Images The people who planted the seed that led President Donald Trump to announce a new agenda to end AIDS in his State of the Union address yesterday had no notion that their idea would receive this kind of prime-time attention.Last summer, a few months after taking the helm of the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta in April 2018, Robert Redfield met with Anthony Fauci, who heads the U.S. National Institute of Allergy and Infectious Diseases in Bethesda, Maryland. One topic of discussion was their vision of how to better coordinate the federal government’s response to the country’s HIV/AIDS epidemic and to help bring it to an end. “We got together and said this can work, let’s start pushing it,” Fauci tells ScienceInsider.About 2 months ago, Fauci and Redfield took their idea to their boss, Alex Azar, who leads the Department of Health and Human Services (HHS) in Washington D.C., and his top deputy, Brett Giroir. “Alex really, really liked it,” Fauci says. “He said, ‘I think we can bring this to the president.’ We said, ‘Wow, wouldn’t that be interesting.’ The president was very excited about it and said, ‘Let’s do it.’” (Fauci, incidentally, says he has developed friendships with all five previous presidents, but has yet to meet Trump.) 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