Just three weeks from Inauguration Day, the once-cordial public relationship between the incoming and outgoing presidents is showing signs of strains.
It may seem like a lifetime ago that President Barack Obama and President-elect Donald Trump, architect of the years-long "birther" movement aimed at delegitimizing the country's first black president, sat side-by-side in the Oval Office and shook hands after an hour-and-a-half long meeting. It was a show of unity after a bitter, divisive contest and a demonstration of one of the most important hallmarks of American democracy — the peaceful, and graceful, transition of power.
Seven weeks later, the relationship between the two leaders doesn't seem so rosy.
Trump, who famously said he wouldn't accept the results of the election unless he won, bristled at assessments from the intelligence community that Russia interfered in the election to help Trump beat Democrat Hillary Clinton. Soon after, Trump openly clashed with the White House over Israel, and he did not take kindly to Obama's contention he would have bested him in November's election.
Here's a timeline of how their relationship has developed in the early weeks:
Nov. 9 - The day after Trump's stunning victory, Obama pledges to aid Trump's transition into the White House and announces he will be meeting with Trump the next day.
"I have instructed my team to follow the example that President Bush's team set eight years ago, and work as hard as we can to make sure that this is a successful transition for the President-elect — because we are now all rooting for his success in uniting and leading the country," Obama says in remarks from the Rose Garden.
Nov. 10 - Obama and Trump meet at the White House two days after the election. It is the first meeting between the two men. Trump calls it "a great honor" being with Obama, and says he looks forward to meeting with the president "many, many more times."
Nov. 20 - During his final foreign trip, Obama says he will not criticize the president-elect in order to give Trump "an opportunity to put forward his platform and his arguments without somebody popping off in every instance."
Nov. 22 - White House press secretary Josh Earnest tells reporters that Obama and Trump have spoken "at least once" since the Oval Office meeting.
Nov. 23 - In an interview with the New York Times, Trump says he and Obama had "great chemistry" when the two met.
"I didn't know if I'd like him. I probably thought that maybe I wouldn't, but I did, I did like him. I really enjoyed him a lot," Trump says. "I've spoken to him since the meeting."
Dec. 9 - A crowd in Louisiana jeer Trump for mentioning Obama during a rally for Republican Congressional candidates. "We've gotten along so well," Trump says as some members of the crowd boo. "He's really doing great, he's been so nice."
Dec. 11 - In an interview with "Fox News Sunday," Trump says he does not intend to take a "wrecking ball" to Obama's legacy. "No. I don't want to do that at all. I just want what's right." It is one of the rare interviews Trump has done since his election victory.
Dec. 15 - The Obama and Trump relationship begins to take a turn after U.S. intelligence agencies conclude that Russia interfered in the 2016 election to help Trump. The president-elect denies the assessments, and on December 15, questions why the White House waited until after his election victory to make the announcements. "Why did they only complain after Hillary lost?" Trump tweets.
Donald J. Trump
✔
@realDonaldTrump
If Russia, or some other entity, was hacking, why did the White House wait so long to act? Why did they only complain after Hillary lost?
1:24 AM - 16 Dec 2016
* 40,952 40,952 Retweets
124,634 124,634 likes
White House press secretary Josh Earnest insists it is a "basic fact" that during the campaign, Trump urged Russia to find information that would hurt Clinton. Trump's transition contended that Trump's pleas to Russia during a July press conference to find Clinton's missing emails were sarcastic.
Dec. 22 - The president-elect calls on the White House to veto a United Nations resolution condemning Israel for the construction of settlements in the West Bank and East Jerusalem. "This puts Israel in a very poor negotiating position and is extremely unfair to all Israelis," Trump says in a statement. The move to take such a public position on a foreign policy issue as president-elect was striking.
Dec. 23 - The U.S. abstains from the UN vote on Israeli settlements.
Dec. 26 - Obama says in a podcast he is "confident" he could have won a third term in office. In an interview with former adviser David Axelrod, Obama insists he did not view the 2016 results as a rebuke of his policies or his presidency. "I am confident in this vision because I'm confident that if I — if I had run again and articulated it, I think I could've mobilized a majority of the American people to rally behind it," Obama said.
Shortly after, Trump responds "no way" on Twitter, and takes a swipe at Obama's signature campaign theme of hope.
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Pres.-Elect Trump Tweets Complaint About Transition, Later Praises Process 2:02
Just three weeks from Inauguration Day, the once-cordial public relationship between the incoming and outgoing presidents is showing signs of strains.
It may seem like a lifetime ago that President Barack Obama and President-elect Donald Trump, architect of the years-long "birther" movement aimed at delegitimizing the country's first black president, sat side-by-side in the Oval Office and shook hands after an hour-and-a-half long meeting. It was a show of unity after a bitter, divisive contest and a demonstration of one of the most important hallmarks of American democracy — the peaceful, and graceful, transition of power.
Seven weeks later, the relationship between the two leaders doesn't seem so rosy.
Trump, who famously said he wouldn't accept the results of the election unless he won, bristled at assessments from the intelligence community that Russia interfered in the election to help Trump beat Democrat Hillary Clinton. Soon after, Trump openly clashed with the White House over Israel, and he did not take kindly to Obama's contention he would have bested him in November's election.
Here's a timeline of how their relationship has developed in the early weeks:
Nov. 9 - The day after Trump's stunning victory, Obama pledges to aid Trump's transition into the White House and announces he will be meeting with Trump the next day.
"I have instructed my team to follow the example that President Bush's team set eight years ago, and work as hard as we can to make sure that this is a successful transition for the President-elect — because we are now all rooting for his success in uniting and leading the country," Obama says in remarks from the Rose Garden.
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Trump, Obama Meet at White House As Transition Process Continues 2:03
Nov. 10 - Obama and Trump meet at the White House two days after the election. It is the first meeting between the two men. Trump calls it "a great honor" being with Obama, and says he looks forward to meeting with the president "many, many more times."
Nov. 20 - During his final foreign trip, Obama says he will not criticize the president-elect in order to give Trump "an opportunity to put forward his platform and his arguments without somebody popping off in every instance."
Nov. 22 - White House press secretary Josh Earnest tells reporters that Obama and Trump have spoken "at least once" since the Oval Office meeting.
Nov. 23 - In an interview with the New York Times, Trump says he and Obama had "great chemistry" when the two met.
"I didn't know if I'd like him. I probably thought that maybe I wouldn't, but I did, I did like him. I really enjoyed him a lot," Trump says. "I've spoken to him since the meeting."
Dec. 9 - A crowd in Louisiana jeer Trump for mentioning Obama during a rally for Republican Congressional candidates. "We've gotten along so well," Trump says as some members of the crowd boo. "He's really doing great, he's been so nice."
Dec. 11 - In an interview with "Fox News Sunday," Trump says he does not intend to take a "wrecking ball" to Obama's legacy. "No. I don't want to do that at all. I just want what's right." It is one of the rare interviews Trump has done since his election victory.
Dec. 15 - The Obama and Trump relationship begins to take a turn after U.S. intelligence agencies conclude that Russia interfered in the 2016 election to help Trump. The president-elect denies the assessments, and on December 15, questions why the White House waited until after his election victory to make the announcements. "Why did they only complain after Hillary lost?" Trump tweets.
Donald J. Trump
✔
@realDonaldTrump
If Russia, or some other entity, was hacking, why did the White House wait so long to act? Why did they only complain after Hillary lost?
1:24 AM - 16 Dec 2016
* 40,952 40,952 Retweets
124,634 124,634 likes
White House press secretary Josh Earnest insists it is a "basic fact" that during the campaign, Trump urged Russia to find information that would hurt Clinton. Trump's transition contended that Trump's pleas to Russia during a July press conference to find Clinton's missing emails were sarcastic.
