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  • Africa's solar-powered way to keep vaccines cool

    It takes a boat to get fisherman Antoni Fianni his new freezer.His home is located on an island in southern Ivory Coast and it's not connected to the electricity grid.That's why Fianni's freezer is a little different.It's solar-powered.The "Koolboks" freezer is an African solution that could have another use – storing vaccines.It was developed by Ghana-headquartered PEG Africa with people like Fianni in mind.It's an affordable way to store perishable items in remote and off-grid locations."Some of the fish we smoke to conserve it longer or we put ice so we can keep it for two or three days before going to deliver at market. Today the cost of buying the ice is a bit high so we are looking at working with the solar-powered freezer."Today Fianni can store his catch for at least ten days before taking it to market.He and his wife pay for the Koolboks via regular instalments.Fianni is using his freezer to store fish, but PEG Africa's CEO for Ivory Coast Thierry Adonis say such cold chain technology is particularly important amid the global health crisis."And if we don't have, if the relevant departments and the health ministries don't follow this cold chain logic, then clearly people living in the more remote areas will not have access to the vaccine."PEG Africa is currently piloting the solar-powered fridges and freezers in Ivorian and Senegalese fishing communities.With funding from Power Africa, a network of private and public groups set up by USAID, PEG has also started providing solar-power systems to off-grid health centers.According to Journal Global Health: Science and Practice, nearly 60% of healthcare facilities in sub-Saharan Africa have no access to electricity.That means the Koolboks could be a useful tool to ensure more of the population gets protected.

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  • 'You will be just fine,' says surgeon general of Johnson & Johnson vaccine, though pause continues

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  • Cuba's new leaders won't have 'historical legacy' as a shield in post-Castro world, scholar says

    For the first time in 60 years, Cuba will soon be without a Castro in a formal, day-to-day leadership position. Raúl Castro, the younger brother of the late Fidel Castro, confirmed Friday that he's stepping down from his role as the leader of the country's Communist Party, with President Miguel Diaz-Canel expected to take on double duties, as the Castro brothers did before him. The younger Castro, who is 90, is poised to remain an influential figure on the island, but he likely won't interfere with daily governance, The New York Times notes. That means a new era is on the horizon, as Cuba faces challenges from both the coronavirus and a struggling economy. The next generation of leadership could allow for more free-market activity, a path that's not completely new for Cuba; Raúl, who is considered more pragmatic than his brother, began the process of implementing some reforms following Fidel's death in 2011, but it's been a slow grind. There's no guarantee a new regime will change that — Richard Feinberg, a professor at the University of California, San Diego, told Al Jazeera that he thinks it's the "worst possible moment" for reforms because the government has "no money." That said, urgency may rule the day in a post-Castro world. Arturo Lopez-Levy, the author of Raul Castro and the New Cuba: A Close-Up View of Change and an assistant professor at Holy Names University, told Al Jazeera that, unlike the brothers, their successors will have to "rely on performance — not on historical legacy — to exercise power and as a source of legitimacy." Read more at The New York Times and Al Jazeera. More stories from theweek.comThe question that will decide the Chauvin case5 colossally funny cartoons about Biden's infrastructure planYou should start a keyhole garden

  • 'We Were Flying Blind': A Doctor's Account of a Woman's J&J Vaccine-Related Blood Clot Case

