Forward Progress Stopped On Grass Fire In Cordelia – CBS Sacramento

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New Ideas To Liven Up Old SacramentoWithout a doubt, that historic district has been one of the hardest-hit areas in the last two years, but it's determined to bounce back from a pandemic punch in the gut.

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Forward Progress Stopped On Grass Fire In Cordelia - CBS Sacramento

We need to make progress – Warwick Beacon

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To the Editor,

Warwick deserves to be well-represented in the Rhode Island Senate. We need a Senator who supports reasonable, positive change, and works with others. Who will help us move forward.

Im running to serve in the Senate again because we need to do more than make noise; we need to make actual progress. Theres work to do. We need to get our act together in Rhode Island.

On education, we can do better. Rhode Island schools were in crisis before COVID hit (recall the scathing report on Providence schools), and the pandemic didnt help the situation. In 2019, my Senate colleagues and I passed a series of education reform laws, modeled after Massachusetts, aimed at raising statewide academic standards, improving curriculum, enhancing school self-governance and requiring greater local accountability. I also pushed for students to receive instruction in Civics as well as Financial Literacy, and those are now required, too. But that was just a start.

What else can we do? Lets get Sen. Hanna Gallos bill for Universal Pre-K passed and implemented. It will make a huge difference, not just for students in school, but later in life (better high school graduation rates, reduced incarceration and recidivism, higher employment and earning levels). Developed countries around the world provide instruction for children starting at age 3 why not Rhode Island?

Ive seen the impressive new East Providence High School. Children walking into a state-of-the-art school get the message their education is a priority. Warwick deserves 21st century schools. The state should provide more help to make that happen.

Rhode Islands ranking for business-friendliness is pathetic. Small businesses had a tough time during the pandemic. I know - I have a small business. We need to improve and modernize services so small businesses can thrive. We shouldnt be 47th in anything. Also, business-friendly is worker-friendly. Lets support college, but also training for trades!

Lets give a break to our citizens who most deserve it: seniors and veterans. Its stunning that our state is one of 8 that taxes Social Security. Ill work to stop that. Rhode Island is also in the minority of states taxing veterans pensions. That should end now.

Ill continue to speak out on other issues, as this campaign unfolds. Warwick is fortunate to have the Senate Majority Leader and the House Speaker here in our community; Ill work with them to seek to improve life for the citizens of Warwick.

Ill listen, too. When I first ran for office, I put my personal cell number on my flyers, and was told Id regret that. But folks have been very respectful. I follow the same rule I do in practicing law I make every effort to get back to someone by the next business day. Ill be accessible, and Ill work with the rest of the team. Its time to move Warwick forward.

Mark McKenney

Former Senator, Warwick District 30

Link:

We need to make progress - Warwick Beacon

Net-zero climate impact by 2030: Our progress and what lies ahead – McKinsey

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April 22, 2022As Head of Environmental Sustainability at McKinsey, each day I feel a mix of cautious optimism and burning urgency. On the one hand, I am energized by the incredible green solutions that are being developed to make operations more sustainable.

Isabelle Schuhmann

This includes recent wins and milestones across technologies such as sustainable aviation fuels and carbon removals. Our fellow Sustainable Aviation Buyers Alliance member United Airlines recently completed the worlds first passenger flight on 100 percent sustainable aviation fuel, while the Frontier initiative, of which McKinsey is a founding member, created an advance market commitment to buy $925 million of carbon removals by 2030.

These examples show us that progress is possible, meaningful, and happening every day around the world. On the other hand, the latest Intergovernmental Panel on Climate Change (IPCC) assessments offer a stark reminder that we must recommit ourselves to our mission daily if we hope to limit global warming to 1.5C degrees.

One year ago, our firm committed to reaching net-zero climate impact by 2030 and set science-based targets for 2025 validated by the Science-Based Targets initiative in line with a 1.5C-degree pathway. Since then, we have made significant progress that we can be proud of, and we also have a long way to go. Today, on Earth Day, I want to take a moment to reflect on our journey.

Embracing electric transportation, shifting to renewable electricity, and creating sustainable office spaces. Within just one year, offices with the highest share of automobile transportation have introduced electric vehicle or hybrid vehicle policies. We are actively working on rolling this out globallyand for countries with nascent electric-vehicle infrastructure, we are exploring alternative mobility packages that enable our colleagues to use different transport options like rail passes, shared mobility memberships, or occasion-based access to rental cars.

In terms of our electricity consumption, we were the first global consultancy to join RE100 in 2018, and we set a target of 100 percent renewable electricity by 2025. We reached 95 percent in 2020, and we are anticipating to have reached 97 percent for 2021. For countries without an established renewable energy certificate system, we are actively working with other RE100 members to send a demand signal to drive progress and scale up renewable energy production globally.

Furthermore, nearly two-thirds of our existing global office space has achieved green-building certification.

Implementing hybrid working models and supporting the advancement of sustainable aviation fuels. Travel accounted for 83 percent of our firms 2019 carbon footprint. With the switch to remote working, we have seen travel drop by 70 to 80 percent over the last two years. As we shift back into the new normal, we are implementing hybrid working models, aiming to walk the fine line between maintaining the social fabric of our firm and how we serve our clients, all the while also drastically reducing emissions. Some examples include virtual recruiting, remote client engagements, and traveling for critical meetings only.

Aside from traveling less, sustainable aviation fuels are the most promising near-term solution that can help us on our 2030 net-zero journey. These fuels have the potential to deliver the performance of fossil jet fuel with over 70 percent fewer lifecycle emissions. However, there is currently no accounting system approved by Greenhouse Gas Protocol to track a companys emission reductions from sustainable aviation fuel against their science-based targets. A functioning certificate and accounting system will be critical to scale demand. This is one of the reasons we are founding members of the Sustainable Aviation Buyers Alliance, and why we are working closely with the World Economic Forum Clean Skies For Tomorrow initiative as knowledge partners and signatories to the Clean Skies for Tomorrow 2030 Ambition Statement to reach 10 percent sustainable aviation fuel adoption by 2030.

Halting the rise of global emissions is one of the worlds biggest challenges, and its complexity is an inspiration for us to work harder...

As the world works toward a green overhaul, it can be intimidating to take on challenges that seem intractable. Our ethos at McKinsey is one of problem solving, and there is no challenge too great to solve. Halting the rise of global emissions is one of the worlds biggest challenges, and its complexity is an inspiration for us to work harder, innovate with our clients and partners, and continue to lead by example.

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Net-zero climate impact by 2030: Our progress and what lies ahead - McKinsey

Psoriatic Arthritis and Heart Disease: What’s the Link? – Healthline

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Psoriatic arthritis (PsA) is an inflammatory disease of the joints. It causes stiffness, pain, and swelling in the joints. Most of the time, people with PsA have psoriasis, which causes red, scaly patches on the skin.

But the impact of PsA goes beyond the joints and skin.

In recent years, researchers and doctors have discovered that PsA is linked to a variety of metabolic issues.

Specifically, people with PsA are more likely to develop heart disease. This puts people with PsA at a higher risk of heart attack, stroke, and death.

Research has shown that chronic inflammation from psoriasis can lead to cardiovascular disease.

Inflammation is a primary driver for atherosclerosis, which is the buildup of fat and cholesterol in artery walls. Over time, this buildup can lead to high blood pressure, heart attack, and stroke.

A 2014 study found that arthritis in one joint has a significant impact on heart health. The researchers found that people with PsA who had sacroiliitis, or inflammation of the sacroiliac joints connecting the spine and pelvis, were more likely to have cardiovascular issues. Inflammation in these specific joints was linked to more inflammation in the heart.

A 2016 review of studies with more than 32,000 patients found that people with PsA were 43 percent more likely to develop cardiovascular diseases compared to the general population.

In addition to the increased likelihood of heart disease, one study found that people with PsA are more likely to have traditional risk factors for heart disease, including obesity and diabetes. Combined with chronic inflammation from PsA, these factors can lead to damage to the blood vessels and arteries.

Whats more, another review of studies found that people with PsA are significantly more likely to have metabolic syndrome. Metabolic syndrome includes conditions that increase the risk for cardiovascular disease, including:

These cardiovascular impacts are most significant in people with moderate and severe PsA, not mild.

Someone with heart disease may not experience symptoms until the disease is already severe and potentially fatal. One study found that cardiovascular disease was the leading cause of death in people with PsA.

Thats why people with PsA should work with their doctors to identify potential risks and symptoms of heart disease before they progress.

These symptoms may include:

If youre experiencing these symptoms, discuss them with your doctor. These symptoms are a sign that you could have heart disease or heart-related health issues.

Its hard to measure the impact of inflammation on the body until its caused significant damage. Inflammation is difficult, but not impossible, to detect.

Regular testing and physicals with your doctor can help you address the heart-related impacts of PsA early on. It is important to monitor key indicators of heart health.

Monitor your heart health by testing for:

Traditional risk assessments for cardiovascular disease look at a persons medical history and lifestyle to predict their risk of heart attack, stroke, and death. These assessments are not as useful for people with PsA because they do not factor in the impact of chronic inflammation.

In the future, more advanced testing to predict the risk of heart disease in people with PsA may be developed. Until then, people with PsA should make sure to regularly check on their heart health.

Newer research says treating PsA properly may help reduce the risk of cardiovascular disease.

One study found that people who had PsA and also took tumor necrosis factor (TNF) inhibitors, a type of treatment that targets specific inflammation markers, had a lower incidence of plaque buildup in their arteries.

In another study, patients with a low cardiovascular risk who were taking a biologic treatment had a 6 percent reduction in arterial plaque after 1 year of treatment. The researchers concluded this is likely the result of reduced inflammation.

Biologics are used to treat moderate or severe cases of PsA, and people with cases at this level are more likely to have greater indications of heart disease. Work with your doctor to find a treatment that both treats PsA and doesnt increase the risk of heart issues. Properly treating PsA may help manage cardiovascular risk.

Certain lifestyle changes may also help treat both heart disease and PsA. These changes include:

Psoriatic arthritis (PsA) doesnt only affect the skin and joints. It can cause heart health problems, too.

People with PsA should carefully monitor their heart health with their doctor and treat any issues like high blood pressure, high cholesterol, and high blood sugar.

Properly treating PsA may reduce your risk for cardiovascular issues. Many other risk factors for heart disease, including obesity and smoking, can be managed or improved. Its possible the same is true for PsA inflammation.

If you have PsA, work with your doctor to monitor for signs of heart health complications. Having PsA doesnt mean you will have heart disease, but being aware of the risk keeps you one step ahead of potential health issues.

Read more:

Psoriatic Arthritis and Heart Disease: What's the Link? - Healthline

50 years ago, scientists were seeking the cause of psoriasis – Science News Magazine

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Cyclic AMP and psoriasis Science News, April 29, 1972

[A team of dermatologists] discovered that cyclic AMP levels in psoriasis lesions are significantly lower than in healthy skin. [The team] is now trying to find out if the cyclic AMP deficiency causes psoriasis and to develop a medication to increase cyclic AMP levels in psoriasis lesions.

Psoriasis, which affects 2 to 3 percent of the global population, is an inflammatory skin disease marked by red, scaly patches that itch or burn. Low levels of cyclic AMP a chemical messenger key to cellular communication havent been found to cause the disease. Psoriasis stems from an overactive immune response. Cyclic AMP is just one player alongside other chemical messengers and immune cells, and certain gene variants can make a person more susceptible. The choice among a range of treatment options today depends in part on the severity of the disease and the areas of the body affected. One drug, called apremilast, approved by the U.S. Food and Drug Administration in 2014, increases levels of cyclic AMP, among other actions.

The rest is here:

50 years ago, scientists were seeking the cause of psoriasis - Science News Magazine

Psoriasis – Symptoms and causes – Mayo Clinic

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Overview How psoriasis develops Open pop-up dialog box

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In psoriasis, the life cycle of your skin cells greatly accelerates, leading to a buildup of dead cells on the surface of the epidermis.

Psoriasis is a skin disease that causes red, itchy scaly patches, most commonly on the knees, elbows, trunk and scalp.

Psoriasis is a common, long-term (chronic) disease with no cure. It tends to go through cycles, flaring for a few weeks or months, then subsiding for a while or going into remission. Treatments are available to help you manage symptoms. And you can incorporate lifestyle habits and coping strategies to help you live better with psoriasis.

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Plaque psoriasis is the most common type of psoriasis. It usually causes dry, red skin lesions (plaques) covered with silvery scales.

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Guttate psoriasis, more common in children and adults younger than 30, appears as small, water-drop-shaped lesions on the trunk, arms, legs and scalp. The lesions are typically covered by a fine scale.

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Psoriasis causes red patches of skin covered with silvery scales and a thick crust on the scalp most often extending just past the hairline that may bleed when removed.

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Inverse psoriasis causes smooth patches of red, inflamed skin. It's more common in overweight people and is worsened by friction and sweating.

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Psoriasis can affect fingernails and toenails, causing pitting, abnormal nail growth and discoloration.

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Pustular psoriasis generally develops quickly, with pus-filled blisters appearing just hours after your skin becomes red and tender. It can occur in widespread patches or in smaller areas on your hands, feet or fingertips.

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The least common type of psoriasis, erythrodermic psoriasis can cover your entire body with a red, peeling rash that can itch or burn intensely.

Psoriasis signs and symptoms can vary from person to person. Common signs and symptoms include:

Psoriasis patches can range from a few spots of dandruff-like scaling to major eruptions that cover large areas. The most commonly affected areas are the lower back, elbows, knees, legs, soles of the feet, scalp, face and palms.

Most types of psoriasis go through cycles, flaring for a few weeks or months, then subsiding for a time or even going into remission.

There are several types of psoriasis, including:

If you suspect that you may have psoriasis, see your doctor. Also, talk to your doctor if your psoriasis:

Viven Williams: Your fingernails are clues to your overall health. Many people develop lines or ridges from the cuticle to the tip.

Rachel Miest, M.D.: Those are actually completely fine and just a part of normal aging.

Viven Williams: But Dr. Rachel Miest says there are other nail changes you should not ignore that may indicate

Rachel Miest, M.D.: liver problems, kidney problems, nutritional deficiencies ...

Viven Williams: and other issues. Here are six examples: No. 1 is pitting. This could be a sign of psoriasis. Two is clubbing. Clubbing happens when your oxygen is low and could be a sign of lung issues. Three is spooning. It can happen if you have iron-deficient anemia or liver disease. Four is called "a Beau's line." It's a horizontal line that indicates a previous injury or infection. Five is nail separation. This may happen as a result of injury, infection or a medication. And six is yellowing of the nails, which may be the result of chronic bronchitis.

For the Mayo Clinic News Network, I'm Vivien Williams.

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Psoriasis is thought to be an immune system problem that causes the skin to regenerate at faster than normal rates. In the most common type of psoriasis, known as plaque psoriasis, this rapid turnover of cells results in scales and red patches.

Just what causes the immune system to malfunction isn't entirely clear. Researchers believe both genetics and environmental factors play a role. The condition is not contagious.

Many people who are predisposed to psoriasis may be free of symptoms for years until the disease is triggered by some environmental factor. Common psoriasis triggers include:

Anyone can develop psoriasis. About a third of instances begin in the pediatric years. These factors can increase your risk:

If you have psoriasis, you're at greater risk of developing other conditions, including:

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Psoriasis - Symptoms and causes - Mayo Clinic

Managing Social Anxiety and Psoriatic Arthritis: What to Know – Greatist

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The connection between psoriatic arthritis (PsA) and anxiety is a two-way street. Anxiety and stress can worsen PsA symptoms, but the reverse is also true: PsA can impact your mental health.

Research shows that joint pain and inflammation from PsA can impact your confidence and your quality of life.

There is also evidence that cytokines, a type of proteins released by your bodys cells, play a role in both PsA inflammation and symptoms of depression and anxiety. So theres a reason you might feel both anxious and inflamed.

Still, there are ways to manage social anxiety with PsA that create a positive feedback loop. Research in 2021 found that managing anxiety and depression made it possible to minimize the effects of PsA.

PsA and the resulting inflammation can cause a wide range of physical and psychological symptoms.

Some of the physical symptoms of PsA are:

Anxiety symptoms that may affect people with PsA include:

Symptoms of depression include:

Its a bit of a vicious cycle, because physical and mental symptoms can intensify each other. For example, some research suggests stress may cause PsA flares, which can create anxiety, which can feed into depression. In turn, depression can worsen the impression of pain, according to a 2003 research review.

Mood disorders are more common among people with PsA. A 2014 study found that rates of depression were higher among people with psoriasis than in the general population and that rates were even higher in people with PsA.

A 2020 review found that 51 percent of people living with PsA may experience depression.

Fatigue resulting from PsA sleep disturbance and pain is associated with anxiety and depression, according to research from 2020. Anxiety and depression can also contribute to fatigue.

Its no surprise that these complications can all impact your social functioning.

When PsA affects your ability to enjoy time with friends, social events, and travel, you can miss out on an important outlet. Social interaction is essential for your well-being. We are people who need other people! But sometimes other people can cause anxiety.

A 2017 study on PsAs close sibling, psoriasis, offers some insight into social triggers that likely apply to both conditions. The study found that the age of disease onset affected its influence on social anxiety.

For people diagnosed with psoriasis in adulthood, the primary cause of social anxiety was concern about their appearance. For people diagnosed before age 18, stigmatizing experiences mattered the most.

Regardless of which applies to you, PsA can increase social anxiety and make you self-conscious about your appearance.

How you feel about the way you look might not seem important until you consider the impact it has on your social support system.

Finding the confidence to get out there socially can make a huge difference, as you will see from these tricks of the trade.

There are things you can do to feel better emotionally, regardless of the physical effects of your PsA.

Fantastic, right? So lets look at some ideas.

Talk therapy can help you change the thought patterns that are undermining your confidence.

There are many different types of therapy, but cognitive behavioral therapy (CBT) has been found effective at helping to improve social anxiety. This goes for in-office visits and CBT appointments held online with therapists.

The CBT techniques you may use include reappraisal of your negative thoughts and exposure therapy.

Further, a 2020 study involving CBT looked at the connection between inflammation and psychiatric disorders. CBT didnt reduce the levels of inflammation-causing cytokines, but participants experienced improvements in their anxiety.

You can start by asking your doctor for advice or asking a friend who has already found an effective practice. There are also search tools, like the Anxiety & Depression Association of Americas therapist directory, that allow you to filter for people who specialize in chronic illness.

If youre taking medication to treat your PsA, you might feel reluctant to add another prescription to the mix. However, there could be a safe and effective option that helps you feel better if anxiety is interfering with your daily functioning.

A 2017 review found some evidence that selective serotonin reuptake inhibitors (SSRIs) helped with diagnosed social anxiety disorder. These meds alter chemicals in your brain, affecting mood and emotion.

SSRIs are typically prescribed by a primary care doctor or a psychiatrist. Often you start with a low dose. You should not stop taking the medication without talking with your doctor.

Exercise has been shown to reduce joint stiffness, pain, and fatigue in people with PsA. Its also a great way to improve your mood.

Low impact options to consider include:

Eating well and adjusting your diet may ease PsA symptoms and improve your mood, but the diet that works best for you might not work for everyone with PsA.

A 2018 review of studies on diet and PsA gave only weak recommendations for any given diet in helping with symptoms. The researchers warned that studies generally used low quality data.

In cases of obesity and overweight, the researchers recommended diets designed for weight loss.

A 2019 study of Swedish people with PsA found that short-term weight loss helped reduce symptoms. However, side effects included severe constipation, hair loss, and low blood pressure. The link between weight and PsA is not straightforward.

It can help to connect with other people who can listen to your story and issue a cathartic SAME!

The National Psoriasis Foundation has a peer support program called One to One for people living with psoriasis and psoriatic arthritis.

Healthline also has Bezzy PsA, a private forum where people with PsA can connect.

Research suggests that self-critical behaviors can make it harder to manage PsA.

Positive beliefs and determination are important parts of a successful mental health strategy for managing chronic pain, according to people interviewed for a 2018 study. So are support people like family, friends, and your medical team.

