Garden State Plaza Mall to require chaperones for kids under 18 amid TikTok-inspired mayhem

 New Jersey is cracking down on “mall”-adjusted teens.

Garden State Plaza Mall will require patrons under 18 to be accompanied by a chaperone who is 21 or older on weekend nights in response to a spate of TikTok-fueled mayhem.

The policy will begin on April 28 and will be in effect after 5 p.m. on Fridays and Saturdays, according to mall officials who said the aim was to stomp out unruly behavior.

“We’ve seen an increase in large crowds of teens, essentially juveniles. … The teens aren’t just enjoying the property in shopping, dining and entertainment,” Wesley Rebisz, senior general manager at Garden State Plaza, told NorthJersey.com.

“They’re being unruly, violating code of conduct, which can include running through the property in large groups, fighting and putting it on TikTok, basically disrupting business and making it uncomfortable for our everyday customers.” 

Police and security guards will be stationed at the entrance of the mall to check IDs and anyone who refuses will reportedly be asked to leave, mall officials said.

“In the event something does try to begin to escalate a little bit, we have a police officer right there on top of it to de-escalate,” said Dan Cenedy, senior vice president of security operation at Garden State Plaza Mall’s parent company, Unibail-Rodamco-Westfield.

A fight at the Garden State Plaza Mall in Paramus on March 11.

Kyle Mazza/NurPhoto/Shutterstock

Reactions to the new policy have been mixed.

“As a teacher, I feel like students need to, I mean, students, kids, everybody needs to be supervised,” shopper Jasmine Mark told CBS News. “I think that when they’re here by themselves, they usually get in trouble, so I think that they should come with a parent.”

Others scoffed at the new rule.

“Kids should deserve that freedom, you know what I mean?” shopper Ali Brightwell said. “I don’t think they need a chaperone,”

“I can see why they did it, but I mean, I don’t think it’s like really that … They shouldn’t enforce it,” Brightwell added.

Garden State Plaza, the second-largest mall in New Jersey, is not the first shopping center to place restrictions on unaccompanied minors.

A complex in Columbia, Maryland, instituted a similar policy last month citing disruption from teens, the Baltimore Sun reported.

Malls in Georgia, North Carolina and Pennsylvania have also done the same.

https://nypost.com/2023/04/15/garden-state-plaza-mall-to-require-chaperones-for-kids-under-18/

Pentagon leak suspect couldn’t act solo, says former Trump intel official

 Accused Pentagon leaker Jack Teixeira could not have acted alone — suggesting the 21-year-old is merely the patsy in a much wider intelligence breach, according to one of former-President Trump’s top national security aides.

“It’s just not possible” for a low-level Air National Guard information technology specialist like Teixeira to have access to the trove of highly sensitive US intelligence he allegedly revealed, according to Kash Patel, Trump’s former deputy director of national intelligence.

“You can be the biggest IT person in [the Department of Defense], and you are still compartmented off of the actual information,” Patel told Breitbart News Saturday.

“Almost never does an IT person need to know, as we say, the substance of the intelligence,” Patel, a onetime Pentagon chief of staff, told the conservative outlet. “Their job is to provide the secure information systems around it to protect any disclosures.”

“This is crazy sensitive stuff,” he said of the detailed data about Ukraine’s military planning that Teixeira is accused of posting online. “Ninety-nine percent of people who have a Top Secret/SCI clearance don’t have access to this information.”

Patel said he does not believe “for a single second” that “this guy — a 21-year-old Air National Guardsman — ran his operation alone.”

Jack Teixeira was arrested on Thursday for leaking US intelligence documents.

AP

Kash Patel doubts that Teixeira acted alone.

Mark Peterson/Redux for NY Post

Instead, he said, the explosive revelations are likely part of “an Assange-style operation” — referring to the WikiLeaks founder who faces espionage charges for helping U.S. Army intelligence analyst Chelsea Manning steal classified diplomatic cables and military files.

“The way it was produced, the way it was put out there — pages, printed photographs taken, published online — that is a methodical way of releasing classified information illegally,” Patel said.

“I think he’s definitely working with other people in DOD or the intel space to get this information out,” he added — calling Teixiera’s Thursday arrest “an extensive cover-up.”

