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Could Future Nerve Implants Detect and Monitor Illness?

Like many of us, Theodoros Zanos hates going to the doctor. A researcher at The Feinstein Institute for Medical Research in Manhasset, N.Y., he tends to avoid his general practitioner unless he’s already sick or in pain. But because he loves his smartphone and other gadgets, he wondered why a piece of hardware couldn’t tell him when he really ought to see a doctor—no ifs, ands or buts. Zanos and his colleagues are working on technology they hope might one day be able to listen to and decode the body’s electrical signals, catching warning signs of illness. “Since I’m always on my phone and it keeps reminding me of almost everything, I always thought it would be a cool idea to work on technology that would enable my phone to tell me to go to the doctor when I’m about to get sick—or, even better, automatically treat the disease—before the symptoms appear,” says Zanos, an assistant professor at Feinstein’s Center for Bioelectronic Medicine. “That’s the technology we’re trying to develop.” It will take a significant amount of time before researchers can diagnose and possibly treat disease using electrical impulses. But Zanos believes some conditions such as diabetes, rheumatoid arthritis, Crohn’s disease and chronic obstructive pulmonary disease could be monitored with nerve implants in the not-too-distant future.   Zanos and colleagues at Feinstein, along with collaborators from GE Global Research, published a study this week in PNAS suggesting some basic steps toward this goal. The study, which examined electrical signals in mouse nerves, describes how the researchers isolated and decoded signals related to two different cytokines—molecules that cause inflammation and are also used by cells to communicate inflammatory states and trigger immune responses. The researchers injected some of the mice with the cytokines interleukin-1 beta and tumor necrosis factor. They implanted cuff electrodes below the animals’ heads on an exposed part of the vagus nerve, a major channel for body–brain information exchange. The electrodes recorded electrical impulses, which were then processed with a relatively simple machine-learning algorithm called Naive Bayes. It differentiated between signals from mice when they had been exposed to the cytokines and when they had not. The study is the first in which specific cytokine exposures were detected by using neural signals, according to the researchers. Could a similar device one day be implanted in humans to tell users when something is wrong and it is time to see a doctor? The concept is not far-fetched. The vagus nerve goes down the neck and runs through the visceral organs. Vagus nerve stimulator devices have been implanted in epilepsy patients since 1988, and received FDA approval for treating the condition in 1997. The mechanism of this approach is poorly understood, but it can help control epilepsy symptoms—sometimes reducing seizures by over 50 percent—when anti-seizure drugs are not effective and conventional surgery is not an option. The implants were approved in 2005 for treating depression and are being studied as a potential therapy for rheumatoid arthritis, Alzheimer’s disease, multiple sclerosis and other chronic conditions. Eavesdropping on impulses coursing through the 80,000 to 100,000 fibers in the vagus nerve is challenging, however, partly because the nerve is insulated by a sheath of connective tissue. Stimulators have an effect because they apply electrical fields that are many times greater than the vagus impulses themselves. “The principle in our study is the same as vagus nerve stimulation, but we’re not stimulating—we’re recording,” Zanos says. “If you use the same approach as stimulation and just try recording, most probably you wouldn’t get anything because the connective tissue attenuates the signal. What Harold Silverman, a co-author on this study, did that’s novel is he de-sheathed the vagus nerve in mice before placing the electrode. That’s not been done yet in humans.” Another challenge is correctly interpreting the data gathered from these tiny neural signals, and removing extraneous “noise” from the heart and elsewhere. The researchers say their machine-learning algorithm correctly guessed whether a cytokine had been injected, and which one had been used, on average 83 percent of the time; if choosing randomly, it would be correct 33 percent of the time. “The idea that you can go from a compound signal and decode it into a signature for a certain signal could be quite useful beyond just the vagus nerve,” says Isaac Chiu, an assistant professor of microbiology and immunobiology at Harvard Medical School who was not involved in the research. “In the study they used simple conditions with two cytokines, which is a good first step. In a complex disease, however, it may be complicated by many types of neural signals, so it is not yet clear you would be able to decode all the signals to get meaningful information.” The researchers are also using their approach to examine metabolic changes, injecting mice with insulin or glucose and looking for vagal responses. By assessing these via more advanced machine-learning techniques, it is possible to correlate vagal activity with blood-glucose levels. In principle this could result in a “neural glucometer,” according to Zanos. “I think this study is fascinating,” says Konrad Kording, a professor of bioengineering and neuroscience at the University of Pennsylvania who was not part of the work. “It’s another sign that the field of neural decoding is growing up. Instead of focusing on the possibility of decoding, they use decoding as a tool to understand biology. Decoding is moving from being a research field to becoming a tool useful across science.” Kording imagines that in about 20 years the field could help produce “a Luke Skywalker–type prosthetic device,” referring to the protagonist’s lifelike artificial hand in the Star Wars franchise. “Bioelectronic medicine combines neuroscience, molecular biology and bioengineering to tap into the nervous system to help the body heal itself,” says study co-author Kevin Tracey, Feinstein president and CEO. “Making effective and targeted bioelectronic medicine devices relies on how much information we have about a condition and its neural signaling. For example, if we know how the neurons in the vagus nerve are signaling inflammation in rheumatoid arthritis, we can develop devices that either stop or modify this signaling and act only when it’s needed.” Source: Scientific American Content: Global
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Blog: Risk of severe weather stretches across upper U.S.

