Revamped Dow’s Gap With S&P 500 Is Set to Widen - The Wall Street Journal

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The Dow Jones Industrial Average has struggled this year to keep up with the gains of its broader counterpart, the S&P 500, which has more representation from surging tech stocks. Changes coming to the Dow on Monday likely won’t help.

That is because the biggest change is Apple Inc.’s stock split, which takes effect Monday and slashes the tech component of the price-weighted Dow more than the addition of new member Salesforce.com boosts it.

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August 31, 2020 at 05:15AM
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Revamped Dow’s Gap With S&P 500 Is Set to Widen - The Wall Street Journal

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Vikings acquire Yannick Ngakoue in trade with Jaguars - NFL.com

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After an uncertain future in Jacksonville, Yannick Ngakoue now has a new home.

The Minnesota Vikings have acquired Ngakoue from the Jaguars for a 2021 second-round pick and a conditional fifth-round pick in 2022, sources tell NFL Network's Tom Pelissero.

ESPN first reported the story.

NFL Network Insider Ian Rapoport later reported, per an informed source, that both sides agreed to a one-year contract worth a few million less than the franchise tag, which is what it took to get the initial deal in Jacksonville done. Ngakoue was set to make $17.8 million with his former team, but he will now play under a revised $12 million deal, electing to play for less to leave Duval, Pelissero reported Sunday evening. There is also no no-tag clause in the deal, so the Vikings can use the franchise tag on the pass rusher in 2021, Pelissero added. Thus, the best scenario for all involved would be a long-term pact (which cannot happen until after the upcoming season as he was franchised this year).

It's evident Ngakoue wanted out of Jacksonville in a big way as he took a big pay cut (roughly 30% this season) and didn't command a no-tag clause. Furthermore, as reported by Pelissero, he was due $17.88 million on the franchise tag tender this season with Jacksonville, which would have come with no personal income tax as is a bonus of playing in Florida. Thus, Ngakoue gave up roughly $6 million to get a fresh start with the Vikings.

Ngakoue posted a statement on Twitter Sunday in regard to the transaction, which indicates his approval. Thus, as Rapoport reported initially, he will begin the process of heading to Minnesota for physical and COVID-19 testing. He's expected to sign when he goes through the protocols.

The Link Lonk


August 30, 2020 at 06:13PM
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Vikings acquire Yannick Ngakoue in trade with Jaguars - NFL.com

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Taliban Violated Afghan Deal With Shelling of American Bases, U.S. Officials Say - The New York Times

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KABUL, Afghanistan — Rockets launched at a U.S. military base and a joint U.S.-Afghan airfield in southern Afghanistan in recent weeks are believed to have been fired by the Taliban, according to three American military officials, in what would amount to a clear breach of the peace agreement between the United States and the insurgent group.

Roughly a dozen rockets struck in late July around Camp Bastion, a sprawling air base used by Afghan and American forces in the southern province of Helmand. And several rockets were fired within the last week or so at Camp Dwyer, a large U.S. military base about 50 miles south of Bastion.

A Taliban commander familiar with the region denied that the group had carried out any strikes on American bases in Helmand and said that the group would investigate. The rocket strikes may also have been carried out by a Taliban faction that is against the agreement, according to one military official who was briefed on the matter.

There were no U.S. casualties in either attack, nor a public response from Washington during a stretch in which American officials have struggled to keep an already shaky peace process on track.

The American-led mission in Afghanistan also declined to comment.

Helmand Province, long considered the Taliban’s heartland and its opium-fueled financial breadbasket, is predominantly controlled by the insurgent group, though well-armed drug barons and differing tribal affiliations ensure that many allegiances and agendas in the region are murky. Afghan government forces there are mostly constrained to the provincial capital, Lashkar Gah, and some villages that serve as district centers.

Image

The United States negotiator Zalmay Khalilzad, left, and Mullah Abdul Ghani Baradar, a founding leader of the Taliban, signing the Feb. 29 peace agreement in Doha, Qatar.Credit...Hussein Sayed/Associated Press

The February peace deal signed in Doha, the capital of Qatar, stipulates that the Taliban would refrain from striking American or NATO forces as they gradually withdrew from the country. And the U.S. military would attack the Taliban only to defend Afghan forces.

The Taliban, long thought to be a conglomerate of various factions with differing agendas, seem to have largely stayed true to the agreement as a unified front, at least publicly, when it comes to not attacking American or coalition forces. But as the Taliban have continued to mount heavy assaults against the Afghan military forces, the United States has carried out dozens of airstrikes to help the Afghans, officials say.

Another sticking point is the Taliban’s reluctance to condemn Al Qaeda, the terrorist group that carried out the attacks of Sept. 11, 2001, and was harbored by the Taliban. A clearly defined tenet of the Feb. 29 peace agreement calls for the Taliban to sever all ties with Al Qaeda before the total withdrawal of U.S. troops. Pentagon officials believe Qaeda fighters continue to be well ingrained with Taliban rank and file.

Gen. Austin S. Miller, the commander of the U.S.-led mission in Afghanistan, said last week that there was a “debate” on Taliban ties to Al Qaeda.

“There are very strict commitments there and they must be upheld,” General Miller told 1TV, an Afghan news outlet.

Violations of the Feb. 29 deal are often raised privately by Taliban and U.S. officials through a communication channel established after the agreement’s signing. Publicly, the Taliban have denounced the United States for carrying out airstrikes on their fighters, claiming the Americans were violating the deal.

“This is one part of a bigger picture,” said Andrew Watkins, a senior analyst on Afghanistan for the International Crisis Group, a Brussels-based conflict resolution organization.

