PROVIDENCE, R.I. – The campus of Butler Hospital is awash in fall colors as the sun moves toward the horizon, on Thursday afternoon, Nov. 7. The shift of nurses, doctors and patients is on the move, the daily changing of the caretakers, as ConvergenceRI struggled on trekking poles to reach the main entrance, on time for an interview with Dr. Linda Carpenter, M.D. One of the pioneering neuroscience researchers at Butler Hospital, Dr. Carpenter is the lead clinical trial researcher on a new, take-home device (Relivion) created by Neurolief to treat major depressive disorder, a chronic and recurring condition that afflicts millions. The interview took place in Dr. Carpenter’s office at Butler Hospital, a portal into a space defined by stylish design and acute attention to detail. Dr. Carpenter is wearing a turquoise scarf that depicts the brain’s synapse structure, replete with dendrites and axons depicted in black. Two days before the interview, former President Donald Trump had been elected the 47th President of the United States, as if the entire nation had been victimized by a mass psychosis where facts no longer seemed to matter. That evening, members of the Rhode Island Senate would convene in a caucus that replicated a medical intervention, as Senators endorsed the continued leadership of Senate President Dominick Ruggerio, despite indications that his chronic health conditions had taken a severe toll. Earlier this summer, ConvergenceRI had conducted an interview with Dr. Carpenter, “Listening to what your brain is telling you,” following her being awarded the Clinical Transcranial Magnetic Stimulation Society Gold Medal. Dr. Carpenter serves as director of the Transcranial Magnetic Stimulation Clinic and Neuromodulation Research Facility at Butler Hospital, a division of Care New England. ConvergenceRI: I am amazed at the latest work, which seems to be just remarkable, in terms of its groundbreaking nature of treatment: The idea that people can have a take-home device that can help them with their treatment of drug-resistant depression. The treatment moves forward in such a way that it may help patients to overcome everything from long-term depression to migraines. CARPENTER: Right. The particular device that we are talking about today which is the subject of clinical trial that we just finished, is the same device that they have already gotten approved for migraines, but the stimulation pattern that it gives for depression is different. You would use this device [taking off her glasses to put on the device to model it], they may look the same, but the stimulation of the prescription , if you will, would be different for migraine than it is for depression. But, it is incredibly exciting, because we don’t yet have any FDA-approved home-use devices for depression. ConvergenceRI: My first question to you is, “How would I be able to get one of these devices?” How would I qualify? Are the clinical trials’ hurdle now over? CARPENTER: The clinical trial was conducted at multiple sites around the country, and I think we also had an Israeli site [the Relivion corporate headquarters are based in Israel with a facility in Florida]. The clinical trial proved the efficacy [of the device] by randomizing people in active or sham, right? The data demonstrated a superior outcome for the people who had active [devices]. At this point, the whole package of results has gone to the FDA, maybe about a month ago. And, they are processing it. Before the FDA started this trial, they gave this company what is known as a “breakthrough designation,” to help them get onto a fast track for going through the regulatory process, because they identified a need for patients with treatment-resistant depression to have [access to a device] at home. Many of [the patients] can’t come to our clinic five days a week for TMS [transcranial modulation stimulation], or they can’t come in for ECT [electro-convulsive therapy]; you would have to have someone drive [the patient] here and then drive them home. The FDA identified the need and put [the firm] on fast track. The company expects, and I don’t work for the company, but I think they expect to receive FDA approval in early 2025. And then, when that happens, they can commercially market the device. Now, how will that work? I don’t know. This is the first of its type, There are a couple different of ways that this can go. It could be that you come to your doctor’s office, they supervise you using it a couple of times until they are confident that you can use it properly. And then you take home the device, use it, come back, check in every two or three or four weeks, something like that. There is also this question of durable medical equipment, which is out of my wheelhouse and how it would work. Which is where you are a clinic and you actually sell the device to the patient. You have a stock of them. I don’t know what the business model will look like. What I do know is that it’s a prescription device . So, you will have to be monitored by a doctor. It doesn’t mean that it has to be a psychiatrist. You could