Being realistic about what you can accomplish can also help you put your condition in perspective and pace yourself.

So, there you have it how you feel matters with PsA. Symptom management is important not just for your physical health, but for your emotional well-being too.

Medication and therapy can help if social anxiety is interfering with your everyday life. Self-care techniques can help you adjust your expectations and perspective on living with the condition and connect with others. Social support and connection can, in turn, become an important piece of your PsA care plan.

More:

Managing Social Anxiety and Psoriatic Arthritis: What to Know - Greatist

Ilumya: Side Effects and What to Do About Them – Healthline

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If you have certain skin conditions, your doctor might suggest Ilumya as a treatment option for you. Its a prescription drug used to treat moderate to severe plaque psoriasis in adults.

The active ingredient in Ilumya is tildrakizumab-asmn. (The active ingredient is what makes the drug work.) Ilumya is a biologic medication (which means its made from living cells).

Ilumya is given as a subcutaneous injection (an injection under your skin). This is done by a healthcare professional in a doctors office.

For more information about Ilumya, including details about its uses, see this in-depth article.

Ilumya is usually a long-term treatment. Like other drugs, Ilumya can cause mild to serious side effects, also known as adverse effects. Like other biologics, this drug has effects on the immune system. Keep reading to learn more.

Some people may experience mild to serious side effects during their Ilumya treatment. Examples of Ilumyas commonly reported side effects include:

* To learn more about this side effect, see the Side effects explained section below.

The most common side effects are also the more mild ones. Examples of mild side effects that have been reported with Ilumya include:

* To learn more about this side effect, see the Side effects explained section below.

In most cases, these side effects should be temporary. And some may be easily managed. But if you have symptoms that are ongoing or bother you, talk with your doctor or pharmacist. And do not stop Ilumya treatment unless your doctor recommends it.

Ilumya may cause mild side effects other than the ones listed above. See the Ilumya prescribing information for details.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If youd like to notify the FDA about a side effect youve had with Ilumya, visit MedWatch.

You might experience serious side effects during Ilumya treatment, although these were rare in the drugs studies. Serious side effects that have been reported with this drug include:

* To learn more about this side effect, see the Side effects explained section below.

If you develop serious side effects during Ilumya treatment, call your doctor right away. If the side effects seem life threatening or you think youre having a medical emergency, immediately call 911 or your local emergency number.

Learn more about some of the side effects Ilumya may cause.

Injection site reactions are skin reactions that happen in the place where your doctor injects Ilumya. They can be mild to serious and were a common side effect in Ilumya studies.

Youll receive Ilumya as a subcutaneous injection (an injection under your skin). Unlike medications you take at home, your doctor will give you this injection. Theyll choose a site where your skin is healthy (meaning it doesnt have bruises, psoriasis plaques, or scars). This may be your belly, upper arm, or thigh. An injection-site reaction is possible in any of these places.

There were several kinds of injection side effects. The reactions were mild to serious and included:

Youll receive your Ilumya injection at a doctors office or other healthcare facility. Your doctor can talk with you about how to manage any injection site reactions you might have.

For a mild reaction, you can use a cool compress to help decrease the inflammation at the injection site. You can also take an over-the-counter pain reliever or antihistamine to help with pain or itching.

If the reaction is severe or doesnt go away in a few days, talk with your doctor. An injection site reaction can lead to a serious skin infection if not treated. Learn more about subcutaneous injections in this article.

An upper respiratory infection was a common side effect in studies of Ilumya, but severe infections were rare. This kind of infection is in your nose, ears, throat, or lungs. An example of an upper respiratory infection is the common cold. Because Ilumya weakens your immune system, youre more likely to get an infection while being treated with this drug. An upper respiratory infection could be caused by several different kinds of bacteria or viruses.

Symptoms of infection that you should watch out for include:

Infections will sometimes go away on their own with time, rest, and supportive care. Its important to drink plenty of fluids and get lots of rest to help your body heal from infection.

There are also over-the-counter medications* you can get to help with your symptoms:

* Be sure to talk with your doctor or pharmacist before taking over-the-counter medications.

For some infections, your doctor may prescribe an antibiotic for you. Be sure to take it exactly as directed and finish all the medication even if you start feeling better.

Talk with your doctor if you have symptoms that feel severe or dont go away. You should also tell them if you develop a cough that doesnt go away or a cough with blood. Rarely, Ilumya can cause severe infection, including tuberculosis (TB). If the infection is serious, your doctor may suggest that you temporarily stop Ilumya treatment. This will allow your immune system to clear the infection faster.

If you have a lot of infections while using Ilumya, your doctor may consider a different treatment for your condition.

Studies of Ilumya reported diarrhea, but most people who took the drug didnt report this side effect. Diarrhea is loose or watery bowel movements that may occur very often. You can have mild to severe diarrhea and may also have some of the following symptoms:

If you have diarrhea, keep track of your symptoms and how long they last. If its more than a few days, let your doctor know. It could be a sign of an infection. Other signs that diarrhea may be part of a serious condition are:

If you have diarrhea thats severe or lasts a long time, its important to figure out the cause. For serious diarrhea, this might involve a fecal test or a colonoscopy. The test results will help your doctor decide on the best treatment for your condition.

There are also ways to treat mild diarrhea symptoms. You can drink lots of fluids with electrolytes. For example, juice or some non-caffeinated sports drinks have electrolytes. This helps your body stay hydrated if youre losing too much fluid due to the diarrhea.

You can also eat plain foods that are easy to digest. For example, toast and applesauce are mild foods for most people. Stick to foods that you know are easy on your stomach. You can avoid foods and drinks that commonly make diarrhea worse, such as:

Be sure to wash your hands well after using the bathroom. This helps prevent the spread of infection.

If your doctor says its safe for you, you can take an over-the-counter medication such as Imodium. This medication can help your symptoms, but its not always the best choice if your diarrhea is caused by an infection.

Like most drugs, Ilumya can cause an allergic reaction in some people. Symptoms can be mild to serious and can include:

If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. They may suggest a treatment to manage your symptoms. This could include:

If your doctor confirms youve had a mild allergic reaction to Ilumya, theyll decide if you should continue using it.

If you have symptoms of a severe allergic reaction, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms could be life threatening and require immediate medical care.

If your doctor confirms youve had a serious allergic reaction to Ilumya, they may have you switch to a different treatment.

During your Ilumya treatment, consider taking notes on any side effects youre having. You can then share this information with your doctor. This is especially helpful when you first start taking new drugs or using a combination of treatments.

Your side effect notes can include things such as:

Keeping notes and sharing them with your doctor will help them learn more about how Ilumya affects you. They can then use this information to adjust your treatment plan if needed.

Get answers to some common questions about Ilumyas side effects.

You may be able to use Ilumya if you have an infection, it depends on whether its mild or serious. Infection was a common side effect in studies of Ilumya, especially upper respiratory infection.

Your doctor may have you wait until your infection clears up before having you start treatment. This is because Ilumya decreases your bodys ability to fight infections.

If you have a latent tuberculosis (TB) infection, your doctor may prescribe a TB treatment while you use Ilumya. Or they may choose a different medication for you. The manufacturer of Ilumya includes a specific warning about TB in the prescribing information.

If youre already using Ilumya and you develop a new infection, your doctor might stop your treatment temporarily.

Ilumya is a biologic medication (which means its made from living cells). Biologics, including Ilumya, are not necessarily more or less safe than creams or lotions used to treat psoriasis. The side effects are just different for each drug.

For example, one kind of psoriasis treatment is steroid cream. These creams often have side effects of thinning skin and sun sensitivity. Another kind of psoriasis treatment is vitamin D cream. These creams have a rare side effect of disrupting your bodys normal use of calcium.

There are many different kinds of psoriasis treatments, and each kind has side effects to consider. Read more about psoriasis treatments and side effects in this article.

Other biologic drugs used to treat psoriasis include Humira, Orencia, and Cosentyx. Although most biologic drug studies report decreased immune function, other side effects are different depending on the drug. Talk with your doctor about whether a biologic drug such as Ilumya is a good choice for you.

Yes, you might develop antibodies to Ilumya, though this was rare in studies of the drug.

Sometimes your immune system mistakes a biologic drug for a bacteria or virus it needs to kill. So your body may develop antibodies that stop Ilumya from being an effective treatment. Your doctor will do frequent blood tests to check for this. Even if your body makes some antibodies against Ilumya, the drug might still be effective. Talk with your doctor about how often you should get tested while using Ilumya.

There are several warnings to keep in mind when considering treatment with Ilumya. This drug may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before starting Ilumya. The list below includes factors to consider.

Frequent infections. Ilumya makes your body less able to fight infection. So if you already get frequent infections, Ilumya could make them worse. Your doctor can help you manage your infections before you start Ilumya.

Live vaccines. If youre planning to get a live attenuated vaccine soon, talk with your doctor about waiting to start Ilumya. Its a good idea to be up to date on your vaccinations before you begin treatment with this drug.

Tuberculosis. Ilumya may cause active disease in people who already have tuberculosis (TB). If you have TB, talk with your doctor about whether Ilumya is the right drug for you. If youve been in close contact with someone who has TB, be sure to get a TB test before you start Ilumya.

Allergic reaction. If youve had an allergic reaction to Ilumya or any of its ingredients, your doctor will likely not prescribe it for you. Ask them about other treatments that might be better options for you.

Alcohol and Ilumya dont interact directly, but a possible side effect of each is diarrhea. Because of this, consuming alcohol during treatment with Ilumya could increase your risk of this side effect.

Alcohol is a psoriasis trigger for some people. If you drink alcohol and it worsens your psoriasis, Ilumya may not work as well.

If you drink alcohol, talk with your doctor about how to limit your intake during your Ilumya treatment.

There are not enough studies yet to know whether Ilumya is safe for use during pregnancy and breastfeeding. Talk with your doctor about the risks and benefits of Ilumya in these situations.

Ilumya may cause side effects that your doctor can help treat. Here are a few possible questions for you to ask them:

For advice on managing your condition and news on treatments for it, sign up for Healthlines psoriasis newsletter.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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Ilumya: Side Effects and What to Do About Them - Healthline

Safety and effectiveness of Apremilast in plaque psoriasis | PTT – Dove Medical Press

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Introduction

Apremilast, a phosphodiesterase 4 (PDE-4) inhibitor, has demonstrated clinical benefits in the management of psoriasis not only in randomized controlled trials (RCTs), ESTEEM 1 and 2 but also in real-world studies.1,2 The inhibition of PDE-4 is associated with an increase in intracellular cAMP levels, and subsequently modulates inflammatory responses, and thus helps in maintaining a balanced immune system.35 While apremilast is proven to be safe and well tolerated, it may cause a few temporary and mild to moderate adverse events (AEs) such as gastrointestinal upset, nausea, muscle pain and headache during the initiation of the therapy.6 These side effects are linked to cAMP levels which are decreased in psoriasis. Because of higher incidence of AEs, dose titration of apremilast is recommended at the initiation of therapy over a period of one week. However, despite the initial dose titration many patients develop AEs, leading to discontinuation of therapy in real-world practice.7

Although several interventions are well demonstrated for the management of AEs, sometimes dose adjustment and discontinuation of the therapy may be required.7,8 Recently published Indian papers on apremilast also highlighted a slowdown of titration in the initial period.9,10 Owing to this, for reduction in AEs and better compliance by patients, many dermatologists in India further slow down titration therapy up to 24 weeks, but studies regarding the safety of apremilast in different titration methods are lacking. The objective of this clinical study is to evaluate the safety and effectiveness of different dose titration methods of apremilast as initiation therapy in the management of patients with plaque psoriasis.

Adult patients (18 years of age) of either gender and diagnosed with chronic plaque psoriasis were included in the study. Patients with history of anti-psoriatic medications in any form within 2 weeks and use of biologics within 1224 weeks were excluded. Additionally, patients with any significant medical illness such as diabetes or cardiac disease, immunocompromised conditions, sexually transmitted diseases, etc. that would have prevented study participation, and female patients who were pregnant or lactating were excluded from the study as per the investigators discretion.

The study was conducted in compliance with the protocol approved by the Ethics Committee (Rajiv Gandhi Medical College and Chhatrapati Shivaji Maharaj Hospital, Thane). Written informed consent was obtained from all the patients prior to participation in the study. This study was registered with a clinical trial registry (CTRI/2020/04/024631). This study was performed in accordance with Good Clinical Practices and the Declaration of Helsinki 1996.

This was an open-label, randomized, prospective, comparative, three-arm, and single-center study. The objective of this study was to study the initial adverse effect profile associated with apremilast titration dose and its effectiveness in each group. Patients were randomized by simple randomization technique into three groups. Group I received apremilast 30 mg twice a day after standard titration for the first 6 days. Group II received all tablets in a starter pack as once a day (OD) for 13 days, followed by apremilast 30 mg twice a day. Group III received two starter packs as 8 tablets of apremilast 10 mg OD for 8 days, followed by 20 mg OD for the next 8 days, and 30 mg OD for the next 10 days; thus totaling 26 days followed by apremilast 30 mg twice a day (Figure 1). All the patients were prescribed moisturizer only along with apremilast with antihistamines if needed. The total duration of the therapy in all groups was 16 weeks.

Figure 1 Apremilast titration methods.

Abbreviation: mg; milligram.

The primary objective of the study was to compare the percentage of patients presenting with adverse events (AEs) and the number of patients discontinuing treatment due to AEs in each group. The secondary objective was to compare the effectiveness of apremilast in each group.

A safety analysis was performed on a full analysis set (SAF), (i.e., those patients who have received at least one dose of apremilast and completed at least one post-baseline follow-up visit). The effectiveness analyses were performed on the intent-to-treat set (ITT), (i.e., those patients who have received at least one dose of apremilast and had at least one post baseline efficacy assessment).

Results were presented as mean scores, and the groups were compared using one-way ANOVA with Tukey HSD test and Fishers exact test. The level of significance was set at p <0.05. The difference in the proportion of patients with a change in mean scores (based on improvement criteria), was analysed using the chi-square test. Data were analysed using the IBM SPSS (Statistical Package for Social Sciences) statistics version 20.

Of the 128 patients enrolled in this study, all (100%) were included in the SAF, and 95 patients (74.22%) were included in the ITT. Thirty-three patients (25.78%) were lost to follow-up before the first effectiveness assessment visit (Figure 2).

Figure 2 Study Design.

There were 38 patients in Group I, 46 patients in Group II and 44 patients in Group III. Male predominance was seen in all groups with a mean (SD) age of 43.58 (9.78) in Group I, 42.53 (10.73) in Group II and 38.7 (12.5) years in Group III, respectively (Table 1). All the baseline characteristics under SAF are noted in Table 1. Patient distribution was homogeneous in all groups.

Table 1 Baseline Demographic Characteristics for Full Analysis Set (SAF)

Safety outcomes in all groups are summarized in Table 2. In Group I, 50% reported AEs, 41.3% reported AEs in Group II whereas 25% reported AEs in Group III. There was statistical difference (p <0.05) between Group I and III but no statistical difference was noted between Groups II and III. Nausea was the most common AE reported in all groups, followed by gastrointestinal upset and headache. Though all the groups experienced AEs, the maximum number of AEs were seen in Group I in first week only (74.19%) compared with other groups whereas in Groups II and III, 24.32% and 42.85% patients reported AEs in first week. In subsequent weeks, there was reduction in occurrence of AEs in all groups, as shown in Table 2. Most of the AEs occurred at the dose of apremilast 30 mg. As a result, 4 patients (10.53%) of the patients discontinued the therapy in Group I, 3 patients (6.52%) in Group II and 1 patient (2.27%) in Group III (Table 2). There was no significant statistical difference between any groups in terms of discontinuation of apremilast.

Table 2 Details of Adverse Events in All Groups

All ITT patients were included in the treatment response group. There were 35 patients in Group I, 33 patients in Group II and 27 patients in Group III. All the baseline characteristics under ITT are noted in Table 3. Patient distribution was homogeneous in all groups.

Table 3 Baseline Demographic Characteristics for Intention to Treat (ITT)

At week 10, in Group I, 10 patients (28.5%) and 5 patients (14.5%) achieved Psoriasis Area and Severity Index (PASI) 50 and 75 respectively while in Group II, 12 (36.3%) and 6 patients (18.1%) achieved PASI 50 and 75 respectively. In Group III, PASI 50 was achieved in 8 patients (29.6%) and PASI 75 in 2 patients (7.4%). At week 16, 14 (40%), 6 (18.1%) and 7 (26%) patients achieved PASI 50 and 11 (31.43%), 14 (42.4%), 9 patients (33.3%) achieved PASI 75 in Groups I, II and III respectively (Figure 3). On intergroup comparison, there was no statistically significant difference between any groups.

Figure 3 Effectiveness evaluation in all groups for PASI.

Abbreviation: PASI; Psoriasis area and severity index.

There was a significant statistical difference between the baseline and the end of treatment in all groups in terms of improvement of all mean scores such as mean PASI, mean body surface area (BSA) and mean symptoms scores (p <0.05) as shown in Figures 4 and 5, but on intergroup comparison, there was no statistical significant difference, as shown in Table 4.

Table 4 Clinical Response at Week 10 and Week 16

Figure 4 Improvement in mean PASI and BSA scores at week 10 and week 16.

Abbreviations: PASI; Psoriasis area and severity index, BSA; body surface area.

Figure 5 Improvement in mean scores at week 10 and week 16.

All the landmark clinical trials1,2 and real-world studies11 have examined the safety and effectiveness of apremilast for a complete duration of therapy but this study has examined safety during the titration of therapy. Apremilast is a PDE-4 inhibitor and the inhibition of PDE-4 is associated with an increase in intracellular cAMP levels, which subsequently modulate the inflammatory responses, and thus help in maintaining balance of the immune system.35 It has been found that the cAMP-specific PDE-4 is highly expressed in some specific organs such as the gastrointestinal tract, the musculoskeletal system, the brain and the skin,1214 and hence adverse effects associated with these systems that are observed with apremilast are accredited to PDE-4 inhibition.13,15,16 Moreover, it has been found that patients with inflammatory diseases express higher levels of PDE-4 than healthy individuals.13,17 Hence, in such patients, more attention is required to minimize AEs with maintaining the balance of efficacy.

In earlier studies where apremilast dosing began at the full dose, more AEs were reported than Phase II studies, where apremilast titration was done over a period of 6 days. Hence initial dose titration is recommended to lower the AEs.18,19 But, despite titration, a high number of AEs were reported from landmark trials and real-world studies, leading to the discontinuation of the drug.11

In our study, 50%, 41.3% and 25% of the patients reported 1 AE in Groups I, II and III, respectively which was statistically significant. This is in line with recently published real-world studies on titration suggesting that a further slowdown of titration led to a lesser rate of AEs.10 Moreover, recently published papers on apremilast also pointed towards a slower titration in the initial period.9,20 Additionally, patients in Group I experienced the maximum number of AEs in the first week compared with other groups. The incidence of AEs in subsequent weeks was reduced in all groups. This suggests that further slowdown of titration helps in reducing the AEs associated with apremilast. Nausea was the most commonly reported AE in our study, unlike the other study on titration where GI upset was the most commonly reported. As reported by Giembycz et al., nausea and emesis were among the commonest adverse effects of PDE-4 inhibitors due to the expression of PDE-4 in the central nervous system.21

Additionally, the percentage of patients discontinuing apremilast was reported as lower compared with other studies, though this was not significant. This could be due to a smaller sample size. But the trend of lower AEs with a slowdown of titration was reported as significant. Additionally, though these AEs were mild to moderate in nature and resolved with the continuation of the drug, most of the AEs occurred in the initial 2 weeks of dosing.

In terms of effectiveness, 31.43%, 42.4% and 33.3% of the patients achieved PASI 75 at the end of 16 weeks in Groups I, II and III, respectively. This is in line with landmark clinical studies on apremilast.1,2 But as mentioned above, there was no statistical difference between any of the groups suggesting that even further slowdown of titration at the initiation of therapy did not affect the efficacy of apremilast. As per a recently published report from India, a minimum of 24 weeks of therapy was recommended by experts for better efficacy.9 Effectiveness was also statistically significant at week 16 from baseline in all groups in the mean score of PASI, BSA and symptoms score suggesting that all titration methods were equally effective.