“The military’s general silence or lack of comment of what seems to be an ongoing dynamic in the conflict feels like a reflection of a larger trend of the Americans willing to overlook ambiguities in how the February agreement is being upheld in the interest of not jeopardizing an agreement that already feels very fragile.”

In the recent attacks, the Taliban fired rockets from several miles away that were mostly inaccurate, said one military official familiar with the events. After rockets struck Camp Dwyer, American aircraft retaliated by striking the launch site, destroying a cluster of munitions that had yet to be fired, the official said.

Camp Dwyer, a British base that was turned over to the Americans at the height of the war, is quietly becoming the strategic hub for American troops remaining in southern Afghanistan.

The U.S.-led mission in Afghanistan has plans to shuttle troops to Camp Dwyer from its large airfield in Kandahar before closing the base in Kandahar altogether in the coming months, according to military officials. Under the February agreement, five American bases were closed and handed over to Afghan forces.

Camp Bastion was once the logistics hub for U.S. and NATO troops in Helmand Province. Conjoined by the U.S. Marine base Camp Leatherneck, the base was handed over to the Afghan security forces in 2014.

Several months later, as the Taliban began retaking much of the province, American forces returned, establishing a small base there and using the airfield for helicopter refueling and other operations.

There are roughly 8,000 U.S. troops still in Afghanistan, with plans to draw down to about 4,500 by the fall. Four American service members have been killed during combat operations this year, a relatively small number compared to this time in 2019, when more than a dozen U.S. troops had already been killed.

Taliban prisoners lined up at Bagram military base before being released in May.Credit...Jim Huylebroek for The New York Times

The Afghan government and the Taliban are stalled on the cusp of direct negotiations in Qatar as a dispute continues about a prisoner exchange on both sides.

Under the deal between the United States and the Taliban, which initiated the phased withdrawal of American troops, direct peace negotiations between the Afghan sides were conditioned on swapping 5,000 Taliban prisoners with 1,000 Afghan security forces held by the insurgents.

While the Taliban has released the Afghan prisoners, President Ashraf Ghani was reluctant to release 400 Taliban prisoners accused of serious crimes until a consultative assembly, convened this month, approved their release.

The talks were expected to begin in a matter of days after Mr. Ghani decreed the release of the last prisoners. But new hiccups have emerged: The Afghan government has conditioned the release of the Taliban on the freeing of more than a dozen Afghan commandos and pilots the insurgents are holding. Australia, France and the United States have also expressed concerns about the release of half a dozen prisoners.

While France and Australia do not want those members of the Taliban accused of attacks on their citizens released, the United States has said it has reason to believe two of the Taliban fighters to be released would join the Islamic State, a senior Afghan official said.

Taimoor Shah contributed reporting from Kandahar, Afghanistan, and Mujib Mashal from Kabul.

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August 31, 2020 at 02:40AM
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Taliban Violated Afghan Deal With Shelling of American Bases, U.S. Officials Say - The New York Times

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With a Pickup Truck and an Open Mind, the Philharmonic Returns - The New York Times

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Dark clouds loomed over Downtown Brooklyn on Friday as the countertenor Anthony Roth Costanzo, standing on the bed of a pickup truck, announced to people gathered at Betty Carter Park that they were about to witness a world premiere.

“No one has heard this music before!” he told the small crowd, as if he were a carnival barker. “We are so excited to do this for you.”

Then he cued a trio of players from the New York Philharmonic, which had not given a public performance since the coronavirus pandemic forced it to close in March. The orchestra made its return with this pop-up, pickup concert from what is being called the NY Phil Bandwagon.

The musicians, wearing orchestra-branded red shirts and black face masks, began the new piece, Carlos Simon’s “Loop,” as raindrops started to fall. With the storm rolling in, the piece’s jittery rhythms took on cinematic urgency. Administrators from the Philharmonic opened umbrellas and held them over the trio, who were using their primary — which is to say their most valuable and precious — instruments.

Image

The countertenor Anthony Roth Costanzo, who conceived the concert series, singing from the Bandwagon in front of the Brooklyn Academy of Music.Credit...Dina Litovsky for The New York Times

People in the audience were undaunted by the weather, as were the players. Once “Loop” ended, Mr. Costanzo asked if the concert should continue; an answer came from the trio as Cynthia Phelps, the orchestra’s principal violist, shouted “Yes!”

After the performance, while the truck was being packed up and prepared for its next surprise show, Ms. Phelps said she didn’t want to stop because it felt good to be playing with her colleagues again. “It’s reminiscent of what we used to do,” she added.

Yulia Ziskel, the trio’s violinist, walked up, exclaiming, “I feel suddenly energized.”

“It’s a charge,” Ms. Phelps replied. “This is the thing, to groove off each other. It’s not the same when we’re at home doing things over the internet.”

For months, the internet has been the Philharmonic’s only venue for performances — archived material streamed on Facebook, videos of pieces recorded individually and edited together in “Brady Bunch”-like tiles. The orchestra’s last public appearance was an open rehearsal on the morning March 12; by the afternoon, that evening’s concert had been canceled, and now a return to David Geffen Hall is unlikely before a coronavirus vaccine becomes widely available.

When rain started to fall during one of the performances, administrators from the Philharmonic — including Adam Crane, the vice president for external affairs, here — held umbrellas over the musicians.Credit...Dina Litovsky for The New York Times

The NY Phil Bandwagon, conceived by Mr. Costanzo, is bringing the orchestra out of its dormancy. The truck — a Ford F-250 decorated in Philharmonic red, white and black, with touches like a gas cap cover that says “PHIL ’ER UP” — will drive to three unannounced locations each Friday, Saturday and Sunday for the next eight weeks, with small ensembles performing chamber works and recently commissioned premieres.

