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Morning Briefing

Summaries of health policy coverage from major news organizations

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Wednesday, Aug 14 2024

麻豆女优 Health News Original Stories 3

  • Kids Who Survived Super Bowl Shooting Are Scared, Suffering Panic Attacks and Sleep Problems
  • Opioid Settlements Promise Mississippi a Windfall. What Happens Next?
  • Listen to the Latest '麻豆女优 Health News Minute'

After Roe V. Wade 1

  • Missourians To Vote On Whether Abortion Ban Will Stand Or Fall

Cancer 1

  • Biden's 'Cancer Moonshot': $150M Will Go Toward Tools To Help Surgeons Remove Tumors

Health Industry 1

  • Local Officials Have No Plans To Save Boston's Carney Hospital From Closure

State Watch 1

  • Eli Lilly Opens Company Hub For Gene-Based Treatments In Boston

Outbreaks and Health Threats 1

  • CDC Warns Of Surging Fifth Disease

Environmental Health 1

  • PFAS Levels In New Moms Might Be Linked To Shorter Breastfeeding

Prescription Drug Watch 2

  • White House Is Trying To Mitigate Increase In Medicare Drug Premiums
  • Perspectives: Pharmaceutical Testing Facility Gave Fraudulent Data. Why Didn't FDA Withdraw Approval?

Editorials And Opinions 1

  • Viewpoints: Kamala Harris Needs To Discuss Her Health Care Plan; There's A Way To Combat Vaccine Hesitancy

From 麻豆女优 Health News - Latest Stories:

麻豆女优 Health News Original Stories

Kids Who Survived Super Bowl Shooting Are Scared, Suffering Panic Attacks and Sleep Problems

Six months after the Feb. 14 parade, parents of survivors under 18 years old say their children are deeply changed. In this installment of 鈥淭he Injured,鈥 we meet kids who survived the mass shooting only to live with long-term emotional scars. ( Bram Sable-Smith and Peggy Lowe, KCUR , 8/14 )

Opioid Settlements Promise Mississippi a Windfall. What Happens Next?

Millions of dollars from national opioid settlements are pouring into Mississippi. The state and localities haven鈥檛 spent much yet. In many cases, how the money will be used is up in the air. ( Violet Jira, Mississippi Today and Henry Larweh , 8/14 )

Listen to the Latest '麻豆女优 Health News Minute'

鈥淗ealth Minute鈥 brings original health care and health policy reporting from the 麻豆女优 Health News newsroom to the airwaves each week. ( 1/7 )

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AFTER MY BROTHER'S RAPID DEATH FROM CANCER ...

Spare me, please, all talk
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modern miracles.

鈥 Timothy Kelley

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Summaries Of The News:

After Roe V. Wade

Missourians To Vote On Whether Abortion Ban Will Stand Or Fall

An initiative to enshrine abortion protections in the state's constitution gathered enough signatures to make the November ballot. Ballot measures in New York and Florida also are in the news.

Abortion will be on Missouri鈥檚 statewide ballot in November. An initiative petition to enshrine the right to abortion up until the point of fetal viability received final approval Tuesday, securing a place on the general election ballot. If the measure receives a majority of votes, Missouri could become the first state to overturn an abortion ban through a citizen-led measure. Abortion is illegal in Missouri, with limited exceptions only in cases of medical emergencies. There are no exceptions for survivors of rape or incest. If the amendment receives more than 50% of votes in approval, the measure would legalize abortion up until the point of fetal viability, an undefined period of time generally seen as the point in which the fetus could survive outside the womb on its own, generally around 24 weeks, according to the American College of Obstetricians and Gynecologists. (Spoerre, 8/13)

A proposed amendment to New York鈥檚 constitution meant to protect abortion access is a crucial part of Democrats鈥 plans to drive voter turnout in the state this fall. But there could be a problem: The ballot question doesn鈥檛 mention the word 鈥渁bortion.鈥 Arguments are set to begin Wednesday over a lawsuit Democrats hope will force election officials to include the term in an explanation of the amendment that voters will see when casting their ballots. (Izaguirre, 8/14)

More than half of Floridians support overturning a state abortion ban, according to a new USA TODAY/Suffolk University/WSVN-TV poll. But with 60% of voters required to approve a constitutional amendment, the race is too close to call. (Rodriguez, 8/14)

