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Democrats should push for universal health coverage ahead of the November election, several health care advocates urged the committee drafting the Democratic National Committee’s platform at a recent session focused on health policy. Their liberal health care proposals echo a similar theme from an environment-themed session the same day, in which activists criticized DNC members for not pushing harder on climate change. The hearing was part of a series of regional events held by the Democratic Platform Drafting Committee “designed to engage every voice in the party.” (McIntire, 6/20)

John McCain is running for reelection like it’s 2010. The Arizona Republican has made his opposition to Obamacare — which dominated Senate races across the country six years ago — a central point of his campaign, by all accounts, the toughest reelection fight of his career. He’s betting that shrinking coverage options and premium increases that could go as high as 65 percent if insurers get their way will resonate with Arizona voters, even as most of his Republican colleagues running this year have moved on to other issues. (Haberkorn and Meyer, 6/20)

The Senate on Monday night rejected four proposals to tighten the nation’s gun laws, as familiar partisan battle lines left lawmakers unable for now to respond to this month’s mass shooting in Orlando, Fla. ... Two measures focused on the background-checks system also stalled Monday night. The Democratic bill would have expanded the use of background checks beyond only federally licensed dealers to include private gun sellers and all sales online. A competing measure from Sen. Chuck Grassley (R., Iowa) that would encourage states to submit relevant mental-health records to the nation’s background-check system was blocked. It would also have changed certain mental-health terminology in a way that Democrats said would make it easier for those with mental illness to procure guns. (Peterson and Hughes, 6/20)

Sens. Elizabeth Warren (D-Mass.) and Tammy Baldwin (D-Wis.) are applying new pressure on the Obama administration to lift long-time restrictions on blood donations from gay men in the wake of the Orlando attacks. The two senators, who have been long-time critics of the policy, wrote to the head of the Food and Drug Administration on Monday blasting what they call a “discriminatory” policy. (Ferris, 6/20)

In the 17 years of mass shootings and stalled debates about gun control that separate Columbine from the recent massacre in Orlando, another debate has evolved among medical professionals and first responders about how to prevent deaths like Sanders’s. It hovers over the decision in Orlando to wait three hours after Omar Mateen began shooting before breaching the Pulse nightclub where he was holding hostages and where unknown numbers were wounded. And it is an increasingly urgent focus for emergency responders, because one of the few comments experts make with confidence about these unpredictable mass attacks is that they are sure to happen again. “Scoop and run” — the idea of moving victims to a trauma hospital as quickly as possible — is a mantra of modern U.S. emergency care. Internal hemorrhage can be handled only in an operating room. But stanching bleeding from arms and legs often needs to happen even sooner. (Stead Sellers, 6/20)

An experimental vaccine for the Zika virus is due to begin human testing in coming weeks, after getting the green light from U.S. health officials. Inovio Pharmaceuticals said Monday it received clearance from the Food and Drug Administration to begin early-stage safety tests of its DNA-based vaccine against the mosquito-borne virus. That puts the company ahead of researchers at the National Institutes of Health, who have said they expect to begin testing their own DNA-based Zika vaccine by early fall. (Perrone, 6/20)

Pennsylvania vaccine maker Inovio Pharmaceuticals and South Korea’s GeneOne Life Sciences said Monday that they had received approval from U.S. regulators to start testing a DNA vaccine, known as GLS-5700, on humans. The early-stage study will include 40 healthy subjects. It is primarily designed to assess the safety of the vaccine but will also measure the immune response generated by the injection. (Cha, 6/20)

Interim results from the trial, which will involve 40 healthy adults, are expected later this year. Testing in mice and monkeys has shown the vaccine triggered what Inovio called a robust antibody response. Gary Kobinger, whose team at Canada’s National Microbiology Laboratory in Winnipeg did the mouse testing, said the Inovio team decided late last year to try to develop a Zika vaccine in the shortest time it could. (Branswell, 6/20)

The tests will be done at three U.S. locations, including Philadelphia, and will evaluate safety, tolerability, and immunogenicity of the vaccine against the mosquito-borne virus. Test results from the study are expected this year, said Inovio president and CEO Joseph Kim. (Loyd, 6/21)

