LINCOLN — With a bill to legalize cannabis for medical use in Nebraska stuck in committee, medical marijuana advocates will try to put the issue before voters for the third straight election cycle.
CFRN action - Certified Flight Registered Nurse Updated: 2023
|CFRN Real test Questions by killexams.com|
Exam Code: CFRN Certified Flight Registered Nurse action June 2023 by Killexams.com team|
CFRN Certified Flight Registered Nurse
1. General principles of transport nursing practice
A. Transport physiology
1. Physiologic stressors of transport
2. Effects of altitude on patients
B. Scene operations
1. Secure landing zone
2. Incident Command System
1. Radio operations
2. Patient handoff (e.g., history from referring provider, updates for receiving provider, SBAR)
3. Crew resource management
D. Safety and survival
2. Navigation (e.g., maps, GPS, night-vision goggles)
3. Transponder codes
4. Survival principles (post-crash)
5. Transport vehicle emergencies
6. Pre-mission preparation (e.g., shift preparedness, risk assessment, crew briefings, weather limitations,AMRM)
E. Management of man-made disasters (e.g., terrorism, industrial accident, transportation accident, mass casualties)
F. Professional issues
1. Evidence-based practice and research
2. Legal issues
d. Mandatory reporting (e.g., abuse, neglect, diversion, non-accidental trauma)
e. Legal concepts in patient care (e.g., negligence, assault, battery, abandonment)
3. Ethical issues
4. Psychosocial issues in transport, including families
1. Quality management and fair work environment
2. Outreach and community education
3. Stress management (e.g., self-care, post-traumatic critical incident)
2. Resuscitation principles 27 31
A. Principles of assessment and patient preparation
1. Physical assessment
2. Pain and comfort assessment
3. Preparing the patient for transport (i.e., packaging)
B. Airway management
1. Airway assessment
2. Airway management
3. Difficulties encountered with airway
4. Rapid Sequence Induction for Intubation (RSI), including pharmacology
C. Mechanical ventilation
1. Invasive ventilation
2. Non-invasive ventilation
1. Components of oxygen delivery
2. Shock pathophysiology
3. Trauma triad (hypothermia, acidosis, coagulopathies)
4. Acid base imbalances
3. Trauma 26 31
A. Principles of management
1. Mechanism of injury
c. Distributive (including neurogenic)
1. Traumatic brain injuries
2. Spinal cord injuries
3. Post-traumatic seizures
1. Chest wall injuries
2. Pulmonary injuries
3. Cardiac injuries
4. Great vessel injuries
1. Hollow organ injuries
2. Solid organ injuries
3. Diaphragmatic injuries
4. Retroperitoneal injuries
5. Abdominal compartment syndrome
1. Vertebral injuries
2. Pelvic injuries
3. Compartment syndrome
5. Extremity fractures
6. Soft-tissue injuries
1. Chemical burns
2. Electrical burns
3. Thermal burns
4. Radiological burns
5. Inhalation injuries
G. Maxillofacial and neck
1. Facial injuries, including fractures
2. Ocular injuries
3. Blunt and penetrating neck injuries
4. Medical emergencies 44 44
1. Seizure disorders
3. Neuromuscular disorders
4. Space occupying lesions
1. Acute coronary syndrome
2. Congestive heart failure
3. Pulmonary edema
5. Aortic abnormalities
7. Mechanical/circulatory support (e.g., IABP, VAD, pacing)
2. Acute lung injury/ARDS
3. Pulmonary infections
5. Pulmonary embolism
1. Abdominal compartment syndrome
2. GI bleed
3. Conditions of the hollow organs (e.g., obstruction,rupture)
4. Conditions of the solid organs (e.g., pancreatitis, hepatitis)
E. Electrolyte disturbances
F. Metabolic and endocrine
1. Diabetic emergencies
2. Neuroendocrine disorders (e.g., diabetes insipidus, SIADH, HHNK)
3. Thyroid conditions
4. Adrenal disorders
1. Coagulopathies (including platelet disorders)
1. Acute kidney injury (i.e., acute renal failure)
2. Chronic renal failure
I. Infectious and communicable diseases
1. SIRS and sepsis
2. Isolation precautions (e.g., MRSA, influenza-like illness, highly-infectious diseases)
3. Distributive (including neurogenic and anaphylaxis)
K. Environmental and toxicological emergencies
a. Allergic reactions
b. Cold related (e.g., hypothermia, frostbite)
c. Heat related (e.g., heatstroke, heat exhaustion)
d. Submersion injuries (i.e., diving injuries, drowning, near drowning)
e. Bites and envenomation
A. Obstetrical patients
1. Complications of pregnancy
2. Delivery and post-partum care of mother and infant
2. Medical (e.g., respiratory, cardiac, and neurological emergencies, metabolic disturbances)
1. Trauma (e.g., falls, immobilization)
2. Medical (e.g., drug interactions and comorbidities, dementia)
D. Bariatric (e.g., logistical issues, drug dosage, skin issues,airway management)
Capnography for non-intubated patients
Central venous pressure measurement
Non-invasive mechanical ventilation
Invasive mechanical ventilation
Blood product administration
Capnography for intubated patients
Medical circulatory devices (VAD, Impella®)
|Certified Flight Registered Nurse|
Medical Registered action
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CGFNS Commission on Graduates of Foreign Nursing Schools
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DANB Dental Assisting National Board
EMT Emergency Medical Technician
EPPP Examination for Professional Practice of Psychology
FPGEE Foreign Pharmacy Graduate Equivalency
NBCOT National Board for Certification of Occupational Therapists - 2023
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NET Nurse Entrance Test
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ANCC-MSN ANCC (RN-BC) Medical-Surgical Nursing
ANP-BC ANCC Adult Nurse Practitioner
APMLE Podiatry and Medical
BCNS-CNS Board Certified Nutrition Specialis
BMAT Biomedical Admissions Test
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MSNCB MSNCB Medical-Surgical Nursing Certification
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NCCT-TSC NCCT Technician in Surgery
NCMA-CMA Certified Medical Assistant
NCPT National Certified Phlebotomy Technician (NCPT)
NE-BC ANCC Nurse Executive Certification
NNAAP-NA NNAAP Nurse Aide
NREMT-NRP NREMT National Registered Paramedic
NREMT-PTE NREMT Paramedic Trauma Exam
OCS Ophthalmic Coding Specialist
PANRE Physician Assistant National Recertifying Exam
PCCN AACN Progressive Critical Care Nursing
RDN Registered Dietitian
VACC VACC Vascular Access
WHNP Women Health Nurse Practitioner
AACD American Academy of Cosmetic Dentistry
RPFT Registered Pulmonary Function Technologist
ACLS Advanced Cardiac Life Support - 2023
GP-Doctor General Practitioner (GP) Doctor
GP-MCQS Prometric MCQS for general practitioner (GP) Doctor
INBDE Integrated National Board Dental Examination (Day 1 exam)
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Certified Flight Registered Nurse
B. status epilepticus
D. drug overdose
E. head injury
The most effective means of minimizing heat loss and facilitating survival in open water is to
Which of the following statements comprises a component of the Emergency Medical Treatment
and Active Labor Act (EMTALA)?
