Washington, Jul 10 (AP/UNB) — President Donald Trump is directing the government to revamp the nation's care for kidney disease, so that more people whose kidneys fail have a chance at early transplants and home dialysis — along with better prevention so patients don't get that sick to begin with.
Senior administration officials told The Associated Press that Trump is set to sign an executive order Wednesday calling for strategies that have the potential to save lives and millions of Medicare dollars.
That won't happen overnight — some of the initiatives will require new government regulations.
And because a severe organ shortage complicates the call for more transplants, the administration also aims to ease financial hardships for living donors, said the officials, who spoke on the condition of anonymity ahead of the announcement.
Another key change: steps to help the groups that collect deceased donations do a better job. Officials cited a study that suggests long term it may be possible to find 17,000 more kidneys and 11,000 other organs from deceased donors for transplant every year.
Federal health officials have made clear for months that they intend to shake up a system that today favors expensive, time-consuming dialysis in large centers over easier-to-tolerate at-home care or transplants that help patients live longer.
"Right now every financial incentive is toward dialysis and not toward transplantation and long-term survivorship," Health and Human Services Secretary Alex Azar, whose father experienced traditional and at-home dialysis before getting a living donor transplant, told a Senate hearing in March. "And you get what you pay for."
About 30 million American adults have chronic kidney disease, costing Medicare a staggering $113 billion.
Careful treatment — including control of diabetes and high blood pressure, the two main culprits — can help prevent further kidney deterioration. But more than 700,000 people have end-stage renal disease, meaning their kidneys have failed, and require either a transplant or dialysis to survive. Only about a third received specialized kidney care before they got so sick.
More than 94,000 of the 113,000 people on the national organ waiting list need a kidney. Last year, there were 21,167 kidney transplants. A fraction — 6,442 — were from living donors, according to the United Network for Organ Sharing, which oversees the nation's transplant system.
"The longer you're on dialysis, the outcomes are worse," said Dr. Amit Tevar, a transplant surgeon at the University of Pittsburgh Medical Center, who praised the Trump administration initiatives being announced Wednesday.
Too often, transplant centers don't see a kidney patient until they've been on dialysis for years, he said. And while any transplant is preferable, one from a living donor is best because those organs "work better, longer and faster," Tevar said.
Among the initiatives that take effect first:
—Medicare payment changes that would provide a financial incentive for doctors and clinics to help kidney patients stave off end-stage disease by about six months.
—A bonus to kidney specialists who help prepare patients for early transplant, with steps that can begin even before they need dialysis.
—Additional Medicare changes so that dialysis providers can earn as much by helping patients get dialysis at home as in the large centers that predominate today. Patients typically must spend hours three or four times a week hooked to machines that filter waste out of their blood.
Home options include portable blood-cleansing machines, or what's called peritoneal dialysis that works through an abdominal tube, usually while patients are sleeping.
Today, about 14% of patients in kidney failure get at-home dialysis or an early transplant. By 2025, the goal is to have 80% of people with newly diagnosed kidney failure getting one of those options, officials said.
These changes are being implemented through Medicare's innovation center, created under the Obama-era Affordable Care Act and empowered to seek savings and improved quality. The Trump administration is relying on the innovation center even as it argues in federal court that the law that created it is unconstitutional and should be struck down entirely.
Other initiatives will require new regulations, expected to be proposed later this year. Among them:
—Allowing reimbursement of lost wages and other expenses for living donors, who can give one of their kidneys or a piece of their liver. The transplant recipient's insurance pays the donor's medical bills. But they are out of work for weeks recuperating and one study found more than a third of living kidney donors reported lost wages, a median of $2,712, in the year following donation. Details about who pays — and who qualifies — still have to be worked out.
—Clearer ways to measure how well the nation's 58 organ procurement organizations collect donations from deceased donors. Some do a better job than others, but today's performance standards are self-reported, varying around the country and making it hard for government regulators or the OPOs themselves to take steps to improve.
