Adams needs to call out exactly who’s handcuffing NYC on crime

 The Manhattan Chamber of Commerce hosted its first-ever Anti-Crime Summit Thursday. That the chamber thought the event was necessary is a bad sign: If things were going well, it would leave the pols to it. The mayor retains a lot of goodwill, largely because he’s not Bill de Blasio — but he’s running out of time for spectacular early results.

Eric Adams’ summit speech illustrated the problem: The mayor can’t decide whether he wants to declare victory or issue a crisis call for help.

He ended on the victory note, telling the crowd, “We’re in a good place, New York. “New York is back,” he declared. “We’re seeing a decrease in crime.” But he’s also smart enough to know you don’t sell a win to people who feel like they’re losing.

Crime in core Manhattan is not down.

In the Manhattan South patrol borough — the half of Manhattan with major businesses — felony crime for the month ending Jan. 15 was up 13.3% percent from a year earlier. It’s up 24.7% relative to 2019, before the pandemic.

These poor results have brought down the whole borough. Serious crime in all Manhattan is up 5.3% from a year ago and 19.8% relative to 2019. 

And Manhattan is faring worse than the city. Citywide, serious crime is down 1.3% from last year.

The summit’s very location, between Midtown and Hell’s Kitchen, was apt, if the goal was to illustrate the problems. Just a block away, barely 24 hours before, a gang of robbers shot an illegal-pot shop worker.

Manhattan DA Alvin Bragg claimed his office is underfunded and “the first issue is resources” when it comes to curbing crime.

Robert Miller

And not even half a block away is a huge storefront that’s been empty for a year because the drugstore there for a quarter-century closed due to mass shoplifting. As Walgreens “asset protection director” Joe Stein told conference-goers, “When these stores close, you create blight.” 

Manhattan’s Upper West Side was the site of the year’s first subway murder later last week, when a violent convict on state parole fatally pushed a man; not far away, an elderly woman was bound and killed in her apartment.

When a moderator asked a panel of business owners and private security officials whether they agreed with the mayor that “New York is back,” the answer was — laughter.

One speaker did allow that things are “better.” Yes, they’re a little better because Broadway and the reopened tourist trade have brought foot traffic, and police are dealing more assertively with the dangerous street vagrants. 

But when laughter is the instinctual reaction, New York needs to do better than awful.

Much of the slow roll isn’t the mayor’s fault. As he said in his speech, state law “handcuffs” police in closing down the city’s 1,400 illegal, all-cash pot shops, like the one where the worker was shot last week. So an incompetent Legislature in drawing up its pot regulations saddled New York with hundreds of nuisance stores that attract crime.

But Adams doesn’t put it that way. “Because of the way the rules were put through Albany . . . we have to work around that,” he observed, rather than calling on the governor and Legislature to fix the rules — now. 

After the mayor left, a panel of the state’s most powerful elected officials showed they aren’t in the mood for more changes to hastily enacted laws that have “handcuffed” New York, whether criminal-justice or marijuana “reforms.” 

So they’ve all agreed that the problem is “resources.” “We have made changes,” state Sen. Jamaal Bailey (D-Bronx) insisted. “Repeat offenders can be held.” 

NYPD Chief of Department Jeffrey Maddrey noted at the summit that police are “constantly arresting the same people.”

Robert Miller

Alvin Bragg, Manhattan district attorney, acknowledged state changes to the evidence-discovery process have forced his office to drop important cases, including domestic-violence cases.

But he, too, implied the state can fix the problems with cash. “We are underfunded,” he said. “The first issue is resources.” 

Assemblyman Jeffrey Dinowitz (D- Bronx) blamed cops for failing to arrest suspects. “It’s really not their call to decide whether somebody should be arrested,” he said of the NYPD. 

To which NYPD Chief of Department Jeffrey Maddrey gamely responded that police are “constantly arresting the same people. . . . They would not be repeat offenders if the officers were not constantly arresting them.”

