Month: October 2017

Trump Administration Proposes Health Care Benefit Changes

The Trump administration Friday proposed new health insurance regulations that could affect basic benefits required by the Affordable Care Act, but not for a couple of years.

Loosening “Obamacare” benefit requirements was a major sticking point for congressional Republicans in thus-far fruitless efforts to repeal the law.

The complex new plan from the administration would give states a potential path to easing some requirements.

Starting in 2019, states could select from coverage levels in another state, which could be less generous. Ten broad categories of services required by the health law would still have to be covered, but the fine print could change.

Plan issued late Friday

Issued late in the day, the 365-page plan also proposes other changes to the inner workings of the health insurance markets created under the Obama-era law. The marketplaces offer subsidized private plans to people who don’t have access to job-based coverage. The changes proposed by the Trump administration cover areas from consumers’ eligibility for subsidies to how insurers are reimbursed.

It could take days for consumer groups, insurers, benefits experts and others to assess the potential impact of the proposal. Among the biggest uncertainties is whether the proposed changes would appeal to state officials, who generally try to protect standards established on their home turf.

The basic benefits that could be affected include:

Outpatient, inpatient and emergency care
Prescription drugs and labs
Preventive care
Pregnancy, maternity and newborn care
Mental health and substance abuse
Rehabilitation
Children’s services, including vision and dental

While those categories are established by law and can’t be changed in a regulation, the fine print can make a big difference. For example, insurers can cover certain drugs, but not others, for a given medical condition. Expensive treatments for complicated chronic illnesses can be subject to limits on the number of visits the plan will cover.

The Trump administration’s proposal also called for changes to small-business health insurance markets created by the ACA.

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Midwest Health Care Provider Cuts Opioid Prescriptions

A major health care system serving the upper Midwest said this week that the number of opioid pills it prescribes has fallen by almost a quarter as it works to respond to America’s opioid epidemic.

South Dakota-headquartered Sanford Health started analyzing its prescribing last year to direct its response to rising opioid and heroin overdose deaths, said Doug Griffin, who spearheaded the system’s data collection as vice president and medical officer for Sanford in Fargo, North Dakota.

Griffin said the health system learned that the numbers are “staggering”: The system reported prescribing 4.3 million opioid pills in the first quarter of 2016, a figure that doesn’t include cancer patients’ prescriptions. Sanford took steps as a result, including mandating opioid education for providers and using its electronic health record system to alert doctors about safe prescribing habits, Griffin said.

Sanford has since seen a significant reduction in both the number of pills prescribed and prescriptions written. Sanford providers wrote 18 percent fewer prescriptions for opioids in the third quarter of 2017 compared to the first quarter of 2016, amounting to 24 percent, or about 1.25 million, fewer pills prescribed, according to the health system.

The Sioux Falls, South Dakota, region saw a 19 percent reduction in pills prescribed, while the Fargo area experienced a 33 percent drop and the Bemidji, Minnesota, region saw a 37 percent decrease, according to Sanford.

​‘Knowledge has changed’

“The stance that we have taken is clearly opioid overdoses, both illicit and prescription overdoses, are a problem in this country, including in our footprint,” Griffin said. “Like many things in medicine, our knowledge has changed and our focus has shifted on this.”

Allison Suttle, chief medical officer at Sanford, said the system’s end goal is to ensure patients are safe and well-treated and that physicians are educated in how to treat patients’ pain while being “good stewards of the use of opioids.”

“Large health systems can serve as examples,” she said.

South Dakota Department of Health Secretary Kim Malsam-Rysdon said that South Dakota has a low opioid overdose death rate compared to other states, but noted that the state had 38 opioid overdose deaths last year. She said large health systems are on the front lines.

“I think they’re extremely committed to this, and I’m really confident that we’re going to see the changes that we need to see to stay ahead of this epidemic that we’re seeing in other states,” she said.

Avera Health, a Sioux Falls-based health system, sponsored a conference this month with the U.S. Attorney’s Office of South Dakota on the opioid epidemic. Deb Fischer-Clemens, Avera vice president of public policy, said the organization’s responsible prescribing program includes patient contracts, educating providers and patients on opioids and working with its electronic health record to create easy access to the state Prescription Drug Monitoring Program.

