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

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    Photo by Morsa Images via Getty

    Three hospitals are launching an effort to reduce the number of surgeries performed by less-experienced doctors. Photo by Morsa Images via Getty

    After James Happli of Mosinee, Wisconsin, was diagnosed with pancreatic cancer, he was referred to a surgeon at a local hospital where he had been treated for lymphoma 28 years earlier. The surgeon told Happli and his wife that although she had never successfully performed a Whipple procedure — the pancreatic cancer operation widely regarded as among the most difficult in surgery — she believed she could do it with the help of a second surgeon.

    But Happli’s operation had to be aborted after it proved too difficult. Several months later, the pipe fitter, now 58, traveled to Froedtert Hospital in Milwaukee, 175 miles from his home. His operation, one of 127 Whipples done at Froedtert last year, was performed successfully by chief surgeon Douglas B. Evans.

    The procedure involves removing part of the pancreas and small intestine as well as the gallbladder, and reconnecting the digestive organs. It proved to be particularly complicated in Happli’s case, Evans said, because of tissue damage caused by radiation treatment for his lymphoma.

    “If this patient is not getting referred [to a specialist], then who is?” asked Evans, who said he has seen a recent uptick in patients treated unsuccessfully by inexperienced surgeons at smaller hospitals.

    The largely unfettered ability of surgeons with minimal expertise to perform high-risk procedures — particularly at hospitals that lack experience caring for significant numbers of patients — has been the subject of a contentious, long-running battle known as the volume-outcome debate.

    A groundbreaking 1979 Stanford study found that patients who underwent operations at hospitals that did more of those surgeries had significantly lower death rates than those treated at hospitals where they were done infrequently. That finding has since been replicated repeatedly across many specialties and found to apply to surgeons as well as hospitals. Last month, a large study found that the risk of complications was far higher among surgeons who performed only one thyroid removal annually than among those who did 25 or more of the tricky procedures per year.

    Recently the volume battle was reignited when a trio of prominent health systems — Johns Hopkins, Dartmouth-Hitchcock and the University of Michigan — pledged that they will require their surgeons and 20 affiliated hospitals to meet minimum annual thresholds for 10 high-risk procedures. The three systems have asked other hospital networks around the country to join them.

    Under the terms of the volume pledge, believed to be the first of its kind, surgeons must perform at least five pancreatic cancer surgeries annually in hospitals where 20 such operations are done each year. For knee or hip replacements, the requirement is 25 per surgeon and 50 per hospital. There are provisions for emergency surgery and for surgeons who sometimes do not meet the threshold because they were on leave; such surgeons might be required to perform a certain number of procedures under supervision.

    “There is this intractableness of patients undergoing surgical care in places that have no business doing it” or performed by “hobbyists” — surgeons who infrequently perform risky surgeries, said John Birkmeyer, chief academic officer at Dartmouth. Birkmeyer devised the pledge with Peter Pronovost, an internationally known expert who directs the Armstrong Institute for Patient Safety and Quality at Johns Hopkins.

    At large teaching hospitals, Birkmeyer noted, “there are usually one or two or three surgeons who are recognized as go-to doctors” for certain procedures and do them frequently. “But there’s this tail of other surgeons who do only a few a year,” such as a shoulder surgeon who performs a handful of hip replacements or a breast cancer surgeon who occasionally attempts a Whipple.

    “We decided to use volume as a pilot case, an initial foray into setting quality and safety standards,” he said. “And we wanted to do it in a way” that was not subject to the discretion of hospital officials.

    Critical Information

    As smaller community hospitals affiliate with larger ones, the questions of which surgeons should do which procedures and where are increasingly confronting health systems. Hospitals of all sizes — both large academic centers and smaller community institutions — face a variety of sometimes competing incentives: to retain lucrative surgical cases and to avoid angering surgeons, who fiercely prize autonomy and wield considerable clout because they generate substantial revenue. And while hospitals formerly reaped a financial reward if patients suffered complications and had to be readmitted, they now face penalties under the Affordable Care Act.

    The Leapfrog Group, a nonprofit organization that represents large employers and purchasers of health care and seeks to advance patient safety, has focused on volume in its hospital rating system. “Volume is a really critical piece of information,” said the group’s chief executive officer, Leah Binder.

    “I think every medical staff should be grappling with these volume benchmarks,” she said, endorsing the pledge. “It’s fundamental.”

    Ashish K. Jha, a practicing internist and professor of health policy at Harvard’s T. H. Chan School of Public Health who has written about efforts to improve medical quality, calls the pledge “very reasonable.”

    Low-volume hospitals, he said, typically lack specialized teams to care for patients as well as state-of-the-art equipment and systems designed to prevent or quickly spot complications — critical factors in improving outcomes. “None of us care about volume; we care about outcomes, and volume is a surrogate” measure of outcomes, Jha noted. “Even though we’ve been talking about this for 35 years, a ton of high-risk surgery still happens among low-volume providers.”

    But surgeons’ groups and the president of the Joint Commission, the Chicago group that accredits the nation’s hospitals, have criticized the pledge as simplistic and overly prescriptive. Some officials say they fear it could unfairly penalize low-volume surgeons and smaller hospitals that have good outcomes.

    “There’s room to improve in low-volume and high-volume hospitals,” said Kevin Bozic, chairman of the department of surgery at the Dell Medical School at the University of Texas at Austin, who heads the committee on research and quality for the American Academy of Orthopaedic Surgeons. “There are high-volume, low-quality hospitals” as well as the converse.

    “I know Harvard may be better than McPherson, Kansas,” said Tyler Hughes, a surgeon at the 25-bed hospital in McPherson and a director of the American Board of Surgery. “But for many patients, the best possible surgery is closest to home.”

    Irate Surgeons

    Although patient-safety experts and some insurance companies have long encouraged patients, especially those with serious illnesses or complex diagnoses, to seek care from experienced specialists at high-volume hospitals, there is little to prevent doctors and hospitals from doing whichever surgeries (other than organ transplants) they see fit, no matter how rarely they do them.

    Many patients don’t know to ask a doctor about volume or outcomes or are unable to ferret out relevant information when choosing a surgeon or hospital. One reason, Leapfrog’s Binder said, is that much important information such as complication rates remains hidden. Hospitals report detailed data about surgical outcomes to registries for internal use, but the information is not publicly available.

    Kerry O’Connell, 59, a Denver construction executive, said that only after a botched elbow operation that required seven corrective surgeries did he learn that his was the second such procedure his orthopedist had performed. “I went to the one clinic where the ER sent me, and the surgeon seemed like a nice guy,” he said.

    “We don’t have enough transparency in health care,” Binder said. “It’s the first thing everyone wants to know: Who’s the best surgeon? And anyone in health care picks up the phone and asks their friends.”

    Recently, Binder notes, there have been new efforts to inform patients. In the past year, the journalism organization ProPublica and Consumer’s Checkbook have launched databases that rate surgeons. Since 1995 New York state has published some data on heart surgeons. And Consumer Reports and the federal government’s Hospital Compare website provide hospital-specific information.

    A report by Leapfrog found that in 2013, one-third of hospitals that performed procedures to remove all or part of the esophagus, a demanding surgery to treat cancer, did only one or two annually, far below the level needed to achieve proficiency. A CNN investigation of an extremely low-volume Florida heart surgery program launched in 2011 found that six babies died in a two-year period, far more than expected; the program has since closed. And a U.S. News analysis last year found that Medicare patients who had knee replacements at the lowest-volume hospitals in the country were 70 percent more likely to die than those whose surgery was performed at the highest-volume centers; for hip replacement, the figure was 50 percent.

    Disparities can be seen among hospitals in the same system, Birkmeyer noted.

    “One of our highest priorities is insuring consistent quality and safety” regardless of where a patient seeks treatment, he said. In the past decade, Dartmouth has grown from a single hospital in Hanover, New Hampshire, to eight in northern New England. Baltimore-based Hopkins has affiliated with smaller hospitals in Washington, D.C. and suburban Maryland.

    Among the most irate reactions Birkmeyer said he encountered came from about 10 surgeons affiliated with Dartmouth’s main hospital who were told they would no longer be allowed to do procedures for which they didn’t meet annual minimums. “They said things like, ‘I’ve been credentialed to do this for 20 years and I’ve never had a complication, and now you’re telling me I can’t do it?’ ”

    That anger and the months required to get the boards of hospitals and their executive committees to agree to the new rules may be among the reasons only three systems have signed on so far, Birkmeyer said. More than a dozen others have expressed interest.

    Some surgeons say that the focus on volume is misguided.

    The problem “is actually much more complicated than volume” said David Hoyt, executive director of the American College of Surgeons. Hoyt said that the group is drafting its own guidelines that will address volume.

    Beyond Numbers

    To Mark Chassin, president of the Joint Commission, the pledge misses the mark. “The surgeon’s contribution to the outcomes patients experience is only one component,” he said.

    “Volume should never be used by an accrediting organization as a measure of quality” because it is too imperfect a measure, Chassin added.

    Patients can help protect themselves, he added, by taking “as much responsibility and interest” as possible in their care.

    In the view of general surgeon Linda Halderman, doctors are the best judges of their abilities. “Every surgeon has to exercise judgment of their own capabilities” and know when to refer to a more experienced colleague, said Halderman, who is based in Selma, California.

    But Harvard’s Jha disagrees. Many surgeons, he said, tell him they “have excellent results and I’ll say, ‘How do you know? Do you actually track your outcomes?’ ” Most, he said, do not.

    Two months ago, Linus Linaweaver, 76, chose to undergo elective abdominal surgery in his home town of McPherson, Kansas, after robotic prostate surgery at a larger hospital in Wichita nearly killed him and left him with a colostomy.

    “I wanted to be back in our town,” he said, adding that he had confidence in Tyler Hughes, his surgeon, and McPherson Hospital. His seven-hour operation went well, and Linaweaver recently said he is “almost back to normal.”

    James Happli is back at work after a year’s medical leave. Following his failed Whipple surgery, the local surgeon proposed trying again. That offer was withdrawn after a second specialist refused to participate. At that point, Happli was referred to Evans in Milwaukee.

    If he had it to do over again, Happli said, “I would have gone to a bigger place” and a more experienced surgeon the first time.

    The post These hospitals are trying to reduce surgeries by inexperienced doctors appeared first on PBS NewsHour.

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    An Apple Inc. iPhone in an arranged photograph in New York. Photo by Chris Goodney/Bloomberg via Getty Images

    Photo by Chris Goodney/Bloomberg via Getty Images

    WASHINGTON — The FBI said Wednesday that it will not publicly disclose the method that allowed it to access a locked iPhone used by one of the San Bernardino attackers, saying it lacks enough “technical information” about the software vulnerability that was exploited.

    The decision resolves one of the thorniest questions that had confronted the federal government since it revealed last month that an unidentified third party had come forward with a successful method for opening the phone. The FBI did not say how it had obtained access, leaving manufacturer Apple Inc. in the dark about how it was done.

    The new announcement means that details of how the outside entity and the FBI managed to bypass the digital locks on the phone without help from Apple will remain secret, frustrating public efforts to understand the vulnerability that was detected and potentially complicating efforts to fix it.

    Apple did not immediately respond to requests for comment.

    In a statement Wednesday, FBI official Amy Hess said that although the FBI had purchased the method to access the phone — FBI Director James Comey suggested last week it had paid more than $1 million — the agency did not “purchase the rights to technical details about how the method functions, or the nature and extent of any vulnerability upon which the method may rely in order to operate.”

    The government has for years recommended that security researchers work cooperatively and confidentially with software manufacturers before revealing that a product might be susceptible to hackers. The White House has said that while disclosing a vulnerability can weaken an opportunity to gather intelligence, leaving unprotected Internet users vulnerable to intrusions is not ideal either.

    An interagency federal government effort known as the vulnerabilities exploit process is responsible for reviewing such defects and weighing the pros and cons of disclosing them, taking into account whether the vulnerability can be fixed, whether it poses a significant risk if left unpatched and how much harm it could cause.

    Hess, the executive assistant director of the FBI’s science and technology branch, said Wednesday the FBI did not have enough technical details about the vulnerability to submit it to that process.