A. Any patient who arrives at an emergency department and requests an examination to
determine the presence or absence of an emergency medical condition shall be provided such an
a patient must be transferred, the transfer facility must have the space and personnel
necessary to care for the patient.
C. In the case of a patient transfer, the referring facility must provide all necessary
documentation to the transfer facility.
D. In the case of a patient transfer, qualified personnel, necessary medical equipment, and the
most appropriate transport mode must be available.
E. All of the above statements comprise components of the Emergency Medical Treatment and
Active Labor Act(EMTALA).
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Stephen and Sandra Swanson were eating dinner beside their Christmas tree in 2017 when a Navy official rang the doorbell with alarming news: Hazardous chemicals from firefighting foam, used during training exercises at a nearby military airstrip, had seeped into their well water.
“We were told, ‘Don’t drink the water. ... It’s toxic.’ Then we were handed bottled water from Safeway,” Stephen Swanson, a 78-year-old retired emergency room physician, said in an interview from his home on Whidbey Island, Wash. “It felt like a gut punch.”
Months later, Swanson provided the Washington state legislature with tests showing his blood was filled with high levels of contaminants found in the foam: per-and polyfluoroalkyl substances, commonly called PFAS or “forever chemicals” because they don’t break down in the body or in nature.
His testimony helped convince the Democratic-controlled state legislature in 2018 to become the first in the nation to restrict the use of firefighting foam that contains the chemicals as well as PFAS-laced food packaging, which numerous studies have linked to cancer, infertility and a host of other diseases.
Since then, at least 106 similar laws have been enacted in 24 states, many with GOP-dominated legislatures, to ban or restrict the use of chemicals that are valued for their waterproof, stain-repelling, nonstick and fire-resistant properties and found in a vast array of everyday products including carpeting and rugs, outdoor apparel and stick-proof cookware.
This year alone, 195 new bills were introduced in dozens of state legislatures, seeking to require that an expanding list of products be PFAS-free. Some states have set deadlines that require all or most products made or sold in their states to be PFAS-free, with Minnesota the latest to pass such a measure last month.
The chemical industry argues that the tide of new legislation is a gross overreaction and that the majority of PFAS chemicals are safe. But the laws have received rare bipartisan support in an era when political divides have deepened in state legislatures, helped by lobbying pushes from broadly popular groups such as firefighters and farmers, and have prompted major companies like McDonald’s, Ikea and Target to set deadlines for eliminating PFAS chemicals in all or most of their products.
“By 2025, these state laws are going to reach a critical mass, and every industry is going to have to face what these other companies have already faced,” said John Gardella, a Boston-based lawyer who represents many of the companies and industries that use the chemicals.
This boom in state-level bans comes as federal regulators have lagged for decades on taking action. While the Agency for Toxic Substances and Disease Registry says the threat of long-term PFAS exposure is not fully known, activists and medical experts point to mounting evidence suggesting the chemicals are linked to liver and immune system damage, as well as other risks. The U.S. Environmental Protection Agency in March proposed for the first time a rule to set legally enforceable limits nationwide on six forever chemicals, although the regulations would cover only water contamination.
After decades of denying that any PFAS chemicals are hazardous, the American Chemistry Council, the industry’s primary trade group, now says at least two of the substances could be problematic at high levels. But the group also argues that the vast majority of the 5,000-plus chemicals in the group are safe and that states are going too far by banning or restricting all of them. The group also says the laws could block production of important products, such as semiconductors and medical devices.
“We have strong concerns with overly broad state legislation that takes a one-size-fits-all approach to the regulation of these chemistries,” said Robert Simon, a vice president with the American Chemistry Council. “Furthermore, a patchwork of conflicting state-based approaches could jeopardize access to important products.”
Simon’s group has asked the federal government to set national standards but has also successfully fought congressional bills to restrict PFAS, including some legislation that died earlier this year, which the group argued went too far by restricting many chemicals the industry says are safe.
State lawmakers who have backed the bills say they’ve fought for broader PFAS bans because new versions of potentially dangerous PFAS chemicals are regularly introduced into the market. Following the industry’s advice would trigger a “whack-a-mole” situation, they say, forcing legislators to pass new laws each time a new PFAS chemical is developed.
The EPA said that its newly proposed ban on two chemicals and restrictions on four others are based on reviews of hundreds of scientific studies showing links to a variety of health problems and are focused on PFAS that can be reliably detected in water and for which there are “proven treatment technologies.” The agency noted that it’s continuing research on other PFAS chemicals and considering further regulations, enforcement actions and technologies that can remove them from the air, land and water.
Until the EPA and other federal agencies do set stricter policies on PFAS use in products and start levying fines to violators, some lawmakers say, state laws are the only recourse.
“What often happens when the federal government fails to act, states step in because we have to protect our citizens,” said Maryland state Del. Sara Love (D-Montgomery), who sponsored a bill signed into law last year that bans forever chemicals in firefighting gear and other products. “We also know that the more states that passed legislation on this, the more it would really push the federal government to do something.”
Forever chemicals were invented in the 1930s and a decade later went to market in nonstick and waterproof coatings in cookware and clothing. By the 1960s, their unique resistance to water, oil and stains prompted a variety of industries to start using the substances, including in firefighting foam and electronics.
The health risks first received widespread notice in 2001, when attorney Robert Bilott sent a 19-page open letter detailing potential hazards and asking the EPA to investigate the disposal of the chemicals by E.I. du Pont de Nemours, commonly referred to as DuPont.