Three quarters of reproductive age women in the United States oppose letting states decide whether abortion is legal,聽including large majorities of Democrats and independents, according to a new survey.聽At least half of all women aged 18 to 49 said they opposed the state-by-state approach regardless of party affiliation, according to the survey released Wednesday from health policy research group 麻豆女优. (Weixel, 8/14)聽

Indiana鈥檚 attorney general has dropped a lawsuit that accused the state鈥檚 largest hospital system of violating patient privacy laws when a doctor told a newspaper that a 10-year-old Ohio girl had traveled to Indiana for an abortion. A federal judge last week approved Attorney General Todd Rokita鈥檚 request to dismiss his lawsuit, which the Republican had filed last year against Indiana University Health and IU Healthcare Associates, The Indianapolis Star reported. (8/13)

In other reproductive health news 鈥

Ami Claxton鈥檚 birth control method 鈥 an intrauterine device 鈥 expired 14 years ago. But she has been too scared to have it removed because of the excruciating pain she experienced the last time she had it replaced. This summer, the 55-year-old asked her gynecologist for options to help manage the pain during removal, but was told there weren鈥檛 any. 鈥淪o I said, 鈥楩orget it. I鈥檓 not going to get it out,鈥 鈥 said Claxton, of Chandler, Ariz. (Bever, 8/13)

麻豆女优 Health News: Listen To The Latest '麻豆女优 Health News Minute'

鈥淗ealth Minute鈥 brings original health care and health policy reporting from the 麻豆女优 Health News newsroom to the airwaves each week. (8/13)

Cancer

Biden's 'Cancer Moonshot': $150M Will Go Toward Tools To Help Surgeons Remove Tumors

The research funds will be allocated to eight colleges and universities across the country, including a team at Tulane, where President Joe Biden spoke Tuesday. The president also focused on the need to break down research "silos" and improve information sharing, Fox News reported.

President Joe Biden, alongside first lady Jill Biden, delivered remarks Tuesday in New Orleans addressing his revamped "Cancer Moonshot" program, which seeks to cut the cancer death rate in the U.S. by about half over the next 25 years. During the president's remarks, which took place at Tulane University, he focused on the need to break down research "silos" and improve information sharing among the cancer research community.聽(Schemmel, 8/13)

President Joe Biden鈥檚 first public event planned since his exit from the 2024 race last month marked a聽cause close to home: Announcing a major financial award from the cancer-curing policy arm he created in the wake of his son Beau Biden鈥檚 death. (Tausche, 8/13)

More cancer news 鈥

The maker of store-brand Mucinex sold by CVS, Walmart and others is reformulating its products to move away from an ingredient that is made with a cancer-causing chemical. Amneal Pharmaceuticals Inc. plans to submit testing data on its new formulation to the US Food and Drug Administration by the end of the year, the company said in a statement. The company expects to bring the products to market before August 2025. (Edney, 8/13)

Cancer detection firm Grail announced sizable workforce cuts on Tuesday in a bid to save cash and concentrate resources on developing a blood-based test to spot early signs of dozens of cancers. (Wosen, 8/13)

Nearly a third of child-cancer hospital admissions in Pennsylvania between 2021 and 2023 were among children from the Philadelphia area, data from a new report shows. Bucks, Chester, Delaware, Montgomery and Philadelphia Counties reported 2,400 child-cancer hospital admissions during the three-year period. Of those, 1,092 admissions were among children from Philadelphia. (Gutman, 8/13)

Health Industry

Local Officials Have No Plans To Save Boston's Carney Hospital From Closure

Employees were told neither state nor city public health authorities will take over the facility by eminent domain. Carney Hospital, owned by troubled Steward Health Care, is thus still slated for closure by Aug. 31. Other reports say Steward is selling its physician group to Rural Healthcare.

