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Minnesota Mall Stabbings

In St. Cloud, Minnesota, a man in a security guard’s uniform stabbed and injured nine shoppers at a mall on Saturday before he was shot dead by an off-duty police officer. The attacker was later identified as Ahmed Adan, a 22-year-old born in Kenya of Somali descent who has lived in the U.S. for the last 15 years.   Adan reportedly mentioned Allah and asked at least one victim if he was Muslim, the police said. All nine victims were expected to survive.  The wounded include seven men, one woman and a teenage girl, all from the St. Cloud area.

Chief William Blair Anderson of the St. Cloud police said the attack had started around 8 p.m. and played out at different sites within Crossroads Center, including multiple businesses and common areas.  Chief Anderson told reporters at the scene, “It has hit home for us,” adding, “But I want everybody in St. Cloud to know that we will be diligent and we will get to the bottom of this.”  “It’s an awful day, honestly,”

In a phone interview the morning after the attack, Mayor Dave Kleis said the mall, Crossroads Center, was an active crime scene and would remain closed. He praised the off-duty police officer, who he said had “clearly saved lives and protected the other individuals.”

Mr. Kleis, who went to Crossroads Center after the attack, said that “there were a lot of people in that mall and clearly a lot of witnesses,” and that police interviews had stretched well into Sunday morning.  Witnesses and local journalists spoke of a busy, crowded and confusing scene after the attack, as well as a swift police mobilization.

Later that day, the off-duty officer was identified as Jason Falconer, a police officer in nearby Avon, Minn. Video footage of the shooting, which has not been released publicly, showed Officer Falconer confronting the attacker in a Macy’s store and shooting him as he charged with a knife.

Chief Anderson said officers had searched two local residences on Sunday in connection with the case. He said the police had had at least three prior interactions with the attacker, mostly for minor traffic violations.  The investigation is proceeding, and Adan’s family is cooperating. But for now, the chief says this looks like the work of a lone attacker.

Authorities say on the night of the attack, around two hours before the attack, Adan told his family he was going to buy an iPhone 7.  It’s unclear what time he put on a security guard’s uniform-similar to the one he wore while working a previous job at a nearby appliance factory.   Once inside the mall, Adan went on a chaotic stabbing rampage, injuring 10 people before the off-duty police officer shot him in the Macy’s store.

In a public statement on Monday night, Adan’s family said they were experiencing the same “deep shock as everyone else is in the state of Minnesota.”  “We are devastated by the incomprehensible tragic event of last Saturday evening,”

Richard Thornton, the special agent in charge for the F.B.I. in Minneapolis, said the agency was treating it as a potential terrorist act but was still investigating.  An ISIS website claimed responsibility, calling the assailant a “soldier of the Islamic State.”

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At around 9:30am on September 17th, a pipe bomb exploded in a trash can along the route of a United States Marine Corps charity run in Seaside Park, no one was injured.  Later that day, at about 8:30 p.m., a homemade pressure cooker bomb exploded on West 23rd Street in the Chelsea neighborhood of Manhattan. Thirty-one civilians were injured, 24 of whom were taken to the hospital. A second pressure cooker bomb was discovered by authorities, four blocks away on West 27th Street.

On September 18, multiple bombs were discovered inside a suspicious package at the Elizabeth train station in Elizabeth, New Jersey. One of those bombs detonated early the next day during the police investigation with no injuries were reported.

The Federal Bureau of Investigation (FBI), the Joint Terrorism Task Force (JTTF), Homeland Security, and the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) responded to the scene of the Manhattan bombing and were involved in the investigation, in addition to the New York City Fire Department (FDNY) and the NYPD.

Initially, the Seaside Park and Manhattan bombings were investigated as separate incidents, but over a period of two days, the investigation yielded similarities between the two incidents, leading the investigators to determine that they were connected, and therefore that it was to be investigated as one overall terrorist act or endeavor, committed by the same party.

