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Saturday, September 24, 2022

Fentanyl crisis is an international attack on America


Nearly 3,000 people were murdered on 9/11 by terrorists who entered the United States. Immediately, our government took action to prevent future attacks and protect Americans. We tightened security. We put checkpoints in our airports – and we began special screening procedures for people entering America from overseas. We changed our cockpit access. We created "no fly" lists. We didn’t just sit there and hope that the threat would go away.

After COVID-19 surfaced in January 2020, it was quickly apparent that our nation was again under attack, very much like that sunny Tuesday morning in September 2001. Except that this time the culprit was a virus from abroad. To respond, our government – and governments around the world – took similar decisive action to slow the spread. The United States and other nations temporarily closed their borders and restricted international travel until we could fully identify the problem and get this enemy under control. When travel reopened, we created new checks and tests to try to prevent infections from overwhelming our health care systems, until we had treatment options and a less lethal form of the coronavirus.

Yet when it comes to a third enemy coming from abroad, one that killed more than 71,000 Americans last year – many of them young people – our government is relying on outdated tactics and old ideas. 

I am talking about the fentanyl crisis, which is killing 195 Americans a day – one of those is country singer Luke Bell, who recently died of an accidental fentanyl overdose. 

Country singer Luke Bell, 32, was found dead in Tucson, Arizona, on Aug. 26, 2022. According to the Pima County Medical Examiner's Office, Bell’s cause of death was from fentanyl intoxication, while the manner of death was ruled accidental.
Country singer Luke Bell, 32, was found dead in Tucson, Arizona, on Aug. 26, 2022. According to the Pima County Medical Examiner's Office, Bell’s cause of death was from fentanyl intoxication, while the manner of death was ruled accidental.© Rick Diamond/Getty Images

Fentanyl is a synthetic opioid that is 50 times stronger than heroin and up to 100 times more potent than morphine, according to the U.S. Centers for Disease Control and Prevention. A lethal dose may be as small as 2 milligrams

When used illicitly, it can kill on the first use. The raw ingredients for illegal fentanyl come from China and are then sent to Mexico, where they are often pressed into pills – including what appear to be legitimate prescriptions like Xanax and valium or prescription pain medication. They could also be made into a powder, or combined with other illegal drugs to lower the cost and create a bigger “high” – a grisly imitation of putting fillers into foods to cut costs.

In one weekend, Sept. 17-18, U.S. Customs and Border Protection officers in Nogales, Arizona, confiscated about 400,000 fentanyl pills arriving from Mexico.

Legitimate fentanyl is used in medical settings, but illicit fentanyl is different. We politely label fentanyl deaths “overdoses,” but a truer term would be “poisonings” – or, given the explosive rise in deaths over the past few years, “murders.”

Fentanyl kills far more Americans each year than gun violence. More and more schools around the nation have “Narcan stations,” the rescue drug that can reverse a fentanyl overdose.

According to the National Institute on Drug Abuse, law enforcement seized nearly 10 million fentanyl-laced pills last year, an astronomical rise from the fewer than 300,000 pills seized in 2018.   

And what is our federal response to this deadly killer coming into our country?

The Biden administration is asking Congress for $42.5 billion for drug control programs – $3.2 billion more than this year. But when it comes to fentanyl, drug control – which is predominantly a combination of prevention and rehab strategies – is too late.

Fentanyl poisoning is often a one-time mistake. A teenager ingesting a fentanyl-laced pill does not simply become an addict needing rehab. Too often, tragically, all we can offer their family is a funeral home.

Last January, a 16-year-old high school sophomore and junior varsity basketball player in Bethesda, Maryland, died in a bathroom in his home after taking what turned out to be a counterfeit Percocet pill, laced with fentanyl. The pills were sold to him by a 23-year-old, according to Montgomery County police.

What about interdiction? The administration did set aside $275 million to disrupt drug trafficking across the nation through law enforcement programs. But by that time, fentanyl is already inside the USA.

It’s past time for all of us, Washington included, to uncover our eyes and see the situation for what it is: an international attack on our people. We are sacrificing more of our people in one year to fentanyl poisoning than the valiant Americans we lost in the Vietnam War

We must commit ourselves to fighting back: Let’s get tough with China’s manufacturing and exporting of fentanyl raw materials. Let’s use trade and financial restrictions to get Mexico to clean up its cartels, and let’s stop the fentanyl from coming over the border. Let’s wake up and fight this crisis head-on.