There is little flexibility in a concert at Geffen Hall; with the program and players planned a year in advance, only encores are unexpected. The Bandwagon, however, is designed to be endlessly adaptable — to weather, crowds or, in the case of Friday’s debut, a demonstration that necessitated a change of venue. A performance can be cut short or extended; repertoire can change at any moment. The series came together quickly and remains a work in progress, especially as organizers work to grow a list of community partners in all five boroughs. A refrain on the first day: “We’re learning as we go.”

Lincoln Center

The day began around 2 p.m. with a soundcheck across the street from Lincoln Center, facing the rear of the Metropolitan Opera and an entrance to the parking garage. Several crew members set up the microphones and lights, helped by Mr. Costanzo and DeAnne Eisch, the orchestra’s personnel manager, who sanitized each stand and seat.

Everyone’s temperature was checked upon arrival, and they were tested for Covid-19 in advance. Adam Crane, the Philharmonic’s vice president for external affairs, described them as being in “a test bubble”; only those in the bubble can touch the equipment, ride in the truck or take part in the performance.

Once the string trio — Ms. Ziskel, Ms. Phelps and the cellist Sumire Kudo — arrived, they played excerpts from the program: movements of works by Beethoven and Dohnanyi, as well as the Simon premiere and, with Mr. Costanzo, vocal music by Handel, Purcell and Gershwin.

This wasn’t an official concert, but an audience formed nonetheless. A man making a Grubhub delivery pulled up on his bike, seeming not to notice amid the music that the bubble tea he was toting had exploded. People recorded on their phones, which continued and was even encouraged (with a hashtag, of course) all day. Gwendolyn Wilson, from Middletown, N.Y., who was in town visiting her daughter, stopped while walking a small dog named Oreo, surprised by what she had found. “I just love music,” she said, smiling.

As if to offer a test for unpredictability, one man walked right into the performance, between the players and the truck. He looked up at Mr. Costanzo, who calmly flashed him a peace sign; he did the same and kept walking until, hearing the sounds of Gershwin’s “I Got Rhythm,” he decided to stay.

Betty Carter Park

At Betty Carter Park, the music stopped passersby who were asked to maintain a safe distance from one another.Credit...Dina Litovsky for The New York Times

The Bandwagon was packed up and driven to Betty Carter Park, where its first actual concert would unfold with the Brooklyn Academy of Music in the background. Already the day had hit a snag: traffic. Mr. Crane and his group arrived first, so they kept a parking space open for the truck by standing in the street. “We wear many hats in this organization,” he said.

It was a loud spot for a string performance. Beethoven was accompanied by a passing cement mixer; a red light forced an orange Jeep Wrangler, Latin music blaring out of its open windows, to stop directly behind the Bandwagon. But the driver muted his stereo and began to mime playing a cello in his seat.

After the first piece, Mr. Costanzo introduced the players and one of the Bandwagon’s partners, Catherine Gray from the League of Women Voters, who came from Park Slope to follow the truck and register voters at each stop.

The program featured  movements from works by Beethoven and Dohnanyi, as well as a premiere by Carlos Simon and songs featuring Mr. Costanzo.Credit...Dina Litovsky for The New York Times

“We also have our friend selling beautiful towels and sheets over here,” Mr. Costanzo joked, gesturing to a sidewalk vendor parked next to the Bandwagon. “I suggest you check them out.”

The audience grew quickly and fluctuated, gaining numbers as people stepped off the B38 bus nearby and losing some as the rain picked up. Samantha Kucher and Michael Roitman were walking their dog, Baby, and their baby, Simon, who applauded throughout.

“Our son loves music,” Mr. Roitman said.

“But,” Ms. Kucher added, “he hasn’t been able to go to any music classes because of all the stuff.”

Brooklyn Bridge Park

Ms. Phelps, the violist, playing as a crowd gathers at Brooklyn Bridge Park for a concert that almost didn’t happen on Friday.Credit...Dina Litovsky for The New York Times

Each location, Mr. Costanzo said, comes with a backup. The second concert was meant to take place at McCarren Park in Williamsburg, but because of a demonstration in solidarity with a march in Washington for social justice, it was moved to Brooklyn Bridge Park, a site that hadn’t been tested yet. Which might be why the Bandwagon immediately ran into trouble when it arrived.

An officer from the Parks Enforcement Patrol rode up on his golf cart and said the Bandwagon would have to leave without a permit. A small group from the Philharmonic told him that they did have one, but the officer said it wasn’t valid because this was a privately owned area. Mr. Costanzo was insistent; he eventually pleaded the Philharmonic’s case on a long call with an official of the park that ended not only with permission, but also with the potential of a future partnership.

The Brooklyn Bridge Park performance drew listeners from nearby restaurants, an ice cream truck across the street and one woman watching from the window of her corner apartment.Credit...Dina Litovsky for The New York Times

One concession: The program would need to be shorter because Mr. Costanzo had promised that it would last less than 15 minutes. So the group winnowed it down to four pieces and started quickly to make up for the delay.

People brought Shake Shack takeout and listened while eating on benches. The man operating a Brooklyn Ice Cream truck leaned out to watch, as did a woman from a corner apartment across the street. Mr. Costanzo found another potential partner in the teenage drummer Ezra Kessler, who got a shout-out during the performance.

As crew members were packing up, someone noticed that a screw had penetrated one of the rear tires. But that problem could wait until tomorrow.

Dante Park

The final concert, at Dante Park near David Geffen Hall, attracted the largest audience, and the most applause, of the day. Credit...Dina Litovsky for The New York Times

Friday’s final concert was the closest thing Lincoln Center has had to a public performance since March. Yet it was across the street, not on the campus, which was barricaded and eerily dark, with even its animated fountain stilled.