    “By necessity, that process requires significant technical insight into a vulnerability. The VEP cannot perform its function without sufficient detail about the nature and extent of a vulnerability,” she said.

    The revelation last month that the FBI had managed to access the work phone of Syed Farook — who along with his wife killed 14 people in the December attacks in San Bernardino — halted an extraordinary court fight that flared a month earlier when a federal magistrate in California directed Apple to help the FBI hack into the device. Since then, the government has not disclosed the entity or said anything about how the work was done.

    At an appearance earlier this month at Kenyon College in Ohio, Comey said the FBI had not yet decided whether to disclose details to Apple but suggested that the agency had reservations about doing so.

    “If we tell Apple, they’re going to fix it and we’re back where we started,” Comey said. “As silly as it may sound, we may end up there. We just haven’t decided yet.”

    The FBI director was correct, but that’s exactly the way the process should work, said Joseph Lorenzo Hall, senior technologist at the Center for Democracy and Technology.

    “If you’re going to use flaws in the technology to gain access, then you better be prepared to report it,” he said. Given the imperfections inherent in software writing, and their ability to be exploited for access, “Those bugs need to be fixed as fast as we can because we have no clue about whether there are tons and tons of bugs — or just a few,” he said.

    Though one can imagine a scenario in which the FBI would hold onto its secret for “a little while,” vulnerabilities generally should be reported to the company so they have an opportunity to patch them, said Susan Landau, a cybersecurity policy professor at Worcester Polytechnic Institute.

    “To me, and I think the government would clearly agree, the default should be report,” she said.

    The post FBI says it won’t disclose how it accessed locked iPhone appeared first on PBS NewsHour.

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    Photo by Peter Dazeley/Getty Images

    Photo by Peter Dazeley/Getty Images

    WASHINGTON — The House has used a rare show of unanimity to approve legislation requiring the government to get a warrant if it wants people’s older emails.

    The legislation would require federal agencies to get a warrant before they can force an email service provider like Google to provide access to data over 180 days old.

    Also covered would be electronic documents like stored videos, text messages and photos.

    The bill updates a three-decade-old law enacted when the use of email was rare. Under it, older emails are considered abandoned and allows government access without a warrant.

    The House approved the bill Wednesday by 419-0. Its top sponsors are Kansas Republican Kevin Yoder and Colorado Democrat Jared Polis.

    A similar, bipartisan Senate bill has yet to advance there.

    The post House backs bill bolstering privacy of old emails appeared first on PBS NewsHour.

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    Buzzfeed employees work at the company's headquarters in New York January 9, 2014. BuzzFeed has come a long way from cat lists. This month one of its journalists was on the ground in Kiev reporting on the crisis in Ukraine, and last December it published an in-depth article on a Chinese dissident living in Harlem, New York. The kittens haven't disappeared, but these days there is serious journalism as well. Founded in 2006, BuzzFeed is now among the top 10 most-visited news and information sites in the United States. Headquartered in New York, BuzzFeed now has more than 150 journalists, an investigative reporting unit, bureaus in Australia and the United Kingdom, and foreign correspondents in far-flung places like Nairobi and the Middle East. Its expansion comes amid a wave of investor interest in new media companies that are trying to capitalize on a decade-long wave of job cuts at newspapers, and new technology that has upended how news and advertising are produced and distributed. To match Feature USA-MEDIA/BUZZFEED  Picture taken January 9, 2014.  REUTERS/Brendan McDermid (UNITED STATES - Tags: MEDIA BUSINESS SCIENCE TECHNOLOGY) - RTX19CUJ

    Buzzfeed employees work at the company’s headquarters in New York. BuzzFeed has come a long way from cat lists. The kittens haven’t disappeared, but these days there is serious journalism as well. New technology that has upended how news and advertising are produced and distributed. Photo by Brendan McDermid/Reuters

    Journalism is (once again) in crisis. This time, the sky really does seem to be falling.

    Newspapers are losing readers and revenue. Some are shutting down all over North America. In Canada, it has been particularly acute, with the largest chain consolidating newsrooms in two-newspaper markets in January. Long-established small town newspapers in Ontario and British Columbia have simply vanished overnight after more than a century of service. Broadcasters continue to shrink, even as local U.S. TV stations in caucus and primary states make their usual profits in an ad-rich election year. Canadian TV stations are threatening to shut their local news operations unless a better model is found.

    Media managers are wondering what went wrong. Reporters and editors are asking why journalism doesn’t pay any more. However, if simple solutions are hard to discern, the media have only to look at the technology they once so eagerly embraced.

    Yet media organizations stubbornly insist that digital is the solution. They cling to digital like a torpedoed sailor clings to a raft, hoping that the submarine won’t hit them again.

    It’s the digital technology. It emerged in the late 1990s and early 2000s and swept through every aspect of modern life, including journalism. As ratings and circulation declined, media organizations, pressured by shareholders and desperate to find a way to return to the great profit margins of the 1980s, seized on digital as the silver bullet of transformations.

    But if ever there was a double-edged sword, it is the digital culture. It has enlarged our informational possibilities while at the same time offering up trivia like cat videos, celebrity sightings and “listicles.” It is, in effect, driving journalistic deviance downward, to paraphrase Daniel Patrick Moynihan.

    Yet media organizations stubbornly insist that digital is the solution. They cling to digital like a torpedoed sailor clings to a raft, hoping that the submarine won’t hit them again.

    In February in Toronto, at a gathering sponsored by the Canadian Journalism Foundation, three prominent newspaper publishers (Montreal’s La Presse, the Toronto Globe and Mail and the Toronto Star) discussed the future of the business. To a person, they were all bullish. And that future for newspapers, they said, is digital, digital and more digital.

    We live in strange times.

    • We have a lodging system called Airbnb. It doesn’t own any actual hotels.
    • There’s a food delivery service called Foodora. It doesn’t own any restaurants.
    • There’s a video service called YouTube. It doesn’t produce movies.
    • There’s a taxi company called Uber. It doesn’t own any cars.

    Journalism is also being Uber-ized. Increasingly, content isn’t created by journalists once employed by legacy media. It comes from freelancers, citizen journalists, bloggers and vloggers. Freelancers are being hired while experienced, older journalists are laid off. In the rush to return to the once-rich profit margins of the early 2000s, media organizations are being urged by their shareholders to dispense with expensive ventures like international reporting. Newspapers have closed or been downsized, broadcasters have cut their more expensive (and more labor-intensive) content. News consultants like Frank N. Magid Associates are hired to tell their news clients that weather, traffic and crime, or WTC, are what most audiences prefer.

    Not coincidentally, WTC also happens to be the cheapest and most readily available content. And all three bits of low-hanging journalistic fruit originate from government sources: weather from the National Weather Service (Environment Canada based in Ottawa), traffic reports from various Department of Transportations at the state and provincial levels and, of course, crime from local police forces. (The last of these may have a financial incentive to make sure that the media reports as much criminal activity as possible, even when crime rates are declining.)

    So much for independent journalistic inquiry.

    And studies are showing that all three of the WTCs evoke strong feelings of anxiety in audiences. The news seems to be in the business of producing “moral panic.”

    Click-bait is rarely newsworthy, but it does attract eyeballs. The assumption seems to be that audiences might stay for the “serious” content after gorging on the fluff.

    It’s not all bad. Many businesses have been properly transformed and modernized by digital. While customers have benefited from the ease, cost-effectiveness and simplicity of digital, there is also a powerful downside: Wages for workers in those industries have plummeted (journalism included), working conditions are often worse, and company morale, in many instances, is still dropping and has not yet hit rock bottom. Journalists’ unions seem particularly ineffective under these circumstances, accepting downsizing and reduced salaries, because they understand their choices and influence are limited to say the least.

    At the same time, profit margins in many industries have never been greater. Media organizations with smaller labor-intensive operations are doing well, and startups are being courted by Wall Street IPOs. (Buzzfeed raised $850 million last year in order to get into the news and film business and away from cat videos and listicles.)

    This increased competition from media organizations like Buzzfeed, Vice Media and Vox have put renewed pressure on legacy media. Broadcasters especially try to entice their audiences through click-bait. This is defined as “an [eye-catching] link on a website which encourages people to read on. It is often paid for by the advertiser (‘Paid’ click-bait) or generates income based on the number of clicks.”

    It’s rarely newsworthy, but it does attract eyeballs. The assumption seems to be that audiences might stay for the “serious” content after gorging on the fluff. The public broadcaster in Canada, the CBC, seems to be particularly smitten with click-bait, even though its own journalists complain, and the public resents this waste of the public broadcaster’s journalistic efforts and reputation.

    One of the best qualities in the journalistic culture is skepticism. But when it comes to digital, skepticism has been replaced with unquestioning enthusiasm.

    No technological change can ever be reversed. Occasionally, it can be slowed, even questioned. Can the effects of the digital culture be made to work on behalf of the culture rather than against it? If journalism is to survive, it has to resist digital’s worst qualities in order to let it offer what’s best on behalf of the public.

    Digital is merely a technology, like the telephone. It’s a technology that will only thrive if it has something of value to transmit. But anxious media managers seem to have become believers in a technology possessed with apparent magical properties.

    One of the best qualities in the journalistic culture is skepticism. But when it comes to digital, skepticism has been replaced with unquestioning enthusiasm. And the information-starved public is being left behind.

    The post Why click-bait will be the death of journalism appeared first on PBS NewsHour.

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    JUDY WOODRUFF: Finally, with growing concern over concussions and related injuries, a start-up company in Upstate New York is using wearable technology to help keep athletes safer.

    It is a device that sends head injury alerts as soon as they happen on the field and in the ring and also measures the cumulative effect of multiple hits.

    From member station WXXI and Public Media’s Innovation Trail, Sasha-Ann Simons WXXI.

    MICHAEL ROBERTSON, Boxer, Aquinas Institute: We start off with a 10-minute run. After the run, we do what’s called a set. We do jumping jacks, pushups, squats, like all that kind of stuff. And we wrap our hands.

    SASHA-ANN SIMONS: It’s a daily ritual for Michael Robertson. The 16-year-old is on the high school boxing team at Aquinas Institute. Six days a week, he gears up to get in the ring.

    His head gear is high-tech. Before every match, he slips a small sensor inside his headband and then puts a helmet on. Jab after jab, the sensor, this one called the Linx Impact Assessment System, or IAS, sends real-time data to his coach and parents through an app.

    Not only does the sensor help spot signs of a concussion. It also can uncover other, more common types of brain injuries.

    DOMINIC ARIOLI, Head Boxing Coach, Aquinas Institute: One of the things that I look at with the device is not only how hard they’re getting hit, but if they’re getting hit, getting hit how often with blows that register.

    SASHA-ANN SIMONS: Aquinas has been field testing the concussion sensor for about two years. Inside the helmet, the sensor registers the amount of force from a blow and will trigger a green, yellow, or red light, with red being the indicator that the hit was too hard to ignore. The data’s available in real time and can be stored for review after the match.

    DOMINIC ARIOLI: We will check with the system, and we will also check with the student, how did their blow feel? And they’re a pretty good system.

    SASHA-ANN SIMONS: The blow is also given an impact assessment score.

    DAVID BORKHOLDER, Chief Technology Officer, BlackBox Biometrics: That gives a number from one to 100, and so you can — the individual can gauge the severity of each of those impacts on that scale. But we also capture all the detailed data, which is really critical for research.

    SASHA-ANN SIMONS: David Borkholder is in charge of the technology at BlackBox Biometrics, which created LINX IAS. His team is brainstorming ways to push the technology forward.

    DAVID BORKHOLDER: Another emerging area that I think is actually going to be even more important are repetitive subconcussive hits.

    SASHA-ANN SIMONS: Recent research has shown that many brain injuries are from subconcussive hits, which don’t display the symptoms of a concussion.

    And according to Dr. Jeff Bazarian of the University of Rochester Medical center, it’s important for wearable sensors to be able to pick up on those, too.

    DR. JEFF BAZARIAN, University of Rochester Medical Center: There are football players that get hit all the time, day in and day out, never have a concussion. We look at their brains, it looks like they have some mild brain injury.

    SASHA-ANN SIMONS: Over the years, more companies have introduced impact sensors and more doctors have diagnosed concussions.

    Bazarian says that wasn’t always the case.

