Bills’ Damar Hamlin returns in first regular season game since cardiac arrest

 Buffalo Bills safety Damar Hamlin played in his first regular season game since suffering a cardiac arrest episode during a regular season game last season. 

Hamlin took part in the Bills’ special teams unit in their Week 4 contest against AFC East divisional rival the Miami Dolphins on Sunday, according to The Associated Press. 

The 25-year-old safety also appeared on the team’s kickoff converge unit after his team, led by star quarterback Josh Allen, scored on their opening drive. 

“It’s go time,” the Bills wrote in a post on X, the social media platform formerly known as Twitter. The post also featured a hand-shaped heart emoji and a video of Hamlin running onto the field during pregame ceremonies, getting a warm welcome by the home team crowd. 

This comes as Hamlin, a former standout at the University of Pittsburgh, sat out the first three games of the season. Hamlin got the nod to play due to an injury to the Bills’ starting safety Jordan Poyer. 

It’s been nearly nine months since Hamlin had to be resuscitated twice by medical officials on the field and at a medical facility after he suffered a cardiac arrest episode when he completed his tackle of Bengals wide receiver Tee Higgins during the first quarter of a Monday night contest between the teams. 

Hamlin stood up after the play was over, only to collapse to the ground a few seconds later. 

Hamlin was released from a Cincinnati area medical facility a week after suffering the cardiac arrest episode. The NFL had to cancel the Bills-Bengals contest and modify its playoff bracket due to the incident. 

In response to the incident, fans have raised more than $9.1 million for Hamlin’s charitable foundation, the Chasing M’s Foundation Community Toy Drive, through the foundation’s GoFundMe page, surpassing its initial $2,500 goal. 

Hamlin recently visited Capitol Hill in an effort to push for the passing of the Access to AEDs Act, bipartisan legislation that would provide grants for elementary and secondary schools to purchase automated external defibrillators and provide training in CPR. 

https://thehill.com/homenews/4232840-bills-damar-hamlin-returns-in-first-regular-season-game-since-cardiac-arrest/

Drugmaker Viatris to divest some of its businesses

 Drugmaker Viatris said on Sunday that it has entered into agreements to divest its businesses, including the Women's Healthcare business and its Active Pharmaceutical Ingredients (API) business. It also received an offer for the divestiture of its Over-the-Counter (OTC) business.

Viatris will divest its API business in India to an Indian pharmaceutical company, Iquest Enterprises, the company said. The transaction includes three manufacturing sites and an R&D lab.

The company also separately entered into an agreement to divest its Women's Healthcare business, primarily related to oral and injectable contraceptives, to Insud Pharma, a Spanish pharmaceutical company.

Viatris said it also received an offer from a European over-the-counter drug manufacturer, Cooper Consumer Health to divest substantially all of its OTC business.

The gross proceeds to the company from all divestitures under the terms of the agreements are up to $6.94 billion, it said, adding that it will retain rights for Viagra, Dymista, and other select OTC products in certain markets representing retained value of about $1.6 billion.

The company's move to divest some of its businesses is part of its efforts to streamline its focus on three core therapeutic areas of ophthalmology, gastrointestinal and dermatology as part of its long-term strategy, it said.

Viatris in August beat Wall Street estimates for second-quarter revenue on the strength of its branded drug portfolio.

https://finance.yahoo.com/news/1-drugmaker-viatris-divest-businesses-220158798.html

International Longshore and Warehouse US dockworkers union files for bankruptcy

 The International Longshore and Warehouse Union (ILWU) representing U.S. dockworkers has filed for a chapter 11 bankruptcy protection to resolve a pending litigation with the Oregon affiliate of the International Container Terminal Services Inc (ICTSI).

The union has listed its assets and liabilities in the range of $1 million to $10 million, according to the Sept. 30 filing made in a San Francisco court.

"While we have attempted numerous times to resolve the decade-long litigation with ICTSI Oregon, at this point, the Union can no longer afford to defend against ICTSI's scorched-earth litigation tactic", said ILWU International President Willie Adams.

"We intend to use the chapter 11 process to implement a plan that will bring this matter to resolution and ensure that our Union continues to do its important work for our members and the community," he added.

ICTSI did not immediately respond to a request for comment.

The union has been facing a looming trial on claims that it illegally slowed down operations over several years at the Port of Portland, then operated by an affiliate of Philippines-based maritime company, according to a Wall Street Journal report.

The ILWU, which has over 4,000 members across United States and Canada, said it will file customary "First Day" motions with the court to maintain its cash management system as part of its reorganization process.

