N.B.A. Western Conference Preview: The Warriors and 14 Other Guys

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from Kevin Durant. But the excuses for Westbrook came to a halt after General Manager Sam Presti landed two superstars this off-season in Anthony and George, along with a tremendous role player in Patterson. That the Thunder gave up so little to get those players is either a testament to Presti’s savvy or an indictment of how some trades are concluded in the modern N.B.A.

George is a star on both ends of the court, and Anthony is a truly gifted scorer, so if Coach Billy Donovan can come up with a rotation that maximizes those two players while getting Westbrook some rest, the Thunder could be at the top of the West alongside Houston and below Golden State.

Status: No more excuses


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Jimmy Butler (23) will be asked to thrive on the court for the Minnesota Timberwolves, while also helping to get his teammates to buy in to Coach Tom Thibodeau’s system.CreditZhong Zhi/Getty Images

Minnesota Timberwolves

31-51 last season

Key newcomers: Jimmy Butler, Jeff Teague, Taj Gibson, Jamal Crawford

Key departures: Ricky Rubio, Kris Dunn, Zach LaVine, Nikola Pekovic

Outlook: Coach Tom Thibodeau is known as a great teacher, but he struggled to turn his lessons into results last season despite having one of the game’s best young players in Karl-Anthony Towns and a potential star in Andrew Wiggins. Now Thibodeau has added two of his favorites — Butler and Gibson, who can simultaneously produce at a high level and help their coach break in the younger players. Teague and Crawford can chip in consistent veteran production, and Minnesota did not have to give up much to put this new team together.

Chemistry is always a question with a club that had a great deal of turnover, and no one really knows what to make of Wiggins, but the combination of Towns and Butler should be enough to make Minnesota a team that no one will want to play.

Status: On the way up


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The Portland Trail Blazers appeared to improve when Jusuf Nurkic, center, came over in a trade with the Denver Nuggets. Whether or not that improvement is sustainable is an open question.CreditSteve Dipaola/Associated Press

Portland Trail Blazers

41-41 last season

Key newcomers: Zach Collins (draft)

Key departures: Allen Crabbe, Festus Ezeli

Outlook: Portland is desperately hoping that its strong play after Jusuf Nurkic was acquired last season was not a mirage. Impassioned debates have arisen over whether Nurkic’s production really was behind the team’s 14-6 regular-season record when he was on the court, and he has become a totem of sorts for those who argue that the Blazers are to be reckoned with this season.

The reality is probably that the Blazers have a terrific backcourt in Damian Lillard and C.J. McCollum but not enough other talent to be considered one of the topteams in the West. With Lillard squarely in his prime, Portland needs some more help soon or it will have wasted the talent of a special player.

Status: Outgunned


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Nikola Jokic, left, and Paul Millsap, right, are remarkably different players, but the Denver Nuggets are hoping they can complement each other and turn the team into a contender.CreditDavid Zalubowski/Associated Press

Denver Nuggets

40-42 last season

Key newcomers: Paul Millsap, Josh Childress

Key departures: Danilo Gallinari

Outlook: Nikola Jokic is probably the best player that you have never seen play. A 6-foot 10-inch passing wonder from Serbia, Jokic, 22, is an absolute machine on offense. He can create plays out of thin air and knock down jump shots if teams try to cheat against him. Because he does not have elite athleticism, there has been a consistent belief that he is a poor defender, but he has worked hard on that element of his game. If he can keep improving in that area, he will be one of the best players in the N.B.A.

It says a lot about Jokic that a free agent like Millsap would choose to join Denver, and they seemingly form a great offense-defense combination that could pay huge dividends for the team, especially if Jamal Murray and Gary Harris can coexist in the backcourt.

Status: A sneaky-fun League Pass team


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Rudy Gobert is a fantastic player, but with the Utah Jazz losing their top two scorers from a year ago, the team is likely to regress.CreditRick Bowmer/Associated Press

Utah Jazz

51-31 last season

Key newcomers: Ricky Rubio, Donovan Mitchell (draft), Tyler Lydon (draft), Josh Hart (draft)

Key departures: Gordon Hayward, George Hill, Boris Diaw

Outlook: There is no getting around the fact that Utah was wounded deeply by the defection of Hayward to Boston. The Jazz had developed him into a star, and many expected him to stay. Utah also lost its second-leading scorer in Hill. So who’s left? Well, Rudy Gobert, who is one of the N.B.A.’s best defenders; Joe Ingles, an entertaining role player; and Mitchell, who could be a breakout rookie.

That’s not enough to prevent a dramatic downturn, but Utah has shown in recent seasons that it knows how to build a team. So the exile to Lotteryville might not last long.

Status: Plummeting, for now


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Chris Paul, far left, and James Harden, center, are an odd pairing for the Houston Rockets, but Coach Mike D’Antoni is known for his creativity.CreditSue Ogrocki/Associated Press

Southwest Division

Houston Rockets

55-27 last season

Key newcomers: Chris Paul, P.J. Tucker

Key departures: Patrick Beverley, Sam Dekker, Montrezl Harrell, Lou Williams

Outlook: The N.B.A. is littered with people who have underestimated Mike D’Antoni and lived to regret it, but this year presents a special challenge for a coach famous for his offensive vision. He now has a team with Paul and James Harden, two ball-dominant point guards who are used to having absolutely everything run through them. On top of that, Paul, at 32, is not exactly suited to the lightning-fast offenses that D’Antoni and Harden prefer.