Greta Van Susteren anchors "The Record" on Newsmax. She is also a former television news anchor for CNN, Fox News and MSNBC.

They Were Entitled to Free Care. Hospitals Hounded Them to Pay

 With the help of a consulting firm, the Providence hospital system trained staff to wring money out of patients, even those eligible for free care.

In 2018, senior executives at one of the country’s largest nonprofit hospital chains, Providence, were frustrated. They were spending hundreds of millions of dollars providing free health care to patients. It was eating into their bottom line. ... The executives, led by Providence’s chief financial officer at the time, devised a solution: a program called Rev-Up. ... Rev-Up provided Providence’s employees with a detailed playbook for wringing money out of patients — even those who were supposed to receive free care because of their low incomes, a New York Times investigation found.

In training materials obtained by The Times, members of the hospital staff were instructed how to approach patients and pressure them to pay. ... “Ask every patient, every time,” the materials said. Instead of using “weak” phrases — like “Would you mind paying?” — employees were told to ask how patients wanted to pay. Soliciting money “is part of your role. It’s not an option.” ... If patients did not pay, Providence sent debt collectors to pursue them.

More than half the nation’s roughly 5,000 hospitals are nonprofits like Providence. They enjoy lucrative tax exemptions; Providence avoids more than $1 billion a year in taxes. In exchange, the Internal Revenue Service requires them to provide services, such as free care for the poor, that benefit the communities in which they operate. ... But in recent decades, many of the hospitals have become virtually indistinguishable from for-profit companies, adopting an unrelenting focus on the bottom line and straying from their traditional charitable missions.

To understand the shift, The Times reviewed thousands of pages of court records, internal hospital financial records and memos, tax filings, and complaints filed with regulators, and interviewed dozens of patients, lawyers, current and former hospital executives, doctors, nurses and consultants. ... The Times found that the consequences have been stark. Many nonprofit hospitals were ill equipped for a flood of critically sick Covid-19 patients because they had been operating with skeleton staffs in an effort to cut costs and boost profits. Others lacked intensive care units and other resources to weather a pandemic because the nonprofit chains that owned them had focused on investments in rich communities at the expense of poorer ones. ... And, as Providence illustrates, some hospital systems have not only reduced their emphasis on providing free care to the poor but also developed elaborate systems to convert needy patients into sources of revenue. The result, in the case of Providence, is that thousands of poor patients were saddled with debts that they never should have owed, The Times found.

Conservative Group Asks IRS To Deny Tax Exemptions To Zuckerberg For 2020 Election Grants

 A conservative activist group has filed a complaint with the IRS asking the agency to deny personal tax exemptions for Mark Zuckerberg and his wife Priscilla Chan arising from the couple’s funding of grant programs to help municipalities pay for the 2020 general election.

In a second complaint, the Center to Renew America (CRA) requested the removal of tax exemptions for three Zuckerberg-supported non-profits: the Center for Tech and Civic Life (CTCL), the Center for Election Innovation and Research (CEIR), and the National Vote at Home Institute (NVAHI).

The complaints allege that the Zuckerbergs and the three organizations pumped almost $500 million into the 2020 election process in an effort to influence the outcome in favor of candidate Joe Biden and other Democrats.

CTCL alone distributed nearly $350 million in grants to local election departments with a stated mission of helping them conduct safe elections during the first year of the COVID-19 pandemic.

A woman holding her ballot walks past a Vote by Mail Drop Box for the 2020 U.S. Elections in Monterey Park, Calif., on Oct. 5, 2020. (Frederic Brown/AFP via Getty Images)

Mark Zuckerberg, through various non-profit organizations, contributed hundreds of millions of dollars towards efforts to rig the 2020 election,” states a Sept. 22 tweet from the CRA. “Today, we filed TWO formal IRS complaints against Zuckerberg to call him on this ILLEGAL activity.”

CTCL brushed off similar allegations from conservative groups in December 2021 as “disinformation,” asserting in its final report on the 2020 COVID-19 response grant program that “partisan considerations played no role in the availability or awarding of funding.”

The report states that nearly 2,500 election departments spread over 49 states received grants ranging from $5,000 to $19 million.

For years, conservatives have accused the Zuckerbergs and the three organizations of directing millions of dollars in grant funding to Democrat-leaning localities.

They allege that most of the money was spent on voter registration drives and get-out-the-vote efforts in the large cities of several swing states, instead of on public health.

