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Medical residents increasingly seek training in states without abortion bans

Ash Panakam is about to graduate from Harvard Medical School. She’s from Georgia and always assumed she would return to the South for her residency. But the Supreme Court’s 2022 decision overturning the nationwide right to abortion changed everything.



“Ultimately I shifted my selection pretty drastically,” she said. “I was struggling to find a residency program in the South where I could still get the training I consider fundamental to the skill set needed to be an OB/GYN.” Instead of going home to Georgia, she’s headed to Pittsburgh to start her medical residency this summer. Panakam has plenty of company.
For the second year running, fewer graduating U.S. medical students applied for residency training in states with abortion bans or restrictions than in the previous year, according to data from the Association of American Medical Colleges. (Overall applications were down slightly, because students are being urged to apply to fewer programs, but the decrease was markedly larger in states where abortion is illegal or significantly restricted.)
It’s not just obstetrician-gynecologists; the decline crosses specialties, including those that don’t serve primarily pregnant patients. That could threaten the future of the overall medical workforce in states with bans, because doctors tend to locate permanently where they do residencies.



“The geographic misalignment between where the needs are and where people are choosing to go is really problematic,” said Debra Stulberg, who chairs the Department of Family Medicine at the University of Chicago. “We don’t need people further concentrating in urban areas where there’s already good access.”
The concerns of graduating medical students extend beyond their ability to practice medicine; they’re also worried about their own health, or that of their partners. “People don’t feel safe potentially having their own pregnancies living in those states,” Stulberg said.


“I feel some guilt and sadness leaving a situation where I feel like I could be of some help,” said new medical school graduate Hannah Light-Olson, who will leave Nashville for OB/GYN training at the University of California at San Francisco this summer. “I feel deeply indebted to the program that trained me, and to the patients of Tennessee.”



It's not that residency programs are going unfilled. There are still more graduating students from medical schools both in the United States and abroad than there are residency slots. But Beverly Gray, an associate professor of obstetrics and gynecology at Duke University School of Medicine, worries that abortion restrictions impact “whether we have the best and brightest coming to North Carolina.”
Residents in states where abortion is banned will still get training in abortion techniques, which are also used for miscarriages and other conditions. But to train on the procedures they’ll have to leave the state. And some students worry the training won’t be sufficient.
“I would rather have not become an OB/GYN than not be trained as a good one,” said Laura Potter, who is moving from medical school at the University of California at Davis to residency at Mass General Brigham in Boston.



But there are students choosing to train in states with abortion restrictions to make sure patients there get the care they need. And others hope to relocate to those parts of the country after their training — including Panakam.
“Long term, I still hope to practice in the South,” she said. “But at this point in my professional journey, it’s a little too early for me to restrict my training in any meaningful way.”

“lack of personnel”

Houston’s police chief has resigned after emails obtained by a local news outlet appear to show that he knew about massive failures in the department well before he said he did. Within hours of issuing a statement about the findings, he resigned.

In February, Houston Police Chief Troy Finner first announced that the Houston Police Department dropped 264,000 crime reports, including violent crimes and sexual assaults, which weren’t investigated because a “lack of personnel” code was assigned to them, The Center Square reported.

In March, new Houston Mayor John Whitmire appointed an independent panel to review an internal HPD investigation into how the hundreds of thousands of criminal incident reports fell through the cracks. When Finner apologized at a news conference for the code being used, he said he first learned of its use in November 2021. He also said he told his senior leadership team to make sure it was no longer used.

According to a report by KHOU 11 News, Finner appears to have known about the HPD’s code use in July 2018 when a report was filed about an April 2018 hit-and-run “road rage” incident.

“The newly surfaced email contradicts what Finner has repeatedly said publicly since the scandal broke this year,” KHOU 11 News reported. “At news conferences on Feb. 22 and March 7, Finner said that November 2021 was the first time he was aware of the code being used. The chief repeated that claim April 2, during a 2-hour off-camera availability with the media and community leaders.”

Finner issued a statement in response, in part saying, “I have always been truthful and have never set out to mislead anyone about anything, including this investigation. Until I was shown the e-mail... I had no recollection of it. Even though the phrase ‘suspended lack of personnel’ was included in this 2018 e-mail, there was nothing that alerted me to its existence as a code or how it applied within the department.”