Even though the explosive spread of the Zika virus has been met with a new level of international response, thanks to lessons learned from the Ebola crisis, experts warn they are only beginning to grasp the damage the mosquito-borne virus can do. Doctors speaking at a U.N. meeting on Global Health Crises said Monday that the Zika virus has already affected 60 countries on four continents, and a major outbreak on the Atlantic Ocean island nation of Cape Verde suggests the disease is now poised to enter continental Africa. Zika has already become epidemic in Latin America and the Caribbean. (Astor, 6/20)

The U.S. government said on Monday it has agreed to help fund two pathogen reduction technologies to help reduce the risk of Zika virus and other infections from being transmitted through the blood supply. (6/20)

By now we know that Zika is dangerous for pregnant women and their future babies. The virus can cause devastating birth defects. But what about for infections after babies are born? Or in older children? Is Zika a danger for them? So far, all the evidence suggests probably not. But there are a few caveats. (Doucleff, 6/20)

A California regulator is approving Aetna Inc.'s proposed acquisition of rival health insurer Humana Inc. Shelley Rouillard, director of the California Department of Managed Health Care, announced her decision Monday. As a condition of the approval, Aetna agreed to limit premium increases in the small group market and to allow greater state oversight of its rates. The company will also have to keep certain decision-making functions in California and must invest in various health initiatives. (6/20)

California officials don’t have the authority on their own to block the national insurance merger, but their decisions can be influential as the companies try to win antitrust approval from the U.S. Department of Justice. Shelley Rouillard, director of the state Department of Managed Health Care, said she reached an agreement with Aetna that should help keep future rate increases to a minimum and improve the quality of patient care. (Terhune, 6/20)

Aetna Inc.’s $37 billion deal to buy Humana Inc. was approved by the California Department of Managed Health Care, which said Monday that it could move forward after the company agreed to invest in the state’s health-care infrastructure. (Horowitz, 6/20)

On Monday, the Connecticut Office of State Ethics started a 30-day comment period regarding whether Insurance Commissioner Katharine Wade’s participation in the Cigna/Anthem merger would violate the State’s Code of Ethics. Wade has come under fire for her handling of two health insurance mega-mergers, Aetna-Humana and Anthem-Cigna. The $54 billion Cigna deal in particular raised eyebrows, as Wade was previously a Cigna vice president and her husband is now an associate chief counsel for the company. (Cuda, 6/20)

The percentage of Americans having trouble paying for healthcare or medicine has fallen to a new low, according to a Gallup survey. The survey finds that 15.5 percent of the public said that in the last 12 months they have not had enough money to afford needed healthcare. (Sullivan, 6/20)

Childhood diabetes rates are on the rise, and a report released Monday pointed to the impact that the cost of their care could have on families -- even those who have employer-sponsored health insurance. The study, conducted by the Health Care Cost Institute (HCCI), found that children as old as 18 with diabetes who were insured through an employer-sponsored plan racked up $2,173 per capita in out-of-pocket health care costs in 2014. That spending level was nearly five times higher than that of kids without the illness. (Heredia Rodriguez, 6/20)

Scope of practice — who can practice what kind of medicine, in what settings and under what type of physician supervision, if any — is an issue that has preoccupied state legislatures and the courts for years. The disputes involve physicians, nurse practitioners, chiropractors, pharmacists, dental hygienists, respiratory therapists, podiatrists, pharmacists, midwives — and just about everyone else in medicine. It has taken on renewed importance in the past few years given the coverage expansion of the Affordable Care Act, the shortage of primary care physicians and mental health practitioners in sections of the country, the needs of an aging population, and the pressures to find ways of providing care less expensively without harming quality. (6/20)

Federally qualified health centers that serve mostly poor and low-income families in distressed or rural communities have always had a tough time recruiting physicians. And now, it's getting even harder. (Johnson, 6/18)

North Carolina becomes the third state to provide unlimited access to a prescription drug that’s already saved more than 2,000 people statewide who were overdosing on heroin, OxyContin or other opium-based drugs. Gov. Pat McCrory signed a law Monday that creates a statewide standing order at all pharmacies to prescribe naloxone to anyone. (6/20)

Naloxone, often known by the brand name Narcan, is available as a nasal spray, a pre-loaded injectable shot or in a vial that can be administered with a syringe. ... Naloxone doesn't "cure" an overdose because opioids remain in the bloodstream for at least four to six hours, but it creates a window during which a person can receive emergency care. ... Beginning Tuesday morning, Texans will be able to obtain naloxone without a prescription at any of 715 Walgreens pharmacies in the state, Walgreens spokesman Phil Caruso confirmed. (Taft, 6/21)

