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David Koresh k ə ˈ r ɛ ʃ ; born Vernon Wayne Howell ; August 17, 1959 April 19, 1993 was an American religious leader 3 4 5 and musician who played a central role in the Waco siege of 1993. Cause of death Gunshot wound to the head Body discovered Branch Davidian ranch McLennan County, Texas, U. Resting place Memorial Park Cemetery 32 21 23 N 95 22 03 W 32. 36750 Memorial Park Cemetery Occupation leader of the Branch Davidians cult Known for 1983 the Son of God, the Lamb prophecy Shootout on November 3, 1987, with George Roden for jurisdiction of Mount Carmel Center Branch Davidian leadership 1988 1993 Apocalypticism, millenarianism, polygamy February 28, 1993 April 19, 1993, 51-day confrontation and stand-off with the ATF and FBI Spouse s Rachel Jones Children.

and 13 others 1. Cyrus Howell Star Howell Bobbie Lane Howell. Parent s Bobby Wayne Howell father Bonnie Sue Clark mother. Coming from a dysfunctional background, Koresh was a member and later a leader of the Branch Davidians, a movement originally led by Benjamin Roden, based at the Mount Carmel Center outside Waco, Texas. Here, Koresh competed for dominance with another leader, Benjamin Roden s son George, until the younger Roden was jailed for murdering yet another rival.

1 Early life 2 Ascent to leadership of the Branch Davidians 3 Name change 4 Allegations of child abuse and statutory rape 5 Raid and siege by federal authorities 6 Aftermath 7 See also 8 References 9 Further reading 10 External links. David Koresh was born Vernon Wayne Howell on August 17, 1959, in Houston, Texas, to a 14-year-old single mother, Bonnie Sue Clark 1944 2009 10 and father Bobby Wayne Howell 1939 2008.

Koresh never met his father, and his mother began cohabitating with a violent alcoholic. 10 In 1963, Koresh s mother left with her boyfriend and placed her four-year-old son in the care of his maternal grandmother, Earline Clark. His mother returned when he was seven, after her marriage to a carpenter named Roy Haldeman. Bonnie Sue and Haldeman had a son together, named Roger, who was born in 1966.

Koresh described his early childhood as lonely. 10 Due to his poor study skills and dyslexia, he was put in special education classes and nicknamed Vernie by his fellow students. 11 Koresh dropped out of Garland High School in his junior year. When he was 19 years old, Koresh had a legal at the time sexual relationship with a 15-year-old girl, who became pregnant. 10 He claimed to have become a born-again Christian in the Southern Baptist Church and soon joined his mother s church, the Seventh-day Adventist Church.

There, Koresh became infatuated with the pastor s daughter, and while praying for guidance, he opened his eyes and allegedly found the Bible open at Isaiah 34 16, stating that none should want for her mate ; convinced this was a sign from God, Koresh approached the pastor and told him that God wanted him to have his daughter for a wife. The pastor threw him out, and when he continued to persist with his pursuit of the daughter, he was expelled from the congregation.

In 1981, Koresh moved to Waco, Texas, where he joined the Branch Davidians not to be confused with the original Davidian Seventh-Day Adventist Church. Benjamin Roden, who died in 1978, originated the Branch group in 1955 with new teachings that were not connected with the original Davidians. Koresh played guitar and sang in church services at the Mount Carmel Center, the sect s headquarters outside Waco.

In 1983, Koresh began claiming the gift of prophecy. David Thibodeau, in his 1999 book, A Place Called Wacospeculated that he had a sexual relationship with Lois Roden, the widow of Benjamin Roden and leader of the cult, who was then in her late 60s. Koresh eventually began to claim that God had chosen him to father a child with Lois, who would be the Chosen One. 10 In 1983, Lois allowed Koresh to begin teaching his own message, called The Serpent s Rootwhich caused controversy in the group.

Lois s son George Roden intended to be the group s next leader and considered Koresh an interloper. When Koresh announced that God had instructed him to marry Rachel Jones who then added Koresh to her namea period of calm ensued at the Mount Carmel Center, but it proved only temporary. In the ensuing power struggle, George Roden claimed to have the support of the majority of the cult, forcing Koresh and his group off the property at gunpoint.

Koresh and around 25 followers set up camp at Palestine, Texas, 90 miles 140 km from Waco, where they lived under rough conditions in buses and tents for the next two years. Before Koresh was born, his father met another teenaged girl and abandoned Bonnie Sue. That same year, he traveled to Israel, where he claimed he had a vision that he was the modern-day Cyrus. During this time, Koresh undertook recruitment of new followers in California, the United Kingdom, Israel, and Australia.

