Latest news with #CCH
Medscape
02-07-2025
- Health
- Medscape
Erenumab Not Effective for Chronic Cluster Headache
TOPLINE: Preventive treatment with the calcitonin gene-related peptide (CGRP) receptor monoclonal antibody erenumab for 6 weeks was not associated with significant reductions in weekly headache attacks, pain severity, or attack duration in adults with chronic cluster headache (CCH), a new phase 2 placebo-controlled trial showed. METHODOLOGY: The CHERUB01 phase 2 12-week, double-blind, placebo-controlled randomized clinical trial was conducted at 11 sites in Germany between 2021 and 2023. About 81 adults with CCH (mean age, 49 years; 74% men) who failed to respond to standard prophylactic therapies were randomly assigned to receive either subcutaneous erenumab (280 mg at baseline, followed by 140 mg at week 4) or a matching placebo. The primary endpoint was change in the mean number of weekly CH attacks from baseline to weeks 5 and 6. Secondary endpoints included the proportion of patients achieving a ≥ 50% reduction in attacks and the number of participants with Patient Global Impression of Improvement (PGI-I) scores of 1 or 2 at week 6. Exploratory endpoints included reduction in CH attack duration and change in mean pain severity on the numeric pain rating scale. TAKEAWAY: The primary endpoint was not met. Although there was a greater reduction in the mean number of weekly attacks for the erenumab group compared to the placebo group, the difference was not statistically significant (-7.3 vs -5.9 attacks per week; 95% credible interval, -5.7 to 2.8). There was no significant difference between groups in the proportion of participants achieving a ≥ 50% reduction in weekly attacks, the number of patients with improved PGI-I scores, changes in attack duration, or change in pain severity. Adverse events were more common in the erenumab group compared to the placebo group (66% vs 43%), with most considered to be mild or moderate. IN PRACTICE: 'Erenumab failed to show a benefit over placebo in patients with CCH, indicating that blockade of peripheral CGRP receptors has no beneficial role in the prophylaxis of CCH,' the investigators wrote. 'To date, all double-blind controlled trials in CCH using an mAb affecting the CGRP pathway were negative, leading to the conclusion that future research should revisit the role of CGRP in CCH,' they added. SOURCE: This study was led by Jasper Mecklenburg, MD, Charité – UniversitätsmedizinBerlin, Berlin, Germany. It was published online on June 17 in JAMA Network Open. LIMITATIONS: Data on patients who progressed from episodic headache to CCH were missing. Additionally, the onset timing of current CCH episodes was unclear, with no detailed records of past steroid responses or reasons for prior treatment failures with verapamil or lithium, which relied on patient recall. DISCLOSURES: This trial was funded by a grant from Novartis Pharma GmbH to Charité – UniversitätsmedizininBerlin. Several investigators reported having financial ties with various sources including the funding company. Full details are listed in the original article. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
CBS News
20-06-2025
- Health
- CBS News
Flaring at Martinez refinery prompts community notification
Flaring at the Martinez Refinery Company early Friday morning prompted a company report to health officials and a subsequent community alert. The refinery said it reported a Level 1 Community Awareness Message to Contra Costa Health at 5:47 a.m. because of the flaring. Following the message, CCH issued a notification telling residents, "You may hear, smell, or see signs related to this event; however no action is required." Flaring at a refinery is a controlled burning of excess or waste gases, primarily hydrocarbons, done as a safety measure to prevent pressure buildup and potential explosions. MRC said that flaring events "are an essential part of a refinery's integrated, engineered safety systems, which are designed to safely manage excess gases and pressure through efficient, effective combustion." In February, a fire at the refinery injured six workers and burned for three days, prompting the refinery to shut down all operations. Earlier this month, an independent report on the fire was released, indicating a lack of qualified contract workers, inadequate training and supervision, and California regulatory issues were among factors leading to the fire. In April, the refinery began restarting some of its process units shut down because of the fire and MRC said it hopes to rebuild the damaged unit and reopen it by the fourth quarter of this year. CCH offers more information on flaring and hazardous materials releases at MRC also provides additional information on flaring at
Chicago Tribune
18-06-2025
- Health
- Chicago Tribune
Cook County preparing for $211M budget deficit for 2026
Cook County is predicting a $211.4 million budget shortfall for 2026, a relatively modest gap that officials said was more of an estimate than usual thanks to extraordinary uncertainty coming out of Washington. County Board President Toni Preckwinkle, who has been able to boast budgets free of taxes, fees or layoffs for the last several years, told reporters at a Tuesday briefing that the 2026 projection is the most 'problematic,' and cautioned that 'this is our best guess.' The county is expecting a general fund shortfall of $102.6 million, thanks mostly to higher wages and fringe benefits when its current contracts with union employees expire. Its health fund, meanwhile, is projecting a $108.8 million deficit thanks to a significant drop in patient revenues. Among the biggest long-term potential threats: how Congress ultimately decides the fate of Medicaid, which has helped prop up the finances of Cook County Health; and various federal grants President Donald Trump targeted with an avalanche of executive orders. The budget proposal that passed the U.S. House — but not yet the full Senate — cuts Medicaid by at least $625 billion over the next decade. As it stands, most of the biggest impacts would not hit until the county's 2027 budget, but health leaders say they are planning their response now. New proposed work requirements and more frequent checks to determine whether people qualify for Medicaid would begin at the very end of 2026, and cost an estimated $88 million in patient fees, according to county estimates. The beginning of a provision meant to curtail the Medicaid program helping immigrant seniors would start in October 2027, according to the county. Ending that Health Benefits for Immigrant Seniors program would mean a $50 million drop in patient fee revenue for the county. The state is already sunsetting its health care program for immigrant adults, which is expected to cost the county $5.5 million in net patient service revenues through the end of this year. Cuts to covered health care typically means the CCH, a safety-net