The Massachusetts Department of Public Health and Boston Public Health Commission have no plans to take over Carney Hospital by eminent domain, officials told a crowd of Carney employees on Tuesday night. ... "Declaring a public health emergency will not give the city, Mayor Wu, or I the regulatory authority, the licensure ability, or most importantly the money that it will take to run Carney Hospital, even in the short term," Boston Public Health Commission Director Dr. Bisola Ojikutu told the crowd. (Moller, 8/13)

Private equity-owned Rural Healthcare Group plans to acquire Steward Health Care鈥檚 physician group for $245 million. Steward Health Care, which filed for Chapter 11 bankruptcy protection in May, signed a definitive agreement to sell Stewardship Health, the for-profit health system鈥檚 physician group that spans nine states. The proposal requires approval from the U.S. Bankruptcy Court for the Southern District of Texas and must clear the customary regulatory process. (Kacik, 8/13)

Residents of this suburban community are pushing back against a planned psychiatric health center on the site of a K-12 academy that they believe would add traffic and make their neighborhoods less safe. The not-for-profit mental health provider KVC Missouri wants the property at 303 North Gore Avenue to add a hospital that would take in hundreds of children and keep them overnight. (Prasad, 8/13)

The role of unpaid family caregivers is drawing focus as Congress decides the future of a hospital care at home waiver. Unpaid family caregivers are increasingly a linchpin in healthcare as more patients opt to get care where they live and providers struggle to recruit and retain staff.聽Nearly one-third of individuals provide care or assistance to at least one person with an illness or disability, according to the University of Michigan鈥檚 National Poll on Healthy Aging released last week. (Eastabrook, 8/13)

Rising healthcare costs have put Blue Cross Blue Shield of Michigan in cost-cutting mode, leading to the elimination of 64 jobs.聽The Detroit-based insurer eliminated the positions this month in response to its聽$544 million聽underwriting loss, largely attributed to a $1.8 billion rise in pharmacy costs. (Walsh, 8/13)

On health care data 鈥

Private equity firm Francisco Partners has agreed to sell healthcare workforce management software company QGenda to media company Hearst. A source with knowledge of the deal said the price is in the range of $200 billion to $300 billion. The deal is expected to close in September. (Turner, 8/13)

Community Hospital Corp. information technology administrators saw unusual traffic on its website coming from Russia on July 24. An audit of the health system鈥檚 recently upgraded firewall alerted the information technology team to a source testing out administrative passwords to gain access to the website. (Kacik, 8/13)

State Watch

Eli Lilly Opens Company Hub For Gene-Based Treatments In Boston

In other news from across the country: U.S. Rep. Steny Hoyer (D-Maryland) had a mild stroke but escaped "lingering" symptoms; the first diagnosed human case of tick-borne Powassan virus in Allegheny County, Pennsylvania; fentanyl overdoses in young Californians; and more.

The world鈥檚 most valuable pharmaceutical company, Eli Lilly & Co., on Tuesday officially opened its new Lilly Seaport Innovation Center in Boston. The $700 million building will accommodate Lilly鈥檚 expanding workforce in Massachusetts and serve as the company鈥檚 hub for gene-based treatments. ... The 346,000-square-foot structure contains laboratories where scientists will develop genetic medicines. Nearly two-thirds of the building consists of lab space. (Saltzman, 8/13)

Rep. Steny H. Hoyer (D), a former House majority leader and longtime Maryland politician, sought medical care for a mild stroke Sunday night, his office said in a statement Tuesday. 鈥淢r. Hoyer has responded well to treatment and has no lingering symptoms,鈥 his deputy chief of staff and spokesperson, Margaret Mulkerrin, said in a statement. 鈥淢r. Hoyer鈥檚 wife and family extend their deepest thanks to his medical team.鈥 The 85-year-old congressman expects to return to his normal schedule next week, Mulkerrin said. (Shepherd, 8/13)

A child in Allegheny County is out of the hospital and recovering at home after being diagnosed with a "rare" disease transmitted by ticks, Allegheny County health officials said. Powassan virus is still rare, but the number of reported cases has increased over the last few years, according to the Centers for Disease Control and Prevention. (Lang, 8/13)

The California State Assembly Select Committee on Fentanyl, Opioid Addiction and Overdose Prevention on Monday during an informational hearing discussed the urgency of combatting the rise in overdose deaths among youth in recent years primarily due to ingesting fentanyl. Between 2019 and 2021, drug overdoses became the third most common cause of death for U.S. children and teens, according to the Centers for Disease Control and Prevention. (8/13)

麻豆女优 Health News: Opioid Settlements Promise Mississippi A Windfall. What Happens Next?