In the last conversation Steve Simcak had with his son, Stephen "Stosh" Simcak texted his father that he wanted to get clean. ... He was one of 183 people to die from heroin and fentanyl in Cuyahoga County in 2015. Officials in Northeast Ohio continue to grapple with the scope of the drugs that are on pace to kill nearly 500 people this year. (Shaffer, 6/20)

Right on schedule, Sierra Yoder went into labor. It was Halloween night, and she was wearing an orange T-shirt with a pumpkin covering her belly. It was embellished with her new son’s name and his expected birth date: “Bentley. Due 10/31/15.” Yoder and her husband, Dustin Yoder, hopped into the car and headed for the hospital — but without any bottles, without any diapers, without a car seat in which to bring their newborn home. They had packed one onesie — light blue with stars — and matching pants and warm, fuzzy socks. The couple expected to bury their son in it very soon. (Bever, 6/20)

Doctors told Dustin and Sierra Yoder that their son, Bentley, would be “‘incompatible with life.” He was born with a rare condition called encephalocele, which caused his skull to form incorrectly, forcing part of his brain to grow up and out of his skull. The Yoders expected to bury tiny Bentley shortly after his birth; he was given little chance of survival. (Caren, 6/20)

A study comparing hospital admissions in “wet” versus “dry” counties in Texas offers a surprising new perspective on how alcohol consumption may affect the health of your heart. The analysis found that people living in dry counties, where sales of alcoholic beverages are prohibited, had a higher risk of being hospitalized for a heart attack or congestive heart failure than people living in wet counties, where such sales are allowed. But residents of wet counties were at elevated risk for a heart rhythm disorder called atrial fibrillation. (Winslow, 6/20)

A special muffin recipe made with polyunsaturated fat helped people lose more weight than those with monounsaturated fat and improve other health measures, according to a small study at the University of Maryland School of Medicine that may help doctors understand the best type of diet in helping combat serious disease. (Cohn, 6/21)

Studies of the long-term impact of egg donation on donors have never been done, even though the practice dates back more than 30 years. Despite sporadic reports of subsequent infertility and a variety of cancers, some fatal, it isn't known whether these problems are linked to the process or are simply the result of chance. Fertility specialists say that egg donation is safe and involves the same process as in vitro fertilization, which uses drugs to stimulate and regulate egg production. A 2013 meta-analysis of 25 studies seeking to evaluate the risks between ovarian cancer and the use of fertility drugs found "no convincing evidence" of an increase in the risk of invasive ovarian cancer. ... But others say the matter remains unsettled because donors haven't been studied. (Boodman, 6/21)

Scientists in Los Angeles have identified a new genetic candidate that could be targeted in order to treat people with post-traumatic stress disorder. ... Using genetic tools, the researchers were able to focus in on a number of genes that were candidates for influencing our learning of fear. They eventually narrowed their search down to the gene Hcn1. (Johnson, 6/20)

Employees at Houston-area Department of Veterans Affairs facilities manipulated scheduling data for hundreds of medical appointments, understating patient wait times by days or even months, according to an agency watchdog. (Barned-Smith, 6/20)

With more investments in health, the well-being of California's children continued its three-year improvement, new data shows. At the same time, measurements in four broad categories of children's welfare place the Golden State in the bottom third of the nation -- 36th out of the 50 states, in an annual survey released Tuesday by the child-advocacy groups the Annie E. Casey Foundation and Children Now. California's overall ranking in children's well-being moved up two places from last year, when it was 38th. (Noguchi, 6/20)

Richmond’s poverty rate among children is the second-highest in Virginia, but more of the state’s youngest residents have health insurance, according to a report to be released today. About 39 percent of the city’s children were living in poverty in 2014, well more than twice the poverty rate for children across the state, according to the 2016 Kids Count Data Book, a report produced by the Annie E. Casey Foundation. (Kleiner and Demeria, 6/20)