Hours later, he submitted his resignation to Mayor John Whitmire, who accepted it. Whitmire sent a notification to HPD that he had accepted Finner’s immediate resignation and had appointed Larry Satterwhite as Acting Chief of Police on May 8.

The next day, Whitmire held a news conference to address the issue, saying, “I was sick when I saw the recent email, but I don’t have time to be sick. I have to protect this city and lead, and it can’t be driven by personality.”

He also noted the code had been used under four police chiefs, saying he was “shocked” and “cannot believe that it goes over 200,000 incidents that are not being reviewed and someone didn’t yell ‘fire,’ or come before this council, or talk.”

The lack of violent crime investigations and dropping crime reports, Whitmire has said, likely skewed crime data, meaning the crime rate for the city was actually higher than reported. The previous mayor and Finner had claimed crime in the state’s largest city was declining despite daily news reports indicating the opposite.

“The unreported crimes that go on in the city are striking, that’s the reason I have questioned the crime reports,” Whitmire said.

Whitmire, who has made fighting crime a priority of his administration, began reversing the political logjam of his predecessor within his first few days in office. Since then, he is advocating for the city hiring more police officers and prioritizing helping victims of crime.

“We’ve got to get back to crime fighting, we’ve got to get out of the press, we’ve got to have the officers have good morale,” he said.

Polling has shown that crime is the top priority of Houston voters. More than half polled say the city was “headed in the wrong direction” before Whitmire was elected.

EV fleet Ryder Report

Transitioning conventional truck fleets to electric vehicles (EVs) pushes up annual operational costs, which subsequently increases economic inflation, according to a recent report from transportation and logistics firm Ryder.

Florida-based Ryder analyzed the potential cost of transportation if internal combustion engine trucks are converted to EVs. There is a 5 percent cost increase for light-duty EVs and a 94–114 percent increase for heavy-duty trucks, the May 8 report states. For a fleet of 25 mixed vehicles—light-, medium-, and heavy-duty trucks—costs surge by 56–67 percent.

As transportation costs have a direct bearing on the price of goods sold in markets across the country, Ryder estimates such increases to eventually add about 0.5–1 percent to overall price inflation in the economy.

“There are specific applications where EV adoption makes sense today, but the use cases are still limited. Yet we’re facing regulations aimed at accelerating broader EV adoption when the technology and infrastructure are still developing,” said Karen Jones, executive vice president and head of new product development for Ryder.

“Until the gap in TCT [total cost to transport] for heavier duty vehicles is narrowed or closed, we cannot expect many companies to make the transition; and, if required to convert in today’s market, we face more supply chain disruptions, transportation cost increases, and additional inflationary pressure.”

In California, the annual TCT increase for a heavy-duty EV tractor was approximately $315,000, with the number rising to more than $330,000 in Georgia. In both cases, equipment costs were the biggest contributor to the increase, rising by 500 percent.

Ryder noted there were 16.4 million Class 3 to Class 8 commercial vehicles in operation in the United States, out of which only an estimated 18,000 EVs have been deployed.

“Therefore, if companies are required to convert to EVs in the near future, availability and production of EVs may be far less than the vehicles needed to run America’s supply chains,” the report states.

The report points to a statement made by Clean Freight Coalition (CFC) that there is currently no network in the United States where truck drivers can take rest breaks and charge their EV batteries at the same time.

CFC estimates that electrifying the United States’ current commercial vehicle fleet would necessitate a $1 trillion investment.

Moreover, the International Council on Clean Transportation calculates that almost 700,000 chargers will be required to accommodate the 1 million Class 4, 6, and 8 electric trucks expected to be deployed by 2030. This alone will consume 140,000 megawatts of electricity per day, which is equivalent to the daily electricity needs of roughly 5 million U.S. homes.

“Ryder’s analysis underscores the reasons EV adoption for commercial vehicles remains in its infancy. In addition to the limited support infrastructure and EV availability, the business case for converting to EV for most payload and mileage applications, is extremely challenging,” the report reads.

Robert Sanchez, chairman and CEO of Ryder, said that although the company is actively deploying EVs and charging infrastructure, it has not seen any “significant adoption” of this technology.

“For many of our customers, the business case for converting to EV technology just isn’t there yet, given the limitations of the technology and lack of sufficient charging infrastructure,” he said.