Hundreds of Mississippians die every year from opioid overdoses, an epidemic that has claimed the lives of tens of thousands more nationwide. In a series of historic settlement agreements, pharmaceutical companies agreed to pay about $50 billion over 18 years for their role in fueling the crisis 鈥 and Mississippi has signed on to be part of the settlements. (Jira and Larweh, 8/14)

麻豆女优 Health News: Kids Who Survived Super Bowl Shooting Are Scared, Suffering Panic Attacks And Sleep Problems

Six months after Gabriella Magers-Darger鈥檚 legs were burned by sparks from a ricocheted bullet at the Kansas City Chiefs Super Bowl parade in February, the 14-year-old is ready to leave the past behind. She is dreading the pitfalls of being a high school freshman, even as she looks forward to being back with friends and at color guard, dance, and volleyball. She might even join the wrestling team to get some respect at school. But the past remains ever present. (Sable-Smith and Lowe, 8/14)

Outbreaks and Health Threats

CDC Warns Of Surging Fifth Disease

CNN notes that the proportion of people with recent parvovirus B19 infections climbed to 10% in June, and children ages 5 to 9 had the highest increase. Meanwhile, federal officials concerned about rising H5N1 have been testing retail dairy products and haven't found live avian flu virus in any samples.

A seasonal respiratory virus named parvovirus B19 鈥 sometimes also called fifth disease 鈥 is increasing in activity, the US Centers for Disease Control and Prevention warned Tuesday. Parvovirus B19 is a common virus spread by respiratory droplets. (Dillinger, 8/13)

On bird flu 鈥

A second round of testing of retail dairy products, which includes more products such as cheese and butter and from a broader geographic area, found no live H5N1 avian flu virus in any of the samples, federal officials said today. The testing included 167 samples from 27 states. (Schnirring, 8/13)

One-in-six dairy products in US retail stores contained signs of inactive bird flu virus this summer, regulators said, slightly lower than the numbers seen in a different survey when the pathogen was first found in the nation鈥檚 dairy herds. None of the 167 samples, which included milk, ice cream, hard cheese, butter, cream cheese and aged raw milk cheese, contained viable H5N1 bird flu virus, the US Food and Drug Administration said. The results show pasteurized dairy remains safe to consume. (Vahanvaty, 8/13)

The U.S. Department of Agriculture said on Tuesday it will expand bird-flu testing of beef entering the food supply as part of its response to the ongoing outbreak among dairy cattle, adding that U.S. beef and dairy products remain safe to consume. USDA officials, in a call with reporters along with staff from other U.S. health agencies, said the tests will begin in mid-September and urged livestock workers to remain vigilant. (Douglas, 8/13)

On mpox 鈥

Mpox, the high infectious disease that used to be called monkeypox, has been declared a public health emergency in Africa by the continent鈥檚 top health body. Scientists from the Africa Centres for Disease Control and Prevention (Africa CDC) say they are alarmed by the speed at which a new strain of mpox has been spreading. Since the beginning of the year, more than 13,700 cases and 450 deaths have been recorded in the Democratic Republic of Congo. The virus, which can cause lesions across the whole body, has spread to other African countries, including Burundi, the Central African Republic (CAR), Kenya and Rwanda. (Jolaoso, 8/13)

There are two strains of mpox 鈥 clade I and clade II. Think of them as two big branches on a tree.Until about five or six years ago these clades weren鈥檛 that diverse. Something has changed. These branches are growing and the leaves on the branches are becoming more numerous. In fact, we have new subclades for both I and II, so two new offshoot branches have appeared. Clade II is far less dangerous with a case fatality rate of about 0.1%. In other words, roughly one person in a thousand dies. (Walter, 8/13)

Vaccines to help curb an escalating mpox outbreak in Democratic Republic of Congo and neighbouring countries may still not reach the central African country for months even as the World Health Organization considers following Africa鈥檚 top public health agency in declaring the outbreak an emergency. On Tuesday, Africa Centres for Disease Control and Prevention declared a public health emergency of continental concern for the first time ever, and on Wednesday, a WHO-led panel meets to decide if it represents a global threat. (Rigby, 8/14)

Also 鈥

The U.S. Food and Drug Administration has upgraded the recall of about two dozen candies and snacks sold at retailers including Target and Walmart to its highest level of health hazard. Shoppers will want to check their pantries because some of the products 鈥 recalled for potential salmonella contamination 鈥 have best-by dates into April 2025. (Snider, 8/13)

Environmental Health

PFAS Levels In New Moms Might Be Linked To Shorter Breastfeeding

The New Hampshire study results were driven largely by PFOA, or perfluorooctanoate. And in other PFAS news, Air Force lawyers who are fighting an EPA order to clean up contaminated drinking water in Arizona say the Supreme Court's recent "Chevron" ruling renders the agency's decision moot.

