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Analysis, background reports and updates from the PBS NewsHour putting today's news in context.

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    Beth Olson, center, a care consultant with the Alzheimer’s Association of Minnesota-North Dakota, says good-bye to Jo Ormiston, 77, after a visit on Friday, April 7, 2017. Also pictured are: daughter Barb Kram, left, and Alan Ormiston. Olson has visited the farmstead a few times and occasionally talks with family members via phone. She provides caregiver training and also connects them with area services. Photo by Ann Arbor Miller/STAT

    North Dakota’s sparse geography has long made it a natural frontier: Pioneers here pushed the boundaries of westward expansion, then agriculture, and recently domestic oil drilling. Now the state finds itself on the leading edge of a new boom that it never would have chosen: Alzheimer’s disease.

    Cases are climbing across the United States, and especially in North Dakota, which has the country’s second highest death rate from the disease. While Alzheimer’s is the sixth leading cause of death nationally, it already ranks third here.

    “Everybody knows somebody” affected by the disease, said Kendra Binger, a program manager with the Alzheimer’s Association of Minnesota and North Dakota. As public awareness rises along with the numbers of cases, “it’s hard to ignore anymore.”

    This makes the state an ideal laboratory to glimpse at the future of Alzheimer’s in America, and to identify strategies that could help the rest of the country cope. The devastating disease has strained families and the state budget. So North Dakota — a place that prides itself on personal independence and financial parsimony — has found new ways to support its residents and a new consensus to spend money on prevention.

    READ NEXT: Are we facing a Alzheimer’s armageddon?

    The state’s primary strategy is to assist family caregivers — the estimated 30,000 North Dakota spouses, siblings, sons, and daughters looking after loved ones with dementia. A half-dozen consultants roam the state to evaluate families’ needs, train caregivers, connect them to services, and offer advice. Studies show the program has helped families keep their loved ones out of nursing homes and save the state money.

    “We are not well-prepared, to put it mildly,” to respond to the growing Alzheimer’s crisis across the country, said Marc Cohen, clinical professor of gerontology and director of the Center for Long-Term Services and Supports at the University of Massachusetts, Boston. Since the burden of caring for dementia patients falls heavily on family members, he added, strategies like North Dakota’s are “exactly what is needed.”

    Betty Mahlke, a retired bookkeeper, discovered the impact of North Dakota’s approach two years ago, when her husband, Larry, started forgetting everyday details — a troubling symptom of the Alzheimer’s diagnosis he’d received years before. It’s lonely enough caring for a loved one with dementia in the heart of a city, surrounded by service organizations and care options. But like Betty, many of North Dakota’s growing ranks of family caregivers are doing it in far lonelier places: on isolated farms or in small towns across 350 miles of the Great Plains.


    Public awareness about Alzheimer’s disease is on the rise in North Dakota as the number of cases in the state increase. Here, Alan and Jo Ormiston’s farmstead sits among a grove of trees. “It’s quiet out here,” says Barb Kram of Munich, N.D. Kram’s parents have lived on this property since 1984. Photographed on Friday, April 7, 2017. Photo by Ann Arbor Miller/STAT

    The Mahlkes lived in Jamestown, a city of 15,000 halfway between Fargo and Bismarck, a hundred miles from each. Jamestown is hardly the state’s most remote community; it is home to the National Buffalo Museum, a stock car racetrack, and high school football games that Larry Mahlke loved to frequent. But it has limited support services compared to a big city. So when a visiting consultant, Beth Olson, came to give a presentation on dementia at the local senior center in March 2015, Betty seized the chance.

    “Every little hint” about how to care for Larry resonated, Betty recalled. “I was just grasping for anything that could help.”

    Soon after, Olson visited the Mahlkes at home, and that began a relationship that would carry Betty through the deepening challenges to come. At first, Olson suggested puzzles and games that could help Larry, a retired furnace installer and insurance salesman, keep his mind active. When he later stopped recognizing his own home, she coached Betty on the best response. Instead of arguing, Betty would invite him into the car, drive a few blocks, drive back, and say they were home. Sometimes the gambit worked, Betty said. “Other times he’d say, ‘This is not my house,’ and we’d have to drive around some more.”

    Olson’s personalized support of the Mahlkes is North Dakota’s model for easing the burden of Alzheimer’s and other forms of dementia. Olson is a care consultant with the state’s Dementia Care Services Program, established in 2009. Republican state Senator Dick Dever proposed the program after discovering personally the difficulty of caring for a family member with Alzheimer’s. The state Legislature approved it with overwhelming support in both houses. Michigan is now piloting a similar program in three counties and working to expand it statewide.

    What makes North Dakota such an Alzheimer’s hot spot? Like much of the rest of the Midwest, it’s graying. Rural counties are emptying out as young people depart for better job prospects elsewhere, leaving an earlier, aging generation behind. This is a familiar story for Betty Mahlke, whose four grown sons all settled out of state (in Minnesota, Nevada, and Idaho) for the sake of work.

    The youth exodus has been countered in North Dakota by a flood of young arrivals coming to work the oil fields — but only in a fraction of the state’s counties, and not enough to divert the overall trend. The state still has a high ratio of elderly residents. Especially large is the group called the “oldest old,” those age 85 and over, who are dramatically more likely to die from Alzheimer’s than the group age 65 and over. In the latest US Census, only Rhode Island had a larger portion of its populace in the “oldest old” range.

    Still, that explanation doesn’t satisfy Dr. Donald Jurivich, chair of geriatrics at the University of North Dakota School of Medicine and Health Sciences, who believes there’s more at play than migration patterns. When he shows his colleagues North Dakota’s high dementia numbers, he said, “People have pretty much been stupefied.” Why wouldn’t Rhode Island, with its higher ratio of “oldest old,” match North Dakota in dementia deaths? And why not Iowa, whose population of “oldest old” is nearly as high? The only state with a comparable ratio of the very elderly whose dementia death rate surpasses North Dakota is neighboring South Dakota.

    Jurivich and his colleagues have speculated on a host of possible causes, none yet proven: Perhaps North Dakota’s high Alzheimer’s death rates could be explained by radon exposure, a meat-heavy diet, genetic predispositions among the northern Europeans who settled this part of the Midwest, or simply state-by-state differences in record keeping. He’s applying for grants to fund further study to solve the mystery.

    The Dementia Care Services Program, meanwhile, has to cope with the realities on the ground. The program, run by the regional Alzheimer’s Association, substantially expanded the shoestring work that the association was doing before 2009. Previously, two consultants had covered the entire state, counseling families one-on-one (including Dever’s family) and raising their own funds. Thus stretched, they couldn’t range far beyond Fargo and Bismarck, the two largest cities.


    Alan Ormiston stays close to wife, Jo, at the couple’s rural home near Nekoma, N.D., on Friday, April 7, 2017. The couple married in September 1959 and raised four children together. Alan has turned to the Alzheimer’s Association of Minnesota-North Dakota to help guide him in caring for Jo. Photo by Ann Arbor Miller/STAT

    Now, six care consultants do the job, dividing the state into eight zones. As Olson did with the Mahlkes, the consultants assess patients’ needs, teach caregivers what to expect and how to respond, refer them to services, lead support groups, and answer questions by phone and in person. Importantly, they often visit patients’ homes, even those in the remotest corners of the state. Between January 2015 and this February, nearly three-quarters of the 2,602 consultations were done in person.

    Deaths from Alzheimer’s have jumped 74 percent since 2000 in North Dakota, and the program’s caseload has similarly exploded. The number of families served has risen steadily since 2011, from about 500 in every two-year period to a current pace that could double that. The program costs the state $600,000 a year.

    The program’s main purpose is to help families keep loved ones with dementia at home, rather than in a nursing facility, for longer. With average nursing home costs running over $8,000 a month per patient, and the state’s share of Medicaid paying half the price, even a few weeks’ delay can make a dent. For families, having the knowledge and support to keep a loved one at home can also make a big emotional impact, relieving the bewilderment and burnout that often afflicts caregivers and preventing costly, avoidable medical care for patients and caregivers alike.

    That’s what it did for Betty Mahlke. Though the caregiving exhausted her, she couldn’t stomach the idea of moving her husband into a care facility. When Larry eventually couldn’t recognize even her, Olson had already prepared her for how to respond.

    “We’d be sitting in the living room and he would look at me strangely, and you could see that fear in his eyes, that this lady is not anybody he knows,” Betty recalled. “There were times when we’d go to bed at night and he’d lay on the edge of the bed, stiff as a board.” When Larry said, “Where’s Betty?” she knew to reassure him: “I’ll go try and find her.” Then she’d leave the room, change her shirt, and come back in.

    Without that preparation, Betty said, she wouldn’t have known how to handle Larry’s confusion. And if she’d had to travel to a bigger city to attend the presentation that first introduced her to Olson, she’d never have gone. All told, without the Dementia Care Services Program, she said, she could never have kept Larry at home for so long.

    A formal evaluation of the program backed up stories like Betty’s with statistics. The study, conducted at the University of North Dakota Center for Rural Health, looked at the first 3 1/2 years of the program. Caregivers reported that it helped them feel more empowered, less likely to need emergency room visits and hospitalizations for their loved ones, and less likely to place their loved ones in long-term care. The researchers estimated the resulting cost savings at $800,000 for medical and hospital services avoided and $39 million for long-term care.


    Alan Ormiston checks in with wife, Jo, at the couple’s rural home near Nekoma, N.D., on Friday, April 7, 2017. The couple married in September 1959 and raised four children together. Alan has turned to the Alzheimer’s Association of Minnesota-North Dakota to help guide him in caring for Jo. “He has risen to the challenge,” says Barb Kram, the couple’s youngest daughter. “It’s been amazing to watch.” Photo by Ann Arbor Miller/STAT

    Michigan, too, studied its similar, small pilot program and found that it reduced nursing home placements by more than 9 percent and saved the state over $500,000 in a single year.

    The bottom line, said Brad Gibbens, deputy director of the UND Center for Rural Health: “If you can provide some support services for the family caregiver, you can improve the lives of those with dementia and the family caregiver, and likely save the public taxpayer some money.”

    Even so, the North Dakota program lost over 10 percent of its funding in a budget crunch last year and could face further cutbacks as the state grapples with a continued shortfall. This comes as Republican congressional leaders in Washington have proposed capping Medicaid money sent to states as part of the Affordable Care Act repeal, which could make such dementia care programs all the more important.

    READ MORE: “Dementia-friendly” communities take root across U.S.

    Over the past quarter-century, the balance of Medicaid money spent on long-term care has shifted away from nursing homes and toward more home- and community-based care. UMass Boston’s Cohen warns that the proposed caps could reverse that trend, resulting in cuts for optional support programs and thus sending more patients into nursing homes.

    “If there is less money available to pay for home and community-based care,” he said, “families will have to pick up the slack — or people will have greater unmet need — and training to make them more effective will become more important.”

    As the number of Alzheimer’s patients grows and federal dollars potentially dwindle, other states are likely to need to develop similar supports for families, for reasons both humane and pragmatic. “We know people do better at home, and people want to care for their loved ones at home,” said Gretchen Dobervich, a one-time field director for the regional Alzheimer’s Association who now represents Fargo as a Democratic member of the state Assembly. Plus, “with the large numbers of people we’re going to see with this disease, there’s no way we’re going to be able to have enough care facilities to treat the number of diagnoses we’re going to see.”


    Beth Olson, a care consultant with the Alzheimer’s Association of Minnesota-North Dakota, drives along North Dakota’s Highway 1 after visiting the home of Alan and Jo Ormiston near Nekoma on Friday, April 7, 2017. “I try to travel smart,” says Olson, who spends a portion of her time on the road visiting families and giving public presentations. Photo by Ann Arbor Miller/STAT

    The North Dakota program ultimately enabled Betty Mahlke to care for Larry at home until just three weeks before his death. One day in March 2016, a year after entering the Dementia Care Services Program and six years after his initial diagnosis, Betty went out for a few hours and left Larry in the care of a health aide from a company Olson had helped her find. Larry, disoriented and distressed, shoved the unfamiliar woman and walked out of the house, searching for Betty. He walked a block in the late-winter cold without a coat or shoes on. Betty told Olson, who happened to be in town for an event, and the two of them brought him home.

    The next night, his last night at home, Betty and Larry had a picnic dinner in the living room and danced waltzes like they had as younger sweethearts. The following day, Betty brought him to a nursing home, where hospice helped pay part of the staggering $1,860-per-week cost. Larry died less than three weeks later, at age 74. The Mahlkes had been married for 51 years.

    “I don’t think that he suffered” during those few weeks in the nursing home, “so that was a blessing,” Betty said. “I did it for my husband, and I know he would have done it for me.”

    This article is reproduced with permission from STAT. It was first published on April 12, 2017. Find the original story here.

    The post ‘Everybody knows somebody’: This state is a laboratory for the future of Alzheimer’s in America appeared first on PBS NewsHour.

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    HARI SREENIVASAN, PBS NEWSHOUR WEEKEND ANCHOR: There’s a special election on Tuesday for an open seat in the House of Representatives to fill the vacancy left by Tom Price, who’s now the secretary of Health and Human Services. The race is getting national attention and money.

    The sixth district in the Atlanta suburbs, as it’s now drawn, has been solidly Republican for 25 years. But a 30-year-old Democratic newcomer, Jon Ossoff, is making a strong run for the seat.