Statistics published by CTCL show that the city of Detroit, a Democrat stronghold, received more than $3.5 million in grant money in the runup to the 2020 presidential election, while most Republican-dominated jurisdictions received $5,000 grants or nothing at all.

Poland Begins Handing Out Iodine Pills On Fears Of Ukraine Nuclear Plant Meltdown

 Poland has begun a program of distributing iodine tablets to emergency workers and first responders, starting with regional fire departments - who can in turn hand them out to the general population - in the event of a possible radioactive disaster at Europe's largest nuclear power plant

A Polish deputy minister first announced the plan on Thursday, warning of the possibility of dangerous radioactive exposure amid continued fighting in neighboring Ukraine, where technicians at the Zaporizhzhia Nuclear Power Plant continue to struggle to maintain safeguards.

"After the media reports about battles near the Zaporizhzhia Nuclear Power Plant, we decided... ahead of time to take protective action to distribute iodine," the Polish official, Blazej Pobozy, said in a national radio broadcast.

"I would like to reassure all citizens that these are routine, preemptive actions that are to protect us in the event of a situation which… I hope will not happen." Iodine tablets can help protect against conditions associated with radioactive exposure such as thyroid cancer.

The plant has suffered frequently cut power cables, having been removed from the nation's power grid multiple times and reverting to back-up measures, amid shelling in the area as some 500 Russian troops have occupied the complex since March.

Both sides have continued to blame the other for the deteriorating operating conditions, which earlier in the month caused plant operators to take a sixth reactor off the grid out of an abundance of caution while a power line was being restored after fire.

Earlier this month, Ukrainian President Volodymyr Zelenskiy said, "Due to Russian provocation, the Zaporizhzhya plant is one step away from a radiation disaster."

A couple of IAEA officials are still present at the site, with the UN nuclear watchdog talking about implementing plans to establish a "nuclear safety and security protection zone" around the plant.

Various attempts have been made to model the impact of potential radiation fallout centered at Zaporizhzhia...

Below is a timeline review of events based on Ukrainian regional reporting and Yahoo News:

  • Russia captured the Chornobyl NPP in the beginning of the full-scale invasion in Ukraine. On 4 March, it captured the Zaporizhzhia NPP, creating a threat of radiation disaster. In mid-March, Russian occupying forces detonated ammunition on the territory of the ZNPP.

  • On 15 July, Energoatom reported that Russia had deployed several missile systems on the territory of the ZNPP. Russian forces were using these weapons to fire on the area around the city of Nikopol.

  • On 1 September, the International Atomic Energy Agency (IAEA) mission arrived at the ZNPP.

  • On 2 September, Rafael Grossi, Director General of the IAEA, confirmed that two representatives of the organisation would remain at the ZNPP after the mission was over.

  • On 5 September, four out of six IAEA inspectors finished their inspection of the plant and left the ZNPP. Two IAEA workers remained at the power plant.

  • On 5 September, as a result of a fire caused by Russian shelling of the ZNPP, the last line connecting the ZNPP and the Zaporizhzhia Thermoelectric Power Plant to Ukraine’s power grid was disconnected.

Beating Inflation Is Easy Online—Except for Sellers

 On the web, inflation isn’t an issue for buyers. Instead, it’s one for the businesses that promote there, with a repute for providing bargains.

Prices are rising rather more slowly on-line than within the wider shopper financial system. During the pandemic, e-commerce companies have been capable of cost a bit extra when retailers have been closed and demand surged, however their pricing energy is sporting off.

In August, on-line costs within the U.S. elevated by 0.4% year-over-year, in line with the Adobe Digital Price Index. Overall inflation was 8.3% for the identical interval, or 6.3% stripping out meals and power prices.

Digital retailers initially used low costs to lure buyers from bricks-and-mortar opponents with nice success. Now there’s intense competitors amongst on-line gamers themselves to supply bargains. The ease of looking 1000’s of various web sites on the click on of a button encourages sellers to chop costs or present low cost codes.

Retailers that promote each by means of shops and on-line might use their web sites to do away with extra inventory at a reduction, cementing the web’s repute for bargains. And classes that contain lots of innovation are typically deflationary as new merchandise push down the price of older fashions, mentioned Vivek Pandya, analyst at Adobe Digital Insights. Electronics, which usually tend to be offered on-line than the common good, have been in deflation on-line since no less than 2014, for occasion.