The founder of the Davidian movement, Victor Houteff, wanted to be God s implement and establish the Davidic kingdom in Palestine. Koresh also wanted to be God s tool and set up the Davidic kingdom in Jerusalem. At least until 1990, he believed the place of his martyrdom might be in Israel, but by 1991, he was convinced that his martyrdom would be in the U. Instead of Israel, he said the prophecies of Daniel would be fulfilled in Waco and that the Mount Carmel Center was the Davidic kingdom.

After being exiled to the Palestine camp, Koresh and his followers eked out a primitive existence. When Lois died in 1986, the exiled Branch Davidians wondered if they would ever be able to return to the Mount Carmel Center, but despite the displacement, Koresh now enjoyed the loyalty of the majority of the Branch Davidian community. To regain it, he challenged Koresh to a contest to raise the dead, going so far as to exhume a corpse to demonstrate his spiritual supremacy. 13 By late 1987, Roden s support was in steep decline.

Koresh went to authorities to file charges against Roden for illegally exhuming a corpse, but was told he would have to show proof such as a photograph of the corpse. Koresh seized the opportunity to seek criminal prosecution of Roden by returning to the Mount Carmel Center with seven armed followers, allegedly attempting to get photographic proof of the exhumation. Koresh s group was discovered by Roden, and a gunfight broke out.

When the sheriff arrived, Roden had already suffered a minor gunshot wound and was pinned down behind a tree. As a result of the incident, Koresh and his followers were charged with attempted murder. At the trial, Koresh explained that he went to the Mount Carmel Center to uncover evidence of criminal disturbance of a corpse by Roden. Died April 19, 1993 1993-04-19 aged 33. Koresh s followers were acquitted, and in Koresh s case, a mistrial was declared. 14 Roden was judged insane and confined to a psychiatric hospital at Big Spring, Texas.

Roden continued to harass the Koresh faction by filing legal papers while imprisoned. When Koresh and his followers reclaimed the Mount Carmel Center, they discovered that tenants who had rented from Roden had left behind a meth lab, which Koresh reported to the local police department and asked to have removed.

Since Roden owed thousands of dollars in unpaid taxes on the Mount Carmel Center, Koresh and his followers were able to raise the money and reclaim the property. Vernon Howell filed a petition in California State Superior Court in Pomona on May 15, 1990, to legally change his name for publicity and business purposes to David Koresh. In 1989, Roden murdered Wayman Dale Adair with an axe blow to the skull after Adair stated his belief that he Adair was the true messiah.

Koresh is the Biblical name of Cyrus the Great کوروش, Kurosha Persian king who is named a messiah for freeing Jews during the Babylonian captivity. On August 28, 1990, Judge Robert Martinez granted the petition. His first name, David, symbolized a lineage directly to the biblical King David, from whom the new messiah would descend. Koresh was alleged to have been involved in multiple incidents of physical and sexual abuse of children.

By taking the name of David Koresh, he was professing himself to be the spiritual descendant of King David, a messianic figure carrying out a divinely commissioned errand. 19 His doctrine of the House of David 20 did lead to marriages with both married and single women in the Branch Davidians. This doctrine was based on a purported revelation that involved the procreation of 24 children by chosen women in the community.

These 24 children were to serve as the ruling elders over the millennium after the return of Christ. These women purportedly chosen through this doctrine included at least one underaged girl, Michelle Jones, who was the younger sister of Koresh s legal wife Rachel and the daughter of lifelong Branch Davidians Perry and Mary Belle Jones. A six-month investigation of sexual abuse allegations by the Texas Child Protection Services in 1992 failed to turn up any evidence, possibly because the Branch Davidians concealed the spiritual marriage of Koresh to Michelle, assigning a surrogate husband David Thibodeau to the girl for the sake of appearances.

21 Regarding the allegations of physical abuse, the evidence is less certain. In one widely reported incident, ex-members claimed that Koresh became irritated with the cries of his son Cyrus and spanked the child severely for several minutes on three consecutive visits to the child s bedroom. In a second report, a man involved in a custody battle visited the Mount Carmel Center and claimed to have seen the beating of a young boy with a stick.

Finally, the FBI s justification for forcing an end to the 51-day standoff was predicated on the charge that Koresh was abusing children inside the Mount Carmel Center. Allegations had been made that he had fathered children with underaged girls in the Branch Davidians. In the hours that followed the deadly conflagration, Attorney General Janet Reno told reporters, We had specific information that babies were being beaten. 23 However, FBI Director William Sessions publicly denied the charge and told reporters that they had no such information about child abuse inside the Mount Carmel Center.

24 A careful examination of the other child abuse charges found the evidence to be weak and ambiguous, casting doubt on the allegations. The allegations of child abuse largely stem from detractors and ex-members. 26 The 1993 Justice Department report cites allegations of child sexual and physical abuse. Legal scholars point out that the Bureau of Alcohol, Tobacco and Firearms ATF had no legal jurisdiction in the matter of child protection and these accounts appear to have been inserted by the ATF to inflame the case against Koresh.