    Joining me to discuss the race is “Atlanta Journal Constitution” reporter, Greg Bluestein.

    Thanks for joining us.

    We don’t usually talk about the Georgia 6th.


    SREENIVASAN: I mean, why is that such a big deal?

    BLUESTEIN: No, we don’t usually talk about the Georgia 6th. And I thought, most people in Atlanta thought this would be a sleepy, all Republican race when Tom Price was tapped as Donald Trump’s health secretary.

    But Trump’s early struggles in his presidency, as well as the tepid support for Trump in the district that has long been solidly red had made this a nationality story.

    SREENIVASAN: And how much money are we talking about this flowing in to both sides of this?

    BLUESTEIN: Yes. I mean, 14 million have already been spent on the advertising in this district alone, and Jon Ossoff has raised an unprecedented $8.3 million for a Democratic newcomer in a congressional campaign. And he’s used that to flood the district with ads, with radio spots, with digital hits, and with fliers. I mean, I’ve talked to voters who’ve gotten two, three, four fliers from him a day.

    SREENIVASAN: Every few years, we come up with this narrative that’s — well, Georgia could be the one that flips back and forth. This is not a district that has ever trended Democratic, I mean, at least not in the last 25 years.

    BLUESTEIN: No, and Tom Price has won landslide victory after landslide victory every two years. That’s, you know, Democrats are trying to temper some of their expectations, at least some of the higher profile Democrats I’m talking to. But with — coupled with the $8.3 million he’s raised and a surge of enthusiasm and there’s clearly an enthusiasm gap and Jon Ossoff is in the 40s in most of the polls, I mean, he’s within the striking distance of getting 50 percent victory outright victory that he wants but it’s unbelievably tough haul for him. I mean, Republicans far outnumber Democrats among primary voters in the district and the district has been in Republican hands essentially since Jimmy Carter’s era.

    SREENIVASAN: This is not expected to decide the winner on Tuesday.

    BLUESTEIN: No, it’s not. There’s 18 candidates overall on the ballot and they’re all on the same ballot regardless of party. If no one gets a majority of vote, that will go — there will be a June 20th runoff between the two top vote-getters. Ossoff’s best chance might be to get that outright victory because the Republicans in the field, there’s 11 of them. They’re divided, they’re fractious and, they’re warring with each other more than they’re targeting him.

    So, Jon Ossoff and his supporters are aiming for that outright victory. And he is close in the polls. He’s about 45 in some of the polls. So, he’s within striking distance but he’s not quite there yet it looks like.

    SREENIVASAN: And has this energized the Democratic base?

    BLUESTEIN: It has. I mean, we are hearing from new Democratic groups that we’ve never heard of before, a group like the Red Clay Rebellion and Milton Seven, and the (INAUDIBLE) Moms for Ossoff, you know, out of the woodwork these Democratic groups in these deep red territories are showing up.

    Johns Creek is one of the reddest parts of the district, and the other day, a Republican strategist sent me a picture of about 150 Ossoff supporters waving signs on this corner saying, “Oh-uh”. So, Republicans are starting to get a little unnerved by it all.

    SREENIVASAN: All right. Greg Bluestein from “The Atlanta Journal Constitution” – thanks so much.

    BLUESTEIN: Thanks for having me.

    The post Georgia Dems aim for upset in Republican stronghold appeared first on PBS NewsHour.

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    Groundwater pumping and storage system for agriculture, in California's Central Valley (San Joaquin Valley), Fresno County. Photo by

    Humans are depleting vital groundwater resources across the globe, creating a significant threat to the international trade of food. Photo by Jenny E. Ross/via Getty Images

    We already know that humans are depleting vital groundwater resources across the globe. But a new study shows one of the biggest causes of disappearing groundwater is the international food trade.

    About 70 percent of freshwater around the globe goes toward irrigation. Researchers from the University College London and NASA’s Goddard Institute of Space Studies now say that a third of that freshwater is drawn from the world’s aquifers — nonrenewable underground pockets of groundwater — and 11 percent of that nonrenewable groundwater is used to irrigate internationally-traded crops.

    That means in time, “the current type of food that’s grown will not be able to be produced,” said Carole Dalin, an environmental engineer at the University College London who led the study published in Nature. “Or we’ll not have the same productivity, so it means prices will increase.”

    When water is used to grow crops, it’s no longer visible to the consumer. This study keeps track of where this ‘hidden’ water is embedded and where it ends up.

    To measure how irrigation drains global aquifers, International Institute for Applied Systems Analysis hydrologist and study co-author Yoshihide Wada used an in-house model that essentially places a computerized grid over the Earth and then measures soil moisture, along with water exchange between the atmosphere, soil layers and the underlying groundwater reservoirs, to see where water was going and why. He validated his calculations by comparing them with satellite measurements that track water flow and underground water storage.

    Meanwhile, Dalin gathered information on global trade and irrigation rates. By combining the information, they could determine how much groundwater was sapped by the agriculture required for the international food supply.

    Rice used 29 percent of the groundwater intended for international food crops, topping the study’s list, followed by wheat (12 percent), cotton (11 percent), maize (4 percent) and soybeans (3 percent). Citrus and sugar crops used about 5 percent each.

    Man in rice paddies in Pakistan. Photo by Mike Powles/via Getty Images

    Man in rice paddies in Pakistan. The majority of Pakistan’s groundwater depletion for irrigation involves rice cultivation. Pakistan and India use the largest volumes of groundwater depletion for irrigation. Every 17 years, Pakistan farmers drain a volume equivalent to that of Lake Erie from the nation’s aquifers. Photo by Mike Powles/via Getty Images

    Who will be hit the hardest? Countries that export the largest number of these crops, those that import a substantial amount of their food and those that both export and import these crops, the study says.

    Pakistan, the United States and India, for example, account for two-thirds of all exported crops irrigated with nonrenewable groundwater. Depletion of this water resource would impede efforts to export crops at their current levels.

    Countries in arid and semi-arid regions that rely heavily on imported goods — like Iraq, Iran, Saudi Arabia and Kuwait — would have the most difficulty getting access to food should groundwater run out and potentially create a global food shortage. In other scenarios, countries such as the U.S., China, Mexico and Iran, all major food producers and importers, would take a hit both in the amount of food they can produce as well as in a drop in the global food supply. U.S. exports to China, Mexico and Japan — largely cotton, wheat, maize and soybeans — are depleting most of the country’s groundwater supply for crops.

    “If you are producing this crop and it disappears, then you can compensate with imports,” Dalin said. But it’s harder if “both your local production and imports … are exposed to the risk.”

    Dalin and Wada, along with colleagues from NASA’s Goddard Institute of Space Studies in New York City and the Senckenberg Biodiversity and Climate Research Centre in Germany, found nonrenewable groundwater was also being extracted at a much higher rate in 2010 than it was just 10 years earlier. Dalin predicts farmers could lose their jobs, nations could face food shortages and economies could suffer if these trends continue.

    Jay Famiglietti, the Senior Water Scientist at NASA Jet Propulsion Laboratory and a professor at the University of California-Irvine, was not involved in the study. But his research indicates two billion people rely on nonrenewable sources of water, and more than half of the world’s aquifers are being depleted passed the “sustainability tipping point.”

    “I think we’re headed to major threats to food security,” Famiglietti told the NewsHour.

    Farmer checks soybean crop in midsummer. Photo by Ryan/Beyer/via Getty Images

    U.S. exports to China, Mexico and Japan account for the majority of its groundwater depletion related to crop trade; the primary commodities are cotton, wheat, maize and soybeans (pictured). Photo by Ryan/Beyer/via Getty Images

    Keeping track of water resources used for tradable goods can improve water sustainability and food production, as populations continue to grow and drought frequency rises.

    “These virtual flows of water are going to become more and more important as population grows and certain regions don’t have enough water to grow food,” Famiglietti said.

    Some regions have attempted to tackle the groundwater problem, but nothing is being done on a global scale, Famiglietti said. There are a number of barriers to doing so.

    “It’s not just how much water we have and how much we’re using, but it’s, ‘Who’s got the rights? What are the policies?’ And we don’t manage the surface water and the groundwater together – we treat them like they’re completely separate, which they’re not,” Famiglietti said.

    California, which recently came out of a years-long drought, is addressing the problem locally, albeit slowly, Famiglietti said. The state passed a Sustainable Groundwater Management Act in 2014 that divides the state into different groundwater management agencies. Each agency now has five years to create and implement 20-year sustainability plans.

    “The whole process is about 27 years, so [it will take until] about 2042 to really understand where we’re at with groundwater,” Famiglietti, who is also an appointed member of the California State Water Boards, said. That’s a little slow, “but at least it’s there,” he added.

    A groundwater well in California's Central Valley (San Joaquin Valley) next to an agricultural field, Fresno County. Photo by

    A groundwater well in California’s Central Valley (San Joaquin Valley) next to an agricultural field, Fresno County. Photo by Jenny E. Ross/via Getty Images

    Kansas is also addressing concerns about its High Plains aquifer, which provides about 70 percent of the water Kansans use each day. Water management officials in Kansas have placed flow meters on 99 percent of the irrigation wells that pull water from the aquifer as a way to measure the amount of liquid that passes through. This data helps scientists who study the groundwater levels.

    “The key to the Kansas situation is the data, because you can’t really manage what you don’t know,” Jim Butler, a senior scientist at the Kansas Geological Survey, said.

    In addition to the data collection, a group of farmers in a small 99-square mile area of northwestern Kansas agreed to reduce the their groundwater crop rate by 20 percent through a grassroots generated program called Local Enhanced Management Areas (LEMA). By changing their irrigation and farming strategies, they have used less water while maintaining their bottom lines. Now in its fifth irrigation season with these new protocols, the group has hit the 20 percent reduction mark each year.

    Dalin said there’s an urgent need for more data on nonrenewable groundwater because “we don’t know exactly how much water is in these aquifers and so we don’t know exactly when they’ll be empty.”

    “The one wish we all have is that we would have moved forward on this 10 to 15 years sooner,” Butler said. “Each year that passes that we don’t do something it just makes it more difficult because you have less and less of an aquifer to work with.”

    The post As global groundwater disappears, rice, wheat and other international crops may start to vanish appeared first on PBS NewsHour.

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    White House Press Secretary Sean Spicer addressed visitor logs during Monday’s news briefing.

    WASHINGTON — The White House defended its commitment to transparency Monday amid criticism of its decision to keep visitors’ records secret and new calls for President Donald Trump to release his federal tax returns.

    Government watchdog groups argue Trump is preventing the public from learning basic details about his financial ties and blocking information about the groups and individuals that are trying to influence the White House. The Obama administration released 6 million White House visitor records over eight years.

    On Monday, White House spokesman Sean Spicer downplayed those disclosures because national security and law enforcement reasons were used to exclude certain visits — despite the fact that the Trump White House has used national security and privacy concerns to justify keeping all visitor information under wraps.

    Spicer said the Obama White House approach amounted to “faux” transparency.

    “It’s not really being transparent when you scrub out the names of the people that you don’t want anyone to know were here,” Spicer said.

    The Obama administration initially fought attempts by Congress and conservative and liberal groups to obtain visitor records. But after being sued, it voluntarily began disclosing the logs in December 2009, posting records every three to four months. It continued to release the records even though a federal appeals court ruled in 2013 that the logs can be withheld under presidential executive privilege.

    READ MORE: White House says it won’t release visitor logs

    Trump has long faced questions about secrecy and transparency given his refusal to release his federal tax returns, a decision that broke decades of tradition for both presidents and presidential candidates. White House aides have also provided few details about Trump’s activities and meetings during his numerous weekend trips to Florida.

    Thousands of protesters marched across the country Saturday demanding anew that Trump release his tax returns. But the protests did little to change Trump’s thinking: Spicer maintained that Trump was unable to make the information public because he is under audit, despite the fact that tax experts say an audit would not prevent him from releasing his taxes.

    Asked whether Trump is simply never going to release his taxes, Spicer said, “We’ll have to get back to you on that.”

    The White House defended Trump’s overall approach to transparency, noting that the president often opens portions of his meetings with business executives and other visitors to journalists. He also takes questions from reporters on a fairly regular basis, including during news conferences with visiting foreign leaders.

    “We bring people in, we release participant lists, we give press the opportunity to come into the room, see everybody who’s there, hear part of the discussion,” Spicer said.

    However, the White House has been tight-lipped about Trump’s activities when he travels to his properties in Florida — his Mar-a-Lago resort and a nearby private golf club. Aides rarely confirm when the president is golfing, even when photos of him on the course pop up on social media.

    During his recent Easter visit to Florida, the president spent two days at Trump International Golf Course. The White House provided no information about his activities, though CNN obtained images of the president golfing.

    The post WATCH: White House defends transparency after visitor log reversal appeared first on PBS NewsHour.

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    A young woman having a stressful time organising her receipts and files for a tax return. Photo by Ida Hollis via Getty Images

    As we’ve seen in other countries, the way to bring about fundamental change in a dysfunctional tax code is to start over — to rewrite from scratch, writes T.R. Reid, author of “A Fine Mess.” Photo by Ida Hollis via Getty Images

    Editor’s Note: The following excerpt is from “A Fine Mess: A Global Quest for a Simpler, Fairer, and More Efficient Tax System” by T. R. Reid. For more, watch economics correspondent Paul Solman’s conversation with Reid below and read his extended conversation with the author here.