A much-watched annual report shows Texas slipping two spots to 43rd in a national ranking of the top states to be a kid. The Annie E. Casey Foundation's 2016 Kids Count assessment released Tuesday ranked Texas 43rd. That's worse than last year's 41st ranking. Texas has hovered around the bottom 10 of states in recent years, despite an economy that has remained strong even amid declining oil prices and a fast-growing, richly diverse population. (Austin Statesman, 6/21)

Life has gotten worse for Louisiana's children since 2008, according to the Annie E. Casey Foundation. The annual Kids Count report, released Tuesday (June 21), compared health, education, community and economic well-being benchmarks from recent years to the start of the recession. (Dreilinger, 6/20)

New Hampshire slipped from second to fourth place in the national Kids Count ranking, according to new data released by the Annie E. Casey Foundation. The Granite State maintained its spot in the top 10 states in the country in the report, which measures the well-being of kids. The report takes four different indicators into account, including economic well-being, health, education and family and community. (Nilsen, 6/20)

The next time older Iowans start harrumphing about “kids these days,” they might want to look at how the state stacks up in a new national report about children’s health and well-being. Iowa kids get strong marks for avoiding pregnancy, remaining sober, staying in school, and having health insurance. (Leys, 6/21)

Regency Hospital of Fort Worth, Texas will permanently close its doors on August 11, leaving 152 employees at the specialty acute-care facility without jobs, according to Select Medical Corporation. The Mechanicsburg, Pa.-based company that operates more than 1,400 healthcare facilities in the U.S. announced the closure of RHC Fort Worth in a June 13 letter to the Texas Workforce Commission. (Rice, 6/20)

Are patients at Allina Health hospitals in the Twin Cities getting the care they need with 4,800 nurses on strike for a week, and 1,400 replacement nurses filling in? There seemed scant agreement on the issue Monday as the nurses’ union, the Minnesota Nurses Association, traded terse words with Allina officials about what is happening at the four hospitals. (Ojeda-Zapata, 6/20)

SSM Health will spend $550 million to build a new academic medical center to replace St. Louis University Hospital in south St. Louis. When SSM Health took over St. Louis University Hospital last year, plans to build a replacement were announced immediately by the network’s president and CEO, Bill Thompson. Thompson has since announced plans to retire next year. (Bouscaren, 6/20)

When the government invested $30 billion dollars to get hospitals and docs these electronic health records this was the dream. And now more than 96 percent of hospitals are digitized, nearly 80% of physician practices as well. ...One significant problem: vendors charging hospitals and docs to share patient data. (Gorenstein, 6/20)

At a public hearing this year, a nursing director from Boston Children’s Hospital made a painfully detailed case for why the hospital needs to expand. In the crowded neonatal intensive care unit, she said, doctors sometimes have to perform emergency surgery at an infant’s bedside, “within feet of other critically ill children and their anxious parents.” The open layout means that only a curtain separates a family preparing to take its baby home from parents who just took theirs off life support, she added, their sobbing heard by all. ... But what might seem an undeniable need for Boston Children’s — a new 11-story building that would house a bigger N.I.C.U. and heart surgery center, and private patient rooms instead of doubles — is instead bogged down in controversy. (Goodnough, 6/20)

Several groups, including Arkansas' largest health insurer, have critiqued components of the state's plan to seek federal approval for a revised version of the private option and a waiver extension through 2021. The state Department of Human Services received nine written comments prior to Friday's public comment deadline. The commenters, including private residents and Arkansas Blue Cross and Blue Shield, attacked a provision that would eliminate retroactive coverage for enrollees to "better align" the program with commercial insurance coverage. Currently, Medicaid covers up to 90 days of medical expenses incurred before the date an enrollee applied. (Field, 6/20)

Indiana remains at odds with the federal government over how to evaluate the state’s unique Medicaid program, a standoff that affects not only Indiana, but also other states looking to adopt Indiana’s model. The Centers for Medicare & Medicaid Services gave Indiana a deadline of June 17 to finalize a data-sharing agreement on the jointly funded health care program for the poor. Instead, Indiana responded in a letter Friday that the federal government hasn’t satisfied the state’s concerns about data safety. (Groppe, 6/20)

The state Department of Health said today that it is throwing the New Orleans nonprofit Alternative Livings Inc. off the state Medicaid program after three family members who run the organization were charged in a federal indictment. (Litten, 6/20)