A risk of severe storms today stretches from Wyoming all the way to New Jersey. In Wisconsin on Wednesday, two tornadoes were reported as more than 40 damaging storms were reported in Michigan and Illinois, where wind gusts exceeded 70 mph. An active storm pattern should continue today in the Midwest, and it's moving farther into the Northeast. Damaging winds and large hail would be the biggest threat for Binghamton, New York, to Philly to Washington D.C. Tornado threat will be small in the Northeast, there a funnel cloud or two shouldn't be ruled out. Another storm system in the Plains may bring severe storms to much of Nebraska. ABC NewsA risk of severe weather today stretches across much of the upper U.S. On Friday, more storms are expected in the Plains, not only in Nebraska but also Kansas, Iowa and northern Missouri. ABC NewsMore stormy weather is expected in the Plains on Friday. Rainfall is expected from the Rocky Mountains to the Northeast over the next few days, with some areas potentially getting more than 3 inches. ABC NewsRainfall is expected from the Rockies to the Northeast through Sunday. Source: ABC News: Top Stories
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Blog: Pilots who safely landed Southwest flight on what happened in the cockpit

Tammie Jo Shults and Darren Ellisor, the pilots who safely landed a Southwest Airlines plane on April 17 after one of its engines failed, said it was teamwork and training that helped them get through the “life changing” experience. “You just realize, obviously, we're at the front end of the aircraft, so we're in charge,” Shults, the captain who landed the plane, said in an exclusive interview with ABC News’ “20/20.” “I don't remember anything other than starting to think through what the plan is. And it worked well.” “Your instincts kick in, you know, stuff that you've prepared for, you know, ever since you started flying … and this training just takes over,” Ellisor, the flight’s first officer, told “20/20” exclusively. “Was there some of that fear? There probably was deep down, but I, you know, pushed it away.” ABC NewsSouthwest Airlines pilot Tammie Jo Shults. Watch the full story on ABC News' "20/20" on Friday, May 11 at 10 p.m. ET. The pilots were forced to land Southwest Flight 1380 at Philadelphia International Airport last month, when it experienced engine failure about 20 minutes after takeoff. The Boeing 737, which was en route from New York City’s LaGuardia Airport to Texas' Dallas Love Field, was carrying 144 passengers and five crew members at the time, officials said. Shults, a U.S. Navy veteran, and Ellisor, a 44-year-old U.S. Air Force veteran, had just met each other the previous day while piloting flights together. Both said they’d flown planes out of LaGuardia countless times. ABC NewsPHOTO:Southwest Airlines copilot Darren Ellisor. “It was really like any other flying day,” Shults, 56, said. Shults’ husband Dean is also a Southwest pilot and was supposed to be the captain on Flight 1380 that day. “I traded for the trip with my husband. I’m not trading with him anymore,” Shults said, laughing. Shults said her husband offered to fly a different flight so that she could make their son’s track meet. “Dean, being the amazing husband he is, said, ‘You go to the track meet, I'll switch and take your trip.’ And so that's why I was on the trip,” Shults recalled. As the plane left New York, Shults was at the controls while taxiing, while Ellisor was in charge of the aircraft during takeoff. Joe Marcus/TwitterThe engine of a Southwest Airlines plane after an emergency landing at the Philadelphia airport, April 17, 2018. “Everything was exactly the way it's supposed to be, just rolling down the runway and when you get to a certain speed, you take off,” Ellisor said. “And then the hardest part was her job, talking to all the air traffic controllers 'cause there's a bunch of airplanes out there talking, and everything was very routine, and that's just all what we do day, after day, after day.” But as the plane passed through at about 32,000 feet, Shults and Ellisor felt the first signs of trouble. “We had a large bang and a rapid decompression. The aircraft yawed and banked to the left, a little over 40 degrees, and we had a very severe vibration from the number one engine that was shaking everything. And that all kind of happened all at once,” said Ellisor. “My first thoughts were actually, ‘Oh, here we go.’ Just because it seems like a flashback to some of the Navy flying that we had done,” Shults said. “And we had to use hand signals [and some yelling], because it was loud, and it was just hard to communicate for a lot of different reasons.” Because of the high vibration of the plane, Ellisor and Shults say they thought it might have been a seizure of the engine’s air. “It means the engine just stops rotating and spinning. And it was very disorienting to have all these things happen at once. And I actually couldn't make heads or tails of what was going on, you know, looking at the engine instruments, trying to figure things out,” Ellisor said. “It's disorienting for a second before you grab everything and start flying again.” They quickly realized it was something else when there was rapid depressurization and the need for oxygen masks. “The seizure of the aircraft would not cause a rapid decompressions, so we knew that something extraordinary had happened pretty quickly,” said Shults. “We would have turned to Philadelphia anyway and started coming down, we just wouldn't have tried to get down so quickly. But getting down to richer oxygen was certainly an important task.” Marty MartinezOxygen masks and a blown out window are seen from inside a Southwest Airlines plane after an emergency landing at the Philadelphia airport, April 17, 2018. Shults communicated with air traffic control that they wanted to land in Philadelphia, after realizing they needed somewhere with runway length and ground support. “Darren handled it beautifully and not trying to force the aircraft to stay on altitude and return to that heading, which is kind of a normal pilot reaction, or can be to get back on course,” Shults said. “He followed the aircraft and let it stay in a nice controlled flight status. And it was a