    DR. JEFF BAZARIAN: People would say, these problems that you’re having are not rooted in anything real. They’re just a psychiatric response to being hit.

    But now that we can see it, people are saying, oh, wow, this is kind of like a stroke or a ministroke. There’s actually injury here.

    SASHA-ANN SIMONS: There’s an adage in boxing that the best defense is to not get hit.

    Arioli is a firm believer technology can’t take the place of his experience and good training, but says he thinks devices like LINX IAS are useful.

    DOMINIC ARIOLI: I can see if they need to keep their hands up, but it gives me something to show them, physically show them, look how often you’re getting hit. What’s the story here?

    SASHA-ANN SIMONS: For the “PBS NewsHour,” I’m Sasha-Ann Simons in Rochester, New York.

    The post When a player takes a hit, this concussion sensor measures the blow appeared first on PBS NewsHour.

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    HARI SREENIVASAN: In the latest NewsHour Bookshelf conversation, a look into a potential new treatment for autism.

    Transcranial magnetic stimulation, or TMS, can be used to diagnose damage from brain injuries and disorders. But a new study investigates whether the therapy can help some autistic patients make connections and understand emotions they have never experienced.

    I recently spoke with one such patient.

    John Robison, thanks so much for joining us.

    So, first, let’s start with, what is transcranial magnetic stimulation, and why did you decide to participate in this research?

    JOHN ELDER ROBISON, Author, “Switched On”: It’s a therapy where they use focused bursts of electromagnetic energy to transmit tiny amounts of electricity through the scalp and through the skull, and into your brain.

    Your brain’s an electrical organ, so if you want to change how it functions, you can change it most directly with targeted electricity. When I heard that there was a study that might help autistic people like me see emotional cues in other people, the idea of it just spoke to the heart of something that I felt had been a disability in me all my life, being unable to read body language and expressions and cues in other people.

    HARI SREENIVASAN: So, you describe this. I want to quote a paragraph.

    It says: “Imagine that, all your life, you have seen the world in black and white. Meanwhile, everyone around you describes the beauty and richness of color. After a while, their talk of color frustrates you. Which do you believe, their words or the evidence before your eyes?”

    So did you get a glimpse of color?

    JOHN ELDER ROBISON: Absolutely.

    That’s really the transformative thing about this. You can be an intelligent adult, and all your life, you hear about color, and yet eventually you start getting angry because the evidence in your eyes is gray.

    And then imagine the doctor does something and they turn on color for half-an-hour. And even if color goes away, for the rest of your life, you’re going to know it’s real. And that’s kind of how it is for me. They stimulated me, and it was a temporary thing.

    The effects lasted for some months, I would say. Some of them faded away quickly, some longer. And that built an ability that’s in me today based on that real experience. And it’s something words and teaching and talk could never have achieved.

    HARI SREENIVASAN: The premise of the stimulation wasn’t that you don’t have the wiring, so to speak, to pick up on emotional cues. It’s just that your wiring was almost dormant.

    JOHN ELDER ROBISON: Well, you know, the magical thing is, the premise of the experiment exploited the hope that I did have the wiring.

    And when they fired the energy into my head, it wasn’t like this gradually came on. It was like I went to bed and I woke up and the next morning, bang, it was there. And I could, like, look in your eyes, and it was like seeing into your soul. And never in my life did I have experience like that before. So, it was from nothing to everything.

    HARI SREENIVASAN: You know, one of the things that you point out is that you were overwhelmed just by waves of emotion.

    JOHN ELDER ROBISON: Just you and me talking like this, I would look at you, and I would sense a curiosity or worry or fear or something, and I would almost be brought to tears by an ordinary conversation.

    And that happened to me the first day. I would say, excuse me. I got to just step away and calm down.

    And it was crazy. I thought not seeing emotion was disabling, but seeing it in such tremendous intensity was, frankly, really disabling and, of course, thankfully, it moderated.

    HARI SREENIVASAN: But what did you see? Did you have an expectation that there was a world of joy and happiness that you weren’t plugging into?

    JOHN ELDER ROBISON: I did. And I was just a — I was just a crazy fool for that, because anyone who looks at the news knows that the world is not beauty and joy and light.

    Well, I thought those are the messages I’m missing, and if I could get them, I would be happy. And instead, the messages were angst, and jealousy and fear and worry and…

    HARI SREENIVASAN: This is what people around you were exhibiting?

    JOHN ELDER ROBISON: It was a pretty big shock to me.

    And the thing that was maybe the hardest was seeing people looking at me, sometimes with contempt or derision. And even my memories, for me to remember a time when I was laughing with somebody, and after the enlightenment of the TMS, I realized they were laughing at me. And that made me really, really sad.

    HARI SREENIVASAN: This also cost you the relationship at home with your wife.

    JOHN ELDER ROBISON: It cost me my marriage. It cost me clients at work, who I felt were — didn’t like me. And, of course, it’s a business, right? And should I even care if somebody likes me? But I did.

    And it cost me friends. And, like I said, it cost me even my memories.

    HARI SREENIVASAN: Now, you go out of your way in the book to mention that this is the experiences that you had, that even other people that participated in the research had very different experiences. You’re not advocating automatically that this is a cure for autism or anything like that.

    JOHN ELDER ROBISON: Oh, absolutely not.

    This is — this is not a cure for autism. But what it is, is, it’s a story of a powerful transformative experience that ultimately had a very positive effect on me, but it was a rough ride. It shows, though, the tremendous power of this TMS technology that’s basically unknown. Even as it’s FDA-approved to treat depression, nobody knows it.

    HARI SREENIVASAN: You know, this also makes me think, looking forward, is there an era that you see where people say, well, I want to do something to my brain to perhaps enhance and wake up certain parts of my brain that might not be as active or efficient as they could be?

    JOHN ELDER ROBISON: I think that that’s a very real thing that we need to start the conversation about now.

    And that’s actually one reason I wrote “Switched On,” because I’m concerned that people are going to read my story, which, frankly, is like a stepping up of my emotional intelligence, and they’re going to read some of the other accounts in newspapers, and they’re going to think, I’m going to do this to get my mathematical I.Q. hopped up.

    And if it’s you or me, if we’re intelligent adults, we can go into it with our eyes open. But what if people start saying, I’m going to do this to my child to speed him up in school? I think we have some real serious ethical crises coming with this kind of technology and how it’s going to be used.

    HARI SREENIVASAN: All right, the book is called “Switched On.”

    John Elder Robison, thanks so much for joining us.

    JOHN ELDER ROBISON: Thank you.

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    Democratic presidential candidate Bernie Sanders speaks to supporters during a campaign rally in Oaks, Pennsylvania. Photo by Lucas Jackson/Reuters

    Democratic presidential candidate Bernie Sanders speaks to supporters during a campaign rally in Oaks, Pennsylvania. Photo by Lucas Jackson/Reuters

    PROVIDENCE, R.I. — Bernie Sanders can thank a patient ferry captain for helping to cement his Democratic presidential primary victory in the sleepy resort community of Block Island.

    Sanders captured 64 percent of the Democratic vote Tuesday on the remote island that’s a 55-minute boat ride from mainland Rhode Island.

    But there wouldn’t have been enough ballots for all 308 islanders who cast Democratic ballots were if not for a frenzied mission to get an emergency shipment to Block Island before its sole polling place closed.

    Town Clerk Molly Fitzgerald panicked at 4 p.m. as she learned there weren’t enough Democratic ballots to last through the night. She had reserved 300 and they were almost gone.

    “The planes had stopped running,” she said. “There was one ferry boat left for the day. It was going to leave the mainland at 4:45 p.m.”

    That’s when Anne Irons, a clerk in the mainland town of Narragansett, got a call for help. Irons jumped in her car, went to a polling place to find extra ballots, sealed them up and drove them to the ferry dock at the Port of Galilee.

    Waiting for her was Steve Kimball, the boat’s longtime captain, and the 92 passengers of the day’s last ferry. Kimball held the boat 22 minutes behind its scheduled departure for the shipment to arrive.

    “We pride ourselves on trying to depart on time, every time,” said Kimball’s colleague Chris Myers, a port captain. “But in this case we thought it worthy to hold the boat.”

    Rhode Island was the only state of the five that held primaries Tuesday where Sanders beat front-runner Hillary Clinton. Fitzgerald said she wasn’t expecting such a heavy turnout.

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    JUDY WOODRUFF: Now: the harrowing account of how a mentally ill man attacked and raped a young couple in Seattle and how it exposed gaps in our system.

    Since the great recession, an estimated $4.3 billion has been cut from mental health services, and only a fraction of those funds have been restored. Most often, this leaves people to suffer quietly and alone, but on rare occasions, that illness can lead to violent behavior, as Pulitzer Prize winner Eli Sanders recounts in a new book.

    William Brangham talked with Sanders and with the surviving victim.

    JENNIFER HOPPER: I think most people who know me, they think of me as this, like, gregarious, outgoing person. And with Teresa, I was the quiet one. She’d walk into a room, you couldn’t not notice her. She just lit up the room with her personality.

    ELI SANDERS, Author, “While the City Slept”: Jennifer and Teresa were two women who took a long time and long roads towards finding themselves and then each other.

    JENNIFER HOPPER: We knew we wanted to be married. We knew we wanted to spend our life together. The night before the attack, we went to our favorite bar. We had this incredible conversation about what life would look like and what we wanted to create for ourselves.

    And she went to go get us another drink, and she just turned around and just mouthed, like, “I love you.”

    WILLIAM BRANGHAM: The very next night, Jennifer Hopper and Teresa Butz’s plans would come apart in the worst way imaginable. They went to sleep in their home in the South Park neighborhood of Seattle.

    They had no warning of what was to come.

    ELI SANDERS: A young man named Isaiah Kalebu came in through an open window in the house that Jennifer and Teresa shared.

    He sexually assaulted each of them under the threat that, if they didn’t do what he wanted, he would harm the other. He used their love against them. He raped both of them. And he began to cut both of them, and, as they resisted, he stabbed Teresa in the heart. She ultimately died. And Jennifer was able to escape out into the street in front of their house.

    WILLIAM BRANGHAM: The attack and murder shocked the city. An immediate manhunt for the suspect began. Thanks to DNA from the crime scene which matched DNA left at this 2008 break-in attempt, Isaiah Kalebu was arrested.

    Eli Sanders reported the story for Seattle’s alternative weekly The Stranger. In 2012, he won the Pulitzer Prize for this feature, “The Bravest Woman in Seattle,” which was about Jennifer Hopper. And now, Sanders has widened the story into this book, “While the City Slept: A Love Lost to Violence and a Young Man’s Descent Into Madness.”

    In it, Sanders tells the stories of Jennifer Hopper and Teresa Butz and their life together. Sanders spent months with Hopper and other family members. But he also examines the troubled life of their attacker.

    ELI SANDERS: He was, at the time of this crime, a nearly 24-year-old young man who came out of very difficult circumstances and had been living for quite some time with a serious mental illness that wasn’t well-treated.

    And he had bounced in and out of the criminal justice and mental health systems in the years before this crime, and had actually been engaged in a series of escalating violent acts.

    WILLIAM BRANGHAM: Your book documents so many different instances where people spent some time with Isaiah and clearly recognized that this was a young man who was in serious trouble and needed some help, and yet that help was never coming.


    I mean, as young as elementary school, he had teachers showing signs of concern. But it wasn’t clear exactly what was going on with him. So, as an adult, for example, his mother at one point, when he was acting very worrisome, and when she urged him to get care, he turned on her. He threatened her. He told her, she said, to enjoy her last day on earth.

    And the day after that, he was smashing the windows of her van with a rock and swinging his dog’s chain at her and hit her in the head with the metal end of his dog’s leash.

    WILLIAM BRANGHAM: As Kalebu’s mental state deteriorated, he got into more and more trouble with the law, and cycled through courtroom after courtroom.

    Just days before the attack, a fight with a police officer landed Kalebu in district court. But the system couldn’t see the looming threat.

    ELI SANDERS: In Washington state, the state that birthed Microsoft, a district court judge’s computer cannot speak to a superior court judge’s computer in another county in a way that was sufficient for the district court judge to see who he had in front of him. And so Isaiah Kalebu was released.