    An 18-year-old woman was stricken with severe headaches, vomiting, seizures, confusion and weakness in one arm early this month, strokelike symptoms that doctors at a Nevada hospital were shocked to see in someone so young. Scans found several large blood clots blocking veins that drain blood from the brain, a condition that can disable or kill a patient. Sign up for The Morning newsletter from the New York Times Doctors performed a procedure to suction huge clots from her brain, only to find that new ones had formed. The patient is one of six women ages 18 to 48 who developed clots in the brain within two weeks of receiving the Johnson & Johnson coronavirus vaccine. One died, and their devastating cases led U.S. health officials to recommend Tuesday that use of the vaccine be paused. Two more cases have been added since then: one involving a man who was vaccinated during the company’s clinical trials and another involving a woman who received the vaccine after it had been authorized for general use. As in several of the original cases, the young woman in Nevada was initially treated with heparin, a standard blood-thinner that experts have since learned may actually worsen the rare clotting disorder that has affected small numbers of people who received the Johnson & Johnson or AstraZeneca vaccines in several countries. But until the last few weeks, doctors around the world had little information about the condition, and the doctors in Nevada did not recognize it immediately. “We were flying blind, based on reports from Europe and the U.K. hematological society,” said Dr. Brian Lipman, an infectious-disease specialist who helped care for the Nevada patient at Dignity Health St. Rose Dominican Hospital, Siena Campus, in Henderson. The U.S. decision to call for suspension of the use of the vaccine was intended to give officials time to learn more about the rare disorder causing the clots, to assess whether it is linked to the vaccine and to inform doctors and patients about how to recognize symptoms and treat the condition. The pause may last until at least next Friday, when expert advisers to the Centers for Disease Control and Prevention are scheduled to meet to review the data and decide whether to resume using the vaccine. Dr. Rochelle Walensky, the director of the CDC, and other top U.S. health officials sought Friday to reassure the public that the pause, now extended more than a week, was a reasonable safeguard to assess risk. They also emphasized that overall, the Johnson & Johnson vaccine and the other vaccines in use in the United States were safe, given how many millions of Americans had gotten their shots without concern. But with the world staggered by a relentless epidemic, even temporarily stopping the use of a highly effective vaccine, which many countries had planned to deploy, is a fraught decision. Public health experts fear that the move sends a message that will erode trust globally even if the vaccine is reinstated and that huge numbers of people who could have been immunized will die needlessly from COVID-19 because they or their governments rejected the company’s vaccine. The United States, where Johnson & Johnson provided only about 5% of the COVID vaccine supply, can afford the suspension: It has plenty of other vaccine doses from Moderna and Pfizer-BioNTech to fill the gap. Other countries do not. And many nations have also stopped or limited the use of another effective vaccine, the one made by AstraZeneca, because it, too, has been linked to a similar rare clotting disorder. About 7.4 million Americans have received the Johnson & Johnson vaccine, and so far, only eight cases of the clotting problem have been reported, seven of them in women. In Europe, Britain, and three other countries, 222 cases have been reported, mostly in women under 60 — of 34 million people who have received the AstraZeneca vaccine. Several countries have now limited its use to older adults because so many cases have involved younger people. Researchers suspect that in these rare cases, the vaccine causes an intense reaction by the patient’s immune system, which churns out antibodies that activate platelets, a blood component needed for clotting. An unusual syndrome results, with extensive clotting that leaves the patient with low platelet levels and a tendency to bleed at the same time. Why this occurs in some people, many of them younger women, is not known, and experts say that they have so far been unable to identify traits or underlying conditions that may make some people susceptible. In a statement issued Wednesday, Johnson & Johnson said: “The safety and well-being of the people who use our products is our number one priority, and we strongly support awareness of the signs and symptoms of this extremely rare event to ensure the correct diagnosis, appropriate treatment and expedited reporting by health care professionals. We continue to believe in the positive benefit-risk profile of our vaccine.” The company also said, in a letter published Friday in The New England Journal of Medicine, that no causal link had been established between its vaccine and the clotting disorder. To some critics, it makes no sense to hobble a global vaccination campaign during a pandemic just because of a few cases of a rare disorder. But while rare side effects may be tolerated as the price we must pay for some drugs or vaccines, even the rarest ones are difficult to accept if they are severe and unpredictable — like blood clots in the brain, especially in young, healthy people. “This is a devastating complication,” Dr. Anthony Fauci, the chief medical adviser for the pandemic