Five months later, Bilott filed a class-action lawsuit against DuPont. A settlement agreement in 2004 awarded affected residents $70 million in damages and created a scientific panel that reviewed existing research and conducted new studies on PFAS exposure, while also testing 69,000 people near a DuPont site in the Mid-Ohio Valley in West Virginia.
The panel released a series of reports in 2011 and 2012 that determined there were probable links from PFAS exposure to kidney and testicular cancer, ulcerative colitis, thyroid disease, pregnancy-induced hypertension and high cholesterol. More than 3,500 of the people tested were later diagnosed with one of the linked diseases.
At the time, DuPont argued the chemical in the study — which it has since phased out — was safe and denied any wrongdoing in the settlement agreement. In response to the panel’s reports, the company in some instances said it did not believe there was a link to health problems and in other instances emphasized reforms it had undertaken, such as the installation of water-filtration systems.
Today, “the company’s use of PFAS is limited,” according to DuPont’s website. “We have systems, processes and protocols in place ensuring that PFAS is used safely, controlled to the highest standards and minimized.”
The EPA also sued DuPont in 2004 for violations of the Toxic Substances Control Act and settled with the company the following year for $16.5 million. Following the release of the panel’s scientific studies, the EPA began testing drinking water at sites across the country, revealing widespread contamination in 27 states that affected 15 million people. The Defense Department followed in 2016, checking water around its military bases and finding it, too, contained PFAS chemicals.
“This information bubbled up to the state legislatures, with state legislators taking notice that their districts were contaminated and grass-roots environmental groups forming to try to address the issue,” said Melanie Benesh, vice president of the Environmental Working Group, which in 2016 first released its map that pinpoints the locations of all the contaminated sites. The map now shows contamination in all 50 states, with about 200 million Americans potentially affected.
The possible health impact of exposure to the chemicals is still a subject of medical study. The EPA recently calculated that restricting six PFAS chemicals in water supplies could have a measurable impact on heart disease alone, preventing 6,000 nonfatal heart attacks, more than 8,800 strokes and 754 deaths. Another peer-reviewed study by Harvard and Chinese-based researchers determined that exposure to one PFAS chemical was associated with 382,000 deaths annually in the United States from 1999 to 2015.
In 2017, bills were introduced in nine state legislatures to ban the chemicals in certain products, with Vermont the first to pass a narrow restriction on one PFAS chemical tied to a single contamination site.
The number of bills quickly rose the following year to 38, with four passing, beginning with Washington state, the first with a broad ban on the entire class of PFAS chemicals in products, beginning with firefighting foam and food packaging.
Similar proposals have increased exponentially ever since, with a record high of 245 bills introduced last year. Two documentaries and the 2019 film “Dark Waters” starring Mark Ruffalo, about Bilott’s fight with DuPont, helped fuel the state legislative movement. (Bilott also wrote about the legal battle in his book “Exposure.”)
In an interview with The Washington Post, Ruffalo credited the film with dispelling myths that poor diets or farming practices had caused the health problems highlighted by Bilott’s suit.
“There is a lot of shame around illness. It showed them it wasn’t them,” Ruffalo said. “It wasn’t their fault. It was done to them, and it was done knowingly.”
Ruffalo said the movie also helped to mobilize victims — along with firefighters and grass-roots environmental groups — to push state lawmakers to take action.
“It’s a case study in the power of film, and it is really what storytelling is all about,” he said. “It is about reaching people where they are. It humanizes us. It humanizes the issue. And it transcends political bounds.”
As the number of state bills have grown, so too has the list of products they are seeking to make PFAS-free, including cookware, surf and ski wax, artificial turf, carpeting, rugs, furniture, outdoor apparel, cosmetics and menstrual products.
Ten states have implemented drinking-water standards with various PFAS limits well below the only existing national standard — a nonenforceable 2016 guideline from the EPA. The agency’s new regulation proposed in March would put legally binding limits of 4 parts per trillion or less on six PFAS chemicals in drinking water, nearly 18 times less than the current guideline. The public comment period for the proposed rule closed May 30, and it could go into effect as soon as December.
“When you had multiple states setting drinking-water standards, that absolutely was part of the pressure that pushed the federal government to finally act,” said Sarah Doll, national director of Safer States, a coalition of environmental health groups focused on toxic chemicals that tracks PFAS legislation.
In other state actions, attorneys general in 17 states have also filed lawsuits to force companies that have produced or used forever chemicals to finance cleanup efforts and to provide medical monitoring to people with high PFAS levels in their bloodstreams.
Companies that make products using PFAS have argued they are not liable, since they didn’t manufacture the substances. And many of the companies that make forever chemicals say their prevalence makes it difficult to pinpoint them as the source of health risks.
Several states have started to move beyond a product-by-product ban of the chemicals to more sweeping laws that set deadlines for removing PFAS from all products, with a few caveats. In 2021, Maine became the first state to do so. The law, which takes effect in 2030, bans any intentionally added PFAS in products. However, if there is not yet a PFAS-free alternative, it allows for exceptions in products deemed to be “essential for health, safety or the functioning of society.”
Minnesota Gov. Tim Walz (D) signed a similar bill last month, setting a deadline for some products to be made without the chemicals by 2025, with others facing a 2032 deadline.
In 2019, the Washington legislature ordered the state Department of Ecology to seek PFAS-free alternatives for a variety of products and then set phaseout deadlines. Last year, legislators expanded the scope of the rule and set a 2025 deadline for some products, including apparel and cookware.
“We were able to speed up the timeline for eliminating PFAS, and it was a big fight,” said state Rep. Liz Berry (D). “The chemical companies and their lobbying efforts were very strong.”
Gardella, the Boston-based attorney who represents many of the affected companies, said the new laws will be difficult to follow since many products made in the United States use materials from overseas.
“These components and chemicals don’t always come in containers that say ‘PFAS,’ right?” Gardella said. “When companies ask if they contain PFAS, they’ll get a response that’s very vague, like, ‘This component that we sell has no hazardous substances in it.’ Okay. That’s nice, but who’s determining that?”
Some companies that are going PFAS-free are pledging to play a more active role in keeping the chemicals from their products. McDonald’s said it is now conducting its own “robust testing for chemicals” with the goal of using PFAS-free food packaging by 2025.
Simon, with the American Chemistry Council, said that many modern-day PFAS compounds are safe and made of shorter chemical chains, which allows them to break down more easily than older versions of the man-made chemicals. “Newer PFAS chemistries are eliminated from the body more quickly and do not accumulate in the body like the legacy products,” Simon said.
