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Inappropriate Diagnosis of Pneumonia Common in Hospitalized Adults

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Inappropriate diagnosis of community-acquired pneumonia (CAP) in hospitalized adults is common, especially among older adults and those with dementia, according to a study published online March 25 in JAMA Internal Medicine.

Ashwin B. Gupta, M.D., from the VA Ann Arbor Healthcare System in Michigan, and colleagues conducted a prospective cohort study to characterize inappropriate diagnosis of CAP in hospitalized patients across 48 Michigan hospitals. Hospitalized patients treated for CAP between July 1, 2017, and March 31, 2020, were retrospectively assessed.

The researchers found that 12.0 percent of the 17,290 hospitalized patients treated for CAP met criteria for inappropriate diagnosis, and of these, 87.6 percent received full antibiotic courses. Patients inappropriately diagnosed were older (adjusted odds ratio, 1.08 per decade) and were more likely to have dementia or altered mental status on presentation (adjusted odds ratios, 1.79 and 1.75, respectively) compared with patients with CAP. The 30-day composite outcomes for full versus brief antibiotic treatment did not differ among those inappropriately diagnosed. Compared with brief duration of antibiotic treatment (no more than three days), full antibiotic treatment was associated with antibiotic-associated adverse events (2.1 versus 0.4 percent).

Woman who is ‘allergic to everything’ can only eat oatmeal and baby milk

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Caroline has MAST syndrome which means she cannot eat a lot of foods, and relies on oatmeal and infant milk three times a day. It comes after she ended up in hospital after eating ice-cream in 2017

A woman who is “allergic to everything” can only eat oatmeal – and says most foods could prove deadly.

In September 2017, 24-year-old Caroline Cray spent 12 hours in hospital after she ate an ice-cream and went into anaphylactic shock. She had three more severe allergic reactions that month to bread and pizza. After eating rice and beans with her family, Caroline reacted again and spent 12 days in intensive care.

After 10 months of tests, she was diagnosed with rare chronic illness mast cell activation syndrome (MCAS) – which causes repeated severe allergy symptoms – in May 2018. She now has a diet that consists of just oatmeal and EleCare – an amino-based acid infant milk – and says everyday things such as fish, peanuts, nuts, sesame and mustard could prove deadly.

Caroline, a health care recruiter, Boston, Massachusetts, US, said: “I am at the point where my diet is only EleCare and oatmeal. I will have that for three meals a day and I only eat three times a day as I have to self-medicate beforehand.

“It is really tough – you don’t think about food at all when you can eat normally. With a limited diet, I have realised that culture is all about food. I don’t rule myself out of things though, I sit down and eat with my family every night. I will go out for meals but I bring my own food and I will go for nights out and take a water bottle.”

After a string of anaphylactic shocks in September 2017, Caroline claims she was initially told her allergies would likely disappear within months. She said: “In the fall when I was having the repeated shocks, my allergist and ER doctors were under the assumption that my reactions would only last a few months.

“They put me on antihistamines and they got me in to see a specialist. It was really discouraging that a few months later I was really sick. Every day I was wondering if I was going to end up in the hospital, I had a really tight throat, and I was itchy and wheezing.”

After a 10-month wait, Caroline was diagnosed with MCAS in May 2018. She said: “I was emotional which was very surprising for me.

“I am a very cut and dry person but me and my mum, Julie, 59, were both crying. It was validating that someone was finally like ‘this is a chronic illness and we need to treat it as one.’ It was 90 per cent relief and 10 per cent ‘oh god I will live with this the rest of my life.'”

Caroline has to take a concoction of medication including xolair shots every 14 days, daily antihistamines and hizentra every seven days. She also avoids foods like nuts, kiwi, sesame and mustard.

She said: “My diet consists of oatmeal and EleCare – my biggest trigger is the process of eating and digesting food. I am currently meeting with my MCAS therapist to try trailing different foods. I will try single foods one by one so if I have a reaction we know exactly what it is to.”

Caroline said she doesn’t rule herself out of family meals of nights out with friends despite her very restricted diet.

“Weirdly enough I don’t mind it, not everyone drinks or cares that you’re not drinking,” she said.

“The fact you’re not eating the same food in the restaurant is more noticeable, especially when I open my Tupperware. When I go on nights out, I am always the designated driver, I can fill people in on what has happened the night before. I have turned that into one of my favourite things, I tell my friends I get second-hand drunk from them.”

