{"id":20590,"date":"2019-07-16T15:14:00","date_gmt":"2019-07-16T15:14:00","guid":{"rendered":"https:\/\/associatednews.us\/content\/2019\/07\/16\/regulations-that-mandate-sepsis-care-appear-to-have-worked-in-new-york\/"},"modified":"2019-07-16T15:14:00","modified_gmt":"2019-07-16T15:14:00","slug":"regulations-that-mandate-sepsis-care-appear-to-have-worked-in-new-york","status":"publish","type":"post","link":"https:\/\/associatednews.us\/content\/regulations-that-mandate-sepsis-care-appear-to-have-worked-in-new-york\/","title":{"rendered":"Regulations That Mandate Sepsis Care Appear To Have Worked In New York"},"content":{"rendered":"<p><span style=\"font-style:italic;font-size:16px\">By  <a class=\"colorbox\" href=\"https:\/\/www.npr.org\/sections\/health-shots\/2019\/07\/16\/741840484\/regulations-that-mandate-sepsis-care-appear-to-have-worked-in-new-york?utm_medium=RSS&amp;utm_campaign=healthcare\">Richard Harris<\/a><\/span>  <\/p>\n<div class=\"ftpimagefix\" style=\"float:left\"><a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/www.npr.org\/sections\/health-shots\/2019\/07\/16\/741840484\/regulations-that-mandate-sepsis-care-appear-to-have-worked-in-new-york?utm_medium=RSS&amp;utm_campaign=healthcare\"><img decoding=\"async\" width=\"150\" src=\"https:\/\/media.npr.org\/assets\/img\/2019\/07\/15\/sciencesource_ss21258004_custom-e0fd276f0ca7903704b337f1183a9445e5dcb6e7-s1100-c15.jpg\" alt><\/p>\n<div>\n            <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/media.npr.org\/assets\/img\/2019\/07\/15\/sciencesource_ss21258004_custom-e0fd276f0ca7903704b337f1183a9445e5dcb6e7-s1200.jpg\"><\/a><\/div>\n<div>\n<div>\n<div>\n            <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/media.npr.org\/assets\/img\/2019\/07\/15\/sciencesource_ss21258004_custom-e0fd276f0ca7903704b337f1183a9445e5dcb6e7-s1200.jpg\">Enlarge this image<\/a>\n        <\/div>\n<\/div>\n<div>\n<div>\n<div>\n<p>\n                Bacteria (purple) in the bloodstream can trigger sepsis, a life-threatening illness.<\/p>\n<p>                <b><br \/>\n                    <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/www.sciencesource.com\/\" target=\"_blank\"><br \/>\n                    Steve Gschmeissner\/ScienceSource<br \/>\n                    <\/a><br \/>\n                <\/b><br \/>\n                <b><b>hide caption<\/b><\/b>\n            <\/p>\n<\/p><\/div>\n<p>            <b><b>toggle caption<\/b><\/b>\n    <\/div>\n<p>    <span><br \/>\n        <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/www.sciencesource.com\/\" target=\"_blank\"><br \/>\n        Steve Gschmeissner\/ScienceSource<br \/>\n        <\/a><br \/>\n    <\/span>\n<\/div>\n<\/p><\/div>\n<p>An unusual state regulation that dictates how doctors need to treat a specific disease appears to be paying off in New York, according to a study published Tuesday.<\/p>\n<p>The disease is sepsis, which is the most common cause of death in hospitals. And the regulations came into being after the story of 12-year-old Rory Staunton became a <em>cause c\u00e9l\u00e8bre.<\/em><\/p>\n<p>As his mother Orlaith Staunton tells it, Rory came home from school one day with a scrape he&#8217;d gotten in gym class. It didn&#8217;t seem like a big deal, but Rory&#8217;s health quickly took a turn.<\/p>\n<p>&#8220;During the night I heard him throwing up and I went out and he said, &#8216;It&#8217;s my leg, Mom, it&#8217;s my leg.'&#8221;<\/p>\n<p>His temperature spiked above 103 and he couldn&#8217;t keep anything down the next day, so she took him to their pediatrician in New York City. <\/p>\n<p>The doctor decided Rory had the flu and sent him on to the hospital to get fluids. Staunton says doctors in the emergency room decided it was simply a stomach bug and sent him home. But Rory kept getting worse.