Tuesday, September 15, 2026
Iraq PM says oil sales greatly affected by Strait of Hormuz situation
Iraq’s oil sales have been greatly affected by the situation in the Strait of Hormuz, Prime Minister Ali al-Zaidi said on Tuesday.
Al-Zaidi added that the Iran-US crisis had affected “the entire world.”
US energy secretary says Saudi East-West pipeline should restart within days
Oil should begin flowing again through Saudi Arabia’s vital East-West pipeline within days after it was temporarily shut following attacks by Iran-backed groups, US Energy Secretary Chris Wright told CNBC on Tuesday.
US, Israel and Arab military commanders met in Germany over Iran war - Axios
Top military commanders from the United States, Israel and several Arab countries met in Germany last week to discuss the war with Iran and broader regional tensions, Axios reported, citing two Israeli officials.
The private retreat was organized by US Central Command commander Adm. Brad Cooper and was not officially announced by any of the participating countries, the report said.
Brain MRI Surveillance Alone Helps Preserve Cognition in Small Cell Lung Cancer
Brain MRI surveillance without prophylactic cranial irradiation (PCI) led to improved cognitive failure-free survival (CFFS) in patients with small cell lung cancer (SCLC), the phase III MAVERICK trial showed.
Patients randomized to MRI surveillance alone were more likely to be alive and free from cognitive decline compared with those randomized to MRI surveillance plus PCI, with estimated 6-month CFFS rates of 38% versus 17% (HR 0.60, 90% CI 0.46-0.78, P=0.0005), reported Chad Rusthoven, MD, of the University of Colorado Cancer Center in Aurora, at the World Conference on Lung Cancer in Seoul, South Korea.
There was no significant difference in the benefit of MRI alone by either disease stage (limited vs extensive) or receipt of immunotherapy.
A preliminary overall survival (OS) analysis conducted after 128 deaths showed no difference between strategies (HR 0.90, 90% CI 0.67-1.20).
"These results support MRI surveillance as the preferred management approach for patients with small cell lung cancer," Rusthoven said.
Invited discussant Hideyuki Harada, MD, PhD, of the Shizuoka Cancer Center in Nagaizumi, Japan, said that "for extensive-stage small cell lung cancer, based on the results from MAVERICK and previous phase III trials, MRI surveillance can be considered the standard of care in the MRI era."
However, he noted that limited-stage SCLC is potentially curable and that the decision to omit PCI should be based on a comprehensive evaluation of the final OS results in MAVERICK, as well as results from the PRIMALung trial, which is evaluating whether brain MRI surveillance alone is noninferior for OS compared with PCI plus MRI surveillance in SCLC.
"Until then, in my opinion, MRI surveillance remains a valid option in limited-stage small cell lung cancer," he added.
In explaining the rationale behind the MAVERICK trial, Rusthoven said that, relative to other tumors, SCLC has high rates of brain metastases.
PCI, which involves radiation to the whole brain in the absence of detectable brain metastases, reduces the rate of subsequent intracranial progression by approximately 50%, he explained. "However, there have long been concerns that PCI may cause toxicity to cognition and quality of life."
While PCI became standard of care when studies from the pre-MRI era demonstrated improved OS with PCI versus observation, Rusthoven noted it has become "increasingly controversial in the era of routine brain MRI staging and surveillance."
"Brain MRI surveillance may allow for earlier detection of brain metastases and more effective salvage therapy, and thus potentially eliminate the overall survival benefit previously observed with PCI," he pointed out.
For this study, Rusthoven and team enrolled 304 patients with both limited- and extensive-stage SCLC between January 2020 and December 2025. Median age was 67 years in the PCI/MRI arm and 66 years in the MRI-alone arm, slightly more than half were women, and about two-thirds had limited-stage SCLC. All patients had completed upfront therapy and had no evidence of brain metastases on MRI prior to enrollment.
In both groups, brain MRIs were performed every 3 months during the first year and every 6 months during the second year, with cognitive testing conducted at the same intervals. Cognitive function assessments included the Hopkins Verbal Learning Test-Revised, the Controlled Oral Word Association, and the Trail Making Test.
