Death toll from coronavirus in care homes set to be published daily | London Evening Standard

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The death tolls for the number of people who have died in care homes after testing positive for coronavirus will now be announced daily, Matt Hancock has said.

The Government previously faced criticism over the fact the daily death toll figures provided by the Department of Health only include hospital fatalities.

To date, figures for deaths in care homes and in the community have been released weekly by the Office for National Statistics.

The news comes as the Care Quality Commission revealed today that 4,343 Covid-19  deaths occurred in care homes between April 10 to the 24.​

Speaking in Downing Street, Mr Hancock said: “From tomorrow we’ll be publishing not just the number of deaths in hospital each day but the number of deaths in care homes and the community too.”

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The Health Secretary said that this was part of a Government effort to “bring as much transparency as possible” during the Covid-19 pandemic.

He added: “This will supplement the ONS and CQC weekly publication and all add to our understanding of how this virus is spreading day by day.”

The move will also “help inform the judgments that we make as we work to keep people safe,” Mr Hancock said.

Answering questions from journalists during the press briefing, he said the spread of Covid-19 through care homes is “absolutely a priority” for the Government.

The Health Secretary also revealed that after successful pilots, the government will be rolling out coronavirus testing to asymptomatic residents and staff in care homes in England as well as staff and patients in the NHS.

“This will mean that anyone who is working or living in a care home will be able to get access to a test whether they have symptoms or not,” he stated.

“I am determined to do everything I can to protect the most vulnerable.”

Professor John Newton, co-ordinator of the national testing effort, addressing the spread of the virus in care homes, said: “We’ve done some intensive studies of infection in care homes.

“What that showed was that the presence of symptoms was not really a good marker in the care home setting, both among residents and staff, for the presence of the virus.

“There were significant numbers who were asymptomatic who had the virus and so we have massively increased the amount of testing available.

Listen to The Leader: Coronavirus Daily podcast

“We have now tested 25,000 residents in care homes and we are rolling out testing now to symptomatic and asymptomatic residents, as well as providing testing through the drive-thru centres and other means.”

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EBB 117 – The Evidence on Inducing for Due Dates – Evidence Based Birth®

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Hi, everyone. On today’s podcast, we’re going to talk about the evidence on inducing labor for going past your due date.

Welcome to the Evidence Based Birth podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD and the founder of Evidence Based Birth. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details.

Hi, everyone. On today’s podcast, we’re going to talk about the evidence on inducing versus waiting for labor when you’re going past your due date. I’m going to be joined by Anna Bertone, MPH, our Research Editor at Evidence Based Birth to talk about this topic.

Before we get started, I have a quick announcement, and that is next week we are hosting free webinars for the public all about the Evidence Based Birth Childbirth Class. On Monday, March 2, we’ll host a special webinar just for parents. We’ll give you a peek behind the scenes at what it’s like to take our Evidence Based Birth Childbirth Class. Then on Tuesday, March 3, we’ll have a special webinar just for birth professionals to give you a tour of the Evidence Based Birth Childbirth Class so that you can decide if it’s something you’d like to recommend to your clients or not. You can register for these free webinars at evidencebasedbirth.com/childbirthclasswebinar. That’s all one word /childbirthclasswebinar.

All right, now back to the topic at hand, inducing labor for going past your due dates. Now before we begin, I do want to give a brief trigger warning. In our discussion about the research evidence on this topic, we will be talking about stillbirth and newborn death. So there has been a ton of new research on the evidence on induction versus waiting for labor when you go past your due date. So much research, in fact, that we have decided to separate our Signature Article on due dates into two separate articles.

So we still have the original article, The Evidence on Due Dates, which you can find at ebbirth.com/duedates. And although we updated that article a little bit, it’s remained very similar to previous additions. It talks about the length of a normal pregnancy, factors that can make you more or less likely to have a long pregnancy, et cetera. But then we separated out the research on induction into a new article that you can find at ebbirth.com/inducingduedates. This is a peer-reviewed article that covers all of the research on induction versus something called “expectant management” for going past your due date. And in today’s podcast, we’re going to update you on the latest info that we found for that article.

Just a heads up, we will not be covering the research evidence on inducing at 39 weeks. We already covered the ARRIVE study, a randomized trial that looked at induction versus expectant management for 39 weeks of pregnancy in episode 10 of the Evidence Based Birth podcasts. And just a tip, if you’re having trouble finding any of our earlier episodes of this podcast, iTunes has stopped showing the earliest podcasts, but they’re still out there and you can find them on Spotify and any other podcasting app. You can also find info about the ARRIVE study at ebbirth.com/arrive.

So we’re not going to talk about induction at 39 weeks. Instead, we’re going to be focusing on the evidence on induction versus waiting for labor once you reach 41 weeks. And to do so, we’re going to talk with our Research Editor, Anna. So welcome, Anna, to the Evidence Based Birth podcasts.

Anna Bertone:   Thank you! I’m glad to be on the podcast again.

So I want to start by explaining to our audience a little bit kind of about the background of why this topic is important. Inductions for non-medical reasons have been on the rise in the United States and all around the world for the past 30 years. And increasingly, more people who are pregnant are being induced for reaching their estimated due date. So we really want to cover the benefits and risks of elective induction for going past your estimated due date. And we’ll also talk about whether or not your goals and preferences for your birth matter, which of course they do, but that kind of plays a role as well.

So how often are people induced for going past their due date? Well, we don’t know for sure because this hasn’t been measured recently. But according to the 2013 Listening to Mothers III survey, which was now published about seven years ago, more than 4 out of 10 mothers in the U.S. said that their care provider tried to induce labor. Inducing labor for going past your due date was one of the most common reasons for an induction. Out of everyone who had an induction in this study, 44% said they were induced because their baby was full term and it was close to the due date. Another 18% said that they were induced because the healthcare provider was concerned that the mother was overdue.

The Centers for Disease Control in the U.S. also reported in 2018 that about 27% of people had their labor induced, but we think that number is probably low and that the percentage of people who have labor induced is under-reported in the Vital Statistics Program in the United States. So Anna, can you talk a little bit about why there’s so much controversy over this concept of electively inducing labor once you go past your due date?

Anna Bertone:   So why is there so much controversy about elective induction? Elective inductions by definition are labor inductions that do not have a clear medical reason for taking place. They occur for social reasons, like the provider wanting the mother to give birth before the provider goes out of town or for other non-medical reasons like the pregnancy getting uncomfortable and for the mother’s convenience. But there’s also a gray zone about what constitutes an elective induction. Many providers only consider an induction to be “elective” when the mother is healthy, pregnant with a single baby, and less than 41 weeks pregnant. The gray zone is that sometimes when the pregnancy goes past 41 weeks, some providers consider that to be a medically indicated induction rather than an elective induction. But in general, inductions are considered medically indicated when there are accepted medical problems or complications with the pregnancy that make it less safe to continue the pregnancy.

For many years, and I remember when I first entered the birth world in 2012, a lot of people talked about the fact that if you have an induction it doubles your chance of cesarean. And then all of a sudden there were people saying that wasn’t true. So can you talk a little bit about that controversy?

Anna Bertone:   So for many years, the common belief was that elective induction doubles the cesarean rate, especially in first-time mothers. But researchers nowadays consider those earlier studies to be flawed. In the earlier studies, what they would do is they would compare people assigned to elective induction to people who went into spontaneous labor. Nowadays, they don’t compare those two groups anymore. They compare people assigned to elective induction to the people assigned to what’s called expectant management, or in other words waiting for labor. And in that group, the person could either go into spontaneous labor or they could require an induction for medical reasons (so that would be a medically indicated induction), or they could choose elective induction further along in the pregnancy.

So that’s a subtle difference but an important one because in the earlier studies they compared elective induction to spontaneous labor. But you don’t have the choice to go into spontaneous labor today. Your choice is to be induced today or to wait for labor to start. And sometimes during that waiting period you might develop complications that require an induction, or you might change your mind and decide to have an elective induction, or you might go into spontaneous labor.

Anna Bertone:   Right. So nowadays, we compare a group assigned to elective induction to a group assigned to expectant management. One example of this was the ARRIVE trial.

The ARRIVE trial was a study comparing elective induction at 39 weeks versus expectant management. We’re not going to go into that trial in detail because we already covered it in detail in episode 10 of the Evidence Based Birth podcasts. But they actually found a lower risk of cesarean in the elective induction group. Researchers think that had to do with the fact that of the people in the expectant management group, more of them developed problems with blood pressure that required medical inductions and increased risk for complications. So again, that just kind of goes to show you that it does make a difference when you compare elective induction to expectant management.

Although, one thing you have to keep in mind with the ARRIVE study is that they had a very low cesarean rate in both groups compared to some settings. The cesarean rate was 19% in the elective induction group versus 22% in the expectant management group. So those research results cannot probably be generalized to settings with extremely high cesarean rates or high cesarean rates with inductions. We have some, for example, some professional members at Evidence Based Birth who talked to us about where they’re practicing and how high the cesarean rates are with the elective inductions there. So I think you have to be careful how you generalize or apply that data from the ARRIVE study, and we talk more about that in episode 10 of the podcast.

Which leads me to another point, and that is some cautions about the evidence. When I say generalize, that means taking research from a research study, and seeing if you can apply that to where people are giving birth in your community. So it’s important to understand that there are some major drawbacks to some of the research that we’re going to be talking about. Many of the studies are carried out in countries or time periods where there are low cesarean rates. So when that happens, when a study is carried out in a setting where culturally there’s low C-section rates, that might not apply to a hospital with high cesarean rates. If your hospital has high rates of “failed inductions” and strict time limits on the length of labor, then the evidence in these studies may not apply to you because induction might be more risky in your community hospital.

Also, another disclaimer about the evidence, in these trials, people are randomly assigned to induction or expectant management. And it’s important to remember that the people assigned to expectant management do not always go into labor spontaneously. There’s a mix of people in that group. Some of them do have a spontaneous labor. Others have an elective induction later on, and others have a medical induction for complications.

Also, you have to look at what they’re doing for fetal testing in the studies. In some studies there’s lots of fetal testing going on in the expectant management group. However, we’re going to talk about one of the studies where they were not doing any standard fetal monitoring during expected management. So those results might not apply to your community if your community does the fetal monitoring, and the study did not have fetal monitoring.

Finally, another disclaimer about the research evidence is that the induction protocols vary from study to study, and even within studies themselves. So knowing what the protocol was for induction in that study can be very helpful to decide if this is going to apply to your unique situation in your local community or not.

So with all of those disclaimers being said, there’s been quite a lot of new research in the past year about induction at 41 weeks. So Anna, can you talk about one of the most recent studies? Let’s talk about the INDEX trial from the Netherlands. There were two trials that came out in 2019, two large randomized control trials. Let’s talk about the INDEX one first.

Anna Bertone:   Sure. So the INDEX trial was from the Netherlands. INDEX stands for induction at 41 weeks, expectant management until 42 weeks. This was a large multicenter trial. It was conducted at 123 midwifery practices and 45 hospitals. Most of these pregnancies were managed by midwives.

…So this was the midwifery-led model of care-

Anna Bertone:   Exactly.

… which is very different than in the United States which is typically an obstetrician-led care model.

Anna Bertone:   The researchers randomly assigned a total of 1,801 pregnant people to either induction at 41 weeks and zero to one days or to wait for labor until 42 weeks and zero days, which is called expectant management. The reason they were able to conduct this study in the Netherlands and got ethical approval for it is because it was standard practice for them to not induce labor before 42 weeks with an uncomplicated pregnancy.

…Whereas in the U.S. it’s rare to see someone go to 42 weeks, in the Netherlands, they typically won’t induce you unless there’s medical reasons until you get to 42 weeks – 

Anna Bertone:   Exactly. So the mothers were enrolled in the study between 2012 and 2016. Everyone had to be healthy, and pregnant with single, head-down babies. The gestational ages were estimated with ultrasound before 16 weeks of pregnancy. They excluded people with a prior cesarean, with high blood pressure disorders, with expected problems with the baby’s growth, abnormal fetal heart rate, or known fetal malformations (congenital anomalies). In both groups, cervical ripening and induction methods depended on local protocol. It’s like what Rebecca was talking about earlier. There wasn’t a standard protocol to apply to both groups in this study when it came to cervical ripening and induction. It was based on local protocol. And this is an important weakness of the study because the providers might’ve managed labor inductions differently based on whether someone was being electively induced or was assigned to the expectant management group. It also limits the study’s generalizability, which means our ability to apply the results of this study to the population at large because providers don’t have an induction protocol that they can replicate.

