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Monday, April 8, 2024

App for ED?

 Little blue pill meets a little blue light.

A digital application can improve erectile function, according to new research presented at the European Association of Urology (EAU) Annual Congress on April 8, 2024.

Researchers developed a 12-week, self-managed program to treat erectile dysfunction (ED). The program is delivered to patients' mobile devices and encourages users to do cardiovascular training, pelvic floor exercises, and physiotherapy. It also provides information about ED, sexual therapy, and stress management.

"The treatment of ED through physical activity and/or lifestyle changes is recommended in current European guidelines but is not well established in clinical practice," according to the researchers.

App or Waitlist

The app, known as Kranus Edera, was created by Kranus Health. It is available by prescription in Germany and France.

To study the effectiveness of the app, investigators conducted a randomized controlled trial at the University Hospital Münster in Münster, Germany.

The study included 241 men who had scores of 21 or less on the International Index of Erectile Function (IIEF-5).

About half of the participants were randomly assigned to get the app. The rest were placed on a waiting list for the technology and served as a control group.

After 12 weeks, those who received the app reported significantly greater improvement on the IIEF-5, with a gain of 4.5 points vs a 0.2-point improvement for men in the control group (< .0001).

Men who received the app also reported gains in measures of quality of life (20.5 vs −0.04) and patient activation (11.1 vs 0.64).

Nearly nine in 10 people who used the app did so several times per week, the researchers reported.

Sabine Kliesch, MD, with University Hospital Münster, led the study, which was presented at a poster session on April 8 at the EAU Congress in Paris.

Fully Reimbursed in Germany

In Germany, Kranus Edera has been included on a government list of digital health apps that are fully reimbursed by insurers, partly based on the results of the clinical trial. The cost there is €235 (about $255).

Patients typically notice improvements in 2-4 weeks, according to the company's website. Patients who are taking a phosphodiesterase-5 enzyme inhibitor for ED may continue taking the medication, although they may no longer need it or they may be able to reduce the dose after treatment with the app, it says.

Kranus also has virtual treatments for incontinence in women and voiding dysfunction.

The app is meant to save doctors time by providing patients with detailed explanations and guidance within the app itself, said Laura Wiemer, MD, senior medical director of Kranus.

The app's modules help reinforce guideline-recommended approaches to the treatment of ED "in playful ways with awards, motivational messages, and individual adjustments to help achieve better adherence and compliance of the patient," Wiemer told Medscape Medical News.

Kranus plans to expand to the United States in 2024, she said.

https://www.medscape.com/viewarticle/app-ed-2024a10006l9

'GOVERNMENT-MADE COMIC BOOKS TRY TO FIGHT ELECTION DISINFORMATION'

 WITH THE 2024 elections looming, the Department of Homeland Security has a little-noticed weapon in its war on disinformation: comic books. Few have read them, but the series is attracting criticism from members of Congress. Calling the comics “creepy,” Rep. Dan Bishop, R-N.C., complained earlier this month that the Cybersecurity and Infrastructure Security Agency-produced series was just another way for the federal government to “trample on the First Amendment” in its zeal to fight so-called disinformation.

“DC Comics won’t be adding these taxpayer-funded comic books … to their repertoire anytime soon,” cracked Kentucky Sen. Rand Paul’s annual report on government waste released in December. 

The comics read like well-meaning (if corny) attempts to grapple with efforts by foreign governments to influence American public opinion, as articulated in intelligence community assessments. But there is a risk that the federal government’s fight against foreign disinformation positions it as an arbiter of the truth, which raises civil liberties concerns. The efficacy of the DHS “Resilience Series” of comic books is also far from obvious. 

The members of Congress might be comforted to know that few people ever noticed the comics. The Cybersecurity and Infrastructure Security Agency urges users to “share” their “Resilience Series” comics, but a search of the webpage’s address on X shows that it is linked to fewer than a dozen times. CISA also produced glossy-looking YouTube trailers for its two graphic novels that garnered just 4,000 and 6,000 views respectively — a far cry from the hundreds of thousands of views trailers for other graphic novels attract. 

For CISA, disinformation is no laughing matter. “Disinformation is an existential threat to the United States,” declares CISA’s webpage detailing its “Resilience Series” of comic books.

Third in sales by genre, only behind general fiction and romance novels, graphic novels are particularly popular among the youngest readers. One industry observer notes that in Japan, more paper is used for manga books than for toilet paper. School Library Journal concluded in their graphic novels survey last year that popularity increased over 90 percent year over year in school libraries. The survey also found that nearly 60 percent of school librarians reported opposition to graphic novels from teachers, parents, and others who didn’t consider them “real books.”