    Ah, the blithe joys of springtime in the United States of America: azaleas in bloom at the Masters, school trips to the state capital, big sales at the garden stores, baseball’s opening day, picnics in the park on bright, breezy April afternoons — and the ordeal of Form 1040, with instructions like this one from the Internal Revenue Service: “If you determined your tax in the earlier year by using the Schedule D Tax Worksheet, or the Qualified Dividends and Capital Gain Tax Worksheet, and you receive a refund in 2016 of a deduction claimed in that year, you will have to recompute your tax for the earlier year to determine if the recovery must be included in your income.”

    As we’ve seen in other countries, the way to bring about fundamental change in a dysfunctional tax code is to start over — to rewrite from scratch.

    The U.S. tax code often seems to be at war with the taxpayers. The tax law has become so stuffed with obscure provisions that were important to some group or other at some point in time that the mess just becomes too difficult for anybody to understand or to manage. The resulting complexity — made worse by the so‑called anti-complexity clause that Congress threw into the stew some years back — has reached absurd dimensions. When I asked the commissioner of the IRS whether anybody in his agency has read all 73,000 pages of IRS regulations, he laughed at the very suggestion.

    At the same time, the tax code often seems to be at war with itself. There are many provisions, for example, that provide benefits or preferences for families that have a child. The problem is that the different sections of the Internal Revenue Code can’t agree on what constitutes a “child” for tax purposes. There’s a “child credit” in the personal income tax that applies to any person under the age of 17. But there’s also a separate “child and dependent care credit,” which defines a “child” as somebody under 13. For families getting the earned income tax credit (that’s the reverse income tax that sends checks to taxpayers who have low-paying jobs), a “child” is any person under 19 — unless the person is a full-time student, in which case a “child” is anybody under 24. Every time Congress decides to give a tax break for having a child, it just picks some definition of “child” and stuffs that language into the tax code, regardless of how many other designations of “child” have been stuffed in the code somewhere else.

    Watch economics correspondent Paul Solman’s conversation with T.R. Reid about how the U.S. could improve its tax system.

    This has been going on since the birth of the federal income tax a century ago. And history has shown that every three decades or so the tax code becomes so huge and complicated and contradictory that the only way to fix it is to scrap the whole mess and start over. By looking at other industrialized democracies that have faced the same tax questions we’re dealing with, we can decide what should be in this new tax code and what should not. That’s why the U.S. Treasury secretary in 1984, Donald Regan, dispatched his policy experts to look at other systems and bring back the best ideas — a process that ended with the dramatic tax changes of 1986, widely recognized as the most sweeping, and most admired, reform in the history of the U.S. tax code.

    Here at home, our political leaders talk about fixing the tax code all the time. But their proposals involve incremental change to the existing system, and incremental change, over the decades, is what got us into the fine mess we’re stuck with today. These approaches to tax reform, including the plans we heard during the 2016 presidential campaign, all suffer from the same problem: They’re too timid.

    They all have a rearranging-the-deck-chairs quality at a time when the whole structure is sinking from its own weight. As we’ve seen in other countries, the way to bring about fundamental change in a dysfunctional tax code is to start over — to rewrite from scratch.

    “You can’t just tinker … Facing a huge, almost incomprehensible system, you have to take it on. Your goal has to be to fix the whole damn thing.”

    The New Zealand parliamentarian Maurice McTigue explained why his country was able to scrap a decrepit, inequitable, inefficient tax code and replace it with a system that has won plaudits from tax experts everywhere. “A key reason was that we did it big,” McTigue said. “They changed almost everything at once. And that’s an important lesson: if you’re going to do tax reform, you’d better make it a large reform. That way, for every change a taxpayer doesn’t like, there’s something else in he package that he wants.”

    It’s the same conclusion the former senator Bill Bradley drew from our country’s successful revamp of the Internal Revenue Code in 1986. “You can’t just tinker,” Bradley said then. “Facing a huge, almost incomprehensible system, you have to take it on. Your goal has to be to fix the whole damn thing.”

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    According to new research, Americans are more empathic to and supportive of policies addressing the wealth-based achievement gap than race-based. Photo by Eric Gaillard/Reuters

    States are beginning to outline new ways to evaluate their schools, rather than relying just on traditional measures such as test scores. Photo by Eric Gaillard/Reuters

    WASHINGTON — How often do students miss school? Are they ready for college? Are they physically fit? Is their school a welcoming place?

    States are beginning to outline new ways to evaluate their schools, rather than relying just on traditional measures such as test scores.

    The plans are required under a federal education law, the Every Student Succeeds Act, which was signed by former President Barack Obama in 2015 and takes effect in the coming school year.

    Under the new law, states are focusing more on academic growth, meaning not just whether students have achieved a certain academic level in reading and math, but whether they have improved over time.

    Mike Petrilli, president of the Thomas B. Fordham Institute, said that’s a big change from the No Child Left Behind Act, the previous version of the education law. “Schools and educators should feel good about that; that will be a fairer way to measure school quality,” he said.

    MORE: Are school vouchers good for education? That debate is playing out in Indiana

    But while most experts praised the flexibility and innovation offered by the new law, some think that in the absence of federal guidelines some states may overlook groups of students who need additional support, such as minorities, students with disabilities and English-language learners. The Republican-controlled Congress moved swiftly this year to rescind key federal accountability guidelines passed by the Obama administration to help states implement the new law.

    So far, nine states and the District of Columbia have submitted their accountability plans to the Education Department for review, and seven states are completing their blueprints. The remaining states will submit their plans in September. Education Secretary Betsy DeVos will decide whether to accept or reject them. She has said her goal is state and local flexibility in education and indicated that she might use the process to advance school choice.

    When evaluating school quality, states are experimenting with new indicators. Almost all of the first-round states have adopted chronic absenteeism, or how many students miss more than 10 percent of the school year, as a key metric.

    Connecticut and Delaware, among others, also will be tracking college readiness, or whether high school students are taking advanced classes and how successful they are on college admission tests like the SAT.

    Tennessee wants to give every public school in the state a grade from A to F, which state Education Commissioner Candice McQueen says would give parents better information about schools. The grade will take into account such things as how well English language learners are doing and whether disabled students are being served. The schools will also be graded on chronic absenteeism rates, and if students are ready for college or the military and whether traditionally underserved students are performing well. Graduation rates also will count.

    MORE: Thinking about math in terms of literacy, not levels

    Nevada outlined a system that focuses on student growth measures, including test scores, English language proficiency, and graduation rates. Massachusetts will be paying attention to academic results in ninth grade.

    In New Mexico, the state will begin tracking the need for additional tutoring in college and linking those back to high schools where the students studied. The state also will look at how students do in science in ranking schools.

    Some states are getting creative. Vermont and Connecticut want to make physical fitness another sign of school quality, while Connecticut also believes access to arts education should be another measure. Illinois wants to conduct “climate surveys” asking whether children feel they are in a safe and welcoming environment.

    “There is a lot more than just tests that matter for student success,” said Natasha Ushomirsky with the Education Trust. “Tests are important and looking at progress is important, but states are getting a better picture of how schools are serving students.”

    MORE: Arne Duncan says we’re testing kids too much

    Another common thread that has emerged from the first round: States are doing a better job of involving parents, teachers and community activists in the process. “They’ve been very proactive to engage anybody who has an interest in the plans,” said Kirsten Carr with the Council of Chief State School Officers.

    But Marc Magee, CEO of 50Can, an education nonprofit, expressed concern that “if everybody doesn’t hold up their end of the bargain, we could go back to that era where certain populations of students become invisible inside schools even if they are struggling mightily and not getting the opportunity that they deserve.”

    And Lindsey Tepe, senior education policy analyst at New America, said there is so much variation in how states want to evaluate their schools that national comparisons could be difficult. “Without the guidance, there isn’t really a recipe to follow,” said Tepe.

    Associated Press writers Sheila Burke in Nashville, Tennessee; Susan Montoya Bryan in Albuquerque, New Mexico; Sally Ho in Las Vegas; Sophia Bollag in Sacramento, California; Steve Karnowski in Minneapolis; and Sean Murphy in Oklahoma City contributed to this report.

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    U.S. President Donald Trump talks to journalist at the Oval Office of the White House after the AHCA health care bill was pulled before a vote,  Photo by REUTERS/Carlos Barria.

    This Mar. 24 photo shows President Donald Trump talking to journalists in the Oval Office of the White House after the AHCA health care bill was pulled before a vote. Photo by REUTERS/Carlos Barria.

    WASHINGTON — A pro-Trump group is airing ads in a dozen Republican-held House districts aimed at drumming up support for the White House’s wounded drive to repeal President Barack Obama’s health care law.

    The $3 million campaign comes during a two-week congressional recess in which GOP lawmakers’ town hall meetings have been rocked by liberal supporters of Obama’s 2010 statute. Underscoring the challenges Republicans face, one poll showed Monday that the public trusts Democrats over the GOP on health care by their biggest margin in nearly a decade.

    Leaders averted a planned House vote last month on a bill replacing much of Obama’s law with a GOP alternative because Republican divisions would have ensured its defeat. White House officials complained at the time that while conservative outside groups opposing the bill had pressured lawmakers, there was insufficient lobbying and advertising by supportive organizations.

    Talks among White House officials and GOP lawmakers have continued during the break, but there have been no tangible signs that they’ve found a way to reverse what has been a damaging defeat for President Donald Trump and congressional leaders.

    The TV and internet ads by America First Policies are running in districts from Arizona to Pennsylvania, the group said Monday. Some are represented by lawmakers who backed the GOP legislation, others opposed it and others hadn’t taken clear public positions.

    One ad aimed at Rep. Gary Palmer, R-Ala., urges people to thank him “for standing with President Trump to repeal Obamacare now.” Palmer said after the House vote was canceled that he backed the decision to pull the bill so work on the legislation could continue.

    America First Policies is run by former Trump White House and campaign staffers including Katie Walsh, who left her job as White House deputy chief of staff shortly after the leaders’ retreat from the House vote.

    A poll by the nonpartisan Pew Research Center showed that by 54 percent to 35 percent, more people think Democrats do a better job than Republicans handling health care. Though the public has usually given Democrats an advantage on the issue in Pew polls, the two parties were ranked about evenly as recently as 2013.

    The post After failed health care bill, pro-Trump group launches ads supporting fight to repeal and replace Obamacare appeared first on PBS NewsHour.

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    JUDY WOODRUFF: Now a former American diplomat takes a candid look at the state of international affairs today.

    It’s the latest addition to the NewsHour Bookshelf.

    Margaret Warner is back with that.

    MARGARET WARNER: President Trump has discovered in his first 100 days that the world is as messy and menacing to U.S. interests as he contended during the campaign, and much more difficult for Washington to manage.

    This is the product of forces driving the world apart for nearly three decades since the end of the Cold War.

    That’s the theme of a new book by Richard Haass, “A World in Disarray: American Foreign Policy and the Crisis of the Old Order.”

    President of the Council on Foreign Relations, Haass served in senior foreign policy positions in the administrations of both Presidents Bush.

    And, Richard Haass, welcome.

    RICHARD HAASS, Author, “A World in Disarray: American Foreign Policy and the Crisis of the Old Order”: Thank you.

    MARGARET WARNER: So, as you and I both recall, at the end of the Cold War, we in the West had this surge of optimism; a new era of international cooperation was at hand.

    Instead, you write in your book, we’re seeing a declining sense of order. Was that inevitable?

    RICHARD HAASS: Turns out not. Very little about history is inevitable.

    In part, though, we reflect, at the end of the Cold War, you had two centers of power controlling things. Now we have any numbers of players on the field, lots of capacity in lots of hands.

    The United States, to some extent, has arguably made things worse, both by things we have done, the 2003 Iraq War, possibly going into Libya, and things we haven’t done, not responding to Syria’s chemical weapons use four years ago, not following up the Libya invasion.

    And then you have globalization, the fact that so much is traveling, the quantity and the speed across borders, and the world simply hasn’t caught up. If anything, the gap is getting larger. So, all this makes for a world in disarray.

    MARGARET WARNER: In disarray.

    You write at one point in the book, I think close to the end, that — and, as you just said, action has consequences, but so does inaction. And you counsel against drift.

    So, with that in mind, I mean, what could President Trump do that’s new about the conflict in Syria?

    RICHARD HAASS: Well, I think he has to avoid both too much and too little.

    To simply wash our hands of it, we have seen, would be a mistake. We saw the refugee flows into Europe. You have got all sorts of terrorists. On the other hand, we’re not going to transform Syria into a democracy anytime soon. We’re not going to be able to get rid of the government of Bashar al-Assad anytime soon.

    So, what I would do is focus on going after ISIS. We’re going to liberate some territory. Let’s make sure we can, with others, make sure any liberated territory remains safe, so people can go back there. We don’t want to have a situation where we win the battle and lose the war.

    And we want to slowly begin a diplomatic process, work with the U.N., and even with Russia, however strained that relationship is, to begin the process of saying, how do we move Syria towards a government that it can live in peace with its own people?

    MARGARET WARNER: At the nub of a lot of the crises that are confronting this new president, let’s take Syria, Ukraine, North Korea, it seems to me, what you really have are tensions between ourselves and two newly assertive powers, old powers, Russia and China.