Fewer prescriptions, fewer pills

Jay Bhatt, senior vice president and chief medical office for the American Hospital Association, said in a statement that the nation’s hospitals and health systems are working to reduce the number of prescriptions written for opioids and the number of days that many patients take them.

Utah-based Intermountain Healthcare pledged in August to cut by 40 percent the average amount of opioids given per acute pain prescription by the end of next year.

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Tech Companies Ready to Face Congress Over Foreign Interference in US Election

Since the 2016 U.S. presidential election nearly a year ago, there has been increasing scrutiny of how Russian-backed operatives used accounts on Facebook, Google and Twitter to try to influence its outcome.

Executives from those companies appear before at least three congressional hearings starting Tuesday, facing questions from lawmakers about what happened and how they plan to respond.

What happened on the internet companies’ services during the 2016 election “was the undermining of our political process,” said Ann Ravel, a lecturer at the University of California-Berkeley’s law school and a former chair at the Federal Election Commission, the federal agency that enforces campaign finance law.

The congressional spotlight on the internet marks a shift in how lawmakers and the public think of the global communications network, observers say. 

View of the internet

For years, the internet was viewed as “an egalitarian force, basically giving voice to the voiceless,” said Nate Persily, a Stanford University law professor.

The 2016 election, with Russian-backed operatives reportedly placing political ads on social networks or posing as Americans talking about hot-button issues, changed that utopian view of the internet.

“We realized that once you allow anyone to speak to as many people as they want no matter when they want, that enables certain types of speakers who hold undemocratic speech,” Persily said.

On the streets of San Francisco, people interviewed echoed frustrations heard around the country that little is known yet about how and why Russian-backed actors used internet firms.

But some say tech companies should take responsibility for what happens on their services and play more of a monitoring role than they have done.

“Social media is accessible to everyone,” peer counselor Moinnette Harris said. “People can engage in it or put whatever they want on there, whether it’s true or false.”

Lia McLoughlin, a stay-at-home parent, said, “I think Facebook has a responsibility. … If you know that there’s something that is affecting our democracy, and if you have any idea that it might be fake, there is a reason to stand in there. It’s our democracy.”

Facebook and other companies share responsibility if their services were used by foreign agents, said Christian Simonetti, an administrative assistant. But any new rules or penalties the internet companies face should be done “without infringing on people’s democratic rights to express themselves,” he said.

Proposed legislation

Law lecturer Ravel said that congressional leaders and regulators should require that internet companies be transparent about who is using their services for political ads, something that billboards, TV stations and newspapers have to do.

In recent weeks, some of the companies have vowed to make changes in reaction to the scrutiny. Twitter and Facebook have said they will do more to make political advertisements more transparent.

Twitter also banned RT and Sputnik, two Russian-backed media companies, from advertising on its site.

But almost everyone agrees it would be harder to regulate — for the government and internet firms — so-called “issue-based ads,” which are about hot topics such as gun rights and gay marriage. Those ads may not be tied to a specific candidate or ballot measure.

Even harder would be fake Facebook or Twitter accounts created overseas but purporting to have been created by people living in a targeted community.

“There is currently no clear industry definition for issue-based ads,” Twitter said in a blog post.

How the U.S. navigates these issues will matter to the rest of the world, Ravel said.

“It’s important for the United States to be a leader to balance innovation we want from the internet for people to speak openly on the internet,” Ravel said, “yet to do something to prevent the intervention in the election.”

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Sessions: War on Opioids Is ‘Winnable’

U.S. Attorney General Jeff Sessions on Friday welcomed President Donald Trump’s declaration of the opioid epidemic as a public health emergency, saying he agreed with Trump that the war on addiction was “winnable.”

Trump on Thursday directed the U.S. Department of Health and Human Services to declare a 90-day public health emergency, but he stopped short of declaring the epidemic a national emergency or asking Congress for additional funds.

Trump’s declaration nonetheless gives states more flexibility to use federal funds, although it will not provide funds specifically for the opioid crisis.

The White House said the administration had allocated more than $1 billion for the opioid epidemic, including $800 million for prevention, treatment, first responders and prescription drug monitoring programs.