go to a primary care doctor. But, when it first rolls out, because it is FDA-approved for people who have not gotten better with at least one anti-depressant medication, it will b prescribed typically by a psychiatrist at first, I think. And as broadly as it can be disseminated, that would be great. Because the goal would be to reach all of those patients who can’t come to a specialty clinic. And there are a lot of those. If you think about, when we talk about treatment resistant depression, basically about a third of patients don’t get better with standard anti-depressant treatment. And, that’ a huge number; it’s millions of patients, [looking it up on her computer]. There are some 21 million patients with depression, 9 million being treated with anti-depressants, and 3 million meet this criteria for treatment resistant depression if they don’t get better with a standard anti-depressant. We are looking to find and implement a treatment that would be more convenient and accessible – and I am very excited about that. ConvergenceRI: For me as the journalist, the question is: How could I get one of these devices and write about it, and perhaps become part of the follow-up. The goal would be, that as much as a scientific endeavor, I think that for people to understand what is going on, it might be helpful to have a journalist who can write about the experience and share that... CARPENTER: ...It would be fantastic. ConvergenceRI: ...in a comprehensive fashion, I am willing to raise my hand... CARPENTER: ...And volunteer? ConvergenceRI: I would volunteer to become a patient, or whatever is required, to do this, because I think for all the studies you can do, having someone to actually talk about it in a cogent fashion is intriguing to me. CARPENTER : Yes. You can go onto the company’s website and get a prescription for the migraine device. And, I don’t how you do that, I just noticed this (Relivion website for migraine) today, and I think you can purchase it and have it sent to you, and it would be very similar. You would get the experience of what it is like; they have a prescription and then there are accessories. ConvergenceRI: Would that come from through my primary care physician? CARPENTER: I was just looking to see if you could get a prescription under the migraine indication. The trial would go on for 60 days. This is a brand new website, (there is a listing, “Getting started. Telehealth and find a doctor.”) You might b able to interact with this website and get one for a migraine, with a telehealth physician. It looks like they give you ways to do that. ConvergnceRI: I will consider following up with that. From what you have described, it seems like it is a major breakthrough in treatment, with the possibility that this device will be something that will change the way that depression is treated. And perhaps conditions that are linked to depression, such as obsessive compulsive behavior. CARPENTER: Well, we haven’t tested those other indications. But I think you have the right idea. And, in fact, here are a number of devices, if you just Google them, you can find them. But the difference between this and those [other devices] is that they haven’t been put through large, randomized control trials, which takes a lot of time and a lot of money. ConvergenceRI: Have you gone through Phase I, Phase II, and Phase III clinical trials? CARPENTER: The clinical trials design are not the same for drugs as they are for devices. This would be a device that they tested it in an early pilot study. And, they have done all their safety testing before they came to this clinical trial. And, then, I guess, after FDA approval, this is all that will likely be needed according to the FDA to get the clearance. And then, after the clearance, there will be a lot of questions we need to address. We studied this, with people using it every day, active or sham, for a period of eight weeks. And then, what happened in this clinical trial, at the end of eight weeks, you got to crossover and go to active, if you had gotten the sham, and if you had already got active for eight weeks, you could, continue with eight more weeks of active. There were a number of questions built into [the study]. One, if you aren’t all the way better by eight weeks, and you keep going, will you get more people into remission? And, the answer to that question was yes, because more people kept getting better. And the other question was: If you had sham for the first eight weeks, and now you get the real device, can you replicate that the same percent of people were getting better, and we did. But some of the questions we haven’t answered are: OK, we’ve had people using the device for up to 16 weeks, what does the maintenance look like? Do you stop using it? Do you continue to use it? Do you continue to use it less often? How long will it last? Is it something that you are going to pick up when you start to slip and your [depressive] symptoms start to come up again? As soon as the FDA approval happens, then those will be next types of studies that we are doing. And also, we will