Iran, Russia, China, Pakistan FMs Hold Meeting To Deal With Afghan Economic Collapse

 Via The Cradle,

The foreign ministers of Iran, Russia, China, and Pakistan held four-way talks on 13 April in the Uzbek city of Samarkand, on the sidelines of the fourth regional meeting of Afghanistan’s neighbors – where various issues and concerns regarding Afghanistan were discussed.

Russian Foreign Minister Sergei Lavrov, Chinese Foreign Minister Qin Gang, Iranian Foreign Minister Hossein-Amir Abdollahian, and Pakistani Minister of State for Foreign Affairs, Rabbani Khar were photographed together before proceeding with the closed-door meeting, Russian news agency TASS reported.

Following the meeting, Amir-Abdollahian said that he and the other diplomats discussed a wide range of issues regarding Afghanistan – including a recent surge in extremist activity, problems caused by US sanctions, the poor living conditions of the Afghan people, and the flow of Afghan refugees into Iran and other countries.

The Iranian foreign minister stressed the importance of countering drug trafficking originating in the country, and the Taliban government’s responsibility in that area.

He also strongly criticized the continued ban on female education in the country – which Iran has repeatedly listed as a condition for its recognition of the interim government.

In this regard, the diplomats discussed steps to bring about a political settlement that includes an inclusive government, something Beijing has also consistently called on the Islamic Emirate of Afghanistan (IEA) to implement.

They also discussed ways to stabilize humanitarian and socio-economic conditions in the country – particularly through "the development of regional economic integration and the implementation of transport and energy projects with Kabul’s participation," TASS said.

In the joint statement released after the meeting, the ministers expressed support for the principle of "Afghan leadership, Afghan ownership" regarding Afghanistan’s political determination and development path, Iran’s semi-official Tasnim news agency said.

Afghanistan is currently facing a severe economic and humanitarian situation as a result of Washington’s decision to freeze billions of dollars in the country’s foreign reserves in 2021. This pushed the country into an acute crisis, given that the central bank lacks the resources to combat high inflation and food insecurity – which has become rampant. The country has also been facing an increased extremist threat through attacks from groups such as ISIS-K. Moscow has accused the US of encouraging ISIS-K activity in Afghanistan.

https://www.zerohedge.com/geopolitical/iran-russia-china-pakistan-fms-hold-meeting-deal-afghan-economic-collapse

Why ‘kicking 15 million people off Medicaid’ is a good thing

 After three years, states are once again verifying Medicaid eligibility for their citizens. Although some media reports are framing this as a disaster for beneficiaries, it is an opportunity to help rein in chronic federal deficits and bolster state finances as revenues begin to flag.

The Medicaid and Children’s Health Insurance Program (CHIP) grew from 71 million beneficiaries before the pandemic to over 92 million in December 2022, the most recent month for which data is available. And, according to estimates from the Kaiser Family Foundation, the rolls may have peaked at 95 million last month.

The Department of Health and Human Services expects that redeterminations will result in the combined Medicaid and CHIP rolls declining by 15 million, still leaving these programs larger than they were pre-pandemic despite the fact that unemployment has retuned to early 2020 levels.

Redeterminations, if done properly, do not remove anyone who is eligible for Medicaid or CHIP from the rolls based on their income or other special needs. Beneficiaries are just being asked to confirm their eligibility with their state of residence.

Meanwhile, because Medicaid redeterminations were suspended back in March 2020, the rolls are filled with ineligible individuals. Some have died, others have relocated to other states, and still others lost their jobs at the beginning of the pandemic and then obtained new employment as the economy recovered. Some of those regaining employment have high incomes and are eligible to participate in their new employer’s health plan.

Why should we worry about those who are deceased, who have relocated, or who now have access to private insurance, since these individuals would not be expected to seek covered medical services anyway?

There are two reasons. First, unscrupulous providers can use identifying information from inactive Medicaid beneficiaries to make false claims.

Second, it is necessary to consider the impact on managed Medicaid programs. When Medicaid started in the 1960s, it was a purely fee-for-service system. Eligible patients would get care from a doctor or hospital, and that provider would then file a claim with the state Medicaid program.

But, to control costs, most states have included managed care options in their Medicaid programs. Today, more than 70 percent of Medicaid enrollees are in a managed care plan. Under Medicaid managed care, the state typically pays a for-profit or not-for-profit system a fixed rate per enrollee.