‘Make a difference’

Sessions, speaking to law enforcement officials at New York’s John F. Kennedy International Airport, called Trump’s announcement a “rare step” that “will make a difference by getting more help to those who need it.”

“In confronting the worst drug crisis in our history, we need to use every lawful tool we have,” Sessions said. “But if we do, there is hope. I agree with the president — I’m convinced that this is a winnable war.”

In August, the Department of Justice formed the Opioid Abuse and Detection Unit, a pilot program that places prosecutors in so-called opioid “hot spots” and uses data to investigate and prosecute opioid-related health care fraud.

Sessions said the program had begun to produce results.

On Thursday, he announced the first case brought by the program, a 14-count indictment of a Pennsylvania doctor for illegally prescribing and dispensing opioid pills and morphine — “often without an examination.”

On Wednesday, the Justice Department announced that the operator of a now-defunct pain management practice had pleaded guilty of opioid-related fraud in the amount of $750,000.

The doctor admitted prescribing a highly addictive version of the synthetic opioid drug fentanyl in exchange for $188,000 in kickbacks from drug company Insys Therapeutics Inc.

The company’s founder and majority owner, John Kapoor, was arrested Thursday and charged with conspiracy to commit bribery and fraud.

‘Overprescribing’ blamed

“Overprescribing is largely how we got into this crisis,” Sessions said. But he added that the proliferation of illegal fentanyl, which is 50 times as potent as heroin, had made the epidemic “much deadlier.”

Last year, more than 20,000 people died of overdoses involving fentanyl, according to the Centers for Disease Control and Prevention. Overall, deaths from drug overdoses topped 64,000 for the first time, making overdoses the leading cause of death for Americans under age 50.

Fentanyl is available as a Schedule II prescription drug in the United States. But drug seizure data suggest that a large number of the increase in opioid-related deaths is related to illicit fentanyl, often sold on the internet.

In recent years, China has emerged as the No. 1 source of illicit fentanyl in the United States. Earlier this month, federal prosecutors charged two Chinese nationals with illegally distributing large quantities of fentanyl in the United States.

In July, authorities shut down the largest illegal drug marketplace operating on the so-called dark web. The site, AlphaBay, had more than 200,000 drug listings, including fentanyl.

Law enforcement officials vowed to continue to go after illegal fentanyl suppliers.

“As a first step in response to the president’s announcement, the Cyber Crimes Center … will serve as ground zero in our efforts to attack the fentanyl issue where it originates — the dark web,” said Derek Benner, acting executive associate director of Homeland Security Investigations at U.S. Immigration and Customs Enforcement.

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Kenyan Wins $100,000 Grant for Device to Help Expectant Mothers

A Kenyan university student has won a $100,000 research grant for an idea aimed at decreasing maternal and infant deaths among cattle-raising families on the Kenya-Ethiopia border.

Dahabo Adi Galgalo secured the 2017 innovation award from AESA, Alliance for Accelerating Excellence in Science in Africa, for designing a GPS-like device to track expectant mothers in the area and ensure they seek health care for themselves and their babies.

Born into a pastoralist family in Kenya’s Marsabit County, Dahabo told VOA Horn of Africa that she always wanted to improve health care for families in the border area who depend on raising and selling livestock to make a living.

“The area of the pastoral community is so vast. The hospitals and health workers are very few. In fact, Marsabit County is among the top counties in Kenya in maternal and infant death,” she said.

One of the key factors contributing to the high death rates, she believes, is a lack of antenatal care (ANC) for pregnant women.

ANC clinics providing prenatal services are few and far between in the area, and pastoralists don’t often visit the ones that do exist, partly because of the long distances they would have to cover.

Dahabo says that in 2015, she conducted a study of mothers who gave birth at a regional hospital. Out of 1,042 mothers who delivered during the one-year period, she says, 116 lost their babies during delivery.

Of those 116 women, she says, 40 percent had never gone to an ANC clinic. And those who did make a visit, often traveled 50 to 80 kilometers to receive checkups and treatment.

“That is when my idea of going mobile came to my mind,” Dahabo said.