For example, the account of former Branch Davidian Jeannine Bunds is reproduced in an ATF affidavit. She claimed that Koresh had fathered at least 15 children with various women and girls, and that she had personally delivered seven of these infants. Bunds also claims that Koresh would annul all marriages of couples who joined the group and had exclusive sexual access to the women and girls.

In his book, James Tabor states that on a videotape that was sent out of the compound during the siege, Koresh acknowledged that he had fathered more than 12 children by several wives. 29 On March 3, 1993, during negotiations to secure the release of the remaining children, Koresh advised hostage negotiators that My children are different than those others, referring to his direct lineage versus those children whom he had previously released.

The Waco siege began on February 28, 1993, when the ATF raided Mount Carmel Center. Shortly after the initial raid, the FBI Hostage Rescue Team took command of the federal operation, because the FBI has jurisdiction over incidents involving the deaths of federal agents. The negotiating team established contact with Koresh inside the compound. Communication over the next 51 days included telephone exchanges with various FBI negotiators. Koresh himself had been seriously injured by a gunshot.

As the standoff continued, his closest male associates and he negotiated delays, so that he could possibly write religious documents, which he said he needed to complete before his surrender. Koresh s conversations with the negotiators were dense and they also included biblical imagery. The FBI negotiators treated the situation as a hostage crisis. The siege of the Mount Carmel Center ended on April 19, 1993, when U. Attorney General Janet Reno approved recommendations of FBI officials to proceed with a final advance in which the Branch Davidians would be removed from the Mount Carmel Center by force.

The ensuing gun battle resulted in the deaths of four ATF agents and six Branch Davidians. In an attempt to flush Koresh out of the stronghold, the FBI resorted to pumping CS gas into the compound with the aid of an M728 Combat Engineer Vehicle, which was equipped with a battering ram. 30 In the course of the advance, the Mount Carmel Center caught fire under circumstances that are still disputed today.

Barricaded inside the building, 79 Branch Davidians perished in the ensuing blaze; 21 of these victims were children under the age of 16. According to the FBI, Steve Schneider, Koresh s right-hand man, who probably realized that he was dealing with a fraud, shot and killed Koresh and then committed suicide with the same gun. 32 A second account gave a totally different story Koresh, then 33, died of a gunshot wound to the head during the course of the fire. No one knows who killed him or if he killed himself.

33 The medical examiner reported 20 people, including five children under the age of 14, had been shot, and a three-year-old had been stabbed in the chest. Koresh is buried at Memorial Park Cemetery, Tyler, Texas in the Last Supper section. In 2004, Koresh s 1968 Chevrolet Camaro, which had been damaged during the raid, sold for 37,000 at auction.

Several of his albums were released, including Voice of Firein 1994. It is now owned by Ghost Adventures host Zak Bagans. Timothy McVeigh and Terry Nichols cited the Waco siege as their motivation for the Oklahoma City bombing of April 19, 1995, which was timed to coincide with the second anniversary of the Waco assault. Four documentary films have been made about the siege, including different versions of Waco The Rules of EngagementWaco A New RevelationWaco The Big Lieand Waco Madman or Messiah.

In 2018, BBC Radio 5 live created a radio podcast titled End of Dayswhich was about the death and life of Koresh, his involvement in the Waco siege, and the recruitment of people who lived in Nottingham, Manchester, and London into the Branch Davidians. The Court TV now TruTV television series Mugshots released an episode about Koresh.

Koresh is portrayed by Taylor Kitsch in the 2018 miniseries Waco. 38 He was also one of the sources of inspiration used to create the fictional cult leader Joseph Seed in the 2018 action-adventure video game Far Cry 5. Biography portal Texas portal. List of messiah claimants List of people claimed to be Jesus List of Seventh-day Adventists Messiah complex. England, Mark.

12 children killed in fire Howell s, ex-member says. Waco Tribune-Herald. Retrieved March 11, 2020. Smyrl, Vivian Elizabeth. Handbook of Texas Texas State Historical Association. Retrieved June 30, 2012. Religion in Society A Sociology of Religion. Johnstone November 17, 2015. CRI Statement. The Branch Davidians. Retrieved April 14, 2009. Madeleine Noa. The Branch Davidians Cult. Historic Mysteries. Retrieved January 11, 2010. Burton, Tara Isabella April 19, 2018. The Waco tragedy, explained.