Teixeira was most recently based at Joint Base Cape Cod.

CJ GUNTHER/EPA-EFE/Shutterstock

Teixeira was a low-ranking Air National Guardsman.

via REUTERS

Teixeira briefly appeared in court on Friday.

AP

Heavily armed federal agents arrested Teixeira at his mother’s home in North Dighton, Mass. after he leaked dozens of sensitive US intelligence documents related to the Ukraine war through a Discord channel with 20 to 30 members.

Photos of the leaked documents first appeared in the “Thug Shakers Central” channel, where members shared their opinions about the war in Ukraine.

The classified documents from the Department of Defense, were marked “Top Secret” and “Secret,” contained detailed information about America’s espionage efforts against Russia, as well as secrets relating to South Korea and Israel.

Relatives of Jack Teixeira leaving court on Friday.

REUTERS

Teixeira first began sharing descriptions of the classified documents in October before eventually dumping hundreds of the classified pages in the gaming channel.

He joined the Massachusetts Air National Guard in September 2019 and worked as a Cyber Transport Systems Journeyman, responsible for the upkeep of military communications hardware for the Air National Guard’s 102nd Intelligence Wing.

https://nypost.com/2023/04/15/pentagon-leaker-jack-teixeira-didnt-act-solo-official/

Chronic Pain Affects 21% of Americans, CDC Reports

 Chronic pain continued to affect more than one in five U.S. adults, new CDC survey data showed.

During 2021, an estimated 51.6 million adults (20.9%) had chronic pain lasting 3 months or longer, and 17.1 million (6.9%) had high-impact chronic pain -- pain severe enough to restrict daily activities -- reported S. Michaela Rikard, PhD, of the CDC's National Center for Injury Prevention and Control, and co-authors.

Pain prevalence was higher in adults who were American Indian or Alaska Native, who identified as bisexual, or who were divorced or separated, the researchers said in Morbidity and Mortality Weekly Reportopens in a new tab or window.

"Clinicians, practices, health systems, and payers should vigilantly attend to health inequities and ensure access to appropriate, affordable, diversified, coordinated, and effective pain management care for all persons," Rikard and colleagues wrote.

The 2022 CDC guideline for prescribing opioidsopens in a new tab or window provides recommendations about multimodal approaches to pain management and strategies to reduce pain care disparities, the researchers stated. "In addition, policies and programsopens in a new tab or window that address primary injury prevention, improved access to affordable, culturally responsive health care, and more effective pain management therapies can mitigate the burden of chronic pain," they pointed out.

The prevalence of chronic pain in 2021 was similar to the prepandemic estimate of 20.4%opens in a new tab or window in 2016, Rikard and co-authors noted.

The new findings come from the 2019-2021 National Health Interview Surveyopens in a new tab or window (NHIS), a cross-sectional poll conducted annually by the National Center for Health Statistics. Sample sizes and response rates for the NHIS were 31,997 adults in 2019 with a response rate of 61.1%; 31,568 in 2020 with a response rate of 48.9%; and 29,482 in 2021 with a response rate of 50.9%.

Consistent with previous surveys, chronic pain was defined as pain most days or every day in the previous 3 months. High-impact chronic pain was defined as chronic pain that limited daily life or work activities most days or every day in the previous 3 months. Pain prevalence was adjusted for age.

Chronic pain prevalence ranged from 28.0% in American Indian or Alaska Native populations to 7.7% in Asian populations. High-impact pain was 12.8% in American Indian or Alaska Native respondents, but considerably less in white (6.5%) and Asian (2.1%) adults.

Among people identifying as bisexual, chronic pain prevalence was 32.9%, and was lower in people who identified as straight (19.3%) and gay or lesbian (20.7%).

Divorced or separated people had a higher prevalence of both chronic pain and high-impact chronic pain (29.6% and 10.1%, respectively) than married people (18.2% and 5.2%, respectively).

Among all chronic medical conditions reported in the survey, the prevalence of chronic pain and high-impact chronic pain was highest among people with a history of myalgic encephalomyelitis/chronic fatigue syndrome (70.0% and 43.8%, respectively) or dementia (54.9% and 34.2%, respectively).

