Volume 13 - 2019 | https://doi.org/10.3389/fncel.2019.00405 This article is part of the Research TopicFundamentals of 21st Century NeuroscienceView all 32 articles The blood–brain barrier (BBB) helps maintain a tightly regulated microenvironment for optimal central nervous system (CNS) homeostasis and facilitates communications with the peripheral circulation maintain close interactions with surrounding brain cells This function facilitates critical intercellular crosstalk giving rise to the concept of the neurovascular unit (NVU) The steady and appropriate communication between all components of the NVU is essential for normal CNS homeostasis and function and dysregulation of one of its constituents can result in disease the cellular composition of the NVU varies differential cues from the immediate vascular environment can affect BBB phenotype To support the fluctuating metabolic and functional needs of the underlying neuropil a specialized vascular heterogeneity is required This is achieved by variances in barrier function This mini-review will take you on a journey through evolving concepts surrounding the BBB Exploring classical experiments leading to new approaches will allow us to understand that the BBB is not merely a static separation between the brain and periphery but a closely regulated and interactive entity and ultimately aim to address the importance of BBB endothelial heterogeneity with regard to the function of the BBB within the NVU and touch on its implications for different neuropathologies Heterogeneity of the cells of the neurovascular unit contributes to a significant vascular heterogeneity of the blood brain barrier endothelium in different brain regions Heterogeneity of the neurovascular unit (NVU): current research has revealed high heterogeneity of e.g. astrocytes and pericytes within the CNS and among different brain areas The heterogeneity of these different cellular components of the NVU in the GM (A) versus the WM (B) contributes to brain vascular heterogeneity to support local physiological and metabolic needs for that particular part of the brain This includes differential expression of specific receptors and transporters on CECs which are represented by the different shapes and colors in GM (A) versus WM-CECs (B) Neuronal effects on the BBB-CEC phenotype include release of growth factors, such as neuregulin and brain-derived neurotrophic factor, (Gauthier et al., 2013). Neuronal activity and neurotransmitter release can regulate BBB permeability through, e.g., glutamate-activating CEC-NMDA receptors and modulate transport of insulin-like growth factor, across the BBB (Nishijima et al., 2010; Vazana et al., 2016) Such diversity may differentially affect phenotype and function of CECs thus contributing to vascular heterogeneity Due to the high oligodendrocyte prevalence in WM CECs in WM are likely to have differential cellular interactions than CECs residing in GM More research on the interactions and communications between oligodendrocytes and CECs and the consequences for specific phenotypes of CECs in WM is needed The physiological/metabolic needs of the highly active neural milieu are in constant flux water and oxygen are conveyed through cues to the brain microvasculature there is high diversity in the cellular composition of the NVU which includes a significant heterogeneity of astrocytes pericytes and oligodendrocytes in different brain areas Taking into account the reciprocal interactions of these brain cells within the NVU and differing metabolic needs and differences in blood flow/shear stress the microvascular phenotype must differ between different brain regions Characterizing and understanding the implications of regional heterogeneity of the brain microvasculature in health and disease is a new frontier for brain vascular research including diversity of astrocytes and pericytes derived from GM versus WM areas and the potential role of oligodendrocytes When studying neuropathologies that differ in their presentation in various brain regions it is particularly important to benchmark in vitro BBB models to the in vivo vasculature of the region of interest considering brain cell heterogeneity in experimental design may lead to BBB models better reflecting WM versus GM vasculature This mini-review aims to highlight the region-specific heterogeneity of the brain’s vasculature and is not meant to be an exhaustive list. Additional BBB topics, including other barrier sites, immune interactions or BBB-development have been recently reviewed (Forrester et al., 2018; Mastorakos and McGavern, 2019; Saunders et al., 2019) Understanding the contributions of cellular diversity of the NVU micro-environment to phenotypic and functional heterogeneity of the brain’s vasculature will aid in elucidating differing region-dependent neuropathologies This can be achieved by combining basic research and clinical approaches with large scale genetic/RNA-seq and proteomic analysis of regional microvasculature and other NVU components this may inform us of novel targets for designing region-specific neuro-therapeutics Cerebral endothelial cells forming a low permeability barrier between the peripheral blood circulation and the CNS Presence of TJ and polarized transporters tightly regulate passage of molecules into and out of the CNS and neurons communicate together to maintain brain homeostasis for optimal functioning of the organism Dysfunction of any one component affects another and can lead to neuro-disease As these cells interact with the brain vascular CECs they can influence the CECs phenotype and function reflecting the needs of the underlying brain tissue cellular and molecular composition of the vasculature Differential interactions with adjacent brain tissue can lead to a heterogeneity of the BBB phenotype and function not only along the vascular tree MS and CP conceptualized and edited the manuscript All authors contributed equally to this manuscript This work was supported by the NIH RO1 HL 130649 the Johns Hopkins Malaria Research Institute CP was supported by the Johns Hopkins Project Restore and the Bart Mclean Fund for Neuroimmunology Research The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest We would like to thank Hector Fabian Plata Santos for his input and help 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system and related neurological diseases Pardo CA and Stins MF (2019) The Evolving Concept of the Blood Brain Barrier (BBB): From a Single Static Barrier to a Heterogeneous and Dynamic Relay Center Copyright © 2019 Villabona-Rueda, Erice, Pardo and Stins. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) distribution or reproduction in other forums is permitted provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited in accordance with accepted academic practice distribution or reproduction is permitted which does not comply with these terms *Correspondence: Monique F. Stins, bXN0aW5zQGpobWkuZWR1 †Present address: Andres Villabona-Rueda Department of Pulmonary and Critical Care Medicine Johns Hopkins University School of Medicine Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher 94% of researchers rate our articles as excellent or goodLearn more about the work of our research integrity team to safeguard the quality of each article we publish A Dover psychiatrist whose license has been on probation off and on for 15 years for sexual offenses and other violations is still seeing patients despite a recent complaint by the Department of Justice that says he gave a handgun and switchblade to a patient and ingested that patient's prescribed stimulants.  Gregory Villabona has been under investigation by the Attorney General's Office since 2016 According to the AG's recent complaints filed with the Department of State Villabona continued to prescribe oxycodone to one patient even after law enforcement officials notified him that the patient had been receiving narcotics from multiple prescribers and was court-ordered to participate in a substance abuse treatment program The patient later died of a heroin overdose Six other patients received pain medication without regular monitoring the most recent complaint said.   State records show that Villabona's Delaware medical license has been on probation off and on since 2003 stemming from sexual offenses with two minors and consensual sex with a former adult patient that "exploited the doctor-patient privilege," along with probation violations the same day The News Journal posted a story online chronicling Villabona's troubles the AG's Office asked Secretary of State Jeff Bullock to order an emergency suspension of Villabona's controlled substances registration based on the "imminent danger he poses to public health."    That amended complaint contained several new allegations Among them: Villabona has been known to "barter" medical services for guns and yard work.    The AG also asked Bullock Thursday to immediately suspend Villabona's medical license but no details on that complaint were available Medical license investigations – unlike most other professional license investigations – are confidential under state law until formal action is taken who has declined to comment to The News Journal has until Monday morning to provide a response to the petitions Bullock is expected to rule on them Monday did not respond to a request for comment Friday AG spokesman Carl Kanefsky told The News Journal that the office's previous complaint did not meet the "threshold" to warrant an emergency suspension of his license Kanefsky noted that an amended complaint was in the works He added that the investigation has involved "voluminous records and multiple witnesses."   Villabona is the only licensed mental health professional in Delaware barred from treating minors according to Department of State spokesman Doug Denison the state of Maryland's medical board refused to license him in 2009 based on "immoral" and "unprofessional conduct in the practice of medicine," according to Maryland records the Delaware AG's office recommended that the Delaware medical board temporarily suspend Villabona's license; the board instead gave him probation both times and continued to allow him to treat patients members of the Delaware Board of Medical Licensure and Discipline declined to comment for this story Beauregard declined to comment on the bulk of accusations against his client He criticized the DOJ for "embellishments" in its investigation but would not be more specific "Sometimes their investigations aren't as thorough as they should be," the Dover lawyer explained The public complaint against Villabona's medical license dates to 2013 when State Department investigators began looking into it It took three years for the complaint to be forwarded to the AG's Office for further investigation Without commenting on Villabona's specific case said it is not uncommon for department investigations to span many months or even years before they are turned over to state prosecutors He noted that an initial complaint can spark other complaints that might broaden the scope of an investigation.  another complaint came in against Villabona's controlled substance registration One of the more serious allegations to emerge from that complaint dates to a 2014 patient appointment Aware that several law enforcement officers had just arrived at his office Villabona handed a patient a 9 mm handgun and switchblade from his desk drawer and the patient took them home according to the complaint. The patient who was being treated for anxiety and pain management, returned the weapons to Villabona one month later said he routinely provided Villabona with "most or all of his methylphenidate prescription" that the psychiatrist had prescribed for him, according to the DOJ complaint is typically used to treat Attention Deficit Hyperactivity Disorder Villabona "sometimes paid Patient D2 for the pills and sometimes he did not," the complaint said Patient D2 observed [Villabona] ingest the Methylphenidate pills." Villabona denies providing weapons to the patient or taking his pills physician-dominated medical boards have been criticized for going easy on their peers accused of sexual misconduct the nonprofit public watchdog group Public Citizen published a study analyzing sexual misconduct records in the National Practitioner Data Bank from 2003 to 2013 Researchers found that most of the physicians reported for sexual misconduct by hospitals medical societies and malpractice insurers were never disciplined by their state medical boards That same year, an Atlanta Journal-Constitution investigation documented widespread sexual abuse by doctors across the country – such as OB-GYNs raping patients and anesthesiologists groping sedated patients – yet fragmented medical oversight The AJC graded each state on how well it protects patients against sexually abusive doctors The newspaper highlighted the Villabona case as an exception since many misconduct investigations are conducted in secret Patients are often reluctant to challenge authority or they feel that their concerns won't be taken seriously due to a history of mental illness Beauregard questioned the credibility of Villabona's accusers "You're dealing with people who are disabled or who have some sort of mental illness," he said president of the California-based Hofmann Healthcare Group said it is relatively common for one state to deny a medical license to a doctor while another state approves it based on the same disciplinary record Not every state professional board conducts a thorough background check Some states are more focused on filling staffing shortages is struggling with a psychiatrist shortage "It is just so lamentable that the state medical boards are not more consistent and effective in making sure these vulnerable patients are not placed at risk," said Hofmann who has testified as an expert witness in cases that involve sexual assault or harassment by clinicians "They have a duty to reduce preventable harm."    