So, if an ineligible beneficiary is on Medicaid managed care, the state is paying his or her Medicaid provider a monthly fee to provide no care. Since many of these providers are for-profit companies, progressives who might normally oppose redeterminations should instead welcome them, because they reduce the amount of money hitting corporate bottom lines.

Just how much unearned revenue corporate Medicaid managed care organizations have received during the pandemic is difficult to assess because their detailed financial records are private. But there is one large publicly owned Medicaid managed care organization in California that did respond to a public records act request on this matter. LA Care, which provides Medicaid services in Los Angeles County, told me that 327,000, or 29 percent, of its enrollees did not receive any health services during the year ended June 30, 2022.

Both before and during the pandemic, Medicaid cost growth routinely outstripped the rate of inflation by a large margin, and, by FY2021, total spending of Medicaid and CHIP reached $773 billion. Containing the growth of these programs is important for both federal and state fiscal policy.

At the federal level, deficits are expected to remain above $1 trillion annually and adjustments to other large-ticket items including Social Security, Medicaid, and Defense appear to be off-limits from a political standpoint.

Meanwhile, states will once again shoulder their full share of Medicaid costs as pandemic-era federal support phases out. At the same time, states dependent on income tax revenues from high earners are experiencing revenue pressure as weakness in the technology sector and on Wall Street reduces these taxpayers’ incomes. Clearing the Medicaid rolls of ineligible beneficiaries is a step these states can take to balance their budgets without cutting other programs.

So far from being a plague, Medicaid redetermination should be seen as a welcome relief at the state and federal levels. And it is a step that does not remove anyone from the rolls that can demonstrate his or her continued eligibility.

Marc Joffe is a federalism and state policy analyst at the Cato Institute.

https://thehill.com/opinion/congress-blog/3949552-why-kicking-15-million-people-off-medicaid-is-a-good-thing/

Too much AI has big drawbacks for doctors — and their patients

 Artificial intelligence in medical care is here to stay — but it can do more harm than good, especially if those implementing it lose sight of the essential importance of a doctor’s clinical judgment.

As a primary-care physician, my job is to evaluate and re-evaluate a patient in an ongoing personalized way even the best AI could never attain. 

Here’s an example: An 80-year-old patient of mine with chronic heart failure drank and ate too much on a recent Caribbean cruise and ended up in a hospital, his lungs filled with fluid.

A cardiac echo revealed an ejection fraction (how well the heart is pumping) of only 15%.

In fact, a recent study concluded AI might have assessed that ejection fraction better than the cardiologist who did so, and this assessment is clearly going to be an important role for AI.

But the actual management of the patient went well beyond a simple number.

And repeated reassessment was required to initiate the correct therapeutic response each time his blood pressure dropped or he gained a few pounds or became slightly short of breath.

No AI could have handled it.

No AI could have managed this patient.

This particular patient didn’t like to complain, and years of experience guided me in how to factor in his personality in a way no AI could have considered.

If my patient had consulted the popular AI app ChatGPT for quick answers in real-time, many of those answers wouldn’t have had the nimbleness to help him. (Yes, some are pushing such uses of ChatGPT.)

Remember, AI is limited by the amount of info you put into it.

Instead, I practiced the art of medicine.

I kept adjusting his blood-pressure medicines and his diuretics.

With less resistance to pump against, his heart function improved to an ejection fraction of more than 30% and prolonged costly hospitalizations were avoided.

AI could be there at the back end to accurately reassess heart function but could never have managed the patient along the way as I could.

There are other anticipated roles for AI too.

Insurance companies and healthcare systems can save money in the short run by implementing AI to replace traditional functions.

One of these is pre-certifications or pre-authorizations, where a patient requires special permission from his or her insurer to perform a specific test or treatment that may go beyond standard protocol.

I may want to order an MRI, for example, because of the slightest tingling or weakness in an extremity that could be indicative of a much larger problem.

This might not reach AI’s criteria, but how am I going to argue effectively with a computer rather than an insurance company’s medical director? 

Or slight shortness of breath and fatigue might not reach an insurance company’s AI criteria for approval for a stress echocardiogram even though I feel it’s indicated.

Or a calcium-scoring CT scan to look for coronary artery disease may be turned down because an algorithm determines the patient is too young.

All these issues are dependent on the particular patient, and it is my role to advocate for them with the insurer and its medical director.

But there is growing pressure for cost-saving AI to take over approvals and rejections, which adds another thick level of bureaucracy to an already-arduous process.

