Nearly 20% Of Seattle Shootings Happened Near Homeless Encampments

 Via The Epoch Times,

Data released by the city of Seattle reveals that homeless encampments are seeing a significant percentage of shots fired in 2022.

According to the latest update from the One Seattle Homelessness Action Plan, nearly 20 percent of all citywide shootings/shots fired through September were connected to an unauthorized encampment or a homeless person.

Out of 573 reports of shootings and shots fired, the city states that 101 reports were in connection to homelessness. That represents about 18 percent of total cases being near encampments throughout Seattle.

Seattle Mayor Bruce Harrell’s office said in a statement that the 101 reports represent an average of three shots fired per week in connection to homeless camps.

The King County Regional Homelessness Authority’s “Partnership for Zero Campaign” is a collaboration of city officials to find solutions to homelessness. Its initial focus is in Downtown Seattle and the Chinatown International-District.

Felicia Salcedo, the executive director of We Are In, previously stated that the two districts represent the largest concentration of the homeless in King County.

Out of the 573 reports of shootings and shots fired through the first nine months of the year, 61 occurred in the Downtown and Chinatown districts combined, according to the Seattle Police Department’s crime dashboard. That represents 10 percent of the total number of cases of shootings and shots fired throughout the city.

Earlier in October, Seattle announced an emergency operations center was up and running. It is located in the heart of the Chinatown District where tents are visibly prominent.

Marc Dones, the CEO of the authority, said the command center has already identified over 300 units of available housing and to date has engaged with over 650 people in need.

https://www.zerohedge.com/political/nearly-20-seattle-shootings-happened-near-homeless-encampments

Endometriosis Linked With Genital Microbiome Changes

 Women with endometriosis have an imbalance in the bacterial populations found in their vaginal microbiome, as well as throughout their entire reproductive system. This is the finding from a literature review focused on a number of case-control studies, the results of which were presented October 6 at the Infogyn 2022 conference. Preventive measures are suggested to promote the development of a balanced microbiome from adolescence.

"Dysbiosis of the vaginal microbiome may be a risk factor for endometriosis. Therefore, between puberty and adulthood, a key period in the development of endometriosis, certain environmental factors that could imbalance the vaginal microbiome, should be avoided," gynecologic surgeon Chadi Yazbeck, MD, of Pierre Cherest Clinic in Neuilly-sur-Seine, France, told Medscape Medical News.

Among these factors, Yazbeck cited gynecological and sexually transmitted infections, as well as endocrine disorders and environmental toxins, which mainly are found in plastic. To limit the risk of endometriosis, "teenagers should also be encouraged to have a varied and balanced diet" since the vaginal microbiome is affected by the gastrointestinal microbiome, he said.

Retrograde Menstruation

Endometriosis is an inflammatory and chronic gynecological condition characterized by the growth of fragments of endometrial tissue outside the uterine cavity. Sensitive to estrogens and to the menstrual cycle, endometriosis-related lesions cause pelvic pain and may lead to infertility. It is estimated that this disease, which develops between puberty and menopause, affects nearly 10% of women.

"The pathophysiology of endometriosis is still not completely understood," said Yazbeck. Endometriosis is often explained as being a consequence of retrograde menstruation, which is thought to take fragments of the endometrium back up toward the pelvis, via the fallopian tubes. "Nowadays, the rate of retrograde menstruation is similar in women with and without endometriosis," stressed Yazbeck.

Retrograde menstruation alone cannot explain the development of endometriosis, since it affects the most women. "Endometriosis is likely a multifactorial disease" linked to mechanical problems, the cause of an obstruction of the genital tract, genetic predisposition, hormonal factors, or even an inappropriate inflammatory response.

Recent data also suggest the role of bacterial contamination in causing dysbiosis in the vagina, throughout the entire reproductive system, as well as in the peritoneal fluid. A healthy microbiome (eubiosis) in the genital tract is made up of more than 90% lactobacilli. Below this threshold, there is an imbalance (dysbiosis) that could be linked to the introduction of pathogenic bacteria.

Increased Pseudomonas Presence

Several recent case-control studies have demonstrated the presence of dysbiosis in women with endometriosis. In one of these cases, a case of stage 3 and 4 endometriosis was associated with dysbiosis characterized by increased Gardnerella-, Escherichia-, and Shigella-type bacteria in the microbiome of the mucous membrane of the cervix, while there was a complete absence of Atopobium vaginae bacteria in the vagina and neck of the uterus.