The union in August ratified a six-year contract for U.S dockworkers that improved pay and benefits for 22,000 employees at 29 ports stretching from California to Washington State.

https://finance.yahoo.com/news/international-longshore-warehouse-us-dockworkers-161827301.html

Stem Cell Transplants Effective in MS

 Most patients with relapsing-remitting multiple sclerosis (RRMS) treated with autologous hematopoietic stem cell transplantation (AHSCT) showed no evidence of disease activity (NEDA) for 5 to 10 years, observational data showed.

Of 174 Swedish patients treated with AHSCT, estimated NEDA was 73% (95% CI 66-81) at 5 years and 65% (95% CI 57-75) at 10 years, reported Joachim Burman, MD, PhD, of Uppsala University in Sweden, and co-authors in the Journal of Neurology, Neurosurgery, and Psychiatryopens in a new tab or window.

A total of 149 patients had baseline disability. Over a median follow-up of 5.5 years, 54% improved, 37% were stable, and 9% deteriorated.

"The incidence of severe adverse events was low, and there was no record of treatment-related mortality, suggesting that AHSCT can be safely implemented within routine healthcare," the researchers wrote.

The findings support the sole randomized controlled trialopens in a new tab or window conducted to date, they added.

High-dose chemotherapy followed by AHSCT has been used to treat MS since the 1990s, Burman and colleagues observed. "The goal of AHSCT is to reset the immune system by eliminating autoreactive lymphocytes, in order to induce long-term remission," they wrote.

The Swedish Board of Health and Welfare approved AHSCT for MS in 2016, but in most countries, it has not yet been integrated into clinical guidelines. In 2020, the National Multiple Sclerosis Society (NMSS) issued recommendationsopens in a new tab or window about using AHSCT in MS.

Consensus is emerging about which patients are best candidates for AHSCT, and questions remain about the ideal protocol, especially the best conditioning regimen to kill immune cells, the NMSS said. The ongoing BEAT-MS trialopens in a new tab or window, which compares investigational AHSCT against high-efficacy biologic drugs for treatment-resistant relapsing MS in the U.S. and U.K. may yield some answers.

To examine the efficacy of AHSCT, Burman and colleagues conducted a retrospective analysis of prospectively collected data from the Swedish MS registry. They assessed safety by reviewing patients' electronic medical records for 100 days after the procedure. Patients were treated between 2004 and 2020.

Of 174 people in the study, 64% were women. Mean age at AHSCT was 31, and median disease duration was 3.4 years. NEDA was defined as the absence of new relapses, new or enlarged lesions on MRI, and confirmed disability worsening.

The annualized relapse rate was 1.7 in the year before AHSCT and 0.035 during the follow-up period. All instances of confirmed disability worsening occurred independently of relapses.

The median Expanded Disability Status Scaleopens in a new tab or window (EDSS) score at baseline was 3.5 on a scale of from 0 (indicating no disability) to 10. At the last follow-up, the median EDSS was 2, significantly lower than the baseline score (P<0.0001).

Patients received a median of two disease-modifying treatments before AHSCT, and 23 patients were previously untreated. After a median of 2.9 years, 20 patients received a disease-modifying drug after AHSCT. After a median of 4.1 years, 10 patients transitioned from RRMS to secondary progressive MS.

Febrile neutropenia was the most common side effect, experienced by 68% of patients. Overall, five patients were required intensive care, and 61 developed a bacterial infection within 100 days of treatment.

Herpes zoster reactivation was documented in three patients, and three patients had a confirmed localized fungal infection. No patient developed Epstein-Barr virus-related or cytomegalovirus-related disease. No treatment-related deaths were reported.

Early trials of AHSCT raised concerns around safety, and "it is important to note that no patients died in this study," observed Ruth Dobson, PhD, of Queen Mary University London in England, who posted comments on the U.K.'s Science Media Centreopens in a new tab or window.

However, five patients needed ICU admission and most patients required treatment of infections during their treatment, Dobson pointed out. "This would be in keeping with other, more recent studies, and highlights the need to select patients carefully for these kinds of treatments," she wrote.

"At 10 years, 65% patients had no evidence of disease activity, 75% at 5 years," she noted. "This underlines the efficacy of this treatment in people with MS. We do need more comparative evidence, such as is being generated with STAR-MSopens in a new tab or window (a U.K. study of [autologous stem cell transplantation] vs high-efficacy treatments), in order to be able to contextualize the efficacy against other treatments that are now in increasingly common use."