This time, there were no major obstacles; some trouble with the lighting was easy compared with rain or parks bureaucracy. And a crowd began to assemble before the players even started to tune. Sybil Wa was there with her daughter Gwyn Parkin. They happened to pass a test run last weekend, and Gwyn liked dancing to the music.

“I miss seeing them in the hall,” said Ms. Wa, a Philharmonic subscriber. “This is a very nice way to hear them.”

The busy location, surrounded by outdoor restaurants and shopping, attracted at least 50 people, more than the previous two concerts. At times, it felt like being back at Geffen Hall: Someone was fishing snacks out of a tote from Zabar’s, and a man who talked loudly into his phone was glared at and shooed away.

Ms. Kudo, the cellist, preparing for the Dante Park concert in her Philharmonic-branded T-shirt and face mask.Credit...Dina Litovsky for The New York Times

There would be lessons learned from the day, and small adjustments to be made for the next round of performances — indeed, the next eight weeks. But when Mr. Costanzo and the Philharmonic trio reached the spirited ending of “I Got Rhythm,” it was a relief just to have gotten through the first day.

And the audience responded with the Bandwagon’s biggest applause yet. “We’ve missed you!” one fan shouted.

“Thank you for coming, thank you for sharing this music,” Mr. Costanzo said as he waved goodbye to the crowd. “We hope to find you on a street corner soon.”

The Link Lonk


August 31, 2020 at 02:00AM
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With a Pickup Truck and an Open Mind, the Philharmonic Returns - The New York Times

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Aspirin with or without Clopidogrel after Transcatheter Aortic-Valve Implantation - nejm.org

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Abstract

Background

The effect of single as compared with dual antiplatelet treatment on bleeding and thromboembolic events after transcatheter aortic-valve implantation (TAVI) in patients who do not have an indication for long-term anticoagulation has not been well studied.

Methods

In a randomized, controlled trial, we assigned a subgroup of patients who were undergoing TAVI and did not have an indication for long-term anticoagulation, in a 1:1 ratio, to receive aspirin alone or aspirin plus clopidogrel for 3 months. The two primary outcomes were all bleeding (including minor, major, and life-threatening or disabling bleeding) and non–procedure-related bleeding over a period of 12 months. Most bleeding at the TAVI puncture site was counted as non–procedure-related. The two secondary outcomes were a composite of death from cardiovascular causes, non–procedure-related bleeding, stroke, or myocardial infarction (secondary composite 1) and a composite of death from cardiovascular causes, ischemic stroke, or myocardial infarction (secondary composite 2) at 1 year, with both outcomes tested sequentially for noninferiority (noninferiority margin, 7.5 percentage points) and superiority.

Results

A total of 331 patients were assigned to receive aspirin alone and 334 were assigned to receive aspirin plus clopidogrel. A bleeding event occurred in 50 patients (15.1%) receiving aspirin alone and in 89 (26.6%) receiving aspirin plus clopidogrel (risk ratio, 0.57; 95% confidence interval [CI], 0.42 to 0.77; P=0.001). Non–procedure-related bleeding occurred in 50 patients (15.1%) and 83 patients (24.9%), respectively (risk ratio, 0.61; 95% CI, 0.44 to 0.83; P=0.005). A secondary composite 1 event occurred in 76 patients (23.0%) receiving aspirin alone and in 104 (31.1%) receiving aspirin plus clopidogrel (difference, −8.2 percentage points; 95% CI for noninferiority, −14.9 to −1.5; P<0.001; risk ratio, 0.74; 95% CI for superiority, 0.57 to 0.95; P=0.04). A secondary composite 2 event occurred in 32 patients (9.7%) and 33 patients (9.9%), respectively (difference, −0.2 percentage points; 95% CI for noninferiority, −4.7 to 4.3; P=0.004; risk ratio, 0.98; 95% CI for superiority, 0.62 to 1.55; P=0.93). A total of 44 patients (13.3%) and 32 (9.6%), respectively, received oral anticoagulation during the trial.

Conclusions

Among patients undergoing TAVI who did not have an indication for oral anticoagulation, the incidence of bleeding and the composite of bleeding or thromboembolic events at 1 year were significantly less frequent with aspirin than with aspirin plus clopidogrel administered for 3 months. (Funded by the Netherlands Organization for Health Research and Development; POPular TAVI EU Clinical Trials Register number, 2013-003125-28; ClinicalTrials.gov number, NCT02247128.)

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August 30, 2020 at 07:34PM
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Aspirin with or without Clopidogrel after Transcatheter Aortic-Valve Implantation - nejm.org

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Dermatology Has a Problem With Skin Color - The New York Times

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In the spring, teenagers started showing up at doctors’ offices in droves with angry red and purple blisters on their fingers and toes. The latest unexpected feature of the coronavirus infection fascinated the public, and suddenly photographs of so-called Covid toes were everywhere on social media.

But almost all of the images depicted glossy pink lesions on white skin. Though people of color have been affected disproportionately by the pandemic, pictures of Covid toes on dark skin were curiously hard to find.

The problem isn’t unique to Covid toes or to social media. Dermatology, the medical specialty devoted to treating diseases of the skin, has a problem with brown and black skin. Though progress has been made in recent years, most textbooks that serve as road maps for diagnosing skin disorders often don’t include images of skin conditions as they appear on people of color.

That’s a glaring omission that can lead to misdiagnoses and unnecessary suffering, because many key characteristics of skin disorders — like red patches and purple blotches — may appear differently on people with different complexions, experts say.