Eventually, New Yorkers will grow tired of excuses — but they will blame the mayor. He needs to be clearer who is “handcuffing” the city and exactly how.

Nicole Gelinas is a contributing editor to the Manhattan Institute’s City Journal.

https://nypost.com/2023/01/22/mayor-adams-needs-to-call-out-exactly-whos-handcuffing-nyc-on-crime/

Zelenskiy promises to swiftly confront Ukraine corruption

 

Ukraine's President Volodymyr Zelenskiy said on Sunday that corruption, the country's chronic problem cast into the background by the war against Russia, would not be tolerated and promised forthcoming key decisions on uprooting it this week.

Zelenskiy's pledge came amidst allegations of senior-level corruption, including a report of dubious practices in military procurement despite officials promoting national unity to confront the invasion.

"I want this to be clear: there will be no return to what used to be in the past, to the way various people close to state institutions or those who spent their entire lives chasing a chair used to live," Zelenskiy said in his nightly video address.

Ukraine has had a long history of rampant corruption and shaky governance, with Transparency International ranking the country's corruption at 122 of 180 countries, not much better than Russia in 2021.

The EU has made anti-corruption reforms one of its key requirements for Ukraine's membership after granting Kyiv the candidate status last year.

"This week will be the time for appropriate decisions," Zelenskiy said. "The decisions have already been prepared. I do not want to make them public at this time, but it will all be fair."

Elected by a landslide in 2019 on pledges to change the way the ex-Soviet state was governed, Zelenskiy said that his government had accepted the resignation of a deputy minister after an investigation into allegations he accepted a bribe.

He did not identify the official, but news reports have said an acting deputy minister of regional development, Vasyl Lozinskiy, was detained on allegations of accepting a bribe.

The renewed focus on corruption involved also Defence Minister Oleksiy Reznikov after a newspaper reported that the military had allegedly secured food at highly inflated prices.

Reznikov's ministry described the allegations as "false" and a parliamentary committee had been asked to investigate.

https://www.marketscreener.com/quote/currency/US-DOLLAR-RUSSIAN-ROUBL-2370597/news/Zelenskiy-promises-to-swiftly-confront-Ukraine-corruption-42788093/

Canada Recommendation on Screening for Postpartum Depression Misses the Mark

 Postpartum/perinatal depression (PPD) remains the most common complication in modern obstetrics, with a prevalence of 10%-15% based on multiple studies over the last 2 decades. Over those same 2 decades, there has been growing interest and motivation across the country – from small community hospitals to major academic centers – to promote screening. Such screening is integrated into obstetrical practices, typically using the Edinburgh Postnatal Depression Scale (EPDS), the most widely used validated screen for PPD globally.

As mentioned in previous columns, the U.S. Preventive Services Task Force recommended screening for PPD in 2016, which includes screening women at highest risk, and both acutely treating and preventing PPD.

Since then, screening women for a common clinical problem like PPD has been widely adopted by clinicians representing a broad spectrum of interdisciplinary care. Providers who are engaged in the treatment of postpartum women – obstetricians, psychiatrists, doulas, lactation consultants, facilitators of postpartum support groups, and advocacy groups among others – are included.

Lee S. Cohen, MD

An open question and one of great concern recently to our group and others has been what happens after screening. It is clear that identification of PPD per se is not necessarily a challenge, and we have multiple effective treatments from antidepressants to mindfulness-based cognitive therapy to cognitive-behavioral interventions. There is also a growing number of digital applications aimed at mitigation of depressive symptoms in women with postpartum major depressive disorder. One unanswered question is how to engage women after identification of PPD and how to facilitate access to care in a way that maximizes the likelihood that women who actually are suffering from PPD get adequate treatment.

The "perinatal treatment cascade" refers to the majority of women who, on the other side of identification of PPD, fail to receive adequate treatment and continue to have persistent depression. This is perhaps the greatest challenge to the field and to clinicians – how do we, on the other side of screening, see that these women get access to care and get well?