hospital, ends up providing tens of millions of dollars of uncompensated care to people without insurance at its emergency rooms and clinics. CCH plans to enroll patients previously covered by the state's immigrant adult program in its CareLink program, which covers 100% of primary and specialty care, hospital care and imaging costs for the next year, a spokeswoman said. Even without federal concerns, the county is expecting other costs to rise, since several union contracts expire in November, opening up bargaining countywide. During the last round of bargaining, the county granted retroactive 3.5% pay increases dating back to 2021 and a 5% raise in 2025. And a pending lawsuit from road builders over the county's spending of 'lockbox' money on public safety offices could affect the bottom line of the general fund. Last year, the projected shortfall mostly took care of itself by the time fall budget season rolled around. Revenues were higher than expected, closing most of the $218 million projected gap. The county is expecting some cushion. Its main general fund is projected to end this year with a $145 million surplus, thanks to a dip in payroll costs and better-than-expected sales tax revenues thanks to a closed loophole involving online sales. Preckwinkle's finance team policy is not to use that money to plug the next year's gap, but officials said they might use the money to keep paying for programs and positions at risk of being cut if federal grants end. As federal pandemic aid dollars dwindle, Preckwinkle's team has also narrowed its list of programs it might extend after 2026, the county's deadline for spending its total $1 billion allocation. It would cost about $100 million a year to keep 19 programs — ranging from lead pipe removal and brownfield remediation to violence prevention and medical debt relief — going. The county has set aside $166 million in a 'reserve' fund to help pay for those, meaning officials must either cut down on its offerings or find another $255 million to keep them running. Preckwinkle will make her budget proposal on Oct. 9, with a final vote scheduled for Nov. 20.
CBS News
04-06-2025
- Business
- CBS News
Report: Martinez refinery fire caused by inadequate training and monitoring of contractors, California workplace rules
A new report on the fire and chemical release at the Martinez Refinery Company in February blames inadequate training and supervision of contractors, as well as regulatory hurdles that created a lack of qualified workers. Contra Costa Health hired an independent firm to perform a root cause analysis to determine why the fire happened and how it can be prevented from happening again. The Feb. 1 fire lasted for three days, injured six workers, and emitted a host of harmful chemicals, prompting a shelter-in-place alert and public health advisory for the surrounding communities. Consultant JEM Advisors was set to present the report to the CCH's Martinez Refining Company Oversight Committee at its meeting on Tuesday. The report determined that the fire at MRC began when workers mistakenly opened a flange on the wrong side of an isolation valve during maintenance work, leading to the release of hydrocarbon material, which quickly caught fire. Contractor issues resulting from California workplace rules The report concluded that the root cause of the fire was inadequate oversight of the operations and work of the contractors, who had limited organizational capability to perform the work. Their limited capability required increased monitoring and operator oversight, the report said. The report also listed four contributing causes, one of which was regulatory restrictions due to California Senate Bill 54, passed in 2013, and co-employment rules included in Assembly Bill 5, passed in 2019. SB 54 requires companies to use source contractor manpower from local union halls, meaning personnel experienced in refinery unit maintenance from other locations cannot be used, and experienced workers are more difficult to find, the report said. Meanwhile, co-employment rules for contractors prevent MRC from approving contractor safety plans and providing safety training directly to contractors. Instead, the rules require sharing such safety training with contractor company leaders, "with the expectation that contractor employees are fully trained in these prior to working on the refinery site," according to the report. "As a result of these two regulations, there is now a higher likelihood for human errors entering into maintenance work performed by contractor resources," the report stated. Other contributing causes were faulty work procedures, inadequate contractor training because of co-employment rules, and inadequate or missing contractor supervision. Among the issues affecting contractors' ability to perform was the small font on work permits, making them difficult to read, and inadequate procedures to mark or tag locations where work is to be done. Smoke billows from the Martinez Refining Company in Martinez, Calif., on Feb. 1, 2025, during a fire. Tony Hicks/Bay City News Previous incidents at the Martinez Refinery Company New Jersey-based BPF Energy acquired MRC from Royal Dutch Shell in 2020. Since then, there have been three major incidents at the refinery as well as other spills and chemical releases. On Thanksgiving Day in 2022, the refinery mistakenly released more than 20 tons of chemicals into the air, covering cars and homes in metallic dust. In July 2023, the refinery spewed petroleum coke dust, also known as petcoke, prompting a hazardous materials investigation. In February, CCH said the chemicals and combustion byproducts from February's fire and release included those that can cause cancer, and heart and lung disease. In a statement issued at the time, county health director Dr. Ori Tzvieli said it was fortunate the wind blew most of the toxic smoke north of the refinery and away from populated areas. "This could have been much worse," Tzvieli said. "We got lucky this time. But our community shouldn't have to rely on luck." CCH said in February that concentrations of chemicals in the air from the fire were mostly below the threshold considered dangerous, but there was a brief period when the particulate matter near the refinery was at a high level. The agency said it was working with toxicologists to determine whether there were any long-term health impacts from the release, including potential impacts to soil and water. The report from JEM Advisors said MRC has already implemented some changes recommended in the report, such as increasing company personnel presence during contractor maintenance work and reinforcing adherence to existing procedures. Other recommendations include increasing operations oversight, closely reviewing and endorsing safety assessment permits to ensure contractors are aware of risks, and providing consequences for poor performance as well as for excellence.