Dec. 22 - The president-elect calls on the White House to veto a United Nations resolution condemning Israel for the construction of settlements in the West Bank and East Jerusalem. "This puts Israel in a very poor negotiating position and is extremely unfair to all Israelis," Trump says in a statement. The move to take such a public position on a foreign policy issue as president-elect was striking.
Dec. 23 - The U.S. abstains from the UN vote on Israeli settlements.
Dec. 26 - Obama says in a podcast he is "confident" he could have won a third term in office. In an interview with former adviser David Axelrod, Obama insists he did not view the 2016 results as a rebuke of his policies or his presidency. "I am confident in this vision because I'm confident that if I — if I had run again and articulated it, I think I could've mobilized a majority of the American people to rally behind it," Obama said.
Shortly after, Trump responds "no way" on Twitter, and takes a swipe at Obama's signature campaign theme of hope.
Donald J. Trump
✔
@realDonaldTrump
President Obama said that he thinks he would have won against me. He should say that but I say NO WAY! - jobs leaving, ISIS, OCare, etc.
8:36 AM - 27 Dec 2016
* 21,569 21,569 Retweets
85,744 85,744 likes
Donald J. Trump
✔
@realDonaldTrump
The world was gloomy before I won - there was no hope. Now the market is up nearly 10% and Christmas spending is over a trillion dollars!
10:32 AM - 27 Dec 2016
* 28,953 28,953 Retweets
120,222 120,222 likes
Dec. 27 - Trump returns to Twitter, criticizing the president for campaigning against him in swing states that Clinton lost.
Donald J. Trump
✔
@realDonaldTrump
President Obama campaigned hard (and personally) in the very important swing states, and lost.The voters wanted to MAKE AMERICA GREAT AGAIN!
8:52 AM - 28 Dec 2016
* 21,432 21,432 Retweets
88,689 88,689 likes
Dec. 28 - Trump tweets that he is "Doing my best to disregard the many inflammatory President O statements." Rep. Chris Collins, a member of Trump's transition team, then says on Fox News that the Obama administration is "doing everything they can to make this a bumpy road."
Trump also takes a dig at the administration's relationship with Israel shortly before Secretary of State John Kerry delivered a speech defending the U.S. decision to abstain from the vote.
Donald J. Trump
✔
@realDonaldTrump
We cannot continue to let Israel be treated with such total disdain and disrespect. They used to have a great friend in the U.S., but.......
1:19 AM - 29 Dec 2016
* 24,430 24,430 Retweets
79,852 79,852 likes
Donald J. Trump
✔
@realDonaldTrump
not anymore. The beginning of the end was the horrible Iran deal, and now this (U.N.)! Stay strong Israel, January 20th is fast approaching!
1:25 AM - 29 Dec 2016
* 27,893 27,893 Retweets
88,476 88,476 likes
"We reject the criticism that this vote abandons Israel," Kerry says in his address.
Later in the day, Trump is asked by reporters gathered outside his Mar-a-Lago resort whether the transition is going smoothly. The president-elect responds, "I think very, very smoothly," adding, "good, very good. You don't think so?" He also tells reporters that he spoke with the president Wednesday and "we had a very nice conversation."
The White House released a statement regarding the call, saying it was "focused on continuing a smooth and effective transition."
Thursday, December 29, 2016
Wednesday, December 28, 2016
By forcing voters show their ID, the UK Government has found another way to disenfranchise the poor - Independent
Renewing my passport recently, I came up against an irritatingly inconvenient side effect. Every time I tried to buy a bottle of wine in a supermarket, the cashiers seemingly refused to believe there wasn’t an outside possibility I might be a 17-year-old and turned me away. Arguments that 17-year-olds generally don’t plan wild nights around cat litter, fresh pasta, hoover bags and mid-price wine didn’t wash: the relative maturity I believed my basket contents conveyed wasn’t a watertight (or legal) indicator of age. And while many people have a driving licence to prove they’ve reached the age where they can destroy their own liver, the fact that I have epilepsy means I can’t even get a provisional licence.
Now that Eric Pickles has announced a pilot to force voters to show identification when voting, this inconvenience could mean that rather than missing out on the ability to buy a bottle of pinot noir, people in my position could end up completely disenfranchised. Explaining to friends that a passport is my only form of ID when I am shown up in a bar, it’s usually assumed I’m in a small minority: but the 2011 census shows that 24 per cent of the UK born population hold no passport at all.
Was 2016 the year the fat cats got their comeuppance?
To vote under these proposals, you’d need to show a passport, driving licence or utility bill. Three million more people hold driving licences than passport, but 10 million UK nationals still lack this form of photo ID. It’s not a stretch to assume many people who lack driving licences also lack passports, and would struggle to provide the necessary paperwork for Pickles’s pilot. Most utility companies have offered financial incentives for customers who choose to receive bills online. I haven’t received a utility bill or bank statement since I was at university in 2009. The Government’s assumption that these three forms of ID are easy to come by ignores the experience of several million potential voters.
Electoral fraud is a problem, though it is not thought to be widespread. What is widespread is voter apathy: even in last year’s general election, which had the highest turnout since Labour’s 1997 landslide, only 66 per cent of registered voters cast their ballot. At a time when a third of the country didn’t vote for any candidates, we’re now seeing a concerted effort to add several layers of difficulty to participation in democracy. For evidence of how voting ID laws disenfranchise communities, you only need to look to the United States, where states who require photo ID to vote have much lower turnout of poor, black, Latino and older voters.
For certain parties this is politically expedient: they argue that the aim is to make voting secure, and that an unexpected side effect is lower turnout amongst those in poverty, migrants and people in precarious jobs and housing. Traditional Conservative voters will have little problem, but for working-class people who are more likely to vote for Labour this will mean a significant number who could previously vote will now find themselves struggling to gather the necessary paperwork. Passports are expensive: £72.50 at the very least, while provisional driving licences cost £34. If you’re solvent, the cost will seem negligible; if you’re struggling to make your rent each month, deciding to spend £34 simply to vote will seem a hefty cost to pay if it means cutting down on your food and fuel budget for a week or two.
The message this move sends is that people can’t be trusted to vote. If you already feel as though the political system has forgotten you, and you feel voting makes little difference, planning weeks in advance to secure the ID you need to vote is unlikely to increase voter turnout. At the moment, campaigners on polling day battle to spread the message that you don’t need your polling card to vote, so that people who might otherwise not vote can drop into their polling station on the way home from work. Making voters jump through hoops is a retrograde step and assumes guilt on the part of voters. To properly combat electoral fraud, a properly funded police unit with the resources to investigate organised fraud makes far more sense.
Earlier this year, 800,000 people found they’d dropped off the electoral register. In the run up to the EU referendum, campaigners scrabbled to communicate this, and get people re-enrolled, since thousands had no idea they’d been disenfranchised quietly. Adding yet more layers of bureaucracy to the process of voting, and a requirement for a form of ID that costs voters is yet more gerrymandering, which will lead to the poorest, and most voiceless, without the prospect of a vote.
Russia's Vladimir Putin Poses Challenge to Donald Trump Administration - NBC News
Russia's Vladimir Putin Poses Challenge to Donald Trump Administration
LONDON — Nobody is more likely to test the new administration than Russia's Vladimir Putin.
Putin has already overlapped with three other American presidents and his government's actions colored the U.S. campaign long before Trump's November win.
U.S. intelligence officials believe with "a high level of confidence" that Putin became personally involved in the covert Russian campaign to interfere with the White House election, two senior officials told NBC News.