<\/p>\n<aside>\n<div><\/div>\n<\/aside>\n<p>&#8220;We brought him back into hospital \u2014 that was on Friday night \u2014 and he died on Sunday evening,&#8221; Staunton says. &#8220;He went straight into intensive care when we brought him back in. And it was after he died that we were told that he had died from sepsis.&#8221;<\/p>\n<p>She says she&#8217;d never heard of sepsis, even though the illness strikes more than a million Americans a year and kills more than 250,000 annually. <\/p>\n<p>Sepsis is an overreaction of the body&#8217;s immune system to an infection. Common <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/www.cdc.gov\/sepsis\/signs-symptoms.html\">symptoms include fever, chills<\/a>, difficulty breathing and an elevated heart rate. <\/p>\n<p>If the hospital had diagnosed Rory correctly during his first visit and treated him aggressively, Staunton says, he likely would have lived.<\/p>\n<p>She and her husband, Ciaran, &#8220;were angry and we wanted to do something that would bring about some change in how sepsis was being diagnosed and how people would know what sepsis was,&#8221; she says.<\/p>\n<div>\n<div>\n    <img decoding=\"async\" src=\"https:\/\/media.npr.org\/assets\/img\/2019\/07\/15\/rsf-rory-by-the-fence_high-res-1-_custom-b8bba0e6d11c7831d3200af9a71b4bb06291ed9a-s1100-c15.jpg\" alt><\/div>\n<div>\n<div>\n<div>\n<p>\n                Rory Staunton, a boy from Queens, New York, whose death from sepsis at age 12 led to regulations that aimed to improve diagnosis and care.<\/p>\n<p>                <b><\/p>\n<p>                    Courtesy of Orlaith Staunton<\/p>\n<p>                <\/b><br \/>\n                <b><b>hide caption<\/b><\/b>\n            <\/p>\n<\/p><\/div>\n<p>            <b><b>toggle caption<\/b><\/b>\n    <\/div>\n<p>    <span><\/p>\n<p>        Courtesy of Orlaith Staunton<\/p>\n<p>    <\/span>\n<\/div>\n<\/p><\/div>\n<p>And as a result of their efforts, Rory&#8217;s death in 2012 catalyzed action in New York state, which in 2013 imposed &#8220;<a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/rorystauntonfoundationforsepsis.org\/rorys-regulations-full-legal-document\/\">Rory&#8217;s Regulations<\/a>,&#8221; a directive to doctors and hospitals on how to treat sepsis. The key is rapid diagnosis, a prompt jolt of antibiotics, and careful management of fluids.<\/p>\n<p><a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/ccm.pitt.edu\/node\/252\">Jeremy Kahn<\/a>, a critical care physician at the University of Pittsburgh who also studies health policy and management, says doctors like him don&#8217;t like to be directed how to treat their patients. They prefer to follow professional guidelines. But as is surprisingly common, doctors are slow to adopt best practices. And that&#8217;s true for sepsis.<\/p>\n<p>&#8220;The decades of undertreating patients with sepsis has a bit weakened our position,&#8221; Kahn says, &#8220;and it&#8217;s time to be a little, be more open about, accepting about these regulatory approaches.&#8221;<\/p>\n<p>But first Kahn and his colleagues wanted see whether the New York regulations really did make a difference. Sepsis death rates are declining nationwide, so the question is whether New York&#8217;s rules led to faster improvement compared to other states.<\/p>\n<p>Kahn and his colleagues compared the rate of improvement in New York to that of other states and concluded that &#8220;these regulations had their intended effect of reducing mortality,&#8221; he says. The <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2738290?guestAccessKey=6bc35b42-5170-4574-b691-d2733c0c6cc5&amp;utm_source=For_The_Media&amp;utm_medium=referral&amp;utm_campaign=ftm_links&amp;utm_content=tfl&amp;utm_term=071619\">results were published in <\/a><em>JAMA,<\/em> the journal of the American Medical Association.