However, critics point to a 2020 peer-reviewed study by a team of scientists at Auburn University that found the short-chain PFAS compounds are “more widely detected, more persistent and mobile in aquatic systems, and thus may pose more risks on the human and ecosystem health” than their long-chain predecessors. The EPA made similar determinations the following year.
Simon’s group disputes that the studies conclusively prove that modern PFAS are as significant a health threat. Simon also said that many products — crucial to everyday life — cannot be made without the use of PFAS. As state laws become more aggressive, he said, it may lead to a shortage of medical devices and semiconductors key for smartphones and computers.
Benesh, with the Environmental Working Group, said that even though important products cannot yet be made PFAS-free, the industry could be doing more to protect the public.
“They should be capturing PFAS in their production processes, they should be filtering their wastewater, and they should be monitoring the release of PFAS into the air and water so they aren’t making this problem any worse,” she said.
Lawsuits against the makers and users of PFAS chemicals have snowballed since Bilott’s original lawsuit, as have the size of the settlements. Last week, DuPont de Nemours Inc. and other companies announced a $1.185 billion settlement over pollution claims tied to the manufacture of the compounds.
Environmentalists are now pushing states to regulate another source of PFAS contamination — sewage sludge, which is widely used as fertilizer on cropland in all but two states. For decades, municipal sewer districts have partnered with farmers as a cheap and reliable way of disposing of the waste.
Connecticut has long banned use of the bio-waste as fertilizer over a variety of environmental concerns, and in 2021, Maine became the first, and so far the only, state to ban its use specifically due to PFAS contamination.
The move came after the state started testing groundwater on farms that were treated with the sludge, which is filled with human and industrial waste. State officials also put out a map of all the sludge-treated sites that contained high levels of PFAS in their groundwater, which included Fred Stone’s dairy farm.
“The map makes the state of Maine look like it has smallpox — it’s that prevalent,” said Stone, who had to close his dairy farm in Maine because of the contamination in his cows’ milk. “If I was operating in most any other state, I’d still be shipping my milk — and that should scare the bejesus out of everyone.”
Alice Crites and Magda Jean-Louis contributed to this report.
The National Nurses United union, which represents 900 registered nurses at Ascension Seton Medical Center Austin, voted May 31 and June 1 to authorize a one-day strike at Ascension Seton Medical Center Austin.
On June 2, the union announced the strike had passed with 98% support. The move follows contract negotiations that have dragged on since at least November, according to the union. The contract negotiations hinge on pay levels and other measures the union said are needed to fill vacancies and ensure retention.
“This action is disappointing given that both bargaining teams continue to work towards an initial collective bargaining agreement and have multiple sessions scheduled through the end of June,” a representative for Ascension Seton said in a statement.
How we got here
Matthew Clark, a registered nurse in the intensive care unit and a member of the negotiating team, said nurses are "leaving in droves" due to ongoing staffing issues.
Clark said nurses are asking for several changes to increase staff levels and ensure safety for staff and patients, including adding updated staffing minimums to the contract and creating a professional practice committee of nurses who can elevate problems and propose solutions to management.
In his unit, Clark said there are daily requests to pull staffing from other departments to handle incoming patients. He said that the low staffing levels mean nurses often work longer shifts than scheduled and are drained by the work. He also said the frequent turnover means a lack of experienced staff.
Previously, the union has staged a candlelight vigil and picketed in an effort to convince the hospital administration to take them more seriously, Clark said.
Community Impact has reached out to Seton for additional comment and will update this story when it is received.
The nurses' strike would be the largest in Texas history and the first at Ascension Seton Medical Center Austin. The NNU said it would provide at least 10 days' notice to the hospital. The Ascension Seton representative said a plan is in place if that notice is received.
What nurses are saying
“Our patients can’t wait any longer,” said Lindsay Spinney, a registered nurse in the neonatal intensive care unit, in a news release. “Nurses are sending a message to management with this overwhelming strike authorization that we are ready to do what it takes to win a strong contract that protects our patients’ safety.”
“It’s morally distressing to work tirelessly for a nonprofit, Catholic system that consistently puts profits over its own patients and staff. We believe it is our duty to exercise our union power to ensure Ascension invests its deep financial resources back into its staff, patients and the Austin community,” said Clark in the release.
What Ascension Seton is saying
“We continue to bargain in good faith with National Nurses United (NNU) to come to a mutually beneficial agreement on an initial contract that supports all and will further our combined goal of providing safe, compassionate care to those we serve. We respect our associates’ right to organize themselves through union representation and participate in a strike authorization vote,” the statement said.
What happens next
Clark said he hopes that the move will motivate management to take the union more seriously. If not, he said the union is prepared to hold the strike.
Lake County General Health District officials continue to encourage residents to take action to prevent Lyme disease, a sickness caused by the bite of a black-legged or deer tick that carries the Borrelia burgdorferi bacterium.
According to the district, there has been a steady increase in the number of reported cases of Lyme disease over the past few years, which is common in the Northeastern and upper Midwestern United States.
Lake County has had five reported cases of Lyme disease so far in 2023, officials recently reported.
Since 2010, the number of black-legged ticks in Ohio has increased steadily, particularly in wooded areas.
Additionally, while humans cannot get the ailment from pets, they can bring the ticks into the home which could then bite and infect.
A Lyme disease vaccine is available for dogs through veterinarians, officials noted.
Typical symptoms of Lyme disease include fever, headache, tiredness, and a characteristic called “bull’s-eye” skin rash. If left untreated, the infection can spread to the joints, heart, and nervous system, causing long-term medical problems.
Health care providers can determine if an individual has Lyme disease based on symptoms and the possibility of exposure to infected ticks. Providers may also run blood tests.
Most cases of Lyme disease can be treated successfully with a few weeks of antibiotics, but there is no human vaccine for Lyme disease, officials added.
“There are several steps we can take to prevent Lyme disease, as well as other diseases caused by the bites of ticks and mosquitoes,” said Bert Mechenbier, environmental health supervisor with the Lake County General Health District.