…So we can learn from what happened in this study, but it’s difficult for us to apply it to across the board because there’s no specific induction protocol that could be followed – 

Anna Bertone:   Yeah. What happened was in the elective induction group, 29% of the participants went into labor before their induction and 71% were induced. Then in the expectant management group, 74% of the participants went into labor spontaneously before their planned induction and 26% were induced.

…And before we talk about how long the pregnancies were, I think it’s important for people to understand that when you have a randomized controlled trial like this the researchers do something called intent to treat analysis. So it doesn’t matter what type of birth they had, whether it was a spontaneous labor or a medical induction, the data were analyzed depending on which group you were originally assigned to. So if you were assigned to an elective induction but you happen to just quick go into labor on your own before the induction, you were still grouped with everyone in the elective induction group and vice versa. So that’s just an important distinction for people to understand. – 

Anna Bertone:   Yes. What happened with these results is that the median pregnancy was only two days shorter in the elective induction group compared to the expectant management group. This is interesting because they still found a difference between these two groups, but-

…And this is important because a lot of people ask us like, “Well, I only want to wait one more day, or two more days, or three or four more days,” but they’re saying by decreasing the length of the pregnancy by two days they found significant results. So what did they find in the INDEX trial? – 

Anna Bertone:   So for mothers, they found that there was no difference in the cesarean rates. This was taking place in a country with low cesarean rates. It was a midwifery model of care and the rates were very low in both groups (11%). 

They only had an 11% cesarean rate then?

Anna Bertone:   Yeah. They also had an outcome called a composite outcome, which is a combined outcome for mothers, and there was no difference in that measure either. They were looking for things like excessive bleeding after birth, manual removal of the placenta, severe tears, intensive care admission, and maternal death, and they didn’t find a difference in those things. There were no maternal deaths in either group. So as far as the bad outcomes for the mothers, there were about 11% to 14% in both groups, but not different.

…And what about for the babies then? – 

Anna Bertone:   And then for the babies, the babies in the elective induction group had a lower composite outcome rate. And in this composite outcome, what they were looking at was perinatal death, Apgar score less than seven at five minutes, low pH, meconium aspiration syndrome, nerve injury, brain bleeds, or admission to a NICU. And here they found a lower composite adverse outcome rate with the babies in the elective induction group (1.7% versus 3.1%). 

And why do they think that outcome was better with the elective induction group?

Anna Bertone:   They think that it was mostly due to the lower rate of Apgar scores less than seven at five minutes, and that probably contributed the most to having a lower adverse outcome rate with the babies in the elective induction group. The author’s note that there was no difference in rates of Apgar score less than four at five minutes, but they found that the combined outcome was still lower in the elective induction group if they used an Apgar score of less than four at five minutes and excluded fetal malformations. So basically, the babies in the elective induction group had better Apgar scores overall.

…And what about stillbirths? Because that’s like the main reason they’re doing these kinds of elective inductions, is to lower the risk of stillbirth. – 

Anna Bertone:   Yep. And they did not find a difference in stillbirth in this study. There was one stillbirth that occurred in the elective induction group. It was at 40 weeks and six days, before the mother was induced. Then, there were two stillbirths that occurred in the expectant management group while the mothers were waiting for labor.

Anna Bertone:   I looked for a few more details about those stillbirths because I was interested in that. Of the two stillbirths that occurred in the expectant management group, one was a small for gestational age baby at 41 weeks and three days to a first-time mother. The other one was to a mother with a prior birth, and that was at 41 weeks and four days. The mother’s placenta showed signs of infection (infection of the membranes). Then, the one stillbirth that occurred at in the elective induction group at 41 weeks was to an experienced mother (someone who had already had given birth before), and that was at 40 weeks and six days, and there was no explanation for that one. But with two versus one, they didn’t find a significant differences in stillbirths between those groups.

And what was the protocol for fetal monitoring in that study?

Anna Bertone:   There was no protocol for fetal monitoring. It depended on local guidelines, just like the induction and cervical ripening protocol. But the study authors say that fetal monitoring and assessment of amniotic fluid levels was typically done between 41 and 42 weeks. 

So how would you sum up the results of this INDEX study then?

Anna Bertone:   They found that elective induction at 41 weeks resulted in similar cesarean rates and less overall bad outcomes for babies compared to waiting for labor until 42 weeks. However, they say that the absolute risk of a bad outcome happening was low in both groups. It was 1.7% in the elective induction group versus 3.1% in the expectant management group (the group that waited until 42 weeks).

All right. Well, the next study we wanted to talk about was the SWEPIS trial from Sweden, also published in 2019, also coming out of Europe. It’s S-W-E-P-I-S, and it stands for the Swedish post-term induction study, or SWEPIS. It got a lot of media attention with headlines like … There was one that said, “Post-term pregnancy research canceled after six babies died.” And it is true that this study was ended early after deaths in the study. The researchers intended to enroll 10,000 mothers from multiple centers across Sweden, but they ended up stopping the study with about 1,380 people in each group after their data safety and monitoring board found a significant difference in perinatal death between the groups.

Data safety and monitoring boards are basically a board that keeps track of what’s going on in the study. They get interim reports. And if they see any concerning safety issues, they have the power to stop the studies. That’s a standard part of a lot of randomized controlled trials is to have one of these safety boards.

Similar to the INDEX trial in the Netherlands, in Sweden, labor is typically not induced before 42 weeks if you have an uncomplicated pregnancy. Also similar to the Netherlands, in Sweden, midwives manage most of the pregnancies and births. It’s a midwifery-led model of care.

The purpose of the SWEPIS study was to compare elective induction at 41 weeks and zero to two days versus expectant management and induction at 42 weeks and zero to one day if the mother hadn’t gone into labor by that point. The study was carried out in the years 2015 to 2018. The researchers enrolled healthy mothers with single babies in head-first position. They had accurate gestational ages. They excluded people with a prior cesarean, diabetes, and other complications such as high blood pressure, small for gestational age, or known fetal malformations.

There is a pretty low stillbirth rate in Sweden, so they thought they would need about 10,000 people to see a difference between groups, but they ended up not needing nearly that many people to find a difference in stillbirth rates. One of the big strengths of the SWEPIS trial is that in contrast to the INDEX trial, in the SWEPIS trial they defined an induction protocol and they used that same protocol with everyone in the elective induction group and everyone in the expected management group who had an induction. The protocol was basically if the mother’s cervix was already ripe, they simply broke her water and gave her oxytocin as needed by IV. If the mother’s cervix was not ripe or the baby’s head was not engaged, they used mechanical methods or Misoprostol, or prostaglandins, or oxytocin, but they did cervical ripening first.

In the elective induction group, most of the people were induced. 86% had their labor induced. 14% went into labor spontaneously before the induction. In the expectant management group, 67% of them went into labor spontaneously and 33% ended up with an induction. Similar to the INDEX trial, there was a really tiny difference in the length of pregnancy between groups. Pregnancy in the elective induction group was in general only three days shorter than pregnancy in the expectant management group, but yet they did go on to find significant differences.

So what the SWEPIS trial found was that for babies – this is why this study was stopped early – there were five stillbirths and one early newborn deaths in the expectant management group out of 1,379 participants for a death rate of 4.4 deaths per 1,000 women. There were zero deaths in the elective induction group out of 1,381 participants. All five stillbirths in the expectant management group happened between 41 weeks, two days and 41 weeks, six days. Three of the stillbirths had no known explanation. One was for a baby that was small for gestational age. The other was with a baby who had a heart defect. There was one newborn death that occurred four days after birth due to multiple organ failure in a baby that was large for gestational age.

The authors mentioned that when complications are present at the end of pregnancy, such as problems of the placenta, or the umbilical cord, or fetal growth, these problems may become increasingly important as each day of pregnancy progresses, which they believe is why they found a higher death rate with expectant management past 41 weeks.

Another key finding of the study was that all of these deaths occurred to first-time mothers, which suggests that 41-week induction may be especially beneficial for babies of first-time mothers. They found that it only took 230 inductions at 41 weeks to prevent one death for a baby, and this was a much lower number than previously thought. If you remember, though, as Anna was saying, the INDEX trial did not find a significant difference in death between the induction group and the expectant management group. We think the reason the SWEPIS study found a difference was because it was a larger study, it was better able to detect differences in rare outcomes like death. Also, with the SWEPIS study, there might not have been as good fetal monitoring. So it’s possible that the better fetal monitoring of participants between 41 weeks and 42 weeks in the INDEX trial might’ve been protective, leading to fewer perinatal deaths. We can’t be certain though because there were no fetal monitoring protocols in either trial.

Another thing to note is that participants in the SWEPIS expectant management group tended to give a birth a little later than the participants in the INDEX expectant management group. That might help explain the higher perinatal death rate in the expectant management group in SWEPIS. They did not find a difference in what they call the composite adverse perinatal outcome, which included death, low Apgar scores, low pH, brain bleeds, brain injury, seizures, and several other major complications, but there was that significant difference in perinatal death (either having a stillbirth or newborn death).

Also, the elective induction babies were less likely to have an admission to intensive care, 4% versus 5.9%. They had fewer cases of jaundice, 1.2% versus 2.3%, and fewer of them were big babies, 4.9% versus 8.3%.

For mothers, the outcomes were overall pretty good. There were no differences in cesarean rates similar to the other trial. The cesarean rate in this study in both groups was about 10% to 11%. More mothers in the elective induction group had an inflammation of the inner lining of the uterus called endometritis, 1.3% versus 0.4%. And on the other hand, more mothers in the expected management group developed high blood pressure, 3% versus 1.4%. They also interviewed the women in both groups and they found that the mothers in the expectant management group really struggled with negative thoughts. They described feeling in limbo while they waited to go into labor. So Anna, can you talk a little bit about the fetal monitoring in this study and how it may have differed from the other study?

Anna Bertone:   Sure. Fetal monitoring in this study was done per local guidelines. So there was no study protocol for fetal monitoring during the 41st week of pregnancy. However, the mothers recruited from one region of Sweden, called the Stockholm region, which made up about half the people in the study, had ultrasound measurements of their amniotic fluid volume and abdominal diameter at 41 weeks, whereas the people that came from the other areas of Sweden in the study did not receive these assessments regularly. None of the six deaths that occurred in this study occurred in the Stockholm region of Sweden where they received this type of fetal monitoring, which leaves us with the question of how important was this fetal monitoring. Could it have made the difference between the Stockholm region participants not experiencing fetal deaths whereas participants from other regions did?

Anna Bertone:   So that’s just an important thing to keep in mind with this study is that the fetal monitoring may have made a difference as far as the perinatal outcomes. It also means that the results of the SWEPIS study might not apply equally to mothers who receive fetal monitoring at the end of pregnancy, specifically during that 41st week of pregnancy which seems to be the really critical time period. Another thing, all of the perinatal deaths in this study occurred to first-time mothers, which tells us that the results might not apply equally to mothers who have already given birth before.

…So in the SWEPIS study, out of the mothers in the study who had already given birth before and were having a subsequent baby, none of them experienced this stillbirth or newborn death, correct?

Anna Bertone:   Correct. Yes.

Okay. So all of the perinatal deaths occurred to first-time mothers.

Anna Bertone:   And the first-time mothers, by the way, they only made up about half of the participants in the sample, so it was about a 50/50 split.

So all of the fetal and newborn deaths from this study came from first-time mothers who lived in the areas of Sweden that did not do any prescribed fetal monitoring during that 41st week of pregnancy.

Anna Bertone:   That’s my understanding. Correct.

Okay. So those are the two big randomized trials that came out in 2019. Before they were published, there was a 2018 Cochrane meta-analysis. Anna, I was wondering if you could talk a little bit about that. This study did not include the SWEPIS and the INDEX trials, but we still wanted to talk about it in our article. So can you explain to our listeners a little bit about this Cochrane review?

Anna Bertone:   Sure. There was a 2018 Cochrane review and meta-analysis by Middleton. Unlike these randomized control trials that we were just talking about, they didn’t focus specifically on the 41st week of pregnancy versus the 42nd week of pregnancy. It was much more broad than that. What they did was they looked at people who were electively induced at some point, and compared them to people who waited for labor to start on its own until some point. So there was a much more broad range of gestational ages there. But they included 30 randomized control trials with over 12,000 mothers, and they compared a policy of induction at or beyond term versus expectant management. All of the trials took place in Norway, China, Thailand, the U.S., Austria, Turkey, Canada, the UK, India, Tunisia, Finland, Spain, Sweden, and the Netherlands.

So it’s quite a global sample.

