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+ Will the Pruitts finally get their mattress as a parting gift from Trump?

+ Pruitt out, coal lobbyist in. Unlike Pruitt, his replacement, Andrew Wheeler , former staffer for climate denier James Inhofe, will only have to collude with himself.

+ A Washington Post columnist named Megan McCardle wrote an absurd column for the Fourth of July laboriously arguing that America needs more displays of gratuitous flag-waving and patriotism not less. The column was illustrated with a photo of the Washington football team standing for the national anthem with hands over their hearts, driving home the point thatblind patriotism goes hand-in-hand with racist nicknames, slogans and logos….

+Trump is back to smearing families fleeing horrid conditions in Central America as “invaders.” This from the man who commands more than 800 US military bases in 70 different countries around the globe.

+ At a meeting last August, Trump the Isolationist berated his staff about why the US couldn’t send troops to Venezuela to overthrow the Maduro regime and, no doubt, seize the nation’s oil reserves. The Monroe Doctrine lives with “non-interventionist” right, who violently oppose immigration but don’t hesitate to support destroying another country in the hemisphere and unleash another stream of desperate immigrants north.

+ Will this be the year of the Soybean Voter ? Here’s a map depicting the 30 congressional districts most impacted by China’s tariffs on soybeans.

+ Korean media : Trump asked Kim Jong Un, whom he had called Rocket Man, if he knows the Elton John song Rocket Man, and Kim said no, so Pompeo is bringing Kim the CD, which Trump has autographed.Trump seems to be fixated on Elton John lately. He had a very weird John moment in his Montana speech on Thursday night about Elton having an “organ” and he doesn’t.

I have broken more Elton John records, he seems to have a lot of records. And I, by the way, I don’t have a musical instrument. I don’t have a guitar or an organ. No organ. Elton has an organ. And lots of other people helping. No we’ve broken a lot of records. We’ve broken virtually every record. Because you know, look I only need this space. They need much more room. For basketball, for hockey and all of the sports, they need a lot of room. We don’t need it. We have people in that space. So we break all of these records. Really we do it without like, the musical instruments. This is the only musical: the mouth. And hopefully the brain attached to the mouth. Right? The brain, more important than the mouth, is the brain. The brain is much more important.

+ Campaigning while black:Janelle Bynum represents the 51st district in the Oregon Legislature. A few days ago, she was going door-to-door a neighborhood on the southeast side of Portland, when she was confronted a sheriff’s deputy who said a local resident had called 911 to report her “ suspicious activity .” Bynum is, of course, black, which automatically makes you a target in one America’s whitest enclaves.

If no randomized trials exist, clinicians and funders of care can still act on the results from observational RCD and other evidence, but they should consider that treatment effects could be more uncertain and substantially smaller than what RCD studies suggest. Therefore, decisions for widespread adoption and reimbursement of expensive interventions with evidence based entirely on RCD may be best withheld until trial evidence becomes available. Large randomized trials might still be needed to address critically important clinical questions for patient relevant outcomes. 1 77 78

What is already known on this topic

Observational studies using routinely collected data (RCD studies) are increasingly used to inform healthcare decisions when RCTs are not available

However, observational studies have an inherent risk of bias due to confounding by indication

Another difficulty is the accuracy and reliability of routinely collected data

What this study adds

RCD studies systematically and substantially overestimate mortality benefits of medical treatments compared with subsequent trials investigating the same question

Observational RCD studies might not necessarily provide very reliable answers on how to best treat patients; caution is needed to prevent misguided clinical decision making

If no randomized trials exist, clinicians and funders of care should consider that treatment effects are probably more uncertain and substantially smaller than RCD studies suggest; decisions for widespread adoption and reimbursement of expensive interventions might be best withheld until trial evidence becomes available

Footnotes

We thank Hannah Ewald, University of Basel, for support in the risk of bias assessment.

Contributors: LGH and JPAI conceived the study. All authors extracted and analyzed the data and interpreted the results. LGH wrote the first draft and all authors made revisions on the manuscript. All authors read and approved the final version of the paper. JPAI is the guarantor.

Funding: This study was supported by the Commonwealth Fund, a private independent foundation based in New York City. The views presented here are those of the authors and not necessarily those of the Commonwealth Fund, its directors, officers, or staff. The Basel Institute for Clinical Epidemiology and Biostatistics received support from Santésuisse, the umbrella association of Swiss social health insurers. The Meta-Research Innovation Center at Stanford is funded by a grant by the Laura and John Arnold Foundation. The work of JPAI is supported by an unrestricted gift from Sue and Bob O’Donnell. The funders had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript or its submission for publication.

Temples of Angkor, Cambodia, by Eleanor

Vines smothering the Temples of Angkor

Built between the 9 th and 14 th century, the Angkor Temple complex is steeped in history and has seen many kings and occupants pass through its doors over the years. Admittedly, the complex can become very busy at times because of its popularity with visitors, but it is possible to stumble a few minutes from the path to find yourself in complete isolation. We take full advantage of our local guides' knowledge and experience - they know which temples to avoid on given days and times.

One of my favourite memories of Cambodia was sitting in the grounds of Ta Prohm at 5am with just the sound of the monks singing and the birds chirping – it was such a serene and magical experience.

Ngorongoro Crater, Tanzania, by

Cheetah, Tanzania

The Ngorongoro Crater is one of the Seven Natural Wonders of the World. With a dense population of wildlife and walls 600 metres high, the animals that are resident there do not tend to migrate out. This provides visitors with the potential to see the Big Five in one small area, as well as being home to the incredibly rare and endangered black rhino species.

I was fortunate enough to spot a playful crash of black rhino on my last visit – I would certainly recommend rising early to increase your chances of a sighting.

The Great Barrier Reef, Australia, by Hannah

Tropical reef, Great Barrier Reef, Australia

The Great Barrier Reef is the largest living thing on Earth and a trip to Australia without time spent exploring here, would be incomplete. There are many different ways to experience this natural phenomenon but one of my favourites is with a stay on Haggerstone Island .

The island is completely secluded and has a real Robinson Crusoe feel to it with spectacularly white, powder-soft sand and beautiful turquoise waters. You can swim onto the reef from here and also spend time relaxing on – in my opinion – the best beach in Australia.

The Golden Temple, India, by Rowena

Take me there

Golden Temple, Amritsar, India

The Taj Mahalis certainly an unmissable site in India but the often overlooked Golden Temple in Black leather Cassius slingbacks outlet explore elYlSxQ4C
exudes majesty in equal measure. Draped in 100 kilograms of gold, the sunlight illuminates the sacred shrine during the daytime which is also when you can peek into the kitchen to see the volunteers preparing Thali meals for up to 40,000 visitors.

On my last visit I returned in the evening to watch the ‘Putting to Bed’ ceremony - this is when the Holy Book is paraded through the crowds before being taken to its nightly resting place.

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