Still, this is a gamble the Rockets had to take. They now have two of the game’s best players and a chance to create something special. But it is going to involve some serious creativity from D’Antoni and a total buy-in from Paul and Harden to make it work.

Status: Learning to share


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Rudy Gay, who has played 11 seasons in the N.B.A., is the latest veteran to search for late-career enlightenment as a member of the San Antonio Spurs.CreditEric Gay/Associated Press

San Antonio Spurs

61-21 last season

Key newcomers: Rudy Gay, Derrick White (draft)

Key departures: Jonathon Simmons

Outlook: The Spurs are the Spurs. They lose players every year and end up fine. They bring in players who do not seem like much and those players suddenly have their best season in years. Gay can probably already be counted on for a surprising resurgence under Coach Gregg Popovich’s tutelage.

The one exception to the Spurs’ magic seems to be forward LaMarcus Aldridge. He came over from Portland a few years ago with great fanfare, but he has not lived up to the difficult task of replacing Tim Duncan. But even without Aldridge having a major impact, a team led by Kawhi Leonard is going to be just fine, at least until the playoffs start.

Status: Quietly thriving


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DeMarcus Cousins and Anthony Davis are a matchup nightmare for almost any team, and the New Orleans Pelicans hope an off-season working together will pay dividends.CreditDavid Zalubowski/Associated Press

New Orleans Pelicans

34-48 last season

Key newcomers: Rajon Rondo, Tony Allen, Ian Clark, Frank Jackson (draft)

Key departures: None

Outlook: Pairing Anthony Davis and DeMarcus Cousins is unapologetically weird in the modern N.B.A., so adding Rondo in the mix makes perfect sense. His potentially divisive personality comes with a huge amount of on-court creativity, and the Pelicans will hope that he is the player who can figure out how to make their big men thrive. He was expected to start alongside Jrue Holiday, but that will have to wait; Rondo is out for four to six weeks after having surgery for a sports hernia.

Allen is past his prime but can still contribute on defense, and Clark is capable of knocking down the open jumpers that the clogged frontcourt should create, so a serious improvement is reasonable once Rondo is back.

Status: Too weird to fail?


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Dirk Nowitzki, left, signed a two-year deal with the Dallas Mavericks this off-season, and he should enjoy them after the team drafted Dennis Smith Jr., right, to run the team’s offense.CreditLM Otero/Associated Press

Dallas Mavericks

33-49 last season

Key newcomers: Josh McRoberts, Dennis Smith (draft)

Key departures: A.J. Hammons

Outlook: The Mavericks will be a delight for as long as Dirk Nowitzki sticks around, though their roster does not seem deep enough to compete in a crowded West. A lot of players would seem frustrated by this situation, but Nowitzki has always seemed to have a good attitude about it, even posting a tweet thanking a fan whosent him $20 to offset some of the money Nowitzki has left on the table over the years to help Dallas try to build a winner.

A version of this article appears in print on , on Page B11 of the New York edition with the headline: Warriors Remain the Team to Catch. Order Reprints | Today’s Paper | Subscribe

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N.F.L. Owners Won’t Penalize Players for Kneeling During Anthem

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The N.F.L. for now will continue to let players kneel or sit during the national anthem without a penalty, capitulating to demands by the athletes for free expression but potentially further alienating fans who object to the protests and feel they are disrespectful to the flag and the military.

But, after a meeting Tuesday with union representatives and players, the league did promise to help support some of the causes targeted by the protesting players, including reform of the criminal justice system.

The owners’ decision to not toughen the league’s stance on anthem demonstrations showed yet again the contortions they have been going through to display support for their players while wrestling with the political fallout of the sideline protests that have persisted since last season.

The players, largely on social media, had made clear they would not abide penalties for sitting or kneeling during the pregame anthem, while legal experts wondered if any punitive change would hold up in court. The gestures began last season, spurred by Colin Kaepernick, then the quarterback of the San Francisco 49ers, to draw attention to racial oppression and police brutality against black Americans.

The Miami Dolphins’ owner, Stephen Ross, speaking in New York at a business meeting of the 32 owners, said that the league had made no changes to its policy and that players would be free to protest again this weekend.

“I can’t really tell you what people are going to do,” Ross said when asked if players would continue to protest. “The league has a policy. It hasn’t changed.”

The league’s rule book never required players to stand for the anthem but says they must be on the sideline during the song and “should” stand for it.

The ambiguity in the rule has made it difficult for the league to fine players who have either sat or knelt for the anthem, and the owners had discussed clarifying the wording to make standing for the anthem mandatory.

By leaving the rule alone, the league has chosen to avoid more internal strife with its players and to potentially weather more criticism from fans and President Trump, who has repeatedly ridiculed the league for not firing players who demonstrate during the anthem.