bit of a rough shudder until we slowed it down a little bit.” Ellisor then switched controls over to Shults, so she, as the captain, could make the landing in Philadelphia as per Southwest protocol during unusual landings. Shults said, “At that point, we really just -- because of the noise and different things -- we had to be flexible and just use things that we had learned in previous training. And we kind of just split the cockpit and I did flying and some of the outside talking, and he took care of everything else.” They also had to put on oxygen masks, with Ellisor putting his on first while Shults kept a hand on the controls. “Then we had some switchology to do to be able to communicate through the mask. And then it was really just back to flying. Aviate, communicate, navigate,” Shults said laughing. A few minutes before landing, the pilots were finally got in touch with the flight attendants, who informed them that there were injured passengers and that a window had shattered. “[The flight attendants] let us know that we would need EMS immediately when we landed,” Shults said. “That’s when we decided it was time to go land,” Ellisor said. Ellisor and Shults say when they knew there were injuries, they decided on a short approach landing, as a opposed to the long approach landing that they first asked air traffic control for, so they could get on the ground even more quickly than they'd have liked to. With a window out, the pilots said they also changed the way they flew the plane. “Obviously, that would mean that the passengers [have] some fast air going through the cabin, so, you know, we just did our best to make it a descent without the high air speed,” said Shults. The two said they were never worried that the plane would land any other way but safely. “As long as you have altitude and ideas, you’re okay. And we had both,” Shults said with a laugh. “It was an Air Force landing, not a typical, hard Navy landing,” Ellisor joked. “But Tammie Jo, she did a fantastic job, considering the condition of the aircraft and the situation it was. She made a great landing.” PlayPilots who safely landed Southwest flight remember moment they knew there was trouble “We kind of knew just from the great training that we've been given, whether it was military or from Southwest. We just took the knowledge that we had, pooled it, and used our system knowledge as well, and decided the flap setting and things,” said Shults. After landing, Ellisor and Shults said they don’t remember saying anything to each other because they were still busy on the job getting their post-landing tasks done. Shults then walked through the plane to check on the passengers and the flight attendants at the back. “My mother had told me, ‘If I'm flying, I want to know what's going on.’ So I thought I would treat them like I would treat my own family,” she said. Ellisor said, “I stood at the front of the aircraft with two passengers that were up there -- that I didn't know why they were standing up there -- but as the passengers came back, as we were getting all the passengers off, they hugged all three of us and were thanking all three of us. So I knew those two gentlemen had done something extraordinary.” As he walked off the plane, Ellisor called his wife Jennifer. “I had to tell her a couple times, ‘I'm okay, but there's been an accident.’ And she was pretty upset,” Ellisor said. When he was finally reunited with her, Ellisor said, “It was a lot of hugging and not a lot of words for a while. Just holding each other for quite a while in the entryway as I came through the door.” Shults said she texted her family, including her 18-year-old son Marshall, who has his private pilot license. “When I told [Marshall] that I'd landed single engine in Philly safe on the ground, his immediate text back was, ‘That's why Southwest gives you two,’ so I didn't get the sympathy you did,” she joked to Ellisor. Obtained by ABC The woman who died following an engine failure aboard a Southwest flight was identified as New Mexico resident Jennifer Riordan. When the window on the plane shattered, Jennifer Riordan, a 43-year-old mother of two sitting in the window seat on the jet near the failed engine, was partially sucked out of the aircraft. Passengers and crew pulled Riordan back inside and attempted to resuscitate her while the pilots executed an emergency landing at Philadelphia International. Riordan was transported to a hospital in Philadelphia where she was later pronounced dead from blunt force trauma to her head, neck and torso, Philadelphia Department of Public Health spokesman James Garrow told ABC News. Her death was listed as an accident, Garrow said. Seven others suffered minor injuries and weren’t taken to hospitals, officials said. According to the NTSB, it was apparently a fragment of the engine cowling that struck the window and shattered it, resulting in depressurization of the aircraft and Riordan’s death. Shults said she and the crew sent a card to Riordan’s husband Michael Riordan. “Hearing some of the things that her husband has said subsequently that just makes us think what a sweet and rich family they are,” Shults said. “We wanted to be respectful and let them have some time to mourn without us being public.” Shults and Ellisor said they’ll be forever bonded by the experience. “Going through something like this, it certainly galvanizes your personalities together and your friendship. I mean, we'll be in touch the rest of our lives. Even though he's going to upgrade and be captain,” Shults joked with Ellisor. “It really was life changing. I mean, because it's not something that we've ever had happen before, and you know, almost certainly won't happen again because the chances are just too astronomical,” Ellisor said. “So you have this surreal moment of going through it and working together to solve the problem. And then you're left to pick up the pieces once we land and move on. And you know, that's something we'll do together as a team and as a family and I'm happy that she was with me.” Watch the full story on ABC News' "20/20" on Friday, May 11 at 10 p.m. ET. Source: ABC News: Top Stories
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Risk of severe weather stretches across upper U.S.