Anna Bertone:   Yes. But one study in this meta-analysis really dominated and accounted for about 75% of the data, and that was the Hannah post-term trial that I think Rebecca is going to be talking about soon. Because that one trial dominated this meta-analysis so much, most of the data was on giving birth at 41 weeks or later.

And they did not include the ARRIVE trial in this meta-analysis.

Anna Bertone:   Right. They didn’t include the ARRIVE, INDEX, or SWEPIS trials. So in its next update, it’s going to be updated with those three randomized control trials. But they did include 30 other randomized control trials. What they found was that a policy of induction at term or beyond term was linked to 67% fewer perinatal deaths compared to expectant management. So that was two deaths with induction at or beyond term versus 16 deaths in the people assigned to expected management.

Anna Bertone:   The Hannah post-term trial excluded deaths due to fetal malformations, but some of the smaller trials that were included in the Cochrane meta-analysis did not. So if we exclude the three deaths from severe fetal malformations, then the final count is one death in the induction group and 14 in the expectant management group. So it doesn’t change the results too much overall to exclude fetal malformations. Overall, they found that the number needed to treat was 426 people with induction at or beyond term to prevent one perinatal death. Specifically, there were fewer stillbirths with a policy of induction at or beyond term.

Which was a different number needed to treat than the SWEPIS trial, which found only took 230 inductions at 41 weeks to prevent one perinatal death.

Anna Bertone:   Yeah. I think part of the reason the SWEPIS trial was so groundbreaking and got so much media attention is because it did find a lower number needed to treat than had been found previously. So the absolute risk of perinatal death was 3.2 per 1,000 births with the policy of expected management versus 0.4 deaths per 1,000 births with the policy of induction at or beyond term. They found that a policy of induction was linked to slightly fewer cesareans compared to expectant management, 16.3% versus 18.4%.

Anna Bertone:   Fewer babies assigned to induction had Apgar scores less than seven at five minutes compared to those assigned to expectant management. They didn’t find any differences between the groups with the rate of forceps or vacuum assistance at birth, perinatal trauma, excessive bleeding after birth, total length of hospital stay for the mother, newborn intensive care admissions, or newborn trauma. The authors concluded that individualized counseling might help pregnant people choose between elective induction at or beyond term or continuing to wait for labor. They stress that providers should honor the values and preferences of the mothers.

We need more research to know who would or would not benefit from elective induction. And the optimal time for induction is still not clear from the research, which is what they said in 2018. I think Rebecca’s going to talk about the famous Hannah post-term study that accounted for 75% of the data in that meta-analysis.

Yeah, so we’re kind of working backwards through time. We started with the 2019 randomized trials, then the 2018 meta-analysis where they said the optimal time for induction is not clear, but they stated that before the two new randomized trials came out. Then even before then going back in time is the 1992 Hannah post-term study, which is one of the most important studies on inducing for going past your due date and it was the largest randomized trial ever done on this topic, larger even than INDEX or SWEPIS. And it controls most of the findings in that Cochrane meta-analysis that Anna just described.

So let’s look at what happened in this study because it plays so much of a role in the meta-analysis. It was carried out between the years 1985 and 1990 when a group of researchers enrolled 3,407 low-risk pregnant people from six different hospitals in Canada into the study. Women could be included if they were pregnant with a live single fetus, and they were excluded if they were already dilating, if they had a prior cesarean, pre-labor rupture membranes, or a medical reason for induction.

This study had a much different expectant management protocol than INDEX or SWEPIS because unlike those studies where the longest you would go was 42 weeks and zero to one or two days, in the Hannah post-term study, the people assigned expectant management were monitored for as long as 44 weeks pregnancy before they were induced, so up to a month past your due date, which is almost unheard of today. At around 41 weeks, people who agreed to be in the study were either randomly assigned to have an induction of labor or fetal monitoring with expectant management.

In the induction group, labor was induced within four days of entering the study, usually about 41 weeks and four days. If the cervix was not ripe and if the fetal heart rate was normal, they were given a prostaglandin E2 gel to ripen the cervix. They used a maximum of three doses of gel every six hours. If this did not induce labor or if they did not need the gel, people were given IV oxytocin, had their waters broken, or both. And they could not receive oxytocin until at least 12 hours after the last prostaglandin dose.

So one strength of this study is that it had a defined induction protocol that providers could replicate. But the big weakness of this study is that the expectant management group did not have that same induction protocol. In the monitored or expected management group, people were taught how to do kick counts every day and they had a non-stress tests three times per week. They also had their amniotic fluid levels checked by ultrasound two to three times per week. And labor was induced if there were concerning results in the non-stress test, or if there was low amniotic fluid, or if the mother developed complications, or if the person did not go into labor on their own by 44 weeks. And if doctors decided the baby needed to be born, mothers in expectant management group did not receive any cervical ripening. Instead, they either had their water broken and/or IV oxytocin, or they just went straight to a cesarean without labor. So Anna, do you want to talk a little bit about what the researchers found in the study?

Anna Bertone:   What the researchers found in the Hannah post-term study is that in the induction group, 66% of the people were induced and 34% went into labor on their own before induction. And in the expectant management group, 33% were induced and 67% went into labor on their own. There were two stillbirths in the group assigned to wait for labor and zero in the group assigned to induction. This difference was not considered to be statistically significant, which means we don’t know if it happened by chance or if it was a true difference between the groups. The more interesting outcome to look at with the Hannah post-term trial are the findings on cesarean rates because they differ depending on what numbers you look at. You can either look at the outcomes for the two original groups, which were the people randomly assigned to induction and then those assigned to expectant management, or you can look at the breakdown of what actually happened to the people in the two groups, in other words what happened to the people who were actually induced or who actually went into spontaneous labor.

Anna Bertone:   So what happened in the original randomly assigned groups? If you look at the two original groups, the overall cesarean rate was lower in the induction group. It was 21.2% versus 24.5%. That was even after taking into account factors like the mother’s age, whether or not it was her first baby, and cervical dilation at the time of study entry. Or you could look at what happened with the people who were actually induced or who actually went into labor on their own. And if you look at that, you see two very interesting things. You see that people who went into spontaneous labor, regardless of which group they were assigned to, they had a cesarean rate of only 25.7%. But if people in the monitoring group had an induction, their cesarean rate was much higher than all the other groups. It was 42%. The same was true for both first-time mothers and for mothers who had given birth before.

Anna Bertone:   So what does this mean? It means that only the people who were expectantly managed but then had an induction had a really high cesarean rate. The people who were expectantly managed and then went into labor spontaneously did not have a higher cesarean rate. One possible reason for this, for the highest cesarean rate seen in the people who were assigned to expectant management but then ended up getting an induction, is that the people in this group might’ve been higher risk to begin with since a medical complication could have led to their induction. The people that were assigned to expectant management and never developed a complication requiring an induction, those were the lower risk people, which means they were the ones less likely to end up giving birth by cesarean.

Anna Bertone:   Then, another important factor that I know Rebecca has discussed previously is that doctors might’ve been quicker to call for a cesarean when assisting the labors of people with medical inductions if their pregnancies were beyond 42 weeks. They may have been less patient waiting for labor.

…Or more easily worried about the course of the labor, big baby, etc. – 

Anna Bertone:   Yes. More worried.

So basically, it seems like from the Hannah post-term trial, one of the benefits of considering expectant management is that if you do have spontaneous labor, your chance of cesarean is pretty low. But the risk is that you’ll develop medical complications and need an induction, in which case an induction at 42 weeks is going to be riskier than an induction at 41 weeks. So what do you think? We have all this research from all over the world, from the Hannah post-term trial, to the 2018 meta-analysis, to two trials out in 2019. Do you still feel like routine induction at 41 weeks is still going to be controversial or not?

Anna Bertone:   I think it’s definitely still controversial, and I think everybody’s still processing the results from the INDEX trial and the SWEPIS trial. Rebecca and I reached out to Dr. Wennerholm who conducted the SWEPIS trial in Sweden, and she said she’s currently working on secondary analysis of the data. They’re talking about the economic implications of the findings in Sweden and what it means for Swedish national policy. So I think it’s still controversial. People are still talking about what to make of these findings.

Anna Bertone:   There was another systematic review from 2019 by Riedel. This one came out too early to include the SWEPIS and the INDEX trials, but it’s still interesting to look at. Because unlike the Middleton Cochrane review, these authors were specifically interested in induction during the 41st week of pregnancy versus during the 42nd week of pregnancy. So in their analysis, they restricted the studies only to people having a routine induction at 41 weeks and zero to six days versus routine induction at 42 weeks and zero to six days. If you remember, the Cochrane review was much broader than that. They also only looked at studies published within the last 20 years. They only looked at studies with low-risk participants, and they ended up with three observational studies, two randomized controlled trials, and two studies that they called “quasi experimental studies”, which they grouped with the randomized controlled trials even though these studies weren’t truly randomized.

Anna Bertone:   What they found was one perinatal death in the 41 week induction group and six deaths in the 42 week induction group. That was a rate of 0.4 versus 2.4 per 1,000. This finding was not statistically significant. In other words, we don’t have strong enough evidence that this couldn’t have happened by chance. These same studies, those two randomized controlled trials and the two quasi experimental studies, they showed no difference in cesarean rates between groups also. But the authors did report that one observational study found an increase in the cesarean rate with the 41 week induction group. So basically, they’re saying if you look much more narrowly at the evidence of induction during the 41st week versus the 42nd week, then there might not be a significant difference in the death rate.

But that Riedel study from 2019 is already outdated because that was before the two big randomized trials came out.

Anna Bertone:   Yes. We need to see a systematic review and meta-analysis that includes those two randomized controlled trials and see if that changes. These authors also expressed concerns about the cesarean rate possibly rising with 41-week induction because both the SWEPIS trial and the INDEX trial took place in countries with very low cesarean rates. So we just don’t really know at this point whether there would be a difference in cesarean rates if they took place in countries with higher rates of cesarean, such as the U.S.

Anna Bertone:   So I think it is still controversial. There’s also countries that are changing their policies about induction and going back and looking at whether that policy change led to any difference in outcomes. One such country is Denmark. They just published a study where they compared birth outcomes from 2000 to 2010 versus 2012 to 2016. And in that time period there was a change in policy from recommending induction at 42 weeks and zero days to 41 weeks and three to five days. They included over 150,000 births in the dataset. And when they looked back, they didn’t see any difference in stillbirths, or perinatal deaths, or low Apgar scores when they compared the period before versus after the policy change. The perinatal death rate was already declining before the policy change in 2011, and it just continued going down without any additional impact from the 2011 policy change. There was also no impact on the rate of Cesareans with the policy to switch from 42 weeks to 41 weeks.

Anna Bertone:   That’s just an example of how this is still controversial. Countries are implementing new policies, and Sweden and the Netherlands may implement new policies based on the INDEX and the SWEPIS studies. Then they’ll probably conduct a study the same way that Denmark did to see if that policy change had any real impact on the population.

I think it’s important to mention, though, that with the Denmark national policy, they switched from 42 weeks and zero days to 41 weeks and three to five days, and that might not have been early enough to make an impact on the stillbirth rate because the studies that we were looking at from 2019, SWEPIS and INDEX, were looking at inductions happening at 41 weeks and zero to one or two days and it was that couple of days difference that made the difference between low stillbirth rate and a higher stillbirth rate.

Anna Bertone:   Right. Exactly. I think that future researchers shouldn’t group 41 weeks and zero to six days together in one grouping because there seems to be differences between the earlier part of the 41st week and the later part of the 41st week because, like you said, SWEPIS and INDEX found that waiting even just two or three days make a difference in outcomes during that week.

So let’s just sum up the pros and cons of induction at 41 weeks versus continuing to wait for labor since that’s what we have the bulk of the evidence on now. I would say that the research shows that the pros of inducing labor at 41 weeks include a lower risk of stillbirth, especially among those with risk factors for stillbirths such as being pregnant with your first baby. In our article, we have a table of the pros and cons. The absolute risk of stillbirth is 4 out of 10,000 pregnancies at 39 weeks, 7 out of 10,000 pregnancies at 40 weeks, 17 out of 10,000 pregnancies at 41 weeks, and 32 stillbirths out of 10,000 pregnancies at 42 weeks. Research also shows a lower risk of the baby receiving intensive care with an elective induction at 41 weeks, lower risk of the baby having jaundice, lower risk of the baby being large for gestational age, and lower risk of needing a cesarean, although that finding may depend on your practice setting. There is a lower risk of mother developing a high blood pressure disorder. at the end of pregnancy. And for some people, they may find an elective induction at 41 weeks convenient and it could help them end an uncomfortable pregnancy.