“We need to be above petty attacks from anybody, because racial and socioeconomic inequality has existed in this country for too long,” Jed York, the chief executive and co-owner of the San Francisco 49ers, said when asked about the president’s criticism of the league. “You got to block out the noise and go do your job, and that’s what we need to focus on.”

The meeting on Tuesday included the N.F.L.’s commissioner, Roger Goodell; the director of the players’ union, DeMaurice F. Smith; and 11 owners, including Robert K. Kraft of the New England Patriots and Arthur M. Blank of the Atlanta Falcons. They met for almost four hours with a dozen players, including Malcolm Jenkins of the Philadelphia Eagles, Eric Reid of the 49ers and Kenny Stills of the Dolphins, all of whom have protested during the anthem.

“We just talked about how the owners could come alongside us and we could, collectively, collaboratively, work together to actually create some change, real changes,” Jenkins said afterward, flanked by other players. “We feel a real responsibility to our country, to our communities, so we’re working through ways to really have long lasting, real change.”

Jenkins said there had been no discussion during the meeting about prohibiting players from kneeling during the national anthem; whether players continue to do so, he said, would be an individual decision.

He also said that Kaepernick had been invited to the meeting but chose not to attend. Kaepernick’s lawyer, Mark Geragos, later said it was possible that Kaepernick would attend future meetings.

The league’s broadcasters and sponsors have tried to tiptoe past the public spat as pockets of fans have said they would no longer go to games or buy N.F.L. merchandise. Some teams, too, have had to handle a large number of calls from angry fans. Last week, the Jaguars took the unusual step of apologizing to military leaders in the Jacksonville area for demonstrating during the national anthem before their game in London last month.

According to a copy of the letter obtained by The Associated Press, the Jaguars’ president, Mark Lamping, said that the team was “remiss in not fully comprehending the effect of the national anthem demonstration on foreign soil has had on the men and women who have or continue to serve our country.”

To find a way to extinguish the crisis, Goodell has tried to persuade the players’ union to help him to persuade the players to stand for the anthem.

On Monday, Goodell and Seattle Seahawks wide receiver Doug Baldwin sent a letter of support to the congressional sponsors of the Sentencing Reform and Correction Act, a bill designed to increase rehabilitation of people convicted of crimes.

Protesters from the Black Lives Matter movement gathered outside the hotel where the owners were meeting. One demonstrator, Hank Newsome, said Kaepernick was being unfairly treated by the N.F.L. because he brought attention to uncomfortable issues, including racism.

“What I see with the N.F.L. owners is a bunch of good old boys telling the players: Stay in your place,” he said.

Not long after, two protesters confronted the Dallas Cowboys owner Jerry Jones as he walked through the lobby of the hotel, saying that the players were kneeling during the anthem to end white supremacy. Jones listened to the protesters but did not speak to them.

Goodell said late Tuesday that the owners had not asked the players for a pledge to stop protesting during the anthem. He said the league and players would most likely meet again in the next two weeks.

Goodell’s efforts to forge a consensus among the owners come as they are considering whether to extend his current contract by another five years.

Goodell has tried to mollify the players by visiting Philadelphia, Miami and other cities to speak to them and witness their work in the community.

But with the president continuing to harangue the N.F.L. on Twitter, and fans increasingly upset about the league’s handling of the issue, including in Jacksonville, where a fan paid to have a plane fly over the Jaguars’ stadium carrying a message calling for a boycott of the team and the N.F.L., the owners continue to fret over the protests and how they will affect the league’s brand when television ratings have started to slip.

The league also continues to grapple with Kaepernick, who filed a grievance accusing the owners of colluding to keep him from joining a team. Kaepernick, who led the 49ers to the Super Bowl in 2013, has remained unsigned since leaving the team in March.

Cowboys’ Ezekiel Elliott Granted Restraining Order, Blocking Suspension

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Another chapter in the Ezekiel Elliott suspension saga was written Tuesday when a federal court in New York paved the way for him to rejoin the Dallas Cowboys.

The six-game suspension, which Elliott, a star running back, received after a yearlong investigation into a domestic violence allegation, has proved to be a particularly contentious issue between the N.F.L. and the league’s players’ association. Both sides have won legal victories, with the league coming out on top last week when a federal appeals court lifted an injunction that had blocked the suspension from going into effect.

But Judge Paul Crotty of the United States District Court for the Southern District of New York granted a temporary restraining order on Tuesday that had been filed by the N.F.L. Players Association on Elliott’s behalf.

With the Cowboys off last week, the players’ association took its time preparing a strategy to get Elliott reinstated. But with Dallas preparing for a game on Sunday against the San Francisco 49ers, and Elliott barred from participating in team activities, they faced a ticking clock before the suspension became reality. The order, which demands the N.F.L. show cause before a presiding judge on or before Oct. 30, delays the suspension for now, which should allow Elliott to resume practicing with the team and to most likely play on Sunday.

The six-game suspension, which is the baseline suspension for a first-time domestic violence offender, was issued as a result of accusations made by a former girlfriend of Elliott’s in July 2016. Elliott was not arrested or charged by prosecutors, but the N.F.L. used statements by a former girlfriend of Elliott’s, along with photos of injuries he is accused of inflicting upon her, to justify the suspension.