Ally Financial Welcomes Michael G. Rhodes as CEO and Board Member

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In a significant announcement, Ally Financial Inc. (NYSE: ALLY) revealed that Michael G. Rhodes is set to assume the role of Chief Executive Officer, commencing April 29, 2024. Simultaneously, Rhodes will join Ally’s esteemed board of directors.

Rhodes assumes leadership from Jeffrey J. Brown, who concluded his tenure in January 2024 after nearly nine years as CEO. Doug Timmerman, Ally’s President of Dealer Financial Services, has been serving as interim CEO since Brown’s departure.

With a robust background spanning over 25 years in retail and consumer banking, Rhodes brings a wealth of expertise in digital, data, and technology strategies, poised to fuel Ally’s evolution.

Prior to his tenure at Ally, Rhodes served as CEO of Discover Financial Services, where he spearheaded transformative initiatives and sat on the company’s board. His illustrious career includes pivotal roles at TD Bank, Bank of America, and MBNA America Bank, culminating in a profound understanding of the financial landscape.

Expressing his enthusiasm, Rhodes extolled Ally’s pioneering strides in digital banking and automotive finance, emphasizing the bank’s adeptness in leveraging technology to craft bespoke financial solutions in line with its ‘Do It Right’ ethos. He eagerly anticipates collaborating with Ally’s 11,000-strong workforce to propel the bank’s strategic agenda forward.

Chairman of the Board of Ally Financial, Franklin Hobbs, lauded Rhodes’ appointment, citing his multifaceted experience and steadfast commitment to driving value for stakeholders. Hobbs underscored Rhodes’ acute understanding of fostering a motivated workforce, which is crucial for sustaining organizational missions.

Rhodes holds an MBA from the Wharton School at the University of Pennsylvania and an undergraduate degree in engineering from Duke University, further enriching his credentials. Notably, he currently serves on Duke University’s Board of Trustees.

Reminder: It is a holiday-shortened week for a number of markets

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Given the holiday, we should see market conditions take on a quieter look and feel to end the week tomorrow. US markets will be open though, so it isn’t a complete shutdown. During which, we will get the PCE price index and also an appearance by Fed chair Powell here. But more importantly, Japanese markets will also be open and that might be the big one to watch.

After several warnings already yesterday, could Japanese officials deliver an Easter surprise before the weekend? Times of lesser liquidity are always most preferred, so just be mindful of that.

USD/JPY has backed off after attempting to contest the 2022 and 2023 highs near 151.90-94 yesterday. The pair is now trading little changed today at 151.35. However, if Tokyo decides to sit on their hands when most markets return to action on Tuesday next week, I reckon the bulls might find some courage to work towards the above highs again.

Kwik Trip discontinues bagged milk after more than 40 years

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Kwik Trip convenience stores won’t be as convenient for buyers of bagged milk. The company announced it’ll stop selling Nature’s Touch bagged milk after carrying the product for more than 40 years in its stores.

Kwik Trip saw a significant decline in sales of bagged milk compared to milk in jugs.

“This is an end to a product that was associated with the Kwik Trip brand for many years, but after evaluating the need and cost for new equipment to replace our antiquated bagged milk equipment, and the decreased customer demand, we made the tough decision to discontinue Nature’s Touch milk in the bag,” John Hughes, Kwik Trip’s vice president of external relations, said.

McHugh said the marketing department has contacted groups who used special promotional coupons for bagged milk and is offering solutions with Kwik Trip’s other milk products. Kwik Trip CEO Scott Zietlow says the company will focus on items that “resonate more strongly with our guests.”

Bagged milk will disappear from stores beginning in May.

New York Yankees take on Houston Astros on MLB Opening Day 2024. Here’s what to know

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HOUSTON — The Yankees begin their quest for a 28th World Series championship — and first since 2009 — when they take on the Houston Astros in the opener of a four-game series at 4:10 p.m. on Thursday at Minute Maid Park.

Juan Soto will make his debut for the Yankees after being acquired in a 7-player trade with the San Diego Padres in the offseason.

On the mound, Nestor Cortes will start for New York against Houston’s Framber Valdes. Reigning AL Cy Young Award winner Gerrit Cole suffered an elbow injury in spring training and will start the season on the injured list.