Indeed, increasing use of AI in medical practice threatens to superimpose a one-size-fits-all model that’s been growing since the day the Affordable Care Act passed.

True, there are estimates AI will lead to $1.3 billion in savings to health-insurance companies this year. 

But at what cost to quality of care?

We must consider that short-term savings can cause longer-term losses as diagnoses are missed or treatments are delayed.

Cigna is already using algorithms to mass reject health claims (without even actually reading them), and few are appealed, ProPublica just found. 

How can any doctor find the time or wherewithal to appeal?

And then there’s malpractice. Practicing physicians like me are concerned we will be held to a standard set by artificial intelligence.

What if I disagree with a computer analysis but am later proven to be wrong?

This will leave me and doctors like me open to liability and push us further in the direction of rigid robotic care to avoid being sued.

And conversely, increased use of AI to diagnose or decide on clinical care puts a hospital or other health system in a position of liability when the AI isn’t up to the task or decides wrong.

“With increasing integration of artificial intelligence and machine learning in medicine, there are concerns that algorithm inaccuracy could lead to patient injury and medical liability,” a recent Milbank Quarterly article noted.

But the problem with the authors’ solution of expanding a “liability framework” to cover the addition of AI is that it means yet another layer of bureaucracy between the patient and the actual care he or she requires.

AI padding the interface is a bad solution to the current health-care bloat.

Artificial intelligence, when used properly, is going to be a useful healthcare tool.

But doctors must control it rather than the other way around to safeguard the essential doctor-patient relationship.

Marc Siegel, MD, is a clinical professor of medicine and medical director of Doctor Radio at NYU Langone Health and a Fox News medical analyst.

https://nypost.com/2023/04/13/too-much-ai-has-big-drawbacks-for-doctors-and-their-patients/

Inflammatory disease biotech ACELYRIN files for a $100 million IPO

 ACELYRIN, a late-stage biotech developing acquired therapies for inflammatory diseases, filed on Thursday with the SEC to raise up to $100 million in an initial public offering.

ACELYRIN's initial focus is on the treatment of diseases with pathology related to excess activation of the immune system, acquiring its portfolio of candidates with the intent to develop and commercialize novel therapies that it believes may provide the opportunity to offer clinically meaningful, differentiated benefits for patients. Its lead candidate, izokibep, is a small protein therapeutic designed to inhibit IL-17A. The candidate is currently in Phase 2b/3 trials for hidradenitis suppurativa, psoriatic arthritis, and uveitis.

The Agoura Hills, CA-based company was founded in 2020 and plans to list on the Nasdaq under the symbol SLRN. Morgan Stanley, Jefferies, TD Cowen, and Piper Sandler are the joint bookrunners on the deal. No pricing terms were disclosed.

Relevant Profile: SLRN

https://www.renaissancecapital.com/IPO-Center/News/98574/Inflammatory-disease-biotech-ACELYRIN-files-for-a-$100-million-IPO

Amazon announces new customizable AI models for cloud customers

 Amazon’s cloud computing division on Thursday announced the release of a new service that will allow customers to access customizable artificial intelligence (AI) models that can be used to develop chatbots and image-generation services.

Amazon Web Services (AWS), the world’s largest provider of cloud computing services, is rolling out a service called Bedrock that will enable business clients to customize foundation models, the core AI technologies that respond to users with human-like text or generate images from a prompt. 

Businesses can use their own data in Bedrock’s models to securely create a unique model that suits their needs.

Bedrock will be based on Amazon’s proprietary foundation models, known as Amazon Titan, although it will also allow users to choose from a menu of models offered by third-party companies. The initial third-party options offered will be from startups AI21 Labs, Anthropic and Stability AI.

Each of the third-party options has unique features: 

• AI21 Labs’ offering includes multilingual language-learning models from the Jurrasic-2 family, which can follow natural language instructions to generate text in Spanish, French, German, Portuguese, Italian and Dutch.
• Anthropic’s language-learning model called Claude can perform conversational and text-processing tasks based on the company’s research into AI systems.
• Stability AI offers text-to-image foundational models, including Stable Diffusion, which can generate unique and realistic high-quality images, art, logos and designs.

An API will allow Bedrock users to access the foundation models (FMs) offered by Amazon, including Titan’s two language-learning models, and those offered by the third-party providers. Users won’t have to deal with managing data center servers, and the AWS servers that power Bedrock will use Amazon’s custom AI chips in addition to chips from Nvidia. 

