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Celtics notebook: Marcus Smart returns with a calming hand



Celtics notebook: Marcus Smart returns with a calming hand

Marcus Smart admits that considering the way he plays, injuries will always be part of the equation.

But the six-game absence that ended with Smart’s return for Sunday’s 116-87 win over Washington was as tough to accept as any he’s been through. He spent his time recovering not only from a breakthrough case of COVID, but also a deep thigh bruise, courtesy of the knee of Indiana’s Domantas Sabonis.

Before playing a minute, though, Smart had a message for every teammate.

“I just told everybody I love them. ‘I love all you guys,’ I’m here and proud and really looking for everybody’s success. I’m glad to be a part of everybody’s success. I know obviously things haven’t been going our way, but we just have to go out there and do what we know we ought to do,” he said. “I pulled Jayson (Tatum), Jaylen (Brown) told them separately by themselves, and I went down the line with everybody individually and told them I appreciate them, I’m proud of them, this is what you do, just go out there and do it and keep doing it, and I told Jaylen and Jayson, keep playing. Don’t worry about it.

“I told Jayson specifically, ‘I know you ain’t hit a 3 in about 20 attempts, just keep shooting.’ I said, ‘I’m going to make sure I find you, I’m going to get you going, I’m going to get you open,’” said Smart. “Just shoot the ball and don’t think about it. Don’t worry about anything else, just play the game of basketball. Don’t worry about anything else then playing the game, play the right way. Defense gives you the shot, you take it. They give you the drive, you drive it. They come on your help, you make the right read and we go from there. Him and Jaylen came out and just showed today, so being able to take that control as the point guard and knowing and understanding my teammates was big and it was something we needed.”

Smart responded with one of his typical stat lines, including 11 points, six assists, two 3-pointers, four steals and four turnovers. He was also exactly what this struggling team has needed — a stable hand.

“Solid. He’s been what he’s been all year,” said Celtics coach Ime Udoka. “He settles us down at times, knows when a guy is going who to get some shots for and obviously his defensive presence, toughness and mentality he brings to the team is invaluable.”

On Sunday, it was easy enough to feed the go-to guy. Tatum set a career-high with nine 3-pointers on the way to the fourth 50-plus performance of his career.

The return of limited opportunities

The Celtics had their full lineup available for only the 13th time this season, and though Aaron Nesmith was available after missing two games to a sprained ankle, he returned to limited opportunity because of the rare availability of the full rotation.

Romeo Langford, like Nesmith one of 14 Celtics to go into health and safety protocol over the last two months, also missed out on some of the opportunity that normally has been available with his teammates out.

“I mean, honestly, unfortunately for them, when they did play when guys were out, they got injured as well,” said Udoka. “Romeo missed quite a few games there and then Aaron as well coming off a game we played well in. So didn’t get the consistent minutes or kind of rolled down with all the guys in and out, so didn’t really get to see them fully like we wanted to in that stretch.

“But they both had their flashes and Josh (Richardson) being out a few games,” he said. “Romeo was really steady and really good before he got hurt. And then Aaron, the same. Like I said he helped us obviously win a game and played great down the stretch, and then obviously rolled the ankle in that game so we haven’t seen him lately. But would have loved to get everybody more opportunity and I felt like injuries were plaguing guys at the wrong time when we had some opportunity with guys out with COVID.”

No more COVID?

Smart’s return, after being the 14th Celtic to fall prey to COVID-19, would seem to indicate that the Celtics are finally in the clear where the virus is concerned. Right?

“Just from a COVID standpoint, everybody’s almost been hit pretty hard. So as far as that, we don’t see that hampering us as much anymore,” said Udoka. “It’s just the entry bugs and, you know, ankle here, and little things here and there. So hopefully guys stay healthy, we can start to shave down some minutes on other guys and go deeper into the rotation. And so at some point it has to balance out and hopefully this is for the rest of the season where it balances out.”


Annabelle De St. Maurice: We’re losing the fight against superbugs, but there’s still hope



Annabelle De St. Maurice: We’re losing the fight against superbugs, but there’s still hope

As parents, we inherently want to protect our children. We tell them stories with happy endings and reassure them that there aren’t monsters hiding under the bed.

But there’s an enemy living among us that poses a fatal threat to kids and adults alike — and we’re simply not doing enough to stop it.