Additionally, the district strongly encourages individuals visiting wooded or forested areas to adhere to the following suggestions:
• Wear white- or light-colored clothing which makes it easier to spot any ticks; shirts and T-shirts should be tucked into pants and socks should be pulled up over the bottom of pants
• Use insect repellents registered by the U.S. Environmental Protection Agency labeled for use against ticks on exposed skin for protection that lasts several hours
• Treat clothing and gear, such as boots and tents with products containing 0.5 percent permethrin (anti-parasite insecticide), which remains protective through several washings; pre-treated clothing is available and may provide longer-lasting protection
• Help younger children apply repellent and keep it away from their eyes, mouth, and hands
• Avoid taking shortcuts through thick brush and grass
• Check for ticks at the end of each day before returning home — check pets as well; shower to wash off unseen ticks
• Remove any attached tick by grasping it with tweezers, as close to the skin as possible, and pulling it straight out
For more information on Lyme disease, visit the following websites: odh.ohio.gov/know-our programs/zoonotic-disease-program/diseases/lyme-disease; www.cdc.gov/lyme/index.html.
Contact the Lake County General Health District at 440-350-2543.
House Majority Leader Nadine Nakamura joins producer/host Coralie Chun Matayoshi to discuss new gun carry, abortion, homeless, medical-aid-in-dying, and other legislation. The Governor has until June 26, 2023 to identify which bills if any, he intends to veto.
Act 001 – specifies that a person may be tried and sentenced for certain alleged felony offenses through the complaint and preliminary hearing process, indictment by grand jury, or by written information. Specifies that multiple attempts to initiate a felony prosecution for the same offense, either through the same initial charging method or an alternative method, or in different forums, shall not be permitted, except in certain circumstances.
SB 1230 – prohibits firearms in certain locations and premises. Requires possession and disclosure of a license to carry. Prohibits leaving an unsecured firearm in a vehicle unattended. Prohibits consuming or being under the influence of alcohol, an intoxicating liquor, or a controlled substance when carrying a firearm. Prohibits carrying or possessing firearms on certain private property without express authorization. Requires annual reports from the department of the attorney general on carry licenses. Amends the requirements for, and revocation of, firearms permits and licenses. Amends the disqualification of persons from owning, possessing, or controlling a firearm. Expands the qualified immunity for health care providers who provide information on firearms applicants to include physician assistants and advanced practice registered nurses.
SB 372 – provides that a law enforcement officer has a duty to intervene if the law enforcement officer reasonably believes that another law enforcement officer is using unnecessary or excessive force on an arrestee. Requires the law enforcement officer to report the incident to the other law enforcement officer’s supervisor. Requires relevant departments to submit annual reports to the Legislature.
Act 002 – Allows licensed physician assistants to perform certain abortions. Repeals the requirement that abortions be performed at certain locations. Clarifies that the State shall not deny or interfere with a pregnant person’s right to choose to (1) obtain an abortion or (2) if necessary to protect the life or health of the patient terminate the pregnancy. Defines “abortion” and “nonviable fetus”. Prohibits a covered entity from disclosing information relating to reproductive health care services. Prohibits the issuance of a subpoena in connection with an out-of-state or interstate proceeding relating to reproductive health care services legally performed in the State. Prohibits agencies from providing information or expending resources in the furtherance of out-of-state or interstate investigations or proceedings relating to reproductive health care services. Prohibits the State from taking adverse action based on pregnancy outcomes or for aiding or assisting a pregnant individual with accessing reproductive health care services. Requires the Governor to deny any demand for surrender of a person charged with a crime involving reproductive health care services unless the conduct constitutes a crime in the State or is made under Article IV, section 2, of the U.S. Constitution. Enumerates laws contrary to public policy and prohibits their application. Prohibits the issuance of a summons for persons to testify in another state with regard to lawful reproductive health care services. Clarifies under various licensing statutes that the provision or assistance in receipt or provision of certain services related to the human reproductive system cannot form a basis for disciplinary action. Prohibits the enforcement of a judgment or order arising from a foreign penal civil action or other penal law with respect to reproductive health care services. Amends the definition of “medical care and services” so that a minor may…(see document for full description).
HB 650 –authorizes advanced practice registered nurses to practice medical-aid-in-dying. Authorizes licensed advanced practice registered nurses and clinical nurse specialists with psychiatric or mental health training and licensed marriage and family therapists to provide counseling to a qualified patient. Reduces from twenty to five days, the mandatory waiting period between the two oral requests required for a qualified patient to obtain a prescription for medication. Waives the mandatory waiting period for terminally ill qualified patients who are not expected to survive the mandatory waiting period.
HB 950 – authorizes psychiatrists or advanced practice registered nurses, after examination of a person for assisted community treatment indication, to request assistance from the attorney general to file an assisted community treatment petition. Authorizes the family court to use online hearings for assisted community treatment petitions. Clarifies provision of notice for assisted community treatment petitions. Authorizes any interested party to request assistance from the attorney general to file a petition for an extension of assisted community treatment. Extends the time period that a family court may order continued assisted community treatment. Reduces the time period that a family court needs to determine whether assisted community treatment should continue.
HB 1366 -requires the department of human services to establish a three-year return-to-home pilot program to provide eligible homeless individuals with assistance in being reunited with family and relatives in their home state. Sunsets 1/1/2026. Appropriates funds.
HB191- requires disclosure of all existing permitted and unpermitted erosion control structures on the parcel in real estate transactions when residential real property lies adjacent to the shoreline. Effective 11/1/2023.
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An ICB has been threated with legal action over its decision to close a 2,800-patient GP practice in Liverpool.
NHS Cheshire and Merseyside has informed patients at Park View Medical Centre, in Tuebrook, in North-East Liverpool, that their practice will be closing at the end of July.
It has now received a letter threatening judicial review proceedings over the decision.
Last year, the ICB ran a procurement process for the practice’s APMS contract, which was due to expire on 31 March, but failed to find a new provider.
Patients have signed a petition to oppose the closure and the practice’s patient participation group has held public meetings to voice their concerns.
A spokesperson for the ICB told Pulse: ‘We were unable to secure a new provider to run Park View Medical Centre, so the decision was made to disperse patients to other local GP practices at the end of the contract term, subject to a short-term extension to enable safe transfer of patients.
‘We have written to all registered patients to inform them that the practice will be closing by the end of July, and that they will be transferred to another nearby practice, as there are 10 practices within a one-mile radius of the Park View site.
‘We have recently received a letter about a proposed claim for a judicial review, which has been responded to and we are awaiting any further responses.’
It is unclear who is threatening legal action and Pulse has asked the ICB for clarification.