To the best of our knowledge, the present study is the first prospective, randomized and comparative realworld experience of safety and effectiveness of apremilast with three different titration methods. This study provides evidence that in patients who are intolerant to apremilast titration in the initial period, further slowdown of titration is an effective strategy. This strategy will not only help in reducing adverse effects but also help in the reduction of the discontinuation of apremilast therapy. Moreover, this strategy may help in improving compliance by patients. Additionally, clinical efficacy was also well documented with the further slowdown of titration. The clinical implication is that apremilast should be titrated gradually and tailored according to the patients tolerance, especially in patients who do not tolerate standard dose titration. There were some limitations such as small sample size and only one center being involved in the study.

In conclusion, the slow titration of apremilast is associated with lesser occurrence of AEs, and hence, fewer chances of discontinuation of the treatment. Additionally, in terms of effectiveness, there was no statistical difference between any groups in terms of PASI and BSA improvement. Hence, it can be concluded that slower titration is a useful strategy for reducing AEs but at the same time maintaining the efficacy of apremilast.

The datasets are available only on request due to privacy/ ethical restrictions, and can be requested from [emailprotected]

Dr Dhiraj Dhoot, Dr Namrata Mahadkar and Dr Hanmant Barkate are employees of Glenmark Pharmaceuticals Ltd. The other authors report no conflicts of interest in this work.

1. Papp K, Reich K, Leonardi CL, et al. Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor, in patients with moderate to severe plaque psoriasis: results of a Phase III, randomized, controlled trial (efficacy and safety trial evaluating the effects of apremilast in psoriasis [ESTEEM] 1). J Am Acad Dermatol. 2015;73(1):3749. doi:10.1016/j.jaad.2015.03.049

2. Paul C, Cather J, Gooderham M, et al. Efficacy and safety of apremilast, an oral phosphodiesterase 4 inhibitor, in patients with moderate-to-severe plaque psoriasis over 52 weeks: a phase III, randomized controlled trial (ESTEEM 2). Br J Dermatol. 2015;173(6):13871399. doi:10.1111/bjd.14164

3. Schafer P. Apremilast mechanism of action and application to psoriasis and psoriatic arthritis. Biochem Pharmacol. 2012;83(12):15831590. doi:10.1016/j.bcp.2012.01.001

4. Schafer PH, Parton A, Capone L, et al. Apremilast is a selective PDE4 inhibitor with regulatory effects on innate immunity. Cell Signal. 2014;26(9):20162029. doi:10.1016/j.cellsig.2014.05.014

5. Maurice DH, Ke H, Ahmad F, Wang Y, Chung J, Manganiello VC. Advances in targeting cyclic nucleotide phosphodiesterases. Nat Rev Drug Discov. 2014;13(4):290314. doi:10.1038/nrd4228

6. Dattola A, Del Duca E, Saraceno R, Gramiccia T, Bianchi L. Safety evaluation of apremilast for the treatment of psoriasis. Expert Opin Drug Saf. 2017;16(3):381385. doi:10.1080/14740338.2017.1288714

7. Daudn Tello E, Alonso Surez J, Beltrn Cataln E, et al. Multidisciplinary management of the adverse effects of apremilast. Manejo de los efectos adversos de apremilast desde un abordaje multidisciplinar. Actas Dermosifiliogr. 2021;112(2):134141. doi:10.1016/j.ad.2020.08.007

8. Langley A, Beecker J. Management of common side effects of apremilast. J Cutan Med Surg. 2018;22(4):415421. doi:10.1177/1203475417748886

9. Rajagopalan M, Dogra S, Saraswat A, Varma S, Banodkar P. the use of apremilast in psoriasis: an Indian perspective on real-world scenarios. Psoriasis. 2021;11:109122. doi:10.2147/PTT.S320810

10. De A, Sarda A, Dhoot D, Barkate H. Apremilast titration: real-world Indian experience. Clin Dermatol Rev. 2021;5(2):183186.

11. Parasramani S, Thomas J, Budamakuntla L, Dhoot D, Barkate H. Real-world experience on the effectiveness and tolerability of apremilast in patients with plaque psoriasis in India. Indian J Drugs Dermatol. 2019;5(2):8388.

12. Chiricozzi A, Caposiena D, Garofalo V, Cannizzaro MV, Chimenti S, Saraceno R. A new therapeutic for the treatment of moderate-to-severe plaque psoriasis: apremilast. Expert Rev Clin Immunol. 2016;12(3):237249. doi:10.1586/1744666X.2016.1134319

13. Li H, Zuo J, Tang W. Phosphodiesterase-4 inhibitors for the treatment of inflammatory diseases. Front Pharmacol. 2018;9:1048. doi:10.3389/fphar.2018.01048

14. Halpin DM. ABCD of the phosphodiesterase family: interaction and differential activity in COPD. Int J Chron Obstruct Pulmon Dis. 2008;3(4):543561. doi:10.2147/COPD.S1761

15. Dyke HJ, Montana JG. Update on the therapeutic potential of PDE4 inhibitors. Expert Opin Investig Drugs. 2002;11(1):113. doi:10.1517/13543784.11.1.1

16. Dietsch GN, Dipalma CR, Eyre RJ, et al. Characterization of the inflammatory response to a highly selective PDE4 inhibitor in the rat and the identification of biomarkers that correlate with toxicity. Toxicol Pathol. 2006;34(1):3951. doi:10.1080/01926230500385549

17. Schafer PH, Truzzi F, Parton A, et al. Phosphodiesterase 4 in inflammatory diseases: effects of apremilast in psoriatic blood and in dermal myofibroblasts through the PDE4/CD271 complex. Cell Signal. 2016;28(7):753763. doi:10.1016/j.cellsig.2016.01.007

18. Busa S, Kavanaugh A. Drug safety evaluation of apremilast for treating psoriatic arthritis. Expert Opin Drug Saf. 2015;14(6):979985. doi:10.1517/14740338.2015.1031743

19. Young M, Roebuck HL. Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor: a novel treatment option for nurse practitioners treating patients with psoriatic disease. J Am Assoc Nurse Pract. 2016;28(12):683695. doi:10.1002/2327-6924.12428

20. Carrascosa JM, Belinchn I, Rivera R, Ara M, Bustinduy M, Herranz P. The use of apremilast in psoriasis: a Delphi Study. Estudio Delphi para el uso de apremilast en la psoriasis. Actas Dermosifiliogr. 2020;111(2):115134. doi:10.1016/j.ad.2019.07.005

21. Giembycz MA. Phosphodiesterase 4 inhibitors and the treatment of asthma: where are we now and where do we go from here? Drugs. 2000;59(2):193212. doi:10.2165/00003495-200059020-00004

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Safety and effectiveness of Apremilast in plaque psoriasis | PTT - Dove Medical Press

Treating PsA: How a Rheumatologist and Dermatologist Work Together – Healthline

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Psoriatic disease is an autoimmune disorder that involves inflammation throughout your body. Its also an umbrella term for two conditions: psoriasis and psoriatic arthritis (PsA).

Psoriasis generally affects the skin and causes plaques or lesions to appear. PsA primarily affects the joints, causing pain and stiffness. People with psoriatic disease may also experience issues with other organs and tissues, and they have a higher chance of developing heart disease or diabetes.

About 30 percent of people living with psoriasis also develop PsA. You may develop PsA without having psoriasis, but its not common.

When treating PsA, a person will often have a team of doctors and specialists. This team typically includes a dermatologist and a rheumatologist. When these healthcare professionals work together, diagnosis and treatment practices may be more effective.

Dermatologists often work with people living with psoriasis. With around 30 percent of people living with psoriasis later developing PsA, dermatologists are often the first to recognize PsA symptoms in their patients.

If youre already living with psoriasis and working with a dermatologist, theyll likely ask you about symptoms related to PsA. If they identify PsA, they can start to administer treatment specifically for PsA.

Early treatment is important to help prevent arthritis from getting worse and causing joint damage. About 40 to 60 percent of people living with PsA will develop joint deformity, which leads to reduced quality of life.

Rheumatologists specialize in diseases that affect the joints and muscles. A rheumatologist can provide an initial diagnosis of PsA or develop a treatment plan following a dermatologists diagnosis.

A rheumatologist can help you develop a comprehensive treatment plan that works for your needs. They will often be the doctor you see for managing your medication, reporting any issues, and other aspects of your PsA care.

Diagnosing PsA can be difficult, but its important to diagnose the condition as soon as possible for more successful treatment outcomes. Early treatment can help prevent permanent joint damage.

The best results may occur when the rheumatologists and dermatologists work together to diagnose the condition. According to a 2021 study, close collaboration between the two doctors can help speed up the diagnosis of PsA.

Diagnosis typically involves ruling out other conditions, which can be difficult because PsA has overlapping symptoms with other types of arthritis. Currently, theres no standard practice for diagnosing PsA.

Symptoms a dermatologist or rheumatologist may look for when diagnosing PsA include:

According to a 2021 study conducted in China, one factor that affects a rheumatologists ability to diagnose PsA effectively is whether they work full time or part time. These findings may not apply the same way in the United States, but they provide helpful insight into the need for rheumatologists to have experience with and be involved in the diagnosis.

Psoriasis often presents before PsA. Due to the likelihood of comorbidity of the two conditions, your dermatologist may be more open to a PsA diagnosis if you have psoriasis and develop joint pain.

Treatment outcomes for PsA may also improve when a rheumatologist and dermatologist work together.

Often, treatments for psoriasis and PsA overlap. This means some of the systemic treatments used to treat one can also help treat the other. Systemic treatments can include biologics and oral medications.

When working with both doctors, a person with PsA will need to communicate which treatment each doctor provides. A dermatologist may work by prescribing skin care treatments, while the rheumatologist may work more on treating the overall disease and joint pain.

Treatments for psoriatic disease include:

Systemic medications often help for PsA, because they target overall inflammation. Your rheumatologist may recommend additional treatment, such as pain medications like nonsteroidal anti-inflammatory drugs (NSAIDs).

When a person with PsA seeks care from both a dermatologist and rheumatologist working together, a diagnosis may come earlier, and treatment outcomes may improve. Earlier diagnosis can help slow disease progression and help prevent joint damage.

Dermatologists often work with people living with psoriasis, and rheumatologists specialize in diseases affecting the joints and muscles. About 30 percent of people living with psoriasis develop PsA.

Speak with your doctors about whether working together would help in developing a comprehensive treatment plan and improving your PsA.

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Treating PsA: How a Rheumatologist and Dermatologist Work Together - Healthline

What is that rash? – ASBMB Today

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Rashes can be thought of as a dysfunctional community of skin cells. Your skin harbors dozens of distinct cell types, including those that form blood vessels, nerves and the local immune system of the skin. For decades, clinicians have largely been diagnosing rashes by eye. While examining the physical appearance of a skin sample under a microscope may work for more obvious skin conditions, many rashes can be difficult to distinguish from one another.

At the molecular level, however, the differences between rashes become more clear.

Scientists have long known that molecular abnormalities in skin cells cause the redness and scaliness seen in conditions like psoriasis and eczema. While almost all the various cell types in your skin can release chemicals that worsen inflammation, which ones leads to rash formation remains a mystery and may vary from patient to patient.

But molecular testing of skin rashes isnt a common practice because of technological limitations. Using a new approach, my colleagues and I were able to analyze the genetic profiles of skin rashes and quantitatively diagnose their root causes.

Traditional genetic analyses work by averaging out the activity of thousands of genes across millions of cells.

Genetically testing tissue samples is standard practice for conditions like cancer. Clinicians collect and analyze tumor biopsies from patients to determine a particular cancers unique molecular characteristics. This genetic fingerprint helps oncologists predict whether a cancer will spread or which treatments might work best. Cancer cells lend themselves to this form of testing because they often grow into recognizable masses that make them easy to isolate and analyze.

But skin is a complex mixture of cells. Collapsing these unique cell communities into a single group may obscure genetic signatures essential to diagnosis.

Recent technological advances called single-cell RNA sequencing, however, have enabled scientists to preserve the identity of each type of cell that lives in the skin. Instead of averaging the genetic signatures across all cell types in bulk, single-cell RNA sequencing analyses allow each cell to preserve its unique characteristics.

Using this approach, my colleagues and I isolated over 158,000 immune cells from the skin samples of 31 patients. We measured the activity of about 1,000 genes from each of those cells to create detailed molecular fingerprints for each patient. By analyzing these fingerprints, we were able to pinpoint the genetic abnormalities unique to the immune cells residing in each rash type. This allowed us to quantitatively diagnose otherwise visually ambiguous rashes.

We also observed that some patients had treatment responses consistent with what we expected with our predicted diagnoses. This suggests that our concept could viably be expanded for further testing.

To make our approach available to clinicians and scientists, we developed an open source web database called RashX that contains the genetic fingerprints of different rashes. This database will allow clinicians to compare the genetic profile of their patients rashes to similar profiles in our database. A closely matching genetic fingerprint might yield clues as to what caused their patients rash and lead to potential treatment avenues.

The rapid development of drugs that target the immune system in recent years has inundated doctors with difficult treatment decisions for individual patients. For example, while certain drugs that act on the immune system are known to work well for conditions like psoriasis or eczema, many patients have atypical rashes that cant be precisely diagnosed.

An open source database like ours could help enable clinicians to profile and diagnose these rashes, providing a stepping stone to choose a suitable treatment.

Furthermore, chronic inflammatory diseases that affect organs other than the skin share similar genetic abnormalities. Lab tests that can illuminate the root causes of skin diseases can likely be expanded to many other conditions.

Our RashX project initially focused on just two very common types of rashes, psoriasis and eczema. It is unknown whether other types of rashes will have similar genetic profiles to psoriasis and eczema or instead have their own unique fingerprints. It is also unclear which parts of the fingerprint would best predict drug response.

But RashX is a living web resource that will grow more useful as more scientists collaborate and contribute new data. Our lab is also working to simplify the process of developing genetic profiles of rashes to make participating in this area of research more accessible for clinics around the world. With more data, we believe that projects like RashX will make precision testing for rashes an essential next step in diagnosis and treatment.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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What is that rash? - ASBMB Today

Does probiotic skin care work? Products, uses, and more – Medical News Today

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Probiotic skin care involves using products that contain live microorganisms to improve the health of the skin. The idea behind this is that it helps maintain a beneficial balance of microbes, helping to reduce the symptoms of skin conditions.

Research on the effectiveness and safety of probiotics in skin care is very preliminary. Early studies indicate that oral probiotics may help with some health conditions, which has led scientists to study whether they may also be useful as a topical treatment.

However, some scientists argue that doctors do not yet understand the skin microbiome well enough to safely use topical probiotics as a skin treatment. The Food and Drug Administration (FDA) also does not regulate topical probiotics.

This article discusses probiotic skin care and the research supporting its use. It also examines potential risks and suggests other factors to consider when shopping for skin care products.

Probiotics are live microorganisms that are beneficial to human health. Probiotic skin care involves applying these microbes topically in the form of products such as creams or treatments.

The concept of probiotics dates back to 1900, when Louis Pasteur discovered them as the source of fermentation in foods such as yogurt. In the human body, probiotics make up part of the microbiome, which is the collection of microorganisms that naturally inhabit the digestive tract, skin, and other parts of the body.

The microbiome contains a huge variety of species. Some of these microbes are beneficial, while others can be pathogenic, or disease-causing. An imbalance in the amount of good and bad microbes is known as dysbiosis.

According to a 2019 study, the composition of the skin microbiome in healthy skin differs from the composition of the microbiome in diseased skin. Research from 2021 also reports that dysbiosis within the skin microbiome can result in the emergence and worsening of skin conditions.

Because of this, scientists and cosmetic companies have become increasingly interested in how probiotics might restore balance to the skin microbiome.

Some common species of probiotics that people may find in skin products include:

Almost any skin care product can contain them, including:

However, it is important to note that while many products may list microbes on their ingredients label, it is not always possible to know whether or not these microbes are alive.

Many companies use preservatives in their products to prolong their shelf life and ensure they are safe to use. Preservatives work by killing bacteria. This means that, in many cases, the probiotics may be inactivated.

A 2021 review looked at the body of research exploring the use of topical probiotics in skin care. Although some studies suggest these may have benefits, research is still in its early stages. Most research on probiotics focuses on oral probiotics.

People with atopic dermatitis (AD), or atopic eczema, have a higher amount of the bacteria Staphylococcus aureus in their skin microbiome, according to a 2017 study.

The authors of the study tested the effects of applying the probiotic Lactobacillus johnsonii to the skin of 31 participants with AD. Analysis of the data indicated that it reduced the number of S. aureus and decreased AD symptoms.

Older research from 2003 investigated the effect of S. thermophilus on AD. After a 2-week application period involving 11 participants, the results suggested that the probiotic reduced redness, scaling, and itching.

A 2016 study reviewed the effects of probiotics on the skin in clinical trials and animal experiments. The results indicated that their benefits include:

This may mean probiotics can reduce some of the visible signs of aging, such as sun damage. However, more research is necessary.

Some studies suggest that topical probiotics may promote wound healing, but the results vary significantly.

Older research from 2005 evaluated the effect of the probiotic Lactobacillus plantarum on preventing infections in wounds. After investigating it in test tubes and in mice, the authors concluded that it might inhibit infection development and improve tissue repair.

More large-scale human trials are necessary to see if it affects people the same way.

A 2020 paper states that topical probiotics may help address a loss of microbial diversity that previous research has found in people with acne. They may also reduce levels of Cutibacterium acnes on the skin, which is a type of bacteria that lives in hair follicles and is strongly associated with acne.

However, at the moment, this is only a theory. There are currently no randomized controlled trials that prove probiotic skin care targets C. acnes.

Data on probiotic treatment of psoriasis is limited, but studies investigating oral probiotics for the condition show promise. Authors of research from 2019 listed psoriasis as a skin condition that they believe oral and topical probiotics may help.

A 2019 review analyzed six clinical trials to explore the safety of topical probiotic treatment for AD. It found no significant side effects.

However, as with other types of skin care, there is always a risk that some people will have hypersensitivity or allergies to the ingredients. This may cause:

If this occurs, or the product burns or stings, a person should wash it off and stop using it.

Even though the probiotics in skin care may not be alive due to preservatives, it is difficult to know for sure. For this reason, people with compromised immune systems should avoid topical products that may contain live cultures, as well as probiotic foods and supplements.

It is important to note that experts are still learning about the skin microbiome. A 2021 paper argues that because scientists do not have sufficient knowledge, using topical probiotics could have unforeseen consequences.

Some species, or groups of species, may be capable of damaging the skin microbiome rather than helping it.

Microbes do not affect the body in isolation. Communities of microbes can have different effects when they coexist. Because this ecosystem is complex and differs from person to person, disruption can be potentially harmful.

The authors of a 2021 study urge scientists to conduct more research to understand how the microbiome as a whole interacts with human health, rather than only looking at individual microbes.

It is also difficult for cosmetic companies to create products that still contain live microbes due to the need to keep the product sanitary using preservatives.

An alternative approach could be to use prebiotics in skin care instead. These are ingredients that feed the beneficial bacteria that already live on the skin. This requires no live cultures to be present in the product and does not introduce new species.

If a person decides to try probiotic skin care, they can do so by following these tips:

Probiotic skin care involves using probiotic-containing products to try to alleviate certain skin conditions or improve its appearance. Some species of probiotics that people may find on skin product labels include S. thermophilus, Lactococcus, and Lactobacillus.

The FDA does not regulate probiotic skin care, so there is currently no recommendation on which types of probiotics are beneficial to the skin and little way of knowing if the probiotics in a product are alive.

Limited studies that examine specific species have suggested topical probiotics may be well-tolerated by many, but more research is necessary to fully understand if they could treat skin conditions and, if so, which species work best.