Her goal was to give expectant mothers a GPS-like device to help health care workers track them, remind them to get proper antenatal care, and arrange a visit with a doctor or health care volunteer.

The solar-powered device — which Dahabo helped design and a manufacturer is helping to build — is the size of a coin, and designed to be worn on a bracelet.

“With this, we can track the expectant mothers wherever they are and give them treatment,” she said.

Under Dahabo’s envisioned system, the program would be centered at the Moyale regional hospital and would cover the majority of Marsabit County with a radius of 160 kilometers.

The program aims to reach up to 200 expectant mothers for an initial period of two years. “We follow the expectant mothers for nine months and follow their children for full immunization,” Dahabo said.

Dahabo has been involved in research and control of diseases for more than 10 years in the Kenyan ministry of health.

She is among eight African inventors who have received research grants from AESA, which is funded by the Bill & Melinda Gates Foundation.

One of the other winners, Diawo Diallo from Senegal, is working on a surveillance system to track Zika-infected mosquitoes.

Another winner, Niaina Rakotosaminanana of Madgascar, is developing a low-cost, minimally invasive diagnostic test for pregnant women using blood samples drawn from finger pricks. 

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US Economy Expands at 3 Percent Rate in Third Quarter

The U.S. economy expanded at a three percent annual pace in July, August and September, about the same pace as the prior quarter.

Friday’s Commerce Department data surprised economists, who thought damage from two hurricanes would cut growth to a lower level. The data show the world’s largest economy is now about 2.3 percent larger than it was at this time last year.

Stuart Hoffman of PNC bank says the “solid” growth data is likely to help corporate profits and reinforce the U.S. central bank’s determination to raise interest rates in December. Josh Bivens of the Economic Policy Institute says the figures “overstate” growth, and he notes inflation is still below the Fed’s two percent target, making an interest rate hike unnecessary at this time.

Officials raise rates to fend off high inflation by cooling economic activity. Rates were slashed during the recession to bolster growth and employment. 

Federal Reserve leaders gather Tuesday and Wednesday in Washington to debate interest rate policy. Most economists predict they will not raise rates until their next meeting in mid-December.

Next Friday, government experts will publish unemployment data for October. September’s rate was a low 4.2 percent.

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Patients Turning to Alternative Pain Treatments Amid America’s Opioid Crisis

In 2015, 92 million Americans used prescription opioids to alleviate or manage pain, with 11.5 million reporting they misused them. Now more than ever, patients are seeking alternative treatments to avoid using potentially addictive pain pills. VOA’s Elizabeth Cherneff introduces us to a Washington doctor who is helping people manage their pain and combat their addictions.

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Drug Court a Lifeline in Battle Against Opioid Addiction

Paul Coles’ journey to becoming one of the 2.5 million Americans addicted to prescription opioids began with painkillers prescribed for injuries suffered during an IED attack in Iraq. The physical scars healed, but emotionally Coles suffered. He had Post Traumatic Stress Disorder and couldn’t stop using drugs. 

“It got to the point I would take three times the lethal dose of heroin and cocaine, load it into a syringe and shoot it up, trying to shut my body down,” Coles said. “I would sit there and say, ‘God if you are out there, just kill me.’”

Time after time, he cheated death. But he couldn’t escape the law. Coles found himself handcuffed, arrested and jailed on charges of felony drug possession. Yet what seemed to be a new low would turn into a lifeline.

From the moment Judge Jeri Beth Cohen looked at Coles, she knew he needed help. 

“My feeling is that opioid addiction is a terminal illness: You’re either going to end up in prison or you’re going to end up dead,” Cohen said.

“I’m seeing more and more cases,” she said. “These are young men and women between the age of, I guess, 21-30. It’s a largely Caucasian population,” she added.

​One judge, two courts, one team

Coles’ case is one of hundreds Cohen has seen during the unfolding prescription opioid and heroin epidemic in South Florida. Inside her courtroom, with graphic photos of what drugs can do to the body, she surrounds herself with professional caseworkers on the frontlines of how America’s criminal justice system handles the boom in opioid abuse.