Investigators discovered surveillance video that showed a suspect planting a bomb on West 23rd Street in Manhattan, then walking to West 27th Street dragging a duffel bag. The subject left the bag at West 27th Street. On September 19, the Federal Bureau of Investigation (FBI) identified 28 year old Ahmad Khan Rahami as the suspect in all of the incidents.  He was captured hours later after a shootout in Linden, New Jersey. The shootout left Rahami and three police officers injured. Rahami was hospitalized and charged with crimes in both New Jersey state court and federal court with the attempted murder of two law enforcement officers  and bombing and use of a destructive device.

Authorities say Rahami was originally from Afghanistan and came to the United States in 2000 and was naturalized in 2011.  He graduated from Edison High School in 2008 and attended Middlesex County College in Edison, New Jersey, from 2010 to 2012, majoring in criminal justice. He did not graduate. He was living in Elizabeth, New Jersey at the time of his arrest.

Rahami travelled to Afghanistan several times, including an extended visit in 2012 and reportedly “showed signs of radicalization” afterwards. Rahami and members of his family also made several trips to Pakistan, where they had Afghan relatives living as refugees.  He spent several weeks in the cities of Quetta, Kuchlak and Kandahar, Afghanistan.

At Quetta, which is home to a large population of Afghan immigrants and some Taliban members-in-exile, he married a Pakistani woman in July 2011. Rahami remained in Pakistan from April 2013 to March 2014, and traveled to Afghanistan during that time.  Following his near-year-long stay in the region, he underwent additional screening. On both occasions, he stated that he visited family members and was cleared by immigration and customs officials. The FBI did not find any signs of ties to terrorism during background checks.

The faculty union at Long Island University announced an agreement to end a 12-day lockout of professors at the university’s Brooklyn campus.  The agreement comes nearly two weeks after the administration took the unprecedented step of barring them from campus after their contract expired.

As part of the lockout, LIU cut off 400 professors’ email accounts and health insurance and told them they would be replaced. The lockout sparked a wave of protests by both faculty and students, who arrived for the beginning of the school year to find their classes being taught by administrators with no experience in the fields.

On Wednesday, the administration agreed to end the lockout, restore faculty members’ health insurance and permit them to return to their classrooms. Contract negotiations remain ongoing.  A statement from the Long Island Faculty Federation, which is affiliated with the American Federation of Teachers, said the lockout is over and a mediator will be used to resolve disputes over a new contract. While that process plays out, the expired contract will be in effect, until the end of May, if necessary. The agreement is similar to one proposed earlier by the union and rejected by the administration. The difference is that the contract extension is for a longer period of time and covers the academic year that just started.

The key issue in the contract negotiations is over how quickly to close a pay gap for faculty members at the two main LIU campuses. The union says the gap is unfair to those who teach in Brooklyn, and the administration says that it can’t afford to close the gap at the speed the union is proposing.

The lockout ended after a day on which students held a mass walkout to protest the lockout of 400 regular faculty members. Students have used social media to share dissatisfaction with last-minute instructor replacements and class cancellations since the lockout began earlier this month over stalled contract negotiations between the university and its faculty union. They shared similar complaints during the walkout. Video footage of the protest shows students exiting the campus via a gate to join their picketing professors on the other side. Long Island University students were joined by student supporters from nearby City University of New York campuses.

After the lockout ended, the university issued a statement from Gale Haynes, vice president, chief operating officer and university counsel, that said the longer time period of the contract extension enabled the administration to support the deal. “The union’s commitment not to strike during this academic year provides us enough runway to reach a reasonable and fair agreement, while providing our students the ability to continue their studies uninterrupted. That has always been our intention. Mediation is a positive step to that end,” Haynes said.

While contract negotiations between faculty unions and administrators are nothing new, the way this was handled is unprecedented in the history of academic labor unions in the United States.  Never before have we seen an administration dismiss all faculty members , replacing them with temporary workers and have administrators teach classes.

Mylan has faced growing scrutiny for jacking up the price of the EpiPen product more than 400 percent since 2009, with lawmakers, consumer advocates and other critics accusing the company of gouging vulnerable patients.  The EpiPen is the most popular epinephrine auto-injector on the market, which is used to treat people who suffer a severe allergic reaction.