After Lewes pediatrician Earl Bradley was convicted in 2011 of raping nearly 100 patients the First State's insular medical establishment enacted sweeping reforms director of Delaware's Division of Professional Regulation credited a coordinated effort on the part of law enforcement the medical community and the general public in identifying doctors' abhorrent behavior the average number of complaints filed against licensed physicians with the state division nearly doubled to 264 compared to each of the seven years prior.  the medical board hasn't received any complaints about doctors' inappropriate sexual behavior with children the board revoked the licenses of three Delaware doctors for inappropriate sexual conduct with adults 'No credible evidence' After graduating from Universidad Central del Caribe Medical School in Puerto Rico Villabona completed a one-year residency in family medicine at Christiana Care Health System followed by three years of residency training at Delaware State Hospital A 1996 News Journal article listed Villabona as a $190,000-a-year staff psychiatrist at Connections CSP He also was on staff at the state-operated Sussex Mental Health Clinic in Georgetown.  Villabona's license troubles began in 2002 when he pleaded guilty to a third-degree sex offense on a female minor and a fourth-degree sex offense on a female minor in the Circuit Court for Queen Anne's County Villabona's nieces had accused him of molesting them from 1978 to 1983 when they were both under 12 years old and Villabona was in his 30s The alleged abuse stopped nearly a decade before Villabona became licensed in Delaware in 1992 Villabona had faced a maximum of 11 years in prison in that case but he received probation before judgment as part of a plea deal which meant that he was spared a conviction on his record and he wasn't required to register as a sex offender he was ordered to undergo an evaluation by a sexual disorder unit and to have no unsupervised contact with anyone under age 18 while on probation for five years Prosecutors also agreed to dismiss 28 criminal counts against Villabona Following the publicity surrounding the Maryland case the state of Delaware terminated Villabona's employment contract Then-Delaware Deputy Attorney General Gregory Smith initially asked the state medical board to temporarily suspend Villabona's license in January of 2003 Villabona's attorney argued that his client was not guilty of "dishonorable or unethical conduct" under state statute and warned that any sanctions against Villabona would harm patients Explaining that there was "no credible evidence" that Villabona had committed sexual misconduct against a child or patient since his graduation from medical school, the hearing panel noted that "a significant number of his patients think very highly of him both as a person and as a physician," state records show The panel also unanimously agreed that Villabona was not mentally ill or incompetent Previous evaluations found no evidence of a sexual disorder or psychiatric disorder other than depression related to numerous "stressors" in his life While concluding that it was "unlikely" that Villabona would commit similar transgressions in the future his "behavior has harmed the public in a general sense," the panel ruled.  placed Villabona's license on probation to run concurrently with his five-year criminal probation in Maryland.   Villabona was prohibited from seeing minor patients without an adult present and was required to be supervised by a physician and disclose his "admitted sexual crimes" to his patients Villabona appealed that decision to Kent County Superior Court which sided with the board in April of 2004 Villabona then appealed to Delaware Supreme Court which affirmed the Superior Court's decision four months later The appeals delayed the board's order from taking effect for nearly a year Villabona successfully petitioned the Maryland Circuit Court and the Delaware medical board for early termination of his probation Delaware's medical board took him off probation but continued to mandate that Villabona treat minors only with adult supervision and notify patients of his record Villabona allegedly treated a 17-year-old psychiatric patient whose mother couldn't attend an emergency appointment A receptionist told investigators that she found Villabona seated in an "inappropriate position" on an ottoman pushed against a sofa where the patient was laying with her underwear visible to the receptionist.  Villabona told a Dover Police detective that he was only in the room for 15 seconds; the patient claimed that she had been alone with him for at least 20 minutes He also challenged the credibility of three of his employees his former psychiatric patients who testified for the state The patient denied any inappropriate contact with Villabona and no criminal charges were ever filed Villabona lost a medical malpractice lawsuit and was ordered to pay $200,000 to a former 22-year-old female patient who claimed that he had sex with her in a car in 2002 according to the lawsuit filed in Superior Court the patient accused Villabona of taking her to a Dover sports bar where he bought her several rounds of drinks even though she was on antidepressants prescribed by him He then drove her back to his office where he had sex with her in the parking lot In court, Villabona denied having sex with his client. Under revised disciplinary guidelines adopted after Bradley's 2011 conviction a doctor who has sex with a current patient faces a minimum six-month license suspension and may be prevented from practicing medicine indefinitely Felony sex offenses also result in licenses being revoked But Villabona was never convicted of a felony and his infractions predate the Bradley reforms His disciplinary record, available for free at the Division of Professional Regulation's online license verification portal provides documentation on the medical board's two disciplinary orders in 2003 and 2007 and a 2008 consent agreement the DOJ recommended that the medical board move for an emergency suspension of his license Under the consent agreement Villabona was permanently banned from treating anyone except male patients over age 18 The national Medicare website, Medicare.gov lists Villabona as accepting Medicare patients and says he is affiliated with Bayhealth Kent General Hospital But a Bayhealth spokeswoman said Villabona does not have hospital privileges As part of the AG's Thursday petition against Villabona Deputy Attorney General Stacey Stewart alleged that many of his patient files were missing required notice forms about his sexual offenses – in violation of the medical board's order Villabona used a substitute form not approved by the medical board stating that he was "falsely accused of the criminal charges and incorrectly stating that the board found no evidence of guilt." The petition also accuses the psychiatrist of ignoring red flags raised by law enforcement and other pain doctors about patients' painkiller addictions After a patient's family member told Villabona in 2016 that the patient intended to commit suicide the next day Villabona prescribed Dilaudid Villabona prescribed a cocktail of stimulants and tranquilizers to the patient after he reported using LSD.  Investigators also discovered two handguns in a safe in Villabona's office that weren't registered to him; he claimed that the guns came from patients concerned with harming themselves.  They found expired antidepressants and antipsychotics in an unsecured cabinet in Villabona's office and observed "medical devices mixed in among over-the-counter medications rodenticide and hazardous waste." Several drugs were registered to an "office account," including testosterone and benzodiazepines in violation of Uniform Controlled Substance Act Regulations In a highly publicized case earlier this year, former Olympic team doctor Larry Nassar was sentenced to 40 to 195 years in prison for molesting young gymnasts and other athletes Despite widespread coverage of that scandal considers it "wishful thinking" to assume that medical licensing boards will overhaul their practices Physicians are entitled to a degree of confidentiality in disciplinary matters to protect their reputation against baseless accusations But patients also rely on hospitals and state licensing officials to properly vet healthcare professionals.  "The level of vigilance and the amount of analysis and intervention are all still lacking," he said on Twitter @MargieTrende or mfishman@delawareonline.com Board revokes doctor's license over painkiller prescriptions Dover OB-GYN ordered to pay $3 million in birth injury case More Delaware doctors disciplined after Earl Bradley conviction This website is using a security service to protect itself from online attacks The action you just performed triggered the security solution There are several actions that could trigger this block including submitting a certain word or phrase You can email the site owner to let them know you were blocked Please include what you were doing when this page came up and the Cloudflare Ray ID found at the bottom of this page ShareSaveCommentInnovationScienceHow Are Microplastics Affecting Colombia’s Lake Microorganisms?ByAndrew Wight Forbes contributors publish independent expert analyses and insights Andrew Wight is a science journalist covering the Global SouthFollow AuthorMay 28 07:00am EDTShareSaveCommentProfessor Silvia Lucía Villabona González of the Universidad Católica de Oriente on April 30 A limnologist in Colombia is tracing plastic pollution down to the microscopic level: looking at its impact on plankton in the nation's swamps and lakes so her research traces the transfer of microplastics through the aquatic food web (phytoplankton "Studying zooplankton has made it possible to demonstrate environmental changes in different aquatic ecosystems growth and reproduction depend on a set of physical conditions chemical processes in the water and conditions related to food supply," she says adding that their rapid response to different types of emerging pollutants is also well established there are no environmental regulations on this type of pollutants in waters adding that the project has generated research alliances with with institutions in other countries such as the Universidade de Pernambuco in Brazil and UNAM in Mexico and has been extended to various types of ecosystems such as rivers "We have registered for the first time in Colombia, the rotifer Kellicottia bostoniensis considered invasive in other countries of South America adding that studies carried out in urban wetlands have shown that despite that in spite of the limiting conditions of these ecosystems several rotifer species and some microcrustaceans can live there it would be one of the greatest losses of taxonomic genetic and functional diversity in the world," she says aquatic food webs would be substantially altered "Although Colombia is a global hotspot of biodiversity its zooplankton fauna remains remains poorly explored," she says adding that most research to date has been focused on the Magdalena-Cauca river basin and the least studied regions are the remote Chocó it is necessary to the ecological and taxonomic studies of these small animals to understand their biodiversity and role in the functioning of ecosystems," she says Villabona was born and raised in the Colombian inland city of Bucaramanga but as a child constantly traveled to the sea "I wondered how animals as tiny as corals could work," she says adding that she would go on to study biology at the Universidad Industrial de Santander in Bucaramanga researching how local microorganisms were migrating between the surface and the bottom of the lakes during the day/night cycle Villabona would go on to do a master's degree and a PhD in biology at the University of Antioquia focusing on the zooplankton of the Ayapel marsh because the presence of aquatic plants favors a greater availability of microhabitats Villabona explains that researchers from the Global South have the advantage of living "in the most diverse territories with the greatest diversity of ecosystems and therefore the greatest biodiversity in the world," and have learned to generate robust results from this hometown advantage "We have taken this as an opportunity to create a Global South scientific community and generate inclusive and and generate inclusive and multicultural networks such as the Latin American Limnology Network," she says adding that these networks contact researchers who live in similar environmental Professor Silvia Lucía Villabona González of the Universidad Católica de Oriente in Colombia a research fellow at the Water Security and Sustainable Development Hub at the University of Leeds is leading a project to analyse water-insecurity risks in river basins The residents of the southern Colombian municipality of Cajibío Cauca have been forced to rely on firewood and charcoal as an economic activity the water risk from this situation is being assessed by Montoya Pachongo and her collaborators from the Universidad del Cauca using a new approach dubbed MUISKA by the researchers it is also crucial to include relevant parties in the research to produce a valid analysis," Montoya Pachongo says "We did this in Cajibío; participants identified their water-insecurity conditions and their systemic connections with root causes and consequences prioritized several risks to be fully assessed and identified preliminary actions to manage some risks." Metrics details An Author Correction to this article was published on 20 April 2021 This article has been updated A Correction to this paper has been published: https://doi.org/10.1038/s41598-021-88469-0 Download references Villabona-Monsalve & Theodore Goodson III The authors declare no competing interests Download citation DOI: https://doi.org/10.1038/s41598-019-47651-1 Anyone you share the following link with will be able to read this content: a shareable link is not currently available for this article Sign up for the Nature Briefing newsletter — what matters in science Baby Jacob is “rocking our world as well as L.A,” the dad joked Delaware prosecutors are seeking to revoke the professional licenses of a Dover psychiatrist who they allege prescribed controlled substances to an addict who later died by heroin overdose traded medical treatment for guns and is "unable to practice medicine safely Gregory Villabona, whose license has been on and off probation for 15 years could lose his licenses to practice medicine and prescribe controlled substances Villabona attended the first of several administrative hearings that will result in a recommendation to the board of medical licensure and discipline.  Villabona attorney Andre Beauregard called the allegations "a witch hunt" that has created national headlines about sex "We believe the matters before this hearing were cherrypicked by the state," he said in his opening statement adding that the emergency suspension in March was unnecessary.  This goes to the slanted story that’s being painted ... It’s not an emergency at all."  Deputy Attorney General Zoe Plerhoples said in opening that Villabona's "egregious misconduct" includes prescribing narcotics to "patients known to be addicts or patients known to have red flags for substance abuse."  Villabona prescribed oxycodone to one patient, even after law enforcement officials told him that the patient was receiving narcotics from multiple healthcare providers and was court-ordered to participate in a substance abuse treatment program, according to a complaint from the Delaware Division of Professional Regulation.  The patient died of a heroin overdose months later The state also said that Villabona is not complying with previous medical board orders and that he gave a handgun and switchblade to a patient ingested that patient's prescribed stimulants and has "bartered" medical services for guns and yard work.    The Attorney General's Office asked Secretary of State Jeff Bullock to order the emergency suspension of Villabona's controlled substances registration in March based on the "imminent danger he poses to public health."    This isn't the first time Villabona's medical license was suspended He has been on and off probation since 2003 stemming from sexual offenses with two minors in Maryland and consensual sex with a former adult patient that "exploited the doctor-patient privilege," along with probation violations Plerhoples said Villabona displays a "willful and blatant disregard for prior board orders and failure or inability to comply with prescription regulations."  Beauregard said prosecutors conducted a "tabloid investigation ... to make people want to hate Dr Villabona." He added the worst that the chief hearing officer, Roger Akin will find is that Villabona had poor housekeeping skills.  "He was somewhat sloppy in keeping his records," he said the majority would say he was a good doctor."  Beauregard recommended his client take a course in record-keeping and be put under closer supervision by the state for a number of years.  including one of Villabona's former office workers She said she left her job in part because "there were certain things going on I couldn’t overlook anymore."  The former employee described situations in which patients allegedly traded guns or lawn mowing services for treatment who the state alleges bought prescription pills from patients told her that "certain patients would do just about anything for a little bit of money."  a patient and longtime friend of Villabona said that he removed a gun and knife from Villabona's office to "help" him when investigators visited the office.  who said it was difficult to testify against his friend also said Villabona gave him cash on several occasions in exchange for pills the doctor prescribed he continued to fill prescriptions from Villabona He said he did it because he worried if he didn't his access to other prescriptions would be cut off.  "I felt intimidated a bit," the witness said Hearings will continue through next week and will conclude with Chief Hearing Officer Akin's recommendation to the board of medical licensure and discipline.  Contact Christina Jedra at cjedra@delawareonline.com (302) 324-2837 or on Twitter @ChristinaJedra AG: Suspend Dover psychiatrist who bartered drugs for guns After sex, drug, gun complaints, state department suspends doctor's license Suspended Dover psychiatrist delays disciplinary hearing Metrics details A Publisher Correction to this article was published on 17 February 2022 Hospital outbreaks of COVID19 result in considerable mortality and disruption to healthcare services and yet little is known about transmission within this setting We characterise within hospital transmission by combining viral genomic and epidemiological data using Bayesian modelling amongst 2181 patients and healthcare workers from a large UK NHS Trust Transmission events were compared between Wave 1 (1st March to 25th July 2020) and Wave 2 (30th November 2020 to 24th January 2021) We show that staff-to-staff transmissions reduced from 31.6% to 12.9% of all infections Patient-to-patient transmissions increased from 27.1% to 52.1% 40%-50% of hospital-onset patient cases resulted in onward transmission compared to 4% of community-acquired cases Control measures introduced during the pandemic likely reduced transmissions between healthcare workers but were insufficient to prevent increasing numbers of patient-to-patient transmissions As hospital-acquired cases drive most onward transmission earlier identification of nosocomial cases will be required to break hospital transmission chains This is probably a substantial underestimate as it represents the number of individuals that meet the narrow definitions for healthcare-associated infection rather than the true number of infected individuals in hospitals To safely continue routine and elective activities in hospitals during times of high SARS-CoV-2 incidence it is important to discern factors that drive hospital-acquired infections This greater understanding can be used to protect staff and patients as well as informing further efforts to contain hospital outbreaks epidemiological and location data into a statistical inference framework offers a possible route to more accurate estimates of within-hospital transmission a transmission event between a pair of individuals is supported if their symptom onset times are compatible with the serial interval distribution SARS-CoV-2 if the individuals are in the same hospital location at the time of a suspected transmission event and if their viral genomes exhibit a high degree of relatedness we characterised the dynamics of SARS-CoV-2 transmission within a hospital setting identifying key differences across the two pandemic waves as well as the relative contribution of different groups and hospital locations to within-hospital transmission Level 2 positive protective equipment (PPE)—aprons eye protection and fluid resistant surgical face mask LFD testing—Lateral flow device testing for staff two times per week Grey bars represent SARS-CoV-2 cases tested (staff and patients) testing positive in the STH pillar 1 diagnostic laboratory with no high-quality sequence available Wave 1 and Wave 2 denote periods and samples included in the study b Details of SARS-CoV-2 positive cases from patients and healthcare workers sequenced and included in the study Testing of all admissions regardless of symptoms commenced on 25th April 2020 and screening of all asymptomatic patients and staff on wards with outbreaks from 18th May 2020 all patients were routinely tested on day 5 of admission from 1st September 2020 Routine twice weekly testing using lateral flow devices followed by confirmatory Nucleic Acid Amplification Test (NAAT) was offered to staff in all clinical areas from 8th December 2020 Level 2 personal protective equipment (PPE; aprons eye protection and fluid resistant surgical face mask) was used by staff only for seeing suspected COVID-19 cases from 17th March 2020 and for all patient contact from 8th April 2020 HCWs were mandated to wear surgical face masks in all areas of the hospital from 15th June 2020 The SARS-CoV-2 staff vaccination programme commenced on 10th December 2020 ward location of cases and comparison between consensus viral genome sequences our model inferred likely hospital transmissions between individuals together with (i) the time of those events (ii) the ward on which the transmission occurred and (iii) whether the infector was a sampled case or a case involved in transmission but not represented in the dataset no ‘community onset-community associated’ patient cases were identified as hospital-acquired by our model during either wave and the majority of ‘hospital onset-hospital acquired’ and ‘hospital onset-suspected hospital acquired’ cases were identified as likely hospital-acquired by our model We identified 95 (95% CI 82–109) transmission chains (defined as contiguous transmission events between 2 or more cases) in Wave 1 and 72 (95% CI 61–84) transmission chains in Wave 2 (Supplementary Fig. 2) The median number of cases per transmission chain was 3 (95% CI 3– 4) in Wave 1 and 4 (95% CI 3–5) in Wave 2 A staff member was identified as the index case in 50.6% (95% CI 42.0– 58.0%) of transmission chains in Wave 1 and in 31.3% (95% CI 23.1–39.7%) of transmission chains in Wave 2 Forty different PANGO lineages were involved in transmission chains in Wave 1 and 13 were found in Wave 2 chains Import = likely community-acquired infection imported into hospital c Comparison of the percentage of each transmission type between the two waves The distributions display the percentages throughout the 10,000 plausible networks The numbers above each distribution are the absolute numbers of each transmission pair with 95% credible intervals shown within the brackets 95% CI 48.9–61.2%) of staff infections resulted from another staff case 95% CI 56.1–71.0%) of patient infections resulted from another patient case which increased to 79.4% (162/204 a The number of infections per ward in Wave 1 b The number of infections per each ward in Wave 2 Wards contributing to 50% of all transmission events in Wave 1 (n = 8) are coloured in orange in both Wave 1 and Wave 2 datasets Wards with <1 transmission (mean of 10,000 networks) in Wave 1 are coloured in green in both Wave 1 and Wave 2 datasets c–f Percentage of staff and patient infector and infectees per ward involved in transmission events All wards with 10 or more transmissions in Wave 1 and Wave 2 are shown Wards are ordered by the percentage of staff infector cases in Wave 1 c and Wave 2 d and percentage of staff infectee cases in Wave 1 e and Wave 2 f Numbers of transmission events per ward are shown at the bottom of each column The percentage of staff-staff transmissions in A&E is artificially high (100%) due to the inability to obtain patient movement data in this location Error bars represent 95% credible intervals A&E accident