in the Biden administration, said in an interview. He added: “One woman died, three are in the hospital, one in intensive care. Even though the numbers are small, it is a devastating complication, so I believe — I didn’t make the decision — I believe their rationale, at least from what they communicated to me, is that they wanted to call a quick pause to see, to alert people. Sometimes this starts with minor symptoms, like a little abdominal discomfort, and then all of a sudden they wind up having a stroke.” He also said, “Maybe there are a lot more people out there we’re not noticing, because of the spectrum of the disease.” Informing doctors and the public of the symptoms — severe headaches, shortness of breath, leg or abdominal pain — could help identify more cases. Another reason for the pause, Fauci said, is to let doctors know that the drug heparin, a standard treatment for blood clots, should not be given to these patients, “because heparin in this circumstance can make things worse.” It is not known whether the heparin initially given to some of the patients exacerbated their condition. Experts are recommending the use of other blood thinners, which patients urgently need, because their blood clots keep growing, and new ones keep forming. Doctors in Europe who treated recipients of the AstraZeneca vaccine who had a similar condition said it could worsen rapidly. “The real issue is how long they take to make up their mind about what they’re going to do,” Fauci said of the CDC’s advisory panel. “The rest of the world is watching this, and J&J is hopefully going to be an important part of the worldwide response, as is AstraZeneca.” He added, “You don’t want to rush them, but I hope they make up their minds in a reasonable amount of time.” Another of the first six patients with the clotting condition was a healthy 48-year-old woman who went to an emergency room in Nebraska because she had felt ill with abdominal pain for three days. Her case was described in a letter to the editor of The New England Journal of Medicine published Wednesday. Her platelet count was low, and other blood tests were also abnormal. A CT scan found extensive blood clots in veins in her abdomen. She began having headaches, and another scan found clots in her brain. She was given heparin. More clots developed, and she had a hemorrhagic stroke. Doctors then learned that she had received the Johnson & Johnson vaccine two weeks before. They stopped the heparin and gave her a different blood thinner, along with intravenous immune globulin, a treatment also recommended for the clotting disorder. Her platelet count increased, but, the doctors wrote, “The patient remained critically ill at the time of this report.” The young woman in Nevada was fighting for her life and had to be placed on a ventilator, according to Lipman. He said he was speaking independently and not as a representative of the hospital. The patient’s family declined a request for an interview. Lipman said that as the team had studied her blood samples, the pieces began to fall into place, and they realized that she appeared to have the same problem that they knew had been occurring in Britain and Europe after patients received the AstraZeneca vaccine, mostly in young women. They switched from heparin to another blood thinner and began following guidance provided by doctors in Britain who had treated AstraZeneca recipients with a similar disorder. Hoping for more information about the condition and any possible connection to the Johnson & Johnson vaccine, Lipman called an emergency number at the Food and Drug Administration. It was a weekend, and he said the person who answered told him that no one was available to help and that the line had to be kept open for emergencies. “I thought this was an emergency,” Lipman said. “She hung up on me.” He called back, to ask how to reach Janssen, which makes the Johnson & Johnson vaccine. That information was not available, and he said the person who answered had also told him that the FDA could not provide advice on patient care. An FDA spokesperson, Stephanie Caccomo, said in an email, “We’ll look into this further to ensure physicians calling FDA for assistance receive the help they are seeking.” Lipman said that the pharmacist at his hospital had submitted a report online to the CDC in early April but that the agency had not contacted him to ask about the case until this week. The agency declined to comment on whether it had communicated with Lipman, a spokesperson, Kristen Nordlund, said by email. At a meeting Wednesday of a CDC advisory panel, Johnson & Johnson and Dr. Tom Shimabukuro, a safety expert at the agency, both presented data about the young woman in Nevada. After the meeting, Nevada officials issued a statement saying the meeting was the first time they had learned of a case in their state — they had previously told the public that no cases had been reported — and they were asking “federal partners” why the state had not been informed. At the Nevada hospital, an interventional radiologist passed a tube through blood vessels and on into the young woman’s brain and used a device to suction out the blood clots. More clots formed later, and he performed the procedure again. But the condition causes more than clots: The patient, like others, also had a brain hemorrhage. She was transferred to a larger hospital, where she is still on a ventilator, Lipman said. Her prognosis is uncertain, he said, adding, “Her life, not just her life, her entire family’s life, has been transformed.” This article originally appeared in The New York Times. © 2021 The New York Times Company