Tracey, Ciaran October 31, 2018. Why 30 Britons joined the Waco cult. Retrieved April 20, 2020. David Koresh and the Waco Siege. Retrieved October 4, 2018. Pitts, William L. Davidians and Branch Davidians. Retrieved November 25, 2012. a b c d e f Wilson, Colin 2000The Devil s PartyLondon Virgin Books, ISBN1-85227-843-9 Final 24 Episode on David KoreshArchived December 21, 2008, at the Wayback Machine.

2001David Koresh and The Cuckoo s Egg pt. Valentine, Carol A. Bromley and Edward D. Silver, The Davidian Tradition From Patronal Clan to Prophetic Movement, p. 54 in Stuart A. Wright, Armageddon in Waco Critical Perspectives on the Branch Davidian Conflict Chicago University of Chicago, 1995 Marc Breault and Martin King, Inside the CultSignet, 1st Printing June 1993.

Australian edition entitled Preacher of Death. Thibodeau, David 1999The truth about Wacoarchived from the original on April 28, 2001 Thomas R. Lujan, Legal Aspects of Domestic Employment of the ArmyParameters US Army War College Quarterly, Autumn 1997, Vol. Linedecker, Massacre at Waco, TexasSt. Martin s Press, 1993, page 94. Bromley and Silver, p.

57 See Christopher G. Ellison and John Bartkowski, Babies Were Being Beaten Exploring Child Abuse Allegations at Ranch Apocalypse, pp. 111 152 in Stuart A.Armageddon in Waco Critical Perspectives on the Branch Davidian Conflict Chicago University of Chicago, 1995 See Bromley and Silver, pp. 60 65 David Thibodeau and Leon Whiteson, A Place Called Waco A Survivor s Story New York Public Affairs, 1999 Ellison and Bartkowski, 120 121. Sam Howe Verovek, In Shadow of Texas Siege, Uncertainty for Innocents.

New York Times, 1993, March 8 Stephen Labaton, Confusion Abounds in the Capital on Rationale for Assault on Cult, New York Times, 1993, April 21 Ellison and Bartkowski, 1995 John R. Hall, Public Narratives and the Apocalyptic Sect, pp. 205 235 in Stuart A.Armageddon in Waco Chicago University of Chicago, 1995 ; Stuart A. Wright, Construction and Escalation of a Cult Threat Dissecting Moral Panic and Official Reaction to the Branch Davidians, pp.

75 94 in Stuart A.Armageddon in Waco U. Department of Justice 1993Evidence of Historical Child Sexual and Physical AbuseReport to the Deputy Attorney General on the Events at Waco, Texas February 28 to April 19, 1993 From ATF Affidavit in Support of Arrest of Koresh, taken from ATF Special Agent Aguilera s interview of former compound resident Jeannine Bunds, included in Agent Aguilera s affidavit in support of the Koresh arrest warrant Davy Aguilera, Special Agent Bureau of ATF, Subscribed and sworn to before me this 25th day of February 1993 Dennis G.

Green United States Magistrate Judge Western District of Texas Waco Redacted ed. DoJ, archived from the original on January 24, 2007retrieved February 4, 2007 Ellison and Bartkowski, 1995; Wright, Construction and Escalation of a Cult Threat, 1995 Tabor, James D. ; Gallagher, Eugene V. 1997Why Waco. Cults the Battle for Religious Freedom in AmericaBerkeley, California University of California Press, ISBN978-0-520-20899-5 Remembering Waco and the Branch Davidian Church 20 years later.

Liberty Under Fire. Retrieved December 14, 2016. April 30, 2013. Frequently Asked Questions about Waco. Retrieved February 27, 2015. Koresh s Top Aide Killed Cult Leader, FBI Official Says - The Washington Post HighBeam Research. David Koresh and the Branch Davidians 6 Things You Should Know. January 24, 2018. Archived from the original on May 23, 2013. Retrieved February 11, 2018. Autopsies Children At Waco Were Shot via www. Hart, Lianne September 26, 2004. Puny market for avid Koresh s pride and joy fails to excite many bidders.

The San Francisco Chronicle. How Oklahoma City bomber Timothy McVeigh changed the fringe right. Michel, Herbeck, Lou, Dan. Buffalo News. Retrieved June 21, 2020. MUGSHOTS David Koresh. December 1, 2013. Archived from the original on November 8, 2017. Retrieved November 8, 2017. Pedersen, Erik August 30, 2016. Michael Shannon Taylor Kitsch Topline Weinstein Co. Series WacoBased on 1993 Siege. Deadline Hollywood. Retrieved May 16, 2017.