    And not long after that, he scared his aunt so badly that she filed for a restraining order against him. And that again failed to set off any alarms in these fragmented, fractured, unintegrated systems.

    The day after, she was killed in an arson. And he was a suspect in that arson, but was then released. And as his defense attorneys later put it, he wandered after that, homeless for days, accompanied only by his dog and his delusions, until early in the morning of July 19, he encountered Teresa Butz and Jennifer Hopper.

    WILLIAM BRANGHAM: At Kalebu’s trial, where he had to be restrained in a chair because of his regular outbursts, Jennifer Hopper relived that terrible night on the witness stand. One of the prosecutors said she was the strongest witness he’d seen in 20 years.

    JENNIFER HOPPER: There was never any question as to whether I would or could testify. There wouldn’t be justice for my family without speaking the truth about what happened, but there would never have been justice for her.

    I mean, I got to survive, and her family had to bury her. I can’t — I can’t imagine what that was like for them, so how could I have ever not given them that peace? I think it helped complete that night for a lot of people, including myself.

    WILLIAM BRANGHAM: Kalebu was sentenced to life in prison with no chance of parole.

    As Eli Sanders spent the next years researching Kalebu’s life, how he’d slipped through the cracks so many times, he became convinced that our system for dealing with mentally ill people in America is terribly broken.

    ELI SANDERS: I believe that if you just look at this one case of Isaiah Kalebu in Washington state — but Washington state is, in the end, a microcosm of the failures of our nation’s mental health and criminal justice systems around the country — you can see how relatively little, potentially, it might have cost to steer him or forcefully nudge him in a different direction much earlier on.

    WILLIAM BRANGHAM: It seems like we have this conversation every time someone with clear mental illness goes on a violent spree. We always talk about how we need to address this. And it seems like we never do.


    And, in a way, it is unfortunate that we only have this conversation in conjunction with violent incidents, because the vast majority of people who live and struggle with mental illness are nonviolent and more likely to be victims of violence than perpetrators.

    But if you want to add up the cost to taxpayers, which we are constantly doing in this country, so let’s add it up. It cost more than $3 million for the taxpayers of Washington state to jail Isaiah Kalebu before his trial, and then try him at public expense. And now we are going to pay to put him in prison for life and keep him there. It wouldn’t have cost more than $3 million to have tried to intervene.

    WILLIAM BRANGHAM: Today, Jennifer Hopper, who is a lifelong classically trained singer, is using those talents to help other victims of sexual assault. She’s part of the Angel Band Project, set up by Teresa Butz’s best friends.

    Their records and concerts help other survivors get the care they need. Jennifer says this work and Eli Sanders’ book telling their story have helped honor Teresa’s memory.

    JENNIFER HOPPER: Through Eli, in the book, she got to be very alive. To have that relationship and that joy that I had told in his voice, like, the way he told it, it’s just — it’s so beautiful. Like, she is still here. She still gets to be, you know, alive.

    JUDY WOODRUFF: Again, the book is called “While the City Slept: A Love Lost to Violence and a Young Man’s Descent Into Madness.” It’s by Eli Sanders.

    We will continue our Broken Justice series tomorrow on the “NewsHour” with a conversation with Deputy Attorney General Sally Yates about the challenges the newly released face after leaving prison.

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    Former U.S. House Speaker Dennis Hastert arrives at the Dirksen Federal courthouse for his scheduled sentencing hearing in Chicago, Illinois, U.S. April 27, 2016.  REUTERS/Frank Polich - RTX2BVKZ

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    HARI SREENIVASAN: But, first, to the sentencing of former House Speaker Dennis Hastert, and the accusations of sexual abuse that became a central part of this case.

    The federal judge overseeing the proceedings, Thomas Durkin, had tough words for the man who was once second in line to the presidency. He said — quote — “Nothing is more disturbing than having serial child molester and speaker of the House in the same sentence.”

    We get more now on what happened inside the courtroom today from Natasha Korecki, who covers Illinois politics and politicians for Politico.

    The trial and the sentencing were not about sexual abuse, but, really, this last phase today, it was pretty much a trial about sexual abuse. The victims came forward. He actually admitted to it?

    NATASHA KORECKI, Politico: That’s right.

    And when Hastert finally did go up and speak, he kind of glossed over that, the abuse part of it. He said — quote, unquote — “I regret, I’m sorry” for mistreating my athletes when I was a coach more than three decades ago.

    But the judge specifically held his feet to the fire and made him spell out each individual, asking him, did you sexually abuse individual A? And he went through the different numbers that have been laid out in the past. And, eventually, Hastert did admit to it.

    It became this very, very pointed, dramatic court hearing, where the victims were just feet away from Hastert himself, and there was a very direct confrontation there.

    HARI SREENIVASAN: You had one of the victims directly, had one of the victim’s family members. And it seemed that Dennis Hastert was actually asking for support, a letter of support from one of those victims’ brothers. It just is appalling.

    NATASHA KORECKI: You know, that really seemed to rub the judge the wrong way, because I think Hastert, going in, his lawyers had been making, you know, this argument that all of this conduct was old. It was decades-old.

    But the judge said he was so disturbed by that specifically, that he called, you know, this — a politician well known-here in Illinois, Tom Cross, who used to be the leader of the GOP in the Illinois House. Hastert was a mentor to Tom Cross. He called him and asked him for a letter.

    Instead, the Cross family contacted federal authorities, and Scott Cross, Tom’s brother, came forward and gave very pointed and very tearful, emotional testimony today. And he was really — is really the first victim that we have heard from publicly. We have heard from a deceased victim’s sister who has been, you know, unrelenting in all of this. And, you know, she finally heard what she wanted to hear from Hastert today as well.

    HARI SREENIVASAN: Now, the criminal proceedings on this case are done. But there’s still a civil lawsuit pending?

    NATASHA KORECKI: The initial transaction that got us here, the structuring count, this was involving this individual A, who we still don’t know the identity of, or — it’s not been reported publicly yet.

    And this individual said they had an agreement, that Hastert had agreed to pay him $3.5 million. The individual initially wanted to get a lawyer involved and so forth. Hastert paid part of the money, about almost $1 million. And this individual says, you still owe me the rest of that money, and filed a complaint in a state court.

    And that’s going to be litigated. One of the little turns in that case now is that individual is trying to see if he can remain an unnamed victim. That part is going to — actually, there’s a hearing tomorrow to discuss that aspect of it.

    HARI SREENIVASAN: So, what happens to Dennis Hastert now? We didn’t see him led off in chains today.

    NATASHA KORECKI: No, we didn’t. He was wheeled out of court. His attorneys described him as frail and very ill.

    He is going to be able to self-surrender. That’s very typical, actually, in federal government for white-collar crimes, so-called white-collar crimes. But he’s going to report to prison. He’s going to be designated to a prison. It usually takes the Bureau of Prisons 60 days or more to find a place.

    He has — the judge said he would recommend what they call a level four medical facility for him to deal with diabetes and some other ailments that he has described in detail to the judge.

    HARI SREENIVASAN: All right, Natasha Korecki of Politico joining us from Chicago, thanks so much.

    NATASHA KORECKI: Thank you.

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    Republican U.S. presidential candidate Donald Trump delivers a foreign policy speech at the Mayflower Hotel in Washington, United States, April 27, 2016.  REUTERS/Jim Bourg - RTX2BXUW

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    JUDY WOODRUFF: And now we return to that Donald Trump and the — or Donald Trump’s speech that he gave this morning here in downtown Washington. It laid out his foreign policy vision, or at least part of it.

    Here are some excerpts.

    DONALD TRUMP, Republican Presidential Candidate: My foreign policy will always put the interests of the American people, and American security, above all else. Has to be first. Has to be.

    That will be the foundation of every decision that I will make. After the Cold War, our foreign policy veered badly off course. We went from mistakes in Iraq to Egypt to Libya, to President Obama’s line in the sand in Syria. Each of these actions have helped to throw the region into chaos, and gave ISIS the space it needs to grow and prosper.

    I have a simple message for them. Their days are numbered. I won’t tell them where and I won’t tell them how. Our allies are not paying their fair share. And I have been talking about this recently a lot. Our allies must contribute toward their financial, political and human costs, have to do it, of our tremendous security burden.

    And, if not, the U.S. must be prepared to let these countries defend themselves. We will discuss how we can upgrade NATO’s outdated mission and structure grown out of the Cold War to confront our shared challenges, including migration and Islamic terrorism.

    We desire to live peacefully and in friendship with Russia and China. We have serious differences with these two nations and must regard them with open eyes, but we are not bound to be adversaries. I believe an easing of tensions and improved relations with Russia, from a position of strength only, is possible.

    Fixing our relations with China is another important step. China respects strength, and by letting them take advantage of us economically, which they are doing like never before, we have lost all of their respect. We have a massive trade deficit with China, a deficit that we have to find a way quickly to balance.

    Under a Trump administration, no American citizen will ever again feel that their needs come second to the citizens of a foreign country.


    I will view as president the world through the clear lens of American interests. I will be America’s greatest defender and most loyal champion. We will not apologize for becoming successful again, but will instead embrace the unique heritage that makes us who we are.

    The world is most peaceful and most prosperous when America is strongest.

    JUDY WOODRUFF: For two perspectives on Donald Trump’s foreign policy approach, I’m joined now by Walid Phares. He’s a scholar and terrorism expert who advises the Trump campaign. And Ambassador Nicholas Burns, he’s been a top foreign policy adviser and diplomat for both Republican and Democratic presidents. He is currently a visiting fellow at the Hoover Institution at Stanford University.

    And we welcome both of you back to the program.

    Ambassador Burns, to you first.

    We heard Donald Trump call the current American foreign policy a complete and total disaster. What was your overall reaction to the speech?

    NICHOLAS BURNS, Former State Department Official: Judy, I thought it was a very revealing speech about Donald Trump.

    And, frankly, as a citizen and voter, I think that it revealed that he doesn’t have the qualities to be a commander in chief and our top diplomat. If you think about the speech today, it betrayed, I think, a lack of in-depth knowledge, a lack of sophistication and nuance about the very complex world that we face, and a lack of humility about the restraint that America sometimes has to apply in the world.

    Those were the qualities, in my mind, that our best Republican presidents of the last 50 years had, Dwight D. Eisenhower, Ronald Reagan, George H.W. Bush. You saw very little of that balance and restraint today.

    Instead, what Mr. Trump did today was, he cast a series of ultimatums and threats mainly against our allies, against NATO and against Japan and South Korea. He was very soft on Russia. I thought it was a very unwise speech.

    JUDY WOODRUFF: Walid Phares, a lack of knowledge and a lack of humility.

    WALID PHARES, Foreign Policy Advisor, Trump Campaign: I wouldn’t opine on his lack of humility, because that would be basically the position of his critics. That’s how they perceive him.

    I would look at Mr. Trump’s new policy that he is proposing, that it is something new. His critics usually try to put him in a box. Either they would accuse him of being an isolationist. And he’s not, because, precisely, he spoke about many alliances he would like to develop.

    Or they would criticize him that he is an interventionist, precisely because the fact that he has opined on many regions and what to do about it. In my view, this speech is revealing a new school of thought which will develop soon and with other speeches, which is functionalist, meaning the question that he has always asked, why are we doing this?

    Why are we, for example, drawing this policy in Syria and failed? Why did we take that action in Libya and failed? Why haven’t we found some joint principles with Russia while we are firm in negotiations? He is trying to propose something new based on a critique, his critique of the past eight years, but also most likely of the last 20 years.

    JUDY WOODRUFF: Nicholas Burns, why couldn’t this be seen as a new approach? He talked about the U.S. shouldn’t continue to be involved in the business of nation-building, but he said we need a new rational approach and we need to seek stability in the world.

    NICHOLAS BURNS: Well, Judy, he made a point about three-quarters of the way through the speech. He says, we have to return to diplomacy and he wants to focus on diplomacy.

    And this is the presidential candidate who has maligned the entire nation of Mexico, 1.6 billion Muslims, our NATO allies and our Asian allies. So, it’s a curious way to return to diplomacy to basically be very critical of our allies.

    But I want to go back to the point I ended on before. He was quite soft on Vladimir Putin. And, right now, the next American president will face Putin, who has annexed Crimea, divided Ukraine, and threatened our NATO allies in Estonia, Latvia, Lithuania and Poland.