In a statement on its website, the practice said: ‘NHS Cheshire and Merseyside is now talking to other local GP practices about arrangements for patients to transfer across to them.
‘There are a range of other GP practices located within a mile of Park View Medical Centre, so we are confident that all patients will still be able to access GP services close to where they live – just as they do now.’
Mersey Care NHS Foundation Trust, which owns the surgery building, is considering selling the property within the next one or two years, which means GP services cannot be contracted to run from the building in the longer term.
Ian Byrne, the Labour MP for Liverpool West Derby, called for the ICB to ‘look at every option available’ to stop the closure.
Mr Byrne said: ‘Park View medical centre is under threat of closure – at a time when GP surgeries are under intense pressure and people are struggling to get appointments, the last thing we need in our community is a GP surgery to close.
‘So I’m calling on the ICB to look at all options that are on the table, and revisit the position that they are now in, which is to close the medical centre.’
Earlier this month, researchers at the University of Manchester found that practice closures are linked with reduced patient satisfaction with services at the surviving practices, which end up having more patients, as well as proportionally less GPs and funding.
NEW DELHI: After derecognising 38 medical colleges, the National Medical Commission (NMC) has also issued show cause notices to 102 medical colleges for failing to fulfil mandatory requirement of marking attendance by all registered faculty members and staff.
The apex body for medical education took the action after it was found that these colleges weren’t following the NMC regulations for mandatory biometric attendance. These colleges can rectify the mistake themselves to abide by the NMC regulations, said a senior health ministry official.
After the formation of NMC in 2020, provision of biometric attendance and CCTV cameras were added in the minimum requirement for medical colleges to eliminate any possibility of fake faculty. Thereafter, the NMC has been continuously issuing notices to all stakeholders, including management of the medical colleges, to strictly implement these provisions.
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“While examining the data available, it was observed that most of the faculty members of medical colleges, even Dean, principal and medical superintendents of pioneer institutes do not mark their attendance on the biometric system. In respect of installation of CCTV cameras at medical colleges, either they are offline or not connected at all,” a source said.
READ ALSO: Faridabad medical college barred from admitting students this year
There are over 390 medical colleges that are due for recognition. Of them, 256 have applied for the same. Health ministry sources said the authorities concerned have assessed 175 applications and 25 have been approved. “Total 38 such applications have been disapproved, 102 have been issued show cause notices and applications of 10 other medical colleges is currently being evaluated,” the source said.
Recently, NMC had written to the department of medical education of all states on the transfer of faculty on a temporary basis to fulfil faculty requirements during inspection.
California's reparations task force is recommending as part of its set of proposals to make amends for slavery and anti-Black racism that state lawmakers address what it calls "racially biased" artificial intelligence used in health care.
The task force, created by state legislation signed by Gov. Gavin Newsom in 2020, formally approved last weekend its final recommendations to the California Legislature, which will decide whether to enact the measures and send them to the governor's desk to be signed into law.
The recommendations include several proposals related to health care, including some concerning medical artificial intelligence (AI), which the task force describes as "racially biased" and contributing to alleged systemic racism against Black Californians.
Specifically, the task force calls for the legislature to fund either state universities or government agencies to study the "potential for harmful biases" in medical AI.
CALIFORNIA REPARATIONS COMMITTEE CALLS FOR MANDATORY 'ANTI-BIAS' TRAINING TO GRADUATE MEDICAL SCHOOL
"The task force recommends that the legislature provide state funding to the California Department of Public Health, a University of California school, a California State University school, or another appropriate entity to study the potential for harmful biases in commercial algorithms and AI-enabled medical devices," the committee writes in the final report outlining its proposals, adding that the study should also recommend how best to regulate medical AI tools in California.
The report additionally suggests the study should probe "'evidence-based research into the use of devices and tools that recommend adjusting patients' treatment or medication based on broad racial categories in the absence of information on genetics or socio-cultural risk factors.'"
The task force quotes from a accurate American Civil Liberties Union (ACLU) paper that it cites several times. The paper provides examples of alleged racial bias in medical AI, such as a tool meant to decide how to best distribute the limited resource of extra care to new mothers at risk of postpartum depression that, according to the ACLU, directed care away from Black mothers and favoring White mothers.
In California, meanwhile, the reparations committee recommends that the legislature require the state's Department of Public Health to issue guidance to hospitals and other medical systems to ensure that AI-enabled medical devices "are not used for clinical applications without FDA approval or clearance, are not used on patient populations they were not intended for, and that cleared tools are not used outside of their intended use cases." That recommendation is also in the ACLU paper.
The task force additionally wants the California Department of Public Health "to make and maintain a public list of software as a medical device (SaMD) products and provide demographic information about the subjects in which the devices were calibrated or trained."
NEW AI TOOL HELPS DOCTORS STREAMLINE DOCUMENTATION AND FOCUS ON PATIENTS
A fourth proposal is to allocate positions and funding to the California Department of Justice to pursue claims against AI medical device manufacturers if their products have a "disparate impact" when providers use them according to manufacturers' instructions or if the products "misleadingly promise fairness."
Despite the task force's claims, however, new AI tools have helped medical professionals treat patients in a variety of ways.
One such tool called RestoreU, for example, helps physicians create personalized care plans for patients with Alzheimer’s and other types of dementia. Another tool known as DAX Express streamlines the note-taking process, a benefit that has reportedly helped doctors Boost patient outcomes, work more efficiently, and reduce costs.
Beyond AI, the California Reparations Task Force is pushing several controversial health-related proposals, such as mandating "anti-bias training" and an assessment based on that training as graduate requirements for medical school.
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The task force is also pushing a universal, single-payer health care system as a way to achieve health "equity" for Black residents in California.
Kenya's Dadaab refugee camp is facing a serious outbreak of cholera: according to the World Health Organization, as of March 2023, Kenya had recorded more than 7,800 cholera cases and over 127 deaths. The outbreak, which began in October 2022, has seen more than 2,700 occupants of the Dadaab camp contract gastrointestinal illness.
One of the satellite complexes, Dagahaley, has been hardest hit: it accounts for around 1,100 infections alone.
"We have already seen the worst cholera outbreak in five years and the risk of other epidemics breaking out is high," Hassan Maiyaki, the country director for the French medical charity Doctors Without Borders or Medecins Sans Frontieres (MSF), told DW.
"If this occurs, it would outstrip medical capacity in the camps, with potentially catastrophic consequences. Maiyaki warned.