The CIA has assessed that Putin's government wanted to elect Trump, although the FBI and other agencies don't fully endorse that view. Few officials dispute that the Russian operation was intended to harm the candidacy of Trump's rival Hillary Clinton by leaking embarrassing emails about Democrats.
While no equivalent Republican leaks occurred during the campaign — and Trump and Putin have both spoken of each other warmly — the wind from the East has never been more chilly.
On Oct. 15, Russia's longstanding U.N. Ambassador Vitaly Churkin said Washington-Kremlin tensions the "worst since 1973."
Former Soviet President Mikhail Gorbachev — the architect of glasnost or "openness" reform policies that hastened the end the Communist U.S.S.R. — has warned that U.S.-Russia ties were at "a dangerous point."
Related: Putin Congratulates Trump by Telegram After Win
Russia tore up a pact to get rid of plutonium that could be used in nuclear warheads, and moved nuclear weapons into Eastern Europe — which unnerved Western governments, including the U.S.
It is also venturing into regions it had neglected for decades, for example helping bomb Syria's Aleppo and holding military exercises with longtime U.S. ally Egypt.
Profound Distrust
It seems like Putin's Russia seems determined to challenge American leadership across the globe. Beneath the bold Russian moves, there is profound distrust between the two countries.
Secretary of State John Kerry's personally warm relationship with Russian Foreign Minister Sergei Lavrov has ensured areas of cooperation, even agreement — but this could end.
Putin won't be deterred from challenging the U.S. and with his economic woes growing at home he may be tempted to double down on risky military moves — nowhere more so than in the Middle East, where Syria is Putin's showcase for the Russian military.
The most profound challenge to the White House's new occupant would be if Moscow made a move in one of the Baltic states, which are members of NATO but are also home to substantial ethnic Russian minorities. This is seen as an extremely unlikely occurrence by experts but it cannot be completely ruled out.
Related: Three Years After U.S. Pulled Tanks From Europe, They're Back
Any incursion would challenge Trump, as NATO's biggest funder, to make a full-scale response based on the alliance's fundamental principle — that an attack against one of its members is considered an attack on all 28.
Another possible tripwire is the Russian enclave of Kaliningrad, which lies between Lithuania and Poland and is home to the Russian Baltic fleet. Russia has now moved nuclear capable Iskander-M missile systems there.

Russian President Vladimir Putin Mikhail Svetlov / Getty Images
Their indefinite placement puts U.S. missile defense systems in Poland within range. Almost certainly, any Russian move to test America's new leader here would be small scale — the military tactic they call "maskirovka," or deception, seen most clearly in 2014 when mysterious soldiers appeared in Ukraine's Crimea. These soldiers, which Putin later admitted had been sent there by the Kremlin, hastened the eventual Russian annexation of the peninsula.
The World's Longest Border
Putin's regime has insisted it is antagonizing the United States in self-defense against what it perceives to be Washington's aggressive policies.
Russia, the country with the longest land border in the world, has historically been concerned about its neighbors' military activities.
Related: Trump Hints at New Relationship With NATO Allies
Russian leaders have for years watched with alarm as NATO expands eastward toward the country's borders. Especially alarming are plans for the U.S. missile defense elements in Eastern Europe.
Trump's own plans may prove as damaging to NATO as Russia's. As a candidate, he sent waves of alarm through Europe when he said he might not come to the aid of NATO allies if they were attacked.
So these are dangerous days.
Related: Why Obama Didn't Do More About Russian Hack
"Russia is still the only country that can destroy the United States as a functioning society in 30 minutes ... both sides maintain their nuclear forces on hair-trigger alert," Russia experts Thomas Graham and Matthew Rojansky wrote in Foreign Policy magazine in October.
There are few good options for the U.S. and all carry risks.
Tillerson's 'Vast experience'
Trump's nomination of oil giant ExxonMobil CEO Rex Tillerson as secretary of state on Dec. 13 may signal the president-elect's strategy for dealing with Russia. While Tillerson has no government or diplomatic experience, he does have exceptionally close ties with Moscow and Putin.
While these links have drawn fire from both Democrats and Republicans, it is likely that Trump actually sees the connections as positive.
"The thing I like best about Rex Tillerson is that he has vast experience at dealing successfully with all types of foreign governments," Trump said via Twitter when the nomination was announced.
Whatever Tillerson's relationship with Russian officials, Putin is now positioning himself to make maximum demands on Trump.
Obama failed to follow through on his famous "red line" threat against the use of chemical weapons in Syria in 2013. With this, Russia and many other countries smelled weakness in Washington.
Related: Donald Trump's Call for 'Arms Race' Boggles Nuclear Experts
Trump has already proven bullish with his rhetoric, suggesting on Twitter last week that the U.S. should expand its nuclear capabilities and telling MSNBC: "Let it be an arms race. We will outmatch them at every pass and outlast them all."
Putin, for his part, boasted during his annual press conference about the strength of his nuclear arsenal.
Trump's challenge is to show Moscow that America isn't withdrawing from the world, or unwilling to share the burdens of global leadership with a responsible Russia.
So after America and Europe both failed to deter Putin, perhaps the best Trump will be able to do is repeat the Cold War and ensure a balance of power through the threat of mutually assured nuclear destruction — an uncomfortable policy that nonetheless provides stability.
Editor's note: This is part 3 of a series. Donald Trump was elected to president on a platform of politics not as usual, so it is fitting he inherits a world in flux. Post-World War II rules are dying, old alliances shifting and traditional roles shed. While Trump is a giant question mark on the world stage, NBC News' Chief Global Correspondent Bill Neelylooks at major international challenges the president-elect faces upon inauguration on Jan. 20.
NBC News
LONDON — Nobody is more likely to test the new administration than Russia's Vladimir Putin.
Putin has already overlapped with three other American presidents and his government's actions colored the U.S. campaign long before Trump's November win.
U.S. intelligence officials believe with "a high level of confidence" that Putin became personally involved in the covert Russian campaign to interfere with the White House election, two senior officials told NBC News.
The CIA has assessed that Putin's government wanted to elect Trump, although the FBI and other agencies don't fully endorse that view. Few officials dispute that the Russian operation was intended to harm the candidacy of Trump's rival Hillary Clinton by leaking embarrassing emails about Democrats.
While no equivalent Republican leaks occurred during the campaign — and Trump and Putin have both spoken of each other warmly — the wind from the East has never been more chilly.
On Oct. 15, Russia's longstanding U.N. Ambassador Vitaly Churkin said Washington-Kremlin tensions the "worst since 1973."
Former Soviet President Mikhail Gorbachev — the architect of glasnost or "openness" reform policies that hastened the end the Communist U.S.S.R. — has warned that U.S.-Russia ties were at "a dangerous point."
Related: Putin Congratulates Trump by Telegram After Win
Russia tore up a pact to get rid of plutonium that could be used in nuclear warheads, and moved nuclear weapons into Eastern Europe — which unnerved Western governments, including the U.S.
It is also venturing into regions it had neglected for decades, for example helping bomb Syria's Aleppo and holding military exercises with longtime U.S. ally Egypt.
Profound Distrust
It seems like Putin's Russia seems determined to challenge American leadership across the globe. Beneath the bold Russian moves, there is profound distrust between the two countries.
Secretary of State John Kerry's personally warm relationship with Russian Foreign Minister Sergei Lavrov has ensured areas of cooperation, even agreement — but this could end.
Putin won't be deterred from challenging the U.S. and with his economic woes growing at home he may be tempted to double down on risky military moves — nowhere more so than in the Middle East, where Syria is Putin's showcase for the Russian military.