In 2007 the company bought the rights to EpiPen, a device used to provide emergency epinephrine to stop a potentially fatal allergic reaction and began raising its price. In 2008 and 2009, Mylan raised the price by 5 percent and added another 19 percent hike at the end of 2009. From 2010-2013 there were 10 percent price hikes.  From the fourth quarter of 2013 to the second quarter of 2016, Mylan steadily raised EpiPen prices 15 percent every other quarter.

With the focus on the skyrocketing price of the EpiPen, many don’t realize that Mylan’s price increases are nothing new for the products they offer.  For instance, the company raised the price of ursodiol, a generic medicine used to treat gallstones, by 542 percent. There was also a 400 percent boost in the price for dicyclomine, which combats irritable bowel syndrome, and a 312 percent increase for metoclopramide, a generic drug that treats gastroesophageal reflux disease.

Those increases were first disclosed two months ago by Wells Fargo analyst David Maris, amid a national debate over prescription drug prices. The disclosure put Mylan on the defensive because, until then, the company had avoided the harsh spotlight fixed mostly on Valeant Pharmaceuticals and Turing Pharmaceuticals, which was run by Martin Shkreli.  The Mylan price hikes also revealed that big increases are not always confined to brand-name drugs. Mylan is one of the world’s largest purveyors of copycat medicines. Two years ago, prices for some generic drugs rose substantially — one topped 17,000 percent — and generated congressional interest.

Not surprisingly, the news that Mylan CEO Heather Bresch got a nearly sevenfold pay increase while hiking the price of her drug company’s popular EpiPen 400 percent over the past eight years has outraged many.  Proxy filings show that from 2007 to 2015, Mylan CEO Heather Bresch’s total compensation went from $2,453,456 to $18,931,068, a 671 percent increase. During the same period, the company raised EpiPen prices, with the average wholesale price going from $56.64 to $317.82, a 461 percent increase, according to data provided by Connecture.

Salaries for other Mylan executives also went up as President Rajiv Malik’s base pay increased 11.1 percent to $1 million and Chief Commercial Officer Anthony Mauro saw his salary increase 13.6 percent to $625,000.  After Mylan acquired EpiPen, its reported spending on lobbying went from $270,000 to $1.2 million.  Legislation that enhanced its bottom line followed, with the FDA changing its recommendations in 2010 that two EpiPens be sold in a package instead of one and that they be prescribed for at-risk patients, not just those with confirmed allergies.

In 2013 the government passed a law to give block grants to states that required they be stocked in public schools.  New York Attorney General Eric Schneiderman said that a preliminary analysis by his office found that Mylan may have included terms in sales contracts with local schools for the anti-allergy drug that ultimately harmed competition.   “No child’s life should be put at risk because a parent, school or health care provider cannot afford a simple, life-saving device because of a drugmaker’s anti-competitive practices,” Schneiderman said in a statement.

 

 

 

 

According to a recent  Wall Street Journal article, there is a growing discontent among physicians, covering everything from feeling unappreciated to the problems with the larger health system. They practice in an environment where treating patients with insensitivity and impatience has become the norm, and they are forced to spend an inordinate amount of time each day on insurance paperwork.

In fact, according to a recent study published in the Annals of Internal Medicine, it could be because your physician is just too overwhelmed with paperwork, due to a healthcare system that has now become all about business – not necessarily about the quality of care and time spent with the patient.  Doctor Writing Notes

The study surveyed 57 doctors and found that for every hour they spend seeing patients, they spend an average of two hours on recordkeeping – either electronic or on paper.  On a typical day, your doctor may spend only about a quarter of their time (27%) in direct contact with patients and almost half (49.2%) documenting what they did.

When the doctors are with patients, they spend more than a third of the time (37%) on a computer or doing paperwork. Only about half (52.9%) of a patient visit involves direct face-to-face contact, according to the study’s findings.

Today’s primary doctor visits are commonly scheduled at 15-minute intervals, and some physicians who work at hospitals are asked to see a new patient every 11 minutes, according to a 2014 article from Kaiser Health News.  Even in that short time frame, doctors probably aren’t listening attentively to their patients.

