Antony J. Blinken, Secretary of State
On behalf of the United States of America, I send best wishes and congratulations to Mauritania on celebrating 61 years of independence.
The United States applauds Mauritania’s efforts to address long-standing human rights issues, combat corruption, and defeat COVID-19. We also appreciate Mauritania’s efforts to combat terrorism within its borders, and its partnership with the United States in countering terrorism.
As you celebrate your independence day, know that the United States looks forward to many more years of collaboration on our shared priorities in the pursuit of prosperity for all Mauritanians.
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- Husband Sentenced to 188 Months in Prison for Human Trafficking Convictions Related to Forced Labor of Foreign NationalsBy Sam NewsOctober 22, 2020The Justice Department today announced that former Stockton, California resident Satish Kartan, 46, was sentenced today to188 months in prison for forced labor violations. In addition, U.S. District Judge Morrison C. England Jr. ordered $15,657 be paid in restitution to three victims, in part to cover their back wages and other losses.[Read More…]
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- Rare Diseases: Although Limited, Available Evidence Suggests Medical and Other Costs Can Be SubstantialBy Sam NewsOctober 18, 2021What GAO Found According to the literature GAO reviewed, diagnosis of any disease can be complicated, and diagnosis of rare diseases can be particularly difficult because of a variety of factors. (See figure.) Although some rare diseases may be detected quickly, in other cases years may pass between the first appearance of symptoms and a correct diagnosis of a rare disease, and misdiagnoses—and treatments based on them—occur with documented frequency. According to the literature GAO reviewed and GAO's interviews, those with undiagnosed, misdiagnosed, or untreated rare diseases may face various negative outcomes. For example, a person's health can suffer when appropriate, timely interventions are not provided or when interventions based on misdiagnoses cause harm. In addition, multiple diagnostic tests, medical appointments, and ultimately unwarranted interventions can add to the costs of the disease. Examples of Factors That May Interfere with Accurate Diagnosis Research on the costs of rare diseases is limited, in part because of the difficulty of diagnosing them. Nonetheless, the costs can be substantial, as indicated by available research from the U.S. and elsewhere and the experts, researchers, and organization officials GAO interviewed. These costs—to those with rare diseases, health care payers, the U.S. government, or a combination—can include direct medical costs (e.g., costs of outpatient visits or drugs), direct nonmedical costs (e.g., costs to modify one's home to accommodate a wheelchair), or indirect costs (e.g., loss of income or diminished quality of life). Peer-reviewed studies of specific rare diseases estimated costs for people with rare diseases that are multiple times higher than costs for people without those diseases. One recent study, which has not yet been peer-reviewed, estimated $966 billion as the total cost (including medical and other nonmedical and indirect costs) in the United States for an estimated 15.5 million people with 379 rare diseases in 2019. The Department of Health and Human Services (HHS) provided technical comments on a draft of this report, which GAO incorporated as appropriate. Why GAO Did This Study By definition, few people have any specific rare disease. But there are many different rare diseases—about 7,000—and as a result, an estimated 30 million people in the United States have one or more of them. About half of those with a rare disease are children. Often genetic, many rare diseases are chronic, progressive (they worsen over time), and life-threatening. Relatively little is known about the costs of rare diseases, either individually or collectively. The Joint Explanatory Statement for the Further Consolidated Appropriations Act, 2020, includes a provision for GAO to study the costs of rare diseases within the U.S. GAO examined, among other things, the challenges to diagnosing rare diseases and what is known about their costs. GAO reviewed documents from two agencies in HHS—the National Institutes of Health (NIH) and Food and Drug Administration (FDA) and published literature, including studies on the costs of rare diseases in the United States and elsewhere published from 2000 through 2021. GAO also interviewed NIH and FDA officials; selected researchers and experts on rare diseases, health care, and health economics; and officials of organizations representing those with rare diseases. The organizations included two devoted to rare diseases in general and six representing those with a specific rare diseases or sets of related rare diseases. For more information, contact at (202) 512-7114 or firstname.lastname@example.org.[Read More…]