Wilson, Jason March 2, 2018. Far Cry 5 cult adviser reveals how these fanatics thrive Follow the money. Retrieved April 1, 2018.From the Ashes Making sense of Waco Lanham, MD Rowman and Littlefield, 1994. Wright, Stuart A.Armageddon in Waco Critical perspectives on the Branch Davidian conflict Chicago, U. Tabor, James, and Gallagher, Eugene, Why Waco. Cults and the battle for religious freedom in America Berkeley, U. of California Press, 1995.

of Chicago Press, 1995. Reavis, Dick J. ISBN0-684-81132-4 Samples, Kenneth et al. The Ashes of Waco An Investigation New York Simon and Schuster, 1995. Prophets of the Apocalypse David Koresh Other American Messiahs Grand Rapids Baker, 1994. Newport, Kenneth G. The Branch Davidians of Waco The History and Beliefs of an Apocalyptic Sect Oxford, Oxford University Press, 2006.State Intervention and Holy Violence Timgad Paleostrovsk Waco, Journal of the American Academy of Religion77,4 2009853 894.

Wikimedia Commons has media related to David Koresh. Wikisource has original works written by or about David Koresh. Vernon Wayne Howell aka David Koresh. Branch Davidians Religious Leader. Find a Grave. July 16, 2002. Retrieved June 26, 2012. Page last updated 02 August 2019. Breastfeeding provides mothers and babies with many benefits and is a key contributor to lifelong health.

Australia s infant feeding guidelines recommend exclusive breastfeeding of infants to around six months of age when solid foods are introduced and continued breastfeeding until the age of 12 months and beyond, if both mother and infant wish. Evidence shows that breastfed babies are less likely to suffer from necrotising enterocolitis, diarrhoea, respiratory illness, middle ear infection, type 1 diabetes and childhood leukaemia.

Available evidence also shows that breastfed babies have enhanced cognitive development. Breastfeeding also benefits mothers by promoting faster recovery from childbirth, reducing the risks of breast and ovarian cancers in later life, increased birth spacing and reduced maternal depression. Breastfeeding also helps with mother-infant bonding.

Australian National Infant Feeding Survey statistics showed that in children aged 0-24 in Australia in 2010, 90 initiated exclusive breastfeeding. 4 of babies were exclusively breastfed to 5 months that is, for less than 6 months. Australian National Breastfeeding Strategy 2019 and Beyond. On behalf of the Australian Health Ministers Advisory Council AHMACthe Department of Health developed a high level strategy to incorporate recent research on effective strategies to support breastfeeding that are relevant to the current environment.

The Australian National Breastfeeding Strategy 2019 and beyond the Strategy seeks to provide an enabling environment for breastfeeding. The Strategy was developed in collaboration with all states and territories through the Breastfeeding Jurisdictional Senior Officials Group BJOGa Breastfeeding Expert Reference Group, and through public consultation. All Health Ministers endorsed the Strategy on 8 March 2019. Reports on Stakeholder Consultation. Report 1 Australian National Breastfeeding Strategy- Report on Stakeholder Consolations- October 2017.

This report summarises the finding from consultations which were undertaken in April and May 2017 to inform the development of an enduring National Breastfeeding Strategy. Report 2 Australian National Breastfeeding Strategy- Report on Public Consultation October 2018. This report presents the key themes from online public consultation on the draft Strategy from 22 May to 18 June 2018.

Evidence Check Literature Review. The Australian Government is committed to protecting, promoting, supporting and monitoring breastfeeding throughout Australia. Review of effective strategies to promote breastfeeding. Australian National Breastfeeding Strategy 2010-2015. The previous breastfeeding strategy was developed following the 2007 Parliamentary Inquiry into the Health Benefits of Breastfeeding.

It aimed to improve the health, nutrition and wellbeing of infants and young children, and the health and wellbeing of mothers, by protecting, promoting, supporting and monitoring breastfeeding. The Evidence Check, Review of effective strategies to promote breastfeeding, provides evidence that indicates the effectiveness of key strategies identified during stakeholder consultation in 2017.

Implementation Plan. Final Progress Report. Key national achievements from Australian National Breastfeeding Strategy 2010-2015. An outline of all achievements can be found in the final progress report, however some key achievements at the national level are presented here. Donor Human Milk Banking in Australia. The need for a policy paper on milk iqoption.c in Australia was recognised in The Best Start Report on the inquiry into the health benefits of breastfeeding, and subsequently by all jurisdictions in the Australian National Breastfeeding Strategy 2010-2015.

The Australian Government Department of Health prepared this paper based on inputs from the Breastfeeding Jurisdictional Senior Officials Group BJOGmilk bank experts nominated by BJOG, the Therapeutic Goods Administration TGA and Food Standards Australia New Zealand FSANZ. Infant Feeding Survey. The 2010 Australian National Infant Feeding Survey ANIFS was the first large-scale, Australian national survey of infant feeding practices and related attitudes and behaviours.