It is possible that probiotics could cause negative effects if they disrupt someones skin microbiome. People may want to ask a dermatologist for advice on the best products to suit their skin, particularly if they have a condition such as AD or acne.

Learn more about creating a dermatologist-recommended skin care routine here.

See more here:

Does probiotic skin care work? Products, uses, and more - Medical News Today

Meet your next Congressional representative series: Brandon Williams – The Ithaca Voice

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This is Part 6 of a daily series from The Ithaca Voice introducing voters to their potential next U.S. House of Representatives member. Brandon Williams is the sixth in the series of eight total. Others will be published each day throughout the week.

TOMPKINS COUNTY, N.Y.Brandon Williams wields the term outsider like its one of his strongest positive attributes and it could be. Considering the general antipathy toward the political establishment, among both parties but particularly in the conservative electorate, Williams, a Republican, has embraced and emphasized that he is the outsider candidate in the race to represent New Yorks 22nd Congressional District in the U.S. House of Representatives.

Williams, a businessman and tech entrepreneur from Cayuga County with a military background, touts himself as a lifelong conservative who felt like he had to jump into politics because of his objections to higher political leadership.

This is our Republic, and were responsible for making things better, Williams said in an interview with The Ithaca Voice. This country doesnt belong to the elites or to the politicians. America is the most successful nation. Were the most successful people in all of history, and were a good people. [] And I just couldnt sit on the sideline and watch the direction that our political leadership was taking us and felt like it is my duty to stand up and try to make things better.

Williams said he enjoys the problem solving aspects of leadership, a sensibility that he hopes to bring to Congress if he does indeed win the election, and said that he believes his knowledge of the military and business worlds would be important foundation if he gets to office.

Overall, Williams lists his primary priorities as freedom (citing COVID-19 mandates as a violation of those freedoms), reindustrializing New York, reducing government spending and fighting what he called the woke agenda in schools. Further, he said he thinks the first proper step to building back up in a potentially post-COVID world would be to find some way to stem ongoing economic inflation.

I think we have to rein in inflation, Williams said. I think weve had very poor fiscal management in our government, very reckless spending thats resulted in this out of control inflation, and were now left with not very good choices of how to deal with that. And its going to have a very negative impact on workers and on the middle class.

Williams said that President Joe Biden has done a poor job on that topic and others, also intimating his belief that Biden isnt mentally fit to serve, and that Bidens withdrawal of troops from Afghanistan had influenced Russias decision to invade Ukraine.

At this point, the lines of the district that Williams is running for are unclear, as a decision potentially invalidating the lines had come down Wednesday afternoon. Before that, the lines had been presumed to lean much more heavily Democratic, but now it is unclear where they will end up. Regardless, Williams said before that ruling that he thought voters of both parties would resonate with his message of outsiders versus elites.

As a political outsider, I think that I bring a perspective of knowing how the economy actually works or how some of these industries actually work and shining light on these political sleight of hands that is really crippling, thats really harming the middle class, he said in response to Bidens decision to release domestic oil reserves but maintain other environmental regulations.

Overall, its clear that Williams sees himself as the true conservative in the race compared to opponent Mike Sigler, who is a Republican Tompkins County Legislator. Williams insists that his own lack of political experience will end up being a positive asset both to convince voters and if he gets into Congress.

This election is a lot more about the political establishment versus everyone else and the elite establishment versus everyone else, Williams said. And Ive operated outside of that. Im a political outsider and been living out in the real world, and I think thats what people really care about this cycle.

The rest is here:

Meet your next Congressional representative series: Brandon Williams - The Ithaca Voice

Press Briefing by Press Secretary Jen Psaki, April 27, 2022 – The White House

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James S. Brady Press Briefing Room

3:07 P.M. EDTMS. PSAKI: Hi, everyone. Okay, I have no toppers today. Dont be so disappointed. And I know we have a hard out for some people to gather, so we will all keep you updated on when that needs to happen.But, Zeke, why dont you kick us off?Q Thanks, Jen. Just two quick. The President put out a statement this morning on the prisoner swap for the release of Trevor Reed. And he called it said there were some difficult decisions that he had to make, involved. Can you just elaborate on what he meant? Is there a concern that this sort of arrangement incentivizes other countries to wrongfully detain Americans?MS. PSAKI: Well, first, let me say that its a huge moment today that speaks to President Bidens commitment to bring home Americans held hostage and wrongfully detained around the world. And he has been clear since the beginning of this administration that he is committed to doing exactly that: to bringing Americans home.Hes brought home Americans from Venezuela, from Afghanistan, from Haiti, from Burma, and now, today, from Russia.And Trevors freedom is the result of months and months of hard, careful work across the U.S. government.Now Ill get to your question. When he referenced the tough decision in his statement this morning, he was referencing the decision to commute the sentence of Konstantin Yaroshenko. I would emphasize that this individual had already served the majority of his prison sentence for a nonviolent drug crime. And our overriding priority here was the safe return of Trevor Reed, knowing not only had he been held against his will for too long, but that his health condition required urgent treatment. Hes going to be able to not only be reunited united reunited with his family, but to receive the treatment he needed from the United States.So, again, our objective is to bring all Americans who are detained, who are held, who are away from their families home from overseas. But Im not going to be able to preview for you what processes or approaches were going to take for those moving forward.Q And is there a concern that now its not just detaining Americans but wrongfully mistreating them allows a lot of them get seriously ill it gives other countries leverage over the United States in terms of creating another opportunity, such as this, for this sort of prisoner swap?MS. PSAKI: Well, again, unfortunately, Zeke, you know, there are Americans who are held in other places around the world who we are still working to bring home. And that has been the case long before the President and, importantly, our hostage negotiator took the steps to bring Trevor Reed home.So I this has been going on for a long time, I guess is my is my larger point. And our effort and our objective was to take steps that we needed to take to bring him home, knowing his health conditions and knowing hes been held for too long.Q And a slightly different topic: Russia yesterday effectively cutting out that cutting off natural gas to Poland and Bulgaria.MS. PSAKI: Yeah.Q Whats the White House response to that? And are there additional steps the U.S. government is taking to reassure its European allies that maybe not so much now, but certainly when the weather turns later this year that they will have the energy supplies they need?MS. PSAKI: Sure. Well, unfortunately, this is not this is the type of step, the type of almost weaponizing energy supplies that we had predicted that Russia could take in this conflict. That is why we, of course, have been in touch with Europe, including over the with these countries including over the last 24 hours, with leaders in Poland and Bulgaria.And we have been working for some time now, for months, with partners around the world to diversify natural gas supply to Europe to in anticipation of and to also address near-term needs and replace volumes that would otherwise come from Russia.I would note that last month, in advance of this, the President launched a task force with the EU to target additional LNG volumes for Europe, including Poland and Bulgaria. This will help replace, over time, Russian gas to Europe, decreasing Europes dependence on Russia and Putins ability to use energy to coerce Europe.I would also note that Poland and Polish leaders have said they have the capacity through the reserves and other imports right now, for the moment. And Bulgaria has said it is also looking at other import actions.So we are working and we have been working to address over the long term. We have been in touch with these leaders over the last 24 hours. And I would also note what theyve said about what their capacities are for the current short term.Go ahead.Q Thanks, Jen. Has the President been in touch with or does he plan to reach out to Paul Whelans family, Brittney Griners family, any of the other families who have loved ones detained in Russia?MS. PSAKI: We have, of course, been in touch with their families over the course of time. Im not going to detail those conversations further.Q But Paul Whelans brother, David Whelan, put out a statement today. He said, If this case required difficult decisions that the President doesnt take lightly, how difficult are the decisions he faces to release Paul? Whats your response to the Whelan family?MS. PSAKI: Our response is that we are going to continue to do, the President is going to continue to do, our State Department officials and negotiators are going to continue to do everything they can to bring Paul Whelan home.Q If I could just ask one more follow-up: The President, of course, met with Reeds family here at the White House. Can you talk about the personal impact that that meeting might have had? Did it did he leave that meeting with a sense of urgency a renewed sense of urgency to get this done?MS. PSAKI: I would say the President has had a sense of urgency about bringing Americans home long before that meeting. Of course, he enjoyed that meeting he had with them. He also spoke with them on the phone when he went and traveled to Texas. And again, I know he was intending to reach out to them this morning as well.Go ahead.Q On the economy, we have a GDP print thats coming out tomorrow thats expected to show fairly marginal growth. Theres increasing expectations from banks, predictions of that were entering a recession.Your budget plan had a focus on budget deficit reduction, as opposed to fiscal stimulus. Is there any plan to change that as we see the threat of a recession looming?MS. PSAKI: Well, again, as Ive said before on the recession question: Obviously, we look closely at economic data. We continue to believe that there are there are strong data in the economy, whether its record job growth, whether it is the current unemployment rate. And that is a result of the actions of the President.I would note on the GDP expectations for tomorrow: As you noted, the market expectations and other analysts out there do expect the growth to be slower in quarter one, which is what the data is being reported out tomorrow, than in quarter the fourth quarter of last year.This largely reflects the str- very strong pace of growth in the fourth quarter. When taken together, growth over the two quarters is expected to be at a solid pace if we look at it over time, which is how we look at data.And looking under the hood, the slowdown relative to quarter four is mainly for technical reasons like the change in inventory. So, last quarter, companies built up their inventories very quickly. And growth in inventories are expected to be slower, though still positive, this quarter.This is something that has been pointed out or this trend or these reasoning this reasoning, I should say, has been pointed out by a range of outside economists and forecasters, including former NEC Director Jason Furman.Q A quick follow-up just on inflation: Theres been some numbers that have shown that, you know, the monthly interest payment that somebody pays when they take out a mortgage has basically doubled over the past year.Youve talked about what youre doing on meat prices. But if you look at the grocery bill, pretty widely there are many categories where were seeing double-digit inflation: flour, coffee, fruit.Is there any strategy to deal with some of these other areas where were seeing, kind of, broad-based inflation?MS. PSAKI: Well, I would say the Presidents plan to address inflation or address causes or costs as theyve gone up for the American people has many different components.Obviously, theres an important purview that the Federal Reserve has, and theyve indicated their plans to recalibrate. We support that that effort or steps they intend to take. And obviously, they have purview over and theyve predicted that inflation will come down and moderate before the end of the year.But how the American people experience inflation is costs, as you noted, whether its at the grocery store or other costs on their pocketbook. And the President has taken a number of steps to address costs, even extending the pause on student loans, which is something he did just a few weeks ago; the steps to fix the family glitch in the Affordable Care Act so more people would be eligible for lower-cost healthcare; and continuing conversations that are happening on Capitol Hill right now on his proposals to lower costs on childcare, healthcare, the cost of prescription drugs. These are all areas that impact and will help families as were working to bring costs down.Go ahead.Q The President told Trevor Reeds family that he wanted to call them in the middle of the night last night but didnt want to jinx the release of their son. Can you tell us more about whats been happening behind closed doors for the last, you know, 12 or 24 hours regarding this release?MS. PSAKI: Sure. And, you know, I think what the President was referring to you know, and Ive fortunately because its a part of history and a great day, obviously, when you bring an American home, and the President has, of course, been a part of many of these in a much higher and more important role is just theres a lot of sensitivity, as you all know, around the period of time when individuals are in transit right? when they are being brought to a third country.As weve noted, you know, we are very grateful to Turkey for allowing the exchange to take place in their country. So, basically, over the last 24 hours one, as I noted, this this had been happening over several months.So, Roger Carstens, the Special Presidential Envoy for Hostage Affairs, and his team and many others have been had been negotiating and engaging in this.And the exchange took place in Turkey during the early hours of the morning, East Coast time.So I think what the President was referring to was his understanding and knowledge that that would be happening but not wanting to put anyone in a position of putting that at risk, even people who are excited and joyful and looking forward to the news.And, you know, then once they got to Turkey and they were safely on a plane on their way back, we were able to obviously make notifications and phone calls and also put out this statement from the President to make all of you aware.Q Were any other conditions agreed to for Trevor Reeds release, besides the release of this Russian?MS. PSAKI: This was the discussion about one issue and one topic, and that was the release of Trevor Reed.Q But were there any other conditions agreed to besides releasing the Russian in exchange for Trevor Reed?MS. PSAKI: There is no other condition. There were no other conditions that Im aware of.Q And what does the White House read into Russias willingness to release Trevor Reed now, in the middle of this invasion of Ukraine?MS. PSAKI: Look, I think the release of Trevor Reed, him returning home to his family, receiving the healthcare that he has long needed, does not change our approach or view, opposition, or the Presidents intention to put forward a package in the coming days to help continue to support the Ukrainians.In terms of what they mean or how they assess it, I would leave it to them to speak to that.Q But does it make anyone here at the White House more optimistic about what could be ahead, or does it have nothing to do with anything MS. PSAKI: This is was about one issue and topic, and I dont think we should read into it further.Q Can we go toward the back?MS. PSAKI: Yeah, we can come to the back in a moment. Go ahead, Weijia.Q Thanks, Jen. To follow up on MaryAlices question, during an interview this morning, Trevor Reeds parents said they believed that personal meeting with the President was the, quote, tipping point, that it made all the difference. Is that true?MS. PSAKI: Well, look, I would say anytime that you meet with a President meets with or any official from the government meets with the parents or family members of someone whos being detained, that impacts them personally.But this had been negotiated in negotiations for months.Q I spoke with David Whelan today, and he is concerned that Reeds release now narrows the chances for his brothers release, because Russia obviously was you know, wanted Yaroshenkos release for years now, and now that its happened, he worries that that was a major concession that the U.S. no longer has. So what do you say to the Whelan family?MS. PSAKI: Well, we would say we will continue to advocate for the immediate, unconditional of Paul Whelan at every opportunity. And using wrongful detention as a bargaining chip represents a threat to the safety of everyone traveling, working, and living abroad. We obviously oppose this practice anywhere, and we are going to continue to do everything we can to bring him home.Q They are thrilled, obviously, about Trevor Reeds release, but they cant help but have some questions about why Paul Whelan, whos been detained in Russia longer than Trevor Reed, is not home. Can you explain that? And did Reeds health, as you mentioned, have anything to do with it?MS. PSAKI: Obviously, our objective continues to be to bring Paul Whelan home and any American who is not with their family and is being detained overseas. But Im just not going to get into more details because I want to maintain the protection of our process.Q And then, on a separate topic: Yesterday, Dr. Jha said that people who are at high risk for developing a severe case of COVID are eligible for Paxlovid. And the Vice President just got her second booster shot. She has no symptoms. Can you help us understand why shes taking it?MS. PSAKI: Well, he also said, which you didnt include in your summary there, but that you should consult with your doctor, and she consulted with her doctor. She has been given Paxlovid. Thats something many Americans may be eligible for; they should also consult with their doctor.And I think, overall, were just grateful that this is an approved drug on the market that many people can benefit from, including the Vice President.Okay, thank you.Q Go ahead in the back. In the way back. Way back.Q Eleven years ago, Japan had a terrible disaster and the U.S. launched a program most people have probably forgotten called Operation Tomodachi. Twenty-five thousand American military and ten thousand volunteers came from Japan to help. And one of those that came was President Biden. Im wondering if on this upcoming trip hell be coming back to that area for a short visit.And while were waiting for advisement, is it possible to do an interview with you?MS. PSAKI: Oh okay. (Laughter.) You often come with an interview request. I should know ahead of time.I will just note I expect we will have more details on the Presidents travel to Asia something he is clearly looking forward to since hes spoken about it publicly soon, in the coming days. But in advance of that, Im just not going to have much more to preview for all of you.Okay, go ahead. Go ahead go ahead.Q Thanks, Jen. Yesterday, after the Vice President announced that she tested positive, the usual people on the Internet and elsewhere who dont like vaccines, who dont think COVID (inaudible), immediately started with the, Well, she would have been fine even if she hadnt gotten the vaccine.It seems like every time theres a high-profile announcement that someone has gotten COVID be it a member of Congress, AG Garland, people at the Gridiron dinner people take it as proof that vaccines dont work.So, what about the White Houses messaging could be better on that, given that 234,000 Americans died?MS. PSAKI: Yeah. Well, first, I would say the truth, is which is, I think, why youre asking me this question is quite the contrary.I mean, the Vice President is continuing to carry out her duties, as the Vice President of the United States, from home, engaging in meetings, policy discussions Im sure youll see her in some capacity publicly from home as well because she is double boosted and she has taken the steps to protect herself, like we have continued to recommend other Americans do.So, I would note that while the vaccine the reason to take the vaccine is, of course, because it can protect you from severe death from death, from severe illness severe death, that was a little intense how I said that (laughter) from death or severe illness, and it by multitudes of numbers.And, you know, were going to continue and if you are eligible for a booster as she was, as the President was, we recommend you get that for a second booster, because it can put you in a position where even if you get COVID, youre able to still not experience minimal symptoms or no symptoms, like the Vice President has been, and to continue to go about daily life the best you can while youre quarantining.Go ahead, Tam.Q Yep, thank you. Dr. Fauci said on the PBS NewsHour last night, quote, This country is out of the pandemic phase of COVID. What phase are we in right now? And also, if we are out of the pandemic phase, why are emergency measures still in place?MS. PSAKI: Well, what Dr. Fauci was saying is that we are in a different phase of this pandemic, and thats absolutely true. Last month, the President announced a plan for how we can move forward safely while staying on our front foot against COVID. As he pointed out, nationwide, cases are relatively low far below the 900,000 cases a day we saw during the Omicron surge.Even as weve seen upticks, hospitalizations are about at about the lowest level since the pandemic, and deaths are declining. So, theres no question that we are in a moment a different moment in our fight against COVID.But we also know COVID isnt over and the pandemic isnt over. And what Dr. Jha said yesterday also is that different doctor, I realize, but I just want to reference him since he was just here is that cases are low, driven by the extremely while cases are low, cases while cases while low, cases are still you know, weve seen an uptick in some places driven by the extremely transmissible BA.2 variant.We know the risk of potential sur- surges, even as a potential new variant or subvariant remains. So, different phase, because were at a much lower level of hospitalizations, of deaths, and even, nationwide, of cases. But we are still seeing people get very sick from COVID and cases of COVID, and we have measures that we should all continue to take to protect ourselves.Q Just a couple of very quick, short other questions. Daleep Singh is reportedly taking a leave of absence. Can you confirm that when hell be gone and what that means for the sanctions work that hes doing that is very important right now?MS. PSAKI: It is very important. Hes a very important member of the national security team. I dont have any details or any confirmation of his plans.What I would note, and if Daleep were here and well invite him he would note is that he has an incredible team he works with who helps put together these sanctions package, help packages helps implementation, helps coordinate diplomatically. And we will there are a number of people who will continue to do that work.Q And when are you sending the funding request for Ukraine funding up to the Hill?MS. PSAKI: Well, the President said last week it will be this week. So, theres only two days left of this week. As soon as tomorrow, but in the next two days.Go ahead.Q Indonesia decided to invite President Zelenskyy to the G20. Im wondering if you have a reaction to that, but also what it says about progress that the U.S. might be making behind the scenes, hoping to expel Russia from that forum, and if the decision to invite President Zelenskyy has informed and the President can confirm that hes going to now attend the summit.MS. PSAKI: Well, weve seen the reports that President Zelenskyy has been invited to the G20. And we certainly welcome that. As you know, President Biden said just last month that Ukraine should be able to participate.But we dont have further confirmation beyond the news reports, which we certainly think are positive.And as he also said last month which is, of course, why youre asking me he doesnt think Russia should be invited, but, ultimately, its a decision for the G20.So, we dont have any new announcements at this point. We will continue to engage. And weve reached out, of course, to Indonesia, as you noted, whos hosting the summit. But we dont have any other additional details.Its six months away. Typically, the President does attend, but I dont have anything to confirm about a trip six months away at this point.Q Just a quick one on Ukraine. Theres been questions about why the U.S. hasnt suspended steel tariffs on Ukrainian steel coming in. Do you have any information about why weve maintained those tariffs, considering everything with (inaudible)?MS. PSAKI:Sure.I obviously, there are a range of considerations to provide not only direct assistance but economic relief to the Ukrainians under consideration.I dont have anything to preview at this point in time.