In approximately 30 women with deep endometriosis, another study revealed an increased presence of Enterococcus- and Pseudomonas-type bacteria in the vaginal and endometrial microbiome, as well as in endometriosis lesions, compared with the microbiomes of women without endometriosis.

To assess endometriosis-related dysbiosis of the female genital tract on a global level, Brazilian researchers from the São Paulo University Clinic Hospital conducted a literature review focusing on 12 case-control studies, including the previous two mentioned here.

Their analysis showed that Pseudomonas-type bacteria were overrepresented in peritoneal fluid among women with endometriosis across multiple studies. They were also observed to be increased in vaginal, endometrial, and intralesional samples. The Gardnerella, Enterococcus, Streptococcus, and Staphylococcus types were also found in abundance.

Nevertheless, this analysis does have its limitations, Yazbeck stressed. In addition to being based only on case-control studies, the control groups included asymptomatic women, which in no way ensures that they are in good health and that their microbiome is healthy. "These women may have endometriosis without knowing," said Yazbeck.

Several hypotheses have been advanced to explain the effect of dysbiosis on the development of endometriosis. "It's likely that the microbiome, especially in a state of dysbiosis, may contribute to immune activation, which strengthens and prolongs peritoneal inflammation and eventually promotes the development of endometriosis," said Yazbeck. The consequence is then that "the evacuation of these cells from the endometrium is not being done correctly."

Future studies must instead confirm that this dysbiosis is indeed a cause of endometriosis and not the opposite, said Yazbeck. More details on the composition of the dysbiosis associated with endometriosis and the identification of disease-specific bacterial species are also pending.

"We could then start testing diagnostic strategies, as well as treatments using antibiotics or probiotics," Yazbeck concluded.

https://www.medscape.com/viewarticle/983197

From design to implementation, covid bivalent shots missed the mark

 In August, the FDA authorized updated COVID-19 vaccine boosters containing an equal mix of the ancestral vaccine and a component tailored against the Omicron BA.4/5 subvariants. It rejected the idea of yet another booster of the original vaccine -- which the U.S. has in abundant supply -- or authorizing a monovalent Omicron-only booster. In our view, this decision was not clear cut and may have been the wrong one.

European countries made different choices based on similar information, opting instead for a bivalent vaccine containing an equal mix of the ancestral vaccine and one designed against the Omicron BA.1 subvariant. Meanwhile, the World Health Organization's Strategic Advisory Group of Experts on Immunization (SAGE) committee recently noted that "...currently available data are not sufficient to support the issuance of any preferential recommendation for bivalent variant-containing vaccine boosters over ancestral-virus-only boosters....The bulk of the benefit is from the provision of a booster dose, irrespective of whether it is a monovalent or bivalent vaccine."

Why are there such different perspectives? Let's look at what the immunology tells us.

When a dose of a BA.4/5-specific vaccine booster is given, most of the resulting increase in antibody production is derived from memory B-cells primed by the ancestral vaccine. Only a small fraction of the antibodies recognize new binding sites unique to BA.4/5. Furthermore, because the bivalent boosters are a 50-50 blend of the ancestral and BA.4/5 vaccines, only a half-dose of Omicron-specific vaccine is being administered. These points are why we and colleagues have argued that the updated boosters may be at best minimally better at eliciting neutralizing antibodies against BA.4/5 compared to the original vaccines. Two preprints released this week show that this is indeed the case. And at least one study provides clinical data showing that the updated COVID-19 booster probably won't protect any better against Omicron infections than the original vaccine. It's important that people recognize these limitations and do not increase their exposure to the virus after being boosted.

A reasonable counter-argument was that we do need to keep up with the times and develop vaccines to better protect against the Omicron subvariants. Yet, administering a monovalent, and hence a full dose, of a BA.4/5 vaccine may have better achieved this goal. The available data suggest that monovalent Omicron vaccines elicit a stronger antibody response to Omicron subvariants than do bivalent formulations.