A large part of the burden on physician time appears to have come from the use of electronic health records (EHRs).  Their implementation was strongly encouraged with financial incentives by the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted in 2009. The idea behind the law was to better organize recordkeeping by replacing handwritten records with computer entries. However, the effect on your physician’s workload may have been the opposite of what was intended.

Doctor Working On I Pad 2

Additionally, as we have seen by recent months news reports, the President’s ‘Affordable’ Care Act (ACA) commonly referred to as ‘Obamacare’, has become a significant liability for insurers.  The rising costs and the addition of high-risk populations has resulted in multi-million dollar losses for United HealthCare, Humana and, most recently, Aetna.  In many states, even the well known Blue Cross subsidiaries have up and left the Obamacare marketplaces.

Insurers are for-profit entities and have an obligation to their shareholders to make sound financial decisions.  When we involve for-profit entities such as insurers in clinical decision making, added pressure is then placed upon the doctors to increase patient load, reduce time spent with that patient, resulting in even further restrictions in getting access to a quality visit with your physician.

Now, three of the largest Obamacare ACA insurers have vowed to significantly reduce their presence by exiting many of the states going forward.  This effect is expected to result in even more limited access for patients to their doctors, fewer choices, and higher costs.  The average Obamacare Silver Plan is estimated to rise by 15% — in some states, these premium increases may approach 45%.  The Silver Plans are generally more flexible in allowing a consumer to still use their primary are doctor.

President Barack Obama speaks at Temple Emanu-El, on Wednesday, Nov. 6, 2013, in Dallas, as he promotes his health care law. (AP Photo/The Dallas Morning News, Louis DeLuca) MANDATORY CREDIT; MAGS OUT; TV OUT; INTERNET USE BY AP MEMBERS ONLY; NO SALES

As a result of the increased pressures brought on by Obamacare, and by the growing mass of paperwork with no change in sight, many doctors do not have time to do things most useful to their patients, society and frankly the clinics and hospitals at which they work.

Moreover, in a study from the Mayo Clinic Proceedings in July, physicians from all specialties from across the U.S. were surveyed and most were found to be dissatisfied with having to use electronic health records (EHR’s) and this led to frustration and burnout.   In this large national study, physicians’ satisfaction with their EHRs and computerized physician order entry (CPOE) was generally low.  Physicians who used EHR’s and CPOE were less satisfied with the amount of time spent on clerical tasks and were at higher risk for professional burnout.

Something has to change with both our healthcare delivery system, and with the insurance plan offerings to consumers.  Healthcare systems may need to hire people to help with the added paperwork, develop better technology to complete the record keeping, give physicians more time to see fewer patients or to minimize the administrative burdens and insurance company oversight and decision making in patient care. Otherwise, doctors will just have less and less time to actually examine and treat patients. And this will hurt everyone and eventually the entire system will hit a breaking point.

Doctor Looking Concerned

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Fox News’s parent company has settled the sexual harassment lawsuit brought by former Fox News anchor, Gretchen Carlson for $20 million.  Carlson’s lawsuit toppled the network’s powerful chairman, Roger Ailes, and engulfed the company in crisis.  In the lawsuit, Carlson said former Fox News Chairperson Roger Ailes repeatedly made advances toward her, calling her “sexy” and explicitly asking for a sexual relationship during a meeting in his office. She says that when she rejected his advances, Ailes retaliated against her by cutting her salary, curtailing her airtime and then refusing to renew her contract.

Carlson first filed her lawsuit in July, paving the way for more than 20 women to also come forward and accuse Ailes of sexual harassment. Ailes resigned later that month, receiving a $40 million severance package.

The $20 million payout to Ms. Carlson has been described as one of the largest-known settlements for a single-plaintiff sexual harassment suit.   Ms. Carlson sued Mr. Ailes alone, but 21st Century Fox, which acts as Mr. Ailes’s corporate indemnifier, will pay the settlement.

Fox has also settled with at least two other women who came forward with complaints about Mr. Ailes.  The company issued a rare public apology to Ms. Carlson, “for the fact that Gretchen was not treated with the respect and dignity that she and all of our colleagues deserve.”

