Latest news with #IGRA
Yahoo
4 days ago
- Politics
- Yahoo
Kansas attorney general: State can legally negotiate gaming compact with Wyandotte Nation
Attorneys representing Gov. Laura Kelly sought a legal opinion on potential of the Wyandotte Tribe entering into a state compact to offer casino gambling that included sports betting. Attorney General Kris Kobach says a Kansas governor is obligated to negotiate in good faith with on a tribal compact. In this image, Kelly speaks at 2024 dedication of a replica of the Ad Astra statue of a Native American pointing an arrow at the North Star. (Tim Carpenter/Kansas Reflector) TOPEKA — Attorney General Kris Kobach said Gov. Laura Kelly was obligated under federal law to negotiate in good faith with the Wyandotte Nation on a compact agreement to allow operation of casino gambling, including sports betting, on tribal land. Negotiations with the Wyandotte Nation wouldn't violate state law applicable to operation of four nontribal casinos in Kansas nor would negotiations be inconsistent with compacts with four tribes in the casino business in Kansas, the attorney general said. On Friday, Wyandotte Nation Chief Billy Friend said he appreciated the attorney general's opinion affirming the tribe's contention that state and federal statute wouldn't interfere with the tribe seeking a gaming compact in Kansas. 'We were pleased with the opinion,' he said. 'We're looking forward to sitting down and negotiating in good faith and coming up with a fair compact.' Kobach's nonbinding legal opinion said the federal Indian Gaming Regulatory Act, or IGRA, governed gaming on tribal land held by the Prairie Band Potawatomi, Sac & Fox, Kickapoo and Iowa tribes in Kansas. IGRA would likewise preempt state law related to a Wyandotte Nation request for a compact applicable to its 7th Street Casino in Wyandotte County and Cross Winds Casino near Park City in Sedgwick County, the opinion said. Under the Kansas Expanded Lottery Act, or KELA, the opinion said the state's jurisdiction over gambling activities was confined to four casinos outside of tribal land in Mulvane, Pittsburg, Dodge City and Kansas City, Kansas. These Kansas Lottery facilities operated through management contracts with private companies. KELA does forbid Kansas from adding state-owned casino zones through 2032. 'Because KELA and the management contracts do not prohibit efforts that further tribal gaming under IGRA, they do not prohibit negotiating with the Wyandotte Nation over a compact,' Kobach said. Kobach said sports wagering could be featured in a compact with the Wyandotte Nation because Kansas permitted that type of gaming at casinos across the state. In 2022, the Legislature and Kelly granted the four state-owned casinos an opportunity to operate sports books. Since 2023, the Iowa, Sac & Fox and Prairie Band Potawatomie nations negotiated sports betting agreements with the state. Friend, chief of the Wyandotte Nation headquartered in northeast Oklahoma, said the intent was to seek a compact with Kansas enabling the tribe to participate in sports gambling. Justin Whitten, chief counsel to the governor, sought the attorney general's insight into the intersection of IGRA and KELA. The request reflected government and industry concern about potential violation of state management contracts with nontribal casinos. 'A compact with the Wyandotte Nation would not fall under, and would not violate, KELA,' Kobach said. 'And, because federal law trumps state law, to the extent there is any conflict between IGRA and Kansas Statutes Annotated 46-2305, IGRA prevails.' Under the existing system of developing gaming compacts in Kansas, a tribe would begin by requesting negotiations with the governor. The negotiated compact documents would be submitted to the Legislature for consideration. If approved, the compact agreement would be forwarded for review to the U.S. Department of Interior. Kobach said the U.S. Supreme Court weakened IGRA's central mechanism for getting states to negotiate with tribes by holding IGRA didn't abrogate state sovereign immunity. 'This means that if the state does not negotiate with the Wyandotte Nation, or if the Wyandotte Nation believes the state is not negotiating in good faith, the state can invoke its sovereign immunity against any resulting suit by the tribe,' Kobach said. While a tribe might not successfully pursue a lawsuit against the state of Kansas, Kobach's opinion said, the federal government could take legal action on behalf of a tribe to sidestep a sovereign immunity defense.