Ill go to Kristen and then Jacqui, and then Ill go to the back.

Go ahead.

QJen, thank you so much. Following up on Tam, we actually just reported that the White House is tomorrow as soon as tomorrow going to request the supplemental, and that will it will be through the end of the fiscal year, and that its going to be massive.

Can you help characterize how much money will the administration be asking for?Will we hear from the President on this?MS. PSAKI:So, let me try to answer all those questions, and then tell me if I dont. I can confirm as soon as tomorrow only two days left in this week, but it will definitely be this week that we will send up the supplemental.

In terms of the Presidents schedule, his role, I have nothing to preview at this point in time. As soon as anything is finalized, if hes going to speak publicly, we will announce that to all of you or let you all know.

In terms of the length or the size, I dont have a number for you at this point in time. But there is plans for this to be a proposal to go through the fiscal year. And it will include, as our past packages have included, security or military assistance, humanitarian, economic assistance, given those, in our view, will help address a range of the needs the Ukrainians have.

Q Thank you. You did answer all of my question.Obviously, there is a renewed push on Capitol Hill and behind the scenes here at the White House for some revised version of the Build Back Better plan a scaled-back version.

When was the last time President Biden spoke with Senator Manchin in earnest about what he could sign off on?

MS. PSAKI: So, were just not going to detail that, per the Presidents request, from here any conversations he has with Senator Manchin or other senators just to protect those conversations.Q Fair enough. Can you characterize, though are the negotiations happening in earnest? Are there real talks going on about specific things that Senator Manchin, that the White House could agree to?MS. PSAKI: I would I would tell you and Im sure your colleagues on the Hill, now that all these senators are back, can confirm this with a number of them right now, or today that there are still a great deal of interest, passion in moving forward with the Presidents plan to lower costs for Americans and a lot of senators who would like to see this move forward.

Q Secretary Mayorkas is getting a real grilling on Capitol Hill today, particularly about Title 42 and the plans that are in place to deal with it. DHS has acknowledged that a surge would put a substantial strain on resources.

Now, obviously, DHS announced this six-point, 20-page plan. But given that strain that DHS is anticipating, why should the American people have confidence that youll be able to deal with that surge of migrants if Title 42 is lifted?

MS. PSAKI: Well, first, I would say, just as a reminder: It is a health authority, not an immigration plan or an immigration authority, and its not meant to be a replacement of. So the determination about where we stand and to lift it was made by the CDC.

Just to note the six-point plan that Secretary Mayorkas put out and talked about today, or over the last 24 hours, includes six pillars: surging resources, including personnel, transportation, medical support; enhancing CBP processing efficiency and moving with deliberate speed to mitigate potential overcrowding; administering consequences for unlawful entry; bolstering the capacity of nongovernmental organizations to receive noncitizens; targeting and disrupting the transnational criminal organization and smugglers; and deterring irregular migration.

So, what he talked about today is exactly what his preparedness plan thats been in the works and in the planning for months would do. And they have talked about the need, potentially, for more resources to make that happen.Q And just to be very clear, and some Democrats have said this: Does the plan will the plan be in place before Title 42 is lifted?MS. PSAKI: That is exactly what the preparedness and implementation plan is intended to do.Q Okay.

MS. PSAKI: Go ahead, Jacqui.

Q Thanks, Jen. Dr. Fauci said that hes not going to the White House Correspondents Dinner, citing COVID concerns. Obviously, hes the Presidents chief medical advisor. As far as we know, the President is still planning to attend. How should people understand Dr. Faucis decision versus the Presidents decision? And is there any concern that the President would be seen as not following the science in some way?MS. PSAKI: Well, first, I would note and respect everyones privacy, including Dr. Faucis, as much as hes very much a public figure. But as you all know, he can speak for himself and his decisions. And every individual will make their own decisions about whether they attend this event, other events, whether they wear a mask at it or not.

Obviously, the White House Correspondents Association is requiring same-day testing. Thats a thats a decision they have made. The President outlined, as you all know, a 100-page plan in March intended to position us to go back to our more normal routines. But in that, that requires making risk assessments and decisions about what youre going to do and what youre going to attend and be a part of, as we all do every day.

Today, the President felt it was very important to be at and speak at the memorial service for a diplomatic icon Secretary Madeleine Albright. He made the decision to do that, despite the fact that there were hundreds if not thousands of people there.

He has made the decision he wants to attend, in a safe way, the White House Correspondents Dinner to show his support showcase his support for the free press, for the work of all of you, for the work of your colleagues around the world to not only share accurate information about COVID but also report on the war in Ukraine and all of the work that happens every single day.

That does stand in stark contrast to his predecessor, who not only questioned the legitimacy of the press on a nearly dai daily basis, but also never attended the dinner, I dont believe.

So, he felt that was important and made a risk assessment to do that in consultation with his doctors and healthcare team.

I would note that we also take additional precautions and steps. I would expect that he may wear a mask when hes not speaking. Ill wear a mask when Im at the dinner, in all likelihood. And we also took steps, including the fact that hes not attending for the eating portion of the dinner and hell be there for the program, which includes a number of speakers, the presentation of scholarships, as you know, and, of course, his speaking and his roasting, where he will be on the menu, as he likes to say, when Trevor Noah is speaking.

So, you know, just like anything, its a risk assessment and a decision he made on a personal basis.Q Thank you. And I want to ask a few questions on Title 42, but real quick, I want to take another stab at a question I tried yesterday. You answered the first part of it. Weve heard the President say over and over again that he has never spoken to his son about his business dealings. Has he ever spoken to his sons business partners about his sons business dealings?MS. PSAKI: Again, nothing has changed about what I said yesterday. The President does not get involved in the business dealings of his son.

Q Even through his sons business partners?

MS. PSAKI: Nothing has changed since what I said yesterday.Q Okay. I dont believe you answered that part of my question yesterday though.

MS. PSAKI: Hes not involved in his sons business dealings.Q Okay. On Title 42, Mayorkas detailed this six-point plan; part of it involves sending healthcare providers from the VA. He was asked about this on the Hill today. He said that its necessary, that this interagency effort is necessary. But is it appropriate to be taking resources away from the VA to help with the surge at the border?

MS. PSAKI: Again, these dec- these decisions and discussions about what resources are possible are made through the interagency process, and clearly, having support and resources for our nations veterans is a top priority to the President. But we also want to take steps we can at the border, even as we anticipate an increase in migrants coming to the border, to keep the American people safe. And this is part of that effort.Q Another piece of this plan talked about the law enforcement help. CBP has 23,000 agents working on the southern border right now. Were already seeing 7,000 illegal crossings a day; that is expected to surge to 18,000 when Title 42 is lifted. So, how does adding 600 law enforcement officers make a dent in that?

MS. PSAKI: Well, I would say, Jacqui, that one of the reasons that Secretary Mayorkas is participating in the important, you know, democratic process of testifying on the Hill is to answer the questions of exactly how the resources hes requesting, and they have identified as needing, to address this potential increase will help address that. So I would point you to his many hours of testimony today and tomorrow.

Q And then theres been reporting that Speaker Pelosi is unhappy with the way that the White House has handled Title 42 and worried that if it comes up for a vote as part of the Ukraine package, that Democrats wouldnt have the votes to defeat that. Does the White House share that concern? And what do you make of Pelosi seeming to be kind of shaky on just how close she is with the White House on this decision?MS. PSAKI: Well, I would say were incredibly close with Speaker Pelosi, and the President has known her for many, many decades. I dont I dont have more to spell out or explain what her meaning was or what defeat it means or doesnt mean.

There are many strong feelings and points of view on Capitol Hill in the House and in the Senate about Title 42. It wasnt a decision made by the White House. Its a decision made to lift it by the CDC. The authority given to was given to them by Congress.

And our effort and our focus is on implementation. And the Department the Secretary of Homeland Security is obviously testifying on that.

So, I dont have any more to explain about the particular comments. But we obviously work very closely with Speaker Pelosi on a range of issues, including immigration.

Q But a number of Democrats are, you know, speaking up about their problems with Title 42. I mean, Mark Kelly was briefed by Mayorkas yesterday. He said that he still has remaining questions about how and when resources are going to hit the ground. These are Democrats saying these things. Theyre not wanting, you know, Title 42 to replace an immigration effort, but theyre saying that there just is not a plan in place to support whats going to happen when Title 42 goes away.MS. PSAKI: Well, what I was trying to note earlier, perhaps not articulately, is that there are a range of members who have strong concerns about it being lifted. Again, not a decision we make a decision made by health and science experts. And there are many members who feel very strongly about it actually being it lifted and that moving forward.This is why Secretary Mayorkas is on the Hill doing, I believe, four hearings, answering extensive questions from a range of members, Democratic and Republican. He put out a six-pillar plan on exactly how hes going to implement it. And that has been a plan thats been in the works for six months. So, this is part of the democratic process happening, and hes happy to be on the Hill answering their questions.Go ahead, Peter.Q Hey, Jen. The bipartisan leadership of the Senate Judiciary Committee, Senators Durbin and Grassley, have expressed concern about the DHS inspector general delaying or diminishing reports on sexual misconduct. This is Trump-era holdover. Is the President going to fire or in some way intervene with Mr. Cuffari, who is the inspector general, and is there any broader sense about what to do about Trump-era inspectors general?MS. PSAKI: I know that there can be changes made. I have not dug into this particular inspector general with the President or the team here. Im happy to do that. And I can follow up with you after the briefing.Go ahead.Q Thanks, Jen. On the issue of student debt, I know youve been asked about this before, but Senator Schumer just told reporters on the Hill that the President is getting closer to canceling up to $50,000 in student loan debt for borrowers. He said, The President is moving in our direction Were getting closer. Is that true? When can we expect a decision?MS. PSAKI: Look, the President has been considering and looking at options for how to provide more le- relief to students across the country.I would note, again, that not a single borrower of federal student loans has paid a penny on these loans since he took office. And this has been the longest time of that for any President, probably, in history. You can factcheck me on that. And hes continuing to consider a range of options in terms of any additional steps.Q A follow-up on that MS. PSAKI: Let me go to the back. Go ahead.Q Thank you, Jen. Two questions. A follow-up on the student loan forgiveness.MS. PSAKI: Yeah.Q You said that the President is looking at a range of options with regards to canceling some student debt. But is the President looking at any options for those students and parents who saved and sacrificed so that they wouldnt have to take out such massive loans? Is he looking at including them in relief retroactively? How would they be made whole if there wassome sort of canceling of debt?MS. PSAKI: You mean for people who have paid off all of their student loans?Q Yeah who made sacrifices so that they wouldnt have to take out some of those loans.MS. PSAKI: Its a good question. What I can tell you at this point is that theres legislation hed be happy to sign for individuals who have $10,000 in existing student debt. If Congress wanted to send that to him, hed be happy to sign it, and hes looking at executive actions and authorities. But I dont have anything to preview on that front.Q Okay. Then, you know, if the President does move on canceling some of the student debt, isnt that just one half of the equation though? I mean, what is he looking at in order to keep some of these public universities from jacking up tuition prices, despite some of the federal subsidies that theyve been getting? I mean, what is it to stop some of these schools from just increasing tuition for the next generation of students? Isnt that half of the equation?MS. PSAKI: I dont know if people would consider it half of the equation. I dont know. Well let Americans define it. I would point you the Department of Education to talk about their efforts on that front.Q And one last quick follow-up. Is the Presidents weekly lunch with the Vice President still a priority for him?MS. PSAKI: Absolutely. Obviously, theyre not going to be dining in person while she is quarantining at home, but they did speak yesterday and I expect they will speak regularly while she is quarantining. And she is participating in a number of policy meetings here, too.Q Thank you, Jen.Q I have a follow-up.MS. PSAKI: Go ahead. Oh, well and then I can come to you next.Oh, go ahead. So polite. Go ahead.Q Do you have any reaction to Boeing claiming that its lost $1.1 billion on the Air Force One contract? And, more important, has the President ordered Boeing to stick with the traditional blue-and-white design instead of the garish red? (Laughter.)MS. PSAKI: This is bringing me back to, like, my first week in this job.Q I know, we gave you a year.MS. PSAKI: Yes, I appreciate it. I actually dont have any information on the plans for the new Air Force One. I can certainly check and see what we know, and I can get back to you on that.Go ahead.Q Thanks, Jen. Do you know why the Vice Presidents doctor recommended she take Paxlovid?MS. PSAKI: Oh, well, I think as Dr. Jha said yesterday, there are a range of Americans who may not know theyre eligible and they should consult with their doctor. Thats exactly what she did. And one of the chal not challenges, but one of our efforts right now is to provide more information publicly and have more people consult with their doctors about whether theyre eligible.Q Do you know if shes, like, showing symptoms? Or would her getting, like, severe COVID present, like, a national security risk?MS. PSAKI: They obviously said yesterday that she did not have any symptoms. I dont have any update beyond that.Shes continuing to work from home, conducting her duties as Vice President, so I dont believe were talking about a national security issue in this moment. She can also do secure calls and video conferences from her home because we have that capacity.Q But if she got severe COVID disease, would that not be a national security risk?MS. PSAKI: Im not going to Q So, Paxlovid would potentially prevent that.MS. PSAKI: Im not going to speak to a hypothetical of the Vice President getting sicker at this point in time, which I think is probably understandable.Go ahead.Q Can the White House give us any update on Trevor Reeds condition after his release or any treatments that he might have received following his release?MS. PSAKI: Well, you know, obviously were going to respect his privacy, and we spoke to his health conditions because we wanted to emphasize how important it was and the urgency of bringing him home. But we will, of course, leave that to him and his family to speak to and respect his health privacy beyond now.Q And then on the Vice President, did her role as Vice President have any impact on her receiving this treatment? Did that you know, her serving as somebody who is in the line of succession, did that have any impact on her getting Paxlovid?MS. PSAKI: Well, I think its important to note Paxlovid is widely available across the country through people consulting with their doctors. So it is not just a treatment that is available to only a small population of the public.In fact, what our effort is and what our focus is, at this point, is more broadly educating people on how they may be eligible for it. Certainly, we are grateful that this treatment is out there and available so that the Vice President, somebody whos incredibly important in the line of succession, can take it. But she did it through consultations with her doctor.Go ahead, in the middle.Q Thanks, Jen. So, Democrats on the Hill today said they will act soon on efforts to lower the prices of gas and that a federal gas tax holiday is still on the table for them. If they give the or if they include a federal gas tax holiday in a bill, would the President support that?MS. PSAKI: The President has long said that hes open to a range of options, including a federal gas tax holiday, and were continuing to consult with members of Congress about a range of options on lowering the price of gas.Go ahead.Q Yeah. So, on Poland and Bulgaria: Energy experts see that as sort of a warning from Russia to Germany, other countries in Europe, to pay in rubles. Is there a me- and were also hearing that some companies in Europe are paying rubles for energy. Is there a message from the White House to those companies or countries that might cave and pay in rubles for energy?MS. PSAKI: I dont think we have a new message to offer today. What I would note is that we have long predicted I mean, this is the Russian playbook; part of the Russian playbook is weaponizing energy. So could they do it other places? That certainly is possible. Thats one of the reasons why this taskforce was launched, at the President that were working with the Europeans on, to ensure that we are diversifying access for LNG and also for oil as well for the Europeans.Q And then, about a month ago, you announced that the U.S. was going to release 1 million barrels a day for six months. Oil prices crude oil prices are still over a hundred dollars a barrel today. Gas prices are up. Is it having the intended effect?MS. PSAKI: Well, weve weve said this is one tool that we can we can utilize. And I know that gas prices also did come down from the beginning as a result of these actions, but were continuing to explore additional options.As we know, the oil markets are a global market, and increasing supply and continuing to work with other countries to increase supply is part of our overall objective here.Q It went down only 3 cents, and were about 20 cents away from the record. So MS. PSAKI: Well, again, were going to continue to take steps to reduce the price of gas for the American people. Every option a range of options remains on the table, as is evidenced by the earlier question. And we know that increasing supply and ensuring supply meets the demand on the marketplace as part of that effort.We also watch closely for any attempt at price gouging. When oil prices come down, obviously gas prices should come down. And as you know, because weve had a range of charts in here, we watch that closely as well. And thats something we will continue to call out.I can do like one Q Thanks, Jen. I think we have to gather in a second.MS. PSAKI: Oh, I think okay. Okay, one last one. Last one.Go ahead.Q Jen, can I just ask quickly: When the supplemental request comes out, either I guess tomorrow or Friday, will there be anything changing any of the COVID-related requests that are previous? Is the only are the only new materials going to be related to the Ukraine request, or will there be a new a new spate of requests on COVID assistance as well?MS. PSAKI: So, we will request assis- COVID funding, and we will reiterate our requests for $22.5 billion for COVID funding, something we feel will help meet the immediate emergency needs we have. And that was a discussion, obviously, that we didnt get through but we will continue with Congress in the coming days and weeks.Thanks so much, everyone.3:47 P.M. EDT

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Press Briefing by Press Secretary Jen Psaki, April 27, 2022 - The White House

Ron DeSantis says ending Disney’s self-governing status will be a ‘process.’ Here’s what might happen next – kuna noticias y kuna radio

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By Eric Levenson and Steve Contorno, CNN

Nearly 55 years ago, Florida passed a law that created the Reedy Creek Improvement District, effectively giving The Walt Disney Company governmental control over the land in and around its central Florida theme parks.

Yet over the course of just a few days last week, Republican legislators in response to Disneys criticism of a law restricting discussion of LGBTQ issues in schools drafted and passed a bill dissolving that special purpose district on June 1, 2023. Florida Gov. Ron DeSantis signed the legislation into law on Friday.

The new law is just two pages long and avoids any discussion of details about how to unwind a half-century of infrastructure deals, nor does it lay out the next steps in the complicated process.

The lack of a concrete plan surprised and frustrated state lawmakers in Orange and Osceola counties, who suddenly realized their taxpayers could be on the hook for funding basic services and paying off Disneys nearly $1 billion of debt.

Theyre trying to unwind a whole municipal government in five days, said Eleanor Wilking, an assistant professor at Cornell Law School studying tax policy. The details are not trivial.

CNN spoke to a handful of experts and lawmakers to try to understand whats next for Florida, Disney and Reedy Creek. Their answers were wary and speculative because, they said, the law itself offered few clues. Disney, too, has been conspicuously silent over the past week.

Broadly, though, they suggested there were three potential paths ahead: One, inertia rules the day and local counties are stuck with a big tax bill; two, Disney files suit to stop the dissolution; or three, Disney and Florida renegotiate a new special district.

It really just depends on what Disney does and what the legislature does, said Aubrey Jewett, associate professor at University of Central Florida and co-author of the book Politics in Florida. If neither of them does much, then it falls to the local governments to sort out this mess.

If nothing else changes, and Reedy Creek is dissolved in June 2023, then Orange and Osceola counties could be on the hook for significant cost increases.

Reedy Creek is important to Disney because it gives them greater control over their parks, said Richard Foglesong, the author of the book Married to the Mouse: Walt Disney World and Orlando. Reedy Creek, whose budget comes almost entirely from Disney, pays for its own fire department, water systems, roadways and building inspectors, and it can issue bonds and take on debt to pay for long-term infrastructure programs.

But if Reedy Creek is dissolved, those expenses and debt payments would be absorbed by neighboring Orange and Osceola counties. The Senate bill analysis noted that the new law will have an indeterminate fiscal impact on the counties.

Officials in Orange County said theyll likely have to raise property taxes on their residents. Orange County tax collector Scott Randolph told CNN on Saturday that residents could be hit with a $163 million a year tax bill when the district is dissolved.

All of that debt and obligation goes over to Orange County the minute that Reedy Creek is dissolved, he said. He said paying that off could mean a property tax increase of 20% to 25% on homeowners. (Florida does not have a personal income tax.)

State Sen. Linda Stewart, a Democrat who represents part of Orange County, told CNN on Monday there was conflicting information about what this would mean for county taxpayers. Orange County is working on releasing a more realistic breakdown of the potential impact in the next few days, she said.

Still, shes already hearing from frustrated constituents concerned that their property taxes will be going up.

Weve got inflation, weve got (high) gas prices, and now were gonna add in a huge tax bill too? No, that is not acceptable, she said.

A second potential path ahead is that Disney sues to block the law from taking effect.

One line of argument may be that the dissolution does not follow state law. According to Florida Statute 189.072, dissolving a special district requires approval by a majority of landowners. The land of Reedy Creek is mostly owned by Disney.

The bill passed last week takes that into account, saying that, Notwithstanding 189.072, any special district established before 1968 will be dissolved next year. Does including the word notwithstanding mean that the prior law doesnt apply?

In debating the bill last week, Rep. Randy Fine, a Republican, said the notwithstanding line passes legal muster.

These are not constitutional requirements. These are statutory requirements. And this bill actually changes the law, which were allowed to do at any time, and says that we dont have to do those things, he said.

To which state Rep. Dotie Joseph, a Democrat, responded: I think to change the law that exists you would repeal it, not just put another one that contravenes it, but what do I know? Im just a lawyer.

Another potential lawsuit could be on free speech grounds. Though the new law does not specifically mention Disney or Reedy Creek, Florida Republicans publicly said the law was in response to the companys criticism of the Parental Rights in Education bill, which critics have termed the Dont Say Gay bill.

That state legislation, signed into law last month, prohibits schools from teaching children about sexual orientation or gender identity in a manner that is not age-appropriate or developmentally appropriate. After an employee uproar, Disney stated that the companys goal was for the law to be repealed or struck down in the courts, earning the enmity of right-wing lawmakers.

They are a California company that is a guest in the state of Florida, Fine said on CNN last week. And they are a guest that has had special privileges that no other company has had. If you want special privileges, youd better be on your best behavior.

Disney could sue and argue that the law was an unconstitutional punishment for corporate political speech.

All of this boils down to a spiteful Disney approach that (Republicans) didnt like what Disney had the freedom of speech to say, Stewart said. People have freedom of speech, so do corporations. Theyre not excluded from having freedom of speech.

Finally, Disney might not even be the only one to sue the state. Tax attorney Jacob Schumer argued that Florida had promised Reedy Creek bondholders that the state wouldnt interfere with the districts bonds. Dissolving Reedy Creek would violate this contractual agreement, he argued.

Florida simply cannot promise to prospective bondholders that it wont interfere with Reedy Creek, and then dissolve Reedy Creek, he wrote on BloombergTax.com.

Reedy Creek itself highlighted this issue in a statement to bondholders last week, prior to the laws signing. Citing that aspect of the law, the district said it expects to continue business as usual.

In light of the State of Floridas pledge to the Districts bondholders, Reedy Creek expects to explore its options while continuing its present operations, including levying and collecting its ad valorem taxes and collecting its utility revenues, paying debt service on its ad valorem tax bonds and utility revenue bonds, complying with its bond covenants and operating and maintaining its properties, Reedy Creek said.

Fitch Ratings, the credit rating agency, put Reedy Creek on Negative Watch, meaning that there is a potential for the rating on their debt to be downgraded. Analyst Michael Rinaldi told CNN the uncertainty of the law was to blame, as the two-page bill did not lay out the process of what happens to nearly $1 billion in debt when the district is dissolved.

Were in no mans land with respect to where things go, he said.

The final path ahead and the one that most lawmakers and experts mentioned is that Disney and Florida renegotiate terms on a new special district with more limited powers the day that Reedy Creek dissolves.

The law passed last week explicitly allows for just such an agreement. An independent special district affected by this subsection may be reestablished on or after June 1, 2023, the law states.

DeSantis said as much on Monday, saying that the dissolution bill passed last week is the first step in whats going to be a process to make sure that Disney should not run its own government.

He insisted that Disney would still pay taxes and its debts.

Trust me, under no circumstances will Disney not pay its fair share of taxes, he said.

Under no circumstances will Disney be able to not pay its debts. We will make sure of that, he added.

Stewart said they could renegotiate on small things, such as ensuring Disney does not start fracking or build a nuclear power plant in the special district. That would allow Disney to keep most of its powers while also allowing DeSantis to maintain his right-wing credibility.

I dont think that anybody is going to go the full route of dissolving Reedy Creek, she said. There may be a couple of things we can do (to negotiate). Whether that will be enough for the governor to save face with, I dont know. I cant read his mind. Nobody can.

Wilking, the tax policy expert, said that any negotiation on the special district misses the broader issues at play: The culture wars have come for big business.

The bigger issue really is this idea that DeSantis and the Florida legislature are willing to really go head-to-head with these really large and locally significant businesses in order to prosecute their preferred cultural agenda, she said. Thats the real story in my opinion. The taxes are less important than the loss of control for Disney.

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Ron DeSantis says ending Disney's self-governing status will be a 'process.' Here's what might happen next - kuna noticias y kuna radio

Foreign Secretary’s Mansion House speech at the Lord Mayor’s Easter Banquet: The return of geopolitics – GOV.UK

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My Lord Mayor, Your Excellencies, Ladies and gentlemen.

According to some, this was destined to be the era of authoritarianism.

Three years ago Vladimir Putin said Western liberalism was dead.

Last year President Xi argued that the west is declining.

In April 2022 things look very different.

Recent months have shown the deep resilience of the human spirit and of free societies

Faced with appalling barbarism and war crimes, which wed hoped had been consigned to history, the free world has united behind Ukraine in its brave fight for freedom and self-determination.

Those who think they can win through oppression, coercion or invasion are being proved wrong by this new stand on global security one that not only seeks to deter, but also ensures that aggressors fail.

We cannot be complacent the fate of Ukraine hangs in the balance.

But lets be clear if Putin succeeds there will be untold further misery across Europe and terrible consequences across the globe.

We would never feel safe again.

So we must be prepared for the long haul. Weve got to double down on our support for Ukraine. And we must also follow through on the unity shown in the crisis. We must reboot, recast and remodel our approach.

My vision is a world where free nations are assertive and in the ascendant.

Where freedom and democracy are strengthened through a network of economic and security partnerships.

Where aggressors are contained and forced to take a better path.

This is the long term prize: a new era of peace, security of prosperity.

Lets be honest. The architecture that was designed to guarantee peace and prosperity has failed Ukraine.

The economic and security structures that were developed after the Second World War and the Cold War have been bent out of shape so far, they have enabled rather than contained aggression.

Russia is able to block any effective action at the UN Security Council. Putin sees his veto as a green light to barbarism.

Hes walked away from the NATO-Russia Founding Act and the Treaty on Conventional Armed Forces in Europe. Hes violated multiple measures on arms control.

The G20 cant function as an effective economic body while Russia remains at the table.

The Soviet Union used to regularly use their UN veto, but, for all the many evils they inflicted, even they behaved with some kind of rationality on the world stage.

They were able to stick to deals when they saw risks to strategic stability, as they did with the Anti-Ballistic Missile Treaty.

They would de-escalate when they were confronted and called out, as with the Cuban Missile Crisis 60 years ago.

And they had their eye on their global reputation.

None of these factors apply to Putin.

We are dealing with a desperate rogue operator with no interest in international norms.

This is at a time when the world economy had never been more open to Russia.

During the Cold War western allies fuelled each others prosperity, and we restricted flows of trade, investment and technology to the USSR.

In the 1990s these constraints were removed but it didnt lead to the expected gains in economic openness and democracy.

We took progress for granted instead of applying the necessary carrots and sticks.

And leaders like Putin spurned the opportunity to change because they feared losing control. Instead they took the money from oil and gas and used it to consolidate power and gain leverage abroad.

Wandel durch handel the assumption that economic integration drives political change didnt work.

We now need a new approach, one that melds hard security and economic security, one that builds stronger global alliances and where free nations are more assertive and self-confident, one that recognises geopolitics is back.

Britain has always stood up to bullies.

We have always been risk takers.

So we are prepared be bold, using our strength in security and diplomacy, our economic heft, and our will and agility to lead the way.

We are already stepping up in Ukraine.

The war in Ukraine is our war it is everyones war because Ukraines victory is a strategic imperative for all of us.

Heavy weapons, tanks, aeroplanes digging deep into our inventories, ramping up production. We need to do all of this.

Our sanctions have already seen Russia facing its first external debt default for a century. We need to go further.

There must be nowhere for Putin to fund this appalling war. That means cutting off oil and gas imports once and for all.

At the same time, we need to deliver support to the Ukrainian people. It means helping refugees, it means delivery of food, medicine, and other essentials, and it means keeping the economy afloat.

It also means holding the Putin regime to account for the appalling crimes that have been committed.

And, when the guns finally fall silent in Ukraine, it means making sure Kyiv has the resources it needs to maintain security, deter further attacks, and rebuild.

Thats why we are working on our joint commission with Poland to ensure Ukraine is equipped with NATO-standard weapons.

And its why we are determined to work with the US, with the EU and other allies on a new Marshall Plan for the country.

Ukraine deserves nothing less than a landmark international effort to rebuild their towns and cities, regenerate their industries, and secure their freedom for the long term.

We are doubling down.

We will keep going further and faster to push Russia out of the whole of Ukraine.

And this has to be a catalyst for wider change.

We must also apply this tough stance to the threats that are emerging beyond Ukraine.

Our new approach is based on three areas: military strength, economic security and deeper global alliances.

Firstly, we need to strengthen our collective defence.

In the words of President Zelenskyy: Freedom must be better armed than tyranny.

Ahead of the NATO summit in Madrid, we need to lift our sights.

We have long argued that NATO needs to be flexible, agile and integrated.

The Eastern Flank must be strengthened, and we must support crucial states like Poland. Thats why we are increasing our troop presence and were deepening our defence cooperation.

We also have to learn the lessons of Ukraine.

The UK sent weapons and trained Ukrainian troops long before the war started.

But the world should have done more to deter the invasion. We will never make that same mistake again.

Some argue we shouldnt provide heavy weapons for fear of provoking something worse.

But my view, is that Inaction would be the greatest provocation. This is a time for courage not for caution.

And we must ensure that, alongside Ukraine, the Western Balkans and countries like Moldova and Georgia have the resilience and the capabilities to maintain their sovereignty and freedom.

NATOs open door policy is sacrosanct.

If Finland and Sweden choose to join in response to Russias aggression, we must integrate them as soon as possible.

And we reject the false choice between stronger traditional defence and modern capabilities. We need to defend ourselves against attacks in space and cyberspace as well as by land, air and sea.

We also reject the false choice between Euro-Atlantic security and Indo-Pacific security. In the modern world we need both.

We need a global NATO.

By that I dont mean extending the membership to those from other regions.

I mean that NATO must have a global outlook, ready to tackle global threats.

We need to pre-empt threats in the Indo-Pacific, working with our allies like Japan and Australia to ensure the Pacific is protected.

And we must ensure that democracies like Taiwan are able to defend themselves.

All of this will require resources.

We are correcting a generation of underinvestment.

Thats why the Prime Minister has announced the biggest investment in our Armed Forces since the Cold War. We recognised Russia as the most acute threat in our Integrated Review, adopting the same vigilance as NATOs Eastern Allies.

Others are now also stepping up as well. But we all need to go further.

Spending 2% on defence must be a floor, not a ceiling.

There is no substitute for hard military power, backed by intelligence and diplomacy.

Secondly, we need to recognise the growing role that the economy plays in security.

In the UK we are now using all of our economic levers trade, sanctions, investment and development policy in a much more assertive way.

We recognise that growth from cheap gas and money syphoned from kleptocracies is growth built on sand. Its not the same as real, sustained growth from higher productivity and greater innovation.

Free trade and free markets are the most powerful engine of human progress. We will always champion economic freedom.

But free trade must be fair and that means playing by the rules.

For too long many have been nave about the geopolitical power of economics. Aggressors treat it as a tool of foreign policy using patronage, investment and debt as a means to exert control and coerce.

They are ruthless in their approach. Our response wont mirror their malign tactics, but we will match them in our resolve.

Its time to wise up.

Access to the global economy must depend on playing by the rules.

There can be no more free passes.

We are showing this with the Russia-Ukraine conflict Russias pass has been rescinded.

We are hitting them with every element of economic policy.

We have raised tariffs on Russian goods. Weve cut them off from WTO terms. Weve banned their ships from our ports, weve banned their planes from our airports.

We have sanctioned more individuals and organisations than any other nation, hitting Russias banks, oligarchs, defence companies, Central Bank reserves, and oil and gas supplies.

Were cutting off the funding for Putins war effort.

We are also cutting investment ties with Russia banning all new outward investment and ending the investor visa.

At the same time, we are removing all import tariffs for Ukraine, and were supporting the Ukrainian economy with loan guarantees, fiscal support and investment.

We are showing that economic access is no longer a given. It has to be earned.

Countries must play by the rules.

And that includes China.

Beijing has not condemned Russian aggression or its war crimes. Russian exports to China rose by almost a third in the first quarter of this year.

Originally posted here:

Foreign Secretary's Mansion House speech at the Lord Mayor's Easter Banquet: The return of geopolitics - GOV.UK

Transcript: Mayor Eric Adams Delivers Address on Future of New York City | City of New York – nyc.gov

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April 26, 2022

Moderator: Welcome to the address on Mayor Eric Adams' first 100 days, and the future of New York City.

Moderator: Performing the national anthem, please welcome Detective Makia Brown.

Detective Makia Brown, Police Department: [Singing].

Moderator: To perform Lift Every Voice and Sing, please welcome firefighter Regina Wilson.

Firefighter Regina Wilson, Fire Department: [Singing].

Moderator: Please welcome Imam Hassan Akbar, Bishop Victor Brown, Rabbi Moishe Indig, Venerable Youwang Shih, and Rabbi Rachel Timoner.

Imam Hassan Akbar: [Foreign language]. We begin in the name of the magnificent creator of all things, the one who is most compassionate and most wise. Ladies and gentlemen, let us take a brief moment of silence to mark the first 100 days in office for our Mayor Eric Adams, and to acknowledge his staff and all who are present who seek and desire to build a better and brighter New York City.

Imam Akbar: Allah says in The Holy Quran, "[Foreign language]. All my servants, call upon me, and I will certainly answer your call." In that spirit, we pray. We ask the almighty, the creator of the heavens and the earth, to bless this gathering, and we beseech you for your blessings as we offer various forms of prayer, seeking that reward that only you could give.

Imam Akbar: In your perfect words found in the Quran and the Torah, in the gospel and in the Psalms, and in every divine book that you have sent; you have put forth a vision of that perfect world. We beseech you that you lead us from hate to love, from violence to peace, and from despair to hope. We ask you, O Almighty, to help us to eliminate poverty, oppression, and prejudice in all of its forms. And we that you help us to make New York City a meeting ground for different cultures and faiths and ideas where women and men can gather together and find the fulfillment of their humanity. We ask you, O God, to accept our prayers. Amen.

Bishop Victor Brown: Let us pray. Oh God, creator and sustainer of this universe; we who are gathered today reverently paused in time and space to give thee thanks for the precious gift of life. In the midst of these tumultuous times, times tainted by COVID, crime and chaos; by your divine prerogative, you have prepared, sanctioned, anointed, elevated, and bestowed the governing mantle of this great city to my friend and brother, the Honorable Eric Adams. He comes to the task having embraced the urgency of this defining hour. In the poignant words of Dr. Martin Luther King, who remarked, "Now is not the time to engage in the luxury of cooling off, or to take the tranquilizing drug of gradualism."

Bishop Brown: Continue to grant unto our mayor the wisdom of Solomon, the strength of Sampson, the moral conviction of Amos, the patience and vigilance of Job, the audacious faith of Noah, the liberating power of Moses, the tenacity of Nehemiah, the visionary prowess of John, and the ubiquitous and unwavering love of Christ for all who comprise his city.

Bishop Brown: And then God, infuse us all with a cooperating spirit to partner with our mayor in making this the best and safest city in the nation. Bless our mayor and his administration, bless the empire state, bless the people of Ukraine, and God bless America. We pray. Amen.

Crowd: Amen.

Rabbi Moishe Indig: A father asked his son, "Five strands of hair is a lot or a little?" The son replied, "It depends where it is. If it's in a cup of coffee, it's a lot. It's on the head? It's a little." We celebrate now 100 days. 100 days of fishing is a lot, but 100 days of working, bringing back the city, doing so much hard work, it's a little.

Rabbi Indig: Thomas Edison once said, "Our greatest weakness is giving up." The most certain way to succeed is always to try, try again, and one more time. Our esteemed mayor is an example of someone who succeeds every time he tries, and the City of New York is the beneficiary of this great effort. With every move forward, we ask you, Mr. Mayor, please do it one more time.

Rabbi Indig: So, let us pray. We ask you God to please bestow your blessings on the Honorable Major Eric Adams. Give him the conviction and fortitude to continue his great work, and may his leadership lead to a more secured and unified society. Please bless the City of New York with success, safety, and peace of mind. Maybe we be it, Almighty God, all see a great hand of guidance with glory and love. Amen.

Venerable Youwang Shih: Let us pray to the Buddha and our spiritual leaders. Dearest Buddha. We come today to you in this thankfulness for guiding the leadership of Mayor Adams and his administration. We are aware of the many challenges that come from them, and all New York's public servants. May they rely upon your wise counsel as they address the needs of our citizens. We have learned from your teachings that all events are interdependent, and that past actions bear the fruits of present situations. We also know that how our government addresses current events will sow the seeds for the illness or health of our city for years to come.

Venerable Shih: Please also Buddha, may your teachings remind our citizens of their moral responsibility to one another. Remind them that our racials and cultural identities are but the exterior of our oneness. Remind them that all citizens desire to live in safety and prosperity. All citizens are deserving of loving kindness, compassion, and joy. Dear Buddha, we therefore pledge to be part of the solution, working with Mayor Adams and public officials. We understand that only by working together can we achieve a healthy, vibrant community. Dear Buddha, compassionate Buddha, please listen to our sincere prayer. Please accept our sincerest prayer. [Foreign language].

Rabbi Rachel Timoner: Dear God, holy one of blessings. You have created every New Yorker in your image without exception. That is why the inequality that we live with as if it was normal is an affront to you. Trying to fix it seems to us to be complicated, because we must work in the realm of budgets and policies and competing interests. But we know that from your perspective, it is not complicated at all. We know that from your perspective, in a city with magnificent prosperity, of course every child and every adult should have all they need to eat, plenty, and safe and secure and affordable housing, an education that uplifts them and inspires and is integrated, and quality and abundant healthcare and mental healthcare, and dignified work that gives them enough to live, and freedom from behind bars, and freedom from oppression and all forms of violence.

Rabbi Timoner: Bless those of us who have enough with knowing that we have enough, and knowing that we will only be well when everyone has enough. Bless our mayor and every person elected and appointed to govern and represent our people, with the courage and the clarity to see through the tangle of complexity, and bring your clarity and the clarity of the Hebrew prophets who taught us in loud voices to bring your justice and your love to every block, and every district, and every zip code, and every borough, and all of our city. And we say together, amen.

[Audio plays]

Moderator: Please welcome former New York City police officer, State Senator and Brooklyn borough president, and currently the 110th mayor of the great City of New York, Mayor Eric Adams.

[Applause]

Mayor Eric Adams: I feel sorry for people that live in a small town and don't live in New York. Just a good feeling, where we are, my fellow New Yorkers. We are here together at last. For two years, we have lived in an alternate version of our city, separated from friends, families, and colleagues, worried about going to school, to work, about staying healthy and our fear was justified.

Mayor Adams: We saw over 40,000 of our fellow New Yorkers die of COVID-19. This pandemic was a mass tragedy unlike anything we have experienced in modern era. But New Yorkers never faulted. We adapted. We improvised. We looked out for each other. We endured, despite the fear, the trauma, the uncertainty, and the heartbreak. We kept going because every New Yorker knew in their hearts that our city will come back. It's already happening. I can feel it everywhere I go. The state of the city is strong because New Yorkers have never been stronger. We've been through a lot. We have struggled and survived. After two years, we are ready to be together again. Reunited and it feels so good.

Mayor Adams: We are still in a time of profound concern, and this city is prepared to keep New Yorkers safe and healthy, no matter what the future brings. And part of that is because of the partnership we have with our City Council and my amazing friend, Adrienne Adams. We were high school students together. You and I both lost our mommies this last year. They're looking down on us and they're telling us, "You got this, baby. You got this." I thank you so much. Adams and Adams Law Firm is going to bring us through this.

Mayor Adams: But we have always known that our city would never be defined by the tragedy, the spirit of New York City will always prevail. We saw that spirit in the millions of essential workers, the city employees who kept us going throughout the pandemic. We saw it just two weeks ago, when a gunman attacked our subway. Transit workers, first responders, police officers, and every day New Yorkers took action to save lives and apprehend the suspect. I want to thank all of you, especially those who are here today with us. Please stand up.

[Applause]

Mayor Adams: Your courage and compassion are what this city is all about. That's sustained us through the first 100 days of this administration, and courage and compassion are what we need to rebuild this city going forward. This is the way President Franklin Delano Roosevelt chose to lead and his example inspires me. And the years after the Great Depression, America faced a cascade of crisis, not unlike what we are experiencing today. Then just as now, there was no easy solution or quick fix. FDR, like ELA understood that people needed an honest and reckoning of the problems and bold plans to solve them. That is what I intend to deliver for my fellow New Yorkers. The truth is, these first 100 days were not easy for our city. We have been tried and tested by some of the most historic difficulties and urgent crises this city has ever gone through.

Mayor Adams: The pandemic has hollowed out our economy and threatened people's livelihoods, stability, and mental health. Housing prices remain out of the reach of working people of this city. Too many of our brothers and sisters are living on the streets, in need of support and shelter. People are still dying from gun violence. It breaks my heart over and over. It keeps me up night after night. New Yorkers have a right to be angry, a right to expect more, to feel safe, to be safe, to know that your city is looking out for you, your family, and those in need. That is why we went all in, and will continue to say, we're getting stuff done during this first 100 days.

Mayor Adams: Let's look at the numbers in the first 100 days. Listen to this, New Yorkers. People are asking what your Police Department is doing. We removed 2,300 illegal guns off our street, 23 illegal guns. And so when you hear people say, "We don't need our police." Let me tell you right here and right now, I will support my police and we will make our city a safe city. And there's a covenant and commitment I'm giving to you. We will give the police the tools they deserve and they require, but my men and women that black wear blue uniform, we will not be abusive to the public that we swore to serve and protect. That is our obligation. That's the partnership.

Mayor Adams: But we've done more than just dealt with the issues of crime. We've added more than 50,000 jobs in the first three months of this year. Significantly, outpacing the national average. Unemployment rate dropped to 6.65% in March, down from 7.4% in December 2021. Hotel rooms demand is now at 86% of pre pandemic levels, up from 63% in January of this year. We have ensured that more than 97% of adults in New York City have at least one dose of COVID-19 vaccine, 97%. That's the number we should be proud of, and you should applaud yourselves for. We have seen a nearly 70% increase in school attendance and continuing low levels of COVID in our schools. People question my ability to keep the schools open, and I made it clear, my children will be in school, where they need to be.

Mayor Adams: We have added nearly 100,000 new beds for homeless New Yorkers, moved 2,500 families into shelters, and placed another 2,700 New Yorkers into subsidized housing. Let's be clear, New Yorkers, there is no dignity in sleeping on the streets. There is no dignity in sleeping on the streets. Our fellow brothers and sisters deserve better, and we're going to give them better. But this is only the start of our efforts to revitalize and rebuild the city. Now is the time to look to the future. To get there, we need a vision. One that we can all share in.

Mayor Adams: My vision of our shared future is this, a city of safety and abundance with jobs, housing, and care for all, a city where our children can play, breathe and thrive, where education embraces the whole child and supports our families. A city will be capitalized progress being made in new forms of energy, transit and commerce. A city that empowers people to live their best possible lives with access to green space, healthy food and preventive healthcare. A city that's inclusive, fair, and responsive to those who call it home. A city that inspires and welcomes all the world. This is the city New Yorkers want and deserve, and it is all possible, if we work together.

Mayor Adams: There are four main areas that we will focus on as we go forward, protecting our people, growing our economy, uplifting our youth, and building our infrastructure. Our new budget reflects those values and provides for them. This budget puts people, especially those who have often been left behind, front and center. Success won't be measured by how much we spend, but how much we accomplish. First, some good news. Despite the massive shocks to our system in the past two years, our city enters fiscal year 2023 on strong financial footing. This is the result of effective planning and fiscal responsibility.

Mayor Adams: Earlier this year, we achieved a savings of almost $2 billion across two fiscal years through our successful program to eliminate the gap, your tax dollars. Since we released this preliminary budget in February, we have also seen an increase in revenues and found opportunities to roll federal funds into the next fiscal year. This will allow us to direct additional funding to programs that address our most urgent challenges. As a result, the executive budget we released today is 99.7 billion dollars. Fiscal year 2022 and fiscal year 2023 remain balanced, and we have a manageable out year gap. In our executive budget, we have achieved more than $400 million in savings over fiscal years 2022 and 2023.

Mayor Adams: How do I tell you to manage your household when we are not managing your tax dollars in our city? We will do that, what we are asking you to do. We are adding 200 million dollars to the rainy day fund, bringing a total level of reserves to a new record of 6.3 billion dollars in fiscal year 2023, the highest it has ever been. This successful management of our resources will allow us to increase investments and critical priorities, fund transformative new policies. Most importantly, it will allow us to devote resources to upstream solutions, not only downstream demands.

Mayor Adams: We must engage and build a strong civic infrastructure that supports New Yorkers throughout their lives, not only in times of crisis. There is no doubt in my mind that New York City will make a full recovery and come back stronger and more resilient than before. But this is only possible if we continue to make public safety our top priority. Safety and justice are the prerequisite of prosperity. We cannot have a city where people are afraid to walk the streets, ride the subway, or send their children to school. And our first 100 days, crime and tragedy looked far too many times and took lives of innocent people. A deadly fire in the Bronx, killed dozens of neighbors and broke the hearts of the Gambian community. And I want to thank Borough President Vanessa Gibson for being on the ground and all of those Bronx electeds who were on the ground doing what needed to be done, responded in a real way.

Mayor Adams: We knew what happened those days and we knew how we responded accordingly. And on Sunday, we lost two more New Yorkers. Carlos Richards, a young man trapped in the burning building in Canarsie, one of our bravest firefighters, Timothy Klein, six year veteran of the Fire Department. They are mourned by this city and their families, and the Fire Department will never forget the sacrifice of firefighter Klein. We will never forget. The city will always stand with our first responders, the men and women who protect us, because keeping New Yorkers safe is essential to keeping our city going strong. There's still far too much violence in our communities. Black and brown lives remain at risk and hate crimes continue to be directed at Asians, Muslim, Jewish, Sikh, and LGBTQ plus communities and other New Yorkers.

Mayor Adams: Our sister Michelle Go was pushed to her death in front of a train, an act of horrifying hatred. Remember embracing her mother and her dad, and just feeling the pain of losing such a promising life at such an innocent moment in her life. Dozens more of our neighbors have been killed by gun violence. Unhoused New Yorkers were shot while they were sleeping on the street. An inspiring rapper was executed in cold blood. A 19 year old girl was killed as she worked the night shift in East Harlem.

Mayor Adams: We saw a grandmother wounded, six bullets in a young girl. An 11 month old baby shot in the head. And two of our police officers were shot dead responding to a call. Their names will echo in our hearts forever. Crystal, Jayquan, Kay, Sally, Angelia, Detectives Wilbert Mora and Jason Rivera. The families and loved ones of many of these New Yorkers are here with us today. Please stand up and show them the appreciation we have for them.

[Applause]

Mayor Adams: I want to speak directly to you. I can only imagine the loss you feel and the pain you live with, but I will not rest until we have addressed the conditions that led to that loss. We would do what is necessary to make all of our communities safe. You have my word, as a former police officer, a fellow New Yorker, and as your mayor. This is why this budget includes funding for our blueprint to end gun violence, our plan to confront increased crime with strategic focus and realistic solutions.

Mayor Adams: The plan ensures that the NYPD is laser focused on apprehending the small number of individuals responsible for the majority of gun trafficking and shootings in our city. And we are not going it alone. Together in partnership with President Biden, Governor Hochul, and law enforcement agencies at the local, state, and federal level, we're working to cut off the flow of illegal guns into our city and crack down on repeat offenders.

Mayor Adams: We're also funding a subway safety plan designed to provide our city with a transit system that's safe, reliable, and clean. And yes, it is essential that we empower our police officers and focus on the downstream impacts of crime and disorder. But what often gets less attention are the upstream solutions. These investments we are making in our most vulnerable brothers and sisters will help keep them and our entire city safe, because public safety is not just about police. It's about people.

Mayor Adams: That is why this budget includes $55 million to expand the B-HEARD program, which stands for Behavior Health Emergency Assistance Response Division. There are teams of EMTs and mental health professionals that respond to 911 calls involving mental health issues. This is not my idea. This is your idea. You told me you needed this and I heard you, and we put it in the budget and expanded it. Not every emergency call needs the police. B-HEARD teams deescalate tense situations and connect people in crises to the care they need. You know I did something right because Jumaane stood up and applauded me.

Mayor Adams: Our future will expand this program to more high-need neighborhoods, Central Brooklyn, Eastern Queens, and the South Bronx. We will also continue to support our crisis management team and violence interrupters all over this city. Some of them are here today. I love them so much AT Mitchell, [inaudible]. These organizations are out there on the front line during the work. Your work is a proven part of reducing violent crimes across our city and we thank you for your commitment and courage.

Mayor Adams: Public safety also means supporting those who need a second chance. That is why we're ensuring that every youth parolee will now have a mentor, someone to help guide them back to the right path after they have been incarcerated. Public safety isn't just about bringing down crime rate. It's about helping those who need it most, including those experiencing homelessness, many of whom are at risk from violence to themselves. That is why we are investing more than $170 million in 1,400 new beds as safe havens and other facilities designed to serve those who have the hardest time moving in traditional shelters.

Mayor Adams: Let me tell you something. It's going to be hard for people to hate me, because we are listening to those who have been on the ground. Working with Speaker Adams in the City Council, we will continue to make this a top priority. In addition to this increased capacity, our social service teams are expanding their road to connect New Yorkers in need to the services and housing options available to them, because it isn't just about building more shelters. It's about building trust.

Mayor Adams: This is the work so many in our city have done. And today I want to thank some of the individuals working every day to deliver housing and hope to those who need it most. My brother, Shams DaBaron. Where's Sham? Thank you. Thank you. Thank you. Formerly homeless, taking your pain and turning into purpose and making sure that other people are not experiencing that same pain. Thank you. Thank you. Thank you. Thank you. Thank you.

[Applause]

Mayor Adams: Rob Robinson also here, please stand, Rob. Thank you. Making sure that our brothers and sisters who have lived through homelessness have a voice in our city. Keeping New Yorkers safe is the key to economic recovery. But we must also use this moment to reimagine our economic system to promote equity and address longstanding problems and historic injustices. Make no mistake, we must restore the major drivers of our city's economy, including the central business districts that have been critical engines of success for centuries, who are making big investments in the cleanliness and safety of our streets and supporting our businesses in Midtown and Lower Manhattan.

Mayor Adams: We're looking at all of our commercial corridors and every borough. But we would not stop there. Our executive budget includes significant investments in jobs and opportunities across the city, including more than $140 million for major new capital investments and Hunts Point in the Bronx. Thank you, Councilman Salamanca for bringing this to our attention and doing what's right. [Inaudible] is to help our small businesses thrive and expand access to city funds for women and minority owned businesses who have been denied for far too long.

Mayor Adams: These are just a few of the more than 70 concrete initiatives we had laid out for our city's economic recovery. By simply creating jobs is one way, but that is not enough. We must do more. Too often in the past, our city has not done enough to help young New Yorkers get the kind of jobs that would transform their futures. If we want to tackle high unemployment in communities of color, we must actively create opportunity. That means educating our youth for the jobs for the future and providing direct on-ramps to those jobs.

Mayor Adams: That's why our executive budget includes $5 million in fiscal year 2023, to help the City University of New York train students for the most in-demand skills and connect them to good jobs at companies that are hiring. To my corporations, support my 100% paid internship programs so our children can have the opportunities that they desire. We're going to see the partnership with some of the largest employers in our fastest growing sectors, including life sciences, green jobs, techs, and advanced manufacturing.

Mayor Adams: That is what we mean when we talk about upstream solutions. It also means investing in an economic ecosystem where New Yorkers can access all the ingredients for jobs, innovation, and economic opportunity in one place. The process is already underway all over the five boroughs in Manhattan. We're expanding the fast growing life scientists and healthcare hub in Kips Bay. Thanks so much, Deputy Mayor Maria Torres-Springer for your vision in this area, getting it right.

Mayor Adams: Today we are announcing that the city will be working with Taconic Partners, DivcoWest, and NYU to build new space on First Avenue for cutting edge research, workforce training, and new startups. A child from Brownsville will learn the skills so he can go to Manhattan and be employed in the new science that's facing our city and our country.

Mayor Adams: We are also helping to bring more lab space online at the Alexandria Center, which has anchored our local biotech industry for over a decade. Together, these two projects will nearly double lab space in Kips Bay and further establish it as the hub for life sciences in our city. Meanwhile, at the Brooklyn Navy Yard, we continue to grow emerging tech and manufacturing companies and connect young people to those opportunities through the Brooklyn Steam Center, an amazing initiative.

Mayor Adams: Our working waterfronts in Sunset Park and Staten Island, we are establishing New York city as a global offshore wind hub to power our future and create thousands of jobs. And across the water on Governors Island, we are building a new academic campus. It will become fantasy island. We're going to do the research and test climate solutions for New Yorkers and the entire globe.

Mayor Adams: To support this hub of opportunity, the executive budget also includes new funding to expand ferry capacity at Yankee Pier, so that more New Yorkers can access the 7,000 jobs and educational opportunities we are creating on Governors Island, because our economy is not some abstract concept. Behind every job is a worker who's driving our city into the future. That's why we must also re-commit to protecting our city workers and support labor unions across our city.

Mayor Adams: Union power is people power. It keeps New York city going strong. I know what it's like to put on a uniform and work a shift in the services of others. My administration is going to make sure union members get the wages, the rights, and care they deserve. That is why in my first 100 days, we delivered raises for essential gig workers. It is why we are going to continue to stand in solidarity with people and unions working in this city. New York City is the largest union town in America.

Mayor Adams: Just a few weeks ago, this union town got even bigger, thanks to our brothers, Chris Smalls and Derrick Palmer, who successfully led the effort to unionize Amazon. Up, stand up. Thank you. Thank you. Thank you. Thank you.

[Applause]

Mayor Adams: Let me tell you something. I'm the first mayor probably that has ever been a union member. I know what it is to worry about your healthcare, to worry about your pension, to worry about putting food on the table, of what you did, and send a symbol.

Mayor Adams: You don't have to wear a suit and tie to mobilize and organize. All you've got to do is just have the ability to do so. Thank you for what you have done. Thank you. I noticed when you stood up, you had a tattoo. You made me want to get a tattoo. Now there are some critics who promote the view that City Hall cannot serve both broken people in the business community. But in fact, that is precisely the role of a fair and democratically elected leader.

Mayor Adams: You have heard me say many times that we do not need to choose between safety and justice. But we also do not need to choose between protecting workers' rights and supporting economic growth. This administration will seek to find a balance that works for the majority of New Yorkers and keep our economy strong. Rebuilding our economy is only one aspect of rebuilding our city for the future, who must also take care of young people in our families.

Mayor Adams: That is why I campaigned on and what I promised, when I was elected. My people's plan advocated for greater expansion of the earned income tax credit and more support for affordable childcare in our city. In the first 100 days, we have delivered on both those promises, working in partnership with the governor, Majority Leader Stewart-Cousins, and Speaker Heastie, and my colleagues in the state, law makers in Albany. We are putting $350 million back in the pockets of working people through our expansion of the earned income tax credit.

[Applause]

Mayor Adams: Thanks to those same colleagues in Albany, the state has committed $4 billion in funding for New York city childcare over the next four years. We have also secured authorization to implement tax incentives that will spur the private sector to create 17,000 new childcare seats in our city. In the upcoming weeks, we'll be releasing our full plan for extending childcare, but I want to share some of those details today.

Mayor Adams: First, I want to announce the new rates will go into effect in June, that will dramatically reduce the fees that eligible families currently pay for subsidized childcare. Look at this, folks, listen to this. A family earning $55,000 a year currently pays $55 a week for full-time subsidized care. Starting June 1st, that same family will pay just $10 per week.

Mayor Adams: Can you imagine that additional dollar? We're also ensuring that families who have been waiting for childcare get access to this critical support, and that families and communities with the greatest need will get priority. We have already begun reaching out to families on this city's childcare voucher wait list and plan to connect with every family on that list by September.

Mayor Adams: We know that working parents don't have time to navigate the complex bureaucracy to get childcare, and we are going to make sure the city government works for them, not that they should be working for city government to get it done. That is why I'm to announce that the first major feature of our new My City web portal will be a unified application process for all subsidized childcare options offered by the city. Making quality care more accessible will change lives, help our economy, and support our children and families.

Mayor Adams: It is a responsibility that too often falls on the women of the city. The story I know all too well, watching mommy having to work two jobs while raising my five siblings and me. The work of care is the work of life. It is essential work, and we're going to treat it that way.

Mayor Adams: In addition to our commitment to affordable childcare, the budget we release today includes bold new initiatives that will support our students and improve our schools. So proud to have Chancellor Banks as part of the team of what we are doing. Good friend, good colleague, and a good leader. While we are all, while all New Yorkers were impacted by the pandemic, our children and students are still feeling the effects of two years of grief, trauma and learning loss. We are proud that we successfully kept the schools open and students safe, but we must do more for our young people, especially when it comes to helping them get prepared and trained for a career in the future. Because I say this over and over again, folks. If you don't educate, you will incarcerate.

Crowd: Yeah.

Mayor Adams: 80% of the men and women on Rikers Island don't have a high school diploma, equivalency diploma. The indictment is not on them. The indictment is on our city, on what we have done for them, to them and betrayed them. Our young people were not getting what they needed from our city when we came into office. Student absenteeism was high. Educators have low morale and our children have fallen behind academically and socially.

Mayor Adams: That is why during the first 100 days, we committed to expanding the Summer Rising Program, which provides academic support, arts recreation and food to our students during the summer months. Thanks so much Sheena Wright for seeing the vision of getting this done and executing and making the plan happen. In the executive budget, we are adding funding to increase the total Summer Rising Program capacity to 110,000 K-8 students this year. We also now announced funding for a record 100,000 summer youth employment opportunities.

Mayor Adams: Those previous city Council Members Brad Lander, Jumaane, Adrienne Adams, and some of you, you've been fighting for this for years and people ignored you, but you came to me and told me what you needed, and what happened? You got it. But we're doing something else. We're allocating more resources to the Fair Futures program. Foster care children that age out at 21 with no support, we already know that there's six to 700 that age out every year, we know they are going to be victims of crime, participate in crime, homeless, mental health issues, no support.

Mayor Adams: We are putting money into Fair Futures to protect these foster care children like we promise we would do. We are expanding our Gifted and Talented Program to reach every district. Phil Banks heard it and he ... I said Phil Banks. David Banks. David Banks heard it, our chancellor, and he responded. Every school district, it's easier for families to access this program by providing two entry points. Both kindergarten and third grade.

Mayor Adams: This is how we raise the bar and deliver opportunities for students in all five boroughs. The budget we released today also includes more resources for our young people who are most in need. I know from my own life the challenges that a learning disability creates for a child and how they can be overcome with early diagnosis and the right support. That's why we will be directing $7.4 million in funding dyslexia screening sites and literacy programs across the city over the next three years.