Also, in our article, we reference one study that found some cognitive benefits for babies. It suggests that the cognitive benefits for the baby from the mom remaining pregnant appear to increase until about 40 to 41 weeks after which there’s no cognitive benefits to the baby’s brain development for continuing to remain pregnant. So Anna, can you share the cons of elective induction at 41 weeks?

Anna Bertone:   Yeah. One of the cons of being induced at 41 weeks instead of continuing to wait and see if you go into labor is the potential for medicalization of birth. One example of this is continuous fetal monitoring may occur if you have the induction, whereas you might not get continuous fetal monitoring if you go into labor on your own spontaneously during that 41st week. 

Anna Bertone:   Another con would be a potential for failed induction leading to a cesarean. That also depends a lot on your practice setting. Another con is the potential for uterine tachysystole, which is defined as more than five contractions in 10 minutes averaged over 30-minute window. There’s a potential increase in the risk of uterine rupture with medical induction. That is especially important among people with a previous cesarean having a VBAC.

Anna Bertone:   Another con is missing the hormonal benefits of spontaneous labor. Another con is increased risk of mother getting inflammation of the inner lining of the uterus, endometritis. One study found that as a possible risk of induction 41 weeks. Then, lastly, medically-induced contractions might increase pain and make epidural use more likely.

We also have a section in the article where we talk about whether there are any benefits to going past your due date. That table we just took you through was comparing the benefits and risks of elective induction. In terms of benefits of going past your due date, one of the major benefits of awaiting for spontaneous labor are the hormonal benefits, which Anna briefly mentioned. In our article, we link to the book Hormonal Physiology of Childbearing by Dr. Sarah Buckley, which talks about the physiologic understandings and the physiology of spontaneous labor. So that is something to keep in mind, and that’s one reason why some people prefer to wait for spontaneous labor. So Anna, if someone wants to wait for labor to begin on its own and they’re talking with their care provider about expectant management, what’s kind of the bottom line about that?

Anna Bertone:   I think the bottom line about that is it all needs to be very individualized. When someone goes past their estimated due date, they could talk to their care provider about the benefits and the risks of elective induction versus continuing to wait for labor and how those benefits and risks apply to them personally. Most research articles and guidelines say that because there are benefits and risks to both options, the pregnant person’s values, goals, and preferences should play a part in the decision-making process.

Anna Bertone:   It’s important for expectant families to be aware of the growing research evidence showing that there could be worse health outcomes for those who wait for labor after 41 weeks of pregnancy instead of being induced at 41 weeks, especially among first-time mothers and those with additional risk factors for stillbirth. But ultimately, after receiving accurate evidence-based information and having conversations with their care providers, pregnant people have the right to decide whether they prefer to induce labor or wait for spontaneous labor with appropriate fetal monitoring.

I want to also let people know about a couple more resources that are in this article at evidencebasedbirth.com/inducingduedates. We have a section all about how people and their care providers can talk about the risk of stillbirth with some sample scripts that healthcare providers can use when they’re talking about risks of stillbirth. We also have links to different guidelines from different organizations about induction at 41 weeks. Then we also have our section called The Bottom Line. So what would you say are some of the bottom lines, Anna, about elective induction at 41 weeks and zero to two days?

Anna Bertone:   I think the bottom line is that elective induction at 41 weeks and zero to two days could help to reduce stillbirths and poor health outcomes for babies without increasing harm, like the risk of Cesarean for mothers. We’re getting that from those two large randomized controlled trials published in 2019 that both found benefits to elective induction at 41 weeks instead of continuing to wait for labor until 42 weeks. One of those studies, as we mentioned, found less perinatal death with 41 week induction and the other found fewer poor health outcomes for babies like intensive care unit admission and low Apgar scores with 41 week induction. Neither of those trials found an increase in the risk of Cesarean during birth with 41 induction compared to continuing to wait for labor until 42 weeks. However, both of those trials took place in countries that follow the midwifery model of care and the overall Cesarean rates were very low. So I think it remains to be seen how that will translate into countries like the U.S. that have higher Cesarean rates. 

So I hope you all found this podcast helpful in looking at the recent research on induction at 41 weeks versus expectant management. Make sure you check out the blog article that goes along with this podcast episode for all of the resources, links, research references. We also have a free one-page handout you can download that summarizes the results of this research. Just go to evidencebasedbirth.com/inducingduedates to download that new article. Thank you so much, Anna, for joining us to help our listeners understand the evidence.

Anna Bertone:   Happy to do it, Rebecca. Thank you.

Today’s podcast was brought to you by the PDF library inside the Evidence Based Birth Professional Membership. The free articles that we provide to the public at evidencebasedbirth.com and this free podcast as well as other resources are supported by our Professional Membership program. Everyone who joins our professional membership gets access to a library with all our printer-friendly PDFs. Each signature article that we publish online has been turned into a professionally-designed, easy-to-print PDF so that our members can print and share evidence-based info with their clients, other parents, or other professionals. To learn how you can become a member today, visit ebbirth.com/membership.

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‘Your seat just ruined my livelihood’: Passenger furious after reclined seat destroys laptop | Stuff.co.nz

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A passenger aboard a Delta Airlines plane has slammed flyers who recline their seats after his laptop was destroyed by the person in the seat in front of him.

Pat Cassidy, an anchor on Barstool Sports’ ‘Hard Factor News’ podcast, was flying in the US when the incident occurred and took to Twitter from the air to voice his fury.

“@Delta small note for the suggestion box, maybe have a little warning sign or someway to prevent my laptop from being destroyed when the person in front of me reclines their seat,” Cassidy tweeted.

PAT CASSIDY/TWITTER
Pat Cassidy said the passenger in front of him had ‘castrated [his] livelihood’.

“Also, this one is more of a critique than a suggestion. I really appreciate that your flight attendant came over to tell me that the passenger in front of me ‘needs to be able to recline’ and then asked him ‘if he was okay?’ as if your seat hadn’t just ruined my livelihood.”

Infuriated by the incident, Cassidy took to the Barstool Sports website with a piece about his experience, where he referred to the person in the seat in front of him as “the selfish b—tard” who had “castrated [his] livelihood”.

@Delta small note for the suggestion box, maybe have a little warning sign or someway to prevent my laptop from being destroyed when the person in front of me reclines their seat. pic.twitter.com/QHmphXiDhH

— Pat Cassidy (@HardFactorPat)

In the article he explains that he was editing photos on his laptop when the person in seat 13A reclined his seat completely, “destroying” Cassidy’s laptop in the process.

“YOU NEVER FULLY RECLINE. It’s rude and a sign of sociopathy,” Cassidy wrote.

“People that fully recline have no souls.”

The incident reignited the ongoing debate over whether it’s socially acceptable to recline your seat on a plane, with people for and against reclining sharing their views.

Update: @Delta is giving me the equivalent of a $75 gift card and an explanation that you would give a six year old. Cool. pic.twitter.com/etGLUXOOjs

— Pat Cassidy (@HardFactorPat)

Some insisted that Cassidy’s laptop was proof that seats should never be reclined on planes, or at least not fully reclined, while others said that the person in front should have reclined more gently.

However, fellow Twitter users pointed out that it wasn’t entirely 13A’s fault that the laptop had been damaged.

“Am I the only one to think this is not the airline’s fault? You tucked the screen into the tray storage area. Frankly, it’s unsurprising that this would happen,” one replied to Cassidy’s original tweets.

Another chimed in: “Pretty easy to tell if you jam your computer under there that will happen.”

Am I the only one to think this is not the airline’s fault? You _tucked_ the screen into the tray storage area. Frankly, it’s unsurprising that this would happen.

— Hisham (@hisham_hm)

On Saturday, Cassidy updated his Twitter thread with Delta’s response to the incident, saying that the airline had offered him “the equivalent of a $75 gift card and an explanation you would give a six-year-old.”

Attached to the tweet was a screenshot of an email that looks to have come from the Delta customer care team, which explains that personal items damaged in-flight by other passengers aren’t reimbursable.

Instead Cassidy was offered 7,500 bonus miles “as a goodwill gesture” and the airline apologised for any “inconvenience”.

Delta later reached out to Pat, responding to his tweet with: “Afternoon, Pat. I would like to review this further with you. May I give you a call? HDR.”

This article first appeared on Nine Honey and is republished with permission. 

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Breakout prospects for 2020 | MLB.com

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Every organization takes pride in its ability to identify and develop talent. We’re the same way at MLB Pipeline, especially when it comes to predicting future breakout prospects.

Looking at last year’s list of breakout candidates, we see many examples of players who realized their potential en route to becoming some of the sport’s premier prospects. White Sox outfielder Luis Robert shot up from No. 44 to No. 3 on MLB Pipeline’s Top 100 Prospects list thanks to a 32-homer, 36-steal campaign across three levels, while Blue Jays right-hander Nate Pearson, another three-level climber in ‘19, ascended from No. 90 to No. 10.

With the start of the 2020 season around the corner, MLB Pipeline once again is picking one breakout candidate from each organization. And while some of the names on this year’s list might be more recognizable than others, they all have the potential to jump on the scene during the upcoming season and establish themselves as can’t-miss prospects.

AMERICAN LEAGUE EAST

Blue Jays: Simeon Woods Richardson, RHP (No. 6) — The Mets’ second-round pick from the 2018 Draft pitched better than his numbers suggest he did at Class A Columbia, and he made six impressive starts for Class A Advanced Dunedin after joining the Blue Jays in the Marcus Stroman Trade Deadline deal to finish his first full season with a 126/24 K/BB and .238 BAA in 106 2/3 innings. The 19-year-old righty is a high-ceiling pitching prospect, armed with a plus fastball-curveball combo, an advanced changeup and a mature overall feel for his craft that could help him move quickly through the Minors.

Orioles: DL Hall, LHP (No. 3, MLB No. 60) — Baltimore’s 2017 first-rounder boasts some of the best pure stuff in the Minors among left-handed pitching prospects, with a plus fastball-breaking ball pairing and a promising changeup. Hall’s overall control, however, leaves much to be desired after the 21-year-old southpaw issued 6.0 BB/9 over 80 2/3 innings last season at Class A Advanced Frederick. The good news is that Hall has never had any issues missing bats (11.1 K/9 across his first 185 1/3 pro frames) and continues to be tough to barrel (.201 BAA), so it’s easy to envision him taking a step forward in 2020 with improved strike-throwing ability.

Rays: Shane Baz, RHP (No. 7, MLB No. 94) — Acquired from the Pirates as the PTBNL in the lopsided Chris Archer deal, Baz spent all of 2019 at Class A Bowling Green in the Midwest League, pitching to a 2.99 ERA with 87 strikeouts and 37 walks in 81 1/3 innings (17 starts). He was especially good down the stretch, too, posting a 2.22 ERA over his final six regular-season starts for the Hot Rods before turning in an eye-opening performance in the Arizona Fall League. With a fastball that can touch triple digits, a devastating slider and a raw but promising changeup, the 20-year-old right-hander could develop into a front-of-the-rotation force if he can improve his control and command.

Red Sox: Gilberto Jimenez, OF (No. 7) — A $10,000 steal from the Dominican Republic in 2017, Jimenez skipped a level last season and led the short-season New York-Penn League in batting (.359) in his U.S. debut. The best center-field defender and one of the fastest runners in Boston’s system, he’ll make the jump to full-season ball in 2020.

Yankees: Clarke Schmidt, RHP (No. 5) — Schmidt had Tommy John surgery as a South Carolina junior a month before New York made him a first-round pick in the 2017 Draft. Though he has been brought back slowly, taking that summer off and totaling 114 innings in 2018-19, he already has reached Double-A and shows the makings of four plus pitches.

AMERICAN LEAGUE CENTRAL

Indians: Aaron Bracho, 2B (No. 13) — Bracho’s advanced bat earned him a $1.5 million bonus out of Venezuela in 2017, but he didn’t make his pro debut until last season because he fractured his right arm in May 2018. A switch-hitter who possesses deceptive power and precocious command of the strike zone, he hit .296/.416/.593 in the Rookie-level Arizona League last summer.

Royals: Kyle Isbel, OF (No. 8) — The Royals were excited after Isbel’s exceptional pro debut after they took him in the third round of the 2018 Draft, but his 2019 season was interrupted by injuries and he played in just 59 games. He made up for lost time in the Arizona Fall League and should use his impressive .315/.429/.438 (leading the league in OBP) showing to catapult him to the upper levels of the system

Tigers: Parker Meadows, OF (No. 12) — The Tigers knew that Meadows — Rays outfielder Austin Meadows’ younger brother — would need time to develop when they selected the athletic prep outfielder in the second round of the 2017 Draft, and his .221/.296/.312 showing over 126 games at Class A West Michigan in his first full season only confirmed that assessment. However, the 6-foot-5, 205-pounder’s five-tool profile offers reason to be optimistic about his future, as all the raw qualities are in place for the 20-year-old to develop into an impact player.