By position, the Yankees’ opening day starters are expected to be:

Catcher: Jose Trevino

First base: Anthony Rizzo

Second base: Gleyber Torres

Shortstop: Anthony Volpe

Third base: Oswaldo Cabrera

Outfield: Alex Verdugo (left), Aaron Judge (center), Soto (right)

Designated hitter: Giancarlo Stanton

The Yankees are 82-40-1 all-time on opening day, including wins in six of their last seven, while the Astros are 33-29.

The Yankees have won five of their last seven meetings with the Astros in the regular season, but Houston defeated New York in the AL Championship Series in 2017, 2019 and 2022.

The opener and the series finale will be broadcast on the YES Network, the second and third games will air on Apple TV+ and FOX, respectively. To see the Yankees’ full regular season game and TV schedule, please click here.

After this series in Houston, the Yankees start a three-game set in Arizona against the Diamondback before taking on the Toronto Blue Jays in the home opener at Yankee Stadium on April 5.

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Stewart Thalblum grew up around the Oakland Athletics as the son of the visiting clubhouse manager.

Now the 21-year-old is pondering the next phase of his life as he prepares for another season as a batboy for the A’s.

“It’s just gone by so fast, working all these seasons and grinding them through,” Thalblum said. “I look up, and I’m like, ‘This is the end.’”

Thalblum lives in the Bay Area and has been a batboy since he was 18, but handling some sort of duty at Oakland Coliseum since he was 8 because his dad, Mike Thalblum, has worked for the A’s since before he was born.

The younger Thalblum also goes to spring training in Mesa, Arizona, where he is wrapping his second stint of roughly six weeks in a full spring with the A’s.

Thalblum says what fans see — batboys in the team’s uniform running to and from home plate while handling other responsibilities around dugouts during games — is a small portion of their day.

The typical day at spring training for Thalblum starts around 7 a.m. and ends roughly 12 hours later. Batboys help take care of food and laundry, and maybe run errands for players. Basically, whatever the players need.

“Our goal is to make sure that when they show up at the ballpark every day, all they have to do is focus on playing baseball,” Thalblum said.

When the A’s break camp, there will be exhibition games at home and across the bay in San Francisco, where Thalblum says he also works when the A’s play there. Then the first seven games of the regular season will be at Oakland Coliseum.

“I did the math the other day,” Thalblum said. “By the time the team goes on the road for the first time in early April, it’s going to be 49 out of 51 days straight for me.”

Thalblum played high school baseball, and since then, he’s been an online student at Arizona State. He’s graduating this year with a degree in sports business and would love to work in the front office of the A’s — even after the team moves to Las Vegas, assuming that deal goes all the way through.

His status as an online student gives Thalblum the flexibility to go to spring training with the A’s, but don’t mistake that for making it easier to juggle both.

“It’s a big time management thing,” Thalblum said. “It’s a lot of late nights for me. It’s going to be worth it, and I’m already seeing it pay off.”

Thalblum isn’t sure, but guesses he is slightly younger than the average batboy. Joseph Ortiz is a 27-year-old who lives in Los Angeles and is working as a batboy for the Dodgers in Arizona this spring.

For Thalblum, it’s a chance to be around a team he grew up loving, and create relationships with players that can last well beyond his time as a batboy.

“It’s getting to know these players as people,” Thalblum said. “These guys are people first, and their job just happens to be playing baseball.”

Bracket revealed for 2024 NCAA men’s hockey tournament

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The road to the Frozen Four has been paved.

After the 16-team field for the 2024 NCAA men’s hockey tournament was finalized on Saturday, the official matchups and schedule were released on Sunday during ESPN’s selection show.

Boston College secured the No. 1 overall seed, followed by Boston University as the second seed, the University of Denver as the third, and Michigan State as the fourth, making them the top seeds in their respective regionals.

In regional play, the No. 1 seed faces the No. 4 seed, while the No. 2 seed competes against the No. 3 seed. The winners of those matchups then advance to face each other in another regional game, with that winner then moving on to the Final Four.

Regional play begins on Thursday and concludes on March 31. The Frozen Four will take place April 11-13 at Xcel Energy Center in St. Paul, Minnesota.

Several top prospects for the 2024 NHL Draft will be featured in the tournament, including projected first-overall pick Macklin Celebrini of Boston University. Other featured prospects from Sportsnet’s latest draft rankings include Artyom Levshunov (Michigan State) and Zeev Buium (Denver).