A recent study of New Hampshire mothers led by a Dartmouth researcher found that mothers with higher PFAS levels were at greater risk of stopping exclusive breastfeeding early. Experts recommend infants be exclusively breastfed for the first six months because of a number of health benefits. (Sullivan, 8/13)

On the environment and the military 鈥

Air Force lawyers are fighting an emergency order from the Environmental Protection Agency requiring the service to clean contaminated drinking water in Arizona, pointing to a recent Supreme Court ruling that restricts regulatory agencies as a justification to dodge the mandate. In a letter last month, lawyers for the Air Force argued that a landmark June decision by the court in Loper Bright Enterprises v. Raimondo 鈥 which reduced regulatory agencies' power by pushing authority to the courts to interpret ambiguous laws, referred to as "Chevron deference" 鈥 makes the EPA's order asking the service to clean contaminated water from the Tucson International Airport moot. (Novelly, 8/13)

Veterans who served at Karshi-Khanabad Air Base in Uzbekistan after Sept. 11, 2001, and have a chronic illness that isn't easily diagnosed are now eligible for expedited disability benefits from the Department of Veterans Affairs. The VA announced Friday that those who served at the installation, known as K2, and have symptoms similar to Gulf War Illness, which the VA calls "medically unexplained chronic multisymptom illness," have a presumptive condition that will make it easier for them to apply for disability compensation. (Kime, 8/13)

On extreme heat 鈥

Melted capsules. Cloudy insulin. Pills that may no longer work. Doctors and pharmacists say the scorching temperatures enveloping the country could be endangering people鈥檚 health in an unexpected way: by overheating their medications. Millions of Americans now receive their prescription medications through mail-order shipments, either for convenience or because their health plans require it. But the temperatures inside the cargo areas of delivery trucks can reach 150 degrees Fahrenheit in the summer, according to drivers 鈥 far exceeding the range of 68 to 77 degrees recommended by the national organization that sets standards for drug handling. (Baumgaertner, 8/13)

On a scorching May 2020 day that topped out at 95 degrees, Austin resident Jos茅 Mario Calles reported to his landscaping job. A lawsuit later filed by Calles鈥 family recounted what happened next: The 51-year-old, who financially supported his wife and kids in El Salvador, fainted. He was rushed to the hospital and spent two nights being treated for a heart condition and diabetes, both known to make people more vulnerable to heat. (Foxhall, Martinez, Schumacher, Baddour and Pskowski, 8/14)

Almost 500 million children will experience double the number of extremely hot days than their grandparents鈥 generation, the United Nations said, with harmful consequences for their health. Extremely hot days with temperatures exceeding 35C degrees (95F degrees) are increasing for nearly one-in-five children globally, many of whom lack access to infrastructure or services that would help them to cope, the United Nations鈥 Children鈥檚 Fund said in a statement on Wednesday. (Hoije, 8/14)

How does climate change affect mental health? 鈥

The mental health of adolescents and young adults has been on the decline and it鈥檚 partly because of 鈥渉armful megatrends鈥 like financial inequality, according to a new report published on Tuesday in the scientific journal The Lancet Psychiatry. The global trends affecting younger generations also include wage theft, unregulated social media, job insecurity and climate change, all of which are creating 鈥渁 bleak present and future for young people in many countries,鈥 according to the authors. The authors argue that mental health is not merely an individual issue to be tackled after someone becomes unwell; it is also necessary to focus collectively on the environmental, social, economic, political and technological changes that contribute to mental distress. (Caron, 8/13)

Prescription Drug Watch

White House Is Trying To Mitigate Increase In Medicare Drug Premiums

Read recent pharmaceutical developments in 麻豆女优 Health News' Prescription Drug Watch roundup.