Rusthoven explained that due to the observed accrual rate, the trial was amended to make CFFS -- previously a key secondary endpoint, defined as time to cognitive failure or death -- the primary endpoint of the trial.
"As expected," the incidence of brain metastases was higher with MRI surveillance alone compared with MRI plus PCI (subdistribution HR 2.19, 95% CI 1.31-3.64), with 6-month cumulative incidence rates of 21% and 7%, and 12-month incidence rates of 30% and 15%, Rusthoven reported.
"However, there were no significant differences in progression-free survival between the arms," he said, although PCI did alter the patterns of initial failure. For patients in the MRI-alone group, there were higher rates of central nervous system progression (18% vs 5% in the PCI/MRI arm), while rates of extracranial-only progression were higher in the PCI/MRI arm (45% vs 31%).
He also reported that brain metastasis-free survival numerically favored the PCI/MRI arm, but the difference between arms was not statistically significant (HR 1.25, 90% CI 0.95-1.66).
Grade ≥3 adverse events occurred in just 0.8% of patients receiving MRI surveillance alone compared with 7.9% of those receiving MRI plus PCI. There was one treatment-related grade 5 encephalopathy event in the latter group.
Disclosures
Rusthoven reported employment with Eastern Radiation Oncology, and relationships with Suzhou Liangihui Network Technology.
Harada reported relationships with AstraZeneca, Accuray, Chugai, Takeda, MSD, Eisai, Pfizer, Brainlab, Hitachi, Novartis, Guerbet Japan, GE Healthcare, Nihon Medi-Physics, Taiho, Novocure, and Regeneron Japan.
'AP: Crackdown on Immigrants Who Use Public Benefits Takes Effect'
Democratic-led states and cities filed lawsuits Monday challenging a federal rule set to begin Friday that they say gives President Donald Trump's administration broad discretion to deny green cards to immigrants who rely on public assistance for food, healthcare, housing, and other basic needs.
New York Attorney General Letitia James, who is leading a coalition of 21 other states in one of the suits, said the rule would force needy immigrant families to choose between seeking assistance and seeking legal status in the country. California, Colorado, Hawaii, Massachusetts, Michigan, Nevada, New Mexico, and Wisconsin are among the states involved in the legal challenge.
"This rule preys on that fear and counts on families forfeiting the food assistance, healthcare coverage, and other public benefits to which they are legally entitled," she said Monday at a news conference in City Hall alongside New York City Mayor Zohran Mamdani and immigrant advocates.
Mamdani filed a separate suit with leaders of other U.S. cities, including Chicago, San Francisco, and Seattle. He said the rule would have a "chilling effect" not just on immigrants seeking legal status but other residents of the nation's largest city.
"The new public charge rule seeks to push immigrant families away from the programs that have kept people fed and healthy for decades," the mayor said. "New Yorkers will be afraid to see a doctor or ask for help they are legally entitled to. That fear will not stop at the families that the federal government is targeting."
The U.S. Department of Homeland Security (DHS), which is named in the lawsuits, dismissed the dire warnings.
"Let's get this straight, sanctuary states are terrified they will lose federal funds because hundreds of thousands of illegals and noncitizens might remove themselves from American welfare programs," the agency said in a statement. "We're shaking in our boots over this supposedly terrible outcome."
The lawsuits challenge DHS's plan to revive a "public charge" rule the Republican president originally imposed during his first term, only to have it reversed under his successor, Democratic President Joe Biden.
The lawsuits, which were both filed in federal court in Manhattan, argue the new rule is "arbitrary and capricious," exceeds the DHS's statutory authority, and departs from the longstanding meaning of the federal government's public charge provision.
Specifically, James said, the rule unlawfully gives immigration officials broad discretion to consider a wide range of public benefits when making their decisions on immigrants seeking legal status in the country.
She said the rule lets immigration officers count nearly any public benefit, used for any length of time, against a green card applicant -- even if it's a U.S. citizen family member who is taking advantage of the benefit.
That means a parent's green card application could be at risk simply because their U.S. citizen child used state-provided health insurance or participated in a school's free lunch program, James said.