and emergency department; AMU acute medical unit Wards comprise a combination of multi-bed bays with shared bathroom facilities and individual en-suite side rooms We used a post hoc analysis to evaluate the contribution of bay-level transmission between patients to the outbreak We identified 38.3% (95% CI 29.9–47.1%) of patient–patient transmissions in Wave 1 and 33.8% (95% CI 27.9–39.6%) in Wave 2 were between patients who shared a bay at some point during their stay We estimated an increased risk of transmission between individuals who shared a bay compared with those who shared a ward as 2.8 (95% CI 2.2–3.5) times higher in Wave 1 and a 2.5 (95% CI 2.1–2.9) times higher in Wave 2 our findings represent the largest collection of SARS-CoV-2 genomic and hospital epidemiology data to date used to reconstruct directional transmission networks where we estimated hospital-acquired SARS-CoV-2 infections across two pandemic waves in the UK using a Bayesian framework our model also accounts for events within the identified transmission networks that were not represented in the dataset which is crucial given the likely presence of unidentified infections or those lacking sequence data We observed different contributions to the total number of within-hospital transmission events from those occurring between and within staff and patients across the two waves We identified transmission hotspots within our institution with a relatively small proportion of locations accounting for most hospital-acquired infections in staff and patients We also found that the majority of SARS-CoV-2 infections resulted in onward transmission with secondary cases identified in >50% of infections but relatively few so called ‘superspreader’ events This was an area that was a hotspot for transmissions involving staff during our Wave 1 analysis but had very few transmission events identified during Wave 2 Patient to staff transmissions remained constant both in terms of absolute and proportion of transmission events across the two waves suggesting that whatever factors are responsible for the reduction in staff-staff infections had limited impact on the risk of patient-to-staff transmissions most staff infections in our NHS trust were estimated to have been acquired from patients so further efforts are required to increase protection for HCWs Staff vaccination is anticipated to have a large impact but is unlikely to have played a significant role in our observations due to the introduction towards the end of Wave 2 very few transmissions were estimated to have occurred on critical care units which may have a number of explanations including universal use of enhanced PPE Although there is no clear threshold for the number of cases of a superspreading event we did not find many examples where a high number of cases were associated with a single case the maximum number of individuals linked to the same index was six across all networks Our findings do not support superspreading events forming a significant proportion of all hospital-acquired infections This may in part be due to our focus on the entire hospital environment rather than on specific epidemiologically identified outbreaks our data suggest that these individuals may acquire SARS-CoV-2 in hospital and have ample opportunity for onward transmission before being detected and isolated This finding indicates that asymptomatic testing of patients on admission and day 5 was insufficient to prevent these scenarios Daily testing of patients in the first week of admission or more regular testing throughout admission may allow greater opportunity for intervention as well as more recent recommendations to IPC guidance such as routine wearing of masks by all patients in bays rapid point-of-care testing (POCT) on admission may also reduce the window for transmission early in admission as it allows earlier isolation of asymptomatic community-acquired cases Our Trust instituted POCT for all medical admissions in mid-January 2021 The effectiveness of various infection control measures on within-hospital transmissions over time in our setting is likely to be generalisable to many UK hospitals as they were based on national guidance applicable to all NHS Trusts we assumed that the probability of inclusion in our dataset was the same for both staff and patients Further granularity could be considered in future developments of the outbreaker model we provide evidence that the integration of clinical surveillance data viral genomic information and modelling enhances our capacity to unravel the complex transmission dynamics of SARS-CoV-2 in times and places of high incidence The application of such a high-resolution framework to healthcare settings offers attractive perspectives for guiding the development of a safe environment for both staff and patients as it may have a significant impact on the reduction of SARS-CoV-2 hospital transmission in subsequent epidemic waves Patients were included in the analysis if they tested positive for SARS-CoV-2 at or during admission Staff were included if they tested positive for SARS-CoV-2 and had worked in a clinical area in the 14 days prior to a positive test Information on symptom onset of patients and their ward movements were extracted from STHNFT electronic records Our Bayesian model calculates the likelihood of a transmission event from case \({{{{{\rm{i}}}}}}\) to case j at a putative transmission time given the time of symptom onset for case i and j the Hamming distance between the corresponding virus genetic sequences and the ward that i and j were on at the time of infection The model also infers unobserved infections and unobserved transmission pathways using a constant reporting rate parameter (an ascertainment probability the proportion of all SARS-CoV-2 positive cases in admitted patients and hospital staff that were captured in our dataset) This parameterization (outlined in Supplementary Methods) allows to infer unobserved transmission pathways linking a given ward to another given ward over consecutive generations of infection We estimated the ascertainment probability as the product of (i) the proportion of all cases that were likely detected via testing (ii) the proportion of detected cases with high-quality sequence and (ii) the proportion of these cases where the ward location was known We used a point estimate of 0.5 for this ascertainment probability but varied this estimate in a one-way sensitivity analysis (Estimates of 0.3 0.6 and 0.7; Full details in Supplementary Methods) The views expressed are those of the author(s) and not necessarily those of the NIHR Public Health England or the Department of Health and Social Care Viral genomes were mapped to the publicly available Wuhan reference genome (GenBank accession number NC_045512). All sequences used in this study are deposited in the European Nucleotide Archive (see Supplementary data 1 for accession numbers) The epidemiological data and linkage to sequences are available under restricted access due to their potentially identifiable nature Access can be obtained by contacting the corresponding author (t.desilva@sheffield.ac.uk) after which a data sharing agreement will be organised We will aim to respond to any requests within 10 working days A Correction to this paper has been published: https://doi.org/10.1038/s41467-022-28681-2 Death from Covid-19 of 23 Health Care Workers in China Nosocomial transmission of coronavirus disease 2019: a retrospective study of 66 hospital-acquired cases in a London teaching hospital Transmission of COVID-19 to Health Care Personnel During Exposures to a Hospitalized Patient — Solano County The proportion of SARS-CoV-2 infections that are asymptomatic: a systematic review Whole-genome sequencing to track SARS-CoV-2 transmission in nosocomial outbreaks Genomic epidemiology of COVID-19 in care homes in the east of England Genomic and healthcare dynamics of nosocomial SARS-CoV-2 transmission Nosocomial outbreak of SARS-CoV-2 in a ‘Non-COVID-19’ hospital ward: virus genome sequencing as a key tool to understand cryptic transmission Explosive nosocomial outbreak of SARS-CoV-2 in a rehabilitation clinic: the limits of genomics for outbreak reconstruction Superspreaders drive the largest outbreaks of hospital onset COVID-19 infection outbreaker2: a modular platform for outbreak reconstruction Bayesian inference of transmission chains using timing of symptoms Roll-out of SARS-CoV-2 testing for healthcare workers at a large NHS Foundation Trust in the United Kingdom The Impact of testing and infection prevention and control strategies on within-hospital transmission dynamics of COVID-19 in English hospitals SARS-CoV-2 seroprevalence and asymptomatic viral carriage in healthcare workers: a cross-sectional study Colton, H. et al. Risk factors for SARS-CoV-2 seroprevalence following the first pandemic wave in UK healthcare workers in a large NHS Foundation Trust. Wellcome Open Res. 6, 220 https://doi.org/10.12688/wellcomeopenres.17143.1 (2021) Lessons from a large norovirus outbreak: impact of viral load patient age and ward design on duration of symptoms and shedding and likelihood of transmission The alpha variant B.1.1.7 was not associated with excess healthcare acquired COVID-19 infection in a multi-centre UK hospital study The risk of SARS-CoV-2 transmission from patients with undiagnosed Covid-19 to roommates in a large academic medical center Epidemiological data and genome sequencing reveals that nosocomial transmission of SARS-CoV-2 is underestimated and mostly mediated by a small number of highly infectious individuals Mo, Y. et al. Transmission of community- and hospital-acquired SARS-CoV-2 in hospital settings in the UK: A cohort study PLoS Med. 18, e1003816 https://doi.org/10.1371/journal.pmed.1003816 (2021) Duration and key determinants of infectious virus shedding in hospitalized patients with coronavirus disease-2019 (COVID-19) Estimating infectiousness throughout SARS-CoV-2 infection course Coronavirus (COVID-19): guidance and support. https://www.gov.uk/coronavirus (accessed 2 June 2021) Genomic evidence for reinfection with SARS-CoV-2: a case study E and RdRp assay for the diagnosis of SARS-CoV-2 infection: experience at a large NHS Foundation Trust in the UK Artic Network. https://artic.network/ncov-2019 (accessed 2 June 2021) Simpson J. nanopolish. Github. https://github.com/jts/nanopolish (accessed 2 June 2021) A dynamic nomenclature proposal for SARS-CoV-2 to assist genomic epidemiology MAFFT: a novel method for rapid multiple sequence alignment based on fast Fourier transform Issues with SARS-CoV-2 sequencing data. https://virological.org/t/issues-with-sars-cov-2-sequencing-data/473 (accessed 27 May 2021) Campbell, F. Developing Methodologies and Software for Bayesian Inference of Transmission Trees from Epidemiological and Genetic Data. https://doi.org/10.25560/79287 Challen, R. et al. Meta-analysis of the SARS-CoV-2 serial interval and the impact of parameter uncertainty on the COVID-19 reproduction number. Preprint at https://doi.org/10.1101/2020.11.17.20231548 The incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application R Core Team R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org/ (2021) Lindsey, B. et al. Characterising within-hospital SARS-CoV-2 transmission events using epidemiological and viral genomic data across two pandemic waves. sheffield_HT Repository. https://doi.org/10.1101/2021.07.15.21260537 (2021) Daily summary. https://coronavirus.data.gov.uk/ (Accessed 2 June 2021) Download references We thank the Sheffield Bioinformatics Core for their thoughtful discussion. We would like to thank the members of the Sheffield Biomedical Research centre for their continued support of the SARS-CoV-2 sequencing work in Sheffield. We thank all partners of and contributors to the COG-UK consortium, who are listed at https://www.cogconsortium.uk/about/ Sequencing of SARS-CoV-2 samples was undertaken by the Sheffield COVID-19 Genomics Group as part of the COG-UK CONSORTIUM and supported by funding from the Medical Research Council (MRC) part of UK Research & Innovation (UKRI) the National Institute of Health Research (NIHR) and Genome Research Limited operating as the Wellcome Sanger Institute are funded by the NIHR Sheffield Biomedical Research Centre (BRC - IS-BRC-1215-20017) is supported by a Wellcome Trust Intermediate Clinical Fellowship (110058/Z/15/Z) were funded by an ERC Starting Grant (action number 757688) This study is partially funded by the NIHR Health Protection Research Unit in Modelling and Health Economics a partnership between Public Health England Imperial College London and LSHTM (grant code NIHR200908); and acknowledges funding from the MRC Centre for Global Infectious Disease Analysis (reference MR/R015600/1) jointly funded by the UK MRC and the UK Foreign Commonwealth & Development Office (FCDO) under the MRC/FCDO Concordat agreement and is also part of the EDCTP2 programme supported by the European Union These authors contributed