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Updated 12:37 AM ET, Tue July 3, 2018


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Why Scott Pruitt may be getting a pass 02:19

A top Environmental Protection Agency ethics official disclosed in a letter to the US Office of Government Ethics that he has referred "potential issues" related to agency chief Scott Pruitt to the EPA's internal watchdog for investigation.

In the June 27 letter, a copy of which was reviewed by CNN, Kevin Minoli, the EPA's principal deputy general counsel and designated agency ethics official, wrote that "potential issues regarding Mr. Pruitt have come to my attention through sources within EPA and media reports" and that he has "referred a number of those matters to EPA's Inspector General."
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Saturday on the letter, which was sent to David Apol, the acting director and general counsel for the US Office of Government Ethics.
Pruitt's leadership at EPA has been the subject of intense scrutiny as he faces criticism and questions over his spending habits and ethical judgment. He free shipping fake clearance for cheap EMANUEL UNGARO Ballet flats fast delivery for sale 6wH8Lz3
into his actions as EPA administrator from ethics watchdogs, federal auditors and congressional committees.
An EPA spokesperson said in a statement to CNN that the letter "reports back to the OGE on a number of administrative and staffing issues, some of which predate the Trump Administration."
Read More
"The Agency has taken early steps to address some of the concerns the OGE raised well before this letter was sent last week, including the hiring of two additional ethics officials and ongoing ethics training and retraining for EPA staff," the statement said. "Assigning new ethics staff within the OGC (Office of General Counsel) was necessary especially at the beginning of the new Administration to evaluate recusals, disclosures, and other ethics reviews involved in hiring new political appointees. Part of the remainder of the letter discusses cooperation with the OIG, a normal course of business for any agency, and the entire EPA is always responsive to the OIG and their requests for information."
The letter does not specify what "potential issues" regarding Pruitt have been referred for examination. But the Times, citing a federal official with firsthand knowledge of the inquiries, reported that one issue Minoli has recommended be investigated is Pruitt's decision to rent a room in a condo owned by the wife of a lobbyist.
Minoli, the EPA's Office of Inspector General and the Office of Government Ethics did not immediately return requests for comment.
After Pruitt's living arrangements came under scrutiny, Minoli initially said that the rental was within federal ethics regulations regarding gifts, but later clarified that analysis to say that he didn't have all the facts when evaluating the lease.

CNN's Gregory Wallace and Cristina Alesci contributed to this report.

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The increasing antibiotic resistance among uropathogens in general and E coli (the most common uropathogen) in particular is a global concern. Many studies show a clear correlation between antibiotic consumption and rising resistance rates. Accordingly, antibiotics are often withheld in cases of self limited, benign bacterial diseases such as acute otitis media, sinusitis, and traveller’s diarrhoea at the cost of a prolongation of symptoms by typically 1-3 days. 29 30 31 32 33 34 35 36 Our results in women with uncomplicated lower UTI are well in line with the prolongation of symptoms observed with symptomatic treatment of these conditions. As many women in the diclofenac group resorted to antibiotic treatment in our trial, a strategy of selectively deferring rather than completely withholding antibiotic treatment may be preferable for uncomplicated lower UTI. 37 This can be achieved through a shared decision making process, during which clinicians inquire about their patients’ ideas and expectations about antibiotic treatment for uncomplicated UTI and also explore the option of delaying antibiotic use as a treatment strategy.

Subgroup analyses did not provide evidence for any clinically relevant treatment by subgroup interactions. In particular, in contrast with the study by Gágyor et al, 10 reduction in antibiotic prescription was comparable in women with and without positive urinary culture results. Testing initial urine samples for other biomarkers associated with UTI, such as heparin binding protein, interleukin 6, acetic acid, trimethylamine, xanthine oxidase, myeloperoxidase, or others, 38 Peter Hahn exquisit Ankleboots in 100 leather 2015 cheap price cheap Xqlmlt
40 might have resulted in promising treatment by subgroup interactions, but these tests are not yet established in clinical practice, and we are unaware of any evidence to suggest that such interactions would be likely. In subgroup analyses, there were no relevant differences in baseline characteristics that would allow an early identification of women likely to benefit from diclofenac alone. However, in additional post hoc analyses, which were purely hypothesis generating, we found that the clinical diagnosis of pyelonephritis was established not earlier than five days after symptom onset, and that C reactive protein values >10 mg/L were more common at baseline in women who subsequently had a diagnosis of pyelonephritis. Taken together, these exploratory findings could support a tailored strategy of immediate antibiotic use in women with C reactive protein levels >10 mg/L and symptomatic treatment in remaining women for up to three or four days after symptom onset, followed by deferred, selective antibiotic use in those women who did not show a clear improvement by then. Naturally, such a tailored strategy would need to be evaluated in an appropriately powered randomised trial.

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