In moving ahead with the bivalent formula, the FDA may have wanted to hedge its bets against the possible re-emergence of a pre-Omicron or Delta-like variant this winter, a scenario that, while unlikely, is not impossible. At the same time, the U.S. was well prepared for that outcome, because we have enormous supplies of the ancestral COVID-19 vaccines, until they expire. These vaccines can now only be used for initial vaccinations, not boosters, at a time when very few Americans are lining up to get their initial COVID-19 vaccine series.

The FDA and CDC didn't assess an approach that could have considered vaccination against the Omicron variants as if they were entirely new viruses. We know that two full doses of the ancestral vaccines were needed to induce strong antibody responses. The same immunology considerations could have been applied to eliciting antibodies against the sites that are unique to the Omicron variants -- here, the science suggests two full-doses of an Omicron-specific monovalent vaccine would be much more effective than the single half-dose that's in the bivalent booster. This might have been a good option for vulnerable populations in need of the strongest practically achievable protection.

In rolling out boosters, the FDA and the CDC should also apply the lessons learned in properly spacing vaccine doses, as this is important for optimal benefit. The CDC advises that a booster can be given "within 2 months" of infection or vaccination. However, a 4- to 6-month interval would be substantially better if the goal is to maximize antibody production. Boosting too soon after the previous dose (or infection) likely won't work as well as waiting a few more months. One reason is the presence of pre-existing antibodies in the blood, which can form complexes with the spike proteins produced by the vaccine and thus impair how the immune system responds to the vaccine. The levels of those anti-spike antibodies are high for a month or two after vaccination or infection, but fall steadily over the next few months. Furthermore, boosting too soon abrogates B-cell responses to vaccination.

As we've heard over and over again, vaccines on shelves don't prevent COVID-19 -- vaccinations in arms do. One obvious factor driving poor booster uptake is that many aren't even aware that updated bivalent boosters exist. A recent Kaiser Family Foundation (KFF) survey shows that over half of adults in the U.S. have heard only "a little" (31%) or "nothing at all" (20%) about them. Another potential factor in the low uptake of the bivalent boosters could be the FDA's decision to authorize it without having human safety data in hand, only mouse studies. As scientists and healthcare professionals with vaccine experience, we have no concerns about the safety of the bivalent vaccine. It's still the same vaccine, just with a tweak. To us, it's akin to having a car resprayed in a different color. We would not require a full safety evaluation before driving it. However, the public is very fickle about mRNA vaccine safety because of the vicious lies circulated by vaccine skeptics. Authorizing a new vaccine based on only mouse data was asking for trouble. A significant fraction of the public (18%) is now in "wait and see mode," perhaps a reflection of a lack of trust in the safety of the bivalent boosters. This outcome was all too predictable. The FDA and CDC should have seen it coming. At the very least, the messaging could have been better. Furthermore, the FDA de-authorization for the standard booster eliminated an option for people who trusted that one but may be antsy about the safety of new bivalent versions.

The people at greatest risk for severe and fatal outcomes are those who haven't yet gotten vaccinated against COVID-19. According to KFF polling, this group has proven very resistant to change, although some are now slowly coming around. Unfortunately, the FDA did not authorize the bivalent vaccines for use as a primary series or to boost a previously infected but never vaccinated person. An updated primary series based on the bivalent vaccine might provide better protection as well. The bivalent vaccine would essentially initiate two different primary series responses -- one against ancestral viruses and one against Omicron subvariants.

There remain many uncertainties about how best to design and implement COVID-19 vaccines in the face of what seems to be an ever-evolving virus. The pandemic, in one form or another, will be with us for many years yet. To respond as effectively as possible, we must continue to study different vaccine designs in carefully designed clinical trials. We must fully factor in the outstanding improvements to the knowledge of viral immunology that have emerged in the past 2 years. Forewarned is forearmed.

John P. Moore, PhD, is a professor of microbiology and immunology at Weill Cornell Medicine in New York City. Céline Gounder, MD, ScM, is an internist, infectious disease specialist, and epidemiologist; a senior fellow and editor-at-large for public health at the Kaiser Family Foundation and Kaiser Health News

https://www.medpagetoday.com/opinion/second-opinions/101432

Hospitals pivot to new tactics as they try to recruit, retain staff

 Health systems are doubling down on their efforts to keep current employees while attracting an increasing number of new staff as the COVID-19 pandemic continues.