    So, the next American president needs to join with our European allies, with the Germans, British, and French, in containing Putin. We didn’t hear any of that today. I think it was a very naive speech in that respect, because he appears to want to try to sidle up to Putin, and yet be so tough on our allies, all of which whom are democracies, that he’s going to alienate them from American leadership.

    JUDY WOODRUFF: Walid Phares, what about that, Nicholas Burns’ point, that he is being tough — or, rather, being soft on Mr. Putin, at the same time he’s coming down hard on America’s allies?

    WALID PHARES: In comparison with the current administration and maybe the last few years of the previous administration in terms of being tough or being nice with our allies, I mean, you have a feeling in the region, first in the Middle East, but also in Europe, that there has been abandonment.

    Ask the Eastern Europeans about our policy with regard to supporting them and the weapon systems that we withdrew from the area. Ask the Czechs, ask the Poles, but attack also the Egyptians. I mean, an overwhelming majority of Egyptians feel that the Obama administration, which would be continued with the Clinton administration, has abandoned them, has supported the Muslim Brotherhood.

    It’s only recently that we have started to change the policy because the people of Egypt have spoken. Ask the Iranians, when they demonstrated in 2009, how we actually abandoned them. So, yes, we can criticize the beginning of a new foreign policy because it didn’t develop yet on the ground.

    But to say that he is basically developing something that has been tested before, I don’t think so. It’s a new policy.

    JUDY WOODRUFF: But just staying with you quickly, Mr. Phares, what about Ambassador Burns’ point that Mr. Trump was soft on Vladimir Putin?

    WALID PHARES: He is soft on Vladimir Putin if the policy would be containment of Russia no questions asked.

    And, yes, he doesn’t want to contain Russia with no questions asked. He wants to sit down with the Russian leadership, the same way Reagan engaged them, and when there was an issue, he confronted them. But at the same time, they were joint issues against terrorism, and we saw how it ended, how the Soviet Union ended, when a new policy was developed by Reagan and those who came after him.

    JUDY WOODRUFF: Ambassador Burns?

    NICHOLAS BURNS: Well, I think it’s naive to think you can sit down with Vladimir Putin and negotiate the future of Europe.

    President Obama and President Bush before him dealt with Putin from a position of strength. We now have sanctions against Putin because he crossed the brightest red line in international police. He invaded another country and took over its territory. There was nothing in the speech about that.

    There was very little in the speech about Chinese assertiveness in East Asia. And I think, Judy, the thing that bothered me the most about this speech, the lack of humility. Donald Trump castigated 35 years of American foreign policy. That includes George H.W. Bush. It includes Bill Clinton and George W. Bush.

    We have had a number of successes over the last 35 years, some failures, too. But to say that we have an entirely — we have been entirely unsuccessful for three decades is simply untrue. And I think it really means to me that he’s out campaigning, and he doesn’t really have an in-depth sense of how the world works.

    And we need to have that confidence in a commander in chief. Hillary Clinton has those qualities, but he surely doesn’t.

    JUDY WOODRUFF: Mr. Phares, was Donald Trump saying that American foreign policy has been wrong for the last 30-plus years?

    WALID PHARES: He actually said, basically, and gave examples in this speech and in previous statements that there were mistakes made. He didn’t say everything made since 1991 until his event has been wrong.

    But he has drawn the attention of the public and the voters and the citizens, because he was addressing the American public at large, to the failures, actually, and I mentioned a few of them, only in Syria and Iraq, the fact that ISIS wasn’t dismantled, the fact that we have abandoned the Arab alliance. It was very clear in the media over past few weeks that there was a — sort of a rejection in the region, at least from the perspective of what the Obama administration has abandoned.

    But, also, on the other hand — and I keep going back to that point — Europeans are maybe critical of what they think Mr. Trump is going to do. But if you ask the Europeans of Central Europe and Eastern Europe, the abandonment was done way before.

    JUDY WOODRUFF: All right, gentlemen, we are going to have to leave it there.

    Walid Phares, Ambassador Nicholas Burns, we thank both of you.

    WALID PHARES: Thank you.

    NICHOLAS BURNS: Thank you very much.

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    Democratic U.S. presidential candidate Hillary Clinton speaks at her five state primary night rally in Philadelphia, Pennsylvania, U.S., April 26, 2016.        REUTERS/Dominick Reuter - RTX2BSZ0

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    JUDY WOODRUFF: To dig into last night’s election results and discuss the race’s dramatic shift going into the last leg of the primary contest, we are joined once again by Susan Page of USA Today and Reid Wilson of the Morning Consult.

    And welcome back to both of you.

    Big night last night.

    Reid, how did the results last night change the trajectory of this race? And let’s start with the Republicans.

    REID WILSON, Morning Consult: On the Republican side, Donald Trump swept just about everything he possibly could have. The only place where John Kasich or Ted Cruz picked up any delegates who will be pledged to them at the convention was in Rhode Island. And there was just a small handful of delegates.

    More dramatically, I think, there were some reports that suggest that about 39 of the unpledged delegates that came out of Pennsylvania are going to back Donald Trump on the first ballot. That puts him a lot closer to a glide path towards the nomination than he was just a few days ago, even after his big wins earlier this month.

    The problem for Trump, though, is that coming up in May, he’s still about 250 delegates short of the number he needs. But in the five contests in May, there are only 199 delegates available. So if Ted Cruz and John Kasich want to stick around, they sure can, least until June.

    JUDY WOODRUFF: So, Susan, where does this leave Ted Cruz and John Kasich?

    SUSAN PAGE, USA Today: Well, I think that leaves them in a predicament, because Donald Trump is now — he called himself last not the presumptive nominee. Now, maybe we’re just a step short of that, but he is certainly now the likely nominee.

    He is now likely to be able to get a majority of convention delegates on that first ballot or come so close, it is impossible politically to deny him the nomination. And you saw him reflect that today by giving a big speech on foreign policy that we had never heard before.

    You also saw Ted Cruz trying to get back in the story by doing something that seemed a little premature, which was announcing his vice presidential pick.

    JUDY WOODRUFF: It’s still April.

    And what about that, Reid? I mean, normally, the nominee of the party waits until either the convention or right before the convention. Ted Cruz is clearly trying to get some headlines.

    REID WILSON: And it looks like this may have been a little bit rushed. Remember, it was just a few days ago when the Cruz campaign leaked that they were vetting Carly Fiorina. The vice presidential vetting process takes weeks and weeks to go through tax records and check and parse interviews for controversial statements.

    So, this clearly is Ted Cruz trying to change the conversation from Donald Trump being the presumptive nominee to some kind of two-person race. I’m not sure how successful he was.

    SUSAN PAGE: You know, the one thing it did do, we’re now talking about his vice presidential pick and whether it makes sense and what will she do, rather than talking about the fact that, as of last night, he doesn’t have a mathematical way to be nominated on the first ballot.

    He’s now mathematically — it’s now mathematically impossible for him to go to the convention with a majority of delegates.

    JUDY WOODRUFF: His hope, you’re saying, is if there’s a contested convention.

    But does the pick of Carly Fiorina help him in any way, Susan?

    SUSAN PAGE: She doesn’t have any delegates. Maybe it helps her — if you’re trying to look at where she might help, it helps him maybe with today’s news cycle. It may help him a bit in California.

    You remember in 2010 she ran for the Senate in California. That’s that big final primary. But this feels, I think, just a little desperate.

    REID WILSON: I think one way in which Carly Fiorina will help is that she has been one of the more effective surrogates to attack Donald Trump. When she took him on head to head earlier in this campaign process, you remember Rick Perry attacked him and then dropped out. And Bobby Jindal attacked him and then dropped out.

    Carly Fiorina was the only candidate to attack Donald Trump and then she got boosted to the main stage in that second debate. So, I think that as somebody who can draw a contrast with Donald Trump, that’s where she helps Cruz.

    JUDY WOODRUFF: She also had some tough words to say about Ted Cruz earlier in the campaign, which we were hearing again.

    But just quickly, Susan, you brought up Donald Trump’s speech today on foreign policy. Are we learning something different from this, as you say, first major speech on the subject?

    SUSAN PAGE: The speech was more prepared than the previous comments he’s made on foreign policy. He actually had a script. He read it off a teleprompter. He does that only rarely.

    But it was pretty much consistent with what he has said about foreign policy issues in the past, and, in that way, at odds with a lot of traditional American foreign policy, especially in the Republican Party.

    So, I think it was a natural thing for him to do as he prepares to run in a general election against Hillary Clinton.

    JUDY WOODRUFF: Let’s move over to the Democrats, Reid. Hillary Clinton won four of the five states last night. Bernie Sanders picks up Rhode Island. Where does this race stand? We learned today that Bernie Sanders is — and we heard that in John Yang’s report — is telling some of his staffers they can’t — they won’t be staying on the payroll any longer. Where does he go from here?

    REID WILSON: So, like the Republican side, Hillary Clinton is as close to the Democratic nomination as Donald Trump is. Actually, she’s a little closer.

    She’s about 200 delegates shy. But there are only about 226 delegates that are going to be awarded in May. So, if Bernie Sanders does want to stick around, he can, and essentially wait until the very last several days of the race before Hillary Clinton reaches that 2,383 delegates she needs.

    But Sanders’ problem is that, while he’s raised a lot of money, he’s spent a lot of money, too. He spent $46 million last month. And though he raised more than $40 million, he is still bleeding some money. I think that’s what the staff departures are all about, trying to conserve as long as possible. As his momentum starts to fade, the donations are going to start to fade, too.

    SUSAN PAGE: But you already see him pivot from the person who think he actually has a chance of winning the nomination, which I think he no longer does, to someone who is figuring out, what is his role going to be?

    He wants to push for progressive — a progressive platform. He wants to affect the party’s stance and Hillary Clinton’s stance on issues like on regulating Wall Street or paying for college tuition for young people. He’s got a big role in this party. But I think you can see him in his comments and the statement he put out last night that he understands his role in this fight is changing now that Hillary Clinton is on a clear path to be the nominee.

    JUDY WOODRUFF: And, Susan, what does Hillary Clinton need to do at this point?

    SUSAN PAGE: Well, she needs Bernie Sanders to get on her side. You know, he’s gotten 70 percent of the votes of millennials. And, you know, those voters I don’t think would naturally go to Trump if they don’t like Clinton. But they might stay home.

    So I think she needs Sanders to embrace her and to give her some of the enthusiasm he’s been able to engender on the left side of the Democratic Party.

    JUDY WOODRUFF: Is that something he can do, Reid? Can Bernie Sanders say to these young people and everybody else who has been enthusiastically showing up at his rallies, now I want you to turn around and vote for Hillary Clinton?

    REID WILSON: Well, it’s not something he has done a lot in the past.

    Bernie Sanders doesn’t have a long track record of working for other Democrats around the rest of the country, though he had done some fund-raising before his presidential campaign. What I think Sanders is most likely to do is give as much of a blessing as he possibly can. Let’s not forget that if Clinton is the nominee and Democrats take back the Senate, he gets a pretty prominent committee chairmanship.

    On the other hand, though, Clinton is going to try to mobilize these voters by pointing out her contrasts with Donald Trump. Negative advertising is something that voters all say they hate, but, boy, it sure works. That’s why we are going to see a lot of it this year, especially when you’re contrasting Hillary Clinton with someone like Donald Trump.

    JUDY WOODRUFF: And, Susan, just quickly, he is saying he is staying in until the convention, even if it’s to see that the platform reflects language he likes.

    SUSAN PAGE: I think he’s guaranteed to stay until the California primary on June 7, as Hillary Clinton did in 2008. But what he — whether he goes to the convention in a disruptive role, I don’t think so.

    I think he is coming around to the idea that he wants to make sure — he doesn’t want to create problems in defeating Donald Trump in November.

    JUDY WOODRUFF: Susan Page, Reid Wilson, thank you both.

    REID WILSON: Thank you.

    JUDY WOODRUFF: Appreciate it.

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    Former Virginia Governor Bob McDonnell is trailed by reporters as he departs after his appeal of his 2014 corruption conviction was heard at the U.S. Supreme Court in Washington, U.S. April 27, 2016. REUTERS/Jonathan Ernst - RTX2BWZH

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    JUDY WOODRUFF: Good evening. I’m Judy Woodruff.