be doing more mechanism of action studies. To do scans, before and after treatment, to look at how is it changing connections in the brain, and the way it does. ConvergenceRI: How has it changed your life? You have spent a large amount of time working on this, to see it come to creation. To now have a device that is sitting on front of you on your desk, and it seems to work, what is that like for you as a researcher, as a neuroscientist? CARPENTER: It is really exciting. I am very big on “the bench to bedside.” Getting all the way to implementation is something that I really, really enjoy. You know, a few of the hurdles that lay ahead are that this is a small, start-up company that is looking for a big company such as Pfizer to buy them and co-license it to help facilitate the next bunch of clinical trials that need to happen to answer all these additional questions. A lot of this is now in the hands of the device manufacturer, to take the next big steps to help get the device out there. I’m thrilled to be able to talk about it. I am thrilled to know that it works and to recommend it. But, access is so important. And, like all these other new treatments, if people can’t afford them, if health insurance doesn’t cover it... There needs to be access. I am just really hopeful that the pieces fall into place and that they are taken care of, because that is not [the focus of] my work. My work is the scientific work. To get it to implementation, so I can see patients using it. And not just in my clinical trials. We want people to be able to be use it; I think that will take some time. To answer your question directly, there is a little bit of antsy-ness about wanting to keep moving forward, and doing the next thing, to get their money and to get their companies and their commercial model all built. But, it’s exciting. It’s exciting to have been a part of designing the trial to help pick the sites, and make sure that it was conducted with scientific rigor. And to have good data. Because, you know, there are a number of devices out there. Congess passed a law in 1972 that said the FDA will regulate medical devices. And, ever since then, all the biomedical devices go through FDA. But, there were a bunch of devices on the market before 1972. And they were grandfathered in. They have been able to market themselves legally, without ever doing clinical trials, So there are all these devices that patients can get that they advertise for depression or for anxiety or pain, or to improve your dreaming, or something. But they just don’t have the science behind them. Psychiatrists and other physicians tend not to prescribe them; patients sometimes find them and ask, “Will you sign this form I got online?” But they haven’t really been incorporated into the mainstream of treatment because they haven’t had the science. So now, we have the first one with the science. And that is really exciting. I would like to see it become used as a regular treatment for depression. ConvergenceRI: What does it feel like for you to be able to help direct the first of its kind device with the promise of something to be so helpful to people, who are often struggling to get by day-today? CARPENTER: It feels great. It feels really great. We all want to do something, you work with patients, and you are experiencing their suffering, and the disabling nature of the depression. And, the problems with side effects. And, the burdens on families and the economy. It feels great to have something. It will feel greater when I can go, here you are. There are so many people who were involved with the device. I didn’t design it; I didn’t invent it. And, the company did really elegant work in putting it together. It has a really elegant interaction with your smart phone that walks you through how to use it, that checks to make sure that the device is on right, and that sends the information to the cloud that I can look at on a dashboard to see if the patient is using the device safely. But, you know, we are not completely at the finish line until it is disseminated. ConvergenceRI: Let me go back and ask about what is actually happening in the brain with the device. And please correct me if I get this wrong. The idea is what you are working with is the way that the brain can reconfigure the way that the synapses and the neurons fire, essentially that there is a learned pattern that takes place, so if you fire the sequence enough times, it becomes the learned pattern in the brain, and it doesn’t go back to all of the intermediate steps. It goes from A to F, without having gone through B, C, D, and E to get to F. What the device seems to be doing is retraining , if that is the right “verb” to use, to get the neurons to fire differently. CARPENTER: Right. ConvergenceRI: To take the “memories” that are contained, if “memory” is the right word, of what gets lost in the translation of the firing of the synapse. Is that accurate? CARPENTER: That’s a good way to think about it. Think about it like a computer. The computer has all these different parts that have to interact and, if one