Mercy, the Chesterfield-based Catholic health system, is suing insurance giant Aetna, claiming the company failed to pay the full amount for care provided to certain newborns. The lawsuit, filed by Mercy on Friday in the U.S. District Court in St. Louis, alleges that Aetna is violating its end of a payment agreement that the two have had in place since 2007. (Liss, 6/21)

Columbus City Council on Monday unanimously passed an amended version of its ordinance to establish a buffer around Planned Parenthood sites, a move that essentially uses a law already in place against disorderly conduct but increases the penalty for violators. Councilwoman Elizabeth Brown had proposed the ordinance as a way to establish a 15-foot buffer around reproductive medical centers and to protect workers and women from aggressive anti-abortion protesters. (Sullivan, 6/20)

A law passed in this year's [Maryland] General Assembly session will allow families and disabled people to set aside up to $14,000 a year — up to $100,000 total — without affecting eligibility for Supplemental Security Income, Medicaid and other government programs. Officials say an estimated 30,000 to 50,000 Marylanders may be eligible to save. (Woods, 6/20)

According to Atlanta Regional Commission, Cobb County has metro Altanta's third-lowest mortality rate, falling behind Gwinnett and Forsyth. But there are still some threats to healthy living that residents should look out for. Cobb County's mortality rate is dominated by three main causes: cardiovascular issues, cancer and external causes. (Santos, 6/20)

Amy Carey's recent Facebook post chronicled how her 3-year-old son, Cason, "almost became 1 of the 40 kids that will die this year from being in a hot car." On average, 37 kids die in sweltering cars each year, according to noheatstroke.org...In her post, Carey explained that she was cleaning in the kitchen on June 15 while her son Cason was "playing 'Minecraft' in his brother's room." Carey is a mom to four boys, between the ages of three and 10. (Ehrler, Haley and Rasheed, 6/20)

Headlines tell of a mental health crisis in this country: Not enough funding to help the most vulnerable people. Poorly run and sometimes dangerous state mental institutions. Troubled people committing terrible crimes. Too many people slip past programs that could help; too many end their lives by suicide. (Robertson, 6/21)

Elmer Bernstam is a professor at the School of Biomedical Informatics and McGovern Medical School at the University of Texas Health Science Center at Houston. He is heading an initiative to facilitate the sharing of medical records among UT System-owned hospitals and clinics. (Conway, 6/20)

Authorities say a New York City man made off with $5 million in a Medicaid fraud scheme. Authorities arrested Joseph Wright Monday morning and charged him with grand larceny, health care fraud and insurance fraud. Wright is the CEO of Assistance By Improve II, Inc. (6/21)

The Minnesota Department of Health has issued a warning about handling baby chicks or other young poultry. Over the past several months there have been nine cases of salmonella in Minnesota linked to handling young birds. Department veterinarian Stacy Holzbauer said even birds that look clean can have enough bacteria on their down, feathers or feet to make a person sick. (Steil, 6/20)

Health leaders from across the world recently gathered in Geneva for the 69th annual World Health Assembly. We met to advance the priorities we share and to tackle the challenges we face together. As part of that, we focused on our ongoing efforts to strengthen the world’s preparedness to respond to public-health emergencies and build strong health systems that we can count on when we need them most. (Sylvia Burwell, 6/20)

A House Republican alternative to Obamacare is coming this week, and some reports suggest it will include a refundable tax credit to subsidize health insurance. This would present some tough political and policy choices about whether and how to pay for a new program of tax credits. Changing the tax treatment of employer-provided health insurance could provide one of the largest potential sources of financing for a new refundable credit. It also would bring hefty trade-offs. On the political side, capping the deductibility of employer-based health plans to finance refundable credits that are considered government spending would not please some Republicans. Put another way: Repealing Obamacare’s tax increases to replace them with other revenue increases is unlikely to go over well with conservative voters, as I wrote in Think Tank late in 2014. (Chris Jacobs, 6/20)

House Speaker Paul Ryan’s health-care task force is expected to outline its alternative to Obamacare this week. The outline reportedly will not include the level of detail that would allow much external analysis of its impact by health-care experts and the media, though Democrats are likely to attack its concepts, most of which will be familiar proposals that Republicans favor and that Democrats have opposed in the past. The outline is part of Mr. Ryan’s effort to add Republican policy ideas to the election debate, in particular to the presidential campaign, and seems aimed at helping down-ticket Republicans as a part of an agenda that can appeal to their base. Details will be needed to understand whether the plan is more progressive or regressive and how many uninsured people would be covered. Another big question is how Donald Trump will respond. (Drew Altman, 6/20)