These enemies are “superbugs” — bacteria and fungi that are resistant to antibiotics and other medications. All microbes, from everyday bacteria to killer superbugs, are constantly evolving. And paradoxically, exposing microbes to antimicrobials — whether a common antibiotic for strep throat or a potent antifungal treatment given in the hospital — can make them stronger in the long run.

While most of the microbes die when treated, the ones that survive can reproduce. These new generations of microbes can build up resistance to certain antimicrobials, rendering some medications less effective or ineffective over time.

Unfortunately, this natural evolutionary process is speeding up for several reasons. We greatly overuse antibiotics in patients with viruses, like the flu, common colds and bronchitis — without benefit. And modern medical care has increased the demand for antibiotics. Advances in cancer care, organ transplants and surgeries such as hip and knee replacements have become much more common. These procedures can extend and improve life, but patients often require antimicrobials because they are at high risk of developing infections.

Bacteria are mutating at a speed that outpaces the development of antibiotics. Penicillin was discovered in 1941, but it wasn’t until 1967 that penicillin-resistant Streptococcus pneumococcus was first identified. By contrast, consider an antibiotic for multidrug-resistant bacteria released in 2015, called ceftazidime-avibactam. That same year a strain of bacteria emerged that was resistant to this new antibiotic.

Drug-resistant pathogens are one of the greatest healthcare threats of our time — for everyone, everywhere, including adults and children. More than 1.2 million people died worldwide from antibiotic-resistant infections in 2019 alone. Multidrug-resistant infections are on the rise in kids. More of these infections originate outside of our hospitals and within our communities.

Without effective antibiotics, run-of-the-mill pneumonia or skin infections can become life-threatening.

COVID-19 exacerbated the situation. Amid the widespread uncertainty and limited treatment options at the beginning of the pandemic, doctors often used antibiotics to treat COVID-19 patients as they tried to help them. Patients may also have been given antibiotics in instances in which it was difficult to distinguish between bacterial pneumonia, which requires antibiotics, and COVID-19.

Hospital stewardship programs — which manage the careful and optimal use of antimicrobial treatments — also had to redirect their limited resources away from antibiotic use to focus on the complex administration of COVID-19 therapeutics. And severely ill patients on ventilators were at a higher risk of contracting secondary infections, especially while their immune system was weakened.

These factors led to an increase in drug-resistant infections acquired in hospitals during the pandemic. Drug-resistant staph infections, MRSA, jumped 34% for hospitalized patients in the last quarter of 2020 compared with the same period in 2019.

Prior to COVID-19, we made initial progress in the fight against antimicrobial resistance. In 2014, California was the first state to pass a law requiring antimicrobial stewardship programs in hospitals. In 2019, Medicare began requiring antibiotic stewardship programs.

Some modest federal investments have also been made in antimicrobial research and development, but not enough to generate the pipeline patients need. We must increase support for antimicrobial stewardship practices, which were under-resourced even before the pandemic. Teaching practitioners to safely use and monitor antimicrobial treatments is a significant step.

We also need to develop novel antimicrobial medicines capable of defeating the superbugs that have grown resistant to previous generations of treatments. But market incentives are misaligned. Because doctors prudently limit their use of antimicrobials to avoid further resistance, there isn’t high demand to sustain the development of new products, which take years of research and billions of dollars in investments.

As a result, many large biopharmaceutical companies have stopped antimicrobial research entirely. And many smaller startups have had success at first, only to face bankruptcy. That’s part of the reason why there have been few new classes of antibiotics developed in the last 35 years.

This is a textbook case of a market failure, but government intervention can help realign market incentives.

The PASTEUR Act is a bipartisan bill in Congress that would establish a payment model for critically needed antimicrobials.

Currently, the government pays manufacturers based on the volume of drugs sold. But under PASTEUR, the government would enter into contracts with manufacturers and pay a predetermined amount for access to their novel antimicrobials — allowing scientists to innovate new treatments without fear of an insufficient return on investment due to low sales volumes.

Essentially, the bill would switch the government from a “pay-per-use” model for antimicrobials to a subscription-style model that pays for the value antimicrobials bring to society. By delinking payments to antimicrobial makers from sales volumes, the measure would stimulate investment in new antibiotics.

The bill would also provide resources to strengthen hospital antimicrobial stewardship programs, which help clinicians use antimicrobials prudently and help the Centers for Disease Control and Prevention closely monitor resistance. Hospitals should join public health leaders in supporting this legislation and invest more of their resources in their antimicrobial stewardship programs.