Poor sanitary conditions at the camp
Some factors that have exacerbated the situation include poor sanitary conditions within the camps, influx of refugees, overstretched resources, and dwindling donor funds.
Dr. Kapil Sharma, a medical doctor and the project coordinator for MSF in Dadaab, blamed the seventh-month-long cholera outbreak on the camp's unhygienic conditions.
"One of the main reasons for cholera, as we all know, is poor sanitary situation," Sharma told DW, adding that the camp also lacks access to latrines. "There is rampant open defecation in the camp, and less than 50% of the people have access to the latrines, so these are all compounding factors for this outbreak to increase."
Call to Boost camp conditions
The medical practitioners in the area are now advocating for improvements in water, sanitation and hygiene to contain the outbreak.
Kenya's Ministry of Health and other humanitarian agencies have conducted a cholera vaccination campaign since February. They also conducted health promotions, but medical practitioners in the area say it was insufficient.
"More needs to be done in terms of water, sanitation and hygiene for this population," Kapil said, calling on more substantial support from the international community to organizations providing water, hygiene, and sanitation services in the camp.
Influx of refugees from neighboring countries
According to the UN Refugee Agency (UNHCR), Dadaab camp hosts over 43% of Kenya's refugee population.
The humanitarian crisis in neighboring countries has led to a further growth in the number of refugees at the Dadaab camp. In 2022 alone, about 100,000 refugees came into the country, 67,000 of whom found their way to Dadaab.
The new arrivals have put more pressure on the camp's capacity. "The camps are already overstretched, and the humanitarian conditions there are already at its limit," Dr. Nitya Udayraj, MSF's medical coordinator in Kenya, told DW.
Tens of thousands of unregistered refugees
There are currently more than 124,000 refugees within the Dadaab refugee complex who have yet to be registered.
The drought that has plagued the Horn of Africa region has exacerbated things further, since most of those coming into the camp are either malnourished, tired, or susceptible to the disease. In addition, the worsening drought in Somalia and the crises in the neighboring Sudan, South Sudan, and Ethiopia have all forced more people to seek refuge in Kenya.
Despite having a holding capacity of 35,000 people, the satellite camp of Dagahaley hosts about 140,000 refugees. Meanwhile, more continue to stream in.
Few doctors for thousands of people
The medical doctors are not only providing care to people within the camp, but also to an additional 14,000 people within the host community, who also require their services. This has left the medical facilities overstretched and almost running on empty if help comes in late.
"MSF calls on the international community, donors and aid agencies to respond urgently to the unfolding crisis in Dadaab, taking immediate action to address the alarming sanitary conditions and prevent the further spread of disease," Maiyaki said.
The global economic crisis has also played a part in the worsening of the situation at the camp. As a result, many aid organizations have delayed remitting funds.
"What is important is the allocation of appropriate resources for organizations responsible to provide these services as fast as possible," Kapil said.
Kenya plans new refugee camp
The Kenyan government has announced plans to reopen a fourth camp, Ifo 2, to accommodate new arrivals and alleviate the strain on resources in the existing camps.
"MSF calls on the government of Kenya and the UNHCR to find durable solutions for the refugees confined within the camps at Dadaab," Maiyaki said.
Even as MSF calls on the government to fulfill the promise urgently, other interventions like water distribution and sanitary facilities supply to the refugees have been in top gear to prevent the further spread of the disease.
"We are providing 50,000 liters of water to the outskirts population of 9,000 people," Kapil said, stressing that the organization had facilitated the construction of 150 latrines for the population. It has also provided them with plastic sheeting and maps.
The MSF health practitioner said he remains optimistic that the situation can improve. "I feel really very sad when I see this number which has really increased over the last few months," Kapil said, calling on all stakeholders to collaborate and provide essential human services "to prevent people from contracting these disease which should not happen actually."
Edited by: Chrispin Mwakideu
LINCOLN — With a bill to legalize cannabis for medical use in Nebraska stuck in committee, medical marijuana advocates will try to put the issue before voters for the third straight election cycle.
Nebraskans for Medical Marijuana filed two initiatives with the Secretary of State’s Office Thursday with the goal of qualifying the measure for the November 2024 general election ballot.
Crista Eggers, the statewide campaign coordinator for Nebraskans for Medical Marijuana, earlier told state senators on the Judiciary Committee that if the Legislature failed to take action that parents like her would.
“For 10 years this has been talked about and advocated for by patients and caregivers like myself,” said Eggers, whose 8-year-old son, Colton, has intractable seizures. “I would have hoped our legislative body had decided it was important enough, but unfortunately that has not happened.”
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Two separate petitions have identical language to a pair of measures that were circulated in 2022. Both seek to force the Legislature to change state statute and legalize cannabis for medical use instead of amend the Nebraska Constitution.
The first petition will enact a new state statute protecting doctors who recommend cannabis and patients who use it for medical reasons, and the second requires the Legislature to legalize the production, supply, and distribution of cannabis for medical purposes.
“We know the people support this,” Eggers said. “We are going to execute and put that into motion to have safe and regulated medical cannabis in Nebraska.”
Once the petition language has been accepted by Secretary of State Bob Evnen, Eggers said Nebraskans for Medical Marijuana are planning to launch their campaign in June, with the goal of exceeding the signature-gathering requirements outlined in state law.
Nebraskans for Medical Marijuana will need to submit a number of signatures equal to 7% of registered voters in the state, including 5% of voters in 38 of Nebraska’s 93 counties.
The renewed effort comes after the two petitions fell about 9,000 signatures short of qualifying for the November 2022 general election ballot and after the Nebraska Supreme Court found a 2020 ballot violated the single-subject rule for ballot initiatives after nearly 200,000 signatures were submitted.
The decision to pursue a ballot initiative also comes as the Legislature once again failed to act on Lincoln Sen. Anna Wishart’s attempt (LB 588) to pass a medical marijuana law in Nebraska.
Wishart’s bill, which was heard by the Judiciary Committee in February, outlined a narrow list of qualifying medical conditions for which patients could seek medical marijuana, and also detailed the steps physicians must perform before they can recommend cannabis to a patient.
Patients recommended cannabis were allowed to purchase and possess up to 2.5 ounces or 2,000 milligrams of tetrahydrocannabinol — better known as THC — from state-licensed dispensaries, which were required to contract with licensed pharmacists trained in medical cannabis.