    Are we moving to a tripolar world, in which these three countries will all have client states? Or is it even messier than that?

    RICHARD HAASS: On one level, it’s messier than that, because globalization is a problem. We have medium states, the Irans, the North Koreas. You have groups like ISIS.

    I’m actually, though, not that worried about what you suggest, Margaret. I think Russia is a one-dimensional power, largely military force, obviously cyber too. They do things in the Middle East and in Europe. But we can also push back. We can strengthen NATO.

    I think Mr. Putin is not going to use large amounts of military force if he realizes it’s going to be costly and potentially unpopular back at home.

    China’s not a revolutionary power in many ways like, say, Russia. China’s integrated in the region and in the world economically. It doesn’t much like the North Koreans. I think the real question is what they’re prepared to do about it.

    But I actually think that China could something of a partner of the United States. And, by the way, we should hope so. It’s a very different 21st century if the United States and China can work together.

    MARGARET WARNER: But, I mean, every past president, at least the last two, have been talking about getting China to do more on North Korea. What leverage does the new president have that the others didn’t?

    RICHARD HAASS: Well, China doesn’t want to see the United States use military force there, and no other president until Donald Trump faced a very stark reality, that, on his watch, China — North Korea is going to be able to put nuclear weapons on missiles that can reach the United States, and threaten the lives of millions of Americans.

    This now — this thing has drifted since the presidency, what, of Bill Clinton. This is a very different situation. This is an urgency now, and China has to know that simply allowing things to drift is no longer a viable option.

    What I don’t know, Margaret, is how much of the leverage they deny they have that you and I know they really have are they prepared to use.

    MARGARET WARNER: Another place in this book, you make the comment that, really, at the turn of the 20th to 21st centuries — quote — “The great powers were not so great anymore.”

    Do you think Americans realize that? Do you think this is something that — kind of a new world order, or just sort of that we have to get used to?

    RICHARD HAASS: I’m not sure we realize it, but it’s real, and in part because there’s so many things going on out there that we can’t control.

    But, also, look at what we have done in things like Iraq and Afghanistan, those massive interventions, and even those two places, we couldn’t control. So, there ought to be a bit of humility.

    But I do think you have also put your finger on a big, big issue, which is, what is the relationship the United States and the world? We can’t control things. We’re still the single most important country. What we do and don’t do, what — how we define success in the world, more than anything else, will make a difference, because we know the world left to its own devices doesn’t sort itself out.

    MARGARET WARNER: Do you think the American public, though, is ready to continue shouldering that responsibility?

    RICHARD HAASS: I’m concerned that we’re not. I think there’s a degree of fatigue after Iraq and after Afghanistan.

    I think there’s some misunderstanding about how much it costs for us. If you look at the inaugural speech, the president talked about it. But what we’re spending on defense is only a fraction of what we spent during the Cold War. We can have our cake and eat it.

    We can have the guns we need, we can have the butter, we can have the domestic policy we need. We have got to understand that what we do in the world is not only good for the world; it’s good for us. It’s not a form of philanthropy; it’s a form of national security.

    MARGARET WARNER: And that’s a case any president has to make.

    RICHARD HAASS: Has to make.

    MARGARET WARNER: Richard Haass, thank you so much.

    RICHARD HAASS: Thank you.

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    JUDY WOODRUFF: Now: why a special congressional election in Georgia is getting national attention.

    Protesters demand to see the president’s tax returns, but do most Americans care? And does President Trump’s travel indicate his priorities?

    We look at all this in Politics Monday with Amy Walter of The Cook Political Report and Tamara Keith of NPR.

    And welcome to both of you.

    So, Amy, we are looking at this congressional — special congressional election tomorrow. Democrats think they have a chance.

    AMY WALTER, The Cook Political Report: They think they have a chance.

    JUDY WOODRUFF: Do they have a chance?

    AMY WALTER: They absolutely do.

    Here’s the thing about this district. We talked a little bit about it last week, but it’s suburban Atlanta district, very wealthy, very well-educated. This is a Republican district, but this is not Trump country.

    This is a district that Mitt Romney won by 20 points. This is a district that the Congress , Republican Congressman Tom Price, who is now the HHS secretary, easily carried, but Trump only won by less than two points.

    This is the kind of district that Democrats think they can win when the president — this becomes a referendum on the president and his popularity much more so than about the Democrats.

    So, we’re going to get a really interesting test of that. Also helping the Democrat in this race are the fact there are 11 Republicans, so that field is very fractured, and they’re also fighting each other, and the fact that the Democrat is benefiting from national excitement about this race.

    He’s raised a ton of money, and enthusiasm among the Democratic base, while the Republican base not quite as enthusiastic.

    JUDY WOODRUFF: So, these are the factors at play here.

    So, this is different from the Kansas race that we watched last week.

    TAMARA KEITH, NPR: This is, because it’s closer. It’s not Kansas. It’s the suburbs of Atlanta.

    And the Democratic candidate has been able to sort of consolidate Democratic support. And the Republicans are sort of fighting each other as much as they’re fighting him. He — this Democrat, Jon Ossoff, is an interesting candidate. He’s a young person, not really any political experience. He’s running for Congress for the first time.

    He raised a loft money, something like $8 million, but most of that came from outside of the district; 95 percent of it, according to the Center for Responsive Politics, came from outside of the district, 80 percent of it from outside of the state.

    So what this says is that this is a proxy war. This is Democrats all over the United States looking at this as an opportunity to send a message. This becomes about President Trump and about the message they can send, and less about sort of the local issues that this could be about.

    JUDY WOODRUFF: Well, you both have covered politics all over the country.

    But, Amy, I read something today. They were saying that — making the point that Democrats are spending a lot of money on television and online, on ads, but they’re not putting enough into actually turning out the vote, the so-called get-out-the-vote effort. Is this a factor here? Are Democrats doing…

    AMY WALTER: Yes, although I am — you’re sort of seeing both things, the Democrats, the committee that is responsible for electing congressional Democrats, putting more people now on the ground in districts, saying, we understand that we need to do more to motivate our base to get out. We have to go literally touch them, rather than to just put ads.

    But the fact is, this Democrat has — as Tam pointed out, he has over $8 million, maybe close to $10 million. It’s getting spent everywhere in this congressional district.

    And I think this is what we’re going to be looking for, whether the president’s low approval ratings and the lack of enthusiasm from Republicans, fired-up Democratic base, they send a warning signal to Republicans. If a Democrat wins here, I think if you’re a Republican up in 2018, you say, uh-oh.

    JUDY WOODRUFF: And it gives heart to Democrats if he wins, clearly.

    TAMARA KEITH: Yes, potentially, if he wins.

    And, of course, this is just the primary. It’s sort of a jungle primary. So if he gets more than 50 percent, he wins. If he doesn’t, there’s another race. There’s a general election which will be a more traditional race, where the Democrat can go after the Republican, and the Republican can go after the Democrat, though the Republicans have been able to train their fire pretty much right at Jon Ossoff because he has consolidated the support.

    JUDY WOODRUFF: So, we’re looking at kind of a rise of Democratic energy across the country. We have been talking about it for the last couple of months.

    But, Amy, and one other way we looked at this weekend — and we mentioned it a minute ago — were these rallies across the country, marches pointing out the president — Tax Day is coming up tomorrow, but President Trump hasn’t released his tax returns.

    The question is, though, is that something that gets people excited or disturbed? Is this something that matters?

    AMY WALTER: It certainly is motivating to the Democratic base.

    And I think, for a lot of voters, the issues of transparency is very important. Despite the fact that the president said nobody cares about his taxes, I think a lot of people care that he didn’t release his taxes. The question issue is whether it is the most important issue to voters.

    And it was not the most important issue when they decided to support the president. I think the challenge for the president right now is actually getting something accomplished.

    And this is why you’re seeing Republican enthusiasm wane. It’s the sense of frustration. I talk to a lot of Republicans who say, man, we have the House, we have the Senate, we have the White House. We still can’t get things done.

    I think the bigger challenge for the president will be if a tax reform bill doesn’t pass, more so than whether he releases his taxes.

    JUDY WOODRUFF: And, by the way, the treasury secretary, Tam, said today that they do not intend or don’t anticipate getting a tax reform plan out there before the August recess, which is late in the summer.

    TAMARA KEITH: That’s right.

    And based on everything we have seen leading up to this point, it doesn’t look like they have found sort of cohesion on what they want on the Republican side. The House wants something different than the Senate. And the White House, I think, has some internal divisions even about what the Trump administration wants.

    So, tax reform is a really big thing. It hasn’t happened since 1986, and it took them, I think, about six years to get it. I mean, it took more than …


    JUDY WOODRUFF: Some of us covered that. And it was complicated and took a long time.

    TAMARA KEITH: Yes, a very long time.


    TAMARA KEITH: And there was some level of bipartisan horse-trading that is not currently happening between the president and Congress. And if his own party doesn’t agree, that presents a challenge.

    AMY WALTER: Yes. And that’s #governingishard. And I think that’s what Republicans are finding out right now, is that, even though they have all the levers of power, they have — they remain incredibly divided.

    And to me, the most interesting number that came out today was a Pew poll that asked of Democrats and Republicans, do you think your party is mostly united or mostly divided? Overwhelming majority of Republicans said, I think our party is divided. Overwhelming majority of Democrats said, I think we’re united.

    And you’re seeing these divisions. We saw it most recently with the health care. And you’re going to see it on taxes, too.

    JUDY WOODRUFF: OK, less than a minute.

    Quickly to Tam on this, a story today that the president has done less traveling both in the U.S. and abroad than both of his predecessors, Obama and George W. Bush.

    Does that say something that should tell us anything about whether he’s going to be successful or not?

    TAMARA KEITH: I don’t know if it’s a predictor of success.

    What it does tell us is, those predecessors, they were campaigning. They were out pushing for policy proposals. President Obama was out there holding town halls, trying to build support for his stimulus package, and President Bush was out there trying to build support for No Child Left Behind and for his tax cut proposal.

    President Trump had about a 17-day period where he could have gone out to push for the health care bill, but it was very much in flux and it wasn’t even clear. He held a couple of rallies and didn’t really campaign for it.

    So, he’s not had the policies to go out and sell to the public. And that might be part, though it’s not clear, of why he has spent less time.

    AMY WALTER: Yes.

    He likes to speak to his base. He likes to preach to his choir, rather than convert new groups. So, his travel schedule is much more like comfort food than it is an attempt to broaden his base. And that is going to be a much bigger challenge for the president going forward, because, as we have seen, his approval rating right now right about 40 percent.

    He can’t survive just at 40 percent or get big things done with that.

    JUDY WOODRUFF: All right, I’m getting my head wrapped around comfort food right now.


    AMY WALTER: Sounds good, doesn’t it?


    JUDY WOODRUFF: Amy Walter, Tamara Keith, thank you both, Politics Monday. Thank you.

    AMY WALTER: You’re welcome.

    TAMARA KEITH: You’re welcome.

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    JUDY WOODRUFF: A cold-blooded murder posted on Facebook on Sunday set off shock and strong reactions across social media and beyond today, as the manhunt for the killer intensified.

    John Yang has the story.

    JOHN YANG: The 57-second video shows a man identified as Steve Stephens driving the streets of Cleveland while talking on the phone. He then steps from the car and confronts Robert Godwin Sr., a 74-year-old retired foundry worker, a father of nine and a grandfather of 14, and shoots Godwin dead.

    The online killing reportedly remained on the site for nearly three hours before Facebook removed it.

    In a statement late today, the company said that the video has “no place on Facebook and goes against our policies and everything we stand for.” The company said it’s reviewing how it operates ‘to be sure people can report videos that violate our standards as quickly as possible.”

    This episode raises fresh questions about the role and responsibility of social media sites like Facebook.

    Before the latest statement, I spoke with Emily Dreyfuss, a senior staff writer at Wired magazine.

    I began by asking her what Facebook could do.

    EMILY DREYFUSS, Wired: First of all, you know, it is true that Facebook is working very hard to keep videos like this off of its site.

    It’s easy in a moment like this to say, you know, this is absurd that it was on Facebook for even three hours. But the fact is that a large apparatus of content moderation and work went into the effort to be able to even get the video down after three hours. And in order for it to be removed, that means that people on Facebook had to flag it as inappropriate, and then that flag had to be sent to people that Facebook employs all over the world to get rid of content like this.

    And they took it down. And, sometimes, this can take up to 48 hours. So, three hours here is not even long in the scheme of things. Now, Facebook could do more. And they are working hard to figure out what they can do.

    One of those things would be to use A.I. and allow artificial intelligence to help humans who are having to flag this sort of terrible, gruesome material so that we don’t see it.

    One of the problems is that A.I. is not really necessarily ready and up to the task of that yet, so Facebook is still trying to figure out how to make this work.

    JOHN YANG: I want to make sure I understand. They rely on Facebook users to flag these things, or do they have people on their staff watching videos being uploaded?

    EMILY DREYFUSS: So, they don’t have people on staff who are watching videos as they’re uploaded.

    What they have, they employ — Facebook employs hundreds of thousands of people who they call content moderators, whose job is to just watch videos like this and, if they see something inappropriate, to take them down.

    However, these people are not watching them before the video hits the Web site. They’re watching them after a video has been uploaded, and then after someone like you or me or anyone else on Facebook has flagged that video as potentially being inappropriate.