Elliott’s appeal of the suspension rests on the belief that the investigation and appeal were unfair to him. A federal judge in Texas agreed with that notion, issuing an injunction in early September that blocked the suspension from starting.

The U.S. Court of Appeals for the Fifth Circuit threw out that injunction last week in a 2-1 ruling, saying that the lawsuit on Elliott’s behalf was “premature” because all the procedures available under the league’s collective bargaining agreement had yet to be exhausted.

On top of further hearings in New York, the players’ association can, and likely has, sought an en banc hearing of the full panel of five judges from the Fifth Circuit to potentially reinstate the injunction.

Aaron Judge Carves Out a Zany Footnote to His Heroics

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A few innings before Aaron Judge took charge of a baseball game the way he often does — by hitting baseballs over and off outfield walls — he was involved in a madcap baserunning incident on Tuesday that was confounding, amusing and then overshadowed by the Yankees’ late-inning rally.

It was a play that involved, among other things, an attempt to double off Judge on a fly ball, a base that Judge failed to touch, a replay review, an aborted appeal attempt, two balls on the field at the same time, and a very shrewd if unsuccessful tactical move by the Yankees. Baseball could be played for another 150 years without a play like it ever happening again.

In the scorebook for Game 4 of the American League Championship Series, it reads as Judge being thrown out attempting to steal second base in the fourth inning of the Yankees’ dramatic 6-4 comeback victory win over the Houston Astros.

But that hardly hints at what actually occurred.

It began with one out and Judge on first base in a scoreless game. Judge then took off on a hit-and-run play, and Gary Sanchez lifted a fly ball to shallow right field. The ball was caught on the run by right fielder Josh Reddick, and Judge, who had already rounded second, scrambled to beat Reddick’s throw to first to avoid being doubled up.

The play was close, but Judge was called out as he slid into the first-base bag. It seemed as if the Astros had pulled off a double play to end the inning.

But the Yankees thought Judge was safe at first and called for a video review. As the play was shown on the large video board, something else became apparent to the 48,000 paying customers at Yankee Stadium, plus the Houston dugout: Judge had failed to again touch second base on his race back to first. By rule, a runner must do so if he is retreating on the basepaths.

“The screen is as big as the state of New York,” Astros Manager A. J. Hinch said. “We could see he didn’t touch second base on the way back.”

But first came the Yankees’ appeal of the play at first. The umpires ruled that Judge was indeed safe, that he had beaten the Houston throw and was not doubled off.

Then it was the Astros’ turn. Hinch went to the umpires and notified them that he would be making an appeal (not to be confused with a video review request) that Judge failed to touch second base when he ran back to first.

But the Yankees also saw that Judge had failed to retouch second base and that he was about to be called out for his snafu. So they began scheming. The appeal by the Astros could only be enacted after the umpires said the game was back in play. At that point, the Houston pitcher, Lance McCullers, would throw the ball to second base, the one Judge had missed, and Judge would presumably be called out.

But if Judge took off for second and stole it before the Astros got the ball to second to officially ask for the appeal, he would create what is called an “intervening play” and nullify the Astros’ appeal attempt.

Really.

“I was going to be out no matter what,” Judge said. “Why not try?”

Still, the story got even more complicated at that point. The first attempt by the Astros to throw the ball to second and start the appeal was waved off by the umpires because they realized there were two baseballs on the field. Why? Because the Houston infielders had begun throwing an extra ball around to stay loose while the Yankees’ replay review dragged on.

The extra ball was removed from the field and McCullers returned to the pitching rubber with the intention of again throwing the ball to second base to initiate the appeal. But before he could do so, Manager Joe Girardi could be seen in the dugout waving to Judge to take off for second.

He did. Judge has good speed for his size and stole nine bases this year. So while he did not beat McCullers’s throw to second and was tagged out — nullifying any need for the appeal — the play was closer than perhaps it should have been, from the Astros’ perspective.

“Pretty smart play by them trying to steal that base,” Hinch said. “We were fortunate to get the tag.”

It all proved academic anyway. Judge hit a home run in the seventh that cut the Astros’ lead to 4-1. Then, in one of his best at-bats of the year, he stroked a 2-2 slider from Ken Giles to left field that scored Didi Gregorius from first base and tied the score at 4-4.

The fans erupted, in stark contrast to the silence that reigned when Judge was thrown out at second four innings before.

“To be out there with the crowd and the atmosphere was unbelievable,” Judge said.

He was talking about his heroics. But the unusual sequence of events in the fourth inning was pretty unbelievable, too.

Dodgers’ Yasiel Puig Is an Object of Affection Once More

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CHICAGO — During perhaps his best all-around major league season to date, Yasiel Puig, the Los Angeles Dodgers’ tantalizing and sometimes maddening star outfielder, developed a tradition with Turner Ward, the team’s second-year hitting coach.

Through countless extra hitting drills and conversations, Ward, who is from Alabama, and Puig, who defected from Cuba in 2012, have formed a close bond.