<\/p>\n<p>One reason some doctors have been reluctant to embrace the regulation is that it expects them to follow a specific set of practices, including a formula regulating how much fluid to infuse and when.<\/p>\n<p>&#8220;There&#8217;s a lot of concern in the clinical community that this much fluid can harm at least some patients with sepsis,&#8221; Kahn says. While the rules overall may be saving lives, this element of them may actually be counterproductive. But doctors aren&#8217;t supposed to deviate from them.<\/p>\n<p><!-- END ID=\"RES742203566\" CLASS=\"BUCKETWRAP INTERNALLINK INSETTWOCOLUMN INSET2COL \" --><\/p>\n<p>There clearly is still room for improvement in treating sepsis, so rules need to be flexible enough to embrace improvements as they emerge, Kahn says. &#8220;The evidence changes all the time,&#8221; he says, &#8220;and when you enshrine [what is currently] &#8216;best practice&#8217; into laws or regulations then you become less nimble.&#8221;<\/p>\n<p>Another question is whether New York&#8217;s success would be repeated elsewhere. New York state started off much worse than many other states, so it&#8217;s possible the regulations simply helped the state catch up with others, he says.<\/p>\n<p>&#8220;It does call into question what kind of impact these regulations will have in other states that may have better sepsis outcomes at baseline,&#8221; Kahn says.<\/p>\n<p>That matters because a few other states have similar regulations or laws, and more than a dozen more are considering them. The Stauntons <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/rorystauntonfoundationforsepsis.org\/\">started a foundation<\/a>, which is now trying to push this nationwide. <\/p>\n<p>Orlaith Staunton says it just won&#8217;t do to leave it to the judgment of individual doctors.<\/p>\n<p>&#8220;It&#8217;s not enough to say, &#8216;Leave it to me and I&#8217;ll recognize it when I see it,&#8217; &#8221; she says. &#8220;Because clearly it has not been recognized. I think good doctors will agree that this is something that needs to be regulated.&#8221;<\/p>\n<p>She hopes the new scientific results will sway some of the doctors and hospitals who are resisting a government mandate.<\/p>\n<p>That won&#8217;t happen overnight. Demetrios Kyriacou, an emergency medicine physician at Northwestern University, <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2738271\">wrote a cautionary editorial<\/a> in <em>JAMA<\/em> saying that &#8220;major public health interventions cannot be based on [Kahn&#8217;s] single observational study.&#8221;<\/p>\n<p>&#8220;Because demands on nurses and physicians to provide rapid intensive care to patients in critical settings can affect patient treatment,&#8221; he wrote, &#8220;any strategy aimed toward reducing sepsis-related morbidity and mortality must be based on convincing evidence before being mandated by governmental regulations.&#8221;<\/p>\n<p><em>You can contact NPR Science Correspondent Richard Harris at <\/em><a class=\"colorbox\" rel=\"nofollow\" href=\"mailto:rharris@npr.org\">rharris@npr.org<\/a>.<\/p>\n<p><strong><a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/blockads.fivefilters.org\/\">Let&#8217;s block ads!<\/a><\/strong> <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/blockads.fivefilters.org\/acceptable.html\">(Why?)