“Pattern recognition is central to dermatology, and a lot of the pattern recognition is training your eye to recognize certain colors that trigger you to think of certain diseases,” said Dr. Jenna Lester, director of the skin of color program at the University of California, San Francisco.

“But the color in question is impacted by the surrounding color,” she said. “It can look different in darker skin. If you’re only trained to look at something in one color, you won’t recognize it in another color.”

A Black patient with so-called Covid toe …Credit...

… and the same condition on a white teenager.Credit...Northwestern University, via Associated Press

Dr. Lester recently reviewed 130 images of coronavirus skin disorders published in medical journals and found they were overwhelmingly of white people.

As the coronavirus spread, dermatologists started an international registry to catalog examples of skin manifestations of Covid-19. The registry compiled more than 700 images, but only 34 of disorders in Hispanic patients and 13 in Black patients were submitted.

It wasn’t until July that Dr. Roxana Daneshjou and her colleagues at Stanford University published some of the first pictures of Covid toes in nonwhite patients in the Journal of the American Academy of Dermatology.

“We know for certain that if dark skin images are not well represented, skin doctors — but also other doctors who are not skin experts — are at a disadvantage for making a proper diagnosis,” said Dr. Hao Feng, an assistant professor of dermatology at the University of Connecticut.

Dr. Feng reported recently that the omissions are still pervasive in textbooks, where only 10 percent of images illustrate dermatologic diseases in dark skin. When pictures of Black patients were available, they most often described syphilis. He found that one digital resource, VisualDx, had a more diverse display of images: 28.5 percent represented dark skin.

“If you have no experience with this in people of color, it’s like saying you don’t know how to examine the lungs or the heart,” said Dr. Art Papier, a dermatologist who co-founded VisualDX.

Updated 2020-08-30T14:43:25.154Z

All doctors observe the skin for clues to disease. Changes in the skin can be the first indication of life-threatening conditions like sepsis, cellulitis or severe drug reactions to medications.

An example of drug-induced hypersensitivity syndrome in a white patient.Credit...VisualDx

The same condition on Black skin.Credit...VisualDx

Cellulitis on a white patient …Credit...VisualDx

… and on dark skin.Credit...VisualDx

Images of skin cancer in dark skin were underrepresented in educational materials examined in Dr. Feng’s study — yet skin cancer, though less common in people with darker skin, is more deadly in Black and Hispanic patients, and often diagnosed at a later stage.

The five-year survival rate is 66 percent for non-Hispanic Black patients, compared with 90 percent for non-Hispanic white patients.

Black patients are generally less likely than whites to see a dermatologist and less likely to undergo screening for skin cancer. Even when they do see a dermatologist, studies have shown, Black patients are less likely to get certain treatments than white people with the same conditions, like oral antibiotics for acne.

“I can tell you from my own clinical experience a lot of things get missed because people don’t recognize the disease process in darker skin,” Dr. Feng said.

Even relatively common skin conditions can stump physicians if they have never seen them in people of color.

When Dr. Lester was in medical school, she recalled, a Black patient came to the clinic with a mysterious rash that had a purplish hue. “No one knew what it was,” Dr. Lester said.

A biopsy revealed it was a common skin condition that doctors usually diagnose on sight, without tests or procedures: psoriasis. Yet it often goes unidentified and untreated in people of color.

The medical literature describes psoriasis as “salmon pink patches with silvery white scales, but that’s not what it looks like in dark skin,” Dr. Lester said. “It has more of a purple hue, and a lot of my Black patients put tons of moisturizer on when the skin is dry, so the scales aren’t as visible.”

Melanoma on a white person’s skin…Credit...VisualDx

… and on dark skin, where the lesion more often appears on palm of the hand or sole of the foot.Credit...VisualDx

The bull’s-eye rash of Lyme disease on darker skin …Credit...VisualDx

… and on white skin.Credit...VisualDx

Many garden-variety rashes will vary in appearance in different complexions. Eczema, which is typically described as making skin red and itchy, tends to be more bumpy in Black people, Dr. Lester said. Pityriasis rosea is usually described as having a distinctive pattern composed of a large spot with smaller spots branching out from it — but it may not appear this way in people with dark skin.

Melanoma, the most serious form of skin cancer, often develops in Black people in spots where doctors may not think to look for it: on the palms of the hands or soles of the feet.

Doctors often miss rosacea in Black patients, too, because clinicians expect to see redness and visible blood vessels on the face, said Dr. Amy McMichael, chair of the dermatology department at Wake Forest Baptist Health in Winston-Salem, N.C.

“You don’t see as much red if the background skin color is brown,” she said.

Pallor, which can be an indication of anemia as well as reduced blood flow and oxygen, will also have a different appearance in Black patients, said Dr. Lynn McKinley-Grant, an associate professor at Howard University College of Medicine and president of the Skin of Color Society, which promotes awareness and education about these variations.

“It’s a different color, kind of a grayish color,” she said. “I have actually thought of George Floyd. When he’s on the ground, his skin is a gray brown, showing lack of oxygen.”

Kawasaki disease, a children’s disease that bears similarities to a Covid-19 complication called multisystem inflammatory syndrome, causes inflammation in blood vessels and presents with redness, but “how it appears in darker skin tone is very different,” said Dr. Susan Taylor, associate professor of dermatology at the University of Pennsylvania Perelman School of Medicine.

A Black patient’s eczema …Credit...VisualDx

… and the condition on white skin.Credit...VisualDx

Pityriasis rosea on a white patient …Credit...VisualDx

… and on a Black patient.Credit...VisualDx

“You don’t want to miss that in a kid because you don’t know how to look for the rash and your eye isn’t trained to see it,” she said.