Rupert Murdoch and his sons, James and Lachlan, who control Fox News’s owner, 21st Century Fox say they have taken extraordinary steps to address problems at the network, which is still the highest-ranked cable news network in the country, beginning with their swift removal of Mr. Ailes.

The evidence that Ms. Carlson had against Mr. Ailes was damning.   For a year and a half, she had recorded her meetings with Mr. Ailes on her mobile phone.  Most of the remarks that she attributed to Mr. Ailes in her lawsuit — including lines like, “I think you and I should have had a sexual relationship a long time ago, and then you’d be good and better and I’d be good and better” — were taken straight from those recordings.  In an interview with The New York Times in July, Ms. Carlson said she recalled “between six and 10” conversations with Mr. Ailes when the chairman made provocative comments.

Officials at 21st Century Fox became aware of the recordings about three weeks after Ms. Carlson filed her lawsuit, after Ms. Carlson’s lawyers spoke to investigators from Paul, Weiss, Rifkind, Wharton & Garrison, the law firm hired to look into the accusations against Mr. Ailes.

Settlement talks started shortly after and a deal was reached in mid-August.  As part of the arrangement, Ms. Carlson signed a confidentiality agreement.  She issued a statement on Tuesday saying she was “ready to move on to the next chapter of my life, in which I will redouble my efforts to empower women in the workplace.”

 

 

 

During his three-day trip to Laos, Obama was also scheduled to meet with the controversial president of the Philippines, Rodrigo Duterte.  President Barack Obama canceled the planned meeting after Duterte called President Obama a “son of a whore” and warned him not to ask about his so-called drug war, in which police and vigilantes have killed at least 2,400 people in only two months.

The White House said last week that Mr. Obama was planning to meet with Mr. Duterte during his trip to Laos for a summit of Asian leaders beginning Tuesday. The meeting would have been the first between the world leaders since Mr. Duterte took office in June.

The president of the Philippines controversial statement was “I am a president of a sovereign state, and we have long ceased to be a colony. I do not have any master except the Filipino people, nobody but nobody. You must be respectful. Do not just throw away questions and statements. Son of a whore, I will swear at you in that forum.”

The insult and cancellation of the meeting follows an outbreak of tensions between two close allies over the Philippines’ new drug war.  President Duterte declared an indefinite national state of emergency Monday after a bombing in the city of Davao killed 14 people on Friday. The declaration does not amount to martial law but does give the police and military sweeping powers. Militants from the group Abu Sayyaf have claimed responsibility for the bombing.

It is rare for Mr. Obama to cancel a meeting with a world leader in an intentional snub. In 2013, he backed out of a meeting with Russian President Vladimir Putin after Moscow granted asylum to Edward Snowden, the former National Security Agency contractor who leaked classified information over White House objections.

Obama has said that he expects the U.S. and the Philippines to maintain close relations. The countries are longstanding treaty allies, and Manila relies on American support in its territorial disputes with China in the South China Sea. Washington is also due to deploy troops to the Philippines as part of the Obama administration’s strategy of rebalancing to the Asia-Pacific region under terms of a 2014 defense pact.

Speaking at a news conference in China before flying to Vientiane, Mr. Obama said he had directed his aides to talk with their Philippine counterparts to make sure “the timing is right” for a meeting after learning that Mr. Duterte said forcefully on Monday that the U.S. president has no standing to confront him about human rights and that “plenty will be killed” in the Philippines’ antidrug campaign.

When Duterte made the comments, he was responding to questions from local reporters about how he would react if Mr. Obama raised the human-rights issue.  He appeared angry and blamed the U.S. for causing the country’s problems because they ran the Philippines as a colony until 1946.

In Connecticut, a judge has ordered the state to fundamentally overhaul its public education system, saying Connecticut is “defaulting on its constitutional duty” and has “left rich school districts to flourish and poor school districts to flounder.”

The ruling is a response to a decade-long lawsuit arguing Connecticut has failed to provide adequate funding for its poorer school districts. The ruling goes far beyond school funding and instead forces Connecticut to change everything from teacher pay to graduation requirements, in addition to school district financing.