part breaks down, then the other parts might go around that part. This part might have the control of that part, like a circuit board. Think of depression like a circuit board. And just like you said, A, B, C, and D. And the circuits are connected by synapses, neurons and synapses, right? And so, like you said, if the part of the reward center and joy is turned off and not coming on, and the fear center and anxiety is on when it shouldn’t be, and the top control isn’t telling the others this isn’t the time to be anxious. This isn’t the time to be turned off, this isn’t the time to be attending – all those different signals. So, we know that there are these functional changes in the brain when someone is depressed. And, by and large, you can see when people get better, although depression has a lot of different versions, right? There are a lot of different versions of depression. If you look at all the different symptoms, and there are lot of different ways that it can look. But, in general, if you think about circuit pathology , that the circuit Is not working properly... ConvergenceRI: Circuit pathology? CARPENTER: Yes. Again, if I have a lot of anxiety in my depression, then my amygdala, its connections to other things are not being regulated. We want our brain to say, “Oh yes, be fearful,” when it is appropriate to be fearful, when you are in a terribly dangerous situation. But not when you are trying to relax, and your reward center should be able to turn on when you experience certain things. And so, negative old memories should stay put, and not come in and re-evaluate what is happening in the present, The question of how the device’s treatment for depression works to fix that is unanswerable. How does psychotherapy fix that? How does ECT fix that? How does medication fix that? What we know is where the device has its actions. Or where EMS has its actions. Or what Prozac sticks to on the molecule, right? And what we know about this device is that it stimulates some peripheral nerves, branches of nerves called the trigeminal nerve in the front and branches of these nerves in the back, and these are right underneath your skin, these nerves are stimulated in this synchronous way, carrying messages down to the brain stem. And, this goes up through a bunch of connections, the solitary tech nucleus, the hypothalamus, and gets into the nodes, as you will, of the circuit. How that fixes the regulation is the question. ConvergenceRI: Am I asking the right questions? CARPENTER: Oh, yes, I think they are great questions. ConvergenceRI: Thanks. Trying to translate what you are saying into language that people can understand, that’s part of the problem. I think I get some of it. But I am very much in awe of what it takes to translate what is happening, and the way that you then see it. There is clearly a difference between causation and correlation. CARPENTER: Just think about Prozac’s impact on the serotonin uptake inhibitors And people said: It sticks on this little thing on the cell and it causes more serotonin to be in the cell. It’s not like we’re all down a quart of serotonin; it still is changing the circuits and how they talk to each other. And sometimes, we act like we know exactly how a treatment works. How does psychotherapy work? And that is really a retraining right? Forcefully creating new habits. ConvergenceRI: How tied into other senses is this work? With psychotherapy, you have to listen. In terms of drug intake, it is all about modulating how we respond to pleasure, versus things that are not pleasurable, and the wirings that enable that to happen. CARPENTER: That’s the black box, the wiring that enables it to happen. So, that when a pleasant thing happens, joy, dopamine, the reward circuit is firing. You see your grandchild, you see your friend. You have a good thing happen. The common bottom line seems to be getting all those different functional areas of the brain to coordinate properly, particularly with top-down control, turning off things that are not appropriate and allowing things that are. When reward circuits are down, people feel apathetic, they feel no interest in things, no drive to pursue things. The last step is making the symptoms go away. Each of the treatments we talked about has a different way of approaching it.Senators visit the Kings following Gaudette's 2-goal performancepg slot game real money 。

Middle East latest: WHO chief says he was at Yemen airport as Israeli bombs fell nearbyAI to affect 14% of PH workforce – IMF report

Wade Taylor IV scored 15 points and dished out 10 assists and C.J. Wilcher added 14 points as No. 13 Texas A&M throttled Abilene Christian 92-54 on Saturday afternoon in College Station, Texas. The Aggies (11-2) were in charge from the jump, forging a 19-point lead at halftime and never looking back. Texas A&M scored the first points of the second half, was up by 28 with 13:23 to play and cruised to the finish line while winning its seventh straight game. Javascript is required for you to be able to read premium content. Please enable it in your browser settings.