With that backdrop, it is surprising that the Canadian Task Force on Preventive Health Care has recently recommended against screening with systematic questionnaires, noting that benefits were unclear and not a particular advantage relative to standard practice. The recommendation carries an assumption that standard practice involves queries about mental health. While the task force continues to recommend screening for PPD, their recommendation against screening with a standardized questionnaire represents a bold, sweeping, if not myopic view.

While the Canadian Task Force on Preventive Health Care made their recommendation based on a single randomized controlled trial with the assumption that women were getting mental health counseling, and that women liked getting mental health engagement around their depression, that is not a uniform part of practice. Thus, it is puzzling why the task force would make the recommendation based on such sparse data.

The way to optimize access to care and referral systems for women who are suffering from PPD is not to remove a part of the system that's already working. Well-validated questionnaires such as the EPDS are easy to administer and are routinely integrated into the electronic health systems records of both small and large centers. These questionnaires are an inexpensive way to increase the likelihood that women get identified and referred for a spectrum of potentially helpful interventions.

PPD is also easy to treat with medications and a wide spectrum of nonpharmacologic interventions. Novel interventions are also being explored to maximize access for women with postpartum mood and anxiety disorders such as peer-delivered behavioral activation and cognitive-behavioral therapy, which could be community based and implemented from urban to rural settings across the United States.

What may need the greatest study is the path to accessing effective treatments and resources for these women and this problem has prompted our group to explore these issues in our more recent investigations. Better understanding of those factors that limit access to mental health providers with expertise in perinatal mental health to the logistical issues of navigating the health care system for sleep-deprived new moms and their families demands greater attention and clearer answers.

The whole field has an obligation to postpartum women to figure out the amalgam of practitioners, resources, and platforms that need to be used to engage women so that they get effective treatment – because we have effective treatments. But the solution to improving perinatal mental health outcomes, unlike the approach of our colleagues in Canada, is not to be found in abandoning questionnaire-based screening, but in identifying the best ways to prevent PPD and to maximize access to care.

Dr. Cohen is the director of the Ammon-Pinizzotto Center for Women's Mental Health at Massachusetts General Hospital (MGH) in Boston, which provides information resources and conducts clinical care and research in reproductive mental health. He has been a consultant to manufacturers of psychiatric medications. Email Dr. Cohen at obnews@mdedge.com.

https://www.medscape.com/viewarticle/987280

AHA Scientific Statement on Rapid Evaluation for Suspected Transient Ischemic Attack

 A new scientific statement from the American Heart Association (AHA) offers a standardized approach to rapidly evaluate patients with suspected transient ischemic attack (TIA), keeping in mind the challenges faced by rural centers with limited resources.

TIAs are "warning shots" of a future stroke and require emergency evaluation, Hardik Amin, MD, chair of the writing committee and medical stroke director, Yale New Haven Hospital, New Haven, Connecticut, said in an AHA podcast.

A key aim of the scientific statement is to help clinicians properly risk-stratify patients with suspected TIA and determine which patients need to be admitted to the hospital and which patients might be safely discharged as long as proper and prompt follow-up has been arranged, Amin explained.

The statement, published online January 19 in the journal Stroke, addresses "how we can identify and be confident in diagnosing a TIA patient and what might suggest an alternative diagnosis," he added.

Diagnostic Challenge

It's estimated that nearly 1 in 5 people who suffer a TIA will have a full-blown stroke within 3 months; close to half of these strokes will happen within 2 days.

The challenge with TIAs is that they can be tough to diagnose because many patients no longer have symptoms when they arrive at the emergency department. There is also no confirmatory test. Limited resources and access to stroke specialists in rural centers may exacerbate these challenges, the authors note.

The statement points out that the F.A.S.T. acronym for stroke symptoms (Face drooping, Arm weakness, Speech difficulty, Time to call 911) can also be used to identify a TIA — even if the symptoms resolve.

The statement also provides guidance on how to tell the difference between a TIA and a TIA mimic.

Table. Factors Distinguishing TIA from TIA Mimics

Factors	TIA	TIA Mimics
Demographics	Older age	Younger patient; no vascular risk factors
Medical History	Vascular risk factors	Epilepsy, migraines, brain tumor
Symptoms	- abrupt onset - maximal symptoms at onset - duration <60 min - preserved mentation - focal neurological symptoms - dizziness with cranial neuropathies, vision loss, trouble with coordination/gait, truncal ataxia, severe nausea - hypertensive at presentation - headache with ptosis/miosis	- symptoms that spread from site of onset might indicate seizure - altered mentation - migraine - signs of alternative diagnosis (ie, positive visual phenomena, seizure-like activity, positional vertigo with focal symptoms)

If available, a non-contrast head computed tomography (NCCT) scan should be done initially in the emergency department to evaluate for subacute ischemia, hemorrhage, or mass lesion. Although the sensitivity of NCCT to detect an acute infarct is low, NCCT is useful for ruling out TIA mimics, the writing group says.

Multimodal brain MRI is the "preferred" method to evaluate for acute ischemic infarct and ideally should be obtained within 24 hours of symptom onset, and in most centers will follow an NCCT.

"When MRI cannot be obtained acutely to definitively distinguish TIA from stroke, it remains reasonable to make a clinical diagnosis of TIA in the ED on the basis of a negative NCCT and symptom resolution within 24 hours," the authors say.

"A potential next step would be hospital admission for MRI, comprehensive workup, and neurology consultation. Other options might include transferring patients to a facility with advanced imaging and vascular neurology expertise or arranging a timely (ideally <24 hours) outpatient MRI," they advise.

The statement also provides guidance on the advantages, limitations, and considerations of doppler ultrasonography, computed tomography angiography, and magnetic resonance angiography for TIA assessment.

Once TIA is diagnosed, a cardiac work-up is advised because of the potential for heart-related factors to cause a TIA.

An individual's risk of future stroke after TIA can be rapidly assessed using the ABCD2 score, which stratifies patients into low, medium, and high risk based on age, blood pressure, clinical features, duration of symptoms and diabetes.

"It is up to each center to use the resources available and create a pathway to ensure successful management and disposition of patients with TIA, with the ultimate goal of reducing the risk of future stroke," the authors conclude.

This scientific statement was prepared by the volunteer writing group on behalf of the American Heart Association's Emergency Neurovascular Care Committee of the Stroke Council and the Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists, and it is endorsed by the American Association of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS).

Stroke. Published online January 19, 2023. Abstract

https://www.medscape.com/viewarticle/987264

Dem Clarke's daughter arrested in Antifa clash with police at Boston protest

 The daughter of House Minority Whip Katherine Clark (D-Mass.) was arrested on Sunday in a clash with police at a protest in Boston, Mass., for allegedly spray-painting a monument and assaulting an officer.

“Last night, my daughter was arrested in Boston, Massachusetts. I love Riley, and this is a very difficult time in the cycle of joy and pain in parenting. This will be evaluated by the legal system, and I am confident in that process,” Clark said on Twitter. 

Boston police arrested 23-year-old Riley Dowell on Saturday night after allegedly defacing the Parkman Bandstand Monument in the Boston Common with spray paint, according to a police department release, which used a previous name.

The graffiti Dowell tagged on the monument included “NO COP CITY” and “ACAB,” an acronym for “All Cops Are Bastards,” according to police.

An officer was reportedly hit in the face during Dowell’s arrest as some 20 other protesters surrounded the officers, shouting profanities through megaphones and blocking traffic on the nearby public street.