equally: Benjamin B The Florey Institute for Host-Pathogen Interactions & Department of Infection Sheffield Teaching Hospitals NHS Foundation Trust Centre for Mathematical Modelling of Infectious Diseases London School of Hygiene and Tropical Medicine Department of Infectious Disease Epidemiology The Department of Neuroscience/Neuroscience Institute MRC Centre for Global Infectious Disease Analysis MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine Contributor roles were assigned as per http://credit.niso.org/ were involved in the conceptualisation of the study were involved in data collection and curation were involved in the supervision of the project All authors were involved in reviewing and editing the final manuscript Members of the Sheffield COVID-19 Genomics Group contributed to the generation of the sequence data used Members of the CMMID COVID-19 Working Group contributed to the interpretation of data and approved the work for publication following manuscript review Members of the COVID-19 Genomics UK (COG-UK) consortium contributed to data curation and analysis Approval for the study was obtained from the UK Health Research Authority (IRAS 281918) with sequencing performed according to The COVID-19 Genomics UK (COG-UK) study protocol approved by the Public Health England Research Ethics Governance Group (R&D NR0195) Approval was provided to undertake viral sequencing on residual clinical diagnostic samples and analysis on pseudo-anonymised data without individual patient consent Fergus Hamilton and Aaron Richterman for their contribution to the peer review of this work Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations Download citation DOI: https://doi.org/10.1038/s41467-022-28291-y Sign up for the Nature Briefing: Translational Research newsletter — top stories in biotechnology A Dover lawyer who is currently fighting to restore the suspended license of a problem-prone psychiatrist had his own license suspended this week.  Beauregard, the managing partner of Brown is suspended from the practice of law for six months beginning July 2 according to a notice posted Wednesday by the Delaware Office of Disciplinary Counsel.  Beauregard was scheduled to appear at an administrative hearing on Wednesday for his client Gregory Villabona Prosecutors say the Dover psychiatrist prescribed controlled substances to an addict who later died by heroin overdose The attorney did not respond to a request for comment.  As manager of his firm, Beauregard "failed to exercise reasonable supervision over non-lawyer employees charged with the keeping of the law firm's books and records failed to take reasonable action to correct known books & records violations and misrepresented his law firm's compliance on his 2015 Certificate of Compliance," according to the disciplinary notice.  "As a managing partner who failed to supervise non-attorney employees, Mr. Beauregard is responsible for those deficiencies," a Delaware Supreme Court opinion states During his suspension, Beauregard may not practice law nor share in any legal fees for referrals or earned for services He may continue to provide defense representation through the Office of Conflicts Counsel which handles cases the Public Defender's Office cannot because of conflicts of interest Following the suspension period, Beauregard is "permanently barred from maintaining his or any law firm's books and records or acting in a supervisory capacity over the law firm's books and records," the notice states.  Beauregard must reimburse the Office of Disciplinary Counsel for costs related to his case and the cost of the "Lawyer's Fund audit," and fully cooperate with the disciplinary office's efforts to monitor the conditions of his suspension.  This isn't the first time Beauregard has been accused of skirting legal bookkeeping rules He was publicly reprimanded in 2005 when he was the managing partner of another law firm Beauregard was previously disciplined for substantially the same books and records violations and thus should have been in a hyper-vigilant state when he assumed the same supervisory responsibilities at his new law firm," the opinion said.  Beauregard practices primarily as a criminal defense attorney in Kent and Sussex counties Disciplinary proceedings are not intended to be punitive Supreme Court judges wrote in their opinion the primary purpose is 'to protect the public' and to 'foster public confidence in the Bar to preserve the integrity of the profession and to deter other lawyers from similar misconduct,'" they wrote.  'Egregious misconduct' could cost Dover psychiatrist Villabona his license AG: Suspend Dover psychiatrist who bartered drugs for guns Lawyers for a suspended Dover psychiatrist whose license has been on and off probation for 15 years for sexual offenses and other violations successfully delayed his disciplinary hearing Monday chief hearing officer for the state Division of Professional Regulation sided with embattled doctor Gregory Villabona over state prosecutors' objections Deputy Attorney General Stacey Stewart argued that she spoke to one witness who agreed to testify that Villabona had doctored patient files in recent days said Villabona left her a voicemail Sunday night Stewart worried that in the coming weeks other witnesses would be too intimidated to come forward.   "I'm unsure whether we could coordinate those same witnesses Akin agreed to delay the hearing until mid-May at the latest to give Villabona's attorneys more time to review the Department of Justice's exhibits and supplemental materials had initially requested an expedited hearing for his client, which was granted citing "a trial by ambush." He noted that he didn't receive a thumb drive containing more than 5,000 pages of case documents from the state "When we get this data dump on Friday – on a holiday – it puts you at a disadvantage," he said.  State prosecutors countered that they initially filed their complaint against Villabona back in September and that four of the five binders of material came directly from Villabona's own files remained silent throughout the nearly 90-minute discussion On March 19, Delaware Secretary of State Jeff Bullock issued an emergency suspension of Villabona's medical license and controlled substances privileges for 60 days citing "an immediate danger to public safety." Bullock considered the findings of two DOJ investigations dating to 2016 which alleged that Villabona prescribed opioids to patients failed to maintain effective controls against diversion of controlled substances Bullock's action came less than a week after The News Journal published an investigation detailing how Villabona was able to continue seeing Delaware patients despite admitted sexual offenses with two minors before he became a doctor consensual sex with a former adult patient and multiple other probation violations a receptionist at the daycare next door to his office supplied photographs to The News Journal showing a crowded parking lot at his office on Woodcrest Drive A Department of State spokesman said the matter is being investigated the Delaware Department of Justice was expected to present testimony before Akin this week during which time Villabona's attorneys would have an opportunity to respond Akin will make recommendations to the state Board of Medical Licensure and Discipline to determine the future of Villabona's practice the Delaware Attorney General's office recommended that the state medical board temporarily suspend Villabona's license; the board instead gave him probation both times the medical board refused to license Villabona in 2009 based on "immoral" and "unprofessional" conduct outlined in his Delaware disciplinary record Delaware medical board members have declined comment on the Villabona case. The current president is George Dahr Delaware Public Health Director Karyl Rattay stepped down as medical board president on March 6 at the end of her one-year term Akin instructed Villabona that he is still temporarily barred from treating his more than 45 patients and he is to have no contact with patients or DOJ witnesses without a DOJ representative being present He is also required to notify the state if he finds supplemental patient files that were not included in the records already provided to the DOJ Beauregard noted that his client had found additional files that he would submit as evidence But Stewart said the state would object to any files that have recently materialized.  The last time a Delaware psychiatrist had an emergency license suspension was in 2010 according to Department of State records.  Twenty-six psychiatrists operated in Kent County in 2014 according to the most recent state statistics That's roughly one psychiatrist for every 9,575 Kent residents Concerned that Villabona's patients might have difficulty accessing immediate care the state Division of Substance Abuse and Mental Health issued an alert to patients and providers on March 23 warning that withdrawal from benzodiazepines can cause serious Signs of withdrawal from benzos like Xanax according to state health officials. Patients experiencing these symptoms are encouraged to go to the emergency room.  Substance abuse division director Elizabeth Romero said she was particularly concerned by the high doses of painkillers prescribed to Villabona's patients Delaware reported 308 overdose deaths in 2016 compared to 120 deaths from traffic accidents More than 15 million people abuse prescription drugs in the U.S. more than the combined number who report abusing cocaine according to the Foundation for a Drug-Free World some of Villabona's patients had reached out to the Division of Professional Regulation about their prescription needs The health alert recommends that patients contact Villabona's office to be referred to another provider, call DSAMH's Mobile Crisis Line for Kent and Sussex Counties at 1-800-345-6785 or visit www.helpisherede.com.    Asked why the state would instruct patients to reach out to a suspended provider for a referral a spokeswoman for the state health department explained: "The suspended provider's office is best situated to provide referrals for continuity of care for his/her patients." Added Romero: "We're going to work closely with anyone that needs help We just need them to come forward and ask for it." Hospital CEOs don't like Delaware plan to rein in health care costs How to find a doctor: 3 qualities doctors look for in their own physician A Dover psychiatrist who has been on and off probation since 2003 for alleged offenses related to sex officially lost his license on Tuesday.  Gregory Villabona's license revocation brings to a close over 15 years of discipline by the state for alleged wrongdoing including child molestation sex with a patient and prescribing controlled substances to known addicts including one patient who died of an overdose "The board made the right decision," said George Dahr president of the Delaware Board of Medical Licensure and Discipline we will continue to serve the public and make sure that physicians are providing the best care possible." The most recent complaints about Villabona center on his allegedly careless manner of prescribing drugs Villabona began treating one patient in 2009 His initial assessment noted a need for a neurosurgical evaluation "in the near future," the board's revocation order states the order states the patient was discharged from another medical provider for securing pain medication prescription from multiple doctors Villabona continued to prescribe Oxycodone to the patient a drug court diversion case manager asked Villabona to stop prescribing addictive medication to the patient because it interfered with the patient's rehabilitation.  there was a gap of about one year where Villabona did not chart visits with that patient but continued providing the patient with controlled substance prescriptions he "conceded" the patient was "clearly doctor shopping" during his treatment But there was no evidence of any urine drug test ever performed on the patient.  That patient ultimately died of a drug overdose.  The board's order describes seven other patients for whom Villabona allegedly prescribed drugs irresponsibly In the case of one patient who tested positive for cocaine and was discharged from his pain management physician Villabona began prescribing him controlled substances The doctor told the patient he would only prescribe them for one month until he found a new pain management doctor the order states he kept prescribing the drugs for two years whenever other doctors refused to do so One cash paying patient had a "barter arrangement" with Villabona through which he could trade services for Percocet prescriptions Villabona kept no records of the patient's visits despite staff testimony stating the patient would come by frequently after hours The board said Villabona "exploited the doctor/patient privilege for personal gain." received prescriptions from Villabona for pain relief and anxiety Villabona would occasionally pay that patient for unused medications when state officials visited Villabona's practice to conduct an investigation Villabona allegedly gave a pistol and knife to the patient and asked him to leave the office with them.  