Results from this survey showed most babies 96 were initially breastfed, with 39 exclusively breastfed meaning breastmilk had been the infant s exclusive source of fluid for less than 4 months and dropping to 15 for less than 6 months. However, 69 of babies were receiving any breastmilk at 4 months of age and 60 at 6 months.

National breastfeeding indicators. The reporting of breastfeeding results from both the ANIFS and Australian Health Survey was based on a draft set of national breastfeeding indicators published by the Australian Institute of Health and Welfare AIHW in 2011. At the national level, the Australian Government has funded the Australian Breastfeeding Association ABA since 2008 to support the infrastructure required to allow volunteers to provide breastfeeding information and support services to more than 80,000 mothers each year.

ABA funding. During the election, the Australian Government announced continued funding until 30 June 2023. Ten Steps to Successful Breastfeeding. In November 2012, the Australian Health Ministers Conference meeting affirmed that all Australian jurisdictions support the effective, practical guidance provided by the WHO UNICEF Baby Friendly Health Initiative BFHI and its ten steps to successful breastfeeding for health services.

The Australian Health Ministers encouraged all public and private hospitals to implement the ten steps to successful breastfeeding and to work towards or to maintain their BFHI accreditation. National Framework for Universal Child and Family Health Services. The National Framework for Universal Child and Family Health Services outlines the core services that all Australian children from birth to eight years and families should receive at no financial cost to themselves, regardless of where they live, and how and where they access their health care.

The Framework was developed through a strong partnership between the Commonwealth, State and Territory governments and the non-government sector. Breastfeeding Breastfeeding and You A Handbook for Antenatal Educators Evaluation Toolkit for Breastfeeding Programs and Projects National Breastfeeding Helpline Evaluation report. Education and Prevention Alcohol Child and Youth Health Environmental Health Illicit Drugs Immunisation Injury Prevention International monitoring Maternal and Infant Health Marketing in Australia of Infant Formula MAIF Breastfeeding Mental Health My Health Record registration National Drug Strategy Nutrition and Physical Activity Patient Education Reproductive Health Tobacco National Preventive Health Strategy Travel Health and Human Biosecurity.

Thank you for taking the time to provide feedback. It will be used to make improvements to this website. Department of Health. Commonwealth of Australia ABN 83 605 426 759. This much-anticipated system connects the t slim X2 pump with the Dexcom G6 CGM continuous glucose monitorproviding glucose prediction and auto insulin shut-off when a low is predicted. Here at the Mine we talked to a bunch of early users who provided glowing reviews last month. Tandem Basal-IQ Review Mostly Crazy Wonderful.

Tandem Diabetes Care, once looking like it would be the latest insulin pump company to go bust, is back with a vengeance with the recent announcement of its latest system, the turbo-charged t slim X2 with new control technology called Basal-IQ. Now I have been using this system myself for the past month, and am finding that it adds a whole new level of CGM integration and control that we ve never seen before. I m personally christening it the BiQ, just because I need an acronym, and that looked cool to me.

In a nutshell The BiQ is a lovely, brilliantly designed pump both physically, and perhaps more importantly, in its programing. Kudos to Tandem especially for putting a CGM status screen front and center with no need to unlock the pump to view it. Oh, and the way the pump shuts off basal really does avoid a lot of lows, increases safety, and makes it possible to be more aggressive on insulin delivery in order to reduce complication risk.

Pumps have come a long way, baby. Still, the BiQ is not perfect. Here s my take on using it the good, bad and ugly of this newest device. Basal-IQ Specifics. Let s start with how the system works. The BiQ uses CGM to power the bottom half of the blood sugar curve. It will shut off basal delivery in two cases When you go below 70 mg dL, or when its predictive algorithm suspects you ll go below 80 mg dL within the next 30 minutes.

It automatically resumes again when the sugar passes nadir and starts rising again. I m happy to see this predictive feature. Real-time data is great. Future data is better. The pump has the same basic touchscreen form factor as its predecessors, so to save space I ll focus on what s new and different. If you want a better understanding of day-to-day operation of Tandem pumps, you can check out my series of reviews on the first gen t slim, here.

Anyone who s ever used a Tandem pump knows the three-button wakeup and confirmation screens can be a bit much. But fortunately with the BiQ, they ve changed the design to offer more viewable info without needing to unlock the device. You just need to wake the pump up by pressing the one physical button on the entire device on the top and you are presented with a very nice, full-color CGM status screen, defaulted to a three-hour look-back view of the CGM trace.

You can scroll through 6, 12, 24, and 1-hour trace screens, all without unlocking the pump. To unlock the pump, the traditional three circular targets have been replaced by three small rectangles at the bottom of the CGM status screen, which sadly are a bit small for big fingers. The current BG and trend are displayed, along with the battery and transmitter status, the volume of insulin in the pump, and current IOB insulin on board.