Medscape
13-05-2025
- Health
- Medscape
AI Identifies Novel Predictors of TB in People With HIV
An artificial intelligence (AI) model using routinely collected data predicted subsequent development of active tuberculosis (TB), Swiss researchers reported. The AI model outperformed biological tests for latent TB in identifying HIV-positive patients at high risk of developing TB. As well as immune function and sociodemographic variables, the AI model retained several biomarkers indicative of patients' well-being and metabolism. In Switzerland and other countries with good access to antiretroviral therapy, TB is a rare but serious co-infection in people living with HIV, frequently linked with late HIV diagnosis. To prevent progression to active TB disease, people known to have latent TB infection can be offered preventive treatment with isoniazid and/or rifampicin. But detection of latent TB is challenging, especially in people with HIV. In a previous Swiss analysis, a combined approach using interferon gamma release assays (IGRA) and tuberculin skin tests identified only 30% of people who subsequently developed active TB. 'It was worse than tossing a coin,' Joahnnes Nemeth, MD, an attending physician in the department of infectious diseases and hospital epidemiology at the University of Zürich, Zürich, Switzerland, told Medscape Medical News. The problem is that the tests rely on immune response, which may be impaired. 'You interrogate the very system that is malfunctioning during HIV infection, so it's not a surprise that the tests perform poorly,' he explained. This led him and his colleagues to look into alternative ways to identify patients at risk. They leveraged data from the Swiss HIV Cohort Study, which includes around 70% of people receiving HIV care in the country. Over 23 years' worth of data were analyzed using machine learning, a subset of AI that enables computers to learn patterns from data and make predictions without being explicitly programmed for each task. Their machine learning model employed a random forest — an algorithm which combines the outputs from multiple decision trees. The model looked at data collected at HIV diagnosis in order to predict active TB disease that developed at least 6 months later. Rather than only considering variables which the researchers thought were potential risk factors, the model reviewed all the variables for which they had sufficient data. 'What I really liked about this machine learning approach is that we threw all the data we collect into the machine and just asked it: Can you do something with that?' Nemeth said. 'I think that really paid off.' The first iteration of the model included 48 variables and had a sensitivity of 70.1% and a specificity of 81.0%. A streamlined second version retained 20 variables — making it computationally less demanding — while delivering a sensitivity of 57.1% and specificity of 77.8%. Given that biologic tests had a sensitivity of 30% and specificity of 94%, for Nemeth this 'blows everything of the water.' The model doesn't require additional data collection or have the expense of IGRA. As might be expected, the 20 retained variables included immunological parameters, hematological markers, and sociodemographic factors, but some were more surprising: along with several variables linked with metabolism (cholesterol, high-density lipoprotein, glucose, and creatinine), body mass index, and mean arterial pressure. The researchers noted that TB is associated with malnutrition and said that some of these markers may reflect metabolic perturbations and compromised muscle mass in people at risk for TB. The model was first validated on a portion of the Swiss cohort which it was not trained on, and then on a cohort in Austria. Despite the many parallels between the two cohorts, initially the model performed badly in Austria. The researchers realized the issue stemmed from different migration patterns between the countries: Most people with TB in Switzerland have moved from sub-Saharan Africa, while in Austria, most come from the former Soviet republics. Only after modifying the ethnicity and region of birth variables did the model begin to work effectively. 'This is a cautionary tale,' said Nemeth. 'You go to a very similar setting with a little difference, and all this stops working. With machine learning models, we really have to be careful and test them vigorously before we rely on them.' Emily Wong, MD, is an associate professor at the University of Alabama at Birmingham who has used AI to aid interpretation of chest radiography in South Africa, but was not involved in the new study. The Swiss research 'opens one's eyes to the idea that with very large data sets with lots of clinical variables, you can discern meaningful and predictive patterns that predict whether someone will go on to develop TB,' she told Medscape Medical News. Nemeth is working on an implementation study in which physicians whose patients have never been tested for TB will be randomly allocated to either receive a reminder to test, or a risk score based on the machine learning model. A key question is whether the latter will be enough to convince physicians to take further action, such as offering preventative therapy. Wong noted that the potential benefits and risks (including liver toxicity) of preventative therapy need to be weighed up for each patient. But a machine learning model could help clinicians to do this. 'The idea that in the future, based on key demographic and clinical information of a person, and maybe including their chest x-ray or IGRA test, or maybe not, we would have a well-functioning clinical decision making tool that would guide a health care worker to make TB prevention decisions for the patient in front of them is definitely a worthy goal,' she said. The study was funded by the Swiss National Science Foundation. Nemeth declared receiving honoraria for presentations from Oxford Immunotec and ViiV.