One of the two Titan FMs that Bedrock users will have access to is a generative language-learning model (LLM) that can do tasks like classification, information extraction, open-ended question and answers, summarization and text generation. 

The other Titan LLM translates text inputs, such as words, phrases or large units of text, into numerical representations called embeddings that contain the semantic meaning of the text. While the embeddings LLM won’t generate text, it would be useful for users in applications like personalization and search because the embeddings produced by the model will produce more relevant and contextual responses than word matching according to Amazon. 

The company says the product search capability on Amazon.com uses a similar embeddings model to help customers find the products they’re looking for.

Amazon noted in a press release that Titan FMs are "built to detect and remove harmful content in the data, reject inappropriate content in the user input and filter the models’ outputs that contain inappropriate content, such as hate speech, profanity and violence.

https://www.foxbusiness.com/technology/amazon-announces-new-customizable-ai-models-cloud-customers

Biden Admin Proposes Reducing Water Supply From Colorado River Basin Amid Drought

 by Caden Pearson via The Epoch Times (emphasis ours),

The Biden administration has proposed a federal mandate to reduce the supply of water to 40 million Americans who live in western states dependent on the Colorado River Basin to address long-term severe drought and low run-off conditions.

The actions were part of a draft report by the Department of the Interior’s (DOI’s) Bureau of Reclamation.

The draft Supplemental Environmental Impact Statement proposes to revise the current guidelines for the near-term operation of Glen Canyon and Hoover Dams.

According to the DOI, the move forms part of the Biden administration’s efforts to invest in climate change resilience for the Colorado River Basin and all the communities that rely on it.

The draft report explores different alternatives to ensure continued water deliveries and hydropower production for the 40 million Americans who depend on the river system.

Two man-made reservoirs along the Utah–Arizona border, Lake Powell and Lake Mead, have dropped to dangerously low levels, nearing the so-called dead pool levels, which threaten water supplies and the hydropower-generated electricity for tens of millions of Americans.

DOI Deputy Secretary Tommy Beaudreau has said failure to act is not an option.

“Recognizing the severity of the worsening drought, the Biden-Harris administration is bringing every tool and every resource to bear through the President’s Investing in America agenda to protect the stability and sustainability of the Colorado River System now and into the future,” Beaudreau said in a statement.

Bureau of Reclamation Commissioner Camille Calimlim Touton said drought conditions in the Colorado River Basin have worsened over two decades.

“To meet this moment, we must continue to work together, through a commitment to protecting the river, leading with science and a shared understanding that unprecedented conditions require new solutions,” Touton said in the same statement.

Proposed Action Alternatives

The draft report proposes two ways to change how the dams are operated. Both involve using less water from the Glen Canyon Dam and dealing with additional water shortages. The main difference between the two proposals is how the shortages are shared out.

The first option, referred to as “Action Alternative 1,” modeled the shortages based on who has the highest priority water rights. The second option, referred to as “Alternative 2,” modeled the shortages being shared out equally among all water users in the Lower Basin.

https://www.zerohedge.com/commodities/biden-admin-proposes-reducing-water-supply-colorado-river-basin-amid-drought

Power issues produce train delays at Grand Central Terminal

 A heat-related power issue in the Bronx is causing significant delays across the Metro-North Railroad, officials said Thursday evening.

The Harlem, Hudson and New Haven lines were delayed by 50 minutes or more during the evening rush, the agency said. The power issues hit two lines especially hard, causing delays of up to 90 minutes for New Haven riders and delays of up to 120 minutes on the Harlem line, Metro-North said.

Thursday brought unseasonably warm temperatures to New York City, resulting in the hottest April day in more than a decade for much of the New York region, according to the National Weather Service.

"Daily records were tied or broken at all 6 of our climate sites as temperatures soared 20-30 degrees above normal," the NWS tweeted Thursday.

Twitter user @sandorsays said they were stuck on their train heading out of Grand Central for more than two hours as of 7:45 p.m. Thursday.

"i am a prisoner of the metronorth. morale is low. why did i pay for this," the tweet said. "soon we will begin to deliberate on who to eat first."

Metro-North first started posting about the delays around 5 p.m. Thursday.

The setbacks left some commuters unaware of which track their trains might arrive on.

"Once the trains are no longer being held, the track numbers should appear," Metro-North said on Twitter.

https://gothamist.com/news/power-issues-produce-train-delays-at-grand-central-terminal