The Coronavirus Outbreak ›

Frequently Asked Questions

Updated August 27, 2020

• What should I consider when choosing a mask?

  • There are a few basic things to consider. Does it have at least two layers? Good. If you hold it up to the light, can you see through it? Bad. Can you blow a candle out through your mask? Bad. Do you feel mostly OK wearing it for hours at a time? Good. The most important thing, after finding a mask that fits well without gapping, is to find a mask that you will wear. Spend some time picking out your mask, and find something that works with your personal style. You should be wearing it whenever you’re out in public for the foreseeable future. Read more: What’s the Best Material for a Mask?

• What are the symptoms of coronavirus?

  • In the beginning, the coronavirus seemed like it was primarily a respiratory illness — many patients had fever and chills, were weak and tired, and coughed a lot, though some people don’t show many symptoms at all. Those who seemed sickest had pneumonia or acute respiratory distress syndrome and received supplemental oxygen. By now, doctors have identified many more symptoms and syndromes. In April, the C.D.C. added to the list of early signs sore throat, fever, chills and muscle aches. Gastrointestinal upset, such as diarrhea and nausea, has also been observed. Another telltale sign of infection may be a sudden, profound diminution of one’s sense of smell and taste. Teenagers and young adults in some cases have developed painful red and purple lesions on their fingers and toes — nicknamed “Covid toe” — but few other serious symptoms.

• Why does standing six feet away from others help?

  • The coronavirus spreads primarily through droplets from your mouth and nose, especially when you cough or sneeze. The C.D.C., one of the organizations using that measure, bases its recommendation of six feet on the idea that most large droplets that people expel when they cough or sneeze will fall to the ground within six feet. But six feet has never been a magic number that guarantees complete protection. Sneezes, for instance, can launch droplets a lot farther than six feet, according to a recent study. It's a rule of thumb: You should be safest standing six feet apart outside, especially when it's windy. But keep a mask on at all times, even when you think you’re far enough apart.

• I have antibodies. Am I now immune?

  • As of right now, that seems likely, for at least several months. There have been frightening accounts of people suffering what seems to be a second bout of Covid-19. But experts say these patients may have a drawn-out course of infection, with the virus taking a slow toll weeks to months after initial exposure. People infected with the coronavirus typically produce immune molecules called antibodies, which are protective proteins made in response to an infection. These antibodies may last in the body only two to three months, which may seem worrisome, but that’s perfectly normal after an acute infection subsides, said Dr. Michael Mina, an immunologist at Harvard University. It may be possible to get the coronavirus again, but it’s highly unlikely that it would be possible in a short window of time from initial infection or make people sicker the second time.

• I’m a small-business owner. Can I get relief?

  • The stimulus bills enacted in March offer help for the millions of American small businesses. Those eligible for aid are businesses and nonprofit organizations with fewer than 500 workers, including sole proprietorships, independent contractors and freelancers. Some larger companies in some industries are also eligible. The help being offered, which is being managed by the Small Business Administration, includes the Paycheck Protection Program and the Economic Injury Disaster Loan program. But lots of folks have not yet seen payouts. Even those who have received help are confused: The rules are draconian, and some are stuck sitting on money they don’t know how to use. Many small-business owners are getting less than they expected or not hearing anything at all.

• What are my rights if I am worried about going back to work?

Dr. Taylor is a co-author of “Dermatology for Skin of Color,” one of the first textbooks that focused on the treatment of skin conditions in moderately to heavily pigmented skin. But new textbooks are not the solution, she said.

“We shouldn’t have to write separate textbooks — that information should be integrated into the quote-unquote standard textbooks,” Dr. Taylor said.

Nearly half of dermatologists and dermatology residents say they were not adequately trained to treat skin conditions in people of color. For Black patients, that often translates into a prolonged, disheartening search for the right diagnosis.

When Tierra Styles, 31, of Auburn, Ga., asked her pediatrician about a rough patch of skin on the back of her toddler’s neck, the doctor said it was nothing. On later visits, it was diagnosed as scabies, then eczema. But the prescribed ointments had no effect.

Finally, Ms. Styles took her son to a dermatologist who was Black. She said the sandpaper-like patch was a benign skin condition called keratosis pilaris.

“The doctor tried to pull up a picture on the internet, but she couldn’t find one,” Ms. Styles said. “There was not one picture of an African-American person that she could show me.”

Ellen Buchanan Weiss, a white mother of a multiracial child in Raleigh, N.C., was so frustrated by her fruitless online searches for information on her child’s skin rashes that she started her own repository of skin images in an Instagram feed called Brown Skin Matters.

Anyone can submit a photo; a physician reviews the images before they are posted.

“It started as a casual reference for other mothers,” Ms. Weiss said. “What’s been surprising to me is that it’s been used mostly by clinicians — doctors, nurses, professionals teaching in medical schools.”

Many Black patients prefer to see Black dermatologists, who may be more familiar with and have a greater understanding of not only skin issues — like acne, which can leave dark, hyperpigmented spots on dark skin — but hair predicaments, said Dr. Natalie Moulton-Levy, a dermatologist in Manhattan.

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Dr. Natalie Moulton-Levy, a dermatologist in Manhattan. Credit...Jeenah Moon for The New York Times

“We as Black people don’t do hair the same way a non-Black person does,” Dr. Moulton-Levy said. “When you’re giving treatment options, some dermatologists are not familiar with that and say, ‘OK, you have to wash your hair every day.’ We don’t wash our hair every day.”