A risk of severe storms today stretches from Wyoming all the way to New Jersey. In Wisconsin on Wednesday, two tornadoes were reported as more than 40 damaging storms were reported in Michigan and Illinois, where wind gusts exceeded 70 mph. An active storm pattern should continue today in the Midwest, and it's moving farther into the Northeast. Damaging winds and large hail would be the biggest threat for Binghamton, New York, to Philly to Washington D.C. Tornado threat will be small in the Northeast, there a funnel cloud or two shouldn't be ruled out. Another storm system in the Plains may bring severe storms to much of Nebraska. ABC NewsA risk of severe weather today stretches across much of the upper U.S. On Friday, more storms are expected in the Plains, not only in Nebraska but also Kansas, Iowa and northern Missouri. ABC NewsMore stormy weather is expected in the Plains on Friday. Rainfall is expected from the Rocky Mountains to the Northeast over the next few days, with some areas potentially getting more than 3 inches. ABC NewsRainfall is expected from the Rockies to the Northeast through Sunday. Source: ABC News: Top Stories
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Arctic Monkeys: Tranquility Hotel Base & Casino review – funny, fresh and a little smug | Alexis Petridis’ album of the week

“I just wanted to be one of the Strokes,” sings Alex Turner at the outset of the Arctic Monkeys’ sixth album. “Now look at the mess you made me make.” Certainly, he and his band seem to have traversed a far greater distance in the last 12 years than any of their peers, to the point where they seem almost unrecognisable. This is evident from the way they look – posing in snakeskin shoes and expensive overcoats they resemble characters from a film, something you could only have said of them in 2006 if it had been directed by Ken Loach – to the way they sound. There is almost nothing to connect the music on Tranquility Base Hotel & Casino with the muscled-up stadium indie rock of its 2013 predecessor AM, let alone the contents of their debut. Instead, Tranquility Base displays the same endearingly puppyish, have-you-heard-this? enthusiasm for Serge Gainsbourg’s Histoire de Melody Nelson and the Beach Boys’ Pet Sounds as the first album by Turner’s side project Last Shadow Puppets did for late 60s Scott Walker. Low-slung and agile, virtually every rhythm track and bassline here could have stepped straight off Gainsbourg’s 1970 masterpiece, while Pet Sounds is paid homage everywhere from the vocal harmonies to the forensic recreation of its sound on The World’s First Ever Monster Truck Front Flip. Their combined influence is heard not just in the sound, but in the songs, which are melodically far richer and less concerned with verses and choruses than anything Arctic Monkeys have previously produced. At their best, they’re fantastic – American Sports and Four Out of Five sound lavish and fresh, their tunes and chord sequences twisting and turning unexpectedly. At worst, uncoupling the songs from a standard structure makes them ramble, as on Batphone. Along the way, Turner has had to deal with the problem that inevitably affects artists who become hugely successful by offering up sharp-eyed vignettes of everyday life: what happens when you become, as Philip Larkin alliteratively put it, the shit in the shuttered chateau, insulated by wealth and fame from the everyday life that initially inspired you? On Tranquility Base, Turner settles on an imagistic collage approach to writing, where snatches of overheard conversation are jumbled together with snappy observations and a dash of Father John Misty-esque fourth-wall-breaking (“I want to make a simple point about peace and love but in a sexy way where it’s not obvious”). Turner is clearly a very smart guy: smart enough to treat rock-star ennui as a joke rather than a subject that’s supposed to elicit sympathy – “I’m gonna run for government,” burbles the jaded narrator of One Point Perspective, “I’m gonna form a covers band an’ all” – and smart enough to tackle the hackneyed topic of social media and its impact with real wit and originality. It’s hard to stifle a groan when it becomes clear the latter is one of Tranquility Base’s preoccupations, but Turner is both funny – “dance as if someone’s watching, because they are” – and bold enough to suggest that the face-to-face contact always promoted as the solution to social media’s remote unreality is a pretty fraught business, too: “I’m so full of shite, I need to spend less time stood in bars waffling on to strangers”. The problem is that a smart guy is sometimes all Turner seems to be. The songs can feel like less than the sum of their parts: a selection of one-liners, wry observations and knowing winks to camera that leave you struggling to work out what he’s driving at – and wondering if he knows, or cares – and to locate any real emotional connection or impact. You find yourself occasionally wishing the kid who plaintively, incisively skewered the demonisation of chavs on their debut album closer A Certain Romance would show himself again. Arctic Monkeys – 10 of the best It’s an issue compounded by Turner’s voice, which has changed a lot. The Yorkshire dialect that was once his USP is now deployed sparingly, as a jolting effect: “He’s got him sen a theme tune.” Elsewhere, his voice carries traces of Gainsbourg’s sprechgesang, and Jake Thackray’s careful enunciation and chewy vowels; he regularly shifts into a mid-Atlantic easy-listening croon (“a lounge singer shimmer,” as Star Treatment has it) that seems deliberately mannered, another knowing wink to camera. It’s an odd mix that’s sometimes compelling and sometimes a bit pleased with itself, as if Turner is delivering every line through a supercilious smirk. At turns thrilling, smug, clever and oddly cold, Tranquility Base Hotel & Casino is only a qualified success; there’s something quietly impressive about the fact that it exists at all, at least as an Arctic Monkeys album. The obvious, craven thing to do would have been to release it as a solo project, then make a crowd-pleasing album in AM’s vein. Instead, here it is, evidence – albeit flawed – of a certain musical restlessness: the very thing, one suspects, that’s caused the band to travel so much further than their contemporaries that they’re virtually the last indie band standing. Source: The Guardian