The most profound challenge to the White House's new occupant would be if Moscow made a move in one of the Baltic states, which are members of NATO but are also home to substantial ethnic Russian minorities. This is seen as an extremely unlikely occurrence by experts but it cannot be completely ruled out.
Related: Three Years After U.S. Pulled Tanks From Europe, They're Back
Any incursion would challenge Trump, as NATO's biggest funder, to make a full-scale response based on the alliance's fundamental principle — that an attack against one of its members is considered an attack on all 28.
Another possible tripwire is the Russian enclave of Kaliningrad, which lies between Lithuania and Poland and is home to the Russian Baltic fleet. Russia has now moved nuclear capable Iskander-M missile systems there.
Russian President Vladimir Putin Mikhail Svetlov / Getty Images
Their indefinite placement puts U.S. missile defense systems in Poland within range. Almost certainly, any Russian move to test America's new leader here would be small scale — the military tactic they call "maskirovka," or deception, seen most clearly in 2014 when mysterious soldiers appeared in Ukraine's Crimea. These soldiers, which Putin later admitted had been sent there by the Kremlin, hastened the eventual Russian annexation of the peninsula.
The World's Longest Border
Putin's regime has insisted it is antagonizing the United States in self-defense against what it perceives to be Washington's aggressive policies.
Russia, the country with the longest land border in the world, has historically been concerned about its neighbors' military activities.
Related: Trump Hints at New Relationship With NATO Allies
Russian leaders have for years watched with alarm as NATO expands eastward toward the country's borders. Especially alarming are plans for the U.S. missile defense elements in Eastern Europe.
Trump's own plans may prove as damaging to NATO as Russia's. As a candidate, he sent waves of alarm through Europe when he said he might not come to the aid of NATO allies if they were attacked.
So these are dangerous days.
Related: Why Obama Didn't Do More About Russian Hack
"Russia is still the only country that can destroy the United States as a functioning society in 30 minutes ... both sides maintain their nuclear forces on hair-trigger alert," Russia experts Thomas Graham and Matthew Rojansky wrote in Foreign Policy magazine in October.
There are few good options for the U.S. and all carry risks.
Tillerson's 'Vast experience'
Trump's nomination of oil giant ExxonMobil CEO Rex Tillerson as secretary of state on Dec. 13 may signal the president-elect's strategy for dealing with Russia. While Tillerson has no government or diplomatic experience, he does have exceptionally close ties with Moscow and Putin.
While these links have drawn fire from both Democrats and Republicans, it is likely that Trump actually sees the connections as positive.
"The thing I like best about Rex Tillerson is that he has vast experience at dealing successfully with all types of foreign governments," Trump said via Twitter when the nomination was announced.
Whatever Tillerson's relationship with Russian officials, Putin is now positioning himself to make maximum demands on Trump.
Obama failed to follow through on his famous "red line" threat against the use of chemical weapons in Syria in 2013. With this, Russia and many other countries smelled weakness in Washington.
Related: Donald Trump's Call for 'Arms Race' Boggles Nuclear Experts
Trump has already proven bullish with his rhetoric, suggesting on Twitter last week that the U.S. should expand its nuclear capabilities and telling MSNBC: "Let it be an arms race. We will outmatch them at every pass and outlast them all."
Putin, for his part, boasted during his annual press conference about the strength of his nuclear arsenal.
Trump's challenge is to show Moscow that America isn't withdrawing from the world, or unwilling to share the burdens of global leadership with a responsible Russia.
So after America and Europe both failed to deter Putin, perhaps the best Trump will be able to do is repeat the Cold War and ensure a balance of power through the threat of mutually assured nuclear destruction — an uncomfortable policy that nonetheless provides stability.
Editor's note: This is part 3 of a series. Donald Trump was elected to president on a platform of politics not as usual, so it is fitting he inherits a world in flux. Post-World War II rules are dying, old alliances shifting and traditional roles shed. While Trump is a giant question mark on the world stage, NBC News' Chief Global Correspondent Bill Neelylooks at major international challenges the president-elect faces upon inauguration on Jan. 20.
NBC News
Tuesday, December 27, 2016
A Christmas song best representing 2016 - New York Times
A song most reflects 2016 X'mas - Have yourself a merry 2017
True, it’s not by Beyoncé or Adele or Rihanna. It’s not even by anyone still alive. But I would like to nominate “Have Yourself a Merry Little Christmas” as song of the year, because if any single tune reflects the miseries of 2016, and the anxious uncertainty with which we greet 2017, it is this 72-year-old holiday chestnut.
The song was introduced by Judy Garland in the 1944 film “Meet Me in St. Louis,” a picture that was itself looking further backward, to the turn of the last century. If this sounds like a Russian nesting doll approach to nostalgia, well, that’s only one facet of the song’s 2016-ness.
Like you, I’ve probably heard “Have Yourself a Merry Little Christmas” dozens of times since Thanksgiving, and hundreds if not thousands of times more across previous holiday seasons. (Mileage will vary depending on how much time you log at Starbucks and CVS.) With its pretty, winding, bittersweet melody, which its co-author likened to a madrigal, and its lyrics about making the best of a rocky present with hopes for a better future, this unusually ambiguous Christmas song falls on the melancholy side of the moody-merry Yuletide music divide (the so-called Guaraldi Line).
To my taste, that is the side to be on, but until last weekend, I hadn’t paid much more attention to “Have Yourself a Merry Little Christmas” than I had to “Rockin’ Around the Christmas Tree” or the odious “Frosty the Snowman.” The occasion was one of the Jazz at Lincoln Center Orchestra’s annual Big Band Holidays concerts, where I found tears running down my cheeks during an especially plaintive version of “Have Yourself a Merry Little Christmas” sung by Catherine Russell and arranged by the tenor saxophonist Victor Goines. Introducing the song, Ms. Russell mentioned that she was going to use its seldom-sung original lyrics, and indeed they proved not only unfamiliar but also — surprising in this generally jolly context — provocative.
New York Times
Monday, December 26, 2016
What is populism ? - Economist
by M.S.
DONALD TRUMP, the populist American president-elect, wants to deport undocumented immigrants. Podemos, the populist Spanish party, wants to give immigrants voting rights. Geert Wilders, the populist Dutch politician, wants to eliminate hate-speech laws. Jaroslaw Kaczynski, the populist Polish politician, pushed for a law making it illegal to use the phrase “Polish death camps”. Evo Morales, Bolivia’s populist president, has expanded indigenous farmers’ rights to grow coca. Rodrigo Duterte, the Philippines’ populist president, has ordered his police to execute suspected drug dealers. Populists may be militarists, pacifists, admirers of Che Guevara or of Ayn Rand; they may be tree-hugging pipeline opponents or drill-baby-drill climate-change deniers. What makes them all “populists”, and does the word actually mean anything?
Widespread use of the term “populism” dates to the 1890s, when America’s Populist movement pitted rural populations and the Democratic Party against the more urban Republicans. (It was also used to refer to Russia’s 19th-century narodnichestvo movement, which largely comprised self-hating intellectuals with a crush on the peasantry.) In the 1950s academics and journalists began applying it more broadly to describe everything from fascist and communist movements in Europe to America’s anti-communist McCarthyites and Argentina’s Peronistas. As Benjamin Moffitt explains in his book “The Global Rise of Populism”, a conference at the London School of Economics in 1967 agreed that the term, while useful, was too mushy to be tied down to a single description. Some scholars linked it to frustration over declines in status or welfare, some to nationalist nostalgia. Others saw it as more of a political strategy in which a charismatic leader appeals to the masses while sweeping aside institutions (though not all populist movements have such a leader). Despite its fuzziness, the term’s use has grown.