The findings have several limitations, Rikard and co-authors acknowledged. Military personnel and people in nursing homes and other institutions were excluded from the study, they noted. Survey responses were self-reported and subject to recall bias. In addition, the COVID-19 pandemic affected data collection and changed health care access and utilization, which may have influenced results.

Disclosures

The researchers reported no potential conflicts of interest.

Primary Source

Morbidity and Mortality Weekly Report

Source Reference: opens in a new tab or windowRikard SM, et al "Chronic pain among Adults -- United States, 2019–2021" Morb Mortal Wkly Rep 2023; DOI: 10.15585/mmwr.mm7215a1.

https://www.medpagetoday.com/neurology/painmanagement/104010

Physicians: Don't Believe These Career Transition Myths

 Are you a physician looking to explore nonclinical career options and make a fresh start? While the thought of transitioning away from your current job might be daunting, these five myths about career transition should not hold you back. There are actually many opportunities available for advancing professionals like yourself who have the courage to seize them.

By shifting our perspective on traditional notions of success and progression, we can adopt an open outlook towards alternative paths that will equip us with new skills and experiences to better meet our professional goals. Don't let fear prevent you from taking control of your future. Read on for more advice about making successful career transitions.

Myth #1: It's too late to make a career change

It can be daunting to think about starting a new career after spending years in a particular field, but the idea that it's too late to make a change isn't necessarily true. Making a big transition at any stage of life is possible with the right ambition and dedication. With resources like career counseling and professional development courses available, anyone can figure out what kind of change to make, determine how to get there, and lay out the steps necessary for completing the process. Switching careers isn't as difficult as it might seem, no matter how much time has passed since you started your current job.

Myth #2: You must have all the necessary qualifications

While it is true that more qualifications can give candidates a better chance of success in any job, they are not necessary to get hired. Companies often value soft skills such as communication and problem-solving much higher than technical qualifications.

When interviewing for a position, focus on the skills you can bring to the role rather than just your education background; this might put you at an advantage over other candidates who have the same qualifications as you. Employers will often overlook lack of technical knowledge in order to hire someone with an eagerness to learn and contribute something new and fresh to their business. Be confident in your abilities and know that your prospects are likely wider than what might appear on paper.

Myth #3: Networking isn't necessary for successful career transitions

Networking is one of the most valuable tools when it comes to career transitions and professional success. While some may believe that it is sufficient to simply send in resumes, tapping into your personal networks, attending events and conferences, and working every day to actively build relationships with those in your industry can be key for an individual looking to make their mark.

For example, one of the most reliable ways to secure a job interview is through referrals from trusted relationships or contacts within the industry. Such referrals often increase the chances that hiring managers take interest, due to someone else vouching for an individual's abilities or character. If you're ever stuck on any aspect of a career transition, your existing connections should also be a source of encouragement and advice. Be sure not to underestimate the power of networking as you pursue career transitions; it could make all the difference.

Myth #4: It takes too long to transition careers

Transitioning careers often can be a relatively quick process. A few months of research, skill building, and network building can prepare you for success in your new field. Granted, depending on the complexity of the new industry and the experience level of the applicant, it could take several more months until a job is secured. However, for people who are willing to put in some hard work and seek out guidance from mentors or recruiters, a career transition may be easier than you think.

Additionally, as technology advances and markets become highly specialized, deep knowledge of a particular field may help you jump into the industry quicker than if you were trying to switch industries completely. So while it may need some effort to make it happen, transitioning careers doesn't have to be a prolonged and arduous process.

Myth #5: You need to quit your job to transition

Seeking a career transition does not always require quitting your job. Career transitions are more than simply changing jobs, and are focused on creating an overall change in one's career trajectory. As such, there are various ways to transition out of an existing job while staying employed. This could mean revisiting opportunities within the same company, taking an inventory of your skill sets, or accepting additional responsibilities within the existing role.

Additionally, pivot jobs (jobs with similar skill sets but in different industries) can provide a great point of transition for new opportunities. Remaining open to possibilities outside of traditional career paths can help to create meaningful transitions without needing to quit outright.

Myth #6: Career transitions always require retraining

With the ever-changing job market, it is understandable why many believe making a career transition always requires retraining. However, this is a myth that many soon-to-be career shifters find to be untrue. Rather than seeing an entire shift in skill set as the only available option for transitioning into a new field, consider the capabilities and experiences you already possess that can transfer to potential opportunities.