Reading his ruling from the bench, Judge Thomas Moukawsher of State Superior Court in Hartford said that “Connecticut is defaulting on its constitutional duty” to give all children an adequate education. Judge Moukawsher’s decision was a response to a lawsuit filed more than a decade ago that claimed the state was shortchanging the poorest districts when it came to school funding.

The current system “has left rich school districts to flourish and poor school districts to flounder,” Judge Moukawsher said, betraying a promise in the State Constitution to give children a “fair opportunity for an elementary and secondary school education.”  “An approach that allows rich towns to raid money desperately needed by poor towns makes a mockery of the state’s constitutional duty to provide adequate educational opportunities to all students,” Judge Moukawsher wrote.

What separates the decision from those in dozens of similar suits around the country is that rather than addressing money only, it requires the state to rethink nearly every major aspect of its system.  Joseph P. Moodhe, who represented the plaintiffs in the case, Connecticut Coalition for Justice in Education Funding, said that virtually every state had faced an education funding suit.

Connecticut is known for the quality of its schools, and the decision cited several impressive statistics about the good ones, including the highest average reading scores in the country for fourth and eighth graders on the 2013 National Assessment of Education Progress, or N.A.E.P., often called the nation’s report card.

The state is also home to failing schools, especially those serving poor children. The 2015 N.A.E.P. report found that poor students in 40 other states, including perennial poorly performing Mississippi and Arkansas, did better than poor students in Connecticut. Schools serving the poorest children are concentrated in 30 of the state’s 169 municipalities.

Connecticut finances its schools with a combination of local property taxes and federal and state money in a way that is supposed to offset the huge disparities in property values between rich and poor towns. Bridgeport, court documents noted, has nearly eight times the population of nearby New Canaan, but property in that wealthy Fairfield County town is worth more than $1 billion more.

The state has faced a punishing fiscal crisis this year, resulting in layoffs and spending cutbacks. That led the General Assembly to cut state education aid to some of the poorest districts, with more than $905,000 cut from Bridgeport, and more than $600,000 cut from New Haven. Comparatively wealthy districts got more money: Branford, a New Haven suburb, got a funding increase of $300,000.

The White House says it has met its goal of resettling 10,000 Syrian refugees this year.  Under pressure from Europe and other countries confronting the global migration crisis last fall, Mr. Obama had raised the number of Syrian refugees who would be offered legal status to at least 10,000 in the 2016 fiscal year.

The refugees who have arrived from Syria since 2012 have been placed in 231 towns and cities.  Some have been resettled in large cities like Chicago and Houston, but most have been sent to more affordable, medium-size cities. Boise, Idaho, has accepted more refugees than New York and Los Angeles combined; Worcester, Mass., has taken in more than Boston.

With the 10,000 admitted this year, the US has now accepted nearly 12,000 Syrian refugees since the civil war began five years ago.  Before the recent surge in admissions, Syrians were just a small percentage of all refugees allowed into the US.  In the 2015 fiscal year, just 2% of the 70,000 refugees admitted were from Syria. The majority were from Myanmar, Iraq and Somalia.

More than 150,000 Syrians already live in the United States, according to census figures, and refugees who have relatives in the country are likely to be resettled with or near them.  Those who do not have family in the United States are placed where jobs are more plentiful and the cost of housing is low. Refugees receive help finding work and housing  but they are expected to become self-sufficient within a year.

Obama’s resettlement program got off to a slow start because Syrian refugees were subjected to an additional layer of background checks, which extended a lengthy vetting process.  Eight months into the program, the United States had accepted only a quarter of the target.  Most of the resettled refugees have been admitted into the US in the last three months, allowing the administration to reach its 10,000-refugee goal a month ahead of schedule.

Since that’s only about 0.2% of the total number of Syrian refugees registered with the United Nations many human rights organizations are calling on the U.S. to accept even more Syrians.   Amnesty International wrote, “So many are still trapped in horrific conditions in refugee camps or war zones. The U.S. must do more.” Nearly 5 million Syrians are currently displaced outside of their country.