Many have dealt with burned out workers quitting, retiring or taking higher-paying traveling jobs over the past two and a half years. The deluge has spurred some systems to revamp their hiring methods, boost wages and benefits and provide other offerings to attract needed staff.

Registered nursing positions have been some of the toughest for hospitals to fill throughout the pandemic. More recently though, hospitals are struggling to find enough nursing assistants, food service and environmental workers, and other more entry-level staff.

“We’re not just competing among healthcare organizations anymore, which used to be the case, but now we’re really competing with the broader labor market, with hotels and restaurants and other industries,” Janet Tomcavage, chief nursing officer at Geisinger, said.

The nonprofit, 10-hospital system based in Pennsylvania has seen staff in housekeeping services, environmental and food services, and some nursing assistants leave for jobs at Walmart, Target and Starbucks, to name a few, “who are aggressively changing their workforce approaches as well,” Tomcavage said.

Persistent shortages of other clinical staff remain with nurses, respiratory therapists and ultrasound laboratory technicians. That’s leading to a gap in experience, as the tenure of nurses, particularly on the inpatient side, has dropped, she said.

“It’s not just the person. It’s the wealth of knowledge and experience that you lose,” she said.

Consequently, retaining current staff by making them feel engaged and valued is now a key part of Geisingers’ efforts to strengthen its workforce.

“One of the first categories that we paid attention to was compensation and making sure that we really are rewarding nurses for the work that they do,” she said. The system offered retention bonuses to entice staff to stay.

Another key tool is conducting stay interviews rather than exit interviews, where nurses and managers can discuss why nurses want to stay in their roles and what additional supports may be needed for them to continue doing that work.

“What annoys you at work? What are the things that are frustrating? Are these things likely to have you look elsewhere?” are some important questions to ask in stay interviews, Carey Goryl, CEO of the Association for Advancing Physician and Provider Recruitment, said.

Managers can use those responses and work to find solutions to commonly cited concerns, Goryl said.

Recruiting new staff is another challenge systems across the country face. At Kaiser Permanente’s 21 hospitals in Northern California, hiring demand increased through the pandemic and has remained elevated since, Ryan Fuller, regional director of workforce strategy for patient care services, said.

“It’s not something that a system can ever stop working on,” Fuller said.

A major part of Kaiser’s current hiring efforts revolves around making the interviewing process faster and simpler for both candidates and managers, Fuller said.

Kaiser recently revamped its processes, incorporating more technology and the ability for candidates to pre-record answers to interview questions for busy managers to review on-demand.

It also changed its application process by asking applicants to submit one application to a facility they’d like to work at — rather than having them apply for each role individually. Kaiser then works to find which open positions at that facility would be a good fit.

Those changes ultimately reduced the time it takes on average to bring new nurses into the system by 30%, Fuller said.

“It’s not just about finding candidates, but then when people want to come work for your system, how do you make sure that it’s the best process you can have?”

Hiring slowdowns typically happen at the decision-making level when too many voices are involved, AAPPR’s Goryl said.

“Candidates have many job offers and smart healthcare organizations know that they need to move quickly,” she said.

Washington-based Providence has stood up mass virtual hiring events in an effort to recruit more full-time nurses to work for the system. It is one of the largest nonprofit hospital operators in the country with 51 hospitals, more than 900 outpatient sites across seven states and an affiliated health plan.

Nursing makes up the largest percentage of the systems’ workforce, and it currently employs over 36,000 nurses. Providence currently has about 3,000 open nursing positions, which include roles for registered nurses, licensed practical and vocational nurses and certified nursing assistants, across all levels of experience, according to the system.

“Hosting events virtually was a natural shift for us as our traditional hiring process also has become primarily virtual,” Carol Kubeldis, Providence’s vice president of talent acquisition, said.

The system does both virtual and in-person recruiting events, with some focused on more regional hiring and filling a handful of roles, and others attempting to fill hundreds of roles across the system. Virtual hiring events can also help streamline the interview process, she said.

Providence is also working to entice staff who left during the pandemic to come back and work for the system again.

“We have very purposeful engagement with former caregivers and have a team in charge of that in regards to reaching out to them,” she said.

https://www.healthcaredive.com/news/hospitals-hiring-events-nurses-retain-recruit-pandemic-providence/631043/

Molina’s contract wins will have ‘profound impact’ on company: CEO

 Molina Healthcare is on a winning streak, securing contracts in new states and counties to provide insurance coverage to those with low incomes. 