Times of Oman
30-03-2025
- Health
- Times of Oman
Health Ministry suspends latent tuberculosis screening during Eid holidays
Muscat: The Ministry of Health has announced the temporary suspension of the "IGRA" latent tuberculosis screening service for expatriate workers during the Eid Al-Fitr holidays. The service will resume after the holiday period. The ministry extended its Eid greetings to all, wishing everyone a joyous and blessed occasion.
Yahoo
14-03-2025
- Politics
- Yahoo
Judge dismisses Running Aces lawsuit against 5 other Minnesota casinos
A judge has dismissed a federal lawsuit by Running Aces Casino against five tribal casinos in Minnesota that it accused of offering games not allowed under state law. The lawsuit was filed last spring under the Racketeer Influenced and Corrupt Organization (RICO) Act, and named 39 current and former executives and employees at Mystic Lake, Little Six, Grand Casino (Hinckley and Mille Lacs) and Treasure Island Resort Casino as defendants. It alleged the casinos were offering games – such as Three Card Poker and Ultimate Texas Hold 'Em – not permitted under state compacts set up through the Indian Gaming Regulatory Act (IGRA) of 1988. But U.S. District Court Chief Judge Patrick Schiltz dismissed the case Tuesday, saying that the current and former employees named did not adequately represent the tribal nations, and as a result the tribes could be negatively impacted by the ruling in a lawsuit in which they are not listed as defendants. However, the judge also acknowledges that sovereign immunity protects tribes from lawsuits such as that filed by Running Aces. "Setting that aside, even if Running Aces's claims have merit, the remaining ... factors – especially the Tribes' sovereign immunity and the magnitude of the prejudice that the Tribes could suffer from a judgment entered in this case – weigh in favor of dismissal. Indeed, courts frequently find that an absent tribe's sovereign immunity outweighs the plaintiff's lack of an alternative forum." "As noted, the gaming that is challenged in this lawsuit is of enormous economic importance to the absent Tribes, and protecting the economic sustainability of tribes is a primary goal of IGRA specifically and federal Indian policy generally... The Court therefore has little trouble concluding that the Tribes' interests in protecting a critical source of funds and jobs outweigh Running Aces's interest in a forum for its claims of competitive injury," it continues. The suit was dismissed without prejudice, meaning a similar lawsuit can be filed in the future, and Running Aces President and CEO, Taro Ito, told Bring Me The News he does intend to file again. He said he was "surprised" to hear of the judge's ruling, claiming the dismissal related to "procedural issues" rather than the merit of his casino's case. He also said the judge's dismissal highlights there is little legal recourse for complaints against tribal casinos, saying tribes can simply claim sovereign immunity. "Obviously it's disappointing because we feel very strongly about our case," he said. "We'll take this to the Supreme Court if we have to." BMTN has reached out to Grand Casino, Mystic Lake, Treasure Island and Little Six for comment on the outcome but haven't heard back.