The Ryder report comes as the Biden administration announced last month that it plans to spend nearly $1.5 billion to make the U.S. freight industry “zero-emissions.”

As part of the program, the Environmental Protection Agency (EPA) will offer $1 billion from the Inflation Reduction Act to cities and states “to replace Class 6 and Class 7 heavy-duty vehicles—which include school buses, trash trucks, and delivery trucks—with zero-emissions vehicles,” the White House said.

“Freight movement continues to represent a significant share of local air pollution, increasing the risk of asthma, heart disease, hospitalization, and other adverse health outcomes for the millions of Americans, especially overburdened communities, who live and work near highways, ports, railyards, warehouses, and other freight routes,” it stated.

The goal to transition to a zero-emissions freight sector “will prioritize actions to address air pollution hot spots and tackle the climate crisis, mobilizing a broad range of government resources, and reflect public participation and meaningful community engagement, furthering the President’s commitment to environmental justice for all.”

A recent report from consulting firm Roland Berger noted that full electrification of the U.S. commercial truck fleet would be an expensive affair. The cost of new electric trucks is twice or three times that of their diesel equivalents. A diesel Class 8 truck costs about $180,000, and a battery-electric truck costs more than $400,000.

Earlier, the EPA finalized the “strongest ever” greenhouse gas standards for heavy-duty vehicles, a move that attracted strong criticism from trucking organizations.

The Owner-Operator Independent Drivers Association called the standards an “assault on small-business truck drivers,” who make up 96 percent of commercial motor carriers.

On April 30, Nick Nigro, the founder of Atlas Public Policy, testified at a House hearing on fleet electrification efforts, supporting such initiatives. He insisted that such a transition is crucial to protect people’s health.

“We aren’t just racing against foreign nations to lead the development of 21st-century vehicle technology,“ he said. ”We’re also in a race to mitigate the worst effects of climate change on the planet and tailpipe pollution on human health.”

The American Lung Association estimates that transitioning to zero-emission trucks could result in $735 billion in public health benefits by 2050, he noted.

In his testimony at the hearing, Taki Darakos, the vice president of vehicle maintenance and fleet service at PITT OHIO, raised concerns about the high costs involved in electrifying fleets.

The upfront costs of zero-emission vehicles (ZEV) “are much higher than their diesel equivalent, making it difficult for fleets to embrace electrification until they see meaningful year-over-year upfront purchase price declines.”

The company incorporated some EVs in its fleet, and Mr. Darakos said: “Increased vehicle weight from the batteries reduced our payload and limited our usage of haul. These limitations have impacted the company’s timeline on how and when to transition to ZEV.”

The American Transportation Research Institute estimated that electrifying the entire vehicle fleet in the United States will consume 40 percent of the United States’ existing electricity generation while requiring a 14 percent overall increase in energy generation.

“Yet our aging grid can hardly meet current demands,“ Mr. Darakos said. ”In California, where rolling blackouts and brownouts are not uncommon, utilities would need to generate an additional 57 percent beyond their current output to support an electric vehicle fleet.”

He pointed out that a truck driver can refuel a new diesel truck within 15 minutes for a journey of up to 1,200 miles. However, charging an EV truck for two hours provides a range of only about 200 miles.
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"Full Court Press:" 4-Episode Docuseries Premieres on May 11 (12pm CT, ABC) & May 12 (11:30am CT, ABC). Features Caitlin, Kamilla Cardoso & Kiki Rice

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Opinion A suit alleges anti-Israel protest groups provide material support to Hamas

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The sight of masked, encamped protesters breaking into buildings, barring Jewish students from classes and spewing Jew-hatred has drawn condemnation from President Biden, revealed too many college administrators’ fecklessness and confirmed that a strain of virulent antisemitism courses through pro-Palestinian protests (which too many pundits chose to ignore or rationalize).