The 16 teams also feature many prospects already drafted to the NHL, such as Anaheim Ducks prospect Cutter Gauthier (Boston College); Arizona Coyotes prospect Michael Hrabal (UMass); Columbus Blue Jackets prospect Gavin Brindley (Michigan); Chicago Blackhawks prospects Frank Nazar (Michigan), Oliver Moore (Minnesota) and Sam Rinzel (Minnesota); Minnesota Wild prospect Charlie Stramal (Wisconsin); San Jose Sharks prospect Will Smith (Boston College); Washington Capitals prospect Ryan Leonard (Boston College) and Winnipeg Jets prospect Rutger McGroarty (Michigan).

Isiah Kiner-Falefa on his favorite moment during Yankees tenure

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TAMPA — In the wake of DJ LeMahieu’s bone-bruised foot jeopardizing his Opening Day availability, the Yankees probably could use a Gold Glove third baseman like the one they played all over the field last season.

But Isiah Kiner-Falefa is now with the Blue Jays on a two-year, $15 million pact after two odd seasons in The Bronx that featured boos, a disappointing stint at shortstop and a rarely seen recovery, in which a player the fans turned on won back much of that fan base.

When Kiner-Falefa looks back on his two years with the Yankees, the first memory that comes to mind is not the 2022 jeers.

His mind does not go immediately to a strange 2023, when he was a rare bright spot playing just about everywhere for a team that disappointed.

The moment that jumps out occurred June 14 of last year when he kept edging off third base against the Mets, and reliever Brooks Raley didn’t see him.

Kiner-Falefa took off and stole home, the first Yankee to do so in nearly seven years.

“I loved stealing home,” Kiner-Falefa said this weekend before the Yankees beat his Blue Jays, 10-9, at Steinbrenner Field. “That Subway Series felt bigger than any playoff game I’ve played.”

Kiner-Falefa grew up a Yankees fan in Hawaii and lived his actual dream, becoming the club’s shortstop in 2022 after a March trade, but he struggled defensively and did not hit enough as he became a focal point of fan anger.

Kiner-Falefa eventually lost his spot during the playoffs, and Anthony Volpe took over the following season.

Yet, Kiner-Falefa went from enemy to fan favorite as he transitioned to a super-utility player who proved he can handle any infield or outfield spot.

He played most often in center field but saw time everywhere besides catcher and first base.

For an offense that underwhelmed in virtually every facet, Kiner-Falefa was solid if not spectacular (.646 OPS in 113 games) while consistently making contact — a rare trait on the team.

“Biggest blessing ever, man,” a bearded Kiner-Falefa said about his time with the Yankees. “Having the experience to play in New York is just — it goes so far. Things that maybe I would learn in five, 10 years, I was able to learn in two years with that experience. … Being able to learn from those guys has helped me so much.”

Kiner-Falefa is playing with a Toronto team with a younger batch of stars and a more open path toward playing time.

IKF said he is getting reps all over, but it is appearing as if he will be the everyday third baseman.

Saturday made for a very New York-tinged scene, as he and non-roster invite Eduardo Escobar took turns at third base before the game, throwing across the diamond to non-roster invite Daniel Vogelbach.

After a 2023 season that he appreciated but was filled with sporadic playing time, Kiner-Falefa is happy.

“It’s nice to get in the lineup,” IKF said. “That’s the biggest thing for me, is just getting a chance. I’m pretty excited.”

Rays acquire C Ben Rortvedt from Yankees in 3-team deal

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The Tampa Bay Rays have acquired catcher Ben Rortvedt from the New York Yankees as part of a three-team trade that also involved the Miami Marlins. The Rays will be sending outfielder Shane Sasaki, who was recently voted the 27th best prospect in the system by the Draysbay community, to the Marlins; meanwhile, the Marlins and Yankees are swapping infielder Jon Berti for pitcher John Cruz.

Considered an elite defender, Rortvedt has gotten limited playing time over the last two seasons — 2022 with the Twins, and following a trade, 2023 with the Yankees — due to various injuries. He’s got serious power, having topped out at 111 mph EV, and is generally a low-chase, pull hitter from the left side.

Rortvedt is out of minor league options, but appeared to be third on the Yankees depth chart after former first rounder Austin Wells and the return of former primary catcher Jose Trevino from injury. NJ.com interviewed Yankees director of catcher Tanner Swanson, a former Twins coach who was an early adopter of coaching one-knee down and pitch framing, on Rortvedt’s situation earlier this week: