LA County Floats "Decarceration" Plan To Give Criminals Slap On Wrist Instead Of Jail Time

 Since Los Angeles apparently isn't violent enough, the County Board of Supervisors have devised an ingenious plan to "decarcerate" jails by citing and releasing anyone with bail of $50,000 or less, Fox News reports, citing city documents.

The Board has added the agenda item to this coming Tuesday's meeting, titled "Los Angeles County to Take Actionable Next Steps to Depopulate and Decarcerate the Los Angeles County Jails," and which was introduced by Democrat supervisors Lindsey Horvath and Hilda Solis, who probably don't live where where there's a lot of crime.

The proposal would "Declare the State of mental health services and overcrowding in the Los Angeles County jails a humanitarian crisis, requiring the County to move with all deliberate speed on meaningful solutions; and prioritize decreasing the number of individuals entering the Los Angeles County Jails."

If passed, the local sheriff would be instructed to review its bail thresholds and to cite and release "individuals with aggregate bail amounts set at $50,000 or below." The Los Angeles Superior Court would be directed to "implement the Emergency Bail Schedule that was in place at the height of the COVID pandemic" in an effort to "prioritize increased opportunities for pre-trial release." -Fox News

According to Eric Siddall, vice president of the Los Angeles Association of Deputy District Attorneys, the idea is "dangerous" (ya think?).

"The Los Angeles County Board of Supervisors’ (BOS) motion to gut parts of the criminal justice system without input from stakeholders is dangerous and recklessness," Siddall told Fox News. "The authors sought no advice from those who know and understand public safety issues. They seek to lower the jail population without addressing the root causes of crime or protecting the public."

The Los Angeles County Men's Central Jail is seen in Los Angeles, Feb. 16, 2021. (Reuters / Lucy Nicholson)

Siddall said that under the proposal, the police would be under orders to cite and release suspects accused of illegally carrying firearms, domestic violence, possession of child porn, residential burglary, robbery, or assault with a firearm.

Activists in Los Angeles called for the closure of the Men’s Central Jail in the downtown area of the city last week, protesting near the Los Angeles County Board of Supervisors on Thursday morning, according to KTLA.

They demanded that the Board of Supervisors commit to a closure timeline that would shutter the jail by March 2025. The protests came after it was reported that three inmates in L.A. died over the course of one week, including one in the Men’s Central Jail. -Fox News

Meanwhile, nowhere in the Board's agenda is any discussion of how to "protect the community from violent criminals."

"This catch-and-release program comes without any plan or infrastructure to protect the community from violent criminals apprehended by law enforcement. Further, it creates no lockdown facilities for the mentally ill. This program benefits no one, except for career criminals. We need to make sure the most dangerous offenders don’t get out, that first-time offenders don’t come back and that those with serious mental illnesses get appropriate care and help. This does none of that," he said.

https://www.zerohedge.com/political/la-county-floats-decarceration-plan-give-criminals-slap-wrist-instead-jail-time

US manufacturing near three-year low; casts a shadow over economy

 U.S. manufacturing activity slumped in March to the lowest level in nearly three years as new orders plunged, and analysts said activity could decline further due to tighter credit conditions.

The Institute for Supply Management (ISM) survey on Monday showed all subcomponents of its manufacturing PMI below the 50 threshold for the first time since 2009. Some economists said this suggested a recession was around the corner, while others said much would depend on the services sector, whose PMI remains consistent with a growing economy.

The survey made no direct comment on recent financial markets turmoil. Makers of miscellaneous products said they were "closely monitoring the global banking situation" but there were no impacts "at this time."

Federal Reserve rate hikes to fight inflation have raised borrowing costs and cooled demand for goods.

"Manufacturing is pulling back, but the service sector was still chugging along in February," said Chris Low, chief economist at FHN Financial in New York. "As long as it remains well above 50 when reported on Wednesday, the broad economy should be just fine. Nevertheless, the health of manufacturing is related to the health of the overall economy."

The ISM's manufacturing PMI fell to 46.3 last month, the lowest level since May 2020, from 47.7 in February. Outside the COVID-19 pandemic, it was the weakest reading since mid-2009.

Economists polled by Reuters had forecast the index would dip to 47.5. The PMI remained below the 50 threshold for the fifth straight month, a sign of contraction in manufacturing, yet hard data have suggested continued moderate growth in manufacturing, which accounts for 11.3% of the economy.