The BiQ comes complete with a colorful 320-page manual that I ve never cracked open. Most Up-to-Date CGM Technology. The CGM that powers the IQ part of the BiQ is the Dexcom G6. Prior to my BiQ trial, I d been rockin the G5, so this was my first experience with the Gen 6. I had wanted to wear both at the same time to compare, but the Dex folks cautioned me not to as the Bluetooth signals from a G5 and a G6 can apparently get scrambled and wreak all kinds of havoc.

I haven t needed to, thanks to a combination of the simple operation, the good online training, the BiQ s built-in prompts, and excellent in-person training from someone wearing a BiQ on her hip, to boot. G6, of course, is approved for direct bolus decisions without need for a confirmatory fingerstick. Actually, with the G6, in theory, you ll never need another fingerstick again.

It self-calibrates, and seems to do a pretty good job at it, but if it does wander off track, you can calibrate it. The sensor runs 10 days, but unlike the G5, isn t as simple to reboot for a second session. How Smart is Basal-IQ. Of course, what you really want to know is how well the new automated basal restriction system works the IQ of the BiQ. I gotta say, it s pretty remarkable. In both garden-variety and steep blood sugar drops, the pump shuts off delivery in time to allow a recovery above 80 mg dL the majority of the time.

It s crazy wonderful. Where the BiQ isn t as good, is with what I call low coasting lows the ones where I m steadily but surely heading low over a period of several hours. In almost every case, the BiQ didn t catch these, and I ended up sucking down orange-flavored Transend glucose gel. I suspect a good way to deploy the BiQ pump is to set your insulin rates slightly on the high side for everything basal programs, insulin-to-carb ratio, and correction factor. This way highs can be shortened and their peaks blunted, without the corresponding risk of low blood sugar as the pump cuts the basal flow as the sugar trends downwards.

Remember that it s only the bottom half of the blood sugar curve by that s controlled by shutting down basal delivery to deal with hypos or projected hypos. But don t worry, the next iteration from Tandem will be the Bolus-IQ Control-IQ model coming in 2019, that will allow for bolus doses to deal with high blood sugars. It s exciting to see this one-two punch in short order to Tandem, and I can t wait. This might be a good time to buy some Tandem stock. But I gotta say, in both this pump and in the Medtronic 670G, I m amazed at how much control is possible just playing with basal alone.

Basal-IQ Blows the Competition Away. It s important to note that there s nothing else like the BiQ system on the market. Sure, I ve mentioned the Medtronic 670G that automatically shuts off insulin when a low is predicted, which also adjusts basal when your blood sugar is heading above the preferred target. I ve used both systems, and am finding that BiQ blows the doors off of the 670G, which is saying a lot as it shouldn t be nearly as capable, given that the BiQ only leverages CGM for lows, making it half the pump the 670G is.

But the reason is largely because the connected Dexcom G6 CGM is simply way more accurate and the insulin pump itself is way less intrusive and easy to use, IMHO. I hooked up Oct. 4th, so for purposes of this initial review my use entailed 22 days. When the BiQ auto-suspends, it looks like 27 of that time is at night not surprising as I tend to run low in late afternoons. For my entire initial test-drive, I saw two suspensions per day on average.

My data speaks for itself. What Else is Good About Basal-IQ. One of the best things about BiQ, and something that really sets it off from its competition, is that it s not a nag. For me, in just these first 22 days of using this Basal-IQ system, I feel it works better than I had expected. You have the choice of letting the pump s CGM-driven basal shutoff and re-start functions run seamlessly in the background without notifications, and this is iqoption.c I set mine up.

I don t need to know it s doing its thing. I just want it done. The less I m bothered, the better. Note that even with the auto shut-off in the background, the CGM status screen still shows great swaths of red when basal is shut down, so you can always quickly check to see what s happening if you want to. As it s based on the X2 platform, the BiQ is fully Internet upgradable and you can do this from home. No waiting forever to exchange your pump for the latest and greatest.

Any changes in the future like CGM control over basal delivery for elevated blood sugars can be installed simply by plugging your existing pump into your computer. This is huge and deserves a shout-out. Additionally, there are other aspects that I like about this device. The G6 can feed CGM data to the pump, a phone, and an Apple Watch all at the same time. When you need a quick bolus for food or a correction, it s not a complicated process. The Quick Bolus feature really is easy, and doesn t require you to unlock the pump.

Instead you communicate with the BiQ using Morse Code via the button on the top of the pump. True of previous versions, it has a meal bolus menu allowing you to add in particular food items on the fly to save yourself from extra mental math. Fancy bolus programs are elegant with a combined extended combo menu. Unlike Medtronic pumps, on each bolus you can choose or ignore these options without adding an extra step.