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Dignity, community and hope in the Haitian slum of Jalousie – in pictures

Behind the brightly painted exterior of Jalousie, one of Haiti’s largest slums, lies a community struggling with a lack of sanitation, intermittent electricity and rivers of plastic waste. Conservative estimates suggest more than 80,000 people now live in Jalousie, many of whom arrived after the 2010 earthquake, which the area miraculously escaped relatively unscathed. Life is often cramped, chaotic and challenging, but Jalousie’s people have dignity, hope and a sense of community, regardless of the poverty and oppression they facePhotographs: Tariq Zaidi Continue reading... Source: The Guardian
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Blog: The Note: Trump’s presidency on the world stage

The TAKE with Rick Klein Interested in The Note? Add The Note as an interest to stay up to date on the latest The Note news, video, and analysis from ABC News. Donald Trump’s presidency stands at this moment somewhere between nuclear war and a Nobel Peace Prize – and somehow seems more stable than it’s been in a while. This particular split-screen – stepping toward an agreement with North Korea while bringing Americans home, stepping toward a confrontation with Iran with a fresh warning after ending the nuclear deal – may be united by little beyond the notion that if President Barack Obama did it, his successor wants to do the opposite. But it’s also the fulfillment of a fundamental campaign promise, one based on Trump’s instinct: to disrupt. This he is doing, with reverberations felt this week alone from Teheran to Damascus to Pyongyang to Jerusalem. Even Trump critics will muster credit for the president if the result is a more peaceful world. That conclusion, though, is not preordained. The pieces Trump is moving on the global stage interact with each other in unpredictable ways – some that may adjust for the president’s style, others that may not. “Overall, we are less safe,” retired Gen. Michael Hayden, a former CIA and NSA director, told us on the “Powerhouse Politics” podcast. “We are the most disruptive force in the world today.” The RUNDOWN with MaryAlice Parks Buried in a barrage of headlines around Iran, North Korea, Russia and the president’s longtime personal lawyer’s financial accounts, the Senate Intelligence Committee dropped a bombshell report this week -- their initial assessment of how the Russians targeted U.S. election infrastructure during the 2016 election. Perhaps it was fitting that they released the document as voters in four key battleground states went back to the polls. Zach Gibson/Getty ImagesMembers of the the Senate (Select) Committee on Intelligence listening to CIA Director nominee, Gina Haspel, May 9, 2018 in Washington, DC. The fact that the midterm primaries are in full swing, as the president is making good on campaign promises, all serves as a reminder of just how much is at stake in keeping elections secure, how vulnerable the country’s systems may still be and how quickly election season is back in the U.S. In case you missed it, according to the Senate report, at least 18 states “had election systems targeted by Russian-affiliated cyber actors.” The report goes on, “In a small number of states, Russian-affiliated cyber actors were able to gain access to restricted elements of election infrastructure… [and] were in a position to, at a minimum, alter or delete voter registration data.” Perhaps one of the most eye-opening lines in the report: Many state election officials apparently reported hearing about the Russian attempts to penetrate their systems only during public oversight hearings on the Hill, only after the 2016 elections. The TIP with Mariam Khan West Virginia Democrat Joe Manchin will not be facing off against ex-coal chief Don Blankenship after all in this year's midterm election. But on Wednesday -- fresh off of his own primary win -- the incumbent Democrat told reporters he's not disappointed in Blankenship's loss, nor is he expecting a tougher challenge from the GOP primary winner, state Attorney General Patrick Morrisey. Bill Clark/CQ Roll Call via NewscomSen. Joe Manchin, D-W. Va., listens during the Senate (Select) Intelligence Committee confirmation hearing for Gina Haspel, nominee to be director of the Central Intelligence Agency, May 9, 2018. "I've said this before: Don was truly the only West Virginia conservative Republican in the race. He truly was the only, and I've known him for a long time," Manchin said. "We've had our differences and we still have our differences. But if you have a look at the record, that was the only truly conservative Republican in the race," he said. Despite the apparent dig at his Republican opponent, Manchin insists he's going to play nice with Morrisey. "Pat Morrisey is my opponent and we look forward to a spirited race, and hopefully we talk about the facts and not talk about each other that much," Manchin said. WHAT YOU NEED TO KNOW President Trump and first lady Melania welcomed freed prisoners home from North Korea at Joint Base Andrews this morning The President meets with the Secretary of Agriculture, Sen. Pat Roberts, R-Kan., and Rep. Mike Conaway, R-Texas at 2 p.m. The President hosts a rally in Elkhart, Indiana at 7 p.m. Former President George W. Bush is honored at the Atlantic Council's Distinguished Leadership Awards at 7 p.m. Former CIA director John Brennan and former Director of National Intelligence James Clapper attend the Aspen Institutes' Security Forum preview at 