<\/a><\/p>\n<p>Source:: <a href=\"https:\/\/www.npr.org\/sections\/health-shots\/2019\/07\/16\/741840484\/regulations-that-mandate-sepsis-care-appear-to-have-worked-in-new-york?utm_medium=RSS&amp;utm_campaign=healthcare\" class=\"colorbox\" title=\"Regulations That Mandate Sepsis Care Appear To Have Worked In New York\" rel=\"nofollow\">https:\/\/www.npr.org\/sections\/health-shots\/2019\/07\/16\/741840484\/regulations-that-mandate-sepsis-care-appear-to-have-worked-in-new-york?utm_medium=RSS&amp;utm_campaign=healthcare<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<div class=\"ftpimagefix\" style=\"float:left\"><a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/www.npr.org\/sections\/health-shots\/2019\/07\/16\/741840484\/regulations-that-mandate-sepsis-care-appear-to-have-worked-in-new-york?utm_medium=RSS&amp;utm_campaign=healthcare\"><img decoding=\"async\" width=\"150\" src=\"https:\/\/media.npr.org\/assets\/img\/2019\/07\/15\/sciencesource_ss21258004_custom-e0fd276f0ca7903704b337f1183a9445e5dcb6e7-s1100-c15.jpg\" alt><\/p>\n<div>\n            <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/media.npr.org\/assets\/img\/2019\/07\/15\/sciencesource_ss21258004_custom-e0fd276f0ca7903704b337f1183a9445e5dcb6e7-s1200.jpg\"><\/a><\/div>\n<div>\n<div>\n<div>\n            <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/media.npr.org\/assets\/img\/2019\/07\/15\/sciencesource_ss21258004_custom-e0fd276f0ca7903704b337f1183a9445e5dcb6e7-s1200.jpg\">Enlarge this image<\/a>\n        <\/div>\n<\/div>\n<div>\n<div>\n<div>\n<p>\n                Bacteria (purple) in the bloodstream can trigger sepsis, a life-threatening illness.<\/p>\n<p>                <b><br \/>\n                    <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/www.sciencesource.com\/\" target=\"_blank\"><br \/>\n                    Steve Gschmeissner\/ScienceSource<br \/>\n                    <\/a><br \/>\n                <\/b><br \/>\n                <b><b>hide caption<\/b><\/b>\n            <\/p>\n<\/p><\/div>\n<p>            <b><b>toggle caption<\/b><\/b>\n    <\/div>\n<p>    <span><br \/>\n        <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/www.sciencesource.com\/\" target=\"_blank\"><br \/>\n        Steve Gschmeissner\/ScienceSource<br \/>\n        <\/a><br \/>\n    <\/span>\n<\/div>\n<\/p><\/div>\n<p>An unusual state regulation that dictates how doctors need to treat a specific disease appears to be paying off in New York, according to a study published Tuesday.<\/p>\n<p>The disease is sepsis, which is the most common cause of death in hospitals. And the regulations came into being after the story of 12-year-old Rory Staunton became a <em>cause c\u00e9l\u00e8bre.<\/em><\/p>\n<p>As his mother Orlaith Staunton tells it, Rory came home from school one day with a scrape he&#8217;d gotten in gym class. It didn&#8217;t seem like a big deal, but Rory&#8217;s health quickly took a turn.<\/p>\n<p>&#8220;During the night I heard him throwing up and I went out and he said, &#8216;It&#8217;s my leg, Mom, it&#8217;s my leg.'&#8221;<\/p>\n<p>His temperature spiked above 103 and he couldn&#8217;t keep anything down the next day, so she took him to their pediatrician in New York City. <\/p>\n<p>The doctor decided Rory had the flu and sent him on to the hospital to get fluids. Staunton says doctors in the emergency room decided it was simply a stomach bug and sent him home. But Rory kept getting worse.<\/p>\n<aside>\n<div><\/div>\n<\/aside>\n<p>&#8220;We brought him back into hospital \u2014 that was on Friday night \u2014 and he died on Sunday evening,&#8221; Staunton says. &#8220;He went straight into intensive care when we brought him back in. And it was after he died that we were told that he had died from sepsis.&#8221;<\/p>\n<p>She says she&#8217;d never heard of sepsis, even though the illness strikes more than a million Americans a year and kills more than 250,000 annually. <\/p>\n<p>Sepsis is an overreaction of the body&#8217;s immune system to an infection. Common <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/www.cdc.gov\/sepsis\/signs-symptoms.html\">symptoms include fever, chills<\/a>, difficulty breathing and an elevated heart rate. <\/p>\n<p>If the hospital had diagnosed Rory correctly during his first visit and treated him aggressively, Staunton says, he likely would have lived.