Empty cartridges can be ejected with the handy Tandem Tool or a quarter. Or a poker chip. Alerts are user-selectable to various volumes, vibrate, or off, and you can choose by each type of alarm, so you don t have just one response for all the pump s feedback. The Bad and Ugly of the Basal-IQ. True of previous versions, the BiQ is exceedingly user-friendly to program. Repeat Data Entry for Boluses My chief bitch about the BiQ is that I need iqoption.c manually enter my CGM sensor glucose value to correct my blood sugar.

That s just crazy. The pump already knows my BG. And it gets worse. After I m forced to enter my blood sugar manually for a correction, I m then asked by the pump if I want a correction for it. Otherwise, why the heck else would I have wasted my time entering it. Hey, one way or the other, Iqoption.c, but not both. Eating When Low. I was also quite annoyed that it isn t possible to layer on a meal when the BiQ had suspended the basal insulin.

I know I m at risk of a Low, but if I m about to eat a banana spilt, it would be a good idea to let me deliver some insulin to cover it without turning the basal back on. Site Changes While the site change reminder can be set for anytime, rather than when you actually did it, the system limits us to 1 2 3-day reminders only. No 4-day, darn it, which is my preferred interval, especially on a new pump when I need to bank supplies. My workaround is to get my supplies out and leave them on the bathroom counter for the next day when my site reminder goes off, but pump reminders should mirror reality in the field, not try to enforce some ideal of medical perfection.

Limited Profiles There s no automatic way to switch between profiles, i. the pump will not start a weekend profile at midnight on Fridays, you have to wake up and do it manually. Too Quick of a Glance The quick glance at the CGM screen, done without unlocking the pump, times out and goes blank in 10 seconds with no way to change that. This isn t long enough and it d be nice to have the ability to prolong that glance period. Once unlocked, users can choose screen time outs of 15, 30, 60 or 120 seconds.

Ugly Case Design Whoever designed the current case for the BiQ clearly doesn t wear an insulin pump. At first glance, it looks like a huge improvement it s one piece, not two, and not only can the pump be charged or downloaded in the case, but the insulin cartridges can be changed without removing the pump from the case. The case has a lovely stainless clip that can be set for either horizontal or vertical wear, but in both cases upside-down.

There s only one vertical choice pig tail up and one horizontal choice pump upside down for viewer. It iqoption.c that making the clip work for all four orientations would have been easy, so I can t imagine why they didn t do that. Confirmation Screens This is a good time to talk about the plethora of are you sure screens that are part and parcel of operating an insulin pump nowadays.

During site changes, the pump guides you step-by-step through the process. But as my comfort level with the system grew, I would have preferred something faster. At first, I liked having an onboard checklist. I d love to see an option for beginner and advanced user. For daily activities like when want to eat or need to correct your blood sugar, you have to work your way through five screens just to do those simple tasks. It s tedious. And because there are so many screens, I sometimes get lost and forget to press the last button to get my bolus.

The pump reminds me about five minutes later that I have an incomplete bolus, but by then it s timed out and I have to start over. Smaller Pig-Tail One of the bizarre things about Tandem pumps is the infusion set connection, now dubbed the t lock Connector. They have a short pig tail of tubing coming out of the top of the pump to connect the infusion set.

It s one of the things I personally hate the most about Tandem pumps. It looks medical, it s too short to tuck into my waistline, and it makes the tubing more snag-prone. I wish they would work on figuring out something better, like putting the stupid tubing straight into the cartridge and being done with it. Anyway, despite being ugly and a snag-prone, it s nice that this new slightly smaller Tandem lock speeds up the tubing fill process at site change, thanks to a skinnier aperture, requiring less insulin.

When I used their first generation pump I used to make coffee, shred potatoes for hash browns, scramble some eggs and run into town for the mail, all while waiting for the tubing to fill. Now I only have time to make the coffee. So that s an improvement. That s all the criticism I have of this new system. A Keeper for Me. Tandem has a real winner here. But the jury is still out on whether it s a keeper, and I will have to decide in the next month of using the loaner.

The first week or two, I had amazing blood sugar control, but I ve noticed that every time I change my therapy, the first few weeks are great. I m convinced that diabetes is an intelligent alien parasite that you can catch off guard, but quickly adapts. To be honest, I ll have to decide whether I can live long-term with the two things I hate most the upside-down case and the damn pig tail. I can MacGyver a case solution, and in fact the folks at Tandem were kind enough to send me one to try my hand at.

The Dremel tool and the Gorilla Glue are standing by. But there s nothing I can do about the pig tail, and that might be the deal-breaker for me. Isn t it amazing how these liveability factors trump everything else when deciding which health tech tools to use. I sure hope industry manufacturers are taking note of that.

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