- Department of Defense: Eating Disorders in the MilitaryBy Sam NewsAugust 7, 2020The Department of Defense (DOD) screens for eating disorders for all applicants entering into the military but does not specifically screen servicemembers for eating disorders after entrance. However, after joining the military, servicemembers receive annual health screenings, and medical personnel may be able to diagnose eating disorders during in-person physical exams. Service branch behavioral health specialists told GAO that DOD medical personnel are trained to notice signs of eating disorders, such as changes in vital signs and emaciated appearance. DOD is examining ways to improve its screening of eating disorders in the military and recently expanded the available research funding for eating disorders in its Peer-Reviewed Medical Research Program (PRMRP). DOD provides health care services to approximately 9.5 million eligible beneficiaries, including services to treat those diagnosed with eating disorders, through TRICARE, DOD’s regionally structured health care system. Servicemembers can obtain these services at military treatment facilities—referred to as direct care—or receive care purchased from civilian providers—referred to as purchased care. DOD officials told us that the specialized level of care necessary to treat eating disorders is available to TRICARE beneficiaries through purchased care, rather than direct care. The Defense Health Agency (DHA), which oversees the TRICARE program, uses two contractors to develop regional provider networks. According to the two TRICARE contractors’ data for purchased care, as of spring 2020, there were 166 eating disorder facilities located in 32 states throughout the country and the District of Columbia. The facilities vary by geographic location, population served, and level of treatment provided: Geography: About half of the 166 facilities (79) are located in the following five states: California (24), Florida (18), Illinois (15), Texas (13), and Virginia (nine). Population: Of the 166 eating disorder facilities, over three-quarters provide treatment to both adult (132 facilities) and child and adolescent (132 facilities) populations. Level of Treatment: Most facilities provide inpatient hospitalization programs, which are for serious cases requiring medical stabilization (81 facilities); partial hospitalization, which are day programs providing treatment 5 to 7 days a week (133 facilities); or intensive outpatient programs, which are treatment programs providing therapy 2 to 6 days a week (107 facilities). About one-fifth of the facilities (35) provide residential treatment services, which are living accommodations providing intensive therapy and 24-hour supervision. TRICARE contractors have met with some challenges entering into contracts with eating disorder treatment facilities in certain areas of the country, according to DHA officials and both contractors. However, both contractors told GAO they consider it their responsibility to ensure beneficiaries receive the care they need regardless of the location of the facility. No access-to-care complaints related to eating disorder treatment were reported by TRICARE beneficiaries, according to the most recent DHA data for years 2018 through 2019. Eating disorders are complex conditions affecting millions of Americans and involve dangerous eating behaviors, such as the restriction of food intake. They can have a severe impact on heart, stomach, and brain functionality, and they significantly raise the risk of mortality. Many with eating disorders also experience co-occurring conditions such as depression. Research has yielded a range of estimates of the number of servicemembers with an eating disorder, due to differences in research methods. For example, a 2018 DOD study concluded that servicemembers likely experienced eating disorders at rates that are comparable to rates in the general population, while other survey-based research suggested the number of servicemembers with eating disorders may be higher than those with a medical diagnoses of such disorders. The potential effects that eating disorders can have on the health and combat readiness of servicemembers and their dependents underscores the importance of screening and treating this population. GAO was asked to provide information on eating disorders among servicemembers and their dependents. To describe how DOD screens for eating disorders among servicemembers, GAO reviewed DOD policies related to health screening and interviewed behavioral health specialists from the military branches. To understand approaches and challenges with implementing screening in a military environment, any planned or ongoing DOD-sponsored research related to this topic, and available eating disorder treatment, GAO interviewed representatives from the Eating Disorder Coalition, Uniformed Services University of Health Sciences, and the University of Kansas. To describe how DOD provides eating disorder treatment to servicemembers and their dependents, GAO interviewed DHA officials and TRICARE contractors and reviewed the TRICARE policy manual to identify the types of eating disorder diagnoses and treatments that are covered through direct and purchased care. GAO received data from the two TRICARE contractors related to the availability of eating disorder treatment services as of spring 2020. For more information, contact Sharon Silas at (202) 512-7114 or Silass@gao.gov.[Read More…]