In 2004 Cas Mudde, a political scientist at the University of Georgia, offered a definition that has become increasingly influential. In his view populism is a “thin ideology”, one that merely sets up a framework: that of a pure people versus a corrupt elite. (He contrasts it with pluralism, which accepts the legitimacy of many different groups.) This thin ideology can be attached to all sorts of “thick” ideologies with more moving parts, such as socialism, nationalism, anti-imperialism or racism, in order to explain the world and justify specific agendas. Poland’s Mr Kaczynski, a religious-nationalist populist, pushes for a Catholic takeover of his country’s institutions from elite secular liberals. The Dutch Mr Wilders, a secular-nationalist populist, demands a crackdown on Islam (in defence of gay rights) and reviles the multicultural elite. Spain’s Podemos, an anarchist-socialist populist party, pushes to seize vacant buildings owned by banks and distribute them to the poor, and attacks “la casta” (the elite caste).This “thin ideology” definition of populism seems apt in Britain, where Brexiteers denounce experts, refer to themselves as “the people” and boast of having “smashed the elite”. Indeed, Brexit seems to lack a unified “thick ideology”: Brexiteers have different attitudes to trade, race, government spending and almost everything else. But other scholars feel that the thin-ideology definition fails to capture some dimensions. Jan-Werner Müller, a political scientist at Princeton University, thinks populists are defined by their claim that they alone represent the people, and that all others are illegitimate. And there are important distinctions within the category, such as that between inclusive and exclusive varieties. Exclusive populism focuses on shutting out stigmatised groups (refugees, Roma), and is more common in Europe. Inclusive populism demands that politics be opened up to stigmatised groups (the poor, minorities), and is more common in Latin America. Mr Mudde argues that while most writers deplore populism, its upside lies in forcing elites to discuss issues they prefer to ignore. But populism’s belief that the people are always right is bad news for two elements of liberal democracy: the rights of minorities and the rule of law.
Economist
Sunday, December 25, 2016
Trump's " Mad Dog " was once considered a stock market villain - Fortune
Donald Trump's new pick for secretary of the U.S. Army may be most famous for owning the Florida Panthers, the hockey team is not what made Vincent Viola rich.
Viola, whom Trump selected Monday for the Army's top post, has a net worth of $2.3 billion, according to Bloomberg. Much of that wealth has come from Virtu Financial (VIRT, +1.94%), the high-frequency trading firm that Viola, 60, founded in 2008 and took public last year: Viola still owns nearly 58% of Virtu, according to the company, which has a market cap of about $2.2 billion.
Indeed, as Virtu filed for an initial public offering in March 2014, The Wall Street Journal declared that Viola was set to become the high-frequency trading industry's very first billionaire upon the IPO.
But there was a problem: It was a terrible time to be a high-frequency trading billionaire.
Trump Foundation
Donald Trump Plans to Shutter His Charitable Foundation, Report Says
Just weeks after Virtu filed for its IPO, author Michael Lewis released his book Flash Boys, which lifted the veil on the secretive world of high-speed trading but also vilified it and argued that such split-second traders had rigged the market against average-Joe investors. Mentioned in a footnote in Lewis' book,Virtu's claim to fame—that in its 5.5 years of trading, it made money every single day except one—was quickly used against the company by critics who accused it of cheating. By mid-April, Virtu was forced to postpone its IPO indefinitely.
A year later, though, Viola's company renewed its plans, thanks in part to an endorsement by Flash Boys protagonist and CEO of IEX Brad Katsuyama, who afterwards called Virtu one of the "good high-frequency traders." Virtu went public in April 2015.
So far, though, Virtu's stock has performed poorly, down 16% since its IPO and more than 30% this year alone. Though Viola has refused a salary for the last three years at Virtu—his contract provides for base pay of $1—he made more than $8.2 million in option awards in 2015, according to the company's most recent proxy. Viola also controls more than 93% of the voting power of Virtu's outstanding common stock.
Before he started Virtu, Viola, a graduate of West Point military academy who served in the Army's 101st Airborne Division, was a floor trader and pioneer of electronic trading. He went on to lead the New York Mercantile Exchange (known as Nymex for short) as chairman through the Sept. 11 terrorist attacks in 2001 until 2004, during which time he reportedly tried to acquire rival Intercontinental Exchange (ICE, -0.80%). That obviously didn't happen: In 2008, Nymex was acquired by CME Group, the leading futures exchange specializing in commodities. By the end of this year, CME Group has promised to close its Nymex trading floors for good, offering strictly electronic trading.
So with a background like that, what does the secretary of the Army do? According to the Department of Defense's job description for the current person in that role, Eric Fanning, the secretary of the Army "has statutory responsibility for all matters relating to the United States Army: manpower, personnel, reserve affairs, installations, environmental issues, weapons systems and equipment acquisition, communications, and financial management."
While high-speed trigger-pulling ability may not be an official job requirement, it probably doesn't hurt, either.Update: A previous version of this article said that Viola owns more than 68% of the Class A common stock of Virtu Financial, as stated in the company's most recent proxy filing. The article has been updated to reflect a comment from Virtu about the percentage of its total stock owned by Viola.
Viola, whom Trump selected Monday for the Army's top post, has a net worth of $2.3 billion, according to Bloomberg. Much of that wealth has come from Virtu Financial (VIRT, +1.94%), the high-frequency trading firm that Viola, 60, founded in 2008 and took public last year: Viola still owns nearly 58% of Virtu, according to the company, which has a market cap of about $2.2 billion.
Indeed, as Virtu filed for an initial public offering in March 2014, The Wall Street Journal declared that Viola was set to become the high-frequency trading industry's very first billionaire upon the IPO.
But there was a problem: It was a terrible time to be a high-frequency trading billionaire.
Trump Foundation
Donald Trump Plans to Shutter His Charitable Foundation, Report Says
Just weeks after Virtu filed for its IPO, author Michael Lewis released his book Flash Boys, which lifted the veil on the secretive world of high-speed trading but also vilified it and argued that such split-second traders had rigged the market against average-Joe investors. Mentioned in a footnote in Lewis' book,Virtu's claim to fame—that in its 5.5 years of trading, it made money every single day except one—was quickly used against the company by critics who accused it of cheating. By mid-April, Virtu was forced to postpone its IPO indefinitely.
A year later, though, Viola's company renewed its plans, thanks in part to an endorsement by Flash Boys protagonist and CEO of IEX Brad Katsuyama, who afterwards called Virtu one of the "good high-frequency traders." Virtu went public in April 2015.
So far, though, Virtu's stock has performed poorly, down 16% since its IPO and more than 30% this year alone. Though Viola has refused a salary for the last three years at Virtu—his contract provides for base pay of $1—he made more than $8.2 million in option awards in 2015, according to the company's most recent proxy. Viola also controls more than 93% of the voting power of Virtu's outstanding common stock.
Before he started Virtu, Viola, a graduate of West Point military academy who served in the Army's 101st Airborne Division, was a floor trader and pioneer of electronic trading. He went on to lead the New York Mercantile Exchange (known as Nymex for short) as chairman through the Sept. 11 terrorist attacks in 2001 until 2004, during which time he reportedly tried to acquire rival Intercontinental Exchange (ICE, -0.80%). That obviously didn't happen: In 2008, Nymex was acquired by CME Group, the leading futures exchange specializing in commodities. By the end of this year, CME Group has promised to close its Nymex trading floors for good, offering strictly electronic trading.
So with a background like that, what does the secretary of the Army do? According to the Department of Defense's job description for the current person in that role, Eric Fanning, the secretary of the Army "has statutory responsibility for all matters relating to the United States Army: manpower, personnel, reserve affairs, installations, environmental issues, weapons systems and equipment acquisition, communications, and financial management."