After each of his home runs, Puig finds Ward in the dugout, ensnares him with a bear hug and lands a kiss on the cheek or forehead.

“I don’t really like him, but I love him so I have to kiss him,” Puig said.

Asked to count the number of kisses this season, Puig did not skip a beat; he knows exactly how many.

There were 28 regular-season home runs, a career high for Puig, and a critical homer in Game 1 of the National League Championship Series against the Chicago Cubs. He also gave Ward a kiss after a bat-flipping, run-scoring double that started the Dodgers’ tying rally in the fifth inning of the same game.

“I give him more kisses than his wife,” Puig said, trying to keep a straight face. “He likes that, but she might get jealous.”

As the Dodgers sit two wins away from advancing to their first World Series since 1988, Puig has been a vital part of the team’s success. Entering Game 3 of the N.L.C.S. on Tuesday night here, he was second on the team to the star third baseman Justin Turner in postseason runs batted in (six), and he led in walks (five) and exuberance (a lot).

“I don’t know if it’s a higher energy, but it’s the focus and intent on every single pitch that is so impressive,” Dodgers pitcher Clayton Kershaw said. “The talent has always been there. He goes through stretches where he does this, but for him to sustain it through the course of a whole game, and every single pitch of every single at-bat, that’s the potential he has. Maybe the postseason is doing that for him right now, getting him all that more focus. It’s pretty fun to watch.”

It has not always been this way for Puig and the Dodgers. When he debuted in June 2013, Puig mesmerized baseball with eye-popping talent and hair-on-fire energy.

After a stellar rookie season and an All-Star campaign in 2014, Puig struggled with poor performance, injuries and questions about his dedication. His on-field behavior, including bat flips, rubbed opponents the wrong way and led to multiple confrontations with the San Francisco Giants’ star pitcher Madison Bumgarner, among others.

SF@LAD: Benches clear after Puig, Bumgarner go at it
Video by MLB

But it was the Dodgers who grew unsettled by Puig’s comportment. Team officials were unhappy that he sometimes showed up late to meetings and did not follow a consistent routine to avoid injuries.

After failing to trade Puig at the nonwaiver trading deadline last season, the Dodgers demoted him to Class AAA Oklahoma City for a month, with an assignment to grow on and off the field. Even then, Puig was caught in an expletive-filled video with his minor-league teammates, which the Dodgers’ president, Andrew Friedman, called disappointing.

Puig worked himself back into the Dodgers’ good graces with improved play, was promoted back to the major leagues and made the postseason roster.

Despite some lingering minor issues — he was benched just before the playoffs because of a late arrival and a baserunning blunder — Puig has been even better this year.

Dodgers Manager Dave Roberts said Puig had grown, especially in regaining trust from his teammates, and caring about them. “Exponential strides, and he’s obviously a huge part of what we’re doing now going forward,” Roberts said, “and I couldn’t be more proud.”

Once limited by repeated hamstring injuries, Puig played in a career-high 152 games. His batting average dropped to .263, but his on-base percentage reached its highest point since 2014 while his slugging percentage was second only to the mark in 2013. In addition to the career high in homers, Puig has also posted his best walk rate (11.2 percent). He may even win a Gold Glove for his strong fielding and stellar arm in right field.

“This is my best season,” Puig said after Game 1 of the N.L.C.S. “With my teammates and my coaches, I grew up a little bit more, and going to the home plate having fun. I know I hit nothing, I do nothing in the game, my teammates are going to have my back.”

His enthusiasm on the field has remained. During an at-bat in the division series against the Arizona Diamondbacks, Puig licked his bat, shuddered at the taste of pine tar and then smashed an R.B.I. double. Asked about his three-walk performance in Game 2 of the N.L.C.S. on Sunday, Puig was, of course, silly.

“I didn’t draw a fourth walk because my tongue didn’t work on the bat so I struck out,” he said.

The day before, when asked what it felt like to have a packed Dodger Stadium chanting his name during an at-bat, Puig deadpanned, “They were shouting my name because I was the one batting at the moment.”

Puig’s goofy personality is distinctive, but similar demonstrative play is often seen among foreign-born Latino players who grew up showing more passion and excitement on the field by flipping bats or admiring home runs.

“As long as he keeps playing like that, he can take his clothes off if he wants,” said the Dodgers utility player Enrique Hernandez.

And keep kissing his coach, too.

Amazon and eBay ‘profit from VAT evasion’

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Amazon and eBay have defended themselves as a report by MPs accuses online marketplaces of profiting from VAT evasion.

The Public Accounts Committee was particularly scathing of the taxman, saying HM Revenue & Customs (HMRC) had failed to get to grips with the scale of fraud, carried out by non-EU sellers on such sites.

Its report said the traders’ fast-growing and “illegal” practice of failing to charge customers VAT on goods housed in the UK was anti-competitive as it allowed them to undercut rivals by at least the 20% tax rate – putting UK retail staff out of their jobs.

It said the online platforms hosting the sellers were making more money than they should as they were raking-in commissions on sales that should have been blocked.

Image:Amazon says it removes any seller UK authorities say is non-VAT compliant

The committee described HMRC’s estimate of an annual loss to the public purse of up to £1.5bn as “out of date and flawed” and hit out at its failure to bring any prosecutions under new enforcement powers.