Manufacturing expanded at a 4.5% annualized rate in the fourth quarter, the government reported last week. Reports last month also showed orders for capital goods excluding aircraft eked out a small gain in February as did manufacturing output.

https://finance.yahoo.com/news/us-manufacturing-sector-weakest-nearly-140249351.html

US to build $300 million database to fuel Alzheimer's research

 The U.S. National Institute on Aging (NIA) is funding a 6-year, up to $300 million project to build a massive Alzheimer's research database that can track the health of Americans for decades and enable researchers to gain new insights on the brain-wasting disease.

The NIA, part of the government's National Institutes of Health (NIH), aims to build a data platform capable of housing long-term health information on 70% to 90% of the U.S. population, officials told Reuters of the grant, which had not been previously reported.

The platform will draw on data from medical records, insurance claims, pharmacies, mobile devices, sensors and various government agencies, they said.

"Real-world data is what we need to make a lot of decisions about the effectiveness of medications and looking really at a much broader population than most clinical trials can cover," Dr. Nina Silverberg, director of the NIA's Alzheimer's Disease Research Centers program, said in an interview.

Tracking patients before and after they develop Alzheimer’s symptoms is seen as integral to making advances against the disease, which can start some 20 years before memory issues develop.

Alzheimer's research has been galvanized by Leqembi, a new treatment from Eisai Co Ltd and Biogen Inc that slows advance of the disease in early-stage patients.

The database could help identify healthy people at risk for Alzheimer's, which affects about 6 million Americans, for future drug trials. It also aims to address chronic underrepresentation of people of color and different ethnicities in Alzheimer’s clinical trials and could help increase enrollment from outside of urban academic medical centers.

Once built, the platform could also track patients after they receive treatments such as Leqembi, which won accelerated U.S. approval in January, and is widely expected to receive traditional FDA approval by July 6.

The U.S. Medicare health plan for older adults will likely require such tracking in a registry as a condition of reimbursement for Leqembi.

"We didn't design it for that purpose," Silverberg said, but "it might be possible" to use it for that purpose.

The Centers for Medicare and Medicaid Services, which runs the U.S. Medicare insurance program, did not respond to a request for comment.

Silverberg said the data platform could also help researchers working in other disease areas understand which patients are most at risk and the impact of medications.

During the pandemic, the U.S. lagged other countries with national health systems in being able to analyze patient data for COVID-19.

The system would be built in a secure computing environment with a number of restrictions to ensure the privacy of people's health data, Silverberg said.

The grant, which was posted on March 13, has been years in the making. The funding announcement sets its earliest start date at April 2024, with a goal to establish an Alzheimer’s registry 21 months later.

Several stakeholders including Medicare and patient advocacy groups the Alzheimer's Association and UsAgainstAlzheimer's took part in a workshop last spring to discuss the design of the platform.

Alzheimer's Association Chief Science Officer Maria Carrillo said in an interview that the organization plans to apply for the NIA platform grant, which will award $50 million a year for up to six years.

Partha Bhattacharyya, chief data officer of the NIH Office of Data Resources and Analytics said: "We envision this platform will allow researchers to recruit across the United States."

"If we are to play a greater role in prevention, we must start early. That is not at age 65," he said.

https://finance.yahoo.com/news/exclusive-us-build-300-million-100326658.html

Saudi crown prince acts to realign Mideast dynamics amid concern over US support

 Saudi Arabia's unpredictable crown prince is pushing hard to realign Middle East dynamics, engaging with old foes and orchestrating OPEC oil cuts like the ones on Sunday which took the global market by surprise.

Crown Prince Mohammed Bin Salman, known as MbS, has signalled he is prepared to go it alone without the help of the United States to pursue Saudi interests, whether it means re-establishing ties with U.S. adversaries like Iran, or removing supplies from the oil market and angering consumers.

The strategy is designed to create conditions enabling Saudi Arabia to focus on MbS's vast economic transformation plan, Vision 2030, in which he has poured hundreds of billions of dollars, hoping it will open the conservative kingdom to business and tourism amid rising regional competition.

The strategic shift began in 2019 after the devastating attacks on Saudi Aramco's oil facilities - after which Riyadh questioned U.S. security commitments to the region - and gained momentum after Israeli attacks on Iranian targets, analysts say.