While high-speed trigger-pulling ability may not be an official job requirement, it probably doesn't hurt, either.Update: A previous version of this article said that Viola owns more than 68% of the Class A common stock of Virtu Financial, as stated in the company's most recent proxy filing. The article has been updated to reflect a comment from Virtu about the percentage of its total stock owned by Viola.
Saturday, December 24, 2016
How hospitals, nursing homes keep lethal ‘superbug’ outbreaks secrets - Reuters
ROSWELL, New Mexico – The outbreak started in January 2014.
That’s when a resident of the Casa Maria nursing home here was diagnosed with Clostridium difficile, a highly contagious and potentially deadly “superbug” that plagues hospitals, nursing homes and other healthcare facilities.
By the end of February, six more Casa Maria residents were suffering from the infection, characterized by fever, abdominal cramps and violent diarrhea.
Under New Mexico regulations, healthcare facilities must report a suspected outbreak of C. difficile to the state Health Department within 24 hours.
But Casa Maria staff did not contact authorities until March 4, 2014, according to the Health Department report on its investigation of the outbreak, a copy of which was obtained by Reuters. By then, nine of the nursing home’s 86 residents had active infections.
Still, Casa Maria downplayed the emergency. The employee who contacted the authorities asked for information on how to handle “a few cases of C. difficile,” according to the report, but “stated it was not an outbreak.” When a Health Department staffer called Casa Maria the next day to follow up, the nursing home again denied it had an outbreak.
By June, the outbreak was over. Fifteen residents had been infected, and eight were dead. The public was never informed — until now.
Superbug gallery: A most unwanted list
“The medical profession should have been able to pick up that it was C. diff and notified the community,” said Ernie Lopez, manager of a local fast-food restaurant.
His mother, Della Baker, entered Casa Maria in December 2013, after three hospital stays for severe diarrhea and a stroke that had paralyzed her left side and rendered her mute.
Several weeks after Baker arrived at Casa Maria, nurses told Lopez that his mother’s unrelenting diarrhea was caused by C. difficile.
New Mexico health officials, citing privacy laws, declined to say whether Baker caught the infection at Casa Maria or was one of several infected patients that investigators found had been transferred to the nursing home from five other healthcare facilities in New Mexico and Texas.
Baker died on March 17, 2014, age 95.
The outbreak and the way it was handled expose what a Reuters investigation found to be dangerous flaws in U.S. efforts to control the spread of superbug infections. An examination of cases across the country reveals a system that protects the healthcare facilities where superbugs thrive, while leaving patients, their families and the broader public ignorant of potentially deadly threats.
Every year, hundreds of thousands of Americans are sickened and tens of thousands die from infections by antibiotic-resistant bacteria and C. difficile, a pathogen linked to long-term antibiotic use. Timely reporting of outbreaks of these infections is essential to stopping the spread of disease and saving lives, public health experts and patient advocates say.
Yet the United States lacks a unified nationwide system for reporting and tracking outbreaks. Instead, a patchwork of state laws and guidelines, inconsistently applied, tracks clusters of the deadly infections that the federal government 15 years ago labeled a grave threat to public health.
IN THE DARK: Della Baker was one of eight people who died during an outbreak of superbug infections at Casa Maria nursing home in Roswell, New Mexico, in 2014. REUTERS/Handout
As a result, the United States has no way to count the deadly spikes in infections that hit the nation. Reuters, drawing on reports from 29 state health departments, has assembled one of the most comprehensive counts yet - identifying at least 300 superbug outbreaks around the nation from 2011 to 2016. The number of people affected was impossible to determine because many reports didn’t include a count of the infected or the dead.
PROTECTIVE SECRECY
To get an idea of how the states are handling the problem, Reuters filed public-records requests with all 50 states to obtain data and details on reported outbreaks of superbug infections in healthcare facilities over the past five years.
In all, 29 states provided at least some information on individual outbreaks. Many of the rest said they either had no outbreaks during the period or were barred by law from releasing the information. Reuters filled in gaps by asking states for additional information and scouring academic literature.
Most states require that hospitals, nursing homes and other healthcare facilities report suspected outbreaks of infectious disease, drug-resistant or otherwise, within one business day or less of identifying the problem so that health officials can intervene to halt their spread.
But while they require that outbreaks be reported, most states do not provide an explicit definition of the term. Instead, they leave it to the healthcare providers to determine when they are experiencing an increase in a particular infection beyond the usual number. That approach assumes that medical practitioners will know what’s normal in their facilities and gives them wide latitude in deciding when, or even whether, to report.
Dr Susan Huang, a professor of infectious diseases at the University of California at Irvine School of Medicine, said the system for identifying outbreaks relies too heavily on staff members’ interpretation of what seems unusual. “Why should anyone be reading this by hand, by eyeball and by gut check?” said Huang, who has developed a software program with Harvard University researchers to identify outbreaks. “People haven’t put real effort into this area.”
St. Mary’s Regional Medical Center in Reno, Nevada, first recognized it had a “problem” on Sept. 10, 2014, according to a state investigation report. It then waited three weeks to notify health officials of a C. difficile outbreak that infected as many as 15 of its patients, three of whom died. Nevada requires that suspected outbreaks be reported “immediately,” according to the Nevada Department of Health and Human Services.
Kimisha Causey, the department’s hospital-acquired-infections coordinator, declined to discuss details of the case. She did say, however, that St. Mary’s was late in reporting the outbreak. “You’ll find that in every state,” she said. “Facilities don’t want the state involved.”
A St. Mary’s spokeswoman said the hospital “did not submit the data late, in fact it was submitted within the standard we have per our internal policies.”
When a state does get involved, punishment is rare to nonexistent. At least 36 states are able to impose civil or criminal penalties, ranging from fines of up to $1,000 to jail time, for failure to properly report outbreaks. Yet not one of those 36 states cited an instance in the past five years when penalties were used.
In the New Mexico outbreak, Casa Maria waited until 10 percent of its patients were infected before contacting officials. Still, the state Health Department did not fault the nursing home for the delay. “Casa Maria appropriately contacted the department as soon as they identified a cluster of C. difficile cases to ensure that they were taking all necessary precautions,” said Paul Rhien, the department’s communications director.
Rhien said state officials have the power to fine facilities, revoke their licenses or even refer individuals for criminal prosecution if they fail to respond properly to an outbreak. The department did not penalize Casa Maria because, despite the 24-hour rule, authorities concluded that the nursing home reported the cases on time.
State investigators also found that medical charts were available for just six of the eight Casa Maria patients who died during the outbreak, and that poor communication between Casa Maria and the five facilities that transferred infected patients to it probably contributed to the outbreak. Rhien said all the facilities involved acted properly.
In a statement emailed to Reuters, Casa Maria said it appropriately notified the state Health Department of the infections and provided effective treatment.
Secrecy enshrouds outbreak reporting. More than a third of states are barred by law from disclosing the location of an outbreak, or in some cases, even that one occurred.
ALARMING SPIKE: Berkeley Medical Center alerted West Virginia authorities after nine patients tested positive for Klebsiella pneumoniae (shown here being cultured in the hospital’s lab). Most of the 40 infections in the outbreak were traced to a local nursing home, Heartland of Martinsburg. REUTERS/Gary Cameron
“You want to say, ‘Don’t take your mom or dad here.’ ”
Angie Gray, Berkeley County Health Department
Many state health officials say disclosing information about outbreaks to the public or punishing facilities risks dissuading hospitals and nursing homes from reporting. They say they see themselves as collaborators with healthcare facilities.