    HARI SREENIVASAN: And I’m Hari Sreenivasan.

    JUDY WOODRUFF: On the “NewsHour”s tonight: Front-runners Donald Trump and Hillary Clinton win big in yesterday’s delegate-rich primaries, pushing the two closer to their party’s nomination — what this means for the rest of the candidates in the race.

    HARI SREENIVASAN: Also ahead this Wednesday:

    DONALD TRUMP (R), Republican Presidential Candidate: We will always save lives, and indeed humanity itself. But to play that role, we must make America strong again.

    HARI SREENIVASAN: In an issue-focused moment of Donald Trump’s campaign, the self-presumed eventual nominee makes a crucial foreign policy speech, outlining his views on the United States’ role in the world.

    JUDY WOODRUFF: And a writer follows the case of a grisly rape and murder to find out if it could have been avoided.

    ELI SANDERS, Author, “While the City Slept”: You can see how relatively little potentially it might have cost to steer him or forcefully nudge him in a different direction much earlier on.

    HARI SREENIVASAN: All that and more on tonight’s “PBS NewsHour.”


    HARI SREENIVASAN: In the day’s other news: The U.S. Supreme Court lent a seemingly sympathetic ear to former Virginia Governor Bob McDonnell. He faces two years in prison for accepting thousands of dollars in gifts and loans from a businessman. But in today’s arguments, both liberal and conservative justices suggested the federal bribery law is overbroad. A decision could come in June.

    JUDY WOODRUFF: Former House Speaker Dennis Hastert was sentenced today to 15 months in federal prison for paying hush money to cover up sexual abuse. The Illinois Republican admitted that he abused at least one teenager as a wrestling coach in high school. He told a federal court in Chicago: “What I did was wrong and I regret it.”

    We will hear about Hastert’s day in court later in the program.

    HARI SREENIVASAN: The fight over federal funding to control the Zika virus will likely go unresolved before next week’s congressional recess. The White House asked for $1.9 billion back in February. But House Speaker Paul Ryan suggested today that may be more than necessary.

    REP. PAUL RYAN (R-WI), Speaker of the House: The administration has a bit of a track record of over-requesting what they need. So we will sit down with the appropriators to figure out the best way forward, to make sure that we’re good stewards of the taxpayers’ money and to make sure that we have what we need to combat and stay ahead of the Zika virus issue.

    HARI SREENIVASAN: At the White House, Press Secretary Josh Earnest fired back, saying the delay is putting the country at risk.

    JOSH EARNEST, White House Press Secretary: You had the director of the National Institutes of Health and a high-ranking official from the Centers for Disease Control stand at this podium about three weeks ago and say they didn’t have the resources that they needed that should be used to fully prepare for the onset of the Zika virus.

    HARI SREENIVASAN: Zika has been linked to a rare birth defect, and is spreading rapidly through the Americas.

    JUDY WOODRUFF: For a second day, a severe weather system menaced a large swathe of the nation. The threat of tornadoes waned, but Kansas City suffered significant flooding early today. And winds of 60 miles an hour tore through the greater Houston area, blowing trees onto houses. So far, one death is blamed on the storms.

    HARI SREENIVASAN: In the Middle East, Israeli security forces killed a Palestinian woman and her teenage brother, the latest in a wave of violent incidents. It happened at a security checkpoint between the West Bank and Jerusalem. Police said they fired after the woman pulled a knife on an officer. They said they found knives on the boy’s body as well.

    JUDY WOODRUFF: The only surviving suspect in November’s terrorist attacks in Paris was extradited to France today. Salah Abdeslam is the alleged logistical planner of the assault that left 130 people dead. He was taken to a Paris court after an early-morning transfer from Brussels, and his lawyer said he plans to cooperate.

    FRANK BERTON, Salah Abdeslam’s Attorney (through interpreter): He gave a spontaneous statement to the investigating judge, and he insisted he would explain himself later. The judge put him under formal investigation on charges of murder, complicity of murder with a terrorist organization, holding weapons and explosives, and kidnapping.

    JUDY WOODRUFF: Abdeslam was captured in Brussels last month.

    HARI SREENIVASAN: Back in this country, it’s being called the biggest gang crackdown ever in New York City. In pre-dawn raids, federal agents and police arrested scores of suspects. They said two rival gangs have terrorized housing projects in the Bronx. In all, 120 people are being charged.

    JUDY WOODRUFF: The latest nation’s report card shows high school seniors are losing ground. The U.S. Department of Education reports that average math scores dropped last year for the first time since assessments began in 1992. Reading scores were flat, but they have dropped five points since 1992. As a result, only 37 percent of all seniors were judged college-ready in math and reading.

    HARI SREENIVASAN: The Federal Reserve today left short-term interest rates unchanged for now. In a statement, policy-makers said there’s been solid job growth, but economic activity appears to be slowing. As a result, the Fed decided to hold off on a further hike until June at the earliest.

    JUDY WOODRUFF: Wall Street took the Fed’s news in stride. The Dow Jones industrial average gained 51 points to close at 18041. The Nasdaq fell 25 points, as Apple slumped 6 percent, and the S&P 500 added three.

    HARI SREENIVASAN: Still to come on the “NewsHour”: is it game over for Ted Cruz and John Kasich?; Donald Trump calls for a hard line on negotiations abroad; former House Speaker Dennis Hastert sentenced in a hush money scandal; and much more.

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    Republican U.S. presidential candidate Ted Cruz waves with Carly Fiorina after he announced Fiorina as his running mate at a campaign rally in Indianapolis, Indiana, United States April 27, 2016.  REUTERS/Aaron P. Bernstein (UNITED STATES  - Tags: POLITICS ELECTIONS)   - RTX2BYHN

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    JUDY WOODRUFF: Today brought a sizable shift in the presidential race. The Republican front-runner turned his attention from his rivals to his world view. But one of those rivals rolled out a running mate.

    John Yang reports on this campaign day.

    DONALD TRUMP (R), Republican Presidential Candidate: It’s time to shake the rust off America’s foreign policy. It’s time to invite new voices and new visions into the fold.

    JOHN YANG: Donald Trump, fresh from a decisive sweep of Tuesday’s primaries, delivered his first major speech on foreign policy.

    SEN. TED CRUZ (R-TX), Republican Presidential Candidate: Carly Fiorina!

    JOHN YANG: Ted Cruz answered with a headline of his own, naming former rival Carly Fiorina as his running mate.

    SEN. TED CRUZ: This ticket is about the future. It is about our children. It is about our grandchildren. The stakes of this election, we are not simply wagering on a sporting contest.

    CARLY FIORINA (R), Republican Vice Presidential Candidate: This is a fight worth having. This is a fight worth winning. And with your help, we will win this fight!

    JOHN YANG: Cruz is banking on next week’s Indiana primary to give him new life. Trump now has more than three-quarters of the delegates he needs for a first-ballot victory. Last night, he declared himself the presumptive nominee, and took aim at the Democrats’ likely standard-bearer, Hillary Clinton.

    DONALD TRUMP: Well, I think the only card she has is the woman’s card. She has nothing else going for her. And, frankly, if Hillary Clinton were a man, I don’t think she would get 5 percent of the vote.

    JOHN YANG: Clinton answered the jibe after winning four states, putting her 90 percent of the way to clinching the nomination.

    HILLARY CLINTON (D), Democratic Presidential Candidate: Well, if fighting for women’s health care and paid family leave and equal pay is playing the woman card, then deal me in!


    JOHN YANG: But Bernie Sanders is not ready to throw in his hand. The Vermont senator spoke today in West Lafayette, Indiana.

    SEN. BERNIE SANDERS (VT-I), Democratic Presidential Candidate: We are in this campaign to win and to become the Democratic nominee.


    JOHN YANG: At the same time, Sanders told The New York Times he plans to lay off hundreds of campaign workers and focus on winning California.

    For the “PBS NewsHour,” I’m John Yang.

    JUDY WOODRUFF: We will examine the race, and hear more of Donald Trump’s foreign policy speech, after the news summary.

    The post Trump shares worldview as Cruz rolls out running mate appeared first on PBS NewsHour.

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    This gif shows a spinning 3D view of one person's cerebral cortex. The color of each voxel indicates its semantic selectivity, or which category of words it is selective for. For example, green voxels are mostly selective for visual and tactile concepts, while red voxels are mostly selective social concepts. White lines show the outlines of known functional brain regions. Visualization by Alexander Huth using pycortex software by James Gao, Mark Lescroart, and Alexander Huth

    This gif shows a spinning 3D view of one person’s cerebral cortex. The color of each voxel indicates its semantic selectivity, or which category of words it is selective for. For example, green voxels are mostly selective for visual and tactile concepts, while red voxels are mostly selective social concepts. White lines show the outlines of known functional brain regions.
    Visualization by Alexander Huth using pycortex software by James Gao, Mark Lescroart, and Alexander Huth

    It’s like Google Maps for your cerebral cortex: A new interactive atlas, developed with the help of such unlikely tools as public radio podcasts and Wikipedia, purports to show which bits of your brain help you understand which types of concepts.

    Hear a word relating to family, loss, or the passing of time — such as “wife,” “month,” or “remarried”— and a ridge called the right angular gyrus may be working overtime. Listening to your contractor talking about the design of your new front porch? Thank a pea-sized spot of brain behind your left ear.

    The research on the “brain dictionary” has the hallmarks of a big scientific splash: Published on Wednesday in Nature, it’s accompanied by both a video and an interactive website where you can click your way from brain region to brain region, seeing what kinds of words are processed in each.

    Yet neuroscientists aren’t uniformly impressed.

    “This is technically very savvy,” said David Poeppel, a neuroscientist who studies language at New York University and who was not involved in the study. But he invoked an old metaphor to explain why he isn’t convinced by the analysis: He compared it to establishing a theory of how weather works by pointing a video camera out the window for 7 hours.

    Indeed, among neuroscientists, the new “comprehensive atlas” of the cerebral cortex is almost as controversial as a historical atlas of the Middle East.

    That’s because every word has a constellation of meanings and associations — and it’s hard for scientists to agree about how best to study them in the lab.

    For this study, neuroscientist Jack Gallant and his team at the University of California, Berkeley played more than two hours’ worth of stories from the Moth Radio Hour for seven grad students and postdocs while measuring their cerebral blood flow using functional magnetic resonance imaging.

    Then, they linked the activity in some 50,000 pea-sized regions of the cortex to the “meaning” of the words being heard at that moment.

    How, you might ask, did they establish the meaning of words? The neuroscientists pulled all the nouns and verbs from the podcasts. With a computer program, they then looked across millions of pages of text to see how often the words from the podcasts are used near 985 common words taken from Wikipedia’s List of 1,000 Basic Words.

    “Wolf,” for instance, would presumably be used more often in proximity to “dog” than to, say, “eggplant.”

    Using that data, the program assigned numbers that approximated the meaning of each individual word from the podcasts — and, with some fancy number crunching, they figured out what areas of the brain were activated when their research subjects heard words with certain meanings.

    Everyone agrees that the research is innovative in its method. After all, linking up the meanings of thousands of words to the second-by-second brain activity in thousands of tiny brain regions is no mean feat. “That’s way more data than any human being can possibly think about,” said Gallant.

    What they can’t agree on is what it means.

    “In this study, our goal was not to ask a specific question. Our goal was to map everything so that we can ask questions after that,” said Gallant. “One of the most frequent questions we get is, ‘What does it mean?’ If I gave you a globe, you wouldn’t ask what it means, you’d start using it for stuff. You can look for the smallest ocean or how long it will take to get to San Francisco.”

    This “data-driven approach” still involves assumptions about how to break up language into different categories of meaning. To MIT neuroscientist Evelina Fedorenko, though, it’s exciting that Gallant’s team has been able to record what’s going on in the brain during the real-life situation of listening to stories. “Of course it’s a very simplified version of how meaning is captured in our minds, but it seems to be a pretty good proxy,” she said.