The kingdom hopes to avoid getting caught up in the crossfire, they say.

"Saudi Arabia is moving from disengagement towards engagement to allow it to focus on pushing ahead on Vision 2030," said Saudi analyst Abdulaziz Sager.

The kingdom has gone into diplomatic overdrive, restoring relations with Iran and agreeing to a rapprochement with Syria in its quest to rebuild regional alliances, instead of leaning entirely on the United States, its long-time big power ally.

Saudi Arabia is planning to invite Syrian President Bashar al-Assad to an Arab League summit that Riyadh is hosting in May, three sources familiar with the plans have said, a move that would formally end Syria's regional isolation.

'UNWISE MOVE'

The kingdom also announced a decision to join the China-led Shanghai Cooperation Organization, a sign that it is cultivating a long-term relationship with Beijing at the expense of the United States.

A Saudi official said the United States and China are both very important partners for Riyadh.

"We certainly hope not to be part of any competition or dispute between the two superpowers. We are not a superpower, but what we are is an important player in the region and global economy," the official, who declined to be named, said.

White House national security spokesperson John Kirby said on Monday Riyadh remains a strategic partner for Washington even if the two did not agree on all issues. Washington and Riyadh are working on addressing common security challenges, he said.

Riyadh's increasing assertiveness extends to oil policies.

On Sunday, the Saudi-led Organization of the Petroleum Exporting Countries and their allies including Russia (OPEC+) announced further production cuts of about 1.16 million barrels per day (bpd), drawing U.S. disapproval.

The Gulf Research Center, a Saudi-based think-tank, said the OPEC cuts show major oil producers can free themselves from U.S.-Western pressure and pursue an independent policy that puts their national interests first.

"We’re in a Saudi First oil market now. Producers don’t just earn more, they enjoy far more geopolitical leverage when markets are tight," said Jim Krane, a research fellow at Rice University's Baker Institute.

MENDING FENCES WITH IRAN

In a significant deal brokered by China, Riyadh reached an agreement with Tehran to revive diplomatic relations, after years of bitter rivalry that have fuelled conflict across the Middle East.

Elisabeth Kendall, a Middle East expert at Cambridge's Girton College, said the abrupt U-turn might have been spurred by the escalating confrontation between Israel and Iran.

"Saudi likely hopes that by thawing relations with Iran, it will avoid getting caught up in another regional conflict, thereby removing the risk of another direct Iranian attack on its infrastructure, such as the crippling 2019 attacks on Aramco," Kendall said. Iran denied responsibility.

On Sunday, Israeli forces carried out air strikes on Iranian outposts in Syria, the Syrian defence ministry said. Western intelligence sources said a series of air bases in central Syria where Iranian personnel are based were hit.

The attack, the latest in a series on Iranian military facilities in Tehran's close ally Syria, raised the spectre of a broader regional confrontation that would put U.S. Gulf allies in the line of fire should military operations escalate.

Previous air strikes on Saudi oil sites, and on a United Arab Emirates fuel depot by Iranian-backed Yemeni Houthi forces, have laid bare the uncertainty surrounding the U.S. security stake in its Arab allies, prompting Riyadh to push for de-escalation with Tehran and diversify its security partners.

There has never been any serious dialogue, either within the U.S. government or with the Saudis, on the conditions under which Washington would come to the defence of Saudi Arabia should it be attacked, said Bilal Saab, Director of the Defence and Security Program at the Middle East Institute in Washington.

"The Saudis don’t want to be in a shooting war between Iran and the United States. They don’t trust that Washington will protect them," Saab said.

Riyadh's growing ties with Beijing have raised security jitters in Washington, which says Chinese attempts to exert influence around the world will not change U.S. policy toward the Middle East.

Shadi Hamid of the Brookings Institution in Washington said Saudi Arabia's view that the U.S. is increasingly disengaged from the region is not entirely wrong.

"The crown prince has decided to hedge his bets, both as a concession to reality but also as a way of provoking the U.S. to pay more attention to its security concerns," Hamid said.