    At that moment, that video will then get sent to this team of content moderators who will look at it. Right now, Facebook doesn’t have a system in place to look at the video and to moderate it and to decide what’s on it and whether it’s appropriate before it hits the Web site. Now, that is something they could decide to do, but that would radically change what Facebook is as we know it.

    JOHN YANG: Talk about that. Rapid change what Facebook is as we know it. They try to be — they want to be crowdsourcing content. They want to have raw, emotional videos like this.


    JOHN YANG: But, at the same time, they don’t want to cross the line, it seems to me. So how do they define what they do and what they are?

    EMILY DREYFUSS: Yes, so this is an incredibly difficult challenge, not just for Facebook, but for society at large, for us to decide what is and is not OK to be shared on social media platforms.

    Now, Facebook has resisted calls to say that it is a media company, like PBS or Wired. Now, we, as journalists, have guidelines for how to deal with what kind of content is appropriate that we would put on TV or in our magazine.

    Facebook, by refusing to call itself a media company, tries to take responsibility away from itself and say, look, rather than being a media company, we are actually a mirror on society, and we’re going to reflect society at its best and at its worst.

    Now, what we saw yesterday with Steve Stephens’ video was clearly society at its worst. But this is a huge, huge challenge. And what Facebook wants to do is encourage people to upload video. And it says it wants to encourage people to upload emotional, raw, intense video, and it is succeeding.

    That’s part of its business model. But if it goes too far and allows videos like this one to show up on people’s timelines, it will also destroy itself, because you and I are not going to continue to log into Facebook if when we go on to see videos or pictures of our nieces and nephews, if we accidentally come upon a video of a gruesome, horrific homicide.

    So, Facebook has an incentive to not make us not want to upload things, which they may do if they were to censor us. You can imagine the outcry of people on Facebook if you went to upload a video, and it didn’t show up right away because Facebook was waiting to approve it.

    People wouldn’t like that either, but nor do we like having videos like this in our timeline. So, it’s a really tough challenge for them to walk that line.

    JOHN YANG: And also — we have about a minute left.

    They’re also trying to bolster their Facebook Live feature.


    JOHN YANG: Now, this was a video that was posted, although this man did use Facebook Live to talk about what he did.

    What’s this going to do to their efforts to boost Facebook Live?


    With Facebook Live, what was, as we were describing, as a very difficult challenge becomes almost impossible. Unless they were to put Facebook Live on a delay, and it would cease to be live, there is no way that they can avoid things like this from hitting the site.

    And it’s honestly a miracle that homicides and horrible, gruesome violence have not been already used in that way. That’s something that Facebook has to know, and it’s deciding that it can depend on its users to flag content soon enough to take it down. But it is definitely taking that risk in order to push this product that is live.

    JOHN YANG: Emily Dreyfuss on the tough questions that new technology is providing us.

    Emily Dreyfuss, thanks for joining us.

    EMILY DREYFUSS: Thanks, John.

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    JUDY WOODRUFF: But first: an unlikely innovation from an unusual innovator.

    Special correspondent Fred de Sam Lazaro has the story of one man who has made it his mission to bring affordable hygiene products to women in India.

    Its part of our series Agents for Change.

    FRED DE SAM LAZARO: Arunachalam Muruganantham says he was a born tinkerer, obsessed with figuring out how things worked, from toys to bicycles. He grew up in poverty after his father died young, dropped out of school and became a welder, a lower-middle-class occupation in India.

    ARUNACHALAM MURUGANANTHAM, Inventor: To support my mother, I stop my schooling.

    FRED DE SAM LAZARO: But his natural curiosity apparently knew no bounds. Years later, it took him into a strictly taboo area in India’s tradition-bound society: menstrual hygiene.

    ARUNACHALAM MURUGANANTHAM: We are able to break the taboo, and using it.

    FRED DE SAM LAZARO: He’s become known as India’s pad man.

    Your goal is to have every woman in this country use sanitary pads, if they need it?

    ARUNACHALAM MURUGANANTHAM: Yes, it’s a movement.

    FRED DE SAM LAZARO: A movement begun by a man who knew almost nothing about the female body until after he was married.

    You didn’t even know what menstruation at all. You had no idea what it was. Is that correct?

    ARUNACHALAM MURUGANANTHAM: Yes, I don’t know when it is happening, how it is happening, even why it is happening. I don’t know.

    FRED DE SAM LAZARO: And, he says, his wife, Shanthi, wasn’t particularly interested in discussing it.

    ARUNACHALAM MURUGANANTHAM: It’s the biggest taboo. Wife never talks to husband. Daughter never talks to mother.

    FRED DE SAM LAZARO: That comes at a high cost in public health. Some experts say millions of girls across the developing world miss school during their periods and remain susceptible to infection throughout adulthood.

    Sanitary pads are widely advertised in India, but surveys suggest only about one in 10 women actually uses them. At first, Muruganantham suggested them to his wife.

    ARUNACHALAM MURUGANANTHAM: I asked simply, there is some products in the market. Why you’re not using that? She instantly told, I also know about that, but we have to cut our family milk budget.

    FRED DE SAM LAZARO: Milk budget?

    ARUNACHALAM MURUGANANTHAM: Yes. Then I find it’s a matter of affordability.

    FRED DE SAM LAZARO: He could afford one package of sanitary pads and gave it to Shanthi as a gift, partly to find out how they were made and why they had to be so expensive.

    ARUNACHALAM MURUGANANTHAM: The white substance inside is a cotton. The raw material cost of the cotton is a few pennies. But I bought the product for dollars. Then, even being illiterate, I thought, why not try to make an affordable pad for my wife?

    FRED DE SAM LAZARO: Over the next few years, he tried, using local cotton, to replicate the commercial pads. His wife suffered through early prototypes that didn’t work and went back to using a rag.

    Muruganantham then coaxed some female medical students to try his subsequent models, figuring the future doctors would be less shy. And he even began wearing a pad himself, creating an artificial uterus and rubber bladder, coaxing a local butcher to provide the raw material, and testing it out while he rode a bicycle.

    ARUNACHALAM MURUGANANTHAM: I filled goat blood, animal blood in it. I tied on my hip. There is a tube connection to the napkin and the bladder.

    FRED DE SAM LAZARO: Shanthi had had enough.

    SHANTHI MURUGANANTHAM, Wife of Arunachalam Muruganantham (through interpreter): Everyone in the village was saying he’d gone off his head. I was truly afraid. People said he had become like a vampire, that he was doing crazy things.

    ARUNACHALAM MURUGANANTHAM: She asked me to, “I want to go my parents’ home for a few days.” She never came back. And third month, I got a divorce notice from my wife.

    FRED DE SAM LAZARO: She filed for divorce?

    ARUNACHALAM MURUGANANTHAM: Yes. I got a divorce notice.

    FRED DE SAM LAZARO: His mother, who lived in the home, also left him. But his curiosity didn’t leave him.

    He called an American supplier posing as an industrialist in his hometown of Coimbatore looking to branch out into feminine hygiene products.

    ARUNACHALAM MURUGANANTHAM: Then I claim myself, I’m a mill owner in Coimbatore. Please send some samples.

    FRED DE SAM LAZARO: The samples arrived and, one day, when he wasn’t home, his dog tore into them.

    ARUNACHALAM MURUGANANTHAM: She took the courier cover. She scratches it. Oh, my God, I saw the secret: the fiber. You can see the fiber.

    FRED DE SAM LAZARO: So, the dog opened this for you?

    ARUNACHALAM MURUGANANTHAM: Opened it. She scratches it with the anger.

    FRED DE SAM LAZARO: It was cellulose, he discovered, that, when scratched vigorously, becomes sponge-like and highly absorbent.

    It took two years to perfect a machine to fluff up the cellulose, he said, a modified food blender in which the blades have to be angled just so.

    ARUNACHALAM MURUGANANTHAM: It got a prestigious award from Indian Institute of Technology as the best innovation.

    FRED DE SAM LAZARO: It’s simple, easily replicated, and can be modified to work without electricity, he says. The pads can be made and sold for a fraction of the commercial varieties.

    This is the model for how Muruganantham would like to see his product distributed, thousands of small factories run by groups of women producing these sanitary pads at very low cost and selling them directly to women.

    Women are far more comfortable buying the pads from women directly, rather than from a store, Muruganantham says. Feminine hygiene is not discussed in open company. Our own questions elicited nervous laughter from the very women making them, even as they praised their product.

    SHANTI UDAYKUMAR, Factory Worker (through interpreter): There’s definitely benefit. Before, we were using only cloth, and it was very difficult. Now girls don’t have that difficulty. It was much easier for them than it was for us.

    FRED DE SAM LAZARO: Muruganantham is determined to change this.

    ARUNACHALAM MURUGANANTHAM: I want to make this as a low-cost sanitary pad movement across the globe.

    FRED DE SAM LAZARO: Helped by awards and his own advocacy, more than 4,000 small factories have started making his sanitary pads across India, each with its own local branding and language.

    ARUNACHALAM MURUGANANTHAM: Malar is meaning of flower.

    FRED DE SAM LAZARO: He gets no royalties from any of this. His workshop does sell the machines, enough to earn him a modest living. But nothing is patented. He wants others to copy or even improve the machines and methods.

    ARUNACHALAM MURUGANANTHAM: The world has a shortage of solution providers. Everybody want to be in the Forbes list.

    FRED DE SAM LAZARO: Everybody want to be in the Forbes list.

    ARUNACHALAM MURUGANANTHAM: Forbes list. Nobody want to be a solution provider.

    FRED DE SAM LAZARO: In the end, Shanthi decided her husband was a solution provider. She returned after a five-year separation, somewhat sheepishly, she admits.

    SHANTHI MURUGANANTHAM (through interpreter): They had his interview on TV that he had discovered sanitary napkins. So I called him, and then I came back. He was angry. I told him I didn’t want to get in his way. That’s why I stepped aside. Now we are happy.

    FRED DE SAM LAZARO: Happy for what her husband’s work may mean for young girls like their 8-year-old daughter, Phrithisri.

    ARUNACHALAM MURUGANANTHAM: The strongest creature created by God in this world, not the tiger, not the elephant, not the lion — the women.

    FRED DE SAM LAZARO: If any man doubts this, he says, see how long you can endure a sanitary pad in your daily routine.

    For the PBS NewsHour, this is Fred de Sam Lazaro in Coimbatore, India.

    JUDY WOODRUFF: Fred’s reporting is a partnership with the Under-Told Stories Project at University of St. Thomas in Minnesota.

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    JUDY WOODRUFF: In a controversial referendum yesterday, the people of Turkey voted by a thin margin for the biggest overhaul of Turkey’s politics since the founding of the modern republic.

    Among the most significant changes, a transition from a parliamentary to a presidential system that could lead to a major consolidation of power by the nation’s leader.

    Our Jeffrey Brown has that.

    JEFFREY BROWN: Flag-waving supporters greeted Turkish President Recep Tayyip Erdogan in Ankara today, after he won sweeping new powers in Sunday’s referendum.

    RECEP TAYYIP ERDOGAN, Turkish President (through interpreter): We have put up a fight against the powerful nations of the world. The crusader mentality attacked us abroad. Inside, their lackeys attacked us. We didn’t succumb. As a nation, we stood strong.

    JEFFREY BROWN: But amid the celebration, questions about the vote’s validity. Turkey’s main opposition party decried a decision by the national elections board to accept ballots without an official stamp.

    BULENT TEZCAN, Deputy Chairman, Republican People’s Party (through interpreter): The only decision that will end the debate about the legitimacy of the vote and ease the people’s legal concerns is the annulment of this referendum by the high

    JEFFREY BROWN: International observers pointed to the intimidation of Erdogan’s opponents.

    WOMAN: Our team observed the misuse of administrative resources and the obstruction of efforts by parties and civil society organizations supporting the no campaign.

    JEFFREY BROWN: The referendum passed with just 51 percent of the vote. It authorizes constitutional changes allowing the president to directly name government ministers and other senior officials, appoint half the members of the country’s highest judicial body, and declare states of emergency and issue decrees.

    The outcome could also cement Erdogan’s hold on power for more than a decade.

    Throughout Turkey, reactions were mixed.

    MAN (through interpreter): It’s obvious that a large part of the society doesn’t accept this referendum.

    WOMAN (through interpreter): I don’t know what the new system will bring, but I am happy because the person I support has become an executive president.

    JEFFREY BROWN: Erdogan says the changes will bring stability, in a country battling the Islamic State group and Kurdish rebels. Opponents say he will be able to rule unchecked. They also fear he will reinstitute capital punishment.

    He’s already carried out a wide-ranging crackdown since surviving a coup attempt last summer. The growing repression has strained relations with the European Union, a body Turkey is trying to join.

    Germany’s foreign minister warned today the referendum could make matters worse.

    SIGMAR GABRIEL, Foreign Minister, Germany (through interpreter): We will only be able to help Turkey if the country stays on a democratic path. For instance, the reintroduction of death penalty would be the end of the negotiations to enter the European Union.

    JEFFREY BROWN: In Washington today, the White House said it awaits a final report by international observers.

    And for more on this referendum and what it means, I’m joined by Steven Cook of the Council on Foreign Relations. His forthcoming book is “False Dawn: Protest, Democracy, and Violence in the New Middle East.” And Kadir Ustun, the executive director of the Foundation for Political, Economic and Social Research, a Washington think tank focused on Turkey and U.S.-Turkey relations.