CBS News
03-06-2025
- Business
- CBS News
Report: Martinez refinery fire caused by inadequate training and monitoring of contractors, regulatory issues
A new report on the fire and chemical release at the Martinez Refinery Company in February blames inadequate training and supervision of contractors, as well as regulatory hurdles that created a lack of qualified workers. Contra Costa Health hired an independent firm to perform a root cause analysis to determine why the fire happened and how it can be prevented from happening again. The February 1 fire lasted for three days, injured six workers, and emitted a host of harmful chemicals, prompting a shelter-in-place alert and public health advisory for the surrounding communities. Consultant JEM Advisors was set to present the report to the CCH's Martinez Refining Company Oversight Committee at its meeting on Tuesday. The report determined that the fire at MRC began when workers mistakenly opened a flange on the wrong side of an isolation valve during maintenance work, leading to the release of hydrocarbon material which quickly caught fire. The report concluded that the root cause of the fire was inadequate monitoring of the operations and work of the contractors, who had limited organizational capability to perform the work. Such limited capability required increased operator oversight, the report concluded. The report also listed four contributing causes, one of which was regulatory restrictions due to California Senate Bill 54, passed in 2013, and co-employment rules included in Assembly Bill 5, passed in 2019. SB 54 requires companies to use source contractor manpower from local union halls, meaning personnel experienced in refinery unit maintenance shutdowns from other locations cannot be used and experienced workers are more difficult to find, the report said. Meanwhile, co-employment rules for contractors prevent MRC from approving contractor safety plans and providing safety training directly to contractors. Instead, the rules require sharing such safety training with contractor company leaders, "with the expectation that contractor employees are fully trained in these prior to working on the refinery site," according to the report. "As a result of these two regulations, there is now a higher likelihood for human errors entering into maintenance work performed by contractor resources," the report stated. Other contributing causes were faulty work procedures, inadequate contractor training because of co-employment rules, and inadequate or missing contractor supervision. Among the issues affecting contractors' ability to perform was the small font on work permits, making them difficult to read, and inadequate procedures to mark or tag locations where work is to be done. Smoke billows from the Martinez Refining Company in Martinez, Calif., on Feb. 1, 2025, during a fire. Tony Hicks/Bay City News New Jersey-based BPF Energy acquired MRC from Royal Dutch Shell in 2020. Since then, there have been three major incidents at the refinery as well as other spills and chemical releases. On Thanksgiving Day in 2022, the refinery mistakenly released more than 20 tons of chemicals into the air, covering cars and homes in metallic dust. In July 2023, the refinery spewed petroleum coke dust, also known as petcoke, prompting a hazardous materials investigation. In February, CCH said the chemicals and combustion byproducts from February's fire and release included those that can cause cancer, and heart and lung disease. In a statement issued at the time, the county health director said it was fortunate the wind blew most of the toxic smoke north of the refinery and away from populated areas. "This could have been much worse," county health director Dr. Ori Tzvieli said. "We got lucky this time. But our community shouldn't have to rely on luck." CCH said in February that concentrations of chemicals in the air from the fire were mostly below the threshold considered dangerous, but there was a brief period when the particulate matter near the refinery was at a high level. The agency said it was working with toxicologists to determine whether there were any long-term health impacts from the release, including potential impacts to soil and water. The report from JEM Advisors said MRC has already implemented some changes recommended in the report, such as increasing company personnel presence during contractor maintenance work and reinforcing adherence to existing procedures. Other recommendations include increasing operations oversight, closely reviewing and endorsing safety assessment permits to ensure contractors are aware of risks, and providing consequences for poor performance as well as for excellence.