"The U.S. has been annoyed but has not retaliated in any way, which in turn has emboldened Saudi Arabia to continue deepening its relationship with America's chief adversaries."

https://www.yahoo.com/entertainment/analysis-saudi-crown-prince-acts-164819336.html

Nearly All Hospital Websites Send Tracking Data to Third Parties

 Third-party tracking is used on almost all U.S. hospital websites, endangering patient privacy, a cross-sectional observational study found.

Of 3,747 hospitals included in the 2019 American Hospital Association (AHA) annual survey, 98.6% of their website home pages had at least one third-party data transfer, and 94.3% had at least one third-party cookie.

"In the U.S., third-party tracking is ubiquitous and extensive," researchers led by Ari B. Friedman, MD, PhD of the University of Pennsylvania in Philadelphia, wrote in Health Affairsopens in a new tab or window. "The high number of entities engaged in tracking on hospital websites heightens potential privacy risks to patients."

The tracking data most commonly went to Google's parent company Alphabet (98.5% of homepages), followed by Meta (formerly Facebook), which was used in 55.6% of hospital homepages. Adobe Systems and AT&T collected data from 31.4% and 24.6% of hospital pages, respectively.

"What we found is that it's virtually impossible to look at any hospital website in the country without exposing yourself to some tracking," study coauthor Matthew McCoy, PhD, of the University of Pennsylvania, told MedPage Today. "That's really significant, because even if you were a patient with privacy concerns and you wanted to avoid this kind of thing, what that means is you really don't have an option to do that."

Hospital website home pages had a median of 16 third-party transfers, with more third-party transfers from medium-sized hospitals as opposed to small and large ones (24, 17, and 13 transfers, respectively). Of hospital characteristic factors, membership in a health system, having a primarily urban patient population, and having a medical school affiliation were all significantly associated with a greater number of third-party transfers on hospital website home pages.

On 100 randomly sampled hospital websites, searches for six "potentially sensitive" conditions turned up 30 patient-facing pages for those conditions -- and all had at least one third-party data transfer.

McCoy said the number of companies tracking data on any given website was alarming. "Imagine you were browsing a hospital website for something related to your health, and you had one person looking over your shoulder and gleaning information about your health from a browsing session -- that would probably make you pretty uncomfortable," he said. "Multiply that by 16, by 20, and you've got that many more people looking over your shoulder."

According to the study, "Many of the third parties to which data are transferred have business models built on identifying and tracking people for the purposes of targeting online advertisements." Some tracking companies, like Acxiom, sell the data to other companies or allow health-related profiling, like Adobe and Oracle.

Because of this tracking, patients might see more targeted advertising for drugs, supplements, or insurance based on their personal medical conditions. Health-related information, the authors wrote, could even be used in risk scores that affect credit or insurance eligibility.

Investigative reportsopens in a new tab or window by media outlets and lawsuitsopens in a new tab or window involving big tech companiesopens in a new tab or window and hospitals have thrown this patient privacy problem into high relief, prompting the Department of Health and Human Services to clarify in 2022opens in a new tab or window that HIPAA protections apply to some data transfers.

Friedman's group suggested policymakers prioritize privacy legislation that prohibits the practice of third-party tracking on hospital websites. Hospitals, they wrote, should audit websites to eliminate tracking, and should also give patients an option to opt out of tracking completely. Not doing so could make hospitals vulnerable to lawsuits over privacy violations.

"Setting aside those kinds of questions about legal liability..., I think most healthcare providers would recognize themselves as having a responsibility to protect the interests of their patients, and that means also protecting their patients' interest in privacy," McCoy said.

Friedman, McCoy, and colleagues used the 2019 AHA annual survey to identify nonfederal, non-acute hospitals and assessed third-party tracking in August 2021. Both the AHA and the Census Bureau's American Community Survey were used to gather the characteristics of these hospitals. If part of a larger health system, some hospitals shared a website.

Researchers used a tool called webXray to record third-party tracking from hospital home pages, count the data transfers that occurred when a page loaded, and linked individual tracking domains to their parent companies.

Limitations of the study included evaluation of only data transfers to third-parties and third-party cookies, but not other forms of tracking. Researchers didn't assess tracking on password protected patient portals and also could not differentiate between uses of data once transferred. They also did not evaluate the contents of the data transfers, only their volume.

Disclosures

Friedman and co-authors received funding from the Public Interest Technology University Network Challenge Fund, along with support from the Penn Medical Communications Research Institute. McCoy reported receiving grants from the Greenwall Foundation. Coauthors reported support from the National Heart, Lung, and Blood Institute; grants from the National Science Foundation outside this work; and gifts from Google, Facebook, and Carnegie Mellon CyLab.

Primary Source

Health Affairs

Source Reference: opens in a new tab or windowFriedman AB, et al "Widespread third-party tracking on hospital websites poses privacy risks for patients and legal liability for hospitals" Health Affairs 2023; DOI: 10.1377/hlthaff.2022.01205.

https://www.medpagetoday.com/special-reports/features/103843

'What Drives Alzheimer's in Women?'

 Female sex, early age at menopause, and hormone therapy use each were associated with higher regional tau in cognitively normal people with elevated beta-amyloid, cross-sectional PET data showed.

The highest levels of tau were seen in hormone therapy users who had a delay of more than 5 years between menopause onset and the start of hormone therapy, reported Rachel Buckley, PhD, of the Massachusetts General Hospital in Boston, and co-authors in JAMA Neurologyopens in a new tab or window.

"While a fair amount of studies have focused on the effects of menopause and hormone therapy on risk of dementia, far fewer studies rigorously tested their association with Alzheimer's disease biomarkers, namely amyloid and tau, in clinically normal older women," Buckley said.

"This is critical to know given that it still remains unclear what might be the driving mechanism of the menopause transition, and any use of hormone replacement, on risk for dementia," she told MedPage Today.

"Counterintuitively, we found that women with elevated amyloid who reported taking hormone therapy also showed higher tau burden," Buckley pointed out. "One would have imagined taking hormone therapy might ameliorate the issues of lost estrogen because you are reintroducing estrogen into the body."

"But this is where it got interesting: after further investigation into this group of women who reported taking hormone therapy, we found that higher risk was only associated with those women who had a long gap between their menopause onset and hormone therapy initiation -- greater than 5 or 6 years," Buckley said. "It seems that introduction of exogenous estrogens after a long pause is not a great idea."

The findings add to an increasing body of literature indicating that menopause -- especially early or premature menopause -- is a contributor to women's greater lifelong risk of Alzheimer's disease, noted Lisa Mosconi, PhD, of Weill Cornell Medicine in New York City, who wasn't involved with the study.

"This study also indicates that menopause hormone therapy may influence some aspects of Alzheimer's pathology, in keeping with previous evidence that women who take hormones during the menopause transition or soon after may experience greater brain-protective benefits as compared to those who start taking hormones later on in life," Mosconi told MedPage Today. "Overall, the connection between menopause and Alzheimer's disease has been overlooked for far too long, despite its potential significance."

Premature menopause -- which can be either spontaneous or the result of surgical intervention before age 40 or 45, respectively -- occurs in 1% to 10%opens in a new tab or window of women and has been associated with worse dementia outcomesopens in a new tab or window.

Early studies had suggested that hormone therapy might ameliorate cognitive impairment in menopausal or postmenopausal women, Buckley and colleagues noted. However, 2 decades ago, the seminal Women's Health Initiative

opens in a new tab or window (WHI) study found that HT use was associated with approximately 2-fold higher incidence of probable dementiaopens in a new tab or window relative to placebo, possibly due to initiating hormone therapy many years after menopause onset.

"When it comes to hormone therapy, timing is everything," co-author JoAnn Manson, MD, DrPH, who also was a lead investigator on the WHI, said in a statement. "Our previous findings from the WHI suggested that starting hormone therapy early in menopause, rather than late initiation, provides better outcomes for heart disease, cognitive function, and all-cause mortality -- and this study suggests that the same is true for tau deposition."

Buckley and colleagues used data from the Wisconsin Registry for Alzheimer's Prevention (WRAPopens in a new tab or window), assessing PET scans of 292 cognitively unimpaired adults (193 women and 99 men) to determine amyloid and tau levels in seven brain regions. Mean age was 67.4 at tau scan; 52 participants had abnormal amyloid-beta and 106 were APOE4 carriers. A total of 98 women were past or current hormone therapy users. Data were collected between November 2006 and May 2021. Age at menopause and use of hormone therapy were self-reported.

Among participants with elevated amyloid, female sex (standardized β=−0.41, P<0.001), earlier age at menopause (standardized β=−0.38, P<0.001), and hormone therapy use (standardized β=0.31, P=0.008) were associated with higher regional tau PET compared with male sex, later age at menopause, and nonuse of hormone therapy. Medial and lateral regions of the temporal and occipital lobes were affected.

Initiating hormone therapy more than 5 years after menopause onset was associated with higher tau PET compared with early hormone therapy (β=0.49, P=0.001). Overall findings remained after adjusting for years of education, APOE4, cardiovascular disease risk, menopause symptom severity, and menopause-related sleep problems.

The study had several limitations, Buckley and co-authors acknowledged. The researchers didn't know what precipitated premature menopause or why women chose to start hormone therapy; both factors may have influenced the findings. In addition, most people in the study were white.

Disclosures

The WRAP study is supported by the NIH.

Buckley is supported by a Pathway to Independence award and an Alzheimer's Association research fellowship. Co-authors reported relationships with the NIH, Fonds National de la Recherche Scientifique, WelBio, Biogen, Roche, Mars Edge, AC Immune, Alector, Genentech, Janssen, Neuraly, Oligomerix, Prothena, Renew, Alnylam, Cytox, JOMDD, NervGen, Neurocentria, Shionogi, Vigil Neuroscience, Ionis, Acumen, Vaxxinity, Eisai, Eli Lilly, Alzheimer's Association, Roche Diagnostics, and Cerveau Technologies.

Primary Source

JAMA Neurology

Source Reference: opens in a new tab or windowCoughlan GT, et al "Association of age at menopause and hormone therapy use with moderate tau and β-amyloid positron emission tomography" JAMA Neurol 2023; DOI: 10.1001/jamaneurol.2023.0455.

https://www.medpagetoday.com/neurology/alzheimersdisease/103844

Mail-Back Envelopes Will Be Dispensed With Outpatient Opioid Scripts

 The FDA will require manufacturers of opioid drugs that are dispensed in outpatient settings to provide prepaid mail-back envelopes to outpatient pharmacies and other dispensers, the agency announced

opens in a new tab or window Monday.

The move is part of the FDA's comprehensive approach to addressing the overdose crisis, according to FDA Commissioner Robert Califf, MD.

"We believe these efforts will not only increase convenient disposal options for many Americans, but also reduce unfortunate opportunities for nonmedical use, accidental exposure, overdose and potential new cases of opioid use disorder," Califf said in a press release. "We're pleased to take this first critical step to increase mail-back envelope options in partnership with the U.S. Postal Service."

The agency first announced the proposed modification

opens in a new tab or window to the Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS) program in a Federal Register noticeopens in a new tab or window a year ago. The plan provides another option -- along with flushing, pharmacy collection kiosks, take-back events, and others -- to safely dispose of unused opioids.

The FDA told all outpatient opioid manufacturers today they are required to submit the potential modification to the Opioid Analgesic REMS within 180 days of the date of the notification letter. The agency anticipates approval of the modified REMS in 2024.

When implemented, outpatient pharmacies and other dispensers will have the option to order prepaid mail-back envelopes from opioid manufacturers which they, in turn, can give to patients. The REMS modification also requires manufacturers to develop materials to educate patients about the safe disposal of opioid analgesics.

The agency indicated that many patients wind up with unused opioids after surgery, and some children and adults use that avenue to gain access to opioids through friends or relatives. A recent studyopens in a new tab or window reported that 9.7 million kids and adults used prescription painkillers for non-medical purposes in 2019, and nearly 50,000 accidental opioid exposuresopens in a new tab or window occurred from 2010 to 2018.

"Data show educating patients about disposal options may increase the disposal rate of unused opioids and that providing a disposal option along with education could further increase that rate," the FDA said.

Multiple mail-back envelope programs currently operate in the U.S. and mail-back envelopes are commercially available. There are long-standing regulations and policies in place under the DEA and U.S. Postal Service to ensure mail-back envelopes are nondescript, fit for this purpose, and can safely and securely transport unused medicines to a location where they will be destroyed, the agency noted.

The FDA also is exploring whether manufacturers of opioid analgesics should be required to make in-home disposal products available to patients. The agency issued a Federal Register Noticeopens in a new tab or window today to seek public comments to help the agency assess in-home disposal methods.

https://www.medpagetoday.com/neurology/painmanagement/103846