JERUSALEM (AP) — A new round of Israeli airstrikes in Yemen on Thursday targeted the Houthi rebel-held capital of Sanaa and multiple ports, while the World Health Organization's director-general said the bombardment occurred nearby as he prepared to board a flight in Sanaa, with a crew member injured. “The air traffic control tower, the departure lounge — just a few meters from where we were — and the runway were damaged,” Tedros Adhanom Ghebreyesus said on the social media platform X. He added that he and U.N. colleagues were safe. “We will need to wait for the damage to the airport to be repaired before we can leave,” he said, without mentioning the source of the bombardment. The Israeli strikes followed several days of Houthi launches setting off sirens in Israel. The Israeli military said it attacked infrastructure used by the Iran-backed Houthis at the international airport in Sanaa and ports in the cities of Hodeida, Al-Salif and Ras Qantib, along with power stations, asserting they were used to smuggle in Iranian weapons and for the entry of senior Iranian officials. Israel's military didn't immediately respond to questions about Tedros' post but issued a statement saying it had "capabilities to strike very far from Israel’s territory — precisely, powerfully, and repetitively.” The strikes came a day after Israeli Prime Minister Benjamin Netanyahu said that “the Houthis, too, will learn what Hamas and Hezbollah and Assad’s regime and others learned" as his military has battled those more powerful proxies of Iran. The Houthis' media outlet confirmed the strikes in a Telegram post, and the Houthi-controlled satellite channel al-Masirah reported multiple deaths. Iran's foreign ministry condemned the strikes. The U.S. military also has targeted the Houthis in Yemen in recent days. The United Nations has noted that the targeted ports are important entryways for humanitarian aid for Yemen, the poorest Arab nation that plunged into a civil war in 2014 . Over the weekend, 16 people were wounded when a Houthi missile hit a playground in the Israeli city of Tel Aviv , while other missiles and drones have been shot down. Last week, Israeli jets struck Sanaa and Hodeida, killing nine people, calling it a response to previous Houthi attacks. The Houthis also have been targeting shipping on the Red Sea corridor, calling it solidarity with Palestinians in Gaza. The U.N. Security Council has scheduled an emergency meeting Monday in response to an Israeli request that the council condemn the Houthi attacks and Iran for supplying weapons to the rebels. 5 journalists killed in Gaza Meanwhile, an Israeli strike killed five Palestinian journalists outside a hospital in the Gaza Strip overnight , the territory's Health Ministry said. The Israeli military said that all were militants posing as reporters. The strike hit a car outside Al-Awda Hospital in the built-up Nuseirat refugee camp in central Gaza. The journalists were working for the local news outlet Al-Quds Today, a television channel affiliated with the Islamic Jihad militant group. Islamic Jihad is a smaller and more extreme ally of Hamas and took part in the Oct. 7, 2023 attack in southern Israel, which ignited the war. The Israeli military identified four of the men as combat propagandists and said that intelligence, including a list of Islamic Jihad operatives found by soldiers in Gaza, had confirmed that all five were affiliated with the group. Hamas, Islamic Jihad and other Palestinian militant groups operate political, media and charitable operations in addition to their armed wings. Associated Press footage showed the incinerated shell of a van, with press markings visible on the back doors. Sobbing young men attended the funeral outside the hospital. The bodies were wrapped in shrouds, with blue press vests draped over them. The Committee to Protect Journalists says more than 130 Palestinian reporters have been killed since the start of the war. Israel hasn't allowed foreign reporters to enter Gaza except on military embeds. Israel has banned the pan-Arab Al Jazeera network and accused six of its Gaza reporters of being militants . The Qatar-based broadcaster denies the allegations and accuses Israel of trying to silence its war coverage, which has focused heavily on civilian casualties from Israeli military operations. Another Israeli soldier killed Separately, Israel's military said that a 35-year-old reserve soldier was killed during fighting in central