    Gallant agrees that there are still hordes of unanswered questions: “We can map where your brain represents the meaning of a narrative text that is associated with family, but we don’t know why the brain is responding to family at that location. Is it the word ‘father’ itself? Is it your memories of your own father? Is it your own thinking about being a parent yourself?” He hopes that it’s just those types of questions that researchers will ask, using his brain map as a guide.

    This article is reproduced with permission from STAT. It was first published on April 27, 2016. Find the original story here.

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    A man carries a child from the rubble caused by an airstrike in the rebel-held area of Old Aleppo, Syria on April 28. Photo by Abdalrhman Ismail/Reuters

    A man carries a child from the rubble caused by an airstrike in the rebel-held area of Old Aleppo, Syria on April 28. Photo by Abdalrhman Ismail/Reuters

    Airstrikes in the northern Syrian city of Aleppo destroyed a hospital Wednesday night, killing at least 27 people including 14 patients and staff.

    The 34-bed hospital, located in rebel-held territory, included an emergency room and obstetric unit supported by Doctors Without Borders and the International Committee of the Red Cross.

    “This devastating attack has destroyed a vital hospital in Aleppo, and the main referral center for pediatric care in the area,” said Muskilda Zancada, Doctors Without Borders’ head of mission in Syria, in a statement. “Where is the outrage among those with the power and obligation to stop this carnage?”

    Secretary of State John Kerry said the attack appeared to be “a deliberate strike on a known medical facility and follows the Assad regime’s appalling record of striking such facilities and first responders.”

    According to various monitors, other airstrikes in the city killed dozens more.

    People search for survivors at a site hit by airstrikes in the rebel-held al-Kalaseh neighborhood of Aleppo, Syria on April 28. Photo by Abdalrhman Ismail/Reuters

    People search for survivors at a site hit by airstrikes in the rebel-held al-Kalaseh neighborhood of Aleppo, Syria on April 28. Photo by Abdalrhman Ismail/Reuters

    Rebels responded to the attack, presumably by government forces, by firing mortars and rockets into the government-controlled side of Aleppo, hitting mostly civilian areas. Casualties, reportedly mostly civilian, were brought to Al Razi Hospital, also in Aleppo.

    Despite a cease-fire that went into effect in February, human rights groups have reported continued loss of life. Aleppo, Syria’s largest city, is at the frontlines in the battle between government and rebel forces in the five-year civil war.

    Marianne Gasser, head of the International Committee of the Red Cross mission in Syria, pleaded with the warring parties to spare civilians.

    “Don’t attack hospitals, don’t use weapons that cause widespread damage. Otherwise, Aleppo will be pushed further to the brink of humanitarian disaster,” she said in a statement.

    The increase in fighting makes it difficult for aid organizations to replenish food and medical supplies for residents, she said.

    President Barack Obama announced this week that he approved sending 250 more American troops to Syria to add to the 50 special forces already there to fight Islamic State militants.

    Anne Barnard of the New York Times describes why attacks in Syria appear to be targeting hospitals and schools.

    The post Airstrike destroys hospital in Syria as cease-fire falters appeared first on PBS NewsHour.

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    Flint residents Gladyes Williamson, center, holds a bottle of contaminated water, and a clump of her hair during a news conference after attending a House Oversight and Government Reform Committee hearing on the Flint, Michigan, water crisis in February. Photo by Mark Wilson/Getty Images

    Flint residents Gladyes Williamson, center, holds a bottle of contaminated water, and a clump of her hair during a news conference after attending a House Oversight and Government Reform Committee hearing on the Flint, Michigan, water crisis in February. Photo by Mark Wilson/Getty Images

    WASHINGTON — A Senate committee on Thursday approved a $220 million aid package for Flint, Michigan, as the city struggles to deal with a water crisis and public health emergency from lead-contaminated pipes.

    The Senate Environment and Public Works Committee backed the bipartisan deal as part of a broader, $4.8 billion bill that authorizes water-related projects across the country for flood control, harbor deepening and other steps.

    The bill was approved, 19-1, and could come up for a Senate vote in May.

    The measure would authorize $100 million in grants and loans to replace lead-contaminated pipes in Flint and other cities with lead emergencies, as well as $70 million toward loans to improve water infrastructure across the country. It also includes $50 million to bolster lead-prevention programs and improve children’s health nationwide.

    The legislation would require the Environmental Protection Agency to warn the public about high lead levels in drinking water if a state or locality fails to do so. The House has passed similar legislation.

    The EPA has come under bipartisan criticism for failing to notify Flint residents about lead in the water after problems became known last year.

    The bill authorizes 25 projects in 17 states to be overseen by the Army Corps of Engineers for flood control, navigation and port improvements, including at Port Everglades, Florida and Charleston Harbor, South Carolina.

    It includes a Democratic-sponsored provision that authorizes $300 million over five years to remove lead pipes from houses, schools and day care centers nationwide.

    Sen. James Inhofe, R-Okla., the committee chairman, said the measure builds on a similar 2014 law and “provides needed investments in America’s infrastructure to support our communities and expand our economy.”

    In a related development, Rep. Dan Kildee, D-Mich., introduced legislation that would set tougher drinking water standards nationwide for lead. Kildee’s bill would reduce the threshold amount of lead found in drinking water from 15 parts per billion to 5 ppb by 2026. Under EPA rules, water systems across the country must take steps to control corrosion if lead concentrations exceed 15 ppb in more than 10 percent of customer taps sampled.

    Kildee’s bill would first set the lead standard at 10 ppb by 2020, in line with a proposal by Michigan Gov. Rick Snyder.

    “The Flint water crisis has been a wake-up call to cities and towns across the United States that we must do more to protect our families from the threat of lead in our drinking water,” Kildee said.

    Nearly 1,500 water systems serving 3.3 million Americans have exceeded the EPA’s lead cap of 15 ppb at least once in the past three years. If Michigan’s proposed new standard of 10 ppb were applied across the country, that number jumps to more than 2,500 systems with 18.3 million customers — a fivefold increase, according to an Associated Press analysis of federal data.

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    Photo by Andrew Harrer/Bloomberg via Getty Images

    Photo of former House Speaker John Boehner by Andrew Harrer/Bloomberg via Getty Images

    FORT WAYNE, Indiana — Former House Speaker John Boehner unloaded on Republican presidential candidate Ted Cruz during a talk to college students, calling the Texas senator “Lucifer in the flesh.”

    Speaking at a town hall-style event at Stanford University Wednesday, Boehner called front-runner Donald Trump his “texting buddy,” but offered a more graphic response when asked about Cruz.

    “Lucifer in the flesh,” the former speaker said. “I have Democrat friends and Republican friends. I get along with almost everyone, but I have never worked with a more miserable son of a b—- in my life.”

    His comments were first reported by Stanford’s student newspaper.

    Cruz, campaigning in Fort Wayne, Indiana Thursday ahead of the state’s May 3 primary, responded by saying Boehner was letting his “inner Trump come out” with his remarks. He attempted to turn the criticism into a slam on Republican front-runner Donald Trump before a campaign stop in Fort Wayne, Indiana Thursday.

    “John Boehner in his remarks described Donald Trump as his texting and golfing buddy,” Cruz said. “So if you want someone that’s a texting and golfing buddy, if you’re happy with John Boehner as speaker of the House and you want a president like John Boehner, Donald Trump is your man.”

    Both Cruz and Carly Fiorina, who was campaigning with him after he named her as his running mate Wednesday, also referred to Boehner’s comments during the rally.

    In 2013, Cruz joined forces with tea party conservatives in the House in triggering a partial, 16-day government shutdown over demands to undo President Barack Obama health care law. There was no chance Obama would agree to such a step, and Republican leaders like Boehner saw the move as a fruitless effort that only hurt the GOP politically.

    Two years later, it was the same House conservatives who challenged Boehner’s leadership, and the speaker decided to step down rather than allow a very public fight.

    Boehner’s successor, House Speaker Paul Ryan, said at his weekly news conference Thursday that he has “a much better relationship than that with Sen. Cruz.”

    “My job is to help unify our party,” Ryan said, when reporters pressed him on Boehner’s comments. “I have a very good relationship with both of these men, and I’m going to keep it that way.”

    Cruz told reporters Thursday that he had never worked with Boehner who stepped down as speaker in the fall.

    “The truth of the matter is I don’t know the man,” Cruz said. “I’ve met John Boehner two or three times in my life. If I have said 50 words in my life to John Boehner, I would be surprised. And every one of them has consisted of pleasantries, ‘Good to see you Mr. Speaker.’ I’ve never had any substantive conversation with John Boehner in any respect.”

    Cruz said he was rebuffed by Boehner when he asked to meet with him during the government shutdown.

    Cruz said Boehner’s comments reflect his frustration with Americans who stand with Republicans who want to hold members of Congress accountable for their campaign promises to repeal Obama’s health care law and pursue other conservative goals.

    “When John Boehner calls me Lucifer, he’s not directing that at me,” Cruz said. “He’s directing that at you.”


    Associated Press writers Erica Werner and Donna Cassata contributed to this report from Washington.

    SUBSCRIBE: Get the analysis of Mark Shields and David Brooks delivered to your inbox every week.

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    Saudi Arabia's Deputy Crown Prince Mohammed bin Salman reacts upon his arrival at the Elysee Palace in Paris, France in this June 24, 2015 file photo. REUTERS/Charles Platiau/Files - RTX29WAH

    With low oil prices plaguing Saudi Arabia, Deputy Crown Prince Mohammed bin Salman has a plan to wean the country from its almost complete dependence on oil. Photo by Charles Platiau/Reuters

    The persistence of low oil prices is wreaking havoc in oil-producing nations, and no country is as vulnerable to the crude crunch as the Kingdom of Saudi Arabia. With almost three-quarters of the government’s budget originating from oil revenues, the prolonged plunge in prices is a mortal threat to the Saudi monarchy.

    Leaders are scrambling to secure a prosperous and stable future for the country. But are these maneuvers too late?

    With almost three-quarters of the government’s budget originating from oil revenues, the prolonged plunge in prices is a mortal threat to the Saudi monarchy.

    The blunt reality is that Saudi Arabia has grown accustomed to high oil prices. At their current level, the regime is facing a $100 billion budget deficit. The gap has forced the Kingdom to cut subsidies and secure its first outside loan in over a decade. Popular sentiment is rapidly shifting as citizens who once enjoyed cushy jobs are facing uncertain futures. Given the state employs two-thirds of native workers, and youth unemployment is approaching 30 percent, the risk of social unrest is rising.

    Amid the seemingly inevitable chaos, 30-year-old Deputy Crown Prince Mohammed bin Salman has emerged with a plan to save the day. Dubbed “Vision 2030,” the plan has Saudi Arabia selling shares in Aramco, the state-run oil behemoth, and building a $2 trillion sovereign wealth fund. To put this number in context, it’s worth noting that the world’s largest sovereign fund — Norway’s Government Pension Fund — is valued at approximately $825 billion, according to the Sovereign Wealth Fund Institute.

    READ MORE: China is spending nearly $1 trillion to rebuild the Silk Road

    The hope is to wean the country from its almost complete dependence on oil, enabling the nation “to live without oil” by 2020. To achieve this transformation, the prince wants to completely overhaul the Saudi economy. Key objectives of the plan include growing investment income, increasing small and medium enterprises as a percentage of the economy and reorganizing and bolstering the 100 percent government-owned domestic military industry.

    The young leader is confident. He recently told Bloomberg Businessweek that he doesn’t care about oil prices, noting the Kingdom’s advantage as a low-cost producer. At the recent OPEC meeting in Doha, he decided not to freeze production levels, because Iran refused to be involved.

    Critics call the deputy crown prince naive and arrogant, while defenders see him as a youthful modernizer forcing necessary change.

    Critics call the deputy crown prince naive and arrogant, while defenders see him as a youthful modernizer forcing necessary change. He certainly thinks of himself as a modern leader representing a new generation, framing his ambitions with analogies to Bill Gates, Steve Jobs and Mark Zuckerberg.

    Reforming Saudi Arabia is no trivial task. To begin, diversifying the economy might require international capital. The Vision 2030 plan acknowledges its ambitions are dependent upon a “capital market open to the world.” Specific plans include the buildout of “special zones” with regulations designed to encourage investment in transportation and tourism, among other industries.