    Welcome to both of you.

    Steven Cook, you wrote a scathing response to the vote. It’s provocatively entitled, “Rest in Peace, Turkey.”

    Do you see this as a kind of existential threat to Turkish democracy?

    STEVEN COOK, Council on Foreign Relations: Well, it is certainly the end of the modern Turkish state that was founded in the early 1920s.

    We’re moving on to something else with President Erdogan’s accumulation of power. That may be something new, but also has echoes in Turkey’s past. And that is, President Erdogan has set things up so that he has so much power, he rules almost like an Ottoman sultan.

    JEFFREY BROWN: What do you see in this, that kind of power for President Erdogan?

    KADIR USTUN, SETA Foundation: Well, this was a historic referendum.

    For the first time in modern Turkish history, the Turkish public, the civilians are deciding the form of government.

    JEFFREY BROWN: As a positive. So you see it as a positive step potentially?

    KADIR USTUN: Sure, yes.

    JEFFREY BROWN: Because this was needed?

    KADIR USTUN: This was needed because you had two elected heads of government with overlaps and conflicts in their powers and responsibilities over each other.

    JEFFREY BROWN: Well, what about that? That’s the argument that President Erdogan and his supporters have made, that this was necessary for the democracy to actually go forward.

    STEVEN COOK: It’s actually kind of a funny argument, because this was never a problem until a few years ago, actually 2011, when President Erdogan, then Prime Minister Erdogan, declared that Turkey needed a new constitution.

    The Turkish prime minister had been the head of the government. The locus of power had been with the prime minister. The president had a number of important powers, but was supposed to be above politics and a statesman.

    Once it was clear that Prime Minister Erdogan was going to move up to become the president of the republic, then this issue became more and more urgent for him and for the ruling Justice and Development Party.

    JEFFREY BROWN: Let me ask you both about the size of the victory, because it was actually smaller than expected and I think than Erdogan and his supporters thought. What does that tell you?

    KADIR USTUN: An average of 52 to 53 percent was expected.

    So it’s in that range. But this was about the referendum. This was about the system change. When you ask about people’s votes, about their parties, you will get similar numbers to the last election. So you see that people didn’t really vote along their party affiliations, but more on this particular change, whether we should go to a presidential system and whether what Erdogan is proposing is the way to go. And they voted yes.

    JEFFREY BROWN: What do you see in the lower vote than expected?

    STEVEN COOK: Well, it was an extraordinarily controversial move to fundamentally alter Turkey’s political system. And there is about half the country that is opposed to it.

    And this is consistent with the AKP era, the Justice and Development Party era, where President Erdogan rules half of the country that supports him and seeks to intimidate the other half of the country.

    There are allegations of electoral — questionable electoral practices, I should say. And the opposition is calling for an investigation into it. It’s unlikely that anything is going to change, but it does suggest a deepening of the polarization of Turkish society.

    JEFFREY BROWN: Well, does it suggest — do you see going forward that he will have to now reach out to opponents to be more accommodating or less so?

    KADIR USTUN: Look, he has tried many times at parliamentary commission to draft a whole new civilian constitution, failed because of political realities.

    And this was the product of a deal between the opposition nationalist party, MHP, and the A.K. party, and I don’t see this as changing the system wholesale in a desirable way.

    JEFFREY BROWN: But what I’m asking is, what do you see changing the stance of President Erdogan? Does he reach out to opponents? Is he more accommodating to all Turks, or tougher?

    KADIR USTUN: When you look at the Turkish political landscape, you see identity policies, these parties, Kurdish party, nationalist party, and CHP, are consolidated , just as A.K. Party’s votes are more or less consolidated.

    You have that kind of situation in the Turkish political landscape. And that won’t change all that much. And we’re going to see in 2019, when you have the presidential and the general elections held on the same day, if there will be significant changes. But I don’t expect those votes to change all that much in the next election.

    JEFFREY BROWN: And what about the Turkish relationship with the West, especially the U.S.? What should the response be from the U.S.?

    STEVEN COOK: Well, there’s a difference between what should the response be and what the reality is likely to be.

    I think that the Obama administration over the course of eight years was too quiet about the excesses of Prime Minister and then President Erdogan and the deepening authoritarianism of Turkey.

    It strikes me that President Trump will accommodate himself to this outcome, because his priorities lie with fighting the Islamic State. And, of course, the United States looks to Turkey as an ally in that fight.

    JEFFREY BROWN: And, briefly, what do you think the U.S. response should be and Europe?

    KADIR USTUN: In relations with the U.S. particularly — that’s what I’m focused on — there are significant strategic differences, especially with the U.S. support for the YPG in Northern Syria, the groups that are fighting ISIS, and that — they are linked to PKK.

    And that’s a significant problem in U.S.-Turkey relations and on several other relations. But I think both sides will need Trump administration. Turks see Trump administration as a new opportunity. And they will need to talk more on this. And there have been talks.

    And we see the lessening of those tensions. In the coming years, I do expect that to move to a better place. But in terms of this authoritarianism argument, I find it overly simplistic and sort of easy explanation, oh, Turkey is authoritarian.

    That doesn’t answer the question about why 50 percent are voting for this party and Erdogan.

    JEFFREY BROWN: All right, we will leave it there and we will watch going forward.

    Kadir Ustun and Steven Cook, thank you both very much.

    STEVEN COOK: Thank you.

    KADIR USTUN: Thank you.

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    JUDY WOODRUFF: We return to our top story, North Korea, its missile and nuclear programs, and the tougher line being drawn with the regime by the Trump administration.

    I spoke a short time ago with William Perry, who served as defense secretary under President Bill Clinton. After Mr. Perry left that post, he led a diplomatic effort on North Korea.

    I started by asking how he interprets the Trump administration position that the time for strategic patience is over.

    WILLIAM PERRY, Former U.S. Defense Secretary: I think it means that they’re prepared to take more drastic action and they’re certainly implying that military action could be a part of that.

    JUDY WOODRUFF: And do you think that that’s an approach that is likely to bring about a response from the North Korean regime that the U.S. wants?

    WILLIAM PERRY: Well, I think that this is an unusually dangerous time, because of both what North Korea is saying and doing and what the administration is thinking of doing.

    My own view is that a military action, while might be appropriate at some time, is not yet appropriate. I think there is still time for diplomacy and there’s time for effective diplomacy, but it must be coercive diplomacy. The earlier diplomacy for the last two administrations has been quite ineffective.

    Now, paradoxically, precisely because of the dangers, I think we have the opportunity to conduct some effective diplomacy, although this is going to be coercive diplomacy.

    JUDY WOODRUFF: And what do you mean by coercive diplomacy?

    WILLIAM PERRY: Diplomacy which threatens actions which are going to hurt North Korea.

    We have in the — past two administrations had sanctions as our element and course of diplomacy, but they were very ineffective and very weak. Now, because of the present situation, we’re in a position to provide really powerful disincentives, very powerful efforts, much more so than the sanctions.

    The two changes are that China, which in the past has not shown much concern over the North Korean nuclear weapon, they’re now being greatly concerned, seeing that this could threaten their very core interests.

    And, therefore, I think China would be willing at this stage to take very powerful actions in their economy, like holding back food and holding back fuel. On the other hand, the threat of military action against North Korea in the past has not really been a credible one, but I think it may have become credible in the last few months.

    JUDY WOODRUFF: And why do you think the Chinese would be ready to be tougher right now than they have been before?

    WILLIAM PERRY: They see their core interests being very heavily threatened right now.

    Certainly, a war on the Korean Peninsula would be very detrimental to their core interests. And the possibility of either South Korea or Japan going nuclear are really quite detrimental to their core interests.

    So, having that in mind, I think they’re willing to take serious action. I do not see that China can solve this problem alone. I do not suggest that. But China and the United States working together could put together a very powerful set of disincentives that can effect a coercive diplomacy that has good chance, I think, of being effective.

    JUDY WOODRUFF: And when you say the U.S. suggests it’s prepared to take military action, isn’t there a very real risk, though, that the North could go after, successfully hit South Korea because it’s so close?

    WILLIAM PERRY: I think there is a very great risk in taking military action.

    And I do not recommend that at this time. My point, though, is that North Korea has to believe there is a possibility now, a very real possibility of military action, and that has to affect their calculus on how seriously they will negotiate.

    So I’m not recommending military action, but I think that the threat of military action has become credible to North Korea now. And I think, therefore, they may be much more willing to negotiate seriously.

    JUDY WOODRUFF: And you see the leadership in the North, Kim Jong-un, the people around him, as being rational, thinking rationally about this?

    WILLIAM PERRY: I think that the regime in North Korea today is not crazy. It’s evil and it’s reckless, but it’s not crazy.

    Their primary goal, which assuredly has been effective for many decades now, is to preserve their regime and power. That’s what they’re trying to do, and that’s their calculus and it’s a rational calculus.

    We need to respond to that. And we do not — if we think they’re crazy, then we would have to be worried about making a preemptive nuclear strike against South Korea, say. They’re not crazy, because they know that, if they do that, that their country will face devastation and their leadership will be swept out of power.

    JUDY WOODRUFF: And what do you think the chances are, Bill Perry, of there being an accident of some sort of that could lead to military action, a misinterpretation?

    WILLIAM PERRY: The reason I do not favor military action now is because, once a military action starts, it will get out — it will escalate, and is all too easy to get out of control.

    It could escalate on to a total general war. It’s a war which North Korea would, in fact, lose, but as they were losing it, and as they saw their regime being swept away and their country being devastated, they might then use nuclear weapons, one last dangerous, but one last sort of an Armageddon, before they were swept out of power.

    So, the danger of nuclear war here is not that North Korea would deliberately start one and provoke like a surprise attack on South Korea. The danger is that we would blunder in a nuclear war by a military conflict, a conventional military conflict and a conventional war escalating into that.

    JUDY WOODRUFF: Finally, how worried should the American people be about this?

    WILLIAM PERRY: I am very alarmed. I’m alarmed because, if we move into a military action, even a minor military action, the danger of escalation, I think, is very great.

    This is not Syria we’re attacking. That is country that undoubtedly would respond with a military response to South Korea. And then, as I said, that action could very well escalate into a general war and even a nuclear war.

    So I’m concerned for that reason. So I think this is an opportunity. This is an opportunity to conduct coercive diplomacy that can be effective. And the question only is, will we see that opportunity and seize it?

    JUDY WOODRUFF: Former Secretary of Defense William Perry, we thank you.

    WILLIAM PERRY: Thank you, Judy.

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    JUDY WOODRUFF: In the day’s other news: Wall Street rallied broadly after the weekend passed without military conflict over North Korea. The Dow Jones industrial average gained 183 points to close near 20637. The Nasdaq rose 51, and the S&P 500 added 20.

    Also today, South Korea’s recently ousted President Park Geun-hye was indicted on charges of bribery, extortion and abuse of power. She could get life in prison, if she’s convicted. Park was arrested after being removed from office. It’s alleged that she and a longtime confidant solicited bribes from businesses while she was president.

    Hundreds of Palestinians in Israeli prisons launched a hunger strike today, in the largest such action in five years. To show their solidarity, thousands staged marches in the West Bank and Gaza. They condemned conditions in the jails and the Israeli policy of detention without trial.

    KHADER ADNAN, Former Prisoner (through interpreter): When prisoners go on hunger strike, they feel the freedom. It is a way to resist. We can win the battle with our empty stomachs, and it is a message to the international community and the free people in the world that Palestinians seek freedom.

    JUDY WOODRUFF: Israeli officials say the strike is politically motivated, and that it denied — it also denies that inmates are being mistreated.

    In Sri Lanka, search teams have now recovered at least 29 bodies from a massive garbage slide that buried dozens of homes Friday night. Today, soldiers kept looking in the huge dump near Colombo, joined by relatives of dozens of people still missing. Crews worked with heavy equipment to clear the mud and trash.

    Newly minted Supreme Court Justice Neil Gorsuch heard his first set of arguments today with fellow justices. It was an employment discrimination case, and it was only 11 minutes into the hearing when he asked his first question. At one point, Gorsuch said he was sorry for taking up so much time.

    Britain’s Prince Harry now says that he suffered from repressed grief and depression for almost 20 years after the death of his mother, Princess Diana. Harry was 12 when she died. He’s now 32. He tells The Daily Telegraph that he came close to what he called a complete breakdown more than once. He says he’s now in counseling, talking openly about his feelings and doing better.

    And president and Mrs. Trump hosted their first Easter egg roll at the White House today. The first couple welcomed the crowd from the Truman Balcony for the annual event that goes back nearly 140 years. Later, the president greeted visitors while the first lady read to children. More than 21,000 people attended. That’s actually down from 35,000 last year.

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    JUDY WOODRUFF: The long-simmering standoff between the United States and North Korea is heating up again, with new warnings from both President Trump and Vice President Pence.

    Our chief foreign affairs correspondent, Margaret Warner, begins our coverage.

    MARGARET WARNER: The warnings started at the demilitarized zone dividing the Koreas, where Mr. Pence vowed action to achieve a nuclear-free Korean Peninsula.

    Later, in Seoul, he said that, if productive talks didn’t start and do the job, President Obama has demonstrated he won’t shrink from military action.