The absence of a control group in their study precluded definitive conclusions about the effect size of AHSCT compared with other RRMS treatments, Burman and co-authors noted. In addition, some data may have been missing which may have led to underreporting, primarily of adverse events, they acknowledged.

Disclosures

This study was funded by the Center for Clinical Research Dalarna, the Marianne and Marcus Wallenberg Foundation, Region Stockholm, Swedish Research Council, Swedish Society for Medical Research, Swedish Society of Medicine, and Uppsala-Örebro Regional Research Council.

Researchers reported relationships with Merck, Sanofi-Aventis, Biogen, Janssen, UCB, Novartis, Chugai, Lundbeck, and Roche.

Primary Source

Journal of Neurology, Neurosurgery, and Psychiatry

Source Reference: opens in a new tab or windowSilfverberg T, et al "Hematopoietic stem cell transplantation for treatment of relapsing-remitting multiple sclerosis in Sweden: an observational cohort study" J Neurol Neurosurg Psychiatry 2023; DOI: 10.1136/jnnp-2023-331864.

https://www.medpagetoday.com/neurology/multiplesclerosis/106570

Low Tidal Volume Compliance Still Lacking in Mechanical Ventilation

 Implementation of a well-established protective ventilation setting was limited in practice in the U.S. and U.K., electronic health records showed.

From the records of mechanically ventilated people, median tidal volume was 7.48 mL/kg of predicted body weight in a U.K. database and 7.91 mL/kg in the U.S., both approaching the accepted upper limit of <8 mL/kg, reported Charlotte Summers, PhD, of the University of Cambridge in England, and colleagues.

Among those at higher risk of not receiving low tidal volume mechanical ventilation (LTVV) were people of shorter stature, namely U.K. patients under 160 cm tall (5'3") and U.S. patients under 165 cm (5'5"). What's more, in both countries, women and patients with a body mass index (BMI) above 30 were at a higher risk of receiving ventilation at a median tidal volume exceeding 8 mL/kg, according to the retrospective study published in CHESTopens in a new tab or window.

"Despite the different environments, patient populations, ICU admission criteria, and health systems in the U.K. and USA, we observed the same factors were associated with implementation of LTVV," Summers and colleagues wrote.

Protective ventilation with lower tidal volumesopens in a new tab or window -- usually in the range of 4-8 mL/kg of predicted body weight -- is widely recommended because it has been shown to improve survivalopens in a new tab or window in people with acute lung injury and acute respiratory distress syndrome (ARDS).

The present findings of nonadherence to LTVV are somewhat surprising given the long-time understanding on LTVV's effectsopens in a new tab or window and previous studies indicating non-compliance -- but implementing LTVV can be challenging, Samuel Acquah, MD, of the Mount Sinai Hospital in New York City, pointed out.

"At initiation of mechanical ventilation, the ideal body weight is usually not known, making it difficult to calculate the ideal tidal volume," he told MedPage Today via email. "Other barriers are mostly due to the very busy nature of the ICU and the fact that the initial settings are usually done in the emergency department or outside the ICU and not subsequently changed."

His hope is that for providers, these findings "will be a wake up call to come up with innovative ways to ensure adherence," noting that he has seen treatment processes change in his own practice.

"We initially had the same issues with compliance to low tidal volume ventilation, however, we have used a combination of alerts on electronic medical records -- when physicians order tidal volume -- to tie it to ideal body weight combined with a daily report to respiratory therapists and the treating team, which highlights noncompliance and helps to improve adherence," Acquah said.

He suggested that other centers also calculate each person's ideal body weight and have alerts in the electronic medical record to allow ordering of tidal volume only based on ideal body weight.

For their multicenter study, Summers and colleagues relied on the electronic ICU clinical relational database (eICU-CRD) for U.S. data, whereas U.K. data were collected from the Critical Care Health Informatics Collaborative (CCHIC).

A total of 5,466 patients from CCHIC and 7,384 patients from eICU-CRD were included in the study. Patients from the U.K. database received ventilation for a median of 6.9 days, while U.S. database patients received it for 5.8 days.

U.K. patients who had a median tidal volume of less than 8mL/kg had significantly lower 30-day mortality (HR 0.86, 95% CI 0.76-0.97), whereas this relationship did not reach significance in the U.S. patients (HR 0.90, 95% CI 0.86-1.00).

Longitudinal trends suggest a fall in tidal volume over time in U.K. centers after December 2016.

Disclosures

The Critical Care Health Informatics Collaborative was funded by a grant from the National Institute for Health Research (NIHR).

Summers was supported by grants from the Medical Research Council and the NIHR Cambridge Biomedical Research Centre.

Acquah had no disclosures.