Villabona allegedly prescribed Oxycodone to another patient every two weeks for three months – despite being aware that the patient consumed illegal drugs and medications not prescribed for him The board found that Villabona "engaged in a pattern of negligence in the practice of medicine."  "The record of how these patients were treated is unsafe and inexcusable," the board wrote in its order Villabona's prescribing practices demonstrate not only unprofessional but dangerous prescribing practices." Villabona had an unlocked cabinet in his office with expired medications It also contained multiple filled prescriptions with the names of his patients.  Villabona testified that he kept drugs for patients for office administration or in case the patients needed them in the future a member of his staff testified that she would observe Dr Villabona consuming these medications himself," the order states The doctor also had a safe in his office containing two handguns with ammunition that he testified were provided to him by patients Villabona had been a licensed medical doctor in Delaware since 1992 His first run-in with the medical board came after he pleaded guilty in Maryland in 2002 to sexually abusing two girls the board ordered his license be put on probation until 2005 because of that "unprofessional conduct" and prohibited him from treating minor patients without adult supervision.  In March 2006, Villabona lost a medical malpractice lawsuit filed by a former female patient who said he had sex with her in a car in 2002 the board put Villabona on probation for three years after he allegedly treated a minor patient without anyone else present he spent up to a half hour alone with a child with the door closed When a receptionist walked in, Villabona's proximity to the girl was "inappropriate," the report states and the girl's underwear was visible.  the board prohibited him from treating any patients under the age of 18 for the duration of the probation period this time for having consensual sexual relations with a 22-year-old female patient The board continued Villabona's probation through June 2015 and put a permanent ban on the doctor treating female and minor patients Villabona is not facing any criminal charges according to the Attorney General's Office.  acts that are grounds for administrative action against a professional license do not necessarily constitute criminal acts and for those that possibly could be criminal the standard of proof for criminal prosecution is higher than for taking administrative action," said DOJ spokesman Carl Kanefsky Messages left with Villabona's lawyer Andre Beauregard did not yield a response Villabona noted that disciplinary guidelines call for license suspension at most He said he has already taken steps to limit his practice to psychiatry patients only Considering his license has been on emergency suspension for nearly a year he said appropriate discipline would be probation with terms that prohibit him from engaging in pain management practice the medical board rejected Villabona's suggestion.  Villabona's practices show a gross deviation from appropriate prescribing practices at the expense of appropriate patient care," the order states "Permanent revocation is the only discipline that ensures that the public will be adequately protected." Source: Delaware medical discipline records 2002: Villabona pleaded guilty to criminal charges in Maryland relating to the molestation of two of his nieces in 1978 and 1983 when they were approximately 11 years old the remaining 28 counts of alleged criminal activity were not pursued 2003: The Delaware Board of Medical Licensure and Discipline put Villabona's license on probation for "dishonorable and unprofessional conduct" regarding the criminal charges in Maryland one third-degree sex offense and one fourth-degree sex offense.  2005: Villabona's license probation ended but he was still required to inform current and future patients of his sexual crimes He was also prohibited from treating minor patients without an adult present.  2006: Villabona lost a medical malpractice lawsuit filed by a 22-year-old former female patient who said he had sex with her in a car in 2002 2007: Villabona was again disciplined by the board He allegedly treated a minor patient without adult supervision The board put him on probation for three years.  2008: Villabona was disciplined again by the board for having consensual sexual relations with a 22-year-old patient in violation of the Medical Practice Act The board ordered Villabona could only treat male patients over the age of 18 His probation was extended until June 2015 2018: Villabona's license is put on emergency suspension by the president of the Board of Medical Licensure and Discipline and Secretary of State Jeffrey Bullock Their order alleges that Villabona:  2019: Villabona's medical license is revoked by the Board of Medical Licensure and Discipline 'Egregious misconduct' could cost Dover psychiatrist Villabona his license Dear Reader,Unfortunately our comment platform isn\'t available at the moment due to issues with our paywall and authentication vendor there were nearly 70 active listings for teachers and full-time substitutes across all 40 school districts but the vacancy listings only tell part of the story Herbert Slater Middle School teacher Genevieve Lilligren tiptoed on a school chair Friday stapling posters of fruits and vegetables on the walls She was decorating her nontraditional classroom in anticipation for the first day of school She greeted parents and teachers who were heading to back-to-school orientation Lilligren teaches culinary arts for three class periods She’s taken on extra courses in response to a shortage of teachers at Slater and gives up her lunch period to transition from one classroom to the next she’s optimistic about the new school year “We’re going to try to make lemonade out of lemons,” Lilligren said as she set up her classroom while her two sons played with Legos nearby but it’s something Lilligren and other Sonoma County teachers are willing to take on as they get ready to start the new school year no one wants to work for free … in any industry,” Lilligren said I think a lot of us understand that we have to create an environment that is going to support not only our students but also support us in supporting our students.” While Sonoma County teachers are trying to stay hopeful and positive for their students union leaders across districts are anticipating continued struggles with teacher vacancies there were 32 active listings for teachers These positions are especially hard to fill. According to a data analysis by Bellwether Education Partners nationwide shortages of teachers in these subjects dramatically increased in the 2000s some are starting to get filled,” said Santa Rosa City Schools Superintendent Anna Trunnell we typically experience a load of applicants So we imagine that we're going to be able to fill these positions very soon However the posted vacancies don’t tell the whole story trustees on the Santa Rosa City Schools board passed a “declaration of need for fully qualified teachers,” stating the need for an estimated 60 additional teachers at the high school level alone They also approved a memorandum of understanding agreeing that newly hired classified employees will be paid a $500 signing bonus on their start date and an additional $500 at the end of the 2023-24 school year The teacher shortage is a national crisis long anticipated Teachers began leaving the profession as early as the 2008 recession and the exodus was exacerbated by the COVID-19 pandemic during which teachers experienced burnout from the demands of online learning This led teachers to retire much earlier than they might have anticipated at the beginning of their careers making up for a major portion of vacancies in teacher positions according to a study in January 2022 by the Learning Policy Institute California has seen the impact of the shortage for nearly a decade Gavin Newsom as early as 2015 to invest billions of dollars annually into teacher recruitment Whether it's the high cost of living in Sonoma County or the salaries offered incoming teachers are not finding the open positions attractive “It’s not just teacher pay,” Montgomery High School Teacher Jim LaFrance said “You look at (how) maybe you can make more money in another position and you don't have the stress and the challenges that educators face.” The individual perception of teachers as professionals has become overwhelmingly negative in recent years said Santa Rosa Teachers Association President Kathryn Howell “If you ask an individual about teachers in general how do you reconcile that within your own self of getting into this profession that is in many ways It's not completely surprising that new graduates are choosing to do something else." Every district in Sonoma County is struggling to fill teacher vacancies math and science positions require teachers with specialized backgrounds which often means experienced teachers take on the brunt of the excess work “We have a ‘memorandum of understanding,’ which is just a temporary agreement that allows for secondary teachers to teach an extra section and give up their prep,” said Sandra Larson president of the Petaluma Federation of Teachers and a longtime teacher This solution — often the first option when a school realizes a vacancy will not be filled in time — is equivalent to a nonstop school day science projects or math tests for each teacher to grade “It’s concerning because I worry about people burning out,” Larson said While teachers are typically compensated an additional 20% of their salary for taking on the extra section workload the additional work affects their ability to teach at full capacity “The main reason teachers do it is for the kids “There are definitely teachers that will take it on especially in their first few years of teaching when their salaries are still pretty low Because that's a huge chunk of money and it could make a difference to a person and their quality and standard of living.” “What they ended up doing is working well beyond the school day and well beyond their contract hours to get all that work done.” Sometimes substitutes can take the additional classes but given the nature of math and science classes “ (Substitutes) often have no background in the subject matter,” Howell said and a substitute teacher is not going to be the best solution.” remembers last year’s scramble to make sure every class had a teacher available to fill in while they waited for a permanent solution The vacant positions outweighed the school’s resources administrators were even subbing in classes “This kind of stresses the whole system,” Lyons said not doing their very best on the part that they're officially assigned to do is there for a reason: to serve students.” is not going to be the best teacher they can be ― the teacher that our students deserve,” she said Lyons said heading into the school year is “gonna be a beautiful disaster.” Districts are looking for creative solutions because increasing teacher pay isn’t easy to achieve past union disputes and teacher strikes have proved that and current negotiations are going to take a while Sonoma County’s average teacher pay in the 2021-22 school year was just below $75,000 for unified school districts according to California Department of Education data California’s average salary for a unified district schoolteacher was $87,732 in 2021-22 who make as little as $42,000 in Sonoma County’s elementary schools live at home with their parents or have roommates to afford the cost of rent Union leaders argue that increased teacher pay is paramount to attracting and retaining professionals in Sonoma County where residents need to earn $103,870 year per household to live comfortably if paying rent president of the Rohnert Park Cotati Educators Association knows the teacher pay issue is not unique to her district “But it's a reflection of the future of education,” she said Their districts are also competing against neighboring Napa and Marin counties which offer teachers much higher average salaries Marin County's average teacher salary for unified districts in 2021-22 was $90,317 according to the California Department of Education Some teachers are willing to just move or make a longer commute she says Sonoma County districts need to be more competitive or they will be in trouble teacher unions will focus on fighting to bridge the gap between cost of living There are 14 school districts across the county that have not reached a contract agreement for the current school year according to the Sonoma County Office of Education meaning they’re in active negotiations or are satisfied with the benefits of their