Miami-Dade County launched the nation’s first drug court in 1989. Today there are 3,000 U.S. drug courts serving 136,000 people. But a report by Physicians for Human Rights claims few communities have adequate treatment facilities and the criminal justice objectives of drug courts often overrule the medical need of the patient.

Cohen’s drug court gives people the chance to beat their addictions, stay out of prison while eventually getting their felony drug charge expunged from the record if they complete the year-long program. 

Like Paul Coles 75 percent of Drug Court graduates remain arrest-free at least two years after leaving the program. 

Miami-Dade County launched its first drug court when the community was facing a previous drug crisis. The approach then did not address people’s addictions, rather it was focused on jailing them for criminal conduct.

“There was a crack cocaine epidemic just like we’re looking at this opioid and heroin epidemic right now. People coming into criminal court in large numbers were taking a plea or going to jail, getting out and getting rearrested,” Cohen said.

Today there’s a stream of people in drug court struggling with addiction to a multitude of prescription pain pills and heroin. Cohen, regarded as one of the top drug court judges in the country, uses a holistic approach.

“What I find is if we can get them stabilized on a drug like Methadone or a Suboxone, which blocks a high, then they’re able to start engaging and they’re much more able to focus on getting well.” she said. The goal of the drug court is to get people treatment, steering them away from prison time and hopefully reducing recidivism rates.

“You have to take many variables into account: trauma, untreated mental illness, the chronicity or severity of the drug usage and also what’s going on in the family. If you’re not developing a treatment plan with your treatment team based on an individual’s particular risk and needs, you aren’t going to be successful with that individual,” Cohen said.

The judge bemoans the system’s lack of compassion.

“People are treated really, really poorly,” she said. “In the jails, in the courts, even in treatment they’re treated poorly. If you have money, it’s easier to access care [but] it’s still hard.”

​Zero tolerance

For all her understanding, Cohen shows little tolerance for those not following the rules. She sentences some to community service hours while others go back to jail.

There are frequent drug screenings to make sure people stick with their sobriety. Those who don’t meet the court’s year-long requirements may be returned to a traditional criminal court to face felony drug charges.

“I don’t think that sick people should be in jail. I do the best that I can to help people get well within our system, to divert them out of jail, but yet hold them accountable,” Cohen said “I feel like I do my job and I feel like I do it well.” 

“If you don’t go into the program, that’s fine with me,” Cohen tells a young, opioid-addicted mother, handcuffed and dressed in orange prison suit. “I am not going to keep you here and I am going to have the state dependency court file a termination of parental rights. I will order them to do it,” Cohen stressed.

Family reunions

“The children in my court have been removed from their parents because they have severe and chronic drug addiction and have failed to get into treatment,” the judge said. Her formula is to get parents who are struggling with opioid addiction intensive drug treatment so they can regain custody of their children.

She said 60 percent of the parents who go through the program get their children back.

“It’s getting into true recovery, improving your relationships with your family, your spouse, your children and starting that long life-long journey to recovery,” Cohen said.

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Drug Court Judge Throws Lifeline to Those Addicted to Opioids

American drug courts are taking a public health approach to help those addicted to prescription opioids and heroin. The goal is long-term recovery and allowing people to have their felony drug charges erased from their records if they complete the program. VOA’s Chris Simkins reports from Miami on how one judge is helping those struggling with opioid abuse.

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Migrants Stranded on Greek Isles Facing Mental Health Crisis

More than 10,000 mainly Syrian refugees who escaped fighting in their country are living on five Greek islands. About 2,500 of them are crowded into camps on the island of Samos, even though there is only room for about 800. VOA’s Kevin Enochs reports aid groups say there is a growing mental health crisis among those refugees.

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Houston-Bound World Series Lifts Spirits, If Momentarily

As the best-of-seven 2017 World Series shifts from Los Angeles to Houston at one game apiece, diehard fans of the hurricane-devastated city can sense a first-ever baseball championship within their grasp. Houstonians admit that a series victory — if only a momentary distraction — would lift the city’s spirits. Ramon Taylor reports from Minute Maid Park, home of the Astros.