The string of Medicaid contract wins amounts to $5.8 billion in additional annual premium revenue, CEO Joe Zubretsky said on an earnings call with investors on Thursday. 

“The new business wins will have a profound impact on our company over the next few years,” he said.

Most notably, Molina won a sizable contract in Los Angeles County in California, which executives said will add significant premium revenue and membership. 

Molina beat out the incumbent Centene to care for Medicaid members in L.A. Centene’s CEO Sarah London said on her company’s earnings call earlier this week that the payer is appealing the award and plans to “exhaust all available avenues of appeal.” She mentioned possibly taking the matter to court.

In addition to California, Molina was awarded statewide contracts in two new states, Iowa and Nebraska, expanding Molina’s footprint to a total of 20 states. 

The Long Beach, California-based insurer also defended its plan in Mississippi and will continue serving members across the entire state.

Zubretsky said the company is already underway on building out staff and scaling IT platforms for the significant expansion in California. 

For the third quarter, Molina’s profit increased to $230 million from the prior-year period on a greater revenue base of nearly $8 billion. 

https://www.healthcaredive.com/news/molina-medicaid-contract-wins-third-quarter-2022/635123/

After CommonSpirit ransomware attack: Why healthcare M&A is a ‘huge’ cybersecurity risk

 As CommonSpirit Health, formed by the merger of Dignity Health and Catholic Health Initiatives in 2019, continues to deal with the fallout from a ransomware attack three weeks ago, security experts say such tie-ups and acquistions make healthcare systems more vulnerable to security breaches.

M&A in healthcare “creates a huge risk” and a “huge opportunity for ransomware,” said Israel Barak, chief information security officer at Cybereason, a firm that helps companies defend against attacks.

Healthcare deals create a higher risk event for a cybersecurity attack because systems typically have a weaker supply chain, Barak added.

Systems like CommonSpirit rely on a vast network of providers. The majority tend to be smaller organizations with a “very low level of sophistication” and they need to share a lot of data between them, Barak said.

“That leads to a situation where a threat that enters the network from one place can impact a very broad set of entities within that network,” Barak said.

Firms that are merging or acquiring are ripe targets because executives tend to be focused on other priorities and may not be as vigilant, according to security experts.

“Anytime there’s chaos or uncertainty, that’s when attackers want to come in and launch their attacks,” said Anneka Gupta, chief product officer at Rubrik, a data security firm whose clients include some of the biggest U.S. businesses.

The FBI has warned that ransomware attackers tend to target companies going through significant financial events, including mergers and acquisitions.

Fitch Ratings analysts said last week that CommonSpirit is in the middle of a sizable debt issuance.

For entities of this size, consolidating onto the same IT platform and systems doesn’t happen with the flip of a switch.

“Typically, it can take years for the IT teams to merge and or align on a particular set of technologies,” said Allie Mellen, a senior analyst of security and risk at Forrester, a research and advisory firm.

Even though some of CommonSpirit’s affiliated systems don’t show the same signs of an attack, it’s not necessarily indicative of different practices, Mellen said.

“They could have made design decisions to keep them fairly separate from an IT standpoint” as a potential defensive measure, Mellen said.  

Due diligence needed before inking M&A deal

Evaluating risk needs to start before two companies integrate, experts say. Before inking a merger deal, companies need to apply the same critical lens to the cybersecurity risk of a deal as they would with other factors.

“Cyber due diligence should be part of the analysis along with the financial analysis, in terms of whether that creates risk to the organization by conducting M&A with a particular entity,” said John Riggi, who advises the American Hospital Association on cybersecurity and risk. He declined to comment directly on the incident at CommonSpirit Health.

Part of that work is also ensuring a company is not inheriting an attack, which can be difficult because companies like to hold cards close to the chest before a deal closes, according to Cybereason’s Barak.  

Still, due diligence failures should serve as a warning, and a 2017 PayPal acquisition is the case study in what not do pre-acquisition, Barak said. 

The digital payment company purchased TIO, a Canadian payment processing company, for $238 million in 2017. Just months after the closing, PayPal announced it was suspending TIO’s operations after finding a security vulnerability exposed the personal information of 1.6 million customers. The company disclosed in a 2017 annual report that it expects to write off $168 million through 2022, a substantial portion of the original acquisition pricetag.