Employers often value experience over technical knowledge, and your transferable skillset could prove to be an asset rather than an initial liability requiring additional financial investment. While there are certainly exceptions and certain circumstances where further education may be necessary, a career transition does not necessarily require retraining for physicians.

Bonus tip: How to successfully transition careers

Making the transition to a new career can be overwhelming, but with planning and determination, it is very possible to make a successful switch. Re-evaluate your goals and find a field that appeals to you more than the one you are currently in. Ask yourself what type of work makes you most fulfilled and breaks away from any limiting beliefs or perfectionism. Research potential employers and find ones that allow for opportunities to grow within their organization.

Most importantly, don't forget to update your resume and portfolio; having recent examples of relevant experience is key to showcasing your capabilities. Networking can also help you find potential job postings that match your new career aspirations or gain insight for how to go about acquiring certain positions. With careful consideration, patience, and strategies, you will be well on your way to a successful career transition.

While making a career transition might seem daunting, myth-busting is the first step towards dispelling any fears you may have. Don't quit your job prematurely, keep in mind that retraining may not always be necessary, and that experience counts for something, no matter what your age.

Finally, success does not necessarily come with making the switch, but instead comes with hard work and dedication. Career transitions can be a scary venture to embark on, but if you go into it armed with knowledge and preparedness, success will be just around the corner.

Jawaria Suhail, MDopens in a new tab or window, is a family physician and life coach who specializes in guiding physicians and health care professionals through various challenges, including life, career, business, and divorce. She can be reached at The Nonclinical MD.

https://www.medpagetoday.com/opinion/kevinmd/104039

Common Diuretic Pauses Atherosclerosis in CKD, T2D

 The diuretic spironolactone stopped the progression of atherosclerosis in people with type 2 diabetes and chronic kidney disease (CKD), according to the MAGMA trial.

Among 79 patients with stages 3 to 4 CKD, those randomized to received 25 mg/day of the mineralocorticoid receptor antagonist saw a significantly smaller change in thoracic aorta wall volume at 12 months (average 0.5% vs 7.3% with placebo, P<0.05) -- meeting the study's primary endpoint, found Matthew Weir, MD, of the University of Maryland in Baltimore, and colleagues.

"We are now finally moving into an era where we have more choices," said Weir during a presentation of the late-breaking findings at the National Kidney Foundation

opens in a new tab or window Spring Clinical Meeting. "And I think [mineralocorticoid receptor] blockade certainly is one to come and be considered in many of our patients."

As for secondary outcomes, patients on daily spironolactone also saw decreases in three other measures of atherosclerosis that only increased for those on placebo:

• Thoracic aorta total wall volume change: -0.04 vs 1.2 cm³ for placebo (P<0.05)
• Left ventricular mass index change: -3.5 vs 2.1 g/m² (P<0.001)
• Left ventricular myocardial T1 times change: -10.3 vs 17.1 ms (P<0.05)

"Progressive increase in native T1 values likely reflects increasing fibrosis and was attenuated with spironolactone," Weir pointed out.

On top of that, 24-hour ambulatory blood pressure also dropped across the board. There was a 5.95 and 2.00 mm Hg change in systolic blood pressure for the spironolactone and placebo groups, respectively, and a significantly different 4.00 and 2.00 mm Hg change for diastolic blood pressure.

"Our mediation analysis so far suggests that this effect on atherosclerosis is a lot more than just blood pressure reduction," Weir added. "Proteomic profile reveals significant downregulation of pathways involved in inflammation, cytokine activation, and immunity."

Outcomes looking at several tertiary endpoints, like transcriptomic profile and assay for transposase-accessible chromatin with sequencing, are to come later this year, said Weir.

Session moderator Joseph Vassalotti, MD, of the Icahn School of Medicine at Mount Sinai in New York City, questioned how spironolactone fits into the bigger picture with other agents in CKD like finerenone (Kerendia).

"Certainly the data from the FIDELTY programopens in a new tab or window would indicate [the finerenone] dose to utilize for clinical benefits. If the patients don't have access to finerenone, then certainly I would say that spironolactone 25 [mg] would be an alternate consideration," Weir responded.