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New Styles, Smarter Machines and Next-Generation Safety Highlight Tokyo Motor Show

Automakers from around the world take the stage this weekend at the 45th annual Tokyo Motor Show. Designers will showcase electronic cars with advanced artificial intelligence and at least one concept car with safety features for the world around it. Arash Arabasadi reports.

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Tech Companies Get Ready to Face Congress Over Foreign Interference in U.S. Election

Facebook, Google and Twitter are heading to Washington to answer questions about how their services were used by Russia-based operatives to influence the 2016 U.S. presidential election. In Silicon Valley, there’s concern that the scrutiny may bring new regulations, as VOA’s Michelle Quinn reports.

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Who Will Be the Next Fed Chief?

President Trump says he is “very close” to picking a person for the most important economic post in the country: the head of the US Federal Reserve. Current Chair Janet Yellen, whose term expires early next year, is one of at least five candidates under consideration. Regardless of the president’s choice, most analysts who spoke with VOA don’t expect big changes in US monetary policy. But as Mil Arcega reports, others say, sooner or later the next Fed Chief could face a slowing economy.

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MSNBC Takes Halperin Off Air After Harassment Claims

MSNBC said Thursday that journalist Mark Halperin had been suspended from his role as network contributor following charges from five women that he sexually harassed them while he was an ABC News executive.

The network said it found Halperin’s conduct as described in a CNN story “very troubling” and that the veteran political reporter would be off the air until questions about his past were fully understood.

Later Thursday, Penguin Press canceled a planned book by Halperin and John Heilemann about the 2016 election, and HBO called off a miniseries that would have been based on the book. Halperin and Heilemann had collaborated on two previous books, including Game Change, a best-seller about the 2008 race that almost single-handedly revived the campaign book genre and was the basis for an award-winning HBO adaptation.

“HBO has no tolerance for sexual harassment within the company or its productions,” the company said in an emailed statement.

The planned book had no title or official publication date, but had been expected to be released in early 2018.

Halperin has apologized for what he termed inappropriate behavior, and ABC said Thursday that no complaints were filed against him during his tenure, which ended more than a decade ago.

The women, who asked to remain anonymous, said they didn’t report Halperin’s conduct because they feared retribution or were embarrassed.

But Emily Miller, a former ABC employee who is now a reporter at One America News Network, retweeted the Halperin story on Thursday with the hashtag “#MeToo.”

She gave no details of her alleged incident, but tweeted that she did not report Halperin to ABC “because I thought I was the only one, and I blamed myself, and I was embarrassed and I was scared of him.”

CNN international correspondent Clarissa Ward, who also used to work at ABC, tweeted that Halperin’s behavior was “an open secret” at the network. She saluted the women who came forward in the CNN story.

“Let’s be very clear — the one responsible for any sexual misconduct that may have taken place is the man who instigated it,” Ward tweeted, “NOT the women who were victims of it, nor their friends and colleagues who tried to support them through it.”

Halperin told CNN Wednesday night that he was “deeply sorry” and was taking a “step back” from day-to-day work to deal with the situation.

His statement came after CNN reported allegations that Halperin had propositioned, fondled and pushed himself against five women in the early 2000s while he was ABC News’ political director.

Halperin said he pursued relationships, sometimes with junior co-workers, but CNN said he denied the groping allegations.

Showtime, where Halperin has co-hosted the political series The Circus, said Thursday that it had not heard of any allegations of untoward behavior. “We are aware of these reports and will continue to evaluate all options should we decide to move forward with another season of The Circus,” the network said.

On MSNBC’s Morning Joe Thursday, co-host Mika Brzezinski informed viewers about Halperin. He has been a frequent panelist on the show.

“We’re going to be following this story as it develops,” she said. “I’m sure we’ll be talking about it again when we know more about it.”

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Experts Say Measles Victims Dropped Below 100,000 in 2016

The World Health Organization, UNICEF, and the U.S. Centers for Disease Control and Prevention say the rate of deaths from measles has dropped 84 percent since the beginning of a global vaccination campaign in 2000.

Experts say the number of people who died from measles in 2016 was about 90,000, compared to more than 550,000 deaths in 2000. This marks the first time that worldwide measles deaths have fallen to less than 100,000 per year.