<\/p>\n<p>She and her husband, Ciaran, &#8220;were angry and we wanted to do something that would bring about some change in how sepsis was being diagnosed and how people would know what sepsis was,&#8221; she says.<\/p>\n<div>\n<div>\n    <img decoding=\"async\" src=\"https:\/\/media.npr.org\/assets\/img\/2019\/07\/15\/rsf-rory-by-the-fence_high-res-1-_custom-b8bba0e6d11c7831d3200af9a71b4bb06291ed9a-s1100-c15.jpg\" alt><\/div>\n<div>\n<div>\n<div>\n<p>\n                Rory Staunton, a boy from Queens, New York, whose death from sepsis at age 12 led to regulations that aimed to improve diagnosis and care.<\/p>\n<p>                <b><\/p>\n<p>                    Courtesy of Orlaith Staunton<\/p>\n<p>                <\/b><br \/>\n                <b><b>hide caption<\/b><\/b>\n            <\/p>\n<\/p><\/div>\n<p>            <b><b>toggle caption<\/b><\/b>\n    <\/div>\n<p>    <span><\/p>\n<p>        Courtesy of Orlaith Staunton<\/p>\n<p>    <\/span>\n<\/div>\n<\/p><\/div>\n<p>And as a result of their efforts, Rory&#8217;s death in 2012 catalyzed action in New York state, which in 2013 imposed &#8220;<a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/rorystauntonfoundationforsepsis.org\/rorys-regulations-full-legal-document\/\">Rory&#8217;s Regulations<\/a>,&#8221; a directive to doctors and hospitals on how to treat sepsis. The key is rapid diagnosis, a prompt jolt of antibiotics, and careful management of fluids.<\/p>\n<p><a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/ccm.pitt.edu\/node\/252\">Jeremy Kahn<\/a>, a critical care physician at the University of Pittsburgh who also studies health policy and management, says doctors like him don&#8217;t like to be directed how to treat their patients. They prefer to follow professional guidelines. But as is surprisingly common, doctors are slow to adopt best practices. And that&#8217;s true for sepsis.<\/p>\n<p>&#8220;The decades of undertreating patients with sepsis has a bit weakened our position,&#8221; Kahn says, &#8220;and it&#8217;s time to be a little, be more open about, accepting about these regulatory approaches.&#8221;<\/p>\n<p>But first Kahn and his colleagues wanted see whether the New York regulations really did make a difference. Sepsis death rates are declining nationwide, so the question is whether New York&#8217;s rules led to faster improvement compared to other states.<\/p>\n<p>Kahn and his colleagues compared the rate of improvement in New York to that of other states and concluded that &#8220;these regulations had their intended effect of reducing mortality,&#8221; he says. The <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2738290?guestAccessKey=6bc35b42-5170-4574-b691-d2733c0c6cc5&amp;utm_source=For_The_Media&amp;utm_medium=referral&amp;utm_campaign=ftm_links&amp;utm_content=tfl&amp;utm_term=071619\">results were published in <\/a><em>JAMA,<\/em> the journal of the American Medical Association.<\/p>\n<p>One reason some doctors have been reluctant to embrace the regulation is that it expects them to follow a specific set of practices, including a formula regulating how much fluid to infuse and when.<\/p>\n<p>&#8220;There&#8217;s a lot of concern in the clinical community that this much fluid can harm at least some patients with sepsis,&#8221; Kahn says. While the rules overall may be saving lives, this element of them may actually be counterproductive. But doctors aren&#8217;t supposed to deviate from them.<\/p>\n<p><!