  • Canadian police refuse provincial order to make random stops amid COVID-19 surge

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  • Why the Vaccine Safety Numbers Are Still Fuzzy

    When federal officials paused administration of the Johnson & Johnson vaccine after six cases of a rare clotting disorder, one fatal, among the 6.9 million people who had received the vaccine, many critics noted that the chance of a serious ailment was so rare as to be negligible — less frequent than being struck by lightning. But that roughly one-in-a-million rate is far from certain. Doctors may ultimately find the vaccine is not responsible for the ailment. However, if the two are linked, it’s also possible that the chance of an adverse effect will be higher, even if it remains low. “Numbers seem quite solid, like, ‘Oh, it’s 10,’” said Caitlin Rivers, an assistant professor at Johns Hopkins University, who studies infectious disease. She said epidemiologists deal with similar matters of uncertainty at the beginning of disease outbreaks. “But they’re estimates, and they will need to be refined, and they may need to be refined a lot, especially since they are small numbers.” Sign up for The Morning newsletter from the New York Times — How do we know how common this event is? If there is a connection between the vaccine and this rare syndrome, new cases are likely to emerge now that the word is out. Regulators announced the pause in part to alert doctors to the existence of this syndrome; as people begin looking, they may be more likely to find and report it. With numbers so low, the addition of even a few more cases could increase the rate. (In the last few days, Johnson & Johnson has reported two more possible cases, one in a woman, and one in a man.) If there’s a link between the vaccine and the syndrome, more people who already got shots might still develop the clotting problem, since it appears to show up within a few weeks of vaccination. About half of Americans who received the Johnson & Johnson shot got it this month, according to government estimates. One reason the Centers for Disease Control and Prevention vaccine safety committee wants to wait longer before updating any guidance on the shot is to see what happens with this group. Since the pause was first recommended, the government count of Americans who have received the shot has increased to 7.7 million. It may turn out that only some segments of the population are at high risk of this problem, in the same way that some populations are at higher risk of serious issues from certain diseases. Most of the cases so far have been in women between 18 and 50. If we look at six cases in that population, the syndrome looks somewhat more common, though still very rare. If more cases are reported, it’s also possible that this gendered pattern will disappear. Dr. Tom Shimabukuro, a vaccine safety expert at the CDC who presented numbers to the vaccine safety board this week, said all of the current calculations are still “crude.” — How can we tell that the clots wouldn’t have happened anyway? It’s hard to tell right now. Studies of such events typically compare people who are given a medication or vaccine with a control group of people who didn’t. With a rare disorder like this, that comparison couldn’t be easily made using clinical trials. Researchers are conducting a large study of the health records of 12 million patients called the Vaccine Safety Datalink, comparing medical records of people who are vaccinated earlier with those who get their shots later — a system that doesn’t rely on voluntary reporting. Those results will take a while. Researchers also look at what’s called a background rate of serious events: the odds someone could have a health problem even if he or she never got a vaccine. Comparing the rate of events among people who get a vaccine with the rate in the overall population can give a sense of whether a given patient’s outcome may be because of the vaccine, or is more likely to just be a coincidence. Women under 50 — the group that may be at risk of the particular type of blood clot that authorities have seen in the vaccinated patients — are more likely than the general population to have these blood clots just by being alive. — What is a rate we should care about? Many medications given to sick people can have serious side effects for some fraction of those who take them. Doctors and patients routinely weigh such risks against the benefits of medical treatment. Birth control pills with estrogen have been frequently discussed this week because they are a common medication carrying a risk of blood clots. Clots caused by birth control pills are different from the syndrome associated with the COVID vaccines, and some experts caution about comparing them directly. The kind of clots caused by oral contraceptives typically form in patients’ legs, not in their brains, but they can still be serious. The pills more than double a typical woman’s risk of such an event, meaning between 3 and 9 women out of 10,000 taking the pills for a year will develop a clot. (Pregnancy, the condition birth control pills are often prescribed to prevent, causes an even higher risk of blood clots.) “I’ll often say the risk of getting a blood clot with birth control pills is kind of similar to having a really serious reaction to penicillin,” said Dr. Raegan McDonald-Mosley, an obstetrician-gynecologist and CEO of Power to Decide, a group devoted to reducing unintended pregnancy. She frequently discusses blood clot risk with her patients, telling them the increase in risk and the overall magnitude of that risk. Most patients, she said, select their form of birth control based on other considerations. For vaccines, however, the threshold for safety is generally higher than for other kinds of medications. As many researchers have noted, COVID-19 puts people at risk of serious blood clots, too — much more so than any plausible estimate of the vaccine effect. But not everyone who fails to get vaccinated is going to get sick. “The disease you get by chance, and the vaccine you get by choice, and that’s what makes it harder,” said Dr. Steven Black, an emeritus professor of pediatrics at Cincinnati Children’s Hospital, who studies vaccine safety. For other vaccines, the risk of serious adverse events is much lower than for birth control pills or penicillin — they generally occur in fewer than 1 in 100,000 who receive a given vaccine. That rate is “clearly much, much less than would be tolerated for a drug,” said Dr. Nicola Klein, director of the Kaiser Permanente vaccine study center, who is involved in the Vaccine Safety Datalink study. Most other vaccines protect against diseases that tend to be rare. By contrast, COVID-19 remains widespread throughout the United States and many parts of the world. Given the seriousness of the illness and its ease of spread, the value of vaccination may be higher now than it is when such trade-offs are usually considered. This article originally appeared in The New York Times. © 2021 The New York Times Company

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