“We do not behave like punishers, we behave like helpers,” said Dr Raoult Ratard, state epidemiologist for the Louisiana Office of Public Health. Louisiana law mandates that information about outbreaks not be released to the public.
NO PROBLEM HERE
Even so, the collaborative approach often fails the public. Reuters found instances in which, even without the risk of penalties, healthcare facilities didn’t report outbreaks.
Twenty-one patients were infected with drug-resistant Acinetobacter baumannii at St. Anthony’s Medical Center in St. Louis, Missouri, from 2008 to 2011, according to a hospital spokesman. The microbe is a particular scourge of hospitals and nursing homes. St. Anthony’s took special steps to eradicate the bug, the spokesman said, but didn’t think the number of cases warranted reporting. Missouri defines an outbreak as illnesses “in excess of normal expectancy.”
Richard Armbruster, a 78-year-old former minor-league baseball pitcher, died two days after he tested positive for the infection while in St. Anthony’s for hip-replacement surgery in 2009.
“You know I’m so angry that they KNEW this bacteria was floating around their hospital in 2008!!!” his daughter, Amy Fix, wrote in an email after Reuters told her about the other cases. “Had that been reported to the authorities and the story picked up by the media, there is NO WAY we would’ve allowed my Dad to have his surgery there.”
The federal Centers for Medicare & Medicaid Services mandates that hospitals and long-term care facilities participating in the huge government insurance programs provide all necessary medical information when a patient is being transferred. However, the state outbreak reports Reuters reviewed showed that hospitals and nursing homes often do not alert each other when they transfer an infected patient, which can allow contagion to spread among multiple locations.
In Ohio, at least 22 patients were infected and seven died this year when an outbreak of antibiotic-resistant Acinetobacter baumannii spread through a hospital and seven long-term care facilities. The facilities frequently failed to warn each other when transferring infected patients. The public was never notified. Nor were the infected patients or their families told of the outbreak.
Jeanette Corey, whose 79-year-old father was the seventh to die, said hospital staff told her only that he had a mysterious infection.
“They were going around two weeks saying they don’t know what it is,” Corey said. “And it doesn’t dawn on someone to tell me,” she said, that “there was an outbreak of this bacteria going on – and that people had died?”
IDEAL TARGETS
As Reuters reported in September, the Centers for Disease Control and Prevention, the national public health monitor, lacks regulatory power to track superbug deaths. It also lacks the authority to enforce outbreak reporting. Instead, it sometimes assists states with their outbreak investigations, a spokesman said, but each state decides which diseases must be reported.
Long-term care facilities — nursing homes, rehab centers and the like — are particularly vulnerable to outbreaks. A Reuters analysis of death certificates found that from 2003 to 2014, annual superbug-related deaths at long-term care facilities increased 62 percent, from about 1,400 to almost 2,300.
Patients in these facilities are ideal superbug targets — the chronically ill, the very old, and anyone else with a compromised immune system. Collected under one roof, these people are easy prey. New Mexico’s investigation report on Casa Maria, for instance, noted that C. difficile was not the sole cause of death of anyone in the outbreak, but was one of often many contributing factors.
In its emailed statement, Casa Maria said: “All C. Diff infections were resolved within two weeks and there were no deaths as a result of the C. Diff infection.”
A MIXED BAG
State outbreak reports often lack basic information, such as how many people were affected, the source of the outbreak, or when it began or ended. In 16 states, the name of the facility must be removed from the report by law before it is released.
In West Virginia, a local hospital alerted the Berkeley County Health Department in January 2011 that nine patients had tested positive for carbapenem-resistant Klebsiella pneumoniae. A joint investigation by the county and state health departments uncovered more cases. The authorities tracked most of the infections to patients transferred from a single long-term care facility, identified only as “LTCF A” in outbreak reports.
Even as the outbreak spread, health officials were prohibited by state law from publicly identifying the facility.
“I can tell you it was very hard to me to not to shout it out,” said Angie Gray, a public health nurse at the Berkeley County Health Department, which monitored the outbreak. “You want to say, ‘Don’t take your mom or dad here.’ ”
Using other information in the report, Reuters identified “LTCF A” as Heartland of Martinsburg, one of the largest nursing homes in the rural northeast corner of the state. The hospital that reported the outbreak was Berkeley Medical Center
Among those infected was Harold P. Lewis of Arden, West Virginia. Lewis had a urinary tract infection when Heartland transferred him to Berkeley Medical Center, where he tested positive for the Klebsiella superbug in February 2011.
“I had never heard of that disease in my life,” said Marjorie Lewis, his widow. “They said it came from unsanitary conditions.” The hospital and nursing home bickered over which was responsible, she recalled: “They passed the buck back and forth.”
SOUNDS STRANGE: Marjorie Lewis says she had never heard of the Klebsiella superbug until her husband, Harold, contracted it during an outbreak at his nursing home in West Virginia. State law prohibits disclosure of the names of facilities where outbreaks occur. REUTERS/Gary Cameron
Heartland had no infection-prevention officer for 9 months. Hand-washing stations were scarce. Up to four patients shared a single bathroom.
Lewis was sickened but survived. Marjorie said she transferred him to another nursing home after he fell out of his wheelchair and broke a leg. His health continued to deteriorate, she said, and he died in 2013, age 80.
She sued Heartland over the fall and “numerous urinary tract infections” that the lawsuit alleged he contracted while living there. The case was settled for an undisclosed amount.
A state investigation found that Heartland had no infection-prevention officer for nine months. Though signs warned staff to take contact precautions with certain patients, there were no gloves, masks or gowns nearby, and hand-washing stations were few and far between, the report said. As many as four patients shared a single bathroom.
The state Bureau for Public Health did not penalize Heartland. The facilities involved in the outbreak “worked to stop the spread of disease,” said bureau spokesman Toby Wagoner.
MAPPING THE SPREAD
At the state’s behest, Heartland began collecting cultures on its patients during the outbreak and sent them for testing to Berkeley Medical. Berkeley Medical also began testing all patients transferred from Heartland on admission.
Berkeley Medical lab manager Tambry Harvey said she had a floor plan of Heartland that she used to track the superbug’s spread from room to room. “It started with three patients, it turned into 11, and by the time I was done, the list was this long,” she said, waving toward a printout taped to a nearby wall that was nearly two feet long.
As of 2013, Harvey said, the lab had identified 40 patients with the superbug, including one who died, and 61 carriers – people who had no symptoms but could infect others. Most had been patients at Heartland, she said.
That year – more than two years into the outbreak – a resurgence of infections prompted the county to stop new admissions to Heartland for several days. Public health staff worked with the facility to improve infection control procedures. “That was considered an extreme measure, and it certainly got their attention,” said Dr Diana Gaviria, Berkeley County health officer at the time.
During the outbreak, Heartland of Martinsburg was owned by HCR ManorCare, one of the largest nursing-home chains in the country. The company sold Heartland in 2015 to Stonerise Healthcare, which changed Heartland’s name to Clary Grove.
HCR ManorCare said: “We became aware of an issue in our center in 2011 and aggressively addressed it.” HCR’s owner, the giant private equity firm Carlyle Group, declined to comment.
PASSING IT AROUND
Reuters documented cases in which infected patients were transferred, sometimes multiple times, without any of the receiving facilities being notified. In some cases, the transferring facility knew of the infections. In others, it was unaware.
KEEPING MUM: Julie McCray, the infection prevention manager at Adena Regional Medical Center in Chillicothe, Ohio, battled a deadly superbug outbreak this year. The hospital did not alert patients or the public. REUTERS/Paul Vernon
Adena Regional Medical Center did not contact health officials until after the count had hit 9 infections and 5 deaths.