    VICE PRESIDENT MIKE PENCE: The world witnessed the strength and resolve of our new president in actions taken in Syria and Afghanistan. North Korea would do well not to test his resolve or the strength of the armed forces of the United States in this region.

    MARGARET WARNER: Mr. Pence also declared again that the U.S. and its allies will act, unless China its influence to rein in North Korea.

    In Washington, President Trump took a moment out from the White House Easter egg roll to send his own briefing warning.

    QUESTION: Any message for North Korea?

    PRESIDENT DONALD TRUMP: Got to behave.

    MARGARET WARNER: But at the United Nations, the deputy ambassador from North Korea, officially the Democratic People’s Republic of Korea, or DPRK, was defiant.

    KIM IN RYONG, Deputy North Korean Ambassador to the United Nations: The DPRK is ready to react to any mode of war desired by the Americans.

    MARGARET WARNER: The dueling rhetoric came after North Korea’s ballistic missile launch on Sunday, which U.S. officials say blew up within seconds.

    A day earlier, Pyongyang had paraded containers large enough to hold new long-range ballistic missiles through the capital. There had been expectations the North would also carry out its sixth nuclear test, but no test occurred.

    Today, though, the vice foreign minister told the BBC that his government will be testing missiles weekly, and he warned of a preemptive nuclear strike by the North if the U.S. takes military action.

    Opinions among South Koreans seem sharply divided.

    KIM JI-EUN, South Korean Resident (through interpreter): As Trump became president, the policies seem likely to become more oppressive, and it worries me that war might actually break out.

    HONG DONG-WAN, South Korean College Student (through interpreter): In fact, I believe we have to strongly respond to North Korea’s provocation.

    MARGARET WARNER: Mr. Pence today echoed other top officials in saying the Obama era policy of strategic patience with the North is over. He will look for more regional support as he travels on to Japan, Indonesia and Australia.

    For the PBS NewsHour, I’m Margaret Warner.

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    An altar of a damaged church is seen in the town of Qaraqosh, south of Mosul, Iraq. Photo taken on April 11, 2017. Photo by Marko Djurica/Reuters

    An altar of a damaged church is seen in the town of Qaraqosh, south of Mosul, Iraq. Photo taken on April 11, 2017. Photo by Marko Djurica/Reuters

    Last week was punctuated with the drop of the GBU-43/B Massive Ordnance Air Blast (MOAB) bomb that killed 95 Islamic State militants in eastern Afghanistan.

    When the bomb was tested back in 2013, it created a mushroom cloud that was visible 20 miles away.

    The strike prompted condemnation from the former Afghan President Hamid Karzai, who called the U.S. strike an “immense atrocity against the Afghan people.” President Donald Trump said it was a “very successful mission.”

    As the strike draws renewed attention to U.S. involvement in Afghanistan, here are five important stories that shouldn’t get lost in coverage of the “mother of all bombs.”

    1. A “misdirected” strike killed 18 Syrian fighters allied with the U.S.

    Syrian Democratic Forces(SDF) fighters stand with their weapons north of Raqqa city, Syria, in March. Photo by Rodi Said/Reuters

    Syrian Democratic Forces(SDF) fighters stand with their weapons north of Raqqa city, Syria, in March. Photo by Rodi Said/Reuters

    The MOAB bomb garnered headlines partly for its sheer size — it’s the U.S. military’s largest non-nuclear weapon — and also because it was used against ISIS fighters in Afghanistan.

    But the same day, reports indicated that another strike intended for an ISIS target mistakenly led to the deaths of 18 Syrian fighters who were allied with the U.S.

    U.S. Central Command issued a statement Thursday saying that a coalition strike executed on April 11 hit a location in Tabqah, Syria, that was initially identified as an ISIS stronghold. But the location turned out to be a “Syrian Democratic Forces fighting position.”

    “The coalition’s deepest condolences go out to the members of the S.D.F. and their families,” Central Command wrote.

    SDF also acknowledged the casualties and mistake in a statement saying, “as a result of error, a painful incident took place.”

    Why it’s important

    A Syrian Democratic Forces (SDF) fighter stands near a flag in northern Raqqa province, Syria, in February. Photo by Rodi Said/Reuters

    struck a mosque, killing dozens of civilians. U.S. Central Command, however, has denied bombing the mosque, saying it instead struck a building nearby.

    Then, in late March, Lt. Gen. Stephen Townsend said there was a “fair chance” that a U.S. airstrike in Mosul killed civilians earlier in the month.

    Shortly after Trump was elected, Pentagon officials reportedly wondered whether the new president would mirror former President Barack Obama’s heavy-handed involvement with their decision-making.

    White House officials told the Times that Trump has taken a lighter touch in managing military operations. However, Thursday’s strike could raise questions about Trump’s preferred method of management.

    2. A more comprehensive timeline of the Pulse shooting emerges

    The Pulse nightclub sign is pictured following the mass shooting in June in Orlando, Florida. Photo by Carlo Allegri/File Photo/Reuters

    The Pulse nightclub sign is pictured following the 2016 mass shooting in Orlando, Florida. Photo by Carlo Allegri/File Photo/Reuters

    Orlando Police Chief John Mina has been sharing with different police groups around the world how his department responded to the June 12 shooting at the Pulse nightclub, an attack that left 49 people dead.

    His 78-page report, obtained by The Orlando Sentinel, offers one of the more comprehensive timelines, to date, of the attack, including body cam footage of authorities engaging with the shooter, Omar Mateen. Mateen was later killed after an hourslong standoff with police.

    In the police chief’s presentation, it’s revealed that about half of the victims died on the dance floor “without a chance to react or run for help,” the Sentinel reported.

    According to the presentation, there were so many people injured on the dance floor that one officer asked, “if you’re alive, raise your hand.”

    Another 13 people died in the club’s bathrooms, where injured patrons — as heard in these previously released 911 calls — waited for police to come help them.

    Why it’s important

    Orlando Police officers enter the Pulse Nightclub, where Omar Mateen killed 49 people, in Orlando, Florida, U.S. as pictured in this image released as part of a briefing document by the Orlando Police on April 13, 2017. Image courtesy of Orlando Police/Handout via Reuters

    Orlando Police officers enter the Pulse Nightclub, where Omar Mateen killed 49 people, in Orlando, Florida, as pictured in this image released as part of a briefing document by the Orlando Police on April 13, 2017. Image courtesy of Orlando Police/Handout via Reuters

    The Sentinel noted that the presentation, which was part self-evaluation, didn’t acknowledge whether police gunfire struck any civilians in the shooting, which also injured 68 people.

    The report also resurfaced questions over why authorities didn’t breach the club sooner in the three-hour standoff. As evidenced by released 911 calls, patrons still in the club repeatedly asked dispatchers why police haven’t come to their aid yet. Mateen started shooting shortly after 2 a.m. local time. Police didn’t storm the club until around 5 a.m.

    Orlando police has maintained that the department feared that Mateen would harm more people in the club. Mateen reportedly told police that he was armed with a bomb vest and had a vehicle in the parking lot rigged with explosives.

    3. Some people recovering from opioid and heroin addiction are losing their memory, and doctors don’t know why

    Attorney General Maura Healey holds a CVS prescription bottle as she announced in a first-in-the-nation settlement -- that CVS Pharmacy will strengthen its policies and procedures around the dispensing of opioids -- at The Dimock Center on Sept. 1, 2016. Photo by John Tlumacki/The Boston Globe via Getty Images

    Attorney General Maura Healey holds a CVS prescription bottle as she announced in a first-in-the-nation settlement — that CVS Pharmacy will strengthen its policies and procedures around the dispensing of opioids — at The Dimock Center on Sept. 1, 2016. Photo by John Tlumacki/The Boston Globe via Getty Images

    Max Meehan started using heroin in college. Five years ago, the then-22-year-old shot up in his bathroom after a night of partying — something he had done many times in the years he’d experimented with drugs and alcohol. But when he woke up the next morning, he collapsed. He was confused, having the same thought about pain in his leg over and over again, punctuated by panicked sobs.

    Max’s family rushed him to a hospital in Massachusetts, where doctors noticed something strange: “two glowing orbs of white” in the brain that seemed to be giving him bouts of amnesia. They couldn’t explain why.

    Today, as detailed by a Buzzfeed investigation, doctors have dubbed the condition “CHIAS” — complete hippocampal ischemic amnestic syndrome. They’re following 13 other people who, inexplicably, can no longer form new memories.

    Doctors still aren’t sure exactly what’s causing the lost memories, as Buzzfeed details in this long look at the issue. But 12 of those patients — from Meehan, to a years-sober 41-year-old father to a 33-year-old woman recovering from a near-fatal overdose — had a history of heroin or opioid use.

    Why it’s important

    The Obama administration praised Baltimore's efforts to combat the opioid epidemic. Under the Trump administration, it is unclear how the nation will face this public health crisis. Photo by Frank Carlson/NewsHour

    The Obama administration praised Baltimore’s efforts to combat the opioid epidemic. Under the Trump administration, it is unclear how the nation will face this public health crisis. Photo by Frank Carlson/NewsHour

    As the opioid epidemic worsens — deaths from opioids have increased by more than 500 percent since 1990, the New York Times reported — states are still struggling with what to do about it. While doctors have curbed things like over-prescription of painkillers, former White House drug czar Michael Botticelli told the Times, “we’ve seen the continued escalation of overdose deaths in many states.”

    Cities like Baltimore have broadened access to naloxone, an opioid antidote, as chronicled by NewsHour’s Laura Santhanam; all states but Missouri now track how often drugs are prescribed and dispensed with real-time electronic records. And an executive order from President Donald Trump puts Gov. Chris Christie in charge of a new national opioid commission.

    READ MORE: In the war on heroin, Baltimore drug programs face an uncertain future

    But there’s still a lot we don’t know. New opioids and mixes of synthetic drugs with heroin means “users often don’t realize the strength of what they’re taking until it’s too late,” as pointed out in a new analysis by the Times. As the Buzzfeed report paints so poignantly, doctors are just starting to learn what exactly happens to the brain when it’s repeatedly exposed to these kinds of substances.

    Next week, Massachusetts is planning to start cataloging cases of CHIAS as a “reportable disease,” as they do with new cases of infectious diseases like Ebola or Zika, Buzzfeed reports. It could offer new insights for states which, now saving residents from addiction, must also learn how to treat them.

    4. In China, scientists are worried about the biggest Bird Flu outbreak yet

    Chickens are seen in a livestock market before the market asked to stop trading on March 1 in prevention of bird flu transmission, in Kunming, Yunnan province, China. Picture taken Feb. 22, 2017. Photo by Reuters

    Chickens are seen in a livestock market before the market asked to stop trading on March 1 in prevention of bird flu transmission, in Kunming, Yunnan province, China. Picture taken Feb. 22, 2017. Photo by Reuters

    More than 1,200 people in China were infected with the H7N9 bird virus in the latest season measured by health experts, Fortune reported.

    This is China’s fifth bird flu epidemic — and has also proven to the deadliest, one researcher told NPR last week. Guan Yi, who runs the world’s leading H7N9 lab at Hong Kong University, says 162 people have died in the latest season, which stretches from September 2016 to March 1.

    “I think this virus poses the greatest threat to humanity than any other in the past 100 years,” he said.

    It’s been four years since scientists discovered bird flu in humans. Since then, the world Health Organization has reported 1,258 cases of the virus. Through September 2016, 41 percent of confirmed bird flu cases resulted in death, according to a report from the Centers for Disease Control and Prevention. Officials believe human infections stem from exposure to live poultry or contaminated environments where there is heavy bird activity.

    The likelihood of humans passing the virus between each other remains low, the World Health Organization reported in March. But the WHO’s Wenqing Zhang warned during a media briefing that behavior of influenza viruses can change and that “this makes influenza a persistent and significant threat to public health.”

    Why it’s important

    Health officers cull poultry at a wholesale market, as trade in live poultry suspended after a spot check at a local street market revealed the presence of H7N9 bird flu virus, in Hong Kong in June. Photo by Bobby Yip/Reuters

    Health officers cull poultry at a wholesale market, as trade in live poultry suspended after a spot check at a local street market revealed the presence of H7N9 bird flu virus, in Hong Kong in June. Photo by Bobby Yip/Reuters

    In China, human infections were first reported in March 2013. People can see the news of more outbreaks and think, like common viruses in the U.S., that it’s not a big deal. But the country has continued to experience epidemics each year, The Washington Post reported.

    Daniel Jernigan, who heads the CDC’s influenza division, told the Post that the increasing number of cases are unusual.

    “This is the virus we were concerned about in 2013, and now we’re seeing these increasing number of cases,” Jernigan said. “This year it came back much stronger, so the numbers of cases we’re seeing has already surpassed all the other waves, and the season isn’t even over yet.”

    There might be some good news on the horizon: Researchers are developing a vaccine they’ll start testing in June and July, after vaccine manufacturers complete their work on making a seasonal flu vaccine, the Post reports. The Biomedical Advanced Research and Development Authority has prepared vaccines to protect first responders against the highest-risk bird flu viruses.

    5. Fifty years after she became the first women to enter the Boston Marathon, Kathrine Switzer runs again

    In 1967, Kathrine Switzer became the first woman to enter the Boston Marathon.