Though first released in 2020 in anticipation of the Trump–Biden presidential election, the comics were intended to be an evergreen resource in the war on disinformation. “Learn the dangers & risks associated with dis- & misinformation through fictional stories that are inspired by real-world events in @CISAgov’s Resilience Series,” the U.S. Attorney for Nevada posted on X last April. 

CISA produced two graphic novels, “Real Fake” and “Bug Bytes.” “Real Fake” tells the story of Rachel O’Sullivan, a “gamer” and a “patriot” who infiltrates a troll farm circulating false narratives about elections to American voters. “Bug Bytes” addresses disinformation around Covid-19, following Ava Williams, a journalism student who realizes that a malicious cyber campaign spreading conspiracy theories about 5G technology is inspiring attacks on 5G towers.

“Fellow comic geeks, assemble!” CISA said when the comic books were initially released. “Let’s band together to take on disinformation and misinformation.” The CISA post quotes another X post by the FBI’s Washington field office recommending the graphic novels and exhorting the importance of “finding trusted information.”

“The resilience series products were released in 2020 and 2021 to raise awareness on tactics of foreign influence and disinformation,” a spokesperson for CISA told The Intercept, noting that despite continued reference by members of Congress and critics, that this series of comic books has now been discontinued.

“The problem is not that panels about African troll farms (Real Fake) or homegrown antivaxxers (Bug Bytes) might make readers feel insecure—it’s that they don’t make readers feel insecure enough,” writes Russ Castronovo, director of University of Wisconsin-Madison’s Center for the Humanities and professor of American studies and English, in Public Books magazine. “Or, more precisely, these comics might be judged aesthetic failures because—due to their proximity to propaganda—they leave little space for the vulnerabilities inherent in the act of reading. So, while readers learn that meddling by foreign powers ‘is scary, especially in an election year,’ the graphic fictions commissioned by US cybersecurity assume reading itself to be a process whereby information (as opposed to disinformation) is obtained, questions are answered, and doubts are resolved.”

Writing in Bulletin of the Atomic Scientists, Thomas Gaulkin said that “the Resilience Series … conjures a certain jingoism peculiar to government publications that can mimic the very threat being addressed.” 

All of which raises the question as to what role the Department of Homeland Security should play in adjudicating “media literacy,” as the series webpage says. 

Both “Real Fake” and “Bug Bytes” were written by Clint Watts, a former FBI special agent who works as a contributor to MSNBC and is affiliated with Microsoft’s Threat Analysis Center, and Farid Haque, an education technology entrepreneur who is CEO of London-based Erly Stage Studios and was previously CEO of StartUp Britain, a campaign launched by then-U.K. Prime Minister David Cameron. 

Watts, who writes and speaks about Russian influence campaigns, has testified to Congress on the matter and has been affiliated with a number of think tanks, including the Alliance for Securing Democracy, the German Marshall Fund, and the Foreign Policy Research Institute. Clearly knowledgeable, his own writings can sometimes veer into hyperbole — a potent reminder that even experts on disinformation are not infallible.

“Over the past three years, Russia has implemented and run the most effective and efficient influence campaign in world history,” Watts said in testimony to the Senate Intelligence Committee in 2017. While Russia’s propaganda regarding its first invasion of Ukraine and Crimea was no doubt effective, that employed in 2016 against the U.S. presidential election was “neither well organized nor especially well resourced” according to a detailed study by the Pentagon-backed Rand Corporation. The think tank later concluded that “the impact of Russian efforts in the West has been uncertain.”

Co-author Haque, according to an interview in Forbes, became involved in the Resilience Series after a chance meeting at a bookstore with actor Mel Brooks’s son, Max Brooks, who would later join Erly Stage’s advisory board and introduce Haque to his Americans contacts, which included Watts.

“There is now a real need for schools and public authorities to educate young people on how much fake news there is across all forms of media,” Haque told Forbes.

Counter-disinformation has become a cottage industry in the federal government, with offices and programs now dedicated to exposing foreign influence, as The Intercept has previously reported. CISA’s Resilience Series webpage directs questions to an email for the Countering Foreign Influence Task Force (not to be confused with the FBI’s own effort, the Foreign Influence Task Force, or the intelligence community’s Foreign Malign Influence Center). In 2021, the CISA Task Force was replaced by a Misinformation, Disinformation, and Malinformation team according to a government audit, which CISA tells The Intercept has now been rolled into something called “the Election Security and Resilience subdivision.” (Malinformation refers to information based on fact but used out of context to mislead, harm, or manipulate, according to CISA.)