Investors have for months been cool to the idea that Anthem and Cigna's proposed $50 billion insurance merger will actually happen. Now things are looking downright frigid. (Max Nisen and Brooke Sutherland, 6/20)

Aetna's acquisition of Humana is creeping toward the finish line, getting an approval Monday from one of California's health insurance regulating bodies. Aetna's approval process stands in stark contrast to Anthem's purchase of Cigna Corp., which has faced more publicized internal and external battles and could be on its way to the chopping block. (Bob Herman, 6/20)

Health care costs are on the minds of many Californians, who see their insurance premiums and out of pocket expenses rising. Unfortunately, as state legislators consider good-faith efforts to address the issue, one measure – Senate Bill 1010, which goes before the Assembly Health Committee on Tuesday – not only fails to protect affordability and access, it threatens to make matters worse. Proponents of SB 1010 say the purpose of the bill is to lower costs driven by drug prices. (Sara Radcliffe, 6/20)

Earlier this month, a new law went into effect in California that allows doctors to prescribe a lethal dose of drugs to terminally ill patients wishing to die on their own terms. Prompted in large part by the experience of Brittany Maynard, a former Bay Area resident diagnosed with cancer who moved with her husband to Oregon to take advantage of that state’s lenient “death with dignity” laws, the law aims to honor what State Senator Lois Wolk (D-Davis) considers an individual’s freedom while providing “appropriate protections to prevent any abuse.” Although the public debate surrounding this issue continues to focus largely on the right to die, perhaps now is as good a time as any to examine the much less talked about issue: the desire to die. (Eric Nelson, 6/19)

Distraught over a poor grade that she thought would ruin her life, the honor-roll student broadcast her suicide for anyone to see. Hours later, she was in the inpatient psychiatric unit where I work, thanks to the quick thinking and action of anonymous viewers. (Kunmi Sobowale, 6/20)

Instead of being lowered to 3,480 people as recently claimed by the state, corrected reports show the backlog actually has more than quadrupled to 15,393. Of that number, 10,961 applicants have waited more than 45 days for the state to process their applications. That is inexcusable. (6/20)

Maybe there is a conversation to be had about allowing private ambulance service within Wichita for nonemergencies. But the way to start it isn’t for the City Council to break the 12-year agreement with Sedgwick County that keeps the county-run Emergency Medical Service comprehensive and strong. Sedgwick County commissioners are upset about the proposed termination, which is on Tuesday’s City Council agenda, and no wonder. As Commissioner Dave Unruh told The Eagle editorial board, ending Sedgwick County’s exclusive right to transport all patients within the city and county boundaries could have a profound effect on the county’s budget and services. (Rhonda Holman, 6/21)

It’s so easy to overact when you are home with a sick child or you feel terrible yourself. ... Rushing to a hospital’s emergency department, while one option, isn’t always the most appropriate choice. Emergency departments are designed for true medical emergencies, especially those that are life-threatening. Emergency care often can be much more costly. (Oded Zmora, 6/20)

According to Substance Abuse and Mental Health Services Administration (SAMHSA), about 42.5 million American adults suffer from some form of mental illness. Only about 46-65 percent with moderate-to-severe impairment are in treatment. Are you one of them and how do you know it’s time to seek treatment? (Judith Zackson, 6/20)

The Food and Drug Administration recently unveiled significant changes to nutritional labels. After a hard-fought battle, the new labels will give consumers greater insight into how much added sugar is hidden in the food we eat. Calories will be displayed more prominently and serving sizes will better reflect actual portion sizes. Public health advocates, consumer groups and the FDA have touted these new requirements as essential to combating America’s obesity epidemic. (Elana Fagotto, 6/20)

If the Senate does not pass the Safe and Accurate Food Labeling Act, food producers across the country will face costs and pass them along to shoppers in every aisle of the grocery store. Michigan families cannot afford to pay another $1,050 per year because of inaction. This federal legislation is needed because Vermont is imposing a labeling standard on food producers that would raise their costs across America. Vermont’s law is driven by fear of genetically engineered food and it is not based on sound science. (John Moolenaar, 6/19)