last contract Petaluma Federation of Teacher’s contract doesn’t expire until 2025 but when the contract opens “wages will definitely be on that list,” Larson said The Bennett Valley Teachers Association, which had the lowest wages in Santa Rosa, was on the verge of a strike last spring but has since reached a settlement and is waiting on the school board to approve a final ratification August 16 Bauman said she’s heading into the school year and negotiations with “cautious optimism.” In 2022, she led a six-day long teacher strike and will help drive their next contract negotiations 2022 teachers hit the picket lines after eight months of stalled negotiations over pay increases Most classes emptied as families and students joined them outside their campuses teachers ended up with a 14.6% raise over three years “I saw how empowered our association was when it really mattered,” Bauman said and I feel positive and encouraged that we're going to be just as strong and unified as we were in March of 2022.” the Santa Rosa Teachers Association will be preparing for open contracts she said it’s likely salary and health benefits will be at the top of their priorities Howell remembers teachers from association chapters across the county joined the Rohnert Park Cotati teachers on the picket line “We're tight knit and we're all one union,” she said “We definitely talk to each other about what’s being bargained in other locals and making sure we don’t just compare ― that we support each other.” You can reach Staff Writer Alana Minkler at 707-526-8531 or alana.minkler@pressdemocrat.com. On Twitter @alana_minkler Report For America corps member Adriana Gutierrez covers education and child welfare issues for The Press Democrat Reach her at Adriana.Gutierrez@PressDemocrat.com Please enable JS and disable any ad blocker The question of how far municipalities can decide in the face of a macro-renewable project was raised by a citizen Francisco Vaquero has interviewed about 70 people to make the film from 11 territories of the Spanish state and in about 170 of the more than 200 screenings of the film he has been present Based on the realities that he has known in all of them he explained that if a municipality expresses a net negative to the company and informs it that it will not provide any facilities the company usually leaves to another municipality that will better receive it This is when the project is already underway he recalled that the city council has the competence to define what each of its lands is useful for and why not A member of the Ezeltzu Viva group said that in consultation with the Government’s Industry Department he told him that the final approval of the project is granted by the City Council Vaquero added that if the company has all the permits until then the refusal of this last authorization by the city council can be understood as a "prevarication" although he stressed that in the procedure until then the prevarication is frequent "But the prevarication does not lead to prison having to stop being mayor and start a new job,” he added suggesting that being mayor for life is not an obligation Member of Parliament and Councillor of Amasa-Villabona also took the floor and explained that the City Council is negotiating with the Premier ESPF North Wind company which wants to install two windmills in Amasamendi They asked the company who had the last word and who told them it was from the city council; they asked the company if they would accept the result of the popular consultation and that the city council said yes The attendees were grateful for the post-film dialogue the discussion on the multiple vertices of the complex reality The citizen who attends this type of initiative will receive what he will not acquire by staying at home organized by Montes de Urumea Viva: Conference by Antonio Turiel entitled The limits of the energy transition in the Sala Sandiusterri in Hernani (the conference will be in Spanish) Twitter: @cupcakelogic Instagram: @aneliencupcake  Can you briefly describe your art or art style?: I try to keep a sense of whimsy in all my art I’m particularly fond of friendly round shapes and bright What inspires/informs your art?: I am heavily influenced by children’s storybooks and Japanese cartoons They tend to give off a sense of charm and light-hearted cheer which are traits I find appealing in a work of art What (if anything) do you hope to impart through your art?: The art I have most fun making in the ability to share a laugh with someone no matter the distance or place in the world Even if it’s just for a short amount of time I’d like to make the world a little lighter Instagram: @annasshole_ Twitter: @annasshole Can you briefly describe your art or art style?: My digital art mainly shows my roots as an ink drawer and so it is mostly black and white with rough lines My usual subject is my own body and how I process it I’m mostly known for the comics I put online which are mainly short ones that reflect on my mental health and how I see myself What inspires/informs your art?: I think what informs and inspires my art is simply my own personal experience and the experience of my loved ones I don’t want to put any pretense in my illustrations Drawing has always been a form of therapy for me and my anxieties and that is what informs and motivates me to draw The ever-present tension in the news on the rights of gender minorities and of disability (including Mental Health) are also points of discussion for what I make as they are topics close to me too What (if anything) do you hope to impart through your art?: I hope people can get honesty and vulnerability from my drawings I don’t want to force a lesson onto someone but I do want them to understand that I make my art as a way of communicating my own story in the sincerest way I can https://www.instagram.com/p/B0deoKeh8iS/?utm_source=ig_web_copy_link & Instagram: @bluetoasterart / www.bluetoasterart.com Can you briefly describe your art or art style?: My art is colorful and stimulating I combined the things I love from artists I adore into my artwork and try to inspire action or spark curiosity with the subjects I draw What inspires/informs your art?: Knowledge It is evident in my works that these things inspire me What (if anything) do you hope to impart through your art?: I hope The goal with every piece I create is to start a discussion about the subject of the piece get the audience to learn more about the subject themselves and someday share what they’ve learned to other people I like to think of myself as the human form of the “small fact frog” or a Fun Facts/Trivia book https://www.instagram.com/p/By70MOslJwZ/ Can you briefly describe your art or art style?: I experiment and play around with my art a lot but what I love working on most are characters with intricate designs and soft color palettes that give each piece a dreamy What inspires/informs your art?: Video games are my main catalyst Ragnarok Online was one of my main influences I’ve always looked to art in games and animation for inspiration It’s great to be surrounded as well by peers who are as passionate about art and are driven to tell stories through different media What (if anything) do you hope to impart through your art?: As cheesy as it sounds art helped me get through some of the toughest moments in life I hope that through the art that I put out it would help at least one other person out there find that “Hope” for whichever passion they choose to pursue https://twitter.com/mich_jpg/status/1135081865834975232?s=21 Instagram: @bedspacers Twitter: @mich_jpg / https://michcervantes.portfoliobox.net/ Can you briefly describe your art or art style?: I’m generally fascinated with shapes so I try to find ways I can blend all of that together in singular illustrations What inspires/informs your art?: I love to think of people as little buildings of sorts I like to ask myself things like… If this person were a room A lot of deconstruction happens before I reinterpret certain subjects in new forms What (if anything) do you hope to impart through your art?: Understanding people and other subjects in unique ways yield interesting results doesn't believe in horoscopes but is 110% Virgo 1988 Agents led down trail to arrest AGENTS from page A1 of running has been linked by federal drug agents to a major drug cartel based in Cali It is considered the direct competitor to the Medellin cartel which a DEA agent said last week is "better known because it's more violent." The men are accused of conspiring to import and distribute "tens of millions of dollars" worth of cocaine in the United States and "laundering" the profits through legitimate businesses and foreign bank accounts according to an affidavit on file with a criminal complaint in U.S Federal grand-jury indictments are expected this week The affidavit accompanying the complaint describes how the pair allegedly built their business and how they attempted to shield it sometimes using family members as couriers and financial covers Law-enforcement authorities apparently first learned that Bennett and Villabona-Alvarado were working together in December 1987 according to the 83-page affidavit written by John S The affidavit does not indicate whether they knew each other before that meeting Los Angeles police and Los Angeles County sheriff's deputies had begun watching Bennett a pudgy man at 5 feet 11 inches and 260 pounds who was variously nicknamed Waterhead Bo "The Pig," "Fatty" and "The Fat One." Bennett's organization had two phony businesses and four check-cashing stores all financed through a mortgage company whose paper work lists a Bennett associate as the incorporator The businesses were used to acquire other property as well as cloud the original source of drug profits Promotion Group in late 1987 bought a $73,623.30 Porsche The company financed $623.30 and paid $73,000 in cash registered with the California secretary of state by Jimmy Washington of Pasadena who later set up the Los Angeles-area check-cashing outlets for Bennett's organization Washington is charged in connection with the drug ring's operation Under police eyes Long before he went to Denmark police watched Bennett and an associate haul suitcases from a hotel near Los Angeles International Airport and load them into a new BMW The associate drove the car out of the parking lot and was stopped by Hijackers returned by Israel HIJACKERS from page A1 quired by a court-ordered expulsion As a condition for returning the hijackers Israel reportedly received assurances that the four men would not face the death penalty Israel Radio reported that one of the hijackers requested political asylum in Israel The eight-man crew of the hijacked jet spent Friday night in the same Tel Aviv hotel as a Soviet consular delegation now working in Israel They were taken to the airport only a short time before the two Soviet planes were scheduled to depart Israeli authorities handed over to Soviet officials several sacks containing approximately $2 million in various currencies that the hijackers had taken as ransom and brought with them on the plane The Israelis also gave the Soviet authorities four pistols and a hunting rifle that the hijackers had carried The Soviet officials signed receipts for the money and guns Liel said the Israeli government has no doubt about the authenticity of the Soviet Union's description of events leading up to the hijacking of the plane and its subsequent landing in Israel "The picture we got from the Soviets and from the criminals themselves is almost identical," he said "There was some doubt about the woman at first but the Soviets made it clear she was brought against her will We are sorry we first spoke of five hijackers." The bizarre hijacking began Thursday in the southern Russian Republic town of Ordzhonikidze where the four men commandeered a bus full of children and demanded money and a plane to fly them to a Western nation BEST AVAILABLE COPY 2 arrested in shooting of officer Held in incident at 'crack house' By Ed Foster Jacques Arizona Republic After coming to Tempe Brian "Waterhead Bo" Bennett continued doing business from a home he reportedly purchased for $500,000 who found $300,000 in the suitcases and arrested I him Surveillance officers often saw Bennett's mother taking bank bags and briefcases into and out of her son's various business offices officers saw her carry a paper bag into a suite at the First Frontier Mortgage office and leave with a Gucci briefcase She then took the briefcase to one of Bennett's check-cashing outlets believed to be a ranking member of the Cali drug cartel It listed as the owner Kaj Nielsen at a Tarzana Villabona-Alvarado had come to the attention of investigators in 1987 during a three-year nationwide drug investigation code-named Operation Pisces undercover agents posing as drug-money launderers in Los geles It was in the course of that investigation that undercover agents discovered that Villabona-Alvarado'sing brother got 12 kilograms