The proliferation of various counter-disinformation entities has been disjointed, prompting the Department of Homeland Security’s own inspector general to conclude that “DHS does not have a unified, department-wide strategy to set overarching goals and objectives for addressing and mitigating threats from disinformation campaigns that appear in social media.”

CISA’s mission, originally focused on traditional cyber and critical infrastructure security, evolved in the wake of the 2016 election. In the waning days of the Obama administration, Secretary of Homeland Security Jeh Johnson officially designated the election systems as a part of critical infrastructure. Since then, CISA has expanded its focus to include fighting disinformation, arguing that human thought can be said to constitute infrastructure.

“One could argue we’re in the business of critical infrastructure, and the most critical infrastructure is our cognitive infrastructure, so building that resilience to misinformation and disinformation, I think, is incredibly important,” CISA Director Jen Easterly said in 2021. 

In pursuit of that cognitive infrastructure, CISA launched the Resilience Series, with an eye to mediums that would appeal to popular audiences.

“We have to find new ways to engage with people through mediums that use soft power and creative messaging, rather than being seen to preach,” Haque said in the Forbes interview.

https://theintercept.com/2024/03/25/government-comic-books-election-disinformation/

Ernst slams Biden over loophole that may allow Chinese spies to invade US islands

 Two Republican lawmakers ripped into the Biden administration Monday over its blasé reaction to concerns raised last year about an apparent carveout that lets Chinese nationals onto US soil without a visa.

Under the policy, certain Chinese nationals can enter the Northern Mariana Islands, an American territory roughly 1,600 miles east of the Philippines, without business or tourism visas for multiple weeks at a time.

“Instead of listening to my calls to close this gap and prevent further [Chinese Communist Party] espionage, the Biden administration dragged their feet for four months and now is defending an outdated policy,” Sen. Joni Ernst (R-Iowa) told The Post.

Ernst, who sits on the Senate Armed Services Committee, had warned in a Nov. 30 letter to Homeland Security Secretary Alejandro Mayorkas that the policy could be exploited by Chinese spies.

The Department of Homeland Security responded last week, insisting that it is “vigilant in its screening and vetting duties.”

"Make no mistake, they are putting our military secrets at risk,” Ernst said. “We must change this visa policy and put an end to Chinese nationals accessing our military installations on US territories for any malign activity.”

The visa waiver program in question dates back to 2009, when the DHS leveraged “discretionary authority” to allow Russian and Chinese nationals into the Northern Mariana Islands for business and pleasure.

The Northern Mariana Islands became a US trust territory after World War II.lesniewski – stock.adobe.com
The Northern Mariana Islands are located not far from Guam.AFP via Getty Images

The 14-island chain officially became a US territory back in 1986 and lies adjacent to the island of Guam, home to numerous key military installations.

Ernst fretted that Chinese nationals could theoretically “use a visa loophole to gain access to our critical military installations in Guam.”

In a response to Ernst and Rep. Neal Dunn (R-Fla.), DHS official Zephranie Buetow stressed that Chinese nationals would not be able to move from the Northern Marianas to other locations.

“[Chinese] nationals may travel to the CNMI without a visa for the purpose of a temporary visit for business or pleasure for up to 14 days; they are not authorized for employment,” Buetow explained.

“Individuals without a visa are not authorized to travel to other parts of the United States, including Guam. When these individuals are encountered at CNMI airports, US Customs and Border Protection will prohibit their onward travel to other US destinations.”

Buetow also said that “where necessary,” US officials have been “denying entry to high-risk travelers” seeking to benefit from the visa waiver program.

Critics like Ernst and Dunn contend that the policy creates the possibility that some Chinese nationals will work illegally or exploit their entrance onto the island chain to advance Chinese Communist Party interests.

“DHS has responded with willful ignorance of ongoing national security concerns,” Dunn argued. “[DHS officials] fail to see why it’s critical that we must implement the requirement of a B-1/B-2 visa to enter the CMNI to successfully deter the Chinese Communist Party’s aggression and transnational repression.”

“Law enforcement does an outstanding job capturing those with ill-intent, but look how DHS handles our border crisis. We cannot risk the same thing occurring in the [Northern Mariana Islands].”

DHS did not immediately respond to a request for comment.

https://nypost.com/2024/04/08/us-news/sen-joni-ernst-slams-biden-over-loophole-that-may-allow-chinese-spies-to-invade-us-islands/