But getting in to see a dermatologist can be difficult, and waits are notoriously long. There is a shortage of dermatologists generally, and a shortage of dermatologists of color in particular: Only 4 percent of practicing dermatologists identify as Hispanic, and only 3 percent identify as Black or African-American, according to one study.

Black and Hispanic patients are far more likely than white patients to use the emergency room for dermatology problems, especially in rural areas and smaller cities where there are fewer dermatologists, studies have shown. People of color are half as likely as white patients to see a dermatologist for the same conditions.

Health insurance can also be a barrier to care. A 2014 study by the physician staffing firm Merritt Hawkins reported that dermatology was among the specialties least likely to accept Medicaid, with only 27 percent of dermatologists accepting payment from the government health plan compared with 63 percent of cardiologists.

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At some safety-net hospitals, waits as long as a year to see a dermatologist have been recorded. Delayed doctors’ appointments, especially for pediatric dermatologists, can have serious consequences.

A Connecticut woman said that when her biracial daughter first developed patches of blanched, hypopigmented skin at age 10, it was misdiagnosed as a benign condition called pityriasis alba.

The woman, who asked not to be identified, to protect her daughter’s privacy, tried to get her child an appointment with a dermatologist, but few in the area took Medicaid and those who did had an eight-month wait.

When the mother switched jobs and obtained commercial health insurance, she made an appointment with a specialist at Yale University, who diagnosed her daughter with a rare cancer, primary cutaneous T-cell lymphoma, also called mycosis fungoides.

The treatment, which consists of ultraviolet light therapy, has been successful, and the blanched spots are no longer visible on her daughter’s “medium brown skin,” the mother said. But it took two years to get the diagnosis. When she searched online, she said, “I couldn’t find anything that looked like my daughter, and it was mostly images of white skin.”

Physicians often say that they “do not see color,” Dr. Moulton-Levy said. “They are trying in a nice, benevolent way to say skin color doesn’t matter.”

“But it absolutely matters, in dermatology and all of health care,” she said. “‘Colorblind’ is a very difficult term for me to hear.”

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Dermatology Has a Problem With Skin Color - The New York Times

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Preaching Equality, Start-Up Didn’t Practice It With Employees - The New York Times

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SAN FRANCISCO — Onstage at an industry conference last year, Henry Ward, chief executive of the financial technology start-up Carta, described his vision for transforming the way that workers get paid.

Working for a paycheck had evolved from indentured servitude and serfdom, he said. In the next era, employees would own a stake in their companies.

“Our mission is to create more owners in the world,” Mr. Ward said.

Carta has turned that message into a $3 billion valuation and become one of Silicon Valley’s hottest start-ups. But even as it espoused its ownership-for-all creed, the company behaved inequitably to many of its own 838 workers, according to interviews with more than a dozen current and former employees, along with reviews of emails, internal communications and corporate documents.

The current and former employees, four of whom spoke on the record, said they were often belittled, excluded from meetings and made to feel as if they were at fault for their own mistreatment. Those who voiced concerns said they were sidelined, demoted or given pay cuts.

Many of those who were mistreated were women, the current and former employees said. One woman was fired after an emotional outburst in a meeting. Another was pushed out after raising regulatory concerns.

Some former workers are now pushing back. Three of them, including a former top operations executive, have sued Carta in the last year, accusing it of wrongful termination. In a suit last month, Emily Kramer, a former Carta marketing executive, said that she had been paid less than her male peers and that Mr. Ward had disparaged her with a vulgarity after she voiced concerns about a presentation. She said that incident had forced her out of the company.

Ms. Kramer’s lawsuit and others said Mr. Ward set the tone by denigrating employees and dismissing concerns. While his blunt management style fostered loyalty among some, the current and former employees said, it alienated many others.

The discontent at Carta has emerged as the mission-driven facade of many idealistic tech start-ups has started cracking. In recent months, workers at the apparel start-up Everlane, the feminist work space The Wing and the therapy app Talkspace have criticized the mismatch between their employers’ public messages of empowerment and justice and their private actions.

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Carta advertised its ownership-for-all creed on billboards in San Francisco.Credit...Cayce Clifford for The New York Times

The current and former Carta employees said what they had experienced was directly at odds with the start-up’s crusade for fairness for workers and more equality for women. Mr. Ward not only stated those goals publicly but had Carta advertise them on billboards in San Francisco, including one that implored other tech companies to close a “gender equity gap” faced by women.

“This is a company that makes a conscious decision to market itself as a company that cares about fair practices,” Ms. Kramer said in an interview. “I know it’s smoke and mirrors.”

A Carta spokeswoman said the start-up was a “consistent, vocal and passionate advocate for gender equity, internally and externally.” She said that one-third of Carta’s top executives were women and that its female employees had reported higher satisfaction than men in its most recent survey.

Jane Alexander, Carta’s chief of staff, said of Mr. Ward: “Henry has a polarizing style that is a combination of his personality, his vision and his passion. It does not work for everyone.” But, she said, he “is fair and cares fiercely about Carta’s employees.”

Mr. Ward, 44, has worked in sales and operations at Silicon Valley start-ups since the early 2000s. In 2012, he founded Carta, initially called eShares. Investors, start-ups and their employees use Carta’s software to manage, issue and value their equity; the company takes a fee for the use of its systems.

The start-up, which is based in Palo Alto, Calif., has raised nearly $700 million from investors including Andreessen Horowitz and Goldman Sachs. Among Carta’s customers are the stock trading app Robinhood and the fitness booking service ClassPass.

Mr. Ward hired new employees quickly. In public, he said he wanted the “Cartans” to stay for a decade or more. But he privately told executives to “hire fast, fire fast” lest workers become too comfortable, said three former employees who heard him. A Carta spokeswoman denied Mr. Ward had said that.