6 p.m. Former ABC News White House correspondent Ann Compton moderates a talk on using artificial intelligence to prevent school shootings that eh National Press Club at 9 a.m. QUOTE OF THE DAY "Mitch McConnell’s cocaine tweet is just more proof that he is not an America person. Thousands die from cocaine use year after year, and he thinks it’s funny that his family’s shipping business hauls cocaine on the high seas. It is not funny. It is sickening." – Don Blankenship in a statement Wednesday responding to a sarcastic tweet posted by Senate Majority Leader Mitch McConnell after Blankenship's defeat in West Virginia’s GOP Senate primary. NEED TO READ American prisoners freed by North Korea meet with Donald Trump. Three American prisoners just freed from North Korea met with President Donald Trump early Thursday morning after landing at Joint Base Andrews in Maryland. (Justin Doom) https://abcn.ws/2G23ISE Three Americans held by North Korea back in US, Trump soon to announce summit details. President Trump said he will announce the time and place for his upcoming summit with Kim Jong Un “within three days”. (Karson Yiu, Meghan Keneally and Jordyn Phelps) https://abcn.ws/2IrYAMZ Women candidates dominate Democratic primaries amid ‘pink wave’ movement. There were 27 open Democratic House primaries and voters selected a female nominee in 17 of them, according to ABC News’ count. (Paola Chavez) https://abcn.ws/2wmHnzI House Democrats obtain new documents from estate of GOP operative in Russia inquiry. Democrats on the House Intelligence Committee have received new materials from the estate of Peter Smith, a GOP operative who reportedly led a campaign to obtain missing Hillary Clinton emails from Russian hackers during the 2016 presidential race, sources tell ABC News. (Benjamin Siegel and Matthew Mosk) https://abcn.ws/2I0NlM2 Republicans draw conflicting lessons from early primaries: ANALYSIS. It marked a good night for the GOP establishment, yet a terrible night for sitting Republican members of the House. Republicans avoided their biggest potential disaster in a key Senate race, while Democrats saw their own promising field of candidates lock into place. (Rick Klein) https://abcn.ws/2KOE1sF Russian company indicted by Mueller pleads not guilty to election meddling charges. In a brief court proceeding in Washington, D.C., on Wednesday, an attorney for a Russian company indicted by special counsel Robert Mueller entered a plea of not guilty to charges related to alleged Russian meddling during the 2016 campaign. (Trish Turner and Lucien Bruggeman) https://abcn.ws/2rvD5kN Republicans draw conflicting lessons from early primaries: ANALYSIS. It marked a good night for the GOP establishment, yet a terrible night for sitting Republican members of the House. Republicans avoided their biggest potential disaster in a key Senate race, while Democrats saw their own promising field of candidates lock into place. (Rick Klein) https://abcn.ws/2KOE1sF Cohen promised health care company access to Trump White House, exec says. When Michael Cohen approached the global health care company Novartis AG to hire him shortly after his longtime boss and client Donald Trump arrived at the White House, Cohen promised one thing: access. (Matthew Mosk, James Hill and Lauren Pearle) https://abcn.ws/2I0xr4i President Donald Trump's nominee to head the CIA faces tough questions during confirmation hearing. Gina Haspel, President Donald Trump’s nominee to head the CIA, on Wednesday affirmed that, should she be confirmed, she will not bring back the agency's controversial rendition, detainee, and interrogation program. (Luis Martinez) https://abcn.ws/2rCzGA3 Ahead of Trump-Kim summit, Japanese abductees' families push US to help secure their release. It’s a deeply painful issue of great urgency in Japan. But now, after demanding their release for decades, the country believes there is an opening. (Conor Finnegan) https://abcn.ws/2K7CPzr The Atlantic reports on how GOP enthusiasm over Don Blankenship's primary loss in West Virginia might be obscuring bad signs for the prospects of their House incumbents. https://theatln.tc/2K6qGKN The New York Times assesses the possibility of President Trump receiving a Nobel Peace Prize. https://nyti.ms/2wrG9mT The Note is a daily ABC News feature that highlights the key political moments of the day ahead. Please check back tomorrow for the latest. Source: ABC News: Top Stories
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The Note: Trump’s presidency on the world stage

The TAKE with Rick Klein Interested in The Note? Add The Note as an interest to stay up to date on the latest The Note news, video, and analysis from ABC News. Donald Trump’s presidency stands at this moment somewhere between nuclear war and a Nobel Peace Prize – and somehow seems more stable than it’s been in a while. This particular split-screen – stepping toward an agreement with North Korea while bringing Americans home, stepping toward a confrontation with Iran with a fresh warning after ending the nuclear deal – may be united by little beyond the notion that if President Barack Obama did it, his successor wants to do the opposite. But it’s also the fulfillment of a fundamental campaign promise, one based on Trump’s instinct: to disrupt. This he is doing, with reverberations felt this week alone from Teheran to Damascus to Pyongyang to Jerusalem. Even Trump critics will muster credit for the president if the result is a more peaceful world. That conclusion, though, is not preordained. The pieces Trump is moving on the global stage interact with each other in unpredictable ways – some that may adjust for the president’s style, others that may not. “Overall, we are less safe,” retired Gen. Michael Hayden, a former CIA and NSA director, told us on the “Powerhouse Politics” podcast. “We are the most disruptive force in the world today.” The RUNDOWN with MaryAlice Parks Buried in a barrage of headlines around Iran, North Korea, Russia