Twins: Wander Javier, SS (No. 7) — While it’s true the Twins didn’t protect Javier on their 40-man roster this offseason, that was a relatively low-risk move given the shortstop hasn’t played above A ball. A torn labrum cost him the 2018 season and he struggled once he got to full-season ball for the first time in late May of 2019 (.177/.278/.323). But he still has tremendous tools, the ones the Twins saw when they gave him $4 million to sign in July 2015.

White Sox: Matthew Thompson, RHP (No. 13) — Before Chicago selected Thompson 45th overall last June, it had spent just two picks that early on high school pitchers in the previous 17 Drafts (Gio Gonzalez in 2004, Spencer Adams in 2013). Though he was inconsistent as a senior last spring, the White Sox love his athleticism and quick arm, which could result in a mid-90s fastball and plus curveball once he’s fully developed.

AMERICAN LEAGUE WEST

A’s: Marcus Smith, OF (No. 30) — The Kansas City high schooler was a bit of a surprise third-round pick, one who wasn’t on our Draft Top 200 list in 2019, but he sure made the A’s look smart during his relatively brief pro debut in the Arizona League (.361/.466/.443 in 29 games). That advanced approach should serve him well and let him use his 70-grade speed to his advantage in his first full season of pro ball.

Angels: Jeremiah Jackson, SS/2B (No. 4) — He’s yet to reach full-season ball, but he set the stage for the jump by leading the Pioneer League in home runs and RBIs in 2019. He’ll need to cut down on his strikeouts (33 percent rate), but he’ll also only be 20 for all of 2020, so there’s time for him to refine his approach and become a truly impactful middle infielder.

Astros: Jeremy Pena, SS/2B (No. 8) — The son of offensive-minded second baseman Geronimo Pena, Jeremy was one of the best defensive shortstops available in the college class of 2018, when Houston popped him in the third round out of Maine. His glove was as good as advertised in his first full pro season, when he exceeded expectations by batting .303/.385/.440 with 35 extra-base hits and 20 steals between two Class A levels.

Mariners: George Kirby, RHP (No. 6) — Kirby made a name for himself as a control artist at Elon University and parlayed that into being a first-round pick last June. He showed just how good that command was by not walking a single batter in 23 innings during his pro debut. Seen as a safe pick who could ride his pitchability quickly up a ladder, his first full season could show that he’s more than that, with the potential to join others from his class on our Top 100 in 2020.

Rangers: Cole Winn, RHP (No. 4) — One of the most polished high school pitchers in the 2018 Draft, Winn went 15th overall but struggled more than expected while being kept on a tight leash in his first full pro season in 2019. But he finished the year with a 2.81 ERA and 46 strikeouts in 51 1/3 innings over his final 12 starts, showing signs of a quality four-pitch mix once he dials in his command.

NATIONAL LEAGUE EAST

Braves: Bryce Ball, 1B — Ball spent two years in junior college before transferring to Dallas Baptist for his junior year. The Braves nabbed him in the 24th round of last June’s Draft after he hit .325/.443/.614 with 18 homers and then he hit 17 more combined in the Appalachian and South Atlantic Leagues during his pro debut. He might have the most power in the system and has already shown the ability to get to it.

Marlins: Braxton Garrett, LHP (No. 7) — The seventh overall pick in 2016, the Alabama high school product required Tommy John surgery after just four pro starts, costing him all of 2018. Garrett looked like his old self last season, pairing a low-90s fastball with a plus curveball in high Class A, and could move quickly in 2020 as he puts elbow reconstruction further behind him.

Mets: Francisco Alvarez, C (No. 5) — Alvarez’s $2.7 million bonus in July 2018 was one of the top totals handed out during the 2018-19 international period, and it wasn’t long thereafter that he began to receive rave reviews from those inside the organization. The Mets challenged Alvarez last summer in his pro debut, assigning him straight to the Rookie Gulf Coast League before a quick promotion to the Appalachian League, and the then-17-year-old backstop responded by slashing .312/.407/.510 with seven homers in 42 games between the two stops. The Venezuela native is already perhaps the best pure hitter in New York’s system, with defensive chops behind the plate that could make him an impactful two-way catcher.

Nationals: Jackson Rutledge, RHP (No. 3) Taken with the No. 17 overall pick in last year’s Draft, Rutledge, a 6-foot-8 right-hander, has some of the best pure stuff among college pitchers from his class with an explosive mid-90s fastball and a wipeout slider that front his four-pitch mix. Harnessing his stuff to throw more strikes and developing a better changeup will be developmental keys for the 20-year-old in his first full season, though he’s exactly the type of power pitcher the Nats have successfully developed in the past.

Phillies: Francisco Morales, RHP (No. 6) — One of the top pitchers in the 2016-17 international signing class, Morales has tremendous raw stuff. In many ways, it played well during his full-season debut in 2019, as he struck out just over 12 batters per nine innings and held hitters to a .226 batting average. He needs to refine his command to reach his very lofty ceiling, but here’s betting he takes a big step forward in 2020.

NATIONAL LEAGUE CENTRAL

Brewers: Tristen Lutz, OF (No. 2) — Tabbed as the Brewers’ top breakout candidate a year ago, Lutz advanced to Class A Advanced Carolina in 2019 and produced a nearly identical line (.754 OPS, 13 HR, 137/46 K/BB) compared to his first full season (.742 OPS, 13 HR, 139/46 K/BB). The elevated strikeout rates fuel questions about the 21-year-old’s hit tool, but there’s a lot to like in his blend of right-handed power potential and patience at the plate. Lutz has the makings of becoming an everyday corner outfielder if it all clicks for him, and a strong showing at Double-A in 2020 would mark a significant turning point in his development.

Cardinals: Ivan Herrera, C (No. 6) — Signed out of Panama for $200,000 in July 2016, Herrera was pushed up to full-season ball at age 18 in 2019 and responded to the challenge by slashing .284/.374/.405 with nine home runs in 87 games across two levels, including Class A Advanced Palm Beach. Herrera continued to impress on both sides of the ball after the season as one of the Arizona Fall League’s youngest players and will enter 2020 with a big up arrow next to his name.

Cubs: Brennen Davis, OF (No. 3) — Though scouts considered Davis one of the better prep athletes in the 2018 Draft, a hamstring injury slowed him as a senior and helped Chicago grab him in the second round. More advanced than expected, he batted .305/.381/.525 and flashed 30-30 upside in low Class A last season — albeit while limited to 50 games by multiple finger injuries.

Pirates: Jared Oliva, OF (No. 11) — A seventh-round pick out of Arizona in 2017, Oliva has had a solid, if unspectacular, first two full seasons of pro ball with a career .274/.348/.403 line, to go along with an impressive 84 steals. He opened a lot of eyes by leading the AFL with 11 steals (in 12 attempts) and hitting .312/.413/.473, setting the stage for a big 2020.

Reds: Tyler Stephenson, C (No. 7) — The 2015 first-round pick got hit by the injury bug quite a bit during the first stages of his career, but he’s going to look back at 2019 as the year it all started to click. After a solid regular season in Double-A, the backstop had a very strong AFL campaign (.347/.372/.410 in 49 at-bats) to earn a spot on the 40-man roster. A big follow-up campaign should vault him onto the top catching prospects list and have him ready for Cincinnati.

NATIONAL LEAGUE WEST

D-backs: Kristian Robinson, OF (No. 2, MLB No. 71) — Signed out of the Bahamas for $2.5 million in July 2017, Robinson offered a glimpse of his potential in 2019 as he slashed .282/.386/.514 with 14 homers and 17 steals while ascending from Class A Short-Season Hillsboro to Class A Kane County in his age-18 season. The 6-foot-3 outfielder’s massive right-handed power highlights an all-around exceptional set of tools, and, overall, it gives him one of the higher ceilings in the Minors among teenage prospects.

Dodgers: Diego Cartaya, C (No. 11) — MLB Pipeline’s top-rated international amateur in the 2018 class, Cartaya signed for $2.5 million out of Venezuela. Often compared to Salvador Perez, he has the tools to make a difference offensively and defensively and hit .281/.343/.432 between two Rookie-ball stops in his 2019 pro debut.

Giants: Alexander Canario, OF (No. 7) — Signed for $60,000 out of the Dominican Republic in 2019, Canario possesses the quickest bat in San Francisco’s system and batted .318/.377/.623 with 16 homers in 59 games between the Rookie and short-season levels last year. He fits the right-field profile well and could have even more value if he’s able to stick in center.

Padres: Reggie Lawson, RHP (No. 21) — The Padres’ second-round pick in the 2016 Draft, Lawson spent much of the ’19 season on the injured list with a balky right elbow, but he returned late in the season to make six starts for Double-A Amarillo, then dominated while making three impressive outings in the Arizona Fall League (0.82 ERA, 14 K, 11 IP), where he operated with a mid-90s fastball, a sharp, 12-to-6 curveball and a promising changeup. With his blend of size and stuff, Lawson could break out in earnest with a healthy 2020 campaign.

Rockies: Helcris Olivarez, LHP (No. 25) — Olivarez made his United States debut in 2019 and missed a lot of bats in the Pioneer League (11.76 K/9 in 46 2/3 IP), largely with a very lively fastball. He’ll need to improve his command (4.63 BB/9) and tighten up his secondary stuff, but the ingredients are all there for him to take a big step forward, perhaps with a move to full-season ball.

Jim Callis is a reporter for MLB.com. Follow @jimcallisMLB on Twitter. Listen to him on the weekly Pipeline Podcast.

Mike Rosenbaum is a reporter for MLB.com. Follow him on Twitter at @GoldenSombrero.

Jonathan Mayo is a reporter for MLBPipeline.com. Follow him on Twitter @JonathanMayo and Facebook, and listen to him on the weekly Pipeline Podcast.

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Tom Green Has One Big Regret About Drew Barrymore and SNL

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Tom Green was never more famous than when he hosted Saturday Night Live on Nov. 18, 2000.

Not only was his insanely popular talk show still airing on MTV, he was coming off a scene-stealing performance in the hit comedy Road Trip. Just weeks earlier, Charlies Angels, in which Green appeared opposite his new fiance Drew Barrymore, debuted at No. 1 at the box office.

It was an amazing thing to have gotten to do it, Green says of his SNL experience, 19 years later, on this weeks episode of The Last Laugh podcast. However, he adds, I think if I could go back and do it again someday, I would do it a lot differently.

When producer Lorne Michaels offered Green the chance to host that fall, the comedian insisted that his childhood friends from Canada, whom he had hired as writers on The Tom Green Show, come in for the week and help write sketches. I didnt understand the politics of Saturday Night Live, he says, acknowledging that SNLs writers at the time, including Mike Schur, who would go on to create The Good Place, future Oscar nominee Adam McKay and head writer Tina Fey, may not have appreciated the input.

I was aggressively trying to deconstruct everything that I encountered, Green explains. Just because I was a kid in my twenties and I was like, thats the way you do it. Lets try to take it apart and put it back together upside down and inside out.

I think in hindsight I would have rather just shown up and worked with everybody else and just kind of went with the flow a bit more, he adds. But I was young and passionate. Green says his friends ended up writing about half of the sketches that aired in his episode, including one in which he appeared in a bathtub with Lorne Michaels as well as his monologue and the final sketch of the night.

Greens big idea for the episode was a gag that would be teased at the beginning of the show and pay off in the final moments. His relationship with Barrymore was all over the tabloids and he thought it would be funny if they appeared together during his monologue and announced they would be getting married on live television at the end of his SNL debut.

I try not to have regrets, but that is something that I actually regret, Green says. So Drew and I actually were engaged at the time. So we thought, this will be a funny prank. Well prank the audience. Well tell everyone were going to get married on SNL and then she wont show up at the altar at the end and that will be the punchline. Even though we were still getting married, like a month after. That was the bit.

But the thing I regret about that bit to this day, which Im actually sad about, to be honest with you, is that the way we wrote the bit, we kept teasing that we were going to get married at the end of the showshes out in the hallway in her wedding dress, my parents are there in the audience, he continues. And then at the end of the show, she doesnt show up. And the end of my SNL I have a meltdown on stage. And its a complete meltdown and the band stops playing and the entire cast disappears and Im just standing alone on stage at the very end of the show.