One of President Joe Biden鈥檚 signature domestic achievements is set to cause a significant spike in Medicare premiums for millions of Americans just ahead of the November election. Now, his administration is preparing to dole out billions of dollars to private insurance companies to blunt the impact of the increase. The jump in premiums is a consequence of efforts to reduce what older Americans pay for prescription drugs, part of the 2022 Inflation Reduction Act. Insurance companies are on the hook for what patients used to pay and are raising drug plan premiums to make up the difference. (King and Lim, 8/13)

The confidential nature of the Biden administration's drug price negotiations has made the process and outcome of the long-sought Democratic policy goal something of a mystery. The administration is expected to announce the results of those negotiations this week, and there's plenty of speculation about the actual savings that will be realized starting in 2026 鈥 and how aggressive the Biden administration got on pharma in an election year. (Goldman, 8/14)

Mark Cuban plans to increase healthcare price transparency by making all future Mark Cuban Cost Plus Drug Co. partnership contracts public. During a conversation with Jon Stewart on "The Daily Show" Monday night, Cuban pivoted the conversation from the Dallas Mavericks to discuss his main priority: shaking up healthcare. (DeSilva, 8/13)

A聽study in Australia suggests the gut microbiomes of nursing home residents harbor hundreds of antibiotic resistance genes (ARGs), researchers reported yesterday in the Journal of Infection. (Dall, 8/13)

Perspectives: Pharmaceutical Testing Facility Gave Fraudulent Data. Why Didn't FDA Withdraw Approval?

Read recent commentaries about pharmaceutical issues.

When the FDA learned that a testing facility in India had submitted fraudulent data for more than 400 drugs (most of them generics), the agency should have withdrawn them from the market. Instead, it has allowed these drugs to continue to be prescribed and distributed for at least a year as the pharmaceutical companies retest them for equivalency to the original brand-name drugs. (Suzanne Robotti, 8/12)

Pharmacy benefit managers have been in the crosshairs of late, as the focus of media scrutiny, government investigations and reports, and proposed federal legislation. A few recent examples make the point: A New York Times story in June 2024 bore the headline, 鈥淧harmacy benefit managers are driving up drug costs for millions of people, employers and the government.鈥 (T. Joseph Mattingly II, David A. Hyman and Ge Bai, 8/12)

Pharmaceutical leaders face competing pressures. Their companies are expected to develop products that reduce the burden of disease and make the enjoyment of the highest attainable standard of health 鈥渙ne of the fundamental rights of every human being.鈥 (Fred D. Ledley, 8/7)

Editorials And Opinions

Viewpoints: Kamala Harris Needs To Discuss Her Health Care Plan; There's A Way To Combat Vaccine Hesitancy

Editorial writers examine these issues and more.

From the moment Kamala Harris became the presumptive Democratic nominee, Republicans have sought to paint her as a far-left California liberal. After all, they argue, she supported getting rid of private health insurance in her 2019 presidential campaign. But Ms. Harris didn鈥檛 seek to eliminate private insurance in 2019. (Jacob S. Hacker, 8/14)

In February 2021, I received my second Covid-19 shot 鈥 the newly developed vaccine that would eventually save millions of lives worldwide 鈥 with great anticipation. It proved to be a life-changing event: Two hours later as I was driving home, the shock of a sudden loud and high-pitched whistling nearly caused me to veer off the road. It was as if an audible dog whistle began blaring right next to me. But it wasn鈥檛 a dog whistle. It was the acute onset of tinnitus, a ringing in the ear with no external source. (Gregory A. Poland, 8/14)

The receptionist checking me in for an early morning medical appointment could not have acted more disinterested: no eye contact, few words and papers pushed at me with no explanation. Maybe she was just having a rough morning. But maybe she wasn鈥檛. (Mary Ellen Podmolik, 8/12)

It鈥檚 fair to say that if obesity has a stranglehold on America, it has a death grip on Black America. Nearly half of Black Americans 鈥 including almost 60 percent of Black women 鈥 are living with obesity, which kicks the door wide open to hundreds of other related conditions, including Type 2 diabetes, cardiovascular disease, stroke and high blood pressure. (Al Sharpton, 8/14)

At the start of the clinic where I see patients with colorectal, stomach, pancreatic, and other gastrointestinal cancers, I remarked to a colleague, 鈥淓very new patient on my schedule is under 45.鈥 She replied, 鈥淭hree of mine are 鈥 this is too many young people with cancer.鈥 We felt as though we were in the trenches and didn鈥檛 know where the bullets were coming from. (Nicholas DeVito, 8/14)

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