While the development ought to make shopping for on-line extra interesting to price-conscious customers, for now e-commerce corporations are dropping market share. Last month, 24% of U.Okay. retail gross sales occurred on-line, down from a peak of 38% early final yr. This principally displays a return to extra regular procuring patterns after a surge in on-line shopping for throughout the pandemic, however spending can be softer. Europe’s greatest online-only trend manufacturers, Zalando and ASOS, count on to extend gross sales by simply 2% or so of their present monetary yr.

Weak demand makes it onerous for digital manufacturers to offset rising prices. They are extra pinched by excessive transport payments than opponents that even have a community of shops. Getting items from a warehouse to prospects’ doorways is changing into costlier due to gasoline surcharges and rising wages for couriers. According to Deutsche Bank Research, prices related to residence supply are equal to 10% to fifteen% of an e-commerce model’s gross sales, in contrast with 2% to three% when a truck delivers stock to a retailer.

Another wave of revenue warnings from online-only retailers appears seemingly. On Friday, British furnishings model put itself up for sale simply 15 months after its preliminary public providing, having lower its revenue steering thrice this yr. Fashion retailer Zalando has launched minimal order values in additional international locations to attempt to defend the corporate’s quickly shrinking working margins.

E-commerce shares have been out of trend currently: ASOS and Zalando are each down greater than 70% this yr. If excessive inflation prompts extra buyers to hunt on-line for bargains, their market share may recuperate. Deutsche Bank’s Adam Cochrane additionally factors out that buy-now-pay-later choices would possibly encourage pinched customers to buy on-line reasonably than stump up the total quantity in shops. For now, although, traders are most likely proper to suppose there are higher offers elsewhere.

Friday, September 23, 2022

Powering up platelet production to battle blood shortages

 A new discovery from the University of Virginia School of Medicine could let doctors ramp up production of blood-clotting platelets on demand, a timely finding following the Red Cross' declaration earlier this year of a national blood "crisis." The group labeled it the worst blood and platelet shortage in more than a decade and said it posed a "concerning risk to patient care."

In addition to making available more lifesaving platelets for transfusion, UVA's new discovery could help doctors better treat thrombocytopenia, a potentially dangerous clotting disorder that strikes almost a third of newborns in intensive care. The finding also could benefit patients battling cancer who need cord-blood transplants.

"Because of worsening shortages of donor-derived platelet units, there has been a big push within both public and private sectors for cell culture-based methods of generating platelets," said Adam N. Goldfarb, MD, the chief of UVA's Division of Experimental Pathology. "In addition to alleviating platelet shortages, the cell culture approach affords the opportunity for creating 'designer platelets' -- for example, platelets that do not elicit an immune response, which is a major problem in cancer patients."

Understanding Platelet Production

The new findings offer important insights into platelet-producing cells called megakaryocytes and how they change between birth and adulthood. In babies, megakaryocytes are much better at proliferating -- making more megakaryocytes -- than they are at making platelets. It's like they're focused on building platelet-production factories. With time, the megakaryocytes begin cranking out platelets in great volume, but this is accompanied by a dramatic slowdown in the production of megakaryocytes. So platelet numbers go up, but the ability to create new "factories" slows to a crawl.

Goldfarb and his team found they could toggle megakaryocytes between their infant and adult modes -- between making factories or making platelets -- by blocking a particular enzyme, Dyrk1a. Need more factories? No problem. That could relieve a major bottleneck in the production of platelets outside the body for transfusion.

Further, the finding could benefit cancer patients who receive cord-blood transplants by helping overcome platelet problems that slow the immune system's recovery and raise the risk of dangerous infections. Patients often receive cord-blood transplants when they cannot find a suitable donor for stem-cell transplants. Finding a donor can be especially challenging for people of African, Asian, Hispanic, Middle Eastern, southern European or mixed ethnic backgrounds.

The discovery could also lead to new treatments for thrombocytopenia, a condition in which the body has too few platelets. This can be the result of immune system problems, a bone marrow disorder such as leukemia (blood cancer), some viral infections or the use of certain medications. Thrombocytopenia is a particular problem for premature babies -- the more premature the baby is, the more severe the condition tends to be. Many premature babies require platelet transfusions to reduce their risk of uncontrolled bleeding inside the body.

Promisingly, there are already drugs to inhibit Dyrk1a -- that could flip the biological switch in megakaryocytes. These drugs are being evaluated to battle diseases ranging from Alzheimer's to diabetes. The availability of the drugs should speed human trials testing the clinical benefits of manipulating megakaryocytes, the researchers say. "Fortunately, these megakaryocytes can be grown in large numbers from umbilical cord blood cells," said researcher Kamaleldin E. Elagib, MBBS, PhD, of UVA's Department of Pathology.