Artistically, Green still thinks it was a pretty awesome way to end the show. But it does sort of ruin my beautiful Saturday Night Live kumbaya moment, he says. At the end of every Saturday Night Live, [the host] is hanging out with the cast and celebrating together. But on his episode, its just Green screaming I thought you loved me! on stage by himself.

In some ways, its kind of a metaphor for the rebellious, naive kid that I was: Were going to go there and were going to try to turn SNL upside down! he says. But in other ways, I think it just sort of ruined my Saturday Night Live experience. He does add that he and Barrymore went to the after party with the cast and had a blast.

Green maintains that it was one of the highest-rated episodes that season because of the prank. It was a massive success in that sense, because we did create a reason to stay up til the end, he says.

According to a Variety item from that week, the cancelation of the wedding was sprung on Lorne Michaels only five minutes before the ceremony was to take place on camera and the show reportedly had a priest and City Hall license on hand. Caroline Kennedy, Tom Hanks, Rita Wilson, Gwyneth Paltrow, Cameron Diaz, and Harvey Weinstein were among the celebrities waiting backstage to celebrate with the newlyweds after the show.

To put it in perspective how crazy his life was at that time, Green tells me that the morning after Saturday Night Live aired, he and Barrymore got on a plane to London to have dinner with Prince Charles at St. Jamess Palace for the royal premiere of Charlies Angels.

Green sat next to Camilla Parker Bowles at the dinner and had a two-hour conversation about stuff like France and organic farming among other topics. Was it a real mouse? Prince Charles asked Green of the infamous scene from Road Trip in which he attempts to feed a snake and ends up putting a live mouse in his mouth. The answer was yes.

Green and Barymore ultimately did get married in July of 2001 and were divorced less than nine months later. Green has called their marriage a crazy whirlwind of a time.

So it was a bizarre time in my life, Green tells me. If he ever gets the chance to host SNL again, which would be nice, he says, I would love to be able to not bring my friends from high school in and not try to make it some crazy, warped episode.

Nearly two decades later, the 48-year-old comedian chalks the whole thing up to the naivety of youth.

I had been so hellbent on causing chaos everywhere I went that suddenly when I was where I was, I still was behaving as if I was living in my parents basement, Green says. I should have probably taken certain opportunities to just be grateful that I was there. And I didnt realize that at the time.

Next week on The Last Laugh podcast: Stand-up comedian and star of ABCs Black-ish and Grown-ish, Deon Cole.

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‘The Fast And The Furious’ Director Rob Cohen Accused Of Sexual Assault

Four years ago, Hollywood director Rob Cohen invited 28-year-old Jane to a business meeting in Manhattan to discuss collaborating on a TV pilot. Cohen chose the cigar lounge where they met and ordered her a drink, even though she didn’t ask for one, Jane would later recall. He then moved the meeting to a restaurant that happened to be situated right by the hotel where he was staying, ordered a carafe of wine and encouraged her to drink some more, she said. 

By the night’s end, Jane said she found herself regaining consciousness in Cohen’s hotel room, naked, while the director sexually assaulted her. She jolted out of bed and threw up.

Medical records reviewed by HuffPost show that Jane sought treatment for sexual assault after meeting with Cohen. Two people close to Jane confirmed that she told them about the assault both immediately after it happened and again about a year later.

HuffPost also reviewed text messages between Jane and Cohen, sent about two-and-a-half years after the alleged assault, in which she told him, “The night we met, you really hurt me and fucked me up.” At the time, Cohen wrote back that he was “so sorry to hear this.” He later told HuffPost, through a lawyer, that he was apologizing for what he believed was a dispute over compensation for her work on the TV pilot. 

In response to a detailed list of questions from HuffPost, Cohen’s lawyer Martin Singer sent a 13-page letter denying any wrongdoing.

“The proposed Story is an outrageous defamatory hit piece, making extraordinarily offensive assertions that my client engaged in heinous sexual misconduct, criminal wrongdoing, and other inappropriate behavior, which are vehemently disputed and denied by my client,” wrote Singer, who is well-known in Hollywood for representing Bill Cosby and other men accused of sexual misconduct in that cutthroat industry. Singer cautioned HuffPost against “publishing this Story in an effort to feed the ‘Me Too’ media frenzy with this salacious Story.”

Cohen is best known for directing the first “Fast and the Furious” film back in 2001, which spawned a $5.8 billion global franchise with seven subsequent installments and two more planned. He directed “xXx,” released in 2002, and “The Mummy: Tomb of the Dragon Emperor,” released in 2008, along with a number of other frenetic films packed with handguns and high-speed car chases. 

In February, his daughter, 32-year-old Valkyrie Weather, publicly accused him of molesting her when she was a toddler. Weather, who is transgender, also recalled trips with Cohen to visit sex workers in overseas shooting locations when she was a teen and still presenting as a boy. Speaking to The Hollywood Reporter, the director described his daughter’s allegations as “categorically untrue.” 

The molestation allegation was not new to Cohen — Weather’s mother brought it up in divorce proceedings more than two decades ago. Cohen, through his lawyer, told HuffPost that his being awarded sole custody of Weather in the divorce proceedings demonstrated that the allegations were not valid. At the time, evaluators could not determine whether abuse took place, according to documents reviewed by HuffPost. 

Jane contacted Weather this year shortly after reading Weather’s public statement. Jane wasn’t interested at the time in making her story public, but the two women had worked together, and Jane wanted Weather to know she wasn’t alone. She agreed to talk to HuffPost as a way of supporting Weather and has now decided to go public with her experience.

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Cohen met Jane, who requested anonymity to protect her privacy, in early 2015 to discuss her role consulting on that TV pilot with his daughter Weather. The director had offered to use the industry contacts he’d accumulated in his four-decade-long career to shop the pilot around to the networks. Emails reviewed by HuffPost confirm that Cohen collaborated with Jane and Weather on the television project, although it never came to fruition. A major network representative also confirmed to HuffPost that she had discussed the project with Cohen.

Jane felt weird about the meeting with Cohen almost immediately. Cohen flirted with her and volunteered details about his sex life, she recalled. But she needed the money and was excited about the career opportunity, so she tried to ignore his comments.

Although Jane’s memory of the later parts of the evening is incomplete, there are details she remembers vividly. She remembers feeling suddenly alone with Cohen in the large restaurant after the other diners had trickled out. She remembers starting to feel “fuzzy.” She remembers him leaning over to kiss her cheek and thinking that was strange. She remembers being at another bar with Cohen — she distinctly remembers the checkerboard-patterned floor. 

The next thing she remembers is waking up naked, she said. She remembers Cohen’s face in her crotch and his fingers inside her. She had not consented to any of this.

She made her way to the bathroom to vomit and stumbled back to the bed. Cohen tried to penetrate her, but he stopped when she told him to, she said.

Meanwhile, Jane’s boyfriend at the time was starting to worry, he said in an interview with HuffPost. Jane had told him about the meeting with Cohen and said she expected to be home around 10 p.m. By that time, he hadn’t received any text messages from her in a while. He thought it was strange for an older man (Cohen was then in his mid-60s) to turn a business meeting with a 28-year-old woman into a late night of drinking, but he knew the show was a good opportunity for his girlfriend — who was struggling to find work — so he tried to be supportive. 

Jane finally arrived at her boyfriend’s house in a taxi around 1:30 a.m. He wanted to know what had happened that night, but they were both tired and just went to bed. When they woke up in the morning, Jane was distant. Her boyfriend still remembers her “thousand-mile stare.” 

At first, Jane didn’t know what to make of her experience with Cohen, she told HuffPost. She had a vague uneasy feeling about the night before but her memory of the encounter was hazy. 

The night after the alleged assault, Jane went out to dinner with her boyfriend. Once they were seated, Jane’s gaze settled on the checkerboard floor. She panicked as memories of the previous night flooded into focus. Unable to conceal her anxiety, she told her boyfriend what had happened after her meeting with Cohen. 

The fact that Jane says she vividly remembers being assaulted but has a hazy recollection of other parts of the evening is not unusual, Patricia Resick, a psychiatry professor at Duke University, said in an interview. Jane would not have been able to form any memories during the time she was unconscious, Resick noted. And even when she was conscious, she would have no reason to remember parts of the evening that did not seem unusual or dangerous.

Jane told HuffPost that she was a social drinker at the time and does not recall consuming enough alcohol to black out or lose consciousness. “It did not feel like being very drunk,” she said.

Within a matter of weeks, Jane went to a health clinic to get tested for sexually transmitted diseases. Medical records reviewed by HuffPost show she sought treatment as a victim of sexual assault. Jane told the medical professional who treated her that she continued to work on show development and communicate with her alleged assailant, medical records show. 

Cohen recalls meeting Jane at a bar in 2015 to discuss the television project, but he denies being in a hotel room with her or sexually assaulting her, Singer wrote. According to his lawyer, Cohen also denies that Jane was unconscious in his presence and claims that Jane left immediately after their meeting ended. 

After the health clinic visit, Jane tried to move on. She still wanted the TV project to work out. And she hoped that what Cohen did to her was a one-time mistake by a man of an older generation, rather than part of a pattern of predatory behavior. Maybe he felt deep regret, she thought. Maybe no one had told him about the importance of confirming consent. But the assault continued to weigh on her, she said. 

In 2016, more than a year after the incident, Jane’s current boyfriend — who didn’t yet know about her experience with Cohen — made a joke about one of the “Fast and the Furious” movies while they were waiting for a train. Jane winced at the joke and her boyfriend could tell he’d said something wrong, he recalled in an interview. Jane told him that she had been raped by Cohen but that she didn’t like talking about it. She asked him not to tell anyone.

hearing all this shit about harvey is really hard and i can’t stop thinking about what you did. i keep wondering if you even know or care how much you hurt me. im guessing no. Jane, in a text message to Rob Cohen after the Harvey Weinstein story broke

Then, in October 2017, The New York Times and The New Yorker exposed Hollywood producer Harvey Weinstein’s decadeslong pattern of sexual misconduct. The news made it even harder to put Cohen out of her mind. She was frustrated that she was still affected by him, even years after the assault, she said. The next month, she decided to confront him. 

“The night we met, you really hurt me and fucked me up. hearing all this shit about harvey is really hard and i can’t stop thinking about what you did. i keep wondering if you even know or care how much you hurt me. im guessing no,” Jane texted Cohen, whose number HuffPost confirmed. “Anyway, im not tryina be in the news or anything, i don’t want anything from you, but an apology would be nice.” 

Cohen texted her back about an hour later. “I’m so sorry to hear this,” he wrote, according to texts reviewed by HuffPost. He asked if he could call her the following day and she agreed. 

When he called, Cohen apologized for causing her pain but framed the incident as a misunderstanding between two people who had drunk too much, Jane said. At the time, she wanted to believe that was true.

Shortly after the phone call, Jane recounted the conversation with Cohen in text messages to her former boyfriend — the one who had been waiting for her to return home the night of the alleged assault. Jane told her ex-boyfriend that Cohen didn’t “challenge [her] account” and “seemed to understand that he needs to be careful about consent especially when drunk in the future,” according to the contemporaneous messages reviewed by HuffPost. 

She felt a little better after the call, she told her ex. She felt like she had passed the guilt on to Cohen. She didn’t want her name in the news and she didn’t think “canceling” him would help her. She just wanted him to understand what he had done to her so that he wouldn’t hurt anyone else. 

Asked by HuffPost about his apologetic text to Jane, Cohen claimed he’d thought she was talking about money. “My client recalls receiving an odd text or email from [Jane] inferring that she had been taken advantage of, which my client understood to be a complaint that she had never gotten paid for consulting on the defunct project,” Cohen’s lawyer Singer wrote. “Significantly, my client categorically disputes that [Jane] said anything to him during that call about any alleged sexual assault.” 

Presented with a screenshot of the text conversation between Jane and Cohen — in which Jane referenced “the night we met” and Harvey Weinstein — Singer said that “nothing in the alleged text exchange you provided is inconsistent” with Cohen’s explanation of events.

Earlier this year, Jane learned she wasn’t the only person with sexual assault allegations against Cohen. On Feb. 21, Cohen’s daughter Weather accused him of having used her body “for his own sexual gratification” when she was 2 years old. Weather posted her statement on Facebook, Twitter and Reddit ― where Jane eventually found it. 

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Valkyrie Weather in a recent photo. 

She always had the sense that she had been sexually abused as a young child, Weather told HuffPost, and it was a feeling that confused her since she couldn’t recall a specific incident of abuse. That feeling grew more acute as she got older, particularly after she came out as transgender and started working with a therapist. In April 2017, when Weather was 30, she decided she needed to ask her mother directly. She wasn’t comfortable discussing it over the phone, so she reached out to her mom on Facebook Messenger. 