    READ MORE: ‘Make In India’ promises manufacturing jobs for millions. Here’s why it won’t work

    But the plans announced this week are not going to be enough. Just consider the $10 billion King Abdullah Financial District. With gleaming towers, cutting-edge technology and a monorail connecting the district efficiently together, this 70 percent complete special zone has just about everything. The one thing it doesn’t have? Banks. A recent Bloomberg story noted that “not a single financial institution has agreed to take space in the 73 buildings” being constructed as part of the project. Oops!

    The problem is complex, but it’s increasingly clear that liberalizing and modernizing Saudi Arabia requires more than grand economic ambitions.

    Social reforms are also needed. The Kingdom severely restricts women’s rights, including their right to drive. Executions this year are on track to double last year’s total. The government employs strict anti-terrorism laws to crush dissent. And academics struggle to understand their role in an illiberal society where criticism can prompt a rapid and harsh backlash.

    Social reforms are also needed. The Kingdom severely restricts women’s rights, including their right to drive, and executions this year are on track to double last year’s total.

    There are signs of progress though. Vision 2030 includes plans to raise home ownership and revamp the education system. In mid-April, the government announced that it would curb the powers of the religious police, formally known as the Commission for the Promotion of Virtue and the Prevention of Vice. Women’s rights have begun to improve, and the deputy crown prince’s plan includes boosting female participation in the labor force. (Interestingly, he also cautioned that the country is not yet ready to let women drive).

    With Vision 2030, Prince Mohammed also signaled a pivot to openness by planning to offer green cards to foreign Arabs and Muslims, letting them work in Saudi Arabia for an extended period of time. The country is also going to greatly increase the availability of tourist visas, which today are only available to pilgrims. According to the New York Times, “untrammeled beaches, ancient sites and unfiltered local culture are all on offer in Saudi Arabia.” Could the Kingdom turn into a tourist hotspot?

    Although progress is being made, the pace and magnitude of reforms may be inadequate to save the country. While the deputy crown prince struggles to modernize the Kingdom, he’s also being buffeted by geopolitical forces increasingly unfavorable to Saudi Arabia.

    In the Middle East, the country’s rivalry with Iran has stretched its military, and the proxy war in Yemen — championed by the deputy crown prince — has been costly and sloppy. The Kingdom even offered to send ground troops into Syria to support Saudi-funded anti-Assad rebels.

    READ MORE:Are skyscraper races a warning of economic chaos to come?

    Moreover, Saudi-U.S. relations have been strained. President Obama publicly criticized Saudi Arabia and its neighbors for being “free riders,” stating they needed to “share the neighborhood” with Iran. The U.S. President’s visit to the Kingdom last week was fraught with tension; he arrived in Riyadh as a bill allowing families of 9/11 victims to sue Saudi Arabia gained traction in the U.S. Senate and earned support from presidential candidates Hillary Clinton and Bernie Sanders.

    The mixture of economic weakness, military assertiveness and a strained relationship with the U.S. is a toxic cocktail. Perversely, it may now be in the country’s interest to provoke a conflict with Iran to draw on strong nationalist sentiments and pull the country together. Facing such radical uncertainty at home and abroad, the deputy crown prince must be both bold and humble as he implements his plan. He should accelerate modernization, diversification and liberalization efforts, and while the outcome of such an approach is far from certain, the risks of not doing so are rising every day.

    The deputy crown prince should accelerate modernization, diversification and liberalization efforts, and while the outcome of such an approach is far from certain, the risks of not doing so are rising every day.

    Saudi Arabia remains an extremely important country in the world. What happens in Saudi Arabia is unlikely to stay in Saudi Arabia, and as such, we must pay attention. In the wise words of Yogi Berra, “it’s tough to make predictions, particularly about the future.” Nevertheless, we need to prepare for several possibilities, from the escalation of the cold war between Iran and Saudi Arabia into a hot one, to a collapse of the Saudi monarchy and the chaos accompanying such a development, to the emergence (if the deputy crown prince succeeds with his bold plans) of a renewed economic powerhouse in the Middle East.

    One thing, however, is certain: The future of Saudi Arabia ain’t what it used to be.

    The post Column: Will Saudi Arabia’s plan to overhaul its oil-dependent economy work? appeared first on PBS NewsHour.

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    File photo of Hillary Clinton supporters by Jonathan Ernst/Reuters

    File photo of Hillary Clinton supporters by Jonathan Ernst/Reuters

    WASHINGTON — Nancy Schumacher says she just wanted to do her civic duty, and so she heeded the call to become a superdelegate for Hillary Clinton. But in the year of the angry voter, not even an administrative assistant from Elk River, Minnesota, can escape the outrage.

    “Some of the (phone and email) messages called me names. Some of them called Hillary names. And others said I was a stupid b—- and something bad will happen to me,” said Schumacher, a Democratic committee member. “It’s kind of hard to take sometimes.”

    Bernie Sanders defied expectations to turn his long-shot presidential bid into a real threat for the Democratic nomination. Now, as his path to the White House becomes all-but-impossible, some of his supporters are lashing out at a system they believe was engineered against them from the start.

    While Sanders decries a “rigged” economy, some of his backers see signs of corruption everywhere — even in the party their candidate hopes to lead. Some have turned their frustration on superdelegates, the party insiders whose ability to back either candidate give them an outsized role in picking the nominee.

    The superdelegates include public officials: governors, former presidents and even Sanders himself. But they also include people like Schumacher, volunteers who’ve generally stayed behind the scenes.

    The Sanders campaign assures everyone that it doesn’t condone harassment.

    Yet Schumacher says she’s received vitriolic phone and email messages from self-identified Sanders backers and doesn’t quite understand how things got quite so nasty. Eight years ago, she backed Clinton but said she “cheerfully” switched to Illinois Sen. Barack Obama. She’d do the same, she said, if Sanders won the popular vote or pledged delegates from state primary elections.

    “I got five emails on Easter Sunday. I mean, give me a break,” she said.

    Barry Goodman, a personal injury lawyer in Detroit, suddenly found his firm’s Yelp business review page besieged by bad ratings.

    “You deserve this rating. Why does some random lawyer get more sway than the citizens,” read one comment.

    Gus Bickford, the former executive director of the Massachusetts Democratic Party, was taken aback by the threats that flowed into his inbox and onto his Facebook page.

    “Someone put up a list of the superdelegates and a person from Rhode Island posted a response that basically said, ‘They should all be assassinated’ and then said ‘I’m only joking,'” recalled Bickford. “With the way people are talking, you never know who’s going to take something like that seriously.”

    Bickford said many of the callers were Sanders supporters who asked him to side with the will of the people, even though Clinton narrowly won Massachusetts in March.

    Democrats aren’t the only ones facing this kind of barrage: Some Republican delegates say they have also found themselves at the receiving end of death threats and other personal attacks from supporters of GOP front-runner Donald Trump.

    But Clinton won the support of many superdelegates even before votes were cast in the primaries, and that has drawn the wrath of many Sanders partisans.

    Clinton is 91 percent of the way to capturing the nomination, meaning that she can lose every remaining primary by a wide margin and still become the party’s standard-bearer, according to an Associated Press analysis. It also means Sanders would need to flip hundreds of superdelegates to his side to have a shot at the nomination — including many from states that Clinton won.

    Though they’ve been part of Democratic presidential elections since 1984, the superdelegates have never been a determining factor. Even in 2008, when several dozen switched to Barack Obama from Clinton, Obama won enough pledged delegates to make superdelegate support largely irrelevant.

    Several liberal organizations have circulated petitions asking superdelegates to align their choice with the vote in their state. Even if that happened, Clinton would still likely be the nominee, given her lead in the popular vote.

    That leaves Sanders’ most ardent fans — many of whom are relatively new to the political process — looking for someone to blame.

    A Sanders backer named Spencer Thayer created the “Superdelegate Hit list,” a website to share the contact information of superdelegates so they can be pressed to switch their votes. Thayer later dropped the word “hit” after it attracted criticism.

    The name change didn’t reassure Clinton-backing superdelegates..

    “It’s not comforting to be on anything that’s called a hit list,” said Wendy Davis, a city commissioner from Rome, Georgia.

    In 2007, Davis was tasked with wooing superdelegates for the presidential candidate of former New Mexico Gov. Bill Richardson. Now, a superdelegate herself, she was shocked when Sanders supporters accused her of being bribed by Clinton for her support.

    “I have been a loyal volunteer for this party. You impugn my integrity and suddenly think there’s something you can say that will draw me to you,” she said. “It’s that a whole bunch of people who haven’t been involved in the details of presidential campaigns started paying attention and suddenly don’t like the rules.”

    The post Clinton backers ‘feel the Bern’ of angry Sanders supporters appeared first on PBS NewsHour.

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    Watch Video | Listen to the Audio

    JUDY WOODRUFF: Finally, another installment in our Brief But Spectacular series, where we ask interesting people to describe their passions.

    Tonight, we hear from Heben Nigatu and Tracy Clayton, the hosts of BuzzFeed podcast “Another Round,” which covers everything from race, gender, pop culture, and more.

    As Nigatu and Clayton explain, their show has carved out a new and important space in the growing podcast landscape.

    HEBEN NIGATU, “Another Round”: We have good sound effects. Give them your air horn. Beautiful.


    TRACY CLAYTON, “Another Round”: It’s not so much that we wanted to fill a space. We wanted to create a space that wasn’t there before.

    HEBEN NIGATU: A lot of podcasters tend to come from the same places, same universities, same, like, NPR-style training, so it all kind of often tends to sound uniform. And, like, Ira Glass is our god.

    TRACY CLAYTON: I saw a comic once, a cartoon, and it was, like, a foot race between white folks. You had a white person in this lane and then a black person in this lane.

    And it’s like you have the same start as everyone else, blah, blah, blah, but in the black person’s lane, there is like alligators and barbed wire. We have to be like the right kind of black for people to pay attention to us.

    We can’t make white people too uncomfortable when we talk about race. And that is exhausting. It is exhausting to have to pick and choose.

    HEBEN NIGATU: I do not have the energy for that.

    TRACY CLAYTON: Yes. Yes. We have so much going on.

    HEBEN NIGATU: We have a life to live.

    Appealing to white people’s consciousness has a rough history in America, but appealing to capitalism does well. Hence, I like to make the diversity argument about larger markets, untapped audiences. There are swathes of people you are not reaching. So, if you are just not here for the moral reason…

    TRACY CLAYTON: Then be here for the money.


    TRACY CLAYTON: As black women, we know what it feels like to be overlooked and ignored. And we were finally like, hey, we have the microphone.

    HEBEN NIGATU: We want this to be a space, all of it is on our terms.

    TRACY CLAYTON: Yes. Yes.

    HEBEN NIGATU: We can have conversations with people, like even like Hillary Clinton, and have it be on our terms.

    TRACY CLAYTON: Ben Smith, our editor in chief, really encouraged us to ask her for the things that we really, really wanted to know.

    He was like, you will probably never interview her again. You’re not trying to make a best friend, so who cares if she gets uncomfortable? She had to meet us where we were. And we talked to her the same way we talked to everybody else. We’re like, you’re in our house.

    HEBEN NIGATU: We didn’t say that.

    TRACY CLAYTON: No, we didn’t at all.

    It feels amazing to not have to be someone’s diversity coach.


    HEBEN NIGATU: Or just even like filter all your thoughts about culture through the prism of, like, one very specific outlook.

    TRACY CLAYTON: Yes, and just, like, not having to worry, like, what are white people going to think? Who cares?

    HEBEN NIGATU: Who cares?

    TRACY CLAYTON: If this show doesn’t make the right sort of space for the general white person to listen to, they can go literally anywhere else and find…


    HEBEN NIGATU: Like 97 percent of podcasts. You all got a lot of stuff.

    TRACY CLAYTON: Yes. Yes.

    HEBEN NIGATU: My name is Heben Nigatu.

    TRACY CLAYTON: I’m Tracy Clayton.

    HEBEN NIGATU: And this is our Brief But Spectacular take on…

    TRACY CLAYTON: Being unapologetically black.

    JUDY WOODRUFF: And you can watch more of our Brief But Spectacular videos online at PBS.org/NewsHour/brief.

    The post What it means to be unapologetically black appeared first on PBS NewsHour.


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