Goldfarb, the associate director of UVA Health's Clinical Hematology Laboratory, notes that the new discovery could have far-reaching benefits. "In the short term, we hope to improve the efficiency of donor-independent platelet production to the point where it could be scaled up for routine clinical use. In the long term, we hope to identify new patient treatments that could stimulate rapid platelet recovery," he said. "Our findings offer a perfect example of how studying infantile versus adult cell development can yield clinical benefits."

The research was supported by the National Institutes of Health, grants R01 HL130550 and R01 HL149667.

Story Source:

Materials provided by University of Virginia Health SystemNote: Content may be edited for style and length.

Journal Reference:

  1. Kamaleldin E. Elagib, Ashton Brock, Cara M. Clementelli, Gohar Mosoyan, Lorrie L. Delehanty, Ranjit K. Sahu, Alexandra Pacheco-Benichou, Corinne Fruit, Thierry Besson, Stephan W. Morris, Koji Eto, Chintan Jobaliya, Deborah L. French, Paul Gadue, Sandeep Singh, Xinrui Shi, Fujun Qin, Robert Cornelison, Hui Li, Camelia Iancu-Rubin, Adam N. Goldfarb. Relieving Dyrk1a repression of MKL1 confers an adult-like phenotype to human infantile megakaryocytesJournal of Clinical Investigation, 2022; DOI: 10.1172/JCI154839

More older adults should be checking blood pressure at home: study

 Only 48% of people age 50 to 80 who take blood pressure medications or have a health condition that's affected by hypertension regularly check their blood pressure at home or other places, a new study finds.

A somewhat higher number -- but still only 62% -- say a health care provider encouraged them to perform such checks. Poll respondents whose providers had recommended they check their blood pressure at home were three and a half times more likely to do so than those who didn't recall getting such a recommendation.

The findings underscore the importance of exploring the reasons why at-risk patients aren't checking their blood pressure, and why providers aren't recommending they check -- as well as finding ways to prompt more people with these health conditions to check their blood pressure regularly. This could play an important role in helping patients live longer and maintain heart and brain health, the study's authors say.

Past research has shown that regular home monitoring can help with blood pressure control, and that better control can mean reduced risk of death; of cardiovascular events including strokes and heart attacks; and of cognitive impairment and dementia.

The findings are published in JAMA Network Open by a team from Michigan Medicine, the University of Michigan's academic medical center. The data come from the National Poll on Healthy Aging and build on a report issued last year.

The poll, based at the U-M Institute for Healthcare Policy and Innovation and supported by Michigan Medicine and AARP, asked adults aged 50 to 80 about their chronic health conditions, blood pressure monitoring outside of clinic settings, and interactions with health providers about blood pressure. Study authors Mellanie V. Springer, M.D., M.S., of the Michigan Medicine Department of Neurology, and Deborah Levine, M.D., M.P.H., of the Department of Internal Medicine, worked with the NPHA team to develop the poll questions and analyze the findings.

The data in the new paper come from the 1,247 respondents who said they were either taking a medication to control their blood pressure or had a chronic health condition that requires blood pressure control -- specifically, a history of stroke, coronary heart disease, congestive heart failure, diabetes, chronic kidney disease or hypertension.

Of them, 55% said they own a blood pressure monitor, though some said they don't ever use it. Among those who do use it, there was wide variation in how often they checked their pressure -- and only about half said they share their readings with a health provider. But those who own a monitor were more than 10 times more likely to check their blood pressure outside of health care settings than those who don't own one.

The authors note that blood pressure monitoring is associated with lower blood pressure and is cost-effective. They say that the results suggest that protocols should be developed to educate patients about the importance of self blood pressure monitoring and sharing readings with clinicians.

Story Source:

Materials provided by Michigan Medicine - University of Michigan. Original written by Kara Gavin. Note: Content may be edited for style and length.

Journal Reference:

  1. Mellanie V. Springer, Preeti Malani, Erica Solway, Matthias Kirch, Dianne C. Singer, Jeffrey T. Kullgren, Deborah A. Levine. Prevalence and Frequency of Self-measured Blood Pressure Monitoring in US Adults Aged 50-80 YearsJAMA Network Open, 2022; 5 (9): e2231772 DOI: 10.1001/jamanetworkopen.2022.31772