    Today, the Boston Marathon is one of the most competitive and beloved 26.2 mile races in the world. Back then, it — like so many other sports — was an all-male tradition. She entered the race under the pseudonym “K.V. Switzer,” able to conceal her identity until she crossed the start line in Hopkinton, Massachusetts. About a mile later, race director Jock Semple told her to “get the hell out of my race” and tried to rip her racing bib off her shirt — a moment captured in an iconic photo that symbolized women’s fight for equality in sports.

    Today, 50 years later, Switzer lined up at the start line in Hopkinton again, wearing the same bib: 261. She finished the race — her ninth marathon and first since 1976, the Boston Herald reported — in 4:44:31, according to the Boston Athletic Association.

    Why it’s important

    Runners from wave 4 cross the starting line for the 121st running of the Boston Marathon in Hopkinton, Massachusetts, on April 17, 2017. Photo by Lisa Hornak/Reuters

    Runners from wave 4 cross the starting line for the 121st running of the Boston Marathon in Hopkinton, Massachusetts, on April 17, 2017. Photo by Lisa Hornak/Reuters

    Switzer didn’t enter the race with the idea of changing women’s running. She did it to prove to her coach at Syracuse that women were not “too fragile” for long-distance running — that they, like men, were capable of running 26.2 miles.

    For those on the front lines in the fight against sexism — or any ism, for that matter — it can be hard to see progress. It’s also hard to see how small goals translate into big action. Switzer toeing the start line today was a nice reminder of that.

    After her first marathon appearance, she went on in the 1980s to help the women’s marathon become an Olympic sport. She also started a group — whose name, 261 Fearless, pays tribute to her first marathon bib — that encourages women’s health and empowerment through running.

    Watch full episodes online of “Makers: Women Who Make America” on PBS here.

    This year, 13,698 women competed in the Boston Marathon, thanks to Switzer’s bet with her coach. In the last two Olympic summer games, in Rio and London, American women took home more of the country’s medals than men. USA women’s soccer and hockey have both recently won big contract negotiations that will better align their pay and benefits with those of their male counterparts. Major League Baseball just hosted its first girls tournament. And an Arizona teen just became the first woman to sign with a Division II or higher football program.

    Of course, women still face barriers in sports, and in other places. But in many ways, Switzer’s run this year was a victory lap. And as if we couldn’t love her any more, she ended her Herald interview with this:

    “That’s one reason [why] Jock Semple and I became the best of friends,” Switzer said. “That photo became an iconic photo and it is now one of the most galvanizing photos of the women’s rights movement. How could I not love somebody who changed my life in such a positive way, even if it was a negative beginning?

    READ MORE: 5 important stories that are totally free of politics

    The post 5 important stories that can help you (mostly) take a break from politics appeared first on PBS NewsHour.

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    The S.S. John Glenn is ready for its close-up.

    In a first for a NASA rocket launch, a 360-degree video camera will live stream the launch of an Atlas V rocket — carrying the Orbital-ATK’s Cygnus spacecraft, dubbed the the S.S. John Glenn — towing supplies and research from Cape Canaveral to the International Space Station.

    Launch time is 11:11 a.m. EST. Watch live in the player above.

    The mission is the sixth Orbital-ATK spacecraft to visit the International Space Station as part of the Commercial Resupply Program, a contract Orbital-ATK shares with Boeing and SpaceX.

    Some of the cargo includes a miniature greenhouse and 38 cubesats, tiny satellites that will study Earth’s thermosphere. This is the last time in the foreseeable future that Cygnus will launch from Cape Canaveral, as the next launches are scheduled to take place at Wallops Island, Virginia.

    It’s been almost three years since Orbital-ATK’s last launch from Wallops exploded seconds after liftoff, resulting in a fiery conflagration that destroyed the launchpad.

    Space missions are no strangers to 360 video. In 2016, cosmonaut Andrey Borisenko shot a 360-degree video tour of the ISS and presented a view of Earth from the Cupola module. But this is the first time you’ll be able to see a rocket launch into space in 360 degrees, from the comfort of your computer.

    The post WATCH LIVE: NASA shows first 360-degree video of rocket launch appeared first on PBS NewsHour.

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    After three years in detention, an Egyptian-American aid worker named Aya Hijazi is scheduled to walk free tomorrow, along with her husband and six other co-defendants, after being cleared of child abuse and human trafficking charges, her lawyers confirmed today.

    The case became emblematic of Egypt’s widespread crackdown on aid groups as well as the country’s Kafkaesque judicial system.

    The judge announced their acquittal on Sunday to a packed Cairo courtroom. Applause and cheers could be heard as the verdict was announced.

    Hijazi co-founded the Belady Foundation in 2013 with her husband Mohamed Hassanein shortly after graduating from George Mason University. The Cairo-based NGO provided resources and counseling to abandoned or runaway children.

    In May 2014, authorities detained Hijazi, Mohammad and six others volunteers with the organization on accusations that they physically and sexually abused these children, and included the children in anti-government protests. They had been held in pre-trial detention ever since.

    Throughout the course of their detention, hearings were adjourned before they began over six times. The verdict was originally scheduled for March, just before Egyptian President Abul Fattah el-Sisi’s first meeting with President Donald Trump in Washington.

    Government officials, including former U.S. Ambassador to the U.N. Samantha Power, had lobbied the Egyptian government for Hijazi’s release through the years. After her acquittal Power tweeted, “At last. Aya’s jailing was outrage. Think about the thousands of jailed Egyptians who aren’t dual Amcitizens & lack donors pushing 4 release.”

    “Aya now wants to spend time with her family after three years apart and focus on recovering from her ordeal,” says Wade McMullen, an attorney with the Robert F. Kennedy Human Rights, a non-profit that has taken on Hijazi’s case.

    WATCH: Has justice taken a backseat to civil order in Egypt’s courts?

    The post American aid worker expected to walk free after three years in Egyptian prison appeared first on PBS NewsHour.

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    House Speaker Paul Ryan (R-WI)  is among the Republicans who have made the case for high risk pools. Photo by Zach Gibson/Getty Images.

    President Donald Trump and House Speaker Paul D. Ryan. Photo by Zach Gibson/Getty Images.

    Shortly after President Donald Trump took office, the White House and Congressional Republicans laid out an aggressive first year agenda so packed with major items that House Speaker Paul D. Ryan stressed not the first 100 days, but the first 200 when talking about the party’s plans.

    For Mr. Trump, the first 100 days is approaching late next week, on April 29. (Prepare yourself for a spate of stories then).

    For Congress, the first 200 days ends July 25, essentially at their August recess. After withdrawing their initial health care bill, Republicans — now nearly half of the way to their self-imposed 200-day mark — have been forced to redraw their calendar as well.

    Here’s what that looks like.

    The original plan: Pass three major items in 2017

    1. Affordable Care Act repeal and replace by April. Republicans hoped to have their marquee reconciliation bill to the president by the end of March.
    2. Tax reform: by May or August. In November, Treasury Secretary-designate Steven Mnuchin said it would happen in the first 90 days, which would be by this week. Congressional Republicans offered a slower timeline, hoping to pass a tax overhaul by August.
    3. Infrastructure: by 2018. Congressional Republicans told reporters in January that the hope was to pass an infrastructure plan by the end of the year.

    The plan now

    1. Affordable Care Act repeal and replace: no date. Speaker Ryan has reversed course and says he will no longer set a timetable for passage of a central piece of health care legislation. Talks among Republicans continue, with some hoping for a vote as soon as next week. Or it could be derailed further.
    2. Tax Reform: after August. Mnuchin told the Financial Times this week that it is no longer realistic to expect tax reform by August. The treasury secretary did not go into more detail, but that timing makes it more difficult to put major tax changes into place next year. In addition, looking at the Congressional calendar, that means September and October are the most likely months for a final tax reform debate, timing which may directly overlap with another funding battle.
    3. Infrastructure: unclear. Consistently seen as the “we’ll get to it after everything else” item, there is a chance that an infrastructure plan could be bundled in with tax reform in the late summer and fall or with a spending bill at various points. Or it could be punted to 2018. Its timeline and shape are the least clear of the three policy areas.

    The post Here’s how Republicans are redrawing their legislative agenda appeared first on PBS NewsHour.

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    (AP Photo/Michael Probst)

    Michael Miller, 44, does what most smokers do to protect his sons and daughter from the fumes of his Marlboro Ultra Lights. He takes it outside.

    After his 7 a.m. coffee, he walks out of his home in Cincinnati to smoke his first cigarette of the day. Then, as a branch manager of a road safety construction company, he smokes dozens more on street curbs.

    The tobacco never appears when Miller is coaching on the baseball or football field, or when he’s in the car with his children. But when he’s alone on the road, he sometimes rolls the windows down and lights up.

    “I know [cigarettes are] bad,” Miller said. “I know I need to quit.”

    New findings highlight the scientific community’s efforts to identify potential dangers of another byproduct of cigarettes that may slip past Miller’s precautions and affect his kids: “thirdhand smoke.”

    A recent study in the journal Tobacco Control found high levels of nicotine on the hands of children of smokers, raising concerns about thirdhand smoke, a name given to the nicotine and chemical residue left behind from cigarette and cigar smoke that can cling to skin, hair, clothes, rugs and walls. This thin film can be picked up by touch or released back into the air when disturbed.

    The researchers examined 25 children who arrived at an emergency room with breathing problems associated with secondhand smoke exposure.

    They discovered the average level of nicotine on the children’s hands was more than three times higher than the level of nicotine found on the hands of non-smoking adults who live with smokers. They said nicotine on the skin of a nonsmoker is a good proxy to measure exposure to thirdhand smoke.

    “Because nicotine is specific to tobacco, its presence on children’s hands may serve as a proxy of tobacco smoke pollution in their immediate environment,” the researchers wrote.

    They also found that all but one of the children had detectable levels in their saliva of cotinine, a biomarker for exposure to nicotine. All of the children in the study had parents who smoked but did not smoke themselves.

    The high nicotine readings on the kids’ hands, coupled with the “light smoking” habits of the majority of their parents, signaled to lead author E. Melinda Mahabee-Gittens that these toxins could have arrived from a source other than direct access to cigarette smoke.

    “Clearly they’re getting it from somewhere, and perhaps it may be this thirdhand smoke connection,” Mahabee-Gittens said.

    Children face a higher risk of developing health complications from thirdhand smoke than adults. Infants tend to spend more time indoors and can be surrounded by contaminated objects like rugs and blankets, according to a 2004 study written by Georg Matt, a professor of psychology at San Diego State University who co-authored the study and has researched thirdhand smoke. An infant’s propensity to place their hands in their mouth increases the likelihood of the young ingesting the toxic residue.

    Researchers at the U.S. Centers for Disease Control and Prevention estimate that since 1964 at least 2.5 million nonsmokers have died of diseases linked to their exposure to cigarette smoke.

    Thirdhand smoke can linger in an area long after a cigarette or cigar is snuffed out — for up to five years, Matt said.

    “Tobacco smoke doesn’t go up in the air and it disappears and it’s gone,” Matt said. “That’s the illusion.”

    The negative health consequences of secondhand smoke are well-established.

    Researchers at the U.S. Centers for Disease Control and Prevention estimate that since 1964 at least 2.5 million nonsmokers have died of diseases linked to their exposure to cigarette smoke.

    In contrast, research on thirdhand smoke gained popularity only a decade ago, but multiple studies suggest the mix of toxins can lead to adverse health outcomes. An animal model simulating thirdhand-smoke-contaminated homes found the chemicals harmed mice’s livers, lungs and healing abilities. A separate 2010 study showed thirdhand smoke mixed with nitrous acid — a gas sometimes emitted from leaky gas stoves — can form cancer-causing chemical compounds. These toxins have also been shown to damage human DNA.

    “All in all, I think the evidence that we’ve gathered is basically pointing to potentially high levels of risk to young children and toddlers, and also expectant mothers,” Anwer Mujeeb, program officer for the Tobacco-Related Disease Research Program.

    Unfortunately, removing thirdhand smoke from a child’s environment is no easy task. The variety of compounds that make up cigarette residue react to cleaning products differently, Matt said, making it difficult to purge a space of pollutants.

    Governments and agencies across the nation have attempted to curb the threat of smoke exposure by implementing tobacco bans. Forty-one states and the District of Columbia have implemented local smoke-free laws, according to the lobbying group Americans for Nonsmokers’ Rights.

    Although the majority of these laws are meant to address secondhand smoke exposure, an unintended benefit of the ordinances is a reduction in thirdhand smoke, said Stanton Glantz, professor of medicine and director of the Center for Tobacco Control Research and Education at University of California-San Francisco.

    Reynolds American Inc., the second-largest tobacco company in the United States, declined to comment on the study. The Altria Group, the leading U.S. cigarette manufacturer, did not respond to requests for comment.

    Mujeeb said more work must be done to better understand the risks of thirdhand smoke. Researchers still do not know the threshold of exposure that leads to harm. Other potential pollutants in the environment need to be identified as well to “properly characterize the risk of thirdhand smoke,” he said.

    Miller is skeptical of the threat thirdhand smoke poses to his family, but he is determined to quit smoking this year on his 45th birthday in July. With the help of medicine, he hopes to break the habit his kids remind him is proven to kill.

    “I think there’s far worse things that are going on than any tar on my hands,” he said.

    Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. You can view the original report on its website.

    The post A new worry for smokers’ families: ‘thirdhand smoke’ appeared first on PBS NewsHour.


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