It urged officials to ensure, by March next year, that online platforms had imposed greater VAT controls on non-EU traders – with Brexit likely to exacerbate the problem as new trade arrangements become clearer.

PAC chair, Meg Hillier, said: “HMRC needs to be far tougher in protecting the interests of British businesses and taxpayers.

Image:Ebay argues it has gone beyond UK requirements in ensuring VAT compliance

“As a priority it must inject more urgency into enforcement action. But it should also push the case for further new powers.

“Online marketplaces tell us they are committed to removing ‘bad actors’, yet that sentiment rings hollow when those same marketplaces continue to profit from the actions of rogue traders.

“They can and should do more to drive them out and we will expect online marketplaces to co-operate fully with HMRC in tackling non-compliance.”

An eBay spokesman said: “We want a fair marketplace for all our buyers and sellers.

“That’s why we have been working together with HMRC – and going above and beyond their requirements – to continue to ensure that our site is the best possible place to do business.”

An Amazon spokesman responded: “We are reviewing the committee’s recommendations and support efforts to ensure businesses and individuals selling across all marketplaces are VAT compliant.

“We offer extensive information, training and tools to assist sellers in their VAT obligations, and we work closely with HMRC on this matter sharing all requested data on non-EU sellers and promptly removing any seller they inform us is not VAT compliant.”

An HMRC spokesman said: “The UK has led the way in holding online marketplaces jointly liable for VAT evaded overseas.

“We introduced tough new rules last year allowing us to hold online marketplaces liable for unpaid VAT by overseas sellers and since then we have seen a ten-fold rise in the number of sellers registering for VAT.

“The new reforms will secure an extra £875m in tax to help pay for vital public services.”

Hospital targets missed en masse as performance slumps

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The performance of hospitals across the UK has slumped with targets for cancer, A&E and planned operations now being missed en masse, BBC research shows.

Nationally England, Wales and Northern Ireland have not hit one of their three key targets for 18 months.

Only Scotland has had any success in the past 12 months – hitting its A&E target three times.

Ministers accepted growing demand had left the NHS struggling to keep up as doctors warned patients were suffering.

The findings are being revealed as the BBC launches its online NHS Tracker project, which allows people to see how their local service is performing on three key waiting time targets:

  • Four-hour A&E waits
  • 62-day cancer care
  • Planned operations and treatment

If you can’t see the NHS Tracker, click or tap here.

The BBC has looked at performance nationally as well as locally across the 135 hospital trusts in England and 26 health boards in the rest of the UK.

Locally there is just one service in the whole of the UK – run by Luton and Dunstable NHS Trust – which has managed to hit all three targets each time over the past 12 months.

Hospital staff the BBC has talked to have described how shortages of doctors and nurses, a lack of money and inadequate room in A&E departments in particular was making it difficult to see patients quickly enough.

While overall the vast majority of patients are still being seen in time, the BBC investigation shows how declining performance is affecting patients.

For example, the chances of not being seen in four hours in A&E has actually more than doubled in the past four years, with one in nine patients now waiting longer than that.

The NHS on the slide

The BBC research has found:

  • Wales has consistently failed to hit its targets. In 2012-13 it did not hit any of its monthly key hospital targets and in 2016-17 it was the same. The last time a target was achieved nationally was 2010.
  • England has seen the biggest deterioration. In 2012-13 it hit its key hospital targets 86% of the time, but in the last year it has missed every monthly target.
  • Scotland is the only part of the UK to hit its targets during the last 12 months, but has only managed to hit do that three times over the summer in A&E when pressures tend to be at their lowest.
  • Northern Ireland is failing to hit its targets despite making it easier to hit the goal for planned operations and care. Since March 2015 it has gradually reduced the target from 80% to 55% but has still not hit it.
  • The north-east is the top performing region in England. Services have hit their key hospital targets 71% of the time in the past year.
  • Twelve out of 135 English hospital trusts, four out of five Northern Irish health trusts and five out of seven Welsh trusts have failed to hit any target in the past 12 months.

‘We don’t have enough doctors’

Prof Srinivasan Madhusudan, head of cancer at Nottingham University Hospitals NHS Trust, which has not hit the cancer target since April 2014, suggested there was simply not enough staff to cope.

“When I get to work I want to treat my patients as soon as I can. So do my colleagues.”

But he added there was a limit to what could be done, pointing out there are 5,000 new cases a year at his hospital trust.

“There are only so many patients that you can treat.

“We have a team of 22 fantastic oncologists who are working very hard to do the best they can under what is quite a stressful situation.”

Meanwhile, Ali Refson, an A&E consultant at London’s Northwick Park hospital, said demand was “incredibly high” which meant it was sometimes impossible to hit the four-hour target.

“We sometimes feel we can’t give the best care. We are working the hardest we can, but we are only human.”

What does this mean for patients?

Ministers across the UK have been quick to point out that most people are still being seen in time.

But the numbers waiting longer for care have been rising.

In A&E patients are now twice as likely to wait more than four hours than they were four years ago – 11% compared to 5%.