Primary Source

CHEST

Source Reference: opens in a new tab or windowSamanta RJ, et al "Low tidal volume ventilation is poorly implemented for patients in North American and United Kingdom intensive care units using electronic health records" CHEST 2023; DOI: 10.1016/j.chest.2023.09.021.

https://www.medpagetoday.com/criticalcare/intensivists/106573

Trump Receives Cheers From CA Crowd After Arguing In Favor Of Shooting Looters

 Donald Trump is, if anything, very skilled at reading the room, or in this case reading the overall mood of the country.  In 2015, suggesting that looters become free game for law enforcement and that they should fully expect to be shot while leaving stores might have been the kind of comment that lost him the election.  Or at least it would have garnered a tidal wave of outrage and debates over police overreach.  Today, the public is tired of certain groups of malcontents being allowed to do whatever they please whenever they please without consequences simply because of their supposed victim group status.

In this day and age, skipping past the arrest process and shooting looters sounds reasonable even to crowds in Anaheim, California.  The pendulum always swings the other direction, and in some cases it swings hard.

With numerous Democrats either lying about the ongoing spike in crime across the country or defending the practice of mass theft as a form of righteous "reparations" or activism, the perception among criminals is that it is now open season, and perhaps they are even justified in their actions.  According to Dems, the criminals are the good guys.

The perception among conservatives and moderates is that progressives fully intend to let America burn while gaslighting the public about how the fire is not that hot.  Americans are obviously not buying it.  Since 2022, polls show that at least 78% of Americans believe crime is rising across the nation with 56% saying they have seen a direct increase where they live. 

These poll results led to an extensive corporate media campaign over the course of 2023, in which journalists used faulty and incomplete stats to argue that crime is actually going down.  In reality, a host of Democrat run cities and states are withholding full reports on their crime statistics while the Federal Government adjusts the manner in which they collate the data.  This readjustment conveniently started during the covid lockdowns as crime began to skyrocket. 

Needless to say, the country is fed up.  However, it should be noted that Trump seems to focus particularly on law enforcement as being held back from doing their jobs while overlooking the reality that property owners in many areas hit with theft are also held back from defending themselves and their businesses.  Fear of targeted prosecution is real, with blue cities aggressively pursuing jail time for people stopping a crime, specifically if a minority happens to be harmed.   

The first line of defense is not local law enforcement, it is the property owner.  When something bad happens, they will be the first people on the scene.  The question of freeing up police to do their jobs is secondary to the question of the attempted degradation of the right to self defense.  Making shop owners safe to shoot looters regardless of the kinds of politicians and prosecutors that run the cities they live in would more likely have the kind of impact on crime that Trump describes.  

https://www.zerohedge.com/political/trump-receives-cheers-ca-crowd-after-arguing-favor-shooting-looters

Dow futures jump more than 100 points after lawmakers avert government shutdown

 Stock futures jumped at the open of trading after U.S. legislators were able to come to a temporary agreement that staved off a government shutdown.

Futures tied to the Dow Jones Industrial Average rose 127 points, or 0.4%. S&P 500 futures gained 0.4%, while Nasdaq 100 futures added 0.7%.

The Senate passed a continuing resolution with just hours to spare before a midnight deadline Saturday, which was then signed by President Joe Biden into law. The bill keeps the government open for 45 more days, an extended period that lawmakers can use to finalize funding legislation.

“Investors don’t like to be run to the edge of the cliff constantly,” said Jamie Cox, managing partner at Harris Financial. With “not having a shutdown, we should see a very positive reaction in markets.”

The looming threat of a government shutdown weighed on investors last week, which also marked the end of the trading month and quarter. Investors feared a shutdown could further weigh on a U.S. economy already seeing slowing growth under the weight of the highest interest rates in 15 years.

September marked the worst monthly performance of the year for the S&P 500 and Nasdaq Composite. The broad S&P 500 index finished the month down 4.9% and the quarter 3.7% lower, while the technology-heavy Nasdaq Composite dropped 5.8% in the month and 4.1% in the quarter. The blue-chip Dow ended the month 3.5% lower and the quarter 2.6% in the red.

But the indexes are still up on the year despite the pullback, underscoring the strength of the rally seen in the first half of the year. The S&P 500 is down about 6% from its 2023 high close in July, but still up 11% for the year.

Investors will watch for economic data due Monday on purchasing and construction spending. Later in the week, attention will turn to a string of reports offering insight into the health of the labor market, including Friday’s all important monthly payrolls data.

https://www.cnbc.com/2023/10/01/stock-market-today-live-updates.html