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But according to a new lawsuit, the protests might have also revealed a disturbing relationship between Hamas and two U.S.-based groups, American Muslims for Palestine (AMP) and National Students for Justice in Palestine (NSJP).
International law firm Greenberg Traurig, in a news release last week, announced a lawsuit seeking “compensatory damages for nine American and Israeli victims of the attack in which Hamas killed 1,200 people and took 240 people hostage, alleg[ing] that AMP and NSJP work in the United States as collaborators and propagandists for Hamas. Hamas is a United States designated Foreign Terrorist Organization.” The suit further argues that defendants “are merely the current version of several prior entities that were already determined by the U.S. government to be supporters of Hamas.” According to the complaint, AMP is the “rebranded” group designed to fill the loss of the previously shut down Islamic Association for Palestine. The complaint alleges overlap in leadership and staffing. (Furthermore, according to the suit, AMP announced in 2010 the “creation of NSJP — AMP’s new on-campus sub-brand — designed to control the management, financing, and messaging of SJP chapters across the country.”)



The defendants have vigorously denied the charges. However, if proved, the allegation could end up as shocking as the bans on the Holy Land Foundation for Relief and Development and certain other Palestinian charities for supporting international terrorist organizations.
The suit raises obvious First Amendment concerns. The law firm points out that “free speech has never included the active support of terrorism, and it has never protected the destruction of private property or the brutalization of innocent men, women, and children of many faiths, not just Jews.” The lawsuit claims AMP and NSJP are not independent activist groups but instead “support and further the goals and directives of Hamas” and have been “intentionally extending their aid to fomenting chaos, violence, and terror in the United States.”
“There is a legal chasm between independent advocacy and knowingly serving as the propaganda and recruiting wing of a Foreign Terrorist Organization in the United States. AMP and NSJP are the latter,” the plaintiffs allege. “They are not innocent advocacy groups, but rather the propaganda arm of a terrorist organization operating in plain sight.”



Certainly, private actors are constitutionally protected to act as cheerleaders for Hamas, provided they do not directly incite violence. American students and student groups are entitled to protection from governmental action for core political speech — even outrageous, heinous speech reeking of Jew-hatred.
However, “material support” for a foreign terrorist organization even in the form of speech is outlawed under U.S. Code. (“The term ‘material support or resources’ means any property, tangible or intangible, or service, including currency or monetary instruments or financial securities, financial services, lodging, training, expert advice or assistance, safehouses, false documentation or identification, communications equipment, facilities, weapons, lethal substances, explosives, personnel ... and transportation.”)


A 2010 Supreme Court opinion written by Chief Justice John G. Roberts Jr. is on point. “Congress has prohibited the provision of ‘material support or resources’ to certain foreign organizations that engage in terrorist activity,” Roberts wrote. “That prohibition is based on a finding that the specified organizations ‘are so tainted by their criminal conduct that any contribution to such an organization facilitates that conduct.’”



In short, both conduct and speech may be prosecuted if material support is “coordinated with or under the direction of a designated foreign terrorist organization.” However, “independent advocacy that might be viewed as promoting the group’s legitimacy is not covered.” Roberts’s opinion held that the statute is not on its face unconstitutional, while leaving open that it might run afoul of constitutional protection in some contexts.
The lawsuit against AMP and NSJP, therefore, will turn on a detailed factual investigation. Constitutional scholar Laurence Tribe tells me, “Unless there are credible allegations of direct assistance, as in training and the like, to Hamas and affiliates terrorist groups, the 1st Amendment seems likely to pose a huge obstacle.” To sidestep First Amendment concerns, the plaintiffs must prove that AMP and its college brand, NSJP, are intertwined with Hamas (i.e., acting at the behest of or in coordination with Hamas), not simply an echo chamber regurgitating Hamas’s public declarations. (To that end, the Institute for the Study of Global Antisemitism and Policy released a report that might help trace funding, as well as connections to other groups parroting Hamas rhetoric, and thereby substantiate the suit’s allegations.)
Seasoned litigators stress to me that finding a “direct connection” between Hamas and the defendant groups will be key. The lawsuit alleges, for example, that “the language of the Hamas-authored disinformation campaign appeared in NSJP propaganda across social media and on college campuses” within hours of the Oct. 7 attack. The very next day, according to the complaint, NSJP released a “toolkit” guiding the groups’ activities and declaring the commencement of a “Unity Intifada” wherein “NSJP confirmed it was ‘PART of this movement, not in solidarity with this movement.’” Still, it is one thing for protesters to feel that they are “part of” a terrorist movement; it is quite another to prove coordination or direction.