Robert Linkins, of the Measles and Rubella Initiative at the CDC, said in a statement that “saving an average of 1.3 million lives per year through measles vaccine is an incredible achievement and makes a world free of measles seem possible, even probable, in our lifetime.”

Since 2000, some 5.5 billion doses of measles vaccine have been administered to children through routing immunization services and mass vaccination campaigns. The disease is contagious through air particles and can spread quickly. Measles kills more people every year than any other vaccine-preventable disease.

But the WHO says the world is still far from reaching regional measles elimination goals. Since 2009, officials have managed to deliver a first dose of the vaccine to 85 percent of the babies who need it, but there has been no improvement in that rate in eight years. And only 64 percent of the affected population has gotten the second dose, which comes when a child is four or five years old.

The WHO says “far too many children” — about 20.8 million — have not had their first measles vaccine dose. Most of those children live in Nigeria, India, Pakistan, Indonesia, Ethiopia and the Democratic Republic of Congo.

The disease puts children at risk of developing complications such as pneumonia, diarrhea, encephalitis and blindness.

Measles vaccine is administered along with vaccines for mumps and rubella, in a shot known widely as MMR.

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Hawaii: No Screen Time While Crossing a Street

Police in Hawaii will ticket people who get caught looking at digital devices while crossing a street in the state capital, Honolulu.

The law, passed in July, came into effect this week, making Honolulu the first major city in the U.S. to pass such a law.

The only exemption to the Distracted Walking Law is to use a device to call 911 to report an emergency.

The fines for the offenses will range from $15 to up to $99 for repeat offenders.

Pedestrians are still allowed to talk on their phones while crossing the streets, as long as they look at their surroundings.

The National Safety Council added “distracted walking” to its annual list of injury risks in 2015.

According to a study in the Journal of Safety Studies in 2015, some 400 pedestrians distracted by a phone were injured in the United States each year between the years 2000 and 2007. But after the introduction of the smartphone, the numbers have risen. The study found an estimated 1,300 pedestrians were injured in 2012.

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Greater Scrutiny Set for Nonimmigrant Work Visa Renewals

The United States has announced changes to its nonimmigrant work visa policies that are expected to make renewals more difficult.

In the past, U.S. Citizenship and Immigration Services would generally approve the renewals unless the visa holder had committed a crime. Now, renewals will face the same scrutiny as the original applications.

“USCIS officers are at the front lines of the administration’s efforts to enhance the integrity of the immigration system,” USCIS Director L. Francis Cissna said, according to the announcement posted on USCIS’ website this week. “This updated guidance provides clear direction to help advance policies that protect the interests of U.S. workers.”

The new regulations could affect more than 100,000 people holding at least eight different types of work visas who fill out the I-129 form for renewals.

Sam Adair, a partner at the Graham Adair business immigration law firm in California and Texas, said that for the most part, he expected visa holders would most likely face lengthier adjudication periods in their renewal processes, as opposed to increased numbers of denials.

“I don’t think it’s going to be a big shift for us,” Adair told VOA. “But I think what we’ll see is just an increase in the number of requests for evidence, an increase in the delays on the adjudication of these petitions, and really it’s going to just result in more costs for the employers who are filing these petitions.”

‘High-skilled’ workers

Of all visa holders affected by this policy, those in the United States on an H-1B, a visa for “high-skilled” workers, are the biggest group. Of 109,537 people who had to submit I-129 forms in fiscal 2017, 95,485 were H-1B holders, according to data sent to VOA by USCIS.

H-1B visas have been threatened in the past, most recently by a bill proposed this year that would have raised the minimum salary requirement for workers brought in on the visa. While advocates of the program argued that it would keep workers from being exploited, many H-1B holders feared that businesses would be less willing to hire them or keep them on board.

But some Americans support the new regulations, saying that nonimmigrant work visas hurt American workers.

“It’s prudent to make sure that the people that receive those visas are in complete compliance with all of the requirements,” Joe Guzzardi, national media director of Californians for Population Stabilization, told VOA.

“It just isn’t possible to think that there aren’t American workers that couldn’t fill these jobs,” he said, noting that while the regulations might hurt businesses, they would help Americans looking for work.

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