In a 2015 memo to new employees, Mr. Ward offered a warning: “Doing Carta is hard. You will learn that soon.”

Issues surfaced. Liz LeCrone, a product manager, said a young female employee staying in Carta’s corporate apartment told her in 2017 that she had woken up to discover a male co-worker, who was senior to her, in her room naked. The woman reported the incident to the company, Ms. LeCrone and two others with knowledge of the situation said. Carta excused it as sleepwalking.

Ms. LeCrone, who left Carta in 2018, said that while the company had believed the woman’s account, “how they handled the situation proved to us that they did not value her.”

A Carta spokeswoman said the company had fully investigated the matter and handled the situation accordingly.

That year, Mr. Ward attended a meeting with an internal group that was set up to discuss women’s issues. The group proposed that Carta create a way for women to anonymously report harassment or discrimination without fear of retaliation, four people who attended said.

Mr. Ward dismissed the idea. Attendees erupted into emotional outbursts and raised voices, the people said.

Henry Ward, Carta’s chief executive, has said, “Our mission is to create more owners in the world.”Credit...Carta

The next day, Carta fired one of the women who had spoken up in the meeting. She was told it was because she did not receive feedback well and had shown frustration in meetings, according to four people, as well as a review of emails and text messages.

Carta said “departure paperwork” for the woman had been filed before the meeting. The company said it created the anonymous reporting tool last year.

Caroline Griffith, who worked on Carta’s sales and marketing teams in 2017 and 2018, said she was fired in 2018 for reasons that were not made clear to her. When she received an offer for a new job afterward, a Carta executive whom Ms. Griffith had little contact with told her future employer that she was difficult. The offer was rescinded, she said.

Carta said it prohibited providing information on former employees, other than confirming dates of employment.

In 2018, the company published a study on women and equity, called the Gap Table. It also examined its own compensation practices and found pay disparities based on gender.

To fix those, Carta added $2 million in annual payroll and issued $8.3 million of equity to employees. But equity is doled out in tranches over years and rises in value when start-ups raise funding at higher valuations, rewarding those who joined early and stayed longer. Carta did not make up for the lost time or higher valuation for the employees who had been underpaid.

“I’m embarrassed that we are part of the problem,” Mr. Ward wrote in a blog post about the study. “But we want to be part of the solution.”

He wrote that Carta would add its first female board member by the end of 2018. The company has not done so. Carta said it was still committed to appointing one.

When Carta raised new funding last year, Andrea Walne, head of liquidity solutions, attended the investor meetings because she led the business side of CartaX, an exchange for private stocks that the company was planning. She said it had become clear that she was not supposed to speak, even when executives told investors that CartaX — which has not been released — would be available by mid-2020.

“I was there as a prop,” she said.

Ms. Walne said she had raised concerns to the legal team that CartaX would not get regulatory approvals by mid-2020. Soon after, she said, she was informed that she had performance issues, though she was not provided details. Then she was offered a “revised” compensation plan of 35 percent less and given 24 hours to decide whether to accept, she said. She left the next week.

Andrea Walne, Carta’s head of liquidity solutions, was pushed out after she raised concerns about regulatory compliance.Credit...Madeline Cass for The New York Times

A Carta spokeswoman denied Ms. Walne’s allegations.

Ms. Kramer said she had been sidelined after she protested a slide in a Carta presentation last year that included a reference to slavery. She said the mention of slavery was offensive.

In November, Mr. Ward told Ms. Kramer in a meeting that she had received passes because she is a woman. He called her an “asshole” who needed to go into recovery for her behavior, her lawsuit said. She left Carta, saying she had no other choice.

Ms. Kramer also said in her suit that she had been granted only a third of the equity of her male peers. While Carta later rectified the disparity, it did not accelerate her vesting schedule to make up for the lost time, she said.

In a Slack message about Ms. Kramer’s departure, which was viewed by The Times, Mr. Ward praised her work. “She bent the arc for us,” he wrote. “We will always be grateful.”

Carta said Ms. Kramer’s allegations were “unfounded.”

In December, Frank Han, a senior vice president of operations who left Carta in March 2019, filed a lawsuit accusing the company of wrongful termination and retaliation. In his suit, Mr. Han said Mr. Ward had recruited him in late 2018, persuading him to walk away from a different job offer he had accepted.

But less than three months after joining, Mr. Han was demoted and Carta tried to lower his compensation, including reducing his equity grant by almost half, the lawsuit said. When Mr. Han protested, he was fired, according to the lawsuit.

He declined to comment. Carta said the suit “has no merit.”

Tyler Borer, who worked in Carta’s client services, also filed a wrongful-termination suit last year. He said in the suit that he had been fired while hospitalized. A lawyer for Mr. Borer said that the case had been resolved and that the resolution was confidential. Mr. Borer and Carta declined to comment on the suit.

Last month, three days after Ms. Kramer’s lawsuit became public, Mr. Ward addressed it on a Zoom call with employees. He repeated the conversation that Ms. Kramer cited in her suit and said many had agreed with him. He also described two times when he had snapped at other employees, displaying his online conversations with those workers and reading one of his apologies aloud, according to two people who attended.

In a question-and-answer session afterward, employees asked about Carta’s gender ratio and efforts to change its culture. Mr. Ward dismissed the questions, the attendees said.

He later posted a message to the company’s Slack channel thanking employees for their feedback.

“I realized I should have started by reiterating that gender and racial inequality in the workplace, particularly in technology, is a serious issue,” Mr. Ward wrote.

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August 30, 2020 at 04:00PM
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Preaching Equality, Start-Up Didn’t Practice It With Employees - The New York Times

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