Mayor Adams: We will also invest $11.2 million in our bilingual education program so that every student has a pathway to multilingualism, and work to ensure the food we serve our students supports their developments and builds lifelong healthy habits. Listen, Chicken McNuggets is not a nutritional meal. Now we want to prepare students for college, but we also know that there are many paths to a good job and bright future for our youth.

Mayor Adams: Many of our young people are ready to join the workforce sooner rather than later, and our education system should serve them too. Four years of college may be the right choice for some, but we must invest in a full and fair range of career training for our youth and actively connect them with jobs and other opportunities upon graduation. Starting this next school year, we will invest $33 million in career pathway programs that focus on high growth sectors like healthcare and technology.

Mayor Adams: We will expand these models citywide in subsequent years. Google, Facebook, startup. You want good talent to go into the communities that have been often denied and recruit them and give them the internship programs and let them be part of your expansion in our cities. We'll expand apprenticeships and support university career readiness and increase the number of high school students getting early college credit. New York City students should be able to succeed no matter what path they choose to take.

Mayor Adams: This administration is committed to changing the way we think about education and preparing all young people for success. By the way, none of this is possible without the continuing support, a mayoral accountability. You have a public school mayor that happens to be African-American. You have a public school chancellor that happens to be African-American, grew up in the city. If mayoral accountability was given to folks that were Red Sox fans, you darn sure can give it to people who are Yankees and Mets fans.

Mayor Adams: Give us mayoral accountability. We're working with our partners in Albany, as they look over to determine, to make sure this is done right. Our state lawmakers, we will continue to reach out and find out how do we continue to give parents input on what the chancellor is doing correctly now. Finally, must lay the foundation for the future of this city itself. Too often in the past, we saw physical changes to our city that did not benefit all of our communities, and we must continue to create safer streets and reduce deaths from traffic violence.

Mayor Adams: That is why my administration will take a new approach and invest in infrastructure for the people. We have used these first 100 days to build a safer, more accessible sustainable city, including starting work to improve 1,000 intersections to increase safety with better traffic signals and raise crosswalks. Working to complete physical barriers along 20 miles of established bike lanes. Committing $75 million to expand the fair, fast, discounted MTA rise for programs and make it permanent. Permanent.

Mayor Adams: Not each year trying to figure it out. Thanks to our speaker, this is something we are going to make permanent. Breaking ground in over 100 poised park projects across the fire boroughs and completing a $50 million sewage and water main overhaul in Southeast Queens to protect homes and streets from chronic flooding. Far too long, we've allowed our critical infrastructure to fall in disrepair, creating crisis after crisis. We must be planning ahead and investing in a city that works for all New Yorkers.

Mayor Adams: That is why this budget includes more than $900 million in creating safer, greener, cleaner streets across the city, and to make sure they're more accessible to our seniors and those living with disabilities. We will build more bus lanes to facilitate faster commuting, complete with countdown clocks so you don't have to guess when the bus is coming. The next one, we'd also be piloting new approaches to last mile deliveries to help reduce the number of trucks and vans holding up traffic and blocking our sidewalks.

Mayor Adams: We will also continue to make historic investments in our city's parks in open spaces, by adding nearly a half a billion dollars in capital funding for our parks system, a significant down payment towards our ultimate commitment of 1% for parks. Our parks are our crown jewels of our city, and New Yorkers all across the five boroughs rely on them for rest, recreation and exercise. This funding will go to new infrastructure, longer weighted repairs and increase trash pickup.

Mayor Adams: We'll be able to refurbish our green ways, improve public pools and extend hours at our recreation centers, and we're also going to plan for the future with 20,000 more trees on city streets providing shade, beauty, and improving air quality. We're making other investments to create a more sustainable city, including ambitious goals for reducing greenhouse emissions and reaching carbon neutrality by 2050, improving access to renewed energy, procuring more plant-based local food options across city agencies and moving towards zero waste with expanded access to composting.

Mayor Adams: As a coastal city in the era of climate change, we must also protect our vast and complex infrastructure from extreme weather and other climate shocks. We're also investing in public health on every level, from preparing for future pandemics to expanding lifestyle medicine programs in all five boroughs. We must help address the factors that led to the epidemic of chronic disease as type two diabetes, high blood pressure, and take them as seriously as we take our other health emergencies.

Mayor Adams: Let me end with this. We must commit to creating the affordable housing that New Yorkers have needed for far so long. Housing cannot be a privilege for those with supportive families or generational wealth. It's a key to living a good life in the greatest city in the world. This must include housing for families, older New Yorkers, people living with disabilities, and those who have experienced homelessness. It must be for young people just starting out, as well as people who are starting over.

Mayor Adams: That is why we are committing $5 billion in additional funding for housing over the next decade. $5 billion. This is the biggest housing investment in generations, and it will impact many generations to come. This money will help make critical repairs at NYCHA, subsidize those who need help staying in their existing homes and build more deeply affordable housing for the entire city. Thank you, Jessica Katz, my chief housing officer, for having the real vision.

Mayor Adams: In the upcoming weeks, we'll be releasing a detailed blueprint for housing and homelessness based on the input of our city's top experts and everyday New Yorkers, and my administration is going to do everything we can to take this dream of equality and turn it into reality. That is getting stuff done on a historic level. These efforts are just the beginning. We will continue to transform our city through good government and responsive leadership. It all comes down to this, safety, jobs, schools and housing.

Mayor Adams: Sounds simple, radically practical, but it is the work of many hands, many minds and many years, and there's no better place to begin than right here. Truth be told, the American dream has always started in New York City, and this is no exception. We're the only country on the globe where dream is attached to our name. There's no German dream, there's no French dream, there's no Romanian dream. There's only an American dream, and we must make sure that dream is a reality for everyone.

Mayor Adams: We have the most talented, adventurous souls anywhere on the earth. They're right here. Over 400 years, we have turned this small port town into the global commerce center, the universe of art and diversity, from skyscrapers to subways. Our wildest dreams have become the world's everyday reality. Now, we're 100 days in to starting out of the new chapter in New York City's histories. This is the part where we find the compassion to help and house and educate everyone, the wisdom to put aside those old arguments and embrace our newfound unity and the courage to work together in solidarity.

Mayor Adams: We don't have to agree with each other all the time. I don't agree with myself all the time. But we have to agree that we have to live together to build a city of hope, equity and justice, a city that will light the way and lead the nation. I know. That's what mommy told me. When I was a little boy walking on the stage to do his speech, I felt the nervousness in the pit of my stomach. She leaned over to me, she said, "Baby, you got this." As I walked on this stage today, I heard mommy's voice, "Baby, you got this," and I want to say to you, New Yorkers, you got this. We got this. We will make it happen. There are only two types of Americans, those who live in New York and those who wish they could. You got this.

[Applause]

###

Link:

Transcript: Mayor Eric Adams Delivers Address on Future of New York City | City of New York - nyc.gov

ANCA calls on Congress to halt military aid to Azerbaijan, expand aid to Artsakh and Armenia – Armenian Weekly

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In ANCA testimony submitted on April 26th, Government Affairs Director Tereza Yerimyan urged US House appropriators to allocate $50 million in US aid to Artsakh to help its families rebuild their lives and resettle in safety upon their indigenous Armenian homeland.

WASHINGTON, DC Government Affairs Director Tereza Yerimyan outlined the Armenian National Committee of Americas (ANCA) policy priorities in testimony submitted today to the US House panel drafting the FY23 foreign aid bill with a sharp focus on ending all US military aid to Azerbaijan and delivering an urgently needed $50 million aid package to Artsakh.

In testimony submitted to Chairwoman Barbara Lee (D-CA) and Ranking Member Hal Rogers (R-KY) of the House Appropriations Subcommittee on State-Foreign Operations, Yerimyan made the case that, in the wake of Azerbaijans ethnic cleansing of Artsakh (Nagorno Karabakh) and amid Bakus ongoing occupation of sovereign Armenian territory, the Congress should hold the Aliyev regime accountable by cutting off all US military aid to its armed forces. She also pressed for a long-term developmental investment in Artsakh, to help its families rebuild their lives and resettle in safety upon their indigenous Armenian homeland.

Speaking to the need for increased aid to Armenia, Yerimyan prioritized US aid programs aimed at materially strengthening Armenias security and sovereignty in the face of escalating Turkish and Azerbaijani threats.

Similar testimony will also be submitted for Senate consideration.

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The Armenian American Community & U.S. Foreign Assistance PolicyFor Fiscal Year 2023

presented byTereza Yerimyan, Government Affairs DirectorArmenian National Committee of America (ANCA)

for the

Subcommittee on State, Foreign Operations, and Related ProgramsCommittee on AppropriationsUnited States House of Representatives

Thank you, Chairwoman Lee, for your strong leadership of this Subcommittee and your long history of support for the national and democratic aspirations of the Armenian nation.

In the wake of Azerbaijans ethnic-cleansing of Artsakh (Nagorno Karabakh), and amid Bakus ongoing occupation of sovereign Armenian territory, we ask this Subcommittee to hold the Aliyev regime accountable by cutting off all U.S. military aid to its armed forces and to help meet pressing humanitarian and developmental needs in Artsakh with a robust assistance package.

As you know, both Artsakh and Armenia continue to endure the brutal consequences of the unprovoked attack launched on September 27th of 2020 by dictatorial Azerbaijan backed by its ally Turkey against democratic Artsakh. USAID has estimated that 90,000 Armenians have been displaced from their ancestral homes, describing their situation as an acute humanitarian crisis. Azerbaijan has destroyed countless homes, churches, and hospitals. It has targeted civilians, used prohibited cluster munitions and white phosphorus, illegally detained and abused Armenian prisoners of war, and continues to desecrate Armenian Christian holy sites and cemeteries. Shockingly, Azerbaijan has yet to be held to account.

Neither the Trump nor Biden administrations have investigated Turkeys role in Azerbaijans aggression, including Ankaras recruitment of jihadist mercenaries from Syria and Libya to fight against Armenians. Nor has either administration investigated reports of Turkish F-16s having been used in Azerbaijans attacks. Closer to home, we have yet to see either the Pentagon or Department of State look into potential violations of U.S. arms export laws related to the discovery of U.S. parts and technology in Turkish Bayraktar drones deployed by Azerbaijan against Artsakh.

Our specific requests related to the FY23 State, Foreign Operations, and Related Programs bill fall into three categories:

1) Aid to Artsakh (Nagorno Karabakh):Through the leadership of this Subcommittee, since Fiscal Year 1998, direct U.S. aid to Artsakh has provided its peaceful inhabitants with maternal health care, clean drinking water, and life-saving demining by the HALO Trust. In the wake of Azerbaijans 2020 attack, this aid program must be meaningfully expanded to meet the humanitarian and development needs confronting the families of Artsakh estimated at well over $250,000,000 helping them rebuild their lives and resettle in safety upon their indigenous Armenian homeland. In this spirit we ask the Subcommittee to support a long-term investment in Artsakh, and, in order to meet the most urgent needs facing Artsakh, request the following language to be included in the body of this Act:

Of the funds appropriated under this act making appropriations for the Department of State, foreign operations, and related programs not less than $50,000,000 shall be made available for global health, humanitarian, and stabilization assistance for the Armenian population in Artsakh:

Refugee Relief: $20,000,000Housing: $10,000,000Food Security: $5,000,000Water/Sanitation: $5,000,000Healthcare: $5,000,000Rehabilitation: $3,000,000Demining/UXO: $2,000,000

2) Azerbaijan

We remain troubled that the Administration even in the wake of Azerbaijans attack on Artsakh has chosen, recklessly and irresponsibly, to waive Section 907 of the FREEDOM Support Act. Compounding this error, the General Accountability Office has confirmed that the Administration has demonstrably failed to meet its statutory reporting obligations under this law.

U.S. military aid to Baku including Section 333 (Capacity Building), Foreign Military Financing, and International Military Education and Training should not materially add to Bakus equipment stores, tactical abilities, and offensive capabilities, or free up its state resources for renewed cross-border action against both Artsakh and Armenia. Moving forward, the Administration should strictly enforce Section 907. Congress, for its part, should rescind the Presidents authority to waive this provision of U.S. law, and enact statutory prohibitions on any new U.S. military or security aid to Azerbaijan.

We request the following language to be included in the body of this Act:

No funds appropriated or otherwise made available under this Act may be provided to the Government of Azerbaijan for U.S. military or security programs.

3) Armenia

Armenia an ancient Christian nation deeply rooted in Western democratic values has, despite the crushing economic impact of Turkish and Azerbaijani aggression and blockades, stepped forward as an ally and partner for the United States on a broad array of complex regional challenges. Armenia is a member of NATOs Partnership for Peace and the Armenian military has been among the highest per capita providers of peacekeepers to U.S.-led deployments, including those in Afghanistan, Iraq, Lebanon, Kosovo, and Mali.

Moving forward, the U.S. aid program to Armenia should focus on Armenias security and sovereignty. As such, we request the following language to be included in the body of this Act:

Of the funds appropriated by this Act, not less than $100,000,000 shall be made available for assistance for Armenia to support Armenias security and sovereignty in the face of regional threats from Turkey and Azerbaijan.

We commend the Subcommittees commitment to American Schools and Hospitals Abroad, and encourage continued support through this program for the American University of Armenia and the Armenian American Wellness Center. We also ask the panel to prioritize supporting Armenias role as a regional safe haven for at-risk refugees.

In closing, we would like to underscore, once again, our urgent calls for robust aid to Artsakh and a statutory prohibition on U.S. security or military aid to Azerbaijan.

The ANCA, as always, thanks you for your leadership and looks forward to working with the Subcommittee to help save Artsakh, defend Armenias sovereignty, strengthen the U.S.-Armenia alliance, and advance American interests and our shared democratic values.

The Armenian National Committee of America (ANCA) is the largest and most influential Armenian-American grassroots organization. Working in coordination with a network of offices, chapters and supporters throughout the United States and affiliated organizations around the world, the ANCA actively advances the concerns of the Armenian American community on a broad range of issues.

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ANCA calls on Congress to halt military aid to Azerbaijan, expand aid to Artsakh and Armenia - Armenian Weekly

Euthanasia – MU School of Medicine

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Euthanasia is the practice of ending the life of a patient to limit the patients suffering. The patient in question would typically be terminally ill or experiencing great pain and suffering.

The word euthanasia itself comes from the Greek words eu (good) and thanatos (death). The idea is that instead of condemning someone to a slow, painful, or undignified death, euthanasia would allow the patient to experience a relatively good death.

Different practices fall under the label euthanasia. Here are some distinctions demarcating different versions.

Active euthanasia: killing a patient by active means, for example, injecting a patient with a lethal dose of a drug. Sometimes called aggressive euthanasia.

Passive euthanasia: intentionally letting a patient die by withholding artificial life support such as a ventilator or feeding tube. Some ethicists distinguish betweenwithholdinglife support andwithdrawinglife support (the patient is on life support but then removed from it).

Voluntary euthanasia: with the consent of the patient.

Involuntary euthanasia: without the consent of the patient, for example, if the patient is unconscious and his or her wishes are unknown.. Some ethicists distinguish between involuntary (against the patients wishes) and nonvoluntary (without the patients consent but wishes are unknown) forms.

Self-administered euthanasia: the patient administers the means of death.

Other-administered euthanasia: a person other than the patient administers the means of death.

Assisted: the patient administers the means of death but with the assistance of another person, such as a physician.

There are many possible combinations of the above types, and many types of euthanasia are morally controversial. Some types of euthanasia, such as assisted voluntary forms, are legal in some countries.

Mercy-killing:The term mercy-killing usually refers to active, involuntary or nonvoluntary, other-administered euthanasia. In other words, someone kills a patient without their explicit consent to end the patients suffering. Some ethicists think that

Physician-assisted suicide:The phrase physician-assisted suicide refers to active, voluntary, assisted euthanasia where a physician assists the patient. A physician provides the patient with a means, such as sufficient medication, for the patient to kill him or herself.

Some instances of euthanasia are relatively uncontroversial. Killing a patient against their will (involuntary, aggressive/active, other-administered), for instance, is almost universally condemned. During the late 1930s and early 1940s, in Germany, Adolf Hitler carried out a program to exterminate children with disabilities (with or without their parents permission) under the guise of improving the Aryan race and reducing costs to society. Everyone now thinks this kind of euthanasia in the service of a eugenics program was clearly morally wrong.

Advocates of active euthanasia typically argue that killing the patients in question is not worse than letting them die. Advocates of voluntary euthanasia often claim that patients should have the right to do what they want with their own lives. Advocates of mercy killing argue that for patients who are in vegetative states with no prospect of recovery, letting them die prevents future needless and futile treatment efforts. If they are suffering then killing them prevents further suffering. Advocates of physician-assisted suicide argue that a physician assisting a terminally ill or suffering patient is merely helping the patient who wishes to die with dignity.

Critics of the euthanasia typically argue that killing is always wrong, that nonvoluntary or involuntary euthanasia violates patient rights, or that physician-assisted suicide violates an obligation to do no harm.

Killing vs. letting die: There is dispute over whether killing a patient is really any worse than letting the patient die if both result in the same outcome.

Commonsense morality usually thinks that letting a person die is not as bad as killing a person. We sometimes condemn letting an innocent person die and sometimes not, but we always condemn killing an innocent person.

Consider different instances of letting die. One might claim that it is wrong to let our neighbor die of an accident if we could easily have saved his or her life by calling an ambulance. On the other hand, we let starving people in poor countries die without condemning ourselves for failing to save them, because we think they have no right to demand we prevent their deaths. But if someone killed a neighbor or starving people we would think that wrong.

Likewise, we would condemn a healthcare professional who kills a patient. But we might accept the healthcare professional who at patient and family request withholds artificial life support to allow a suffering, terminally ill patient to die.

The distinction between killing and letting die is controversial in healthcare because critics charge there is no proper moral basis for the distinction. They say that killing the above patient brings about the same end as letting the patient die. Others object to this and claim that the nature of the act of killing is different than letting die in ways that make it morally wrong.

Ordinary vs. extraordinary treatment: Ordinary medical treatment includes stopping bleeding, administering pain killers and antibiotics, and setting fractures. But using a mechanical ventilator to keep a patient breathing is sometimes considered extraordinary treatment or care. Some ethicists believe letting a patient die by withholding or withdrawing artificial treatment or care is acceptable but withholding or withdrawing ordinary treatment or care is not. This view is controversial. Some claim the distinction between ordinary and extraordinary treatment is artificial, contrived, vague, or constantly changing as technology progresses

Death intended vs. anticipated: Some ethicists believe that if a suffering, terminally-ill patient dies because of intentionally receiving pain-relieving medications, it makes a difference whether the death itself was intended or merely anticipated. If the death was intended it is wrong but if the death was anticipated it might be morally acceptable. This reasoning relies on the moral principle called the principle of double effect.

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Euthanasia - MU School of Medicine

Euthanasia | American Medical Association

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Code of Medical Ethics Opinion 5.8

Euthanasia is the administration of a lethal agent by another person to a patient for the purpose of relieving the patients intolerable and incurable suffering.

It is understandable, though tragic, that some patients in extreme duresssuch as those suffering from a terminal, painful, debilitating illnessmay come to decide that death is preferable to life.

However, permitting physicians to engage in euthanasia would ultimately cause more harm than good.

Euthanasia is fundamentally incompatible with the physicians role as healer, would be difficult or impossible to control, and would pose serious societal risks. Euthanasia could readily be extended to incompetent patients and other vulnerable populations.

The involvement of physicians in euthanasia heightens the significance of its ethical prohibition. The physician who performs euthanasia assumes unique responsibility for the act of ending the patients life.

Instead of engaging in euthanasia, physicians must aggressively respond to the needs of patients at the end of life. Physicians:

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Code of Medical Ethics:Caring for Patients at the End of Life

Visit theEthics main pageto access additional Opinions, the Principles of Medical Ethics and more information about the Code of Medical Ethics.

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Euthanasia | American Medical Association