of cocaine in March 1987 from a ring thought to include Mario VillabonaAlvarado It was not known last week whether Fernando Villabona-Alvarado has been charged in connection with the drug operations drug agents had enough evidence to persuade Danish authorities to freeze about $450,000 in Copenhagen bank accounts held by Mario Villabona-Alvarado and his wife Nielsen and Bennett checked into the Savoy Hotel in Copenhagen Two days Brian Bennett The pudgy man was variously nicknamed "'Waterhead Bo," "The Pig," "Fatty" and "'The Fat One." later a Danish court authorized police to place wiretaps and bugging devices in their rooms The wiretaps recorded calls to Colombia and Los Angeles the trio was staying with Nielsen's father the wiretaps recorded conversations involving the shipment of more than a ton of cocaine from Colombia to Los Angeles Villabona-Alvarado and Bennett left Copenhagen for Milan Villabona-Alvarado discussed buying a house in Cuernavaca and an apartment or condominium elsewhere in Mexico the men traveled from Milan to Mexico City The affidavit mentions nothing else about their activities until January when authorities decided that the men knew they were being watched The Associated Press One of four hijackers who took a jet to Israel is surrounded by Soviet officials as he is taken aboard a plane in Tel Aviv for the return trip the ex-wife of gang member Pavel Yakshiyants whom the Soviets described as a drug addict with a criminal record took some of the children and Mikhailova onto the Aeroflot plane given them by authori: ties The hijackers also received sacks of money in different currencies which Israeli officials later said was worth $2 million Yakshiyants and the other hijackers released the remaining children minutes before the plane took off Mikhailova was forced to fly with the hijackers and the aircraft's crew to Israel The news that the unidentified hijackers had demanded to be flown In late March Villabona-Alvarado went to Denmark for two weeks "after detecting renewed police surveillance." Breakout 'mastermind' On April 4 Villabona-Alvarado phoned a contact named Oscar in Cali They discussed an associate's unsuccessful attempt to escape from a U.S federal prison in March and the reaction of drug authorities "Villabona-Alvarado said they (the U.S authorities) believe Villabona-Alvarado was the the affidavit says "Villabona-Alvarado stated that 'they' want to catch 'me' red-handed but that 'he' (Villabona-Alvarado) does not 'touch' anything VillabonaAlvarado then complained that things went wrong whenever he is not there." Villabona-Alvarado and Bennett now were dealing in millions of dollars of cocaine a week An April 9 phone call to Villabona-Alvarado from Cali detailed the delivery of 6,107 pounds at a total cost of $25.917 million to VillabonaAlvarado's organization from Dec The money was laundered through the check-cashing outlets Some of it was sent to Colombia to pay for cocaine and some of it was turned into cashier's checks and sent to Denmark The DEA played a role in the money transfers with some of the cash given to undercover agents posing as money launderers who agreed to arrange to move it to Panama There is no mention of his movements again in the affidavit until May 17 Moves in Los Angeles Although Villabona-Alvarado continued living at a Malibu home living in houses and apartments in the Wilshire Argentine mutiny continues ARGENTINE from page A1 armed-forces members "have not been able to dominate the rebels." Juan Carlos Pugliese "Democracy is in danger," and called the insurrection "a clear coup attempt." The insurrection began shortly before dawn Thursday when about 400 soldiers deserted their posts under the leadership of the charismatic Col later joined by about 50 coast guard members seized the infantry school Friday morning at the giant Campo de Mayo military base Government forces and tanks surrounded the base and exchanged several rounds of mortar and rifle fire with the rebels Friday Government forces did not fire on the rebels It said the rebels drove past the government troops aboard several trucks which they had loaded with weapons and ammunition Telam said the rebels arrived a few minutes later at a motorized military unit in Villa Martelli about eight miles away The unit's officers earlier had been reported as sympathizing with the rebels The rebels fortified their positions and set up snipers Several explosions were heard outside the base late Saturday night the private news agencies Noticias Argentinas and Diarios Noticias reported Telam said lights at the base went out shortly afterward More than 100 area residents showed their opposition to the rebels district and in other Los Angeles-area communities The men and their associates changed mobile-phone numbers every few months each time renting a phone under a new fake name They also used pagers and pay telephones in an effort to avoid wiretaps They often swapped cars among each other or bought new vehicles Villabona-Alvarado was seen in a Rolls- Royce Officers saw Villabona-Alvarado and Bennett associates exchanging briefcases and canvas bags at apartments and parking lots throughout metropolitan Los Angeles the suspects drove using "antisurveillance methods" intended to lose the officers: making quick lane changes driving down dead-end streets and making U-turns back out while driving at high speeds Bennett apparently moved to Tempe about June when Los Angeles police and federal agents seemed too close for comfort The beginning of the end came in early November Missouri Highway Patrol officers stopped a speeding 1985 Chevrolet Silverado pickup truck near Springfield A search of the truck led to the seizure of 1,100 pounds of cocaine and two mobile phones programmed to dial Bennett's Tempe home DEA agents in Detroit seized $5.4 million in cash being delivered by alleged Bennett representatives to Colombian money launderers DEA agents arrested Bennett and Villabona-Alvarado The Arizona Republic Two men have been arrested in the shooting Thursday night of an undercover police officer at a south Phoenix "crack house," a police spokesman said Saturday was arrested Friday night at his mother's home in Los Angeles was upgraded to good from critical at Maricopa Medical Center Calles was shot five or six times during a raid on the suspected crack house in the 2500 block of East Mobile Lane Anderson said Phoenix police had notified Los Angeles officers that Rayford might be there members of the LAgang unit went to Rayford's mother's home and found him there," Anderson said "They picked him up and booked him on one count of attempted murder contacted an attorney to assist him in giving up about 1:30 He was booked on one count of attempted murder early this Anderson said both Rayford and Walter claim to be members of the Crips "Information we have been able to develop would say that," he said The term "crack house" is used to describe a house occupied by dealers of crack Anderson said Calles was shot after a vehicle drove up to the south Phoenix house as officers prepared to serve a drug-related search warrant He said that as other officers approached the occupants of the vehicle He ran to the house and was shot as he entered Anderson said Calles fired four times but apparently did not hit anyone Anderson said Rayford and Walter are believed to have done the shooting Two other men believed to have been in the house have been questioned was questioned by police Friday and released "He is still being questioned," Anderson said I don't anticipate him going to jail." John Perryman was arrested Thursday on an earlier drug charge The Associated Press A soldier helps blacken the face of another rebel at Argentina's Campo de Mayo military base to Israel caused confusion and some alarm in Jerusalem Hundreds of police and soldiers were deployed at Ben-Gurion International Airport to cope with the possibility that the plane bore terrorists docile hijackers surrendered to the army after brief discussions during which they were mostly concerned with making sure they were in Israel and not in Syria Israeli police identified the other hijackers as Vladimir Morbalov The other ages and the occupations of the men were not known The Associated Press contributed to this report by shouting insults and stoning a car as it entered the base rebels fired blanks to disperse the demonstrators Presidential spokesman Jose Ignacio Lopez acknowledged Saturday evening that Cabinet ministers and military chiefs meeting at Government House were "nervous," adding that the presidential guard was being reinforced "If a group of rebels moves from one place to another and you don't know where they're going the least you have to do to protect the president is reinforce the guard," he said Military uprisings in 1987 and earlier this year were led by Lt They also were called to support fellow officers being prosecuted in civilian courts over humanrights abuses during the dark days of Argentina's military dictatorships bombings and assassinations by leftist groups were curtailed but at least 9,000 Argentines "disappeared" and were presumed executed by security forces including former military Presidents Jorge Videla and Roberto Viola were convicted in civilian court of crimes including kidnapping The military toppled the elected government of President Isabel Peron in 1976 ran for president when the military junta finally allowed elections in 1983 Alfonsin won on a platform of human rights and honesty in government It was the first defeat of the labor-based Peronist Party in open elections since 1945. (Combined Dispatches) -A 9-month-old boy was found dead of dehydration yesterday aboard an Amtrak sleeper car where a gunman had held off police for three days after slaying his sister Police defended their decision to wait for the gunman to give up peacefully instead of using force "I feel good that we didn't fire a single shot," said Police Chief Frederick K "We were all saddened by the loss of the baby but I felt we got all we possibly could out of this." The gunman identified as Mario Evangelista Villabona Navas of Money habit hard to kick HE WAS YOUNG and some he was and hand- of course he had to have a lot of money; he dressed well and there always was champagne on the tables of these places with awnings on Second and Third which was where the public part of the romance was JIMMY conducted BRESLIN He was from Dallas and the first thing she remembered about him See BRESLIN Page 16 UPI son are rolled from an Amtrak car in Villabona Navas is led away after surrender dead in rail 6 I feel good that we didn't fire a single shot released his sister's 3-year-old daughter Heineman said Villabona Navas had earlier been ordered deported to his native Colombia as a condition of parole after serving part of a 13-year sentence on a drug conviction POLICE SAID they did not know for sure why the man initiated the long siege as the Miami-to-New York Amtrak Silver Star approached the Raleigh train station Friday morning a Wake County emergency technician who negotiated with the gunman in Spanish for 72 hours said she believed the infant died Sunday morning "HE HAD RUNNING water there," she said "There was no reason for the baby to have died of dehydration." said the man had been arguing with his sister "He was basically scared," said Oliva "He just overloaded himself and did the wrong thing." Raleigh Police Sgt Watson speculated that the gunman might have been angered by the crying of the baby boy The woman was presumed killed Friday morning a pediatrician who monitored the children's health by listening to their The gunman passed the girl through a window in a pink blanket about 1 a.m He threw down his machine gun and gave himself up about 5:45 a.m were removed later from the stifling 6-foot-by-10-foot compartment Police said their decision not to shoot at the gunman was based on negotiating tactics "It's a judgmental kind of situation," said Watson We felt as long as we had communications open and as long as we were getting some reaction from him that certainly there was hope that we could do it peaceful CONNORS Investors banking on still-lower interest rates bought heavily in the stock market yesterday sending the Dow Jones industrial average soaring through the magic barrier The Dow rocketed 25.94 points to close at 1,012.79 its loftiest peak since the 1,016.93 of April 28 Volume on the New York Exchange boomed to 138.5 million shares making it the second busiest Big Board session topped only by the 147 million shares that changed hands last Thursday 9 "strong vote of confidence" for his policies President Reagan hails the Wall Street rally as a October In another reaction to tumbling interest charges the price of gold jumped $30 an ounce to $448 Bonds also rose as investors reacted to indications 2861 by Federal Reserve Chairman Paul Volcker at the weekend that the Fed was easing its grip on the growth of the money supply tempered the rampant bullishness after the Dow had See STOCKS' Page'39