Dowell was charged with damage of property by graffiti, destruction of personal property and assault by means of a dangerous weapon and will likely be arraigned in Boston Municipal Court.

https://thehill.com/homenews/house/3825297-katherine-clarkes-daughter-arrested-in-clash-with-police-at-boston-protest/

WSJ Shreds Vaccine Makers, Biden Admin Over "Deceptive" Booster Campaign

 Wall Street Journal editorial board member Allysia Finley has taken a flamethrower to vaccine makers over their "deceptive" campaign for bivalent Covid boosters, and slams several federal agencies for taking "the unprecedented step of ordering vaccine makers to produce them and recommending them without data supporting their safety or efficacy."

You might have heard a radio advertisement warning that if you’ve had Covid, you could get it again and experience even worse symptoms. The message, sponsored by the Health and Human Services Department, claims that updated bivalent vaccines will improve your protection.

This is deceptive advertising. But the public-health establishment’s praise for the bivalent shots shouldn’t come as a surprise. -WSJ

The narrative behind the campaign was simple; mRNA Covid shots could simply be 'tweaked' to to target new variants - in this case, the jabs were claimed to confer protection against BA.4 and BA.5 Omicron variants, along with the original Wuhan strain.

To call this wishful thinking would be extremely generous.

As Finley writes, three scientific problems have arisen.

1. The virus is mutating much faster than vaccines can be updated.
2. Vaccines have 'hard wired' our immune systems to respond to the original Wuhan strain, "so we churn out fewer antibodies that neutralize variants targeted by updated vaccines."
3. Antibody protection wanes after just a few months.

Finley has brought receipts too...

Two studies in the New England Journal of Medicine this month showed that bivalent boosters increase neutralizing antibodies against the BA.4 and BA.5 variants, but not significantly more than the original boosters. In one study, antibody levels after the bivalent boosters were 11 times as high against the Wuhan variant as BA.5.

The authors posit that immune imprinting “may pose a greater challenge than is currently appreciated for inducing robust immunity against SARS-CoV-2 variants.” This isn’t unique to Covid or mRNA vaccines, though boosters may amplify the effect. Our first exposure as children to the flu—whether by infection or vaccination—affects our future response to different strains. -WSJ

Here's what happened

For those who took (or were forced to take) the original vaccine, our memory B-cells were trained to produce antibodies against the original Wuhan strain. And as a New England Journal of Medicine article notes, people who have taken said original vaccine were "primed" to respond to the Wuhan strain, and 'mounted an inferior antibody response to other variants.'

The studies directly contradict marketing information from Pfizer and Moderna, which asserted that the bivalent boosters produced a response to the new strains (BA.4 and BA.5) that's 4-6x that of the original boosters - which the WSJ says is "misleading."

For starters, neither Pfizer or Moderna conducted a randomized trial.

They tested the original boosters last winter, long before the BA.5 surge and 4½ to months after trial participants had received their third shots. The bivalents, by contrast, were tested after BA.5 began to surge, 9½ to 11 months after recipients had received their third shots. -WSJ

Here's the moneyshot: "The vaccine makers designed their studies to get the results they wanted. Public-health authorities didn’t raise an eyebrow, but why would they? They have a vested interest in promoting the bivalents."

In June, the FDA ordered vaccine makers to update the boosters against BA.4 and BA.5, and rushed the companies to push them out before clinical data was available. Meanwhile, Biden's CDC recommended the bivalents for all adults without evidence that they were effective or necessary.

Finley further notes that vaccine makers could have performed small, randomized trials last summer and early fall on the bivalents - with results available by the end of September. But the Biden administration didn't want to wait (and now we know why).

The CDC published a study in November that estimated the bivalents were only 22% to 43% effective against infection during the BA.5 wave—their peak efficacy. As antibodies waned and new variants took over later in the fall, their protection against infection probably dropped to zero.

Another CDC study, in December, reported that seniors who received bivalents were 84% less likely to be hospitalized than the unvaccinated, and 73% less likely than those who had received two or more doses of the original vaccine. But neither study controlled for important confounding factors—for one, that the small minority who got bivalents were probably also more likely than those who hadn’t to follow other Covid precautions or seek out treatments such as Paxlovid. -WSJ

We're amazed the Journal even put this out there... Kudos to them.