-- END ID=\"RES742203566\" CLASS=\"BUCKETWRAP INTERNALLINK INSETTWOCOLUMN INSET2COL \" --><\/p>\n<p>There clearly is still room for improvement in treating sepsis, so rules need to be flexible enough to embrace improvements as they emerge, Kahn says. &#8220;The evidence changes all the time,&#8221; he says, &#8220;and when you enshrine [what is currently] &#8216;best practice&#8217; into laws or regulations then you become less nimble.&#8221;<\/p>\n<p>Another question is whether New York&#8217;s success would be repeated elsewhere. New York state started off much worse than many other states, so it&#8217;s possible the regulations simply helped the state catch up with others, he says.<\/p>\n<p>&#8220;It does call into question what kind of impact these regulations will have in other states that may have better sepsis outcomes at baseline,&#8221; Kahn says.<\/p>\n<p>That matters because a few other states have similar regulations or laws, and more than a dozen more are considering them. The Stauntons <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/rorystauntonfoundationforsepsis.org\/\">started a foundation<\/a>, which is now trying to push this nationwide. <\/p>\n<p>Orlaith Staunton says it just won&#8217;t do to leave it to the judgment of individual doctors.<\/p>\n<p>&#8220;It&#8217;s not enough to say, &#8216;Leave it to me and I&#8217;ll recognize it when I see it,&#8217; &#8221; she says. &#8220;Because clearly it has not been recognized. I think good doctors will agree that this is something that needs to be regulated.&#8221;<\/p>\n<p>She hopes the new scientific results will sway some of the doctors and hospitals who are resisting a government mandate.<\/p>\n<p>That won&#8217;t happen overnight. Demetrios Kyriacou, an emergency medicine physician at Northwestern University, <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2738271\">wrote a cautionary editorial<\/a> in <em>JAMA<\/em> saying that &#8220;major public health interventions cannot be based on [Kahn&#8217;s] single observational study.&#8221;<\/p>\n<p>&#8220;Because demands on nurses and physicians to provide rapid intensive care to patients in critical settings can affect patient treatment,&#8221; he wrote, &#8220;any strategy aimed toward reducing sepsis-related morbidity and mortality must be based on convincing evidence before being mandated by governmental regulations.&#8221;<\/p>\n<p><em>You can contact NPR Science Correspondent Richard Harris at <\/em><a class=\"colorbox\" rel=\"nofollow\" href=\"mailto:rharris@npr.org\">rharris@npr.org<\/a>.<\/p>\n<p><strong><a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/blockads.fivefilters.org\/\">Let&#8217;s block ads!<\/a><\/strong> <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/blockads.fivefilters.org\/acceptable.html\">(Why?)<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[47],"tags":[],"class_list":["post-20590","post","type-post","status-publish","format-standard","hentry","category-health"],"_links":{"self":[{"href":"https:\/\/associatednews.us\/content\/wp-json\/wp\/v2\/posts\/20590","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/associatednews.us\/content\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/associatednews.us\/content\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/associatednews.us\/content\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/associatednews.us\/content\/wp-json\/wp\/v2\/comments?post=20590"}],"version-history":[{"count":0,"href":"https:\/\/associatednews.us\/content\/wp-json\/wp\/v2\/posts\/20590\/revisions"}],"wp:attachment":[{"href":"https:\/\/associatednews.us\/content\/wp-json\/wp\/v2\/media?parent=20590"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/associatednews.us\/content\/wp-json\/wp\/v2\/categories?post=20590"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/associatednews.us\/content\/wp-json\/wp\/v2\/tags?post=20590"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}