Finerenone, the first non-steroidal, selective mineralocorticoid receptor antagonist, was approved in July 2021opens in a new tab or window to reduce the risk of sustained estimated glomerular filtration rate (eGFR) decline, end-stage kidney disease, cardiovascular death, non-fatal myocardial infarction, and hospitalization for heart failure in adults with CKD associated with type 2 diabetes.

In MAGMA

opens in a new tab or window, following a 2-week placebo run-in phase, 37 patients were titrated up to receive 25 mg per day of spironolactone over a 4-week dose-escalation phase. This was followed by a 48-week treatment phase.

MRI was used at the start of the dose-escalation phase to measure the aorta, and was performed again at the end of the treatment phase. The researchers measured a series of sagittal sections on the imaging to calculate the percentage of thoracic aorta wall volume.

All participants had to be over the age of 45, have type 2 diabetes with an HbA1c below 9%, a GFR below 90 mL/min/1.73 m² with proteinuria or below 60 regardless of proteinuria. Everyone also had to check off at least one of several pre-specified cardiovascular-related risk factors. All were also on a stable angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker therapy.

Weir noted that they initially started with one of the key exclusion criteria as a GFR below 30 but then later dropped it down to 20 based on a protocol adjustment. Some other exclusion criteria included uncontrolled hypertension, "out of control lipids," hyperkalemia, and known atherosclerotic events in the prior 6 months.

At baseline, the average age was 64, most were male, and most participants were Black patients. Nearly all were on statins at baseline, and most were also taking aspirin and RAS inhibitors. Mean GFR was around 46, potassium was 4.3 mmol/L, and LDL cholesterol was 74 mg/dL.

Throughout the trial, potassium levels "surprisingly" didn't change that much, as they expected to have to use more potassium binders in patients, said Weir. This was likely due to the low daily dose of spironolactone used. Overall, the side effects of spironolactone were "minimal," according to him.

Disclosures

The study was supported with grants from the NIH.

Weir reported relationships with Johnson & Johnson, AstraZeneca, Merck, Bayer, Vifor, Boehringer-Ingelheim, Novo Nordisk, and Akebia.

Primary Source

National Kidney Foundation

Source Reference: opens in a new tab or windowRajagopalan S, et al "Magnetic resonance imaging evaluation of mineralocorticoid receptor antagonism in diabetic atherosclerosis (MAGMA)" NKF 2023; Poster #387.

https://www.medpagetoday.com/meetingcoverage/nkf/104042

U.S. begins testing bird flu vaccines for poultry after record outbreak

 The U.S. government is testing four potential bird flu vaccines for poultry, officials said on Friday, after more than 58 million chickens, turkeys and other birds have died in the nation's worst outbreak ever.

The trials, conducted by the U.S. Department of Agriculture's (USDA) Agricultural Research Service, are the first step in a lengthy process toward the possible first use of vaccines to protect U.S. poultry from the lethal virus.

Bird flu, also known as highly pathogenic avian influenza (HPAI), has killed hundreds of millions of birds around the world, raising interest in vaccines. The virus is largely spread by wild birds that transmit it to poultry.

The USDA is testing one vaccine from Zoetis Inc, one from Merck Animal Health, and two developed by the department's Agricultural Research Service.

Zoetis said it previously supplied its vaccine to a USDA stockpile in 2016, following a massive 2015 outbreak, but it was never used.

Initial data from a study using a single dose of a vaccine are expected in May, while results from studies on two-dose vaccine regimens are expected in June, the USDA said.

If the trials are successful and USDA decides to continue development, it would take at least 18-to-24 months for a vaccine that matches the current virus to be commercially available, the agency said.

The government needs to ensure vaccinations would not disrupt trading with major buyers, said Greg Tyler, president of the industry group USA Poultry & Egg Export Council.

Governments have previously focused on culling infected flocks to control the virus due to concerns importers would block shipments of vaccinated poultry to avoid the risk of infections.

The USDA said on Friday its "current strategy of stamping out and eradicating HPAI... continues to be the most effective strategy because it works."

France said last week it was launching an order for 80 million doses of vaccines to use in ducks in the autumn if final trial results are positive, the first EU member to start such a plan.

https://sports.yahoo.com/u-begins-testing-bird-flu-150803562.html