Fortunately for big pharma and the Biden administration, information overload is the new Soma, and Rachel Maddow et al. have everything under control.

https://www.zerohedge.com/political/wsj-shreds-vaccine-makers-biden-admin-over-deceptive-booster-campaign

Behind emotional 'blunting' caused by common antidepressants

 Scientists have worked out why common anti-depressants cause around half of users to feel emotionally "blunted." In a study published today in Neuropsychopharmacology, they show that the drugs affect reinforcement learning, an important behavioral process that allows people to learn from their environment.

According to the NHS, more than 8.3 million patients in England received an antidepressant drug in 2021/22. A widely used class of antidepressants, particularly for persistent or severe cases, is selective serotonin reuptake inhibitors (SSRIs). These drugs target serotonin, a chemical that carries messages between nerve cells in the brain and has been dubbed the "pleasure chemical."

One of the widely reported side effects of SSRIs is "blunting," where patients report feeling emotionally dull and no longer finding things as pleasurable as they used to. Between 40% and 60% of patients taking SSRIs are believed to experience this side effect.

To date, most studies of SSRIs have only examined their short term use, but, for clinical use in depression these drugs are taken chronically, over a longer period of time. A team led by researchers at the University of Cambridge, in collaboration with the University of Copenhagen, sought to address this by recruiting healthy volunteers and administering escitalopram, an SSRI known to be one of the best-tolerated, over several weeks and assessing the impact the drug had on their performance on a suite of cognitive tests.

In total, 66 volunteers took part in the experiment, 32 of whom were given escitalopram while the other 34 were given a placebo. Volunteers took the drug or placebo for at least 21 days and completed a comprehensive set of self-report questionnaires and were given a series of tests to assess cognitive functions including learning, inhibition, executive function, reinforcement behavior, and decision-making.

The team found no significant group differences when it came to "cold" cognition—such as attention and memory. There were no differences in most tests of "hot" cognition—cognitive functions that involve our emotions.

However, the key novel finding was that there was reduced reinforcement sensitivity on two tasks for the escitalopram group compared to those on placebo. Reinforcement learning is how we learn from feedback from our actions and environment.

In order to assess reinforcement sensitivity, the researchers used a "probabilistic reversal test." In this task, a participant would typically be shown two stimuli, A and B. If they chose A, then four out of five times, they would receive a reward; if they chose B, they would only receive a reward one time out of five. Volunteers would not be told this rule, but would have to learn it themselves, and at some point in the experiment, the probabilities would switch and participants would need to learn the new rule.

The team found that participants taking escitalopram were less likely to use the positive and negative feedback to guide their learning of the task compared with participants on placebo. This suggests that the drug affected their sensitivity to the rewards and their ability to respond accordingly.

The finding may also explain the one difference the team found in the self-reported questionnaires, that volunteers taking escitalopram had more trouble reaching orgasm when having sex, a side effect often reported by patients.

Professor Barbara Sahakian, senior author, from the Department of Psychiatry at the University of Cambridge and a Fellow at Clare Hall, said, "Emotional blunting is a common side effect of SSRI antidepressants. In a way, this may be in part how they work—they take away some of the emotional pain that people who experience depression feel, but, unfortunately, it seems that they also take away some of the enjoyment. From our study, we can now see that this is because they become less sensitive to rewards, which provide important feedback."

Dr. Christelle Langley, joint first author also from the Department of Psychiatry, added, "Our findings provide important evidence for the role of serotonin in reinforcement learning. We are following this work up with a study examining neuroimaging data to understand how escitalopram affects the brain during reward learning."

More information: Chronic escitalopram in healthy volunteers has specific effects on reinforcement sensitivity: A double-blind, placebo-controlled semi-randomised study, Neuropsychopharmacology (2023). DOI: 10.1038/s41386-022-01523-x

https://medicalxpress.com/news/2023-01-scientists-emotional-blunting-common-antidepressants.html