Hotel chain Marriott unknowingly inherited a massive breach when it acquired Starwood Hotels & Resorts Worldwide in 2016. Two years later, Marriott said it learned that hackers had access to sensitive customer information for four years, exposing 500 million people. The hack did not affect Marriott properties. Hackers had breached Starwood’s reservation database. Marriott’s and Starwood’s reservation databases were kept separate for a period of time after the merger, according to reports.  

It’s not necessarily the technology that’s the most difficult hurdle, it’s having the right people and processes in place, Gupta of Rubrik said.

Who’s responsible when something goes wrong? That’s a key question companies need to have worked out before an attack, Gupta said.

That may pose a challenge for healthcare firms that are braiding together the operations and management of legacy systems in different regions and states all across the country. 

“Very often, organizations aren’t prepared. Maybe they have the technology in place but they haven’t even prepped their organizations for what are you going to do,” Gupta said.

A cyberattack, an extremely high pressure and crisis situation, should not be the first time certain leaders are interacting, Gupta said.

If companies don’t have these processes fine tuned, they run the risk of feeling greater pressure to pay the ransom attackers demand in exchange for regaining information or access to their systems.

“There’s just a ton of preparedness from the people, process and technology standpoint, that has to happen in order for organizations to stop paying the ransom,” Gupta said.

CommonSpirit is born from a megamerger

CommonSpirit is just three years old.

The system made its debut in 2019 following a megamerger between San Francisco-based Dignity Health and Colorado-based Catholic Health Initiatives.

The deal stitched together Dignity’s operations in the West with CHI’s systems located mostly in the Midwest and South.

The combination created one of the nation’s largest health systems, with a portfolio of 142 hospitals spanning 21 states and combined revenue of nearly $29 billion in 2019.

At the time, executives claimed CommonSpirit was created to solve pressing national health issues and needed greater size and scale to make a nationwide impact.

Currently, CommonSpirit has more than 25,000 physicians and clinicians and more than 2,200 care sites, according to its latest annual report. That doesn’t include all the providers who interact and share information with the system as independent providers.

Possibly providing a clue on the scope of the issue, Healthcare Dive found affiliated health systems in seven states had banners displayed on their websites warning of an ongoing IT issue. In all but one instance, those warnings were displayed on CHI sites.

Website warnings:

• CHI Saint Joseph Health - Kentucky
• CHI Health - Nebraska
• CHI Health - Iowa
• CHI St. Alexius Health - North Dakota
• CHI St. Gabriel’s Health - Minnesota
• CHI St. Luke’s - Texas
• CHI Baylor St. Luke’s - Texas
• Virginia Mason Franciscan Health - Washington

CommonSpirit seemed to confirm that the other half of its network, Dignity Health, was not experiencing the same disruption.

The system said in a recent statement that its Dignity Health-affiliated systems experienced no impact to clinic or patient care along with its TriHealth and Centura Health facilities.

With that admission and the online warnings, the attack seems to have been more acute for the CHI Health entities.

The attack comes at a difficult time for providers.

The pandemic’s effects are still weighing on hospital operators, CommonSpirit said of its 2022 financial results. Staffing shortages are pushing up expenses for pricier labor. The system posted a $1.8 billion loss for 2022.

However, Fitch Ratings said it does not expect to ding the system with a rating change as a result of the cyberattack. CommonSpirit has cybersecurity insurance, Fitch reports.  

https://www.healthcaredive.com/news/commonspirit-ransomware-attack-healthcare-ma-huge-cybersecurity-risk/634421/

Russia says UK navy blew up Nord Stream, London denies involvement

 

• Russia says UK navy personnel blew up pipelines
• Russia says UK navy personnel helped attack Crimea
• Russia does not give evidence for claim
• Britain denies Russian claims
• Russia says will seek UN attention

Russia's defence ministry said on Saturday that British navy personnel blew up the Nord Stream gas pipelines last month, a claim that London said was false and designed to distract from Russian military failures in Ukraine.

https://www.reuters.com/world/europe/russia-says-british-navy-personnel-blew-up-nord-stream-gas-pipelines-2022-10-29/