Unfortunately, superbugs aren’t an easy enemy to defeat. We need to be fighting them more vigorously to ensure that they don’t get around our best defenses.

Annabelle de St. Maurice is an associate professor of pediatric infectious diseases at the David Geffen School of Medicine at UCLA, and head of pediatric infection control and co-chief infection prevention officer at UCLA Health. She wrote this for the Los Angeles Times.

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Orioles ace John Means ‘looking forward to the grind’ of recovery from Tommy John surgery



Orioles ace John Means ‘looking forward to the grind’ of recovery from Tommy John surgery

John Means is in the early stages of his recovery from Tommy John elbow reconstruction surgery, but the mustache he sported Wednesday in the Orioles’ clubhouse was in vintage form.

“Gotta keep it interesting, you know?” Baltimore’s left-handed ace said. “I was losing my mind.”

Without baseball as he recovers from his season-ending procedure, Means has turned to facial hair. He’s only three weeks into a recovery and rehabilitation process that will take at least a year, but he said he and doctors are pleased thus far.

“Honestly, it’s going better than it’s supposed to be,” Means said. “My range [of motion], they said we’re ahead of schedule, so I don’t know, three weeks, and we got 12 months to go. Little victories here and there.”

Means unexpectedly exited his second start after only four innings, with testing eventually revealing the ulnar collateral ligament in his left elbow was “about 90% torn,” he said. Dr. Keith Meister performed the surgery in Arlington, Texas, on April 27, three day after Means’ 29th birthday.

Means spent his offseason training at Meister’s Texas Metroplex Institute, hoping to strengthen a left shoulder that has landed him on the injured list in two of his first three major league seasons. In 2021, Means had a 2.05 ERA through 11 starts before exiting his 12th outing in the first inning with a left shoulder strain. He missed nearly two months, then had a 4.88 ERA after returning.

He had no previous elbow injuries before this one. He’s back at TMI to rehab.

“I’m definitely going to be working out like crazy to try and keep that competitive edge and all that,” Means said. “I’m looking forward to coming back. I’m looking forward to the grind of this.”

He’s also getting more time around his family, watching his 1-year-old son, McCoy.

“That’s been the best part, let me tell you,” Means said. “He’s swinging off the tee now, and he’s running around constantly. I’m getting my workout in just chasing him around the living room and kitchen to try to keep his hands off the oven and microwave.”

Means said he hopes to visit the Orioles at least once a month and will be traveling with them for their upcoming road series in New York. The day after, he’ll have his arbitration hearing to determine his salary for this season.

“It’s tough watching games and that sort of thing,” Means said. “You just want to be there — good, bad, whatever it is, you want to be there for your team and be a part of it. That part’s been hard, but I’m getting used to it. I’m going to come back as much as I possibly can to be around the guys.”

Orioles manager Brandon Hyde has been pleased with how Baltimore’s pitching staff has handled losing Means, who served as their opening day starter for the second straight season. Having him around on occasion will benefit the other pitchers, Hyde said.

“He’s still a big part of our team,” Hyde said, “and it’s great to have him in the building.”


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Twins power way to series victory in Oakland with 14-4 rout in finale



Twins power way to series victory in Oakland with 14-4 rout in finale

OAKLAND, Calif. — Before Sonny Gray threw his first pitch on Wednesday, the veteran starter was sitting on a three-run lead. It was that kind of day for the Twins, who put on a show on offense and rode a quality start from Gray to a 14-4 victory and a series win over the Athletics at the Oakland Coliseum.

The Twins opened up the game in the first inning, using four hits and a walk to produce their three runs. Gary Sánchez, who has started to heat up as of late, dropped a broken-bat single into left field to give the Twins a two-run lead. Gio Urshela followed with an RBI single of his own.

The Twins tacked on runs throughout the game, including a five-run sixth inning in which they broke the game wide open.

Carlos Correa, activated off the injured list earlier in the day, finished with two hits and a walk. He drove in a run on a double to center in the fourth, part of a two-run inning that included a Luis Arraez RBI double. Arraez finished the day with a team-leading three hits.

That was more than enough support for Gray, who threw six innings in his longest start of the season. While he ran into some trouble in the earlier innings, he seemed to settle in later, retiring the final 10 batters he faced.

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