Gaza early Thursday. A total of 389 soldiers have been killed in Gaza since the start of the ground operation more than a year ago. The war began when Hamas-led militants stormed across the border in an attack on nearby army bases and farming communities. They killed around 1,200 people, mostly civilians, and abducted around 250. About 100 hostages are still inside Gaza, at least a third believed to be dead. Israel's air and ground offensive has killed more than 45,000 Palestinians, according to the Health Ministry. It says more than half the fatalities have been women and children, but doesn't say how many of the dead were fighters. Israel says it has killed more than 17,000 militants, without providing evidence. The offensive has caused widespread destruction and driven around 90% of the population of 2.3 million from their homes. Hundreds of thousands are packed into squalid tent camps along the coast, with little protection from the cold, wet winter. Also Thursday, people mourned eight Palestinians killed by Israeli military operations in and around the city of Tulkarem in the occupied West Bank on Tuesday, according to the Palestinian Health Ministry. The Israeli military said that it opened fire after militants attacked soldiers, and it was aware of uninvolved civilians who were harmed in the raid. Shurafa reported from Deir al-Balah, Gaza Strip. Associated Press writer Nasser Karimi in Tehran, Iran, contributed. A previous version of this story was corrected to show that the name of the local news outlet is Al-Quds Today, not the Quds News Network. Follow AP’s war coverage at https://apnews.com/hub/israel-hamas-warIntech Investment Management LLC decreased its stake in shares of AutoNation, Inc. ( NYSE:AN – Free Report ) by 56.0% in the third quarter, Holdings Channel reports. The institutional investor owned 4,349 shares of the company’s stock after selling 5,531 shares during the quarter. Intech Investment Management LLC’s holdings in AutoNation were worth $778,000 as of its most recent SEC filing. A number of other large investors have also added to or reduced their stakes in AN. WINTON GROUP Ltd bought a new position in shares of AutoNation in the second quarter worth approximately $15,832,000. Lodge Hill Capital LLC bought a new position in AutoNation in the 2nd quarter valued at approximately $15,141,000. International Assets Investment Management LLC bought a new position in AutoNation in the 3rd quarter valued at approximately $131,250,000. Cubist Systematic Strategies LLC boosted its stake in AutoNation by 4,275.6% during the 2nd quarter. Cubist Systematic Strategies LLC now owns 50,107 shares of the company’s stock valued at $7,986,000 after purchasing an additional 51,307 shares during the last quarter. Finally, Dimensional Fund Advisors LP increased its holdings in shares of AutoNation by 2.7% in the 2nd quarter. Dimensional Fund Advisors LP now owns 1,605,708 shares of the company’s stock worth $255,910,000 after purchasing an additional 41,712 shares in the last quarter. Hedge funds and other institutional investors own 94.62% of the company’s stock. Analyst Upgrades and Downgrades AN has been the topic of several recent analyst reports. JPMorgan Chase & Co. dropped their price objective on AutoNation from $190.00 to $180.00 and set a “neutral” rating on the stock in a research report on Tuesday, November 5th. Morgan Stanley raised shares of AutoNation from an “equal weight” rating to an “overweight” rating and raised their price target for the company from $145.00 to $200.00 in a report on Wednesday, September 25th. Wells Fargo & Company reduced their price target on shares of AutoNation from $187.00 to $181.00 and set an “equal weight” rating for the company in a research note on Tuesday, October 15th. Bank of America lowered their price objective on shares of AutoNation from $220.00 to $215.00 and set a “buy” rating on the stock in a research report on Monday, October 14th. Finally, Guggenheim cut their target price on shares of AutoNation from $190.00 to $189.00 and set a “buy” rating for the company in a research report on Thursday, November 21st. Three research analysts have rated the stock with a hold rating and five have assigned a buy rating to the company’s stock. According to MarketBeat.com, the company has an average rating of “Moderate Buy” and an average target price of $199.29. AutoNation Stock Performance Shares of NYSE AN opened at $178.89 on Friday. AutoNation, Inc. has a 