The proportion of people waiting over 62 days for cancer treatment has risen by a third in the past four years. Nearly one in five patients now wait longer.

The chances of delays before you have a planned operation or treatment, such as a hip replacement, has increased by nearly three-quarters in four years. Currently 12% of patients wait longer than they should.

It means there are now over 500,000 people on hospital waiting lists in England, Wales and Northern Ireland that have waited too long. That compares to nearly 230,000 four years ago.

British Medical Association chair Dr Chaand Nagpaul said the situation highlighted by the BBC was “unacceptable”.

He said while for some patients the delays were simply an “inconvenience”, for many more they would have a “real impact on their treatment and outcome”.

Time for ‘honest debate’

Scottish Health Secretary Shona Robison said record levels of investment were being put into the health service in Scotland.

She said efforts were being made to “shift the balance of care away from hospitals” and into the community that should make it easier to hit the targets.

And she added a ministerial working group had been established to improve cancer care.

A spokesman for the Department of Health in England said more money was being spent on services, and said despite the longer waiting times the majority of hospitals were still providing good or outstanding care, according to inspectors.

And he pointed out that because of the ageing population “health systems worldwide face similar pressures”.

A Welsh government spokesman acknowledged some people were waiting “too long”, but pointed to the rising demand being faced.

The number of A&E visits made each year across the UK has risen by a fifth in four years to top 30 million, while the number of cancer cases has risen by more than a quarter to top 170,000.

Nonetheless, Labour’s shadow health secretary in England, John Ashworth, called the decline in performance “staggering”.

Saffron Cordery, of NHS Providers, which represents hospital bosses, said it was time to consider whether these targets were still achievable unless more money was provided.

“It’s time for an honest debate about what we can realistically expect the health service to deliver in such difficult circumstances.”


The services where targets have been missed for whole year

England:

  • Basildon and Thurrock NHS Trust
  • Colchester Hospital University NHS Trust
  • Guy’s and St Thomas’ NHS Trust
  • University Hospitals of North Midlands NHS Trust
  • The Royal Wolverhampton Hospitals NHS Trust
  • Leeds Teaching Hospitals NHS Trust
  • Gloucestershire Hospitals NHS Trust
  • East Kent Hospitals University NHS Trust
  • Hull & East Yorkshire Hospitals NHS Trust
  • United Lincolnshire Hospitals NHS Trust
  • Maidstone & Tunbridge Wells NHS Trust
  • Worcestershire Acute Hospitals NHS Trust

Wales:

  • Betsi Cadwaladr University Health Board
  • Hywel Dda University Health Board
  • Abertawe Bro Morgannwg University Health Board
  • Cwm Taf University Health Board
  • Aneurin Bevan University Health Board

Northern Ireland:

  • Belfast Health Trust
  • South Eastern Health Trust
  • Southern Health Trust
  • Western Health Trust

Based on performance against the monthly or quarterly targets for A&E, 62-day cancer care and planned operations for the most recent 12 months for which there is data. The way the targets work is different across the UK so the BBC has simply looked at whether the key targets are being me in each nation.


Research by the BBC’s data journalism unit

Pre-sex HIV drug ‘no-brainer” for NHS

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A drug to dramatically cut the risk of HIV infection during sex would save the UK around £1bn over the next 80 years, say scientists.

The team at University College London says Prep, or pre-exposure prophylaxis, is a “no-brainer” for the NHS.

The study predicts that giving Prep to men who have sex with men would prevent one in four HIV cases.

NHS England is currently funding a trial of Prep in 10,000 patients, but does not offer the treatment routinely.

Prep is already available in Scotland. The health service in England fought against paying for Prep in the courts, but agreed to trialling it in selected clinics.

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Preventive pills

Prep disables HIV before it gets a stranglehold in the body and trials show it can cut the risk of being infected by up to 86%.

The financial analysis, published in the Lancet Infectious Diseases, looked at the cost-effectiveness of a national roll-out of Prep, focusing on the highest risk group – men who have sex with men.

It showed offering Prep would cost the NHS money initially as it paid for both Prep and lifelong care for people already infected with HIV.

It could take up to 40 years to become cost-effective, when savings from the falling number of new HIV cases equal the cost of Prep.

Eventually, after 80 years, the pills would deliver a saving of £1bn, say the researchers.

Dr Alison Rodger, part of the UCL team, told the BBC: “Not only is it a highly effective treatment, it will save money. It’s a no-brainer so it’s a good thing to do.”

The researchers’ mathematical model predicted:

  • In the first year Prep was available, 4,000 men would start taking it, rising to 40,000 within 15 years
  • Men would take Prep for 4.5 years on average
  • Men would take two pills before sex, followed by one-a-day until they had gone two days without condom-less sex
  • Men would average five pills a week

It is still cost-effective with a daily Prep pill, but it takes longer to become cost-effective. Both options are being investigated as part of the NHS England trial.

The other major unknown is the long-term cost of the drugs, which may fall as cheaper alternatives become available.

Dr Michael Brady, medical director at the Terrence Higgins Trust, said: “It is important that all who need Prep can access it, and evidence like this reinforces the need for Prep to be fully commissioned and given a long-term, sustainable home on the NHS in England.”