“Was I raped?” she asked her mother, Dianna Mitzner. 

“When you were a toddler,” Mitzner wrote back, “I walked into the bathroom you were in the bathtub with him he was usu g [sic] your body to masturbate.”

Cohen denied the allegations when Weather confronted him via email days later. “NONE OF THAT WAS TRUE,” he wrote in an email, which HuffPost has reviewed. “It was SHE who had you on top of her naked body in the bath tub when I came home unannounced.” 

Cohen offered a more measured statement when Weather went public with her story this year. “I hope and pray that one day, my child will come into the realization that no matter what anyone says or tries to convince her was the case when she was a child, it is both untrue and unimaginable,” he told The Hollywood Reporter in February. 

When Mitzner brought up the alleged bathtub incident during her divorce from Cohen in the early 2000s, he denied the allegations but did not accuse Mitzner of being the abuser. He also made no mention of abuse by Mitzner in his communication with HuffPost. 

After a yearslong custody battle, Weather was sent to live with Cohen in Los Angeles, which had more schooling options than the rural area where her mother resided. Weather chose to move back in with her mother less than a year later, she told HuffPost. 

Through his attorney, Cohen pointed to the custody outcome of the divorce proceedings as vindication. Because there were no other witnesses, HuffPost could not independently corroborate Mitzner’s version of events. But to Weather, her mother’s description of the abuse rang true. It felt like the answer to a question she had been struggling with for most of her life. And it resonated with her memories of her father thrusting his pelvis in front of her face when she was a child and taking her to see sex workers in Thailand and the Czech Republic when she was a teenager.

The “narrative that I was somehow tricked into believing he abused me, that I was too young to remember my experiences at that age, falls short when talking about a barely adolescent child in Prague and Bangkok,” she told HuffPost.

Weather felt it was important to come forward because she suspected her father had mistreated others. “My greatest hope is that others who have been hurt by Rob Cohen feel that they are able to come forward as well,” she wrote in her statement earlier this year. 

When Jane saw Weather’s post on Reddit, she was angry that she had convinced herself that her experience with Cohen was an anomaly. 

Oh, what the fuck, she thought.

By then, the television project had fizzled. Jane and Weather were no longer in regular contact but they still occasionally swapped podcast recommendations or movie trailers. Jane had never told Weather about being assaulted by Cohen because she didn’t want to damage Weather’s relationship with her father. And she still didn’t want to go public with her story. But she did want Weather to know she wasn’t alone.

“Hey,” Jane wrote on Facebook Messenger.

“I kinda never wanted to tell u cause i thought it’d be super awkward for u and i couldn’t imagine how it’d be helpful, but, uh me, as well.”

Do you have information you want to share with HuffPost? Here’s how.

Need help? Visit RAINN’s National Sexual Assault Online Hotline or the National Sexual Violence Resource Center’s website.

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Beto O’Rourke is back in the mix. Will voters give him another look?

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(CNN)Beto O’Rourke is fighting with Pete Buttigieg. He’s angering Democrats in Washington. He’s cussing, and being warned about his language. He’s being called “dummy Beto” by President Donald Trump.

After five months of struggling to find his place in the crowded Democratic field, a campaign reboot following the early August shooting that left 22 dead in his hometown of El Paso, Texas, has moved O’Rourke into a position where he appears more comfortable than he was in the first five months of the race: An outsider attempting to lead a movement.
His message, in campaign stops, emails to supporters and social media posts, has shifted in a way that shows his campaign has found an animating cause. His language has changed, with O’Rourke — an at-times profane campaigner in Texas who early in the race promised he’d stop dropping f-bombs — now back to cursing regularly, a decision being heard by supporters as plainly communicating the urgency of the issue and by critics as an attention-grabbing gimmick.
    So has his travel schedule: O’Rourke is setting aside the traditional path through the early voting states in favor of a new emphasis on those that vote on Super Tuesday. He’s campaigning with down-ballot candidates, visiting downtrodden Democratic Party organizations and stopping in cities and towns facing tumult.
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    It’s tough to tell whether Democratic voters are giving O’Rourke a fresh look in light of his new approach: A recent CNN poll found him with 5% support, which his backers hoped was a sign O’Rourke was beginning to climb out of the low single digits. But an NBC/Wall Street Journal poll this week showed him with just 1% support. Given the margin of error, it’s possible O’Rourke hasn’t moved much at all.

    Battling with Buttigieg

    O’Rourke has drawn headlines since Democrats’ third primary debate in Houston last week — the one his aides said he prepared for the least, with zero sessions behind a podium and the one day that had been devoted to readying him for the showdown scrapped in favor of a last-minute trip to Midland, Texas, after a shooting there.
    Days before the debate, the Democratic National Committee passed on a warning to campaigns that ABC would be broadcasting the debate with no delay — which meant no chance to bleep out curse words. The warning didn’t name O’Rourke directly, but there was little doubt why it had been issued.
    On stage, O’Rourke delivered one of the night’s most memorable moments when he advocated for mandatory buy-backs of assault-style rifles, telling a cheering audience: “Hell yes, we are going to take your AR-15, your AK-47. We are not going to allow it to be used against fellow Americans anymore.”
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    The comment led to criticism from Republicans and Democrats — and it gave O’Rourke an opportunity to brawl with the foe his supporters have been angry at since he mocked O’Rourke’s habit of “standing on things” in New Hampshire in early April: Buttigieg, the mayor of South Bend, Indiana.
    The blowback began the morning after the debate, when Delaware Sen. Chris Coons, a Joe Biden supporter, said O’Rourke had given Republicans an opening to characterize Democrats as gun-grabbers, endangering a push for other reforms.
    Coons’ prediction proved accurate on Wednesday, when Trump did just what he’d warned of, tweeting: “Dummy Beto made it much harder to make a deal. Convinced many that Dems just want to take your guns away. Will continue forward!”
    The fallout with more potential to affect the 2020 Democratic race, though, came when Buttigieg was asked on CNN on Sunday whether Coons was right that O’Rourke’s push for mandatory buy-backs was playing into the GOP’s hands.
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    As Buttigieg built establishment support and fundraising might, O’Rourke’s camp has seethed. His aides and backers note Buttigieg’s private flights and point out that O’Rourke often drives himself around the campaign trail (and recently took the Bolt Bus from New York to Boston). They see — and want voters to see — a clash that’s geographical, with Buttigieg representing the industrial Midwest where Democratic support has slipped and O’Rourke from the Sun Belt, a more diverse region where the party is gaining strength.
    Even as O’Rourke supporters relish the fight with Buttigieg, the bigger picture of the race shows the steep hill O’Rourke must climb. Buttigieg a week ago released his first television advertisement in Iowa — a luxury O’Rourke likely cannot afford, since Buttigieg raised $25 million in 2019’s second quarter to O’Rourke’s $3.6 million.
    O’Rourke’s campaign sees evidence this new approach is working. Aides said the three days following the debate were O’Rourke’s best fundraising days since April, the month after he launched his presidential bid.

    A moment of doubt

    While O’Rourke has become a more critical player in the Democratic race in the seven weeks since the El Paso, Texas, shooting, there was a point in the immediate aftermath when he wasn’t sure he would remain a candidate at all.
    The day after a gunman who police say had posted online a racist screed warning of a “Hispanic invasion” killed 22 people in an El Paso Walmart, O’Rourke had a moment he worried might have ended his chances of winning the Democratic presidential nomination.
    He was on his way to his van after a vigil outside Las Americas, an immigration advocacy center in El Paso — already emotional and unable to find his wife, who had been there, too — when he found himself boxed in between two cars and a handful of reporters behind the building. One asked him whether there was anything Trump could do to make things better.
    “Members of the press, what the f—?” O’Rourke said, chastising reporters for failing to draw what he saw as obvious connections between the violence and Trump’s racist rhetoric and policies that target immigrants.
    Everyone there knew they had seen a significant moment. Two O’Rourke aides nervously approached this reporter, asking about what had happened. Soon afterward, on Twitter, O’Rourke’s comment went viral.
    O’Rourke, meanwhile, was on his way to another vigil. He looked at his wife and said, “Look, I f—ed up,” he told The Atlantic’s Edward-Isaac Dovere in a podcast interview this month.
    In the moment, O’Rourke said, it felt “like maybe this is over.”
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    “Nobody spoke in the van. I didn’t speak. I was pissed. I was pissed at myself, I was pissed at the world, I was pissed at that question. I was pissed that we were even having this conversation — like, how in the world could we be asking ourselves these questions as civilized, intelligent human beings, who report the news, make the news, you know, report on the policy, make the policy? Why are we even asking, is Donald Trump racist? Did he have something to do with this? Could he make this better?” O’Rourke said.
    “I think I was mostly mad at myself: Why have I not been able to figure this out? And why have I not been able to make these connections more clear? Why have we not been able to change this?”
    O’Rourke said he didn’t consciously work through what he might do other than run for president. Instead, he said, his thought after the shooting was, “What am I doing, at all?”
    Did he consider dropping out? What had happened in his hometown, he said, “just down in my bones or my essence, made me question myself. And so to some degree, yes.”
    There were also decisions to be made — such as whether O’Rourke would join the rest of the Democratic field and visit the Iowa State Fair, one of the rituals of the presidential campaign trail.
    “I was like, f— no, uh-uh,” he said. “I can’t pretend. I would be pretending.”
    “And to some degree, you’re performing when you’re running for office, right?” O’Rourke said. “You’re never fully, wholly, truly yourself, warts and all. You are on a stage and you’re projecting and you’re acting in a way that you want people to read and form their picture of you. No one can help that. … We’re all actors on that stage, and no one more so than perhaps someone running for president. But I couldn’t go do that.”
    His decision to skip Iowa forced O’Rourke and his aides to have bigger-picture conversations about where he would go and what kind of campaign he would run moving forward.
    At the same time, Trump’s administration had targeted undocumented workers in Mississippi in an immigration raid.
    Republican Party
    “The two seemed very connected to me in a very obvious way — this manner of terrorizing people and trying to terrify the country about immigrants and Hispanics and people who are really the most vulnerable and the most defenseless in America,” O’Rourke said. “And I said, I want to be there. I want to go there. And I want to go anywhere where people are being kept down or made to be afraid.”
    His return to the campaign trailnearly two weeks later started with a speech in El Paso in which O’Rourke for the first time called for mandatory buy-backs of assault-style rifles, and said he would take a new route — with fewer performative stops in the early states and more visits to vulnerable or forgotten places across the country.
    Since then, he has spent less time in the first four states to vote in the presidential primary process — Iowa, New Hampshire, Nevada and South Carolina — and more in the Super Tuesday states.
    Texas
    Among those Super Tuesday state stops: O’Rourke has campaigned with down-ballot candidates in Virginia. He visited Skid Row in Los Angeles. He delivered a speech that drew a large online audience in front of Democrats in Arkansas. And he visited the Oklahoma City bombing memorial in Oklahoma.
    The changes suggest O’Rourke’s strategy is merely to survive the first month ofprimary season and then begin racking up delegates in March, with Super Tuesday including his home state of Texas. In May, he tapped Jeff Berman, a delegate strategy veteran of Barack Obama and Hillary Clinton’s presidential campaigns, as a senior adviser.
      The new approach to his schedule, the gun control advocacy and the more direct — and sometimes foul — language are all part of his reaction to the shooting that he told The Atlantic “just, at a really deep, fundamental level, made me wonder what I’m doing or what I’ve ever been doing or what we are doing.”
      “And all of the, you know, performance, the ritual, and the — you know, I don’t know, all the editing, that goes into speaking when you’re running for office,” he said, “just really evaporated or didn’t seem as important, or I didn’t even really know that I cared at that point.”

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      Mike Johnson Speaks Out About Demi Lovato & Not Being The Bachelor | Betches

      While a lot of us (Sweetest Betch You’ll Ever Meet and It’s Britney, Betch) are saying a prayer of thanks that Mike Fleiss has finally granted us reprieve from six hours of reality television every week, others (me, Brett Vergara) are still reeling from the revelation that Peter will be the next Bachelor. Now, don’t get me wrong, on any other season, Peter would have been a great choice. I’m glad they didn’t pull some bullsh*t and revive some random dude from the dead (or, in Bachelor terms, five years ago). And, to be clear, Peter is a fine choice for Bachelor. He made it to the top three on Hannah’s season, and he seems like a perfectly nice guy. But notice the lack of enthusiasm here? That’s because I, like many people, were hoping against all hope that this would be the year that ABC would finally do something different. That they’d choose a Bachelor who wasn’t the human incarnation of mayonnaise on Wonder Bread. And this time, it actually seemed likely! I was fighting a losing battle last year, hoping they’d choose Wills for Bachelor. But this year, we had Mike Johnson. We had Mike’s smile. We had Mike calling women queens. It seemed that our dreams of having a diverse Bachelor may finally become reality. And then they didn’t. Now, Mike Johnson is finally speaking out about getting passed over for the Bachelor gig, on Bachelor Happy Hour with Rachel & AliRachel Lindsay and Ali Fedotowsky’s podcast.