and the president’s longtime personal lawyer’s financial accounts, the Senate Intelligence Committee dropped a bombshell report this week -- their initial assessment of how the Russians targeted U.S. election infrastructure during the 2016 election. Perhaps it was fitting that they released the document as voters in four key battleground states went back to the polls. Zach Gibson/Getty ImagesMembers of the the Senate (Select) Committee on Intelligence listening to CIA Director nominee, Gina Haspel, May 9, 2018 in Washington, DC. The fact that the midterm primaries are in full swing, as the president is making good on campaign promises, all serves as a reminder of just how much is at stake in keeping elections secure, how vulnerable the country’s systems may still be and how quickly election season is back in the U.S. In case you missed it, according to the Senate report, at least 18 states “had election systems targeted by Russian-affiliated cyber actors.” The report goes on, “In a small number of states, Russian-affiliated cyber actors were able to gain access to restricted elements of election infrastructure… [and] were in a position to, at a minimum, alter or delete voter registration data.” Perhaps one of the most eye-opening lines in the report: Many state election officials apparently reported hearing about the Russian attempts to penetrate their systems only during public oversight hearings on the Hill, only after the 2016 elections. The TIP with Mariam Khan West Virginia Democrat Joe Manchin will not be facing off against ex-coal chief Don Blankenship after all in this year's midterm election. But on Wednesday -- fresh off of his own primary win -- the incumbent Democrat told reporters he's not disappointed in Blankenship's loss, nor is he expecting a tougher challenge from the GOP primary winner, state Attorney General Patrick Morrisey. Bill Clark/CQ Roll Call via NewscomSen. Joe Manchin, D-W. Va., listens during the Senate (Select) Intelligence Committee confirmation hearing for Gina Haspel, nominee to be director of the Central Intelligence Agency, May 9, 2018. "I've said this before: Don was truly the only West Virginia conservative Republican in the race. He truly was the only, and I've known him for a long time," Manchin said. "We've had our differences and we still have our differences. But if you have a look at the record, that was the only truly conservative Republican in the race," he said. Despite the apparent dig at his Republican opponent, Manchin insists he's going to play nice with Morrisey. "Pat Morrisey is my opponent and we look forward to a spirited race, and hopefully we talk about the facts and not talk about each other that much," Manchin said. WHAT YOU NEED TO KNOW President Trump and first lady Melania welcomed freed prisoners home from North Korea at Joint Base Andrews this morning The President meets with the Secretary of Agriculture, Sen. Pat Roberts, R-Kan., and Rep. Mike Conaway, R-Texas at 2 p.m. The President hosts a rally in Elkhart, Indiana at 7 p.m. Former President George W. Bush is honored at the Atlantic Council's Distinguished Leadership Awards at 7 p.m. Former CIA director John Brennan and former Director of National Intelligence James Clapper attend the Aspen Institutes' Security Forum preview at 6 p.m. Former ABC News White House correspondent Ann Compton moderates a talk on using artificial intelligence to prevent school shootings that eh National Press Club at 9 a.m. QUOTE OF THE DAY "Mitch McConnell’s cocaine tweet is just more proof that he is not an America person. Thousands die from cocaine use year after year, and he thinks it’s funny that his family’s shipping business hauls cocaine on the high seas. It is not funny. It is sickening." – Don Blankenship in a statement Wednesday responding to a sarcastic tweet posted by Senate Majority Leader Mitch McConnell after Blankenship's defeat in West Virginia’s GOP Senate primary. NEED TO READ American prisoners freed by North Korea meet with Donald Trump. Three American prisoners just freed from North Korea met with President Donald Trump early Thursday morning after landing at Joint Base Andrews in Maryland. (Justin Doom) https://abcn.ws/2G23ISE Three Americans held by North Korea back in US, Trump soon to announce summit details. President Trump said he will announce the time and place for his upcoming summit with Kim Jong Un “within three days”. (Karson Yiu, Meghan Keneally and Jordyn Phelps) https://abcn.ws/2IrYAMZ Women candidates dominate Democratic primaries amid ‘pink wave’ movement. There were 27 open Democratic House primaries and voters selected a female nominee in 17 of them, according to ABC News’ count. (Paola Chavez) https://abcn.ws/2wmHnzI House Democrats obtain new documents from estate of GOP operative in Russia inquiry. Democrats on the House Intelligence Committee have received new materials from the estate of Peter Smith, a GOP operative who reportedly led a campaign to obtain missing Hillary Clinton emails from Russian hackers during the 2016 presidential race, sources tell ABC News. (Benjamin Siegel and Matthew Mosk) https://abcn.ws/2I0NlM2 Republicans draw conflicting lessons from early primaries: ANALYSIS. It marked a good night for the GOP establishment, yet a terrible night for sitting Republican members of the House. Republicans avoided their biggest potential disaster in a key Senate race, while Democrats saw their own promising field of candidates lock into place. (Rick Klein) https://abcn.ws/2KOE1sF Russian company indicted by Mueller pleads not guilty to election meddling charges. In a brief court proceeding in Washington, D.C., on Wednesday, an attorney for a Russian company indicted by special counsel Robert Mueller entered a plea of not guilty to charges related to alleged Russian meddling during the 2016 campaign. (Trish Turner and Lucien Bruggeman) https://abcn.ws/2rvD5kN Republicans draw conflicting lessons from early primaries: ANALYSIS. It marked a good night for