Without commenting on the merits of the suit, Mimi Rocah, district attorney of Westchester County, N.Y., and former federal prosecutor, tells me, “One of the important functions of lawsuits like this is that, in addition to possible compensation for victims, a lot of information will come to light through the discovery process about who is behind some of these more violent protests, which are not protected by the First Amendment.”
Recent violent actions on college campus, including occupation and destruction of university property, provide grist for the suit:
Defendants’ members and allies responded to [Hamas’s] command by engaging in illegal acts of domestic terrorism — including trespass, assault, vandalism, robbery, destruction of property, harassment, and intimidation — to further the “resistance” efforts.
The complaint’s allegations are just that — allegations — at this point. While Roberts’s ruling and the specific allegations likely will help the suit survive a motion to dismiss, the burden will be on the plaintiffs to prove the connections, if any, between the defendants and Hamas. No one should prejudge the results — nor minimize the suit’s potential impact.

Iowa schools draw fewer candidates for superintendent jobs

When Greg Batenhorst decided to retire as superintendent of Mount Vernon schools this summer, he gave the school board over a year’s notice to find a qualified replacement — reflecting the challenges Iowa districts face in filling their top education job.



About one-third of the state’s school districts will see a change in leadership between the 2023-24 school year and this fall. There are about 50 K-12 superintendents leaving their districts, according to the Iowa Association for School Boards. Many are retiring. Others are leaving after serving as an interim leader. Still others are leaving for another opportunity.


But fewer qualified candidates are seeking the jobs, and those who get it now tend to stay only for a few years, school leadership search firms say.




The challenges make it difficult for a district to find the right person who will lead it through long-term strategic planning, setting goals for student achievement, planning for future facilities and wading through financial quandaries.


Eastern Iowa schools, in particular, have seen a big shift in school leadership over the last three years:


  • Tawana Grover was hired as the new leader of the Cedar Rapids Community School District last year after the death of former superintendent Noreen Bush.

  • Amy Kortemeyer was hired by the Linn-Mar school board — finishing her first year as superintendent of the school district this spring — to replace Shannon Bisgard, who retired last summer, ending his contract with the district two years early.

  • Corey Seymour was hired in spring 2022 as the new superintendent of the Clear Creek Amana Community School District, replacing interim superintendent Joseph Brown Sr.

  • And rural school districts like Central City and North Linn — which share a superintendent — and Alburnett also have new school leaders this year.

Batenhorst, who also is ending his contract a year early, has been superintendent in the Mount Vernon Community School District for seven years. But the average tenure for K-12 school leaders is much shorter than that — between four and five years for superintendents across the United States, search firms say.


Cedar Rapids-based Ray & Associates — one of the largest national search firms for school leadership — has a higher-than average stay for superintendents it has placed, at about eight years. Ray & Associates President Molly Schwarzhoff attributes this to the firm’s relationship-building and “personal” approach.


“We find the right fit for the district,” she said.


Yet the number of people applying for these jobs — which open pay at a six-figure salary — is shrinking. Schwarzhoff said the number of applicants the firm receives for jobs is about half what it was five years ago.


An open K-12 superintendent position receives an average of 20 to 30 applicants, but Schwarzhoff said these positions used to see up to 70 applicants per opening before the pandemic began in 2020.


The majority of superintendents in Iowa originally are from in-state, but many are hired from neighboring states, Schwarzhoff said.


Candidates for school leadership positions also are trending younger.






“I’m 76, so back when I was a kid, the guy who stayed around the longest ended up being the superintendent,” said Rick Elliott, president of the Mount Vernon school board. “Nowadays people who have a career goal of being administrators prepare themselves for that. By the time they’re 40, they already have the education and have gone through several administrative roles — activities director, principal, associated superintendent.”


The Mount Vernon board used Ray & Associates to guide the search process to replace Batenhorst. The board hired Matthew Leeman, associate superintendent of the Clear Creek Amana Community School District, as the next leader in Mount Vernon. He begins July 1.


Elliot said Leeman will be tasked with difficult budget decisions, as many schools struggle financially amid declining enrollment and per-pupil state aid that fails to keep up with inflation. Elliot said there will be some “creative budgeting” in the coming years in the district.


“I sincerely hope we don’t have to cut any staff,” Elliot said. “We are very proud of our teachers, our administrative staff, supporting staff — nearly all of them who live in our community. We don’t want to lose jobs because of budgetary problems.”




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