"This new rule sweeps away more than a century of settled law to unlawfully broaden the definition of 'public charge' in a way that Congress never intended," added Steve Banks, the city's corporation counsel.
California Attorney General Rob Bonta called the rule a "cruel policy."
Federal law already requires those seeking permanent residency or legal status to demonstrate they will not rely on public benefits.
The new rule does not specify the programs that could be taken into account. It simply says officers, "using good judgment and discretion," will make "individualized, fact-specific public charge inadmissible determinations, based on a totality of the alien's circumstances."
https://www.medpagetoday.com/washington-watch/washington-watch/123005
'Chart Note Disarray: Technology may be the best tool to help streamline medical records'
When was the last time you read, from beginning to end, a really long chart note that helped you take better care of a patient?
Sometimes when I read a specialist's notes (and even notes of some primary care providers) that go on for page after page, carrying forward every previous visit, it can be incredibly difficult to figure out what happened, what's going on right now, what issue they were dealing with, and what the recommendations were.
Sure, you can sometimes skip to the end, right before the assessment and plan, and find the section of the note labeled "today's visit" (sometimes with the added bonus of that day's date). But this can be hard to pull out sometimes, as every paragraph seems to be labeled, "today's visit."
I recall one instance where I misunderstood and thought a patient was in the midst of getting a treatment that they had finished long ago, and it definitely delayed care. And another where I thought someone else was providing treatment, but they thought I was taking over, and neither of us ended up doing anything until that mess got cleared up.
When did it become "fashionable" to make each note a complete copy of the entire patient's chart that came before?
We see notes with every part of the hospital course, every outpatient visit, every lab value, every imaging study, every procedure, cut-and-pasted into a non-hierarchical mess, that sometimes makes it hard to figure out what's happened, what's happening, and what should happen.
And doesn't this go against the whole point of our notes?
Subjective, objective, assessment, and plan. That was always supposed to be it.
What I learned from the patient today, what I found on my exam, what I think is going on, and what I plan to do about it.
It's true, sometimes the patient's past medical and surgical history can inform, can provide an important reference, a sounding point from which to make today's decisions better, some hidden nugget, a clinical pearl, to prevent the mistakes we made in the past, to see the whole picture.
But when bringing it all into today's note ends up creating something that's just too long to read, too big to get your head around, and just not that useful for making decisions, then maybe it's time we do better.
In the old days, our paper charts got thicker and thicker as a patient's medical course grew longer and more complex: more interactions with us, more complications, more pathways that we went down trying to get them healthy, more journeys with bumps along the way.
Now, much of this sits in the electronic medical record, right there for us whenever we need it.
So, in my opinion, maybe it's better just to refer to it than cutting and pasting it all into your own note.
It's also true that sometimes a really nice synopsis, a way to get access to the deeper story, can be very powerful, and help prevent us from missing something critical to a patient's health.
Perhaps this is where artificial intelligence (AI) can really help us in healthcare -- synthesizing massive amounts of data and telling stories, the true story of a patient, in a way that we can wrap our heads around, to make sure we don't miss the forest for the trees.
In the past week or so we've started to hear rumblings of looming problems with AI, fears of it getting out of hand, taking over, wiping out all of humanity. But I remain hopeful that if we learn how to harness it well, it could prove to be invaluable in healthcare, maybe more so than for almost any other field.
Cutting and pasting everything that's ever happened to a patient into a note used to be a way that we were able to bill for complexity, but now it just seems like an effort in redundancy and insanity.
My hope is that we can start to use these incredibly smart tools to dive into the chart, to ferret out the details, to make sure we don't miss anything, to broaden our differential and narrow our scope of vision, always focusing on the best thing for the patient.
What are we missing, what else could we do here, how will we know we're heading down the right path, and how can we learn when we're not.
Can anyone out there honestly tell me that when they open up a note and are confronted with page after page of old office visits copied forward, that you really read through them all again, synthesize them, use them to make a better decision for today?
Or do we all just skip to the end, avoiding that long journey that, more often than not, takes us nowhere? Certainly not to where we want to be.
https://www.medpagetoday.com/opinion/patientcenteredmedicalhome/123006
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