12-month low of $133.01 and a 12-month high of $197.18. The firm has a market capitalization of $7.09 billion, a price-to-earnings ratio of 10.34, a price-to-earnings-growth ratio of 3.76 and a beta of 1.21. The company has a current ratio of 0.80, a quick ratio of 0.20 and a debt-to-equity ratio of 1.58. The firm has a 50 day moving average of $168.02 and a 200 day moving average of $168.80. About AutoNation ( Free Report ) AutoNation, Inc, through its subsidiaries, operates as an automotive retailer in the United States. The company operates through three segments: Domestic, Import, and Premium Luxury. It offers a range of automotive products and services, including new and used vehicles; and parts and services, such as automotive repair and maintenance, and wholesale parts and collision services. Featured Articles Want to see what other hedge funds are holding AN? Visit HoldingsChannel.com to get the latest 13F filings and insider trades for AutoNation, Inc. ( NYSE:AN – Free Report ). Receive News & Ratings for AutoNation Daily - Enter your email address below to receive a concise daily summary of the latest news and analysts' ratings for AutoNation and related companies with MarketBeat.com's FREE daily email newsletter .

AAC Technologies Holdings Inc. ( OTCMKTS:AACAY – Get Free Report ) saw a significant decline in short interest in the month of November. As of November 15th, there was short interest totalling 6,100 shares, a decline of 45.5% from the October 31st total of 11,200 shares. Based on an average trading volume of 41,400 shares, the days-to-cover ratio is currently 0.1 days. AAC Technologies Trading Down 0.3 % Shares of AACAY stock opened at $4.46 on Friday. AAC Technologies has a fifty-two week low of $2.04 and a fifty-two week high of $4.74. The stock has a 50 day simple moving average of $4.06 and a two-hundred day simple moving average of $3.80. About AAC Technologies ( Get Free Report ) Featured Articles Receive News & Ratings for AAC Technologies Daily - Enter your email address below to receive a concise daily summary of the latest news and analysts' ratings for AAC Technologies and related companies with MarketBeat.com's FREE daily email newsletter .By CHRIS MEGERIAN and COLLEEN LONG WASHINGTON (AP) — In the two weeks since Donald Trump won the presidency, he’s tried to demonstrate his dominance by naming loyalists for top administration positions, even though many lack expertise and some face sexual misconduct accusations. It often seems like he’s daring Congress to oppose his decisions. But on Thursday, Trump’s attempt to act with impunity showed a crack as Matt Gaetz , his choice for attorney general, withdrew from consideration. Trump had named Gaetz, a Florida congressman, to be the country’s top law enforcement official even though he was widely disliked by his colleagues, has little legal experience and was accused of having sex with an underage girl, an allegation he denied. After being plagued by investigations during his first presidency, Trump wanted a devoted ally in charge of the Justice Department during his second. However, it was never obvious that Gaetz could win enough support from lawmakers to get confirmed as attorney general. Trump chose for a replacement Pam Bondi, a former Florida attorney general who defended him during his first impeachment trial and supported his false claims of voter fraud. Now the question is whether Gaetz was uniquely unpalatable, or if Trump’s other picks might exceed his party’s willingness to overlook concerns that would have sunk nominees in a prior political era. The next test will likely be Pete Hegseth, who Trump wants to lead the Pentagon despite an allegation of sexual assault that he’s denied. So far, Republicans are rallying around Hegseth , an Army veteran and former Fox News host. Sen. Thom Tillis, a North Carolina Republican who serves on the Senate Judiciary Committee, said the controversy over Gaetz would have little bearing on Trump’s other choices. He said they would be considered “one at a time.” Sen. Richard Blumenthal, a Connecticut Democrat, suggested otherwise, claiming “the dominoes are falling.” “The drip drip of evidence and truth is going to eventually doom some others,” he said. Trump’s election victory was a sign that there may not be many red lines left in American politics. He won the presidential race despite authoritarian, racist and misogynist rhetoric, not to mention years of lies about election fraud and his role