"Some OPOs are very aggressive and move forward with getting organs allocated and donors consented, and there are those that are a little more lackadaisical about it," said Pittsburgh's Tevar. Unlike the medical advances in transplantation, "we haven't really made big dents and progress and moves in increasing cadaveric organs or increasing live donor options."
Charles City, Jul 10 (AP/UNB) — Sturgeon were America's vanishing dinosaurs, armor-plated beasts that crowded the nation's rivers until mankind's craving for caviar pushed them to the edge of extinction.
More than a century later, some populations of the massive bottom feeding fish are showing signs of recovery in the dark corners of U.S. waterways.
Increased numbers are appearing in the cold streams of Maine, the lakes of Michigan and Wisconsin and the coffee-colored waters of Florida's Suwannee River.
A 14-foot Atlantic sturgeon — as long as a Volkswagen Beetle — was recently spotted in New York's Hudson River.
"It's really been a dramatic reversal of fortune," said Greg Garman, a Virginia Commonwealth University ecologist who studies Atlantic sturgeon in Virginia's James River. "We didn't think they were there, frankly. Now, they're almost every place we're looking."
Following the late 1800s caviar rush, America's nine sturgeon species and subspecies were plagued by pollution, dams and overfishing. Steep declines in many populations weren't fully apparent until the 1990s.
"However, in the past three decades, sturgeon have been among the most studied species in North America as a result of their threatened or endangered status," said James Crossman, president of The North American Sturgeon and Paddlefish Society, a conservation group.
Scientists have been finding sturgeon in places where they were thought to be long gone. And they're seeing increased numbers of them in some rivers because of cleaner water, dam removals and fishing bans.
These discoveries provide some hope for a fish that is among the world's most threatened.
But the U.S. sturgeon population is only a tiny fraction of what it once was — and the health of each species and regional populations vary widely.
While some white sturgeon populations on the Pacific Coast are abundant enough to support limited recreational and commercial fishing, Alabama sturgeon are so rare that none have been caught for years.
Across America, dams still keep some sturgeon populations low by blocking ancient spawning routes. And the fish face newer threats such as rising water temperatures from climate change and the sharp propellers of cargo ships.
It will take decades to measure a population's recovery, experts say. Sturgeon sometimes live longer than humans. And they spawn infrequently, often requiring half a century to bounce back from overfishing.
Environmentalists warn that more conservation efforts are still needed.
"They've survived relatively unchanged for 200 million years," said Jeff Miller, a senior conservation advocate at the Center for Biological Diversity, which is planning a lawsuit seeking federal safeguards for sturgeon in the Great Lakes and Mississippi River watersheds. "If they're going to survive us, they're going to need additional protection."
Sturgeon swam with the dinosaurs. Bony plates line their bodies. Whisker-like barbels hang from their chins. Their toothless mouths telescope out and vacuum up anything from worms to mussels.
Their meat fed Native Americans, the starving settlers of Jamestown and the Lewis and Clark expedition. Delaware River shad fishermen would yank up their nets as thousands of sturgeons swam toward spawning grounds.
Then came caviar. The Russian delicacy of salt-cured sturgeon eggs became a fad for Europe's new middle class —and that took a heavy toll on American sturgeon.
"People just massacred them, just like we massacred the buffalo," said Inga Saffron, author of the 2002 history "Caviar."
"The difference being they were catching the sturgeon as they were migrating to spawn," she said. "Not only did they kill the fish, they killed future generations of fish."
By 1900, American sturgeon populations were collapsing. Dams were going up. Pollution sucked oxygen from rivers.
But as decades passed, fishing bans took effect, and environmental laws became stronger.
Among the species showing improvement is Atlantic sturgeon, whose range stretches from Florida to eastern Canada.
The population around the Chesapeake Bay was feared to be extinct in the mid-1990s. Now, thousands of are believed to be there, according to Virginia Commonwealth University scientists.
Last fall, Matthew Balazik, a sturgeon research ecologist with the university and the U.S. Army Corps of Engineers, netted more than 200 baby Atlantic sturgeon in the James River — the first seen there in years. "This could be a kind of a comeback generation," Balazik said.