- Secretary Pompeo Participates in the Geneva Consensus Declaration Signing CeremonyBy Sam NewsOctober 21, 2020
- Spectrum Management: Agencies Should Strengthen Collaborative Mechanisms and Processes to Address Potential InterferenceBy Sam NewsJuly 20, 2021What GAO Found The Federal Communications Commission (FCC) and National Telecommunications and Information Administration (NTIA) regulate and manage spectrum, and other agencies, such as the National Oceanic and Atmospheric Administration (NOAA) and National Aeronautics and Space Administration (NASA) are among federal spectrum users. To address potential interference among proposed uses of spectrum, these agencies employ various coordination mechanisms. For domestic matters, the agencies coordinate through an NTIA-led committee that provides input to FCC’s spectrum proceedings. For U.S. participation in the International Telecommunication Union’s (ITU) World Radiocommunication Conferences (WRC), agencies coordinate via a preparatory committee that provides input used to develop U.S. positions that the Department of State submits to a regional body or directly to the WRC (see figure). Technical Coordination Process for U.S. Participation in WRC These mechanisms reflect some key collaboration practices but do not fully reflect others. For example, while the documents that guide coordination between FCC and NTIA and the preparatory committee emphasize reaching consensus whenever possible, there are no clearly defined and agreed-upon processes for resolving matters when agencies cannot do so. Additionally, neither document has been updated in almost 20 years, though agency officials said conditions regarding spectrum management activities have changed in that time. GAO’s review of U.S. participation in ITU’s 2019 WRC shows that these issues affected collaboration. For example, disputes among the agencies and the inability to reach agreement on U.S. technical contributions challenged the U.S.’s ability to present an agreed-upon basis for decisions or a unified position. NOAA and NASA conduct and FCC and NTIA review technical interference studies on a case-by-case basis. When originating from ITU activities, the agencies conduct or review technical interference studies through participation in international technical meetings and the preparatory committee process. However, the lack of consensus on study design and, within the U.S. process, specific procedures to guide the design of these types of studies, hampered U.S. efforts to prepare for the 2019 WRC. For example, the U.S. did not submit its studies on certain key issues to the final technical meeting, resulting in some stakeholders questioning whether the corresponding U.S. positions were technically rooted. Agreed-upon procedures could help guide U.S. efforts to design these studies and consider tradeoffs between what is desirable versus practical, to mitigate the possibility of protracted disagreements in the future. Why GAO Did This Study This testimony summarizes the information contained in GAO's June 2021 report, entitled Spectrum Management: Agencies Should Strengthen Collaborative Mechanisms and Processes to Address Potential Interference (GAO-21-474). For more information, contact Andrew Von Ah at (202) 512-2834 or email@example.com, or Karen L. Howard at (202) 512-6888 or firstname.lastname@example.org.[Read More…]
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- Secretary Michael R. Pompeo, Secretary of Defense Mark Esper, Indian Minister of Defense Rajnath Singh, And Indian Minister of External Affairs Subrahmanyam Jaishankar Opening Statements at the U.S.-India 2+2 Ministerial DialogueBy Sam NewsOctober 27, 2020Michael R. Pompeo, [Read More…]