Dr Paul Revill, from the centre of health economics at the University of York, said the NHS needed to be “far sighted [and] invest now and reap long-term gains”.

He added: “With a combination of frequent HIV testing, immediate treatment, and Prep availability, there is now the prospect of bending the curve of new HIV infections downwards in a way that did not seem feasible just a few years ago.”

A spokesperson for NHS England said: “The Lancet study makes an important contribution to the growing evidence for cost effectiveness of PrEP, highlighting the factors which will determine this, such as price and duration on PrEP.”

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‘Go to the dentist and get fined £100’

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Going to the dentist is something that many would want to avoid – but how about if you also faced a penalty fine?

More than 40,000 people a year in England are getting fines of £100 – from an automated system that dentists say is hitting the most vulnerable.

They warn that people such as dementia sufferers are unfairly getting caught up in a system meant to stop fraudsters from getting free treatment.

The NHS accepts there is a problem with errors and is promising changes.

The fines, about £4m per year, are being applied by a random screening process that checks on whether people going to the dentist are really eligible for free treatment.

But dentists say rising numbers of people with dementia, or those with learning difficulties, are being unfairly fined for something as simple as ticking a wrong box in confusing paperwork.

When these have been challenged, about 90% have been overturned as having been incorrectly applied.

The British Dental Association says the problem seems to be increasing and with an ageing population is only likely to get worse.


Why dentists are complaining

Charlotte Waite, a senior dentist working in Loughborough, Leicestershire, says this is a problem appearing on a “daily basis”.

“This has become a significant barrier to care. It can cause a lot of distress if people feel they are seen as fraudulent,” she says.

Mrs Waite, vice-chair of the British Dental Association’s England community dental services committee, is leading a campaign to stop a wave of fines for elderly and frail people, those with dementia or learning difficulties, who have made honest mistakes when filling in forms about free care.

She says even when patients are eligible for free treatment, an incorrect description of specific benefits or failure to renew documents can trigger a penalty fine, which rises to £150 if there is a delay in payment.

And she says because it typically affects vulnerable and often low-income families, there has been a lack of a “powerful advocate” to raise the issue.

Many such patients will be brought to the dentist by a carer, and Mrs Waite says they might not have the detailed information about types of benefit and exemption certificates.

She says this becomes a dilemma for dentists, whether to turn away patients or to treat them and then risk that they will face a fine.

Patients might turn up for the dentist and go away again without treatment because of confusion over benefits and entitlements and worries about being fined.

“I feel very strongly that clinical time should be spent on clinical work,” she says, rather then trying to navigate the benefits system.

“It’s an extreme waste of clinical time.

“We really need to sort this out now.”


What dentists say they’ve seen

  • “This patient has severe learning disabilities and cannot communicate verbally.

“They were fined twice over an 18-month period, due to the change in exemption and Mum accidently putting the wrong thing on the form.

“Mum was having a bad year and the patient had suffered a few health problems, and these fines were very upsetting and caused lots of anxiety.

“We did manage to get the fines turned around, but this took long periods of time and many phone calls and a letter. We were constantly up against a brick wall.”

  • “A vulnerable adult who has a valid certificate – which he brought in for us to see and the number was recorded correctly – was sent a fine for £100 saying he was claiming free treatment incorrectly.

“He contacted me in quite a panic and I had to reassure him and request that he brought in the paperwork to me to see, I completed the appeal form for him as he was entitled to claim free dental care.

“The appeal form that needed sending back was quite a complex letter, and I think our patient would have struggled to respond to it without help.

“I felt it was most unfair for him to have to go through that.”

  • “I had a patient whose parents didn’t realise her exemption certificate had expired, only to be fined.

“I phoned on her behalf, but they would not accept my word regarding the patient’s special needs and wanted a letter from the patient’s doctor.

“It took three weeks for the patient to get in to see the doctor as it wasn’t urgent. All I could get was a deferral in increasing the fine [for non-payment] while the patient waited for a letter from her doctor.”


What the NHS wants to do in response

The NHS Business Services Authority, which oversees the fining system, accepts there is a problem and is looking for a way to make improvements.

A spokeswoman says no-one wants vulnerable people to be unfairly fined or for dentists to waste valuable clinical time.

The checks have an important role in making sure free treatment isn’t being unfairly accessed by those who should pay.

The screening system compares what people have put on forms at the dentist against two databases of information about benefits and entitlements – and if these do not match, the fining system generates a penalty notice.

The most recent figures suggest almost 120,000 fines have been issued over the past three years.

But the British Dental Authority says when 30,000 of these fines were checked, almost 90% were overturned, suggesting the scale of the error in the system.

  • The NHS says it will run a national awareness-raising campaign, so people will have a much better understanding of who is entitled to free dental treatment
  • There are plans for simpler forms and clearer information, particularly for vulnerable patients

“We want to make sure that patients, particularly those who struggle with literacy, understand if they are entitled to receive free dental treatment or if they should pay,” says a NHS Business Services Authority spokeswoman.

“We recognise the importance of information and access to it for everyone.”