LB 588 also would have prohibited patients from smoking or vaping cannabis, cultivating their own marijuana plants, operating a motor vehicle while under the influence of cannabis or from using cannabis while riding as a passenger.
The bill, which Wishart said would have been one of the most conservative medical marijuana laws in the country, was the result of agreements between doctors, pharmacists and state senators who voiced concern about past efforts they found too broad.
But even after emotional testimony from a handful of parents of the roughly 19,600 Nebraska children who live with severe epilepsy and other individuals who described living with chronic pain, Wishart’s bill remained stuck in committee.
Wishart said turnover in the Legislature and on the Judiciary Committee resulted in a membership that did not follow the actions of past committees which had advanced medical marijuana legislation to the floor for debate.
Attorney General Mike Hilgers, who opposed medical marijuana when he was a state senator, and Nebraska’s chief medical officer also added to the opposition at the committee hearing earlier this year.
Wrestling with how to proceed, Wishart tried to narrow the bill further than it had already been narrowed, eventually landing on a “right to try” proposal for parents of children with severe epilepsy only.
That proposal would not have allowed for dispensaries to open in Nebraska — “there would have been no industry here,” Wishart said – but would have allowed those patients, at the recommendation of their doctor, to travel to other states to buy cannabis.
It also would have decriminalized possession of marijuana for those individuals, she added.
“I think I could have gotten that out of committee,” Wishart said, “but I didn’t feel confident I would have enough votes on the floor and because of that and because it was so narrow, we decided we needed to go back to the ballot.
“There are more people than those with epilepsy that would benefit from having access,” she added.
Eggers said she likely would have stepped aside had the Legislature acted on the “right to try” legislation, which she says would have helped her son.
But with the bill still sitting in committee and with its paths closed this year, she said she’s prepared to throw herself behind the ballot initiative again, even as she acknowledges that doing so will mean she misses out on precious time with her ailing son.
“I voiced this to several senators that if the Legislature does not do something, anything to show progress, that we would do it ourselves,” Eggers said. “It was a straight-up threat, and I intend to follow through with that threat.”
The new ballot initiatives revive what Wishart called the “battle-tested” language reviewed by local and state attorneys used in a previous effort that fell just short of gathering the needed votes in 2022.
Wishart, who is one of the sponsors of the initiative, said filing the petition language more than a year ahead of the July 2024 deadline for qualifying for the ballot will supply the campaign a long runway to collect the necessary number of signatures.
“What we’ve learned is that we don’t have to wait for a major donor to start,” she said. “We basically collected 180,000 signatures on a volunteer-led, shoestring budget campaign the last time around, and now we’ve got a year and a half to do what we did in three months last time.”
Eggers added the lessons learned from falling just short in two campaigns over the last two years have been used to adjust the strategy moving forward.
“We have signers who have signed this petition, not once but twice,” she said. “We have a lot going for us, and I think we have the ability to get it done.”
Reach the writer at 402-473-7120 or email@example.com.
On Twitter @ChrisDunkerLJS
Microbot Medical Inc. (NASDAQ:MBOT) price closed lower on Friday, June 02, dropping -18.52% below its previous close.
A look at the daily price movement shows that the last close reads $2.16, with intraday deals fluctuated between $1.65 and $2.2708. The company’s 5Y monthly beta was ticking 3.15. Taking into account the 52-week price action we note that the stock hit a 52-week high of $6.33 and 52-week low of $1.00. The stock added 61.47% on its value in the past month.
Microbot Medical Inc., which has a market valuation of $21.10 million, is expected to release its quarterly earnings report Aug 14, 2023 – Aug 18, 2023. Analysts tracking MBOT have forecast the quarterly EPS to shrink by -0.28 per share this quarter, while the same analysts predict the annual EPS to hit -$1.04 for the year 2023 and up to $0 for 2024.
Revisions to the company’s EPS highlights a short term direction of a stock’s price movement, which in the last 7 days came up with no upward and no downward reviews. On the technical perspective front, indicators supply MBOT a short term outlook of 50% Sell on average. Looking at the stock’s medium term indicators we note that it is averaging as a 50% Sell, while an average of long term indicators are currently assigning the stock as 100% Sell.
Here is a look at the average analyst rating for the stock as represented on a scale of 1.00 to 5.00, with the extremes of 1.00 and 5.00 suggesting the stock is strong buy or strong sell respectively. Specifically, 1 analysts have assigned MBOT a recommendation rating as follows: 0 rate it as a Hold; 1 advise Buy while 0 analyst(s) assign an Overweight rating. 0 analyst(s) have tagged the Microbot Medical Inc. (MBOT) stock as Underweight, with 0 recommending Sell. In general, analysts have rated the stock Buy, a scenario likely to bolster investors out for an opportunity to add to their holdings of the company’s shares.
The overview shows that MBOT’s price is at present 11.90% off the SMA20 and 1.50% from the SMA50. The Relative Strength Index (RSI) metric on the 14-day timeframe is pointing at 50.17, with weekly volatility standing at 21.41%. The indicator jumps to 26.24% when calculated based on the past 30 days. Microbot Medical Inc. (NASDAQ:MBOT)’s beta value is holding at 3.12, while the average true range (ATR) indicator is currently practicing 0.42. Considering analysts have assigned the stock a price target range of $8.00-$8.00 as the low and high respectively, we find the trailing 12-month average consensus price target to be $8.00. Based on this estimate, we see that current price is roughly -354.55% off the estimated low and -354.55% off the forecast high. Investors will no doubt be excited to see the share price fall to $8.00, which is the median consensus price, and at that level MBOT would be -354.55% from current price.
An analysis of the Microbot Medical Inc. (NASDAQ:MBOT) stock in terms of its daily trading volume indicates that the 3-month average is 3.52 million. However, this figure increases on the past 10-day timeline to an average of 22.58 million.
Current records show that the company has 8.01M in outstanding shares. The insiders’ percentage holdings are 2.98% of outstanding shares while the percentage share held by institutions stands at 21.00%. The stats also highlight that short interest as of May 14, 2023, stood at 81010.0 shares, which puts the short ratio at the time at 0.89. From this we can glean that short interest is 1.00% of company’s current outstanding shares. Notably, we see that shares short in May rose slightly given the previous month’s figure stood at 53900.0. But the -41.53% downside, the stock’s price has registered year-to-date as of last trading, will likely reignite investor interest given the prospect of it rallying even higher.
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