in sparking the Jan. 6, 2021, attack on the U.S. Capitol. He was also criminally convicted of falsifying business records to pay hush money, and he was found liable for sexual abuse in a civil case. Empowered by voters who looked past his misconduct and saw him as a powerful agent of change, Trump has shown no deference to Washington norms while working to fill his second administration . The transition team hasn’t pursued federal background checks for Trump’s personnel choices. While some of his selections have extensive experience in the areas they’ve been chosen to lead, others are personal friends and Fox News personalities who have impressed and flattered Trump over the years. Several have faced allegations involving sexual misconduct . Hegseth is facing the most scrutiny after Gaetz. Once Trump announced Hegseth as his nominee for Pentagon chief, allegations emerged that he sexually assaulted a woman in California in 2017. The woman said he took her phone, blocked the door to the hotel room and refused to let her leave, according to a police report made public this week. Hegseth told police at the time that the encounter had been consensual and denied any wrongdoing, the report said. However, he paid the woman a confidential settlement in 2023. Hegseth’s lawyer said the payment was made to head off the threat of a baseless lawsuit. Trump’s choice for secretary of health and human Services, Robert F. Kennedy Jr., has faced allegations of misconduct too. A woman who babysat for him and his second wife told Vanity Fair magazine that Kennedy groped her in the late 1990s, when she was 23. Kennedy did not deny the allegation and texted an apology to the woman after the article was published. That isn’t the only hurdle for Kennedy; he’s spent years spreading misinformation and conspiracy theories about vaccines, raising fears about making him a top health official in the new administration. Linda McMahon, chosen by Trump to be education secretary, is fighting a lawsuit connected to her former company, World Wrestling Entertainment. She’s accused of knowingly enabling sexual exploitation of children by an employee as early as the 1980s, and she denies the allegations. Tulsi Gabbard is another person who could face a difficult confirmation battle, but for very different reasons. The former Democratic representative from Hawaii has been a vocal Trump ally, and he chose her to be national intelligence director. But there’s grave concern by lawmakers and national security officials over Gabbard’s history of echoing Russian propaganda. Critics said she would endanger relationships with U.S. allies. Gaetz was investigated by federal law enforcement for sex trafficking, but the case was closed without charges and Republicans have blocked the release of a related report from the House Ethics Committee. However, some allegations leaked out, including that Gaetz paid women for sex. One of the women testified to the committee that she saw Gaetz having sex with a 17-year-old girl, according to a lawyer for the woman. As Gaetz met with senators this week, it became clear that he would face stubborn resistance from lawmakers who were concerned about his behavior and believed he was unqualified to run the Justice Department. “While the momentum was strong, it is clear that my confirmation was unfairly becoming a distraction,” Gaetz wrote on social media when announcing his withdrawal. Sen. Mike Braun, an Indiana Republican, said he believed there were four to six members of the caucus who would have voted against Gaetz, likely dooming his nomination, and “the math got too hard.” He said some of the issues and allegations around Gaetz were “maybe beyond the pale.” “I think there were just too many things, it was like a leaky dike, and you know, it broke,” Braun said. Trump thanked Gaetz in a post on Truth Social, his social media website, without addressing the substance of the allegations against him. “He was doing very well but, at the same time, did not want to be a distraction for the Administration, for which he has much respect,” Trump wrote. Associated Press writers Mary Clare Jalonick, Stephen Groves and Lisa Macaro contributed from Washington. Jill Colvin in New York and Adriana Gomez Licon in Fort Lauderdale, Florida, also contributed.

Trump convinced Republicans to overlook his misconduct. But can he do the same for his nominees?Charles Schwab Investment Management Inc. Boosts Stock Position in Avient Co. (NYSE:AVNT)