the GOP establishment, yet a terrible night for sitting Republican members of the House. Republicans avoided their biggest potential disaster in a key Senate race, while Democrats saw their own promising field of candidates lock into place. (Rick Klein) https://abcn.ws/2KOE1sF Cohen promised health care company access to Trump White House, exec says. When Michael Cohen approached the global health care company Novartis AG to hire him shortly after his longtime boss and client Donald Trump arrived at the White House, Cohen promised one thing: access. (Matthew Mosk, James Hill and Lauren Pearle) https://abcn.ws/2I0xr4i President Donald Trump's nominee to head the CIA faces tough questions during confirmation hearing. Gina Haspel, President Donald Trump’s nominee to head the CIA, on Wednesday affirmed that, should she be confirmed, she will not bring back the agency's controversial rendition, detainee, and interrogation program. (Luis Martinez) https://abcn.ws/2rCzGA3 Ahead of Trump-Kim summit, Japanese abductees' families push US to help secure their release. It’s a deeply painful issue of great urgency in Japan. But now, after demanding their release for decades, the country believes there is an opening. (Conor Finnegan) https://abcn.ws/2K7CPzr The Atlantic reports on how GOP enthusiasm over Don Blankenship's primary loss in West Virginia might be obscuring bad signs for the prospects of their House incumbents. https://theatln.tc/2K6qGKN The New York Times assesses the possibility of President Trump receiving a Nobel Peace Prize. https://nyti.ms/2wrG9mT The Note is a daily ABC News feature that highlights the key political moments of the day ahead. Please check back tomorrow for the latest. Source: ABC News: Top Stories
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Efficacy of electroacupuncture compared with transcutaneous electric nerve stimulation for functional constipation: Study protocol for a randomized, controlled trial.

Efficacy of electroacupuncture compared with transcutaneous electric nerve stimulation for functional constipation: Study protocol for a randomized, controlled trial. Medicine (Baltimore). 2018 May;97(19):e0692 Authors: Zeng Y, Zhang X, Zhou J, Wang X, Jiao R, Liu Z Abstract BACKGROUND: To treat functional constipation, both electroacupuncture (EA) therapy and transcutaneous electric nerve stimulation (TENS) are safe and effective. However, no head-to-head comparison trial has been conducted. This trial compares the efficacy of electroacupuncture relative to transcutaneous electric nerve stimulation for functional constipation. METHODS: Individuals with functional constipation will be randomly allocated to receive either EA or TENS (n = 51, each), 3 times per week for 8 weeks. The primary outcome is the percentage of participants with an average increase from baseline of 1 or more complete spontaneous bowel movements at week 8. The secondary outcome measures are the following: at the time of visits, changes in the number of complete spontaneous bowel movements, number of spontaneous bowel movements, stool character, difficulty in defecation, patients' assessment of quality of life regarding constipation (self-report questionnaire), and use of auxiliary defecation methods. DISCUSSION: The results of this trial should verify whether EA is more efficacious than TENS for relieving symptoms of functional constipation. The major limitation of the study is the lack of blinding of the participants and acupuncturist. PMID: 29742718 [PubMed - in process] Source: pubmed: acupuncture
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The effectiveness and safety of nonsurgical integrative interventions for symptomatic lumbar spinal spondylolisthesis: A randomized controlled multinational, multicenter trial protocol.

The effectiveness and safety of nonsurgical integrative interventions for symptomatic lumbar spinal spondylolisthesis: A randomized controlled multinational, multicenter trial protocol. Medicine (Baltimore). 2018 May;97(19):e0667 Authors: Kim K, Youn Y, Lee SH, Choi JC, Jung JE, Kim J, Qu W, Eldrige J, Kim TH Abstract BACKGROUND: Surgery is generally accepted as the main therapeutic option for symptomatic lumbar spondylolisthesis. However, new nonsurgical therapeutic options need to be explored for this population. OBJECTIVES: The objective of this study is to assess the effectiveness and safety of a 5-week Mokhuri treatment program compared with conventional nonsurgical treatments for symptomatic lumbar spondylolisthesis. METHODS: This is a study protocol for a multinational, multicenter clinical randomized controlled trial comparing the effectiveness and safety of 5 weeks of nonsurgical integrative treatments (a Mokhuri treatment program consisting of Chuna, acupuncture, and patient education) with nonsurgical conventional treatments (drugs for pain relief, epidural steroid injections, and physical therapy). Clinical outcomes including visual analogue scale (VAS) scores ranging from 0 to 100 for low back pain and leg pain, EQ-5D scores, Oswestry disability index (ODI) scores, Roland-Morris Disability Questionnaire (RMDQ) scores, Zurich Claudication Questionnaire (ZCQ) scores, walking duration and distance without leg pain, and a 5-minute treadmill test, and the ratio between the actual duration of participation and the originally scheduled duration in each group, the presence of any additional spondylolisthesis treatments, the types of concomitant treatments during the follow-up period, and adverse events (AEs) will be assessed at 7 weeks, 18 weeks, 30 weeks, 54 weeks, and 102 weeks after the end of the treatments. CONCLUSION AND DISCUSSION: The results of this study will provide clinical evidence on nonsurgical integrative interventions for patients with symptomatic lumbar spondylolisthesis. CLINICAL TRIAL REGISTRY:: clinicaltrials.gov (NCT03107468). PMID: 29742708 [PubMed - in process] Source: pubmed: acupuncture
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