      Rachel first asks Mike if he was, in fact, in talks to be the next Bachelor, or if we all just wildly projected. He answered, “I was 100% in talks to be the next Bachelor.” So that settles that—ABC was considering switching it up, and ultimately decided not to. I think I speak for all of us when I say: Y tho???

      He added, “people probably didn’t think I was considered to be the Bachelor because I was trying to be so respectful of the crew at Bachelor world and I didn’t want to speak about it.” He then explained that Peter didn’t do interviews after The Bachelorette, so he didn’t have to answer questions about being the next Bachelor all the time. Mike then goes on to say that he definitely wanted the gig. “I 100% wanted to be the Bachelor,” he said. “Reasons being: One, I do want to find a wife. Two, it was bigger than me and I wanted to represent for all people of color. And then, also, talking about people of color, they need to have an Asian Bachelor, they need to have an Indian Bachelor. They need to have other people outside of just black and white. And so I want to speak on that as well.” Ugh, I stan a woke king. Remind me why they didn’t choose this guy again?! This is a crime against humanity.

      So Mike affirms that he definitely did audition to be the Bachelor, and he wanted it, but he ultimately wasn’t chosen. And he kind of found out in the crappiest way possible: on TV, like the rest of us. “I found out in the trailers, before you do on the Bachelor in Paradise reunion,” he said. Damn, they couldn’t have given him a phone call? He admitted, “When I first found out, I’m not gonna lie, I was sad. I was annoyed when I very first found out. But then by the end of the night, I wasn’t annoyed no more because I was appreciative and thankful that they told me no right then and there because now I could focus on myself and I’m just blessed because I know I’m gonna find my wife and find my claim.” Well, that’s a lot more graceful than I would be. Personally I would have probably followed through on my many threats to burn down ABC. One of these days, I’m going to do it for real!!

      Obviously, Mike had some opinions on why they chose Peter instead—but they are annoyingly vague. He said, “ultimately, it just came down to, they chose the right person for what they want.” WHAT DOES THAT MEAN?? Is “what they want” to placate middle America types who can’t handle seeing a non-white person on their television? Please, I need more information.

      But we all know now that you can’t always get what you want (if what you want is diversity in Bachelor Nation). And now it doesn’t really matter, because Mike is seeing Demi Lovato. And of course Rachel asked about it (doing the Lord’s work). He admitted he and Demi have met in person “more than one time”. What does that mean!! Stop being coy! The people demand it.

      He gushed over Demi, saying, “I think she’s amazing. She’s incredibly humble.” He added, “When Demi and I are together, it’s laughter and we talk about real sh*t. Like, she’s a down-to-earth woman and I respect it so much. And she’s just a really humble, really cool, really fun, down-to-earth person.”

      Cool, cool, cool. I don’t know why I’m crying in the club at my desk right now. Next, Rachel asked what we’ve all been thinking ever since Mike posted that thirsty comment on Demi’s Insta: “What is the status of your relationship with Demi Lovato?” Here’s what Mike said:

      “My status of the relationship with Demi and I are that we are two people exploring each other.”

      Oooookayyyy, seriously? “Two people exploring each other” sounds like what you’d say about the person who taught you how to give a blow job as a teenager at summer camp. But, okay fine, it makes sense that Mike wouldn’t say he and Demi dating or anything, considering it’s been, like, two weeks since they have been in contact (that we know of).

      SO this interview basically reaffirmed to me that Mike would have been a great Bachelor, but that we do not deserve him. And Peter will be cool I guess. It could have been worse—they could have chosen Blake. Listen to the full interview with Mike Johnson here.

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      Bill Nye Wants a Rematch With Tucker Carlson

      Subscribe to The Last Laugh on Apple Podcasts

      This week, Bill Nye joined The Last Laugh podcast to offer some advice to the 10 Democratic presidential primary candidates who will be participating in CNNs upcoming Climate Crisis Town Hall. After all, the Science Guy has a lot of experience making the case for climate action on TV.

      Oh god, Nye says when I bring up the appearance he made on Tucker Carlsons show a couple of years ago. As one headline put it at the time, Bill Nye appears on Fox News and it doesnt go well.

      The experience was just a lot of adrenaline, Nye tells me. He was in Washington, D.C., where Carlson tapes his show. It was a beautiful night, gorgeous, and Tucker Carlson was on the roof of the building doing his schtick from there. Fox invited him on to talk about climate change and he agreed, making his first appearance on that network in nearly a decade despite being a semi-frequent presence on CNN and MSNBC.

      So we were going to go on the roof, beautiful night, this will be fun, Nye thought to himself. But then the producers told him he wasnt going to be on the roof with the host but rather in a small room on a lower floor of the same studio. They moved me, changed my chair three times to throw me off, he says.

      During his introduction, Carlson mocked his guest as Bill Nye the Psychoanalyst Guy for claiming that climate change deniers suffer from cognitive dissonance. The host was clearly itching for a fight.

      As the segment began, Nye quickly realized that every time he started to talk, Carlson would interrupt him. Working as fast as I could, I took my phone out and tried to show him with a stopwatch that he interrupted me every six seconds, Nye says. So its hard to make a point with him.

      By the end of their nine minutes on screen together, Carlson was shouting at Nye, Im open-minded, you are not!

      Carry on, Mr. Carlson, Im sure we will cross paths again, Nye told him, a bit ominously. They havent crossed paths since.

      Hes really drifted off, with respect, Nye says of Carlson, who has become the most prominent white nationalist voice on Fox News under President Trump. I mean hes gotten odder and odder. Besides the racism, Nye was enraged by a recent show in which he attacked the metric system.

      The other thing I wonder about Tucker Carlson is, hes got four kids, Nye says, turning more serious. I just wonder how his children feel about climate change. They keep a pretty low profile. I wonder about it, because it much more difficult to meet a climate change denier who is young.

      Nye had a much better time making a cameo on Last Week Tonight with John Oliver earlier this year. God, that was a blast, he says of the sketch in which he lit a globe on fire to demonstrate the impact of climate change. As the longtime host of a childrens program, he has spent most of his career communicating his message in a kid-friendly way. But on HBO, he got to scream, The planets on fucking fire! at the top of his lungs. It was heartfelt! he says.

      And yet Nye does not regret his attempt to get through to Fox News viewers on the climate crisis. Ill go back on there almost anytime, he says, explaining that he was asked back shortly after his original appearance but said no at the time and hasnt been invited since.

      Ive offered to be on The Five and they wouldnt have me on, Nye adds of Foxs afternoon roundtable show. It wouldnt be fun, he admits, but youve got to meet people where they are.

      Lets all go fishing at the other guys fishin hole, Nye says, explaining that he means that literally as well as figuratively. Because were more alike than we are different.

      When I ask if that applies to him and Tucker Carlson, Nye sighs and replies, Yeah, I guess. Like Nye, Carlson used to be famous for wearing bow ties on television. He used to, Nye says of Carlson, but he lost his nerve.

      Next week on The Last Laugh podcast: Stand-up comedian and host of Comedy Centrals Good Talk, Anthony Jeselnik.

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      Were women with brown skin, talking proudly about sex

      Explicit podcasts are booming, but the three women behind Brown Girls Do It Too say theirs is different

      Digital media

      As the truism goes, every generation thinks it invented sex. But surely this is the first to be talking about it more and doing it less?

      On Thursday, BBC Asian Network launched Brown Girls Do It Too, a six-episode sex podcast hosted by three millennial British women of second-generation Bangladeshi, Indian and Iranian heritage. Not to be confused with Brown Girls Do It, a well-established independent podcast about books, politics, race and class, the newer project is at the Carry On meets Carrie Bradshaw end of the cultural spectrum.

      In it, Poppy Jay, 33, Rubina Pabani, 31, and Roya Eslami, 24, talk about their sexual experiences and discoveries in what is pitched to listeners as a raucous, intimate over-share. And so Eslami tells of losing her virginity to a Tinder date, Pabani explains how she pulled the hottest man in the room and Jay insists sex [need not be] a special, precious thing it is just an activity for me, like going to the gym, its a function and a release.

      All three of them work in the media in London and were approached by a male producer at the station to work on the project. None of them knew each other beforehand or had even met until the day of recording.

      We went to the pub before the recording of the first episode, says Eslami, who tongue-in-cheek describes herself as a Persian princess. I think it helps were not friends when I told these girls about [the boys Ive slept with], they heard that for the first time, so I hope there is a freshness when youre listening to it.

      Thats one perspective, but some will find that Brown Girls feels contrived, and a cynical move by the Asian Network. In person, the three of them are entertaining; they insist that there is nothing like their show out there and specifically, in terms of British Asian girls talking about masturbation and blowjobs on a BBC platform, there isnt but the business of aural sex is booming.

      Women talking frankly and explicitly about sex and relationships is a major podcast genre there are now dozens out there. Given that episodes are invariably listened to solo rather than as shared experiences, the format lends itself perfectly to the subject. In the UK alone, Laid Bare, Project Pleasure and Unexpected Fluids have already been smash hits, following in the wake of Cock Tales and Inner Hoe Uprising.

      Sex is so personal, no two stories are exactly the same, says Eslami, so Im not worried about ours sounding similar. The difference for them, she says, is that we all talk a lot about being 15-year-old Asian girls, having a moustache, not being fancied by any boy in school. I want to tell [girls like that], that one day youre going to love yourself and youre going to enjoy sex and you dont need to worry about this period where you feel like a sexless being.

      The three agree that theyre horrified at the idea of their parents listening but beyond that they dont worry too much about the response they get. Of course we worry about what our mums and dads think, says Jay, but I dont even know the words for sex in Bengali its never talked about and that shame is used to control women. Sex comes with all this baggage of guilt and it really shouldnt.

      I think the members of my community who do hear about it will be shocked, but I think thats OK and its fine, nods Pabani. Its not about destroying ties to our culture or religion or communities. [Other Asians] seeing me a certain way might make bridges for women after me, to be able to be freer and to speak. Im fine with it.

      Yet on the flipside, when it comes to a broader audience, Pabani thinks it would be upsetting if people thought it was radical. Were just women talking about sex, we just happen to have melanin in our skin. And we want to feel multi-dimensional Id like people to see us as quite chill about the way we speak about sex. Were not ashamed, were proud of our exploits and the things weve learned.

      A long list of reasons have been reported as to why millennials are having less sex than generations before them economic insecurity, porn and the distraction of Netflix have been cited by psychologists explaining the 21st century sex recession. But Eslami, who also admits Ill never sleep with anyone unless Im waxed downstairs, is adamant that sex is evolving with us. I think its amazing we sext, send nudes and a guy can use an app to send his girlfriend a buzz on her sex toy from across the country.

      The three brim with contradictions, but overturning stereotypes imposed on them, they say, is key. Often, white people dont see Asian people as sexual beings. The perception is that were more modest, humble or prudes, says Eslami.

      And so she tells listeners that she has made a list of all the people she has slept with on her phone but is also still in the process of trying to orgasm with a partner. We dont come across as experts, she says. Were just girls who have done really good things with sex and really bad things with sex the theme is that were just honest about the good, bad and ugly.

      Jay, who says Ive been playing catch-up since I was 25, wants to spread the word that everyone is bonking. Theyre bonking in cars, hotel rooms, parks and we need to be honest about it.

      Eslami laughs. And by talking about it, we want to break the myths and fictitious representations of sex the sex you see on TV where there is five pumps and the girl has come? Thats not how it is.

      Listen and learn: more sex podcasts

      Laid Bare

      Three black British women have formed a special club for the sex positive and opinionated to lay bare just how much they, and their listeners, get laid.

      Project Pleasure

      By promising theyre putting the pleasure back into safe sex and healthy relationships, two friends explore how everyone can have a better time in bed.

      Savage Lovecast

      The original that spawned so many podcast offspring, Dan Savages sex and advice series started as a weekly newspaper column in North America. Now he tackles the problems posed by his listeners.

      Unexpected Fluids

      Alix Fox and Riyadh Khalaf offer real-life, embarrassingly honest stories about sex particularly when things go awry. Expect tales of amazement and despair and over-sharing from their guests.

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