Bungled handoffs were the issue from January through September this year as a deadly Acinetobacter baumannii infection swept through healthcare facilities in three counties in south-central Ohio.
Staff at Adena Regional Medical Center in Chillicothe detected the superbug on an incoming transfer patient in January, said Julie McCray, the infection prevention manager there. Two more cases were detected on admission the next month. More appeared over the next couple of months.
McCray said nursing homes regularly failed to notify the hospital when sending patients with confirmed drug-resistant infections. By the time hospital staff discovered the information buried in the patient’s record or through lab tests, the bug might have spread.
She acknowledged, too, that while the hospital usually gave notice to the receiving facility when transferring an infected patient out, “sometimes it was missing.”
McCray didn’t contact local public health officials until late May, after the count had swelled to nine infections and five deaths. Ohio requires notice within one business day of an outbreak, which it defines as “above the expected” number of infections. McCray said she didn’t consider the case reportable until three patients died within two weeks in May.
Her move prompted an Ohio Department of Health investigation. It found that the same A. baumannii strain had spread through seven nursing homes, as well as Adena, and confirmed what McCray had suspected: That nursing homes were transferring infected patients without alerting the receiving facilities.
Jeanette Corey’s father, David Houser, had been in and out of the hospital and nursing homes for multiple ailments, when he was transferred to Adena in July with a suspected case of bacterial pneumonia. The nursing home he came from was Heartland of Chillicothe, owned by HCR ManorCare – the same company that owned Heartland of Martinsburg in West Virginia during that outbreak.
Corey said hospital staff told her they didn’t know what kind of infection her father had. And, she said, they never mentioned that the hospital was in the midst of an A. baumannii outbreak.
A. baumannii can cause pneumonia, but McCray said medical records show Houser wasn’t tested for the superbug until Aug. 4, the day he died. Three days later, lab results confirmed the infection. The hospital didn’t wait for those results to complete Houser’s death certificate. Cause of death: “Congestive heart failure.” Adena confirmed that Houser was the seventh patient to die in the outbreak.
McCray said she left the decision of whether to inform patients and the community about the outbreak to health officials because the hospital was not the only source of the infections. “Was it our role to tell them or the health department’s?” she said.
An Ohio Department of Health spokeswoman said the outbreak wasn’t made public because “there are no national public health guidelines suggesting public notices in such instances.”
Adena Regional Medical Center and the nursing homes involved in the outbreak agreed at a Dec. 16 meeting to use a new form to alert other facilities when transferring infected patients, McCray said.
It wasn’t the only recent A. baumannii outbreak Ohio kept under wraps.
In the summer of 2015, three patients fell ill and one died at Galion Community Hospital, two hours north of Adena. Last winter, an hour north of Adena, a dozen patients fell ill and three died at Mount Carmel West. Adena was in the dark.
“That would have been good to know,” McCray said.
PASSED AROUND: The superbug outbreak in south-central Ohio this year spread among seven nursing homes and Adena Regional Medical Center (left) as infected patients were transferred without the receiving facility being notified of the bug; Jeanette Corey (right) says no one told her that her father, David Houser, was a victim of the outbreak. REUTERS/Paul Vernon/Jay LaPrete
Meet the Startup Trying to Reinvent Food Delivery - TIME Business
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Posted: 22 Dec 2016 08:29 AM PST
Yet as incredible as it is to easily get anything from Crab Rangoon to a meatball sub with a few taps of an app, food delivery isn’t perfect. Meal and packaging quality can vary wildly. Timing can be a crapshoot. And as any seasoned New Yorker knows, there are some foods you just don’t order for delivery — like sushi on a hot summer day. After all, most restaurants view delivery as a secondary revenue stream to augment money made from sit-down eaters. It’s not their primary objective. The opposite is true at Maple, a New York restaurant startup that has spent nearly two years working to perfect food delivery. Unlike rivals like Seamless, which offers existing restaurants a platform for digital ordering, Maple runs the “full stack” restaurant experience — meaning it has its own apps, kitchens (five “neighborhood kitchens” in Manhattan, plus a commissary in Brooklyn), delivery staff and so on. The daily menu, which has some rotating options and some customer-favorite staples, is designed with portability at top of mind. The back-end software built in-house tracks orders, cooks and delivery workers, seeking to optimize the entire operation via artificial intelligence and cloud computing. And most strikingly, there is no sit-down location. This is The Internet Restaurant. “For us, the entire process is about doing delivery really well, and doing it with ingredients you can’t get anywhere else,” says Caleb Merkl, co-founder and CEO at Maple. His firm has raised $25 million from investors like David Chang, founder of the Momofuku group and an icon of the New York food scene. When Maple first launched, its delivery range was limited to Manhattan’s Financial District, a densely packed and mostly commercial neighborhood at the island’s southernmost tip. Marketing was largely through word-of-mouth, with the company’s logo proudly displayed on the bags that sit on workers’ desks as they eat, inviting inquires from curious officemates. (That’s a drawback compared to brick-and-mortar restaurants, whose locations serve as massive advertisements for themselves.) The firm’s delivery zone has since expanded to everywhere below 14th street, plus large swaths of midtown. I first heard of Maple through a co-worker several months ago. But I didn’t try it for myself until a particularly busy day this past November. The app is smooth and visually engaging, with food photography worthy of a glossy magazine. Seeking a flavorful vegetarian option, I went for the General Tso’s Tofu, which cost $11 plus about a dollar in tax. (Maple once charged a flat fee for meals and delivery and discouraged tips, but it has since added a surcharge to boost delivery worker pay and benefits.) I picked a delivery window of 12:20-12:40, threading the needle between two meetings. The meal arrived at the latter end of that range but still within the goal posts, along with several other Maple packages for delivery in my building, no doubt a result of the company’s efficiency-seeking software. Akshay Navle, Maple co-founder and chief operating officer, says the technology underpinning his company makes the whole operation possible. “The reason we’re so tech-enabled is that it allows us to do better food, and to get it to the most people possible,” says Navle. “If there was a way to do this without tech, we would certainly look at it. But we don’t believe that’s true.” To be sure, Maple, which is not currently profitable, has plenty of competition. There’s the aforementioned Seamless, but also similar services like UberEATS, the car-hailing service’s food-delivery platform, and Postmates, a delivery service that offers food and other products. While models differ — the other firms offer delivery from a range of restaurants, whereas Maple is a restaurant unto itself — hungry consumers might not know the difference. There’s also a cautionary tale in the form of Munchery, a California startup that, like Maple, also runs the “full stack,” but has reportedly suffered from food waste and other issues despite raising more than three times the amount in Maple’s coffers. And unlike “sharing economy” darlings like Uber, Maple is dependent on its own labor, meaning it has to consider minimum wage laws, benefits, overtime pay and other regulatory matters. Maple’s slow-and-steady approach to growth, a welcome reprieve from Silicon Valley’s “move fast and break things” mentality, might help it deal with any problems before they grow out of hand. That said, Merkl and his team certainly have big long-term ambitions. He’s already thinking about how Maple’s model might move outside the city and into the suburbs, where success would require a different approach. Dinner options, a recent addition to Maple’s menu, may be part of the solution. “Forty-eight percent of dinner meals purchased from a restaurant today are eaten at home,” says David Portalatin, a food industry analyst at research firm NPD. So it’s easy to see some kind of pickup-only restaurant working well for the bridge-and-tunnel crowd picking up family dinner on their way home from the office. And as urbanites flock to the burbs in search of space and cheaper living, they might welcome food options beyond Applebee’s. My tip? Try the General Tso’s. |
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