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- Commercial Shipping: Information on How Intermodal Chassis Are Made Available and the Federal Government’s Oversight RoleBy Sam NewsMarch 8, 2021What GAO Found Containerized shipping—performed by oceangoing vessels using standardized shipping containers—accounted for approximately 60 percent of all world seaborne trade, which was valued at approximately $12 trillion in 2017. At a port, shipping containers are placed on "intermodal chassis" (chassis), standardized trailers that carry shipping containers and attach to tractors for land transport. Multiple entities are involved in the movement of shipping containers, including intermodal equipment providers (IEP) (which own and provide chassis for a fee); ocean carriers (which transport cargo over water); and motor carriers (which transport shipping containers over land via chassis). Four distinct models are used in the U.S. to make chassis available to motor carriers (see table), each with benefits and drawbacks according to the entities GAO interviewed. While chassis are generally provided to motor carriers using one of these four models, more than one model may be available at a port. Chassis Provisioning Models Model 1: Single chassis provider An individual intermodal equipment provider (IEP) owns chassis that are directly provided to shippers or motor carriers. Model 2: Motor carrier-controlled A motor carrier owns or is responsible for a chassis that it has procured under a long-term lease. Model 3: Gray pool A single manager, often a third party, oversees the operations of a pool that is made up of chassis contributed by multiple IEPs. Model 4: Pool-of-pools Each IEP manages its respective chassis fleet, but each allow motor carriers to use any chassis among the fleets and to pick up and drop off chassis at any of the IEPs’ multiple locations. Source: GAO. | GAO-21-315R Entities GAO interviewed identified multiple benefits and drawbacks to each of the chassis provisioning models. Regarding benefits, for example, both the single chassis provider model and the motor carrier-controlled model allow IEPs and motor carriers to have direct control over the maintenance and repair of their chassis, something these entities potentially lose under other chassis provisioning models. Further, the gray pool and the pool-of-pools models can resolve many of the logistical concerns regarding the availability of chassis, leading to operational efficiencies for port operators and the ability of motor carriers to choose whatever chassis they wish. Regarding drawbacks, cost considerations were identified in some cases. For example, under the single chassis provider model, two IEPs told us that while an expected part of the business, repositioning chassis to ensure there is a sufficient supply of chassis where they are needed can be costly to the IEPs. The federal government provides oversight of chassis safety but has a limited economic oversight role regarding chassis. The Federal Motor Carrier Safety Administration (FMCSA) employs several inspection methods to help oversee chassis safety and compliance with regulations. For example, inspectors perform roadside inspections on commercial vehicles, including chassis, in operation. FMCSA also performs investigations of individual IEPs to oversee chassis safety. While one stakeholder GAO spoke with stated that FMCSA should consider maintaining safety ratings for IEPs—as is currently done for motor carriers—FMCSA officials told us that the current processes provide sufficient information to select IEPs for investigation. The Federal Maritime Commission (FMC) oversees ocean carriers that provide service to and from the U.S. and works to ensure a competitive and reliable ocean transportation supply system. Entities may file complaints with FMC to allege violations of the Shipping Act of 1984, as amended. One such complaint was filed in August 2020, in which the complainants allege, among other things, that although ocean carriers do not own chassis, they still control the operation of chassis pools at ports. An initial decision on this complaint is expected in August 2021. None of the entities GAO spoke with identified additional actions they would like for FMC to take regarding chassis. Why GAO Did This Study Senate Report 116-109—incorporated by reference into the explanatory statement accompanying the Further Consolidated Appropriations Act, 2020—contained a provision for GAO to study intermodal chassis. Within the U.S., some entities have expressed concerns about chassis, including limited availability of chassis in some circumstances, as well as the age and safety of chassis. This report describes selected stakeholders' views on: (1) the ways in which chassis are made available for the movement of shipping containers and the benefits and drawbacks of those models, and (2) the federal government's role in the chassis market. To address these objectives, GAO reviewed relevant reports on chassis provisioning and federal oversight. GAO interviewed representatives from FMC, FMCSA, five industry associations, and the three largest intermodal equipment providers. GAO also interviewed three ocean carriers, five port operators, and a motor carrier selected, in part, for their large number of container movements. The information obtained from these interviews provides a broad perspective of relevant issues but is not generalizable to all entities. For more information, contact Andrew Von Ah at (202) 512-2834 or email@example.com.[Read More…]
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