Not every river is seeing improvement. Dewayne Fox, a fisheries professor at Delaware State University, said the Delaware River's population remains low, possibly because of collisions with cargo vessels or dredging on spawning grounds.
But overall, Atlantic sturgeon appear to be slowly recovering after a species-wide fishing moratorium went into effect in 1998, according to a 2017 assessment by the Atlantic States Marine Fisheries Commission.
The shortnose sturgeon also shows signs of bouncing back. In Maine, scientists have captured about 75 this decade on the Saco River, where they were previously never seen.
In Maine's Kennebec River, the shortnose population nearly doubled from about 5,100 in the late 1970s to more than 9,400 around 2000, and it has likely grown since, said Gail Wippelhauser, a fisheries biologist with Maine's Department of Marine Resources.
Wippelhauser credits cleaner water: "They used to just dump sewage into the river. There were paper mills that used to dump chemicals in."
Lake sturgeon are waging a slow but steady comeback. The largest group is in the river corridor linking Lakes Huron and Erie, said Ed Baker, a research biologist with the Michigan Department of Natural Resources.
The species is benefiting from fishing limits and stocking programs, some by Native American tribes. But dam construction over more than a century has slowed the recovery.
One solution has been a fish elevator and tanks that haul them around two hydroelectric dams on the Menominee River, which flows between Wisconsin and Michigan's Upper Peninsula.
The number of Gulf sturgeon is also growing, particularly in Florida's Suwannee River. That population has at least doubled since the mid-1990s to about 10,000 fish.
The species still faces various threats including the Gulf Coast's ever-warmer waters, said Adam Kaeser, an aquatic ecologist with the U.S. Fish and Wildlife Service.
Decimated by dams, only one Alabama sturgeon has been caught since 2007, but DNA tests of river water confirm some are still there.
"They're hanging on," said biologist Steve Rider with the Alabama Department of Conservation and Natural Resources. "But they're barely hanging on."
Chicago, Jul 10 (AP/UNB) — Chicago police investigators have cracked the case: A 4-5 foot alligator is living in a lagoon at one of the city’s most popular parks.
Chicago police spokesman Anthony Guglielmi says Tuesday that investigators went to Humboldt Park Lagoon on the city’s West Side and confirmed that the unusual resident is there as reported on social media.
Officials couldn’t say how the creature got there.
City officials say alligator traps are being placed around the lagoon in hopes the animal will swim into one and be safely removed.
Guglielmi says the animal was expected to be trapped “and relocated to a zoo for veterinary evaluation.”
Alligators favor warm weather climates such as Florida but have been known to survive temporarily in the cold through a process similar to hibernation.
Washington, July 10 (Xinhua/UNB) -- As many as two-thirds of suspects, or 67 percent exactly, displayed symptoms of mental illness or emotional disturbance when launching mass casualty attacks across the United States last year, according to a report released by the U.S. Secret Service on Tuesday.
In at least 93 percent of last year's attacks, authorities found that the suspects had a history of threats or other troubling communications beforehand, said the report, which covered 27 attacks in 2018 that left 91 people dead and 107 injured.
"Because these acts are usually planned over a period of time, and the attackers often elicit concern from the people around them, there exists an opportunity to stop these incidents before they occur," the report concluded.
The Secret Service identified 28 such attacks in 2017, according to a USA Today report.
Shijiazhuang, July 10 (Xinhua/UNB) -- A handwritten family tree dating back to the Ming Dynasty (1368-1644) was discovered in north China's Hebei Province, according to local authorities.
The thread-bound family tree, found in Shuangpengtou Village, Xingtai City, was completed in August 1637 and is well-preserved with clear and neat handwriting.
The manuscript recorded the pedigree of a family of Meng and the family's rules and rituals, and also described the politics, economy and culture around the city.
"The well-preserved family tree offers us valuable insight into the family rules and rituals, economy and culture in central and southern Hebei in the Ming Dynasty," said Lan Jianhui, an expert on culture and history in the city.