npr--2020-02-01--11 Confirmed Cases Of Coronavirus In U.S.; 1st Death Outside China In Philippines

11 Confirmed Cases Of Coronavirus In U.S. ; 1st Death Outside China In Philippines Updated at 1:15 a.m .
ET Monday Health officials confirmed two new cases of the coronavirus in the U.S. Sunday evening in San Benito County , Calif. , south of San Jose .
The two are husband and wife , both 57 .
The county 's Health and Human Services agency said in a statement that the husband recently traveled from Wuhan , China , though his wife did not , making this the second person-to-person transmission of the virus in the U.S .
The county @ @ @ @ @ @ @ home since the husband 's return from China .
Earlier Sunday health officials confirmed another U.S. case of the newly identified strain of the coronavirus , in a woman in Santa Clara County , Calif. She is from Wuhan , China , and traveled to the San Francisco Bay Area to visit family on Jan. 23 .
She developed symptoms and remained at home except for seeking medical care twice .
It 's the second case in Santa Clara County — though health officials say there has been no person-to-person spread of the @ @ @ @ @ @ @ I understand that people are concerned , but based on what we know today , the risk to general public remains low , '' said Dr. Sara Cody of the Santa Clara County Public Health Department in a statement .
She said the woman has been regularly monitored and was never sick enough to be hospitalized .
Family members have also self-isolated and have not left the home .
The new California cases bring the total in the U.S. to 11 .
Health officials in China , meanwhile , said on Monday morning @ @ @ @ @ @ @ 17,000 , with nearly 3,000 new cases in 24 hours , and 361 people have now died on the mainland from the virus .
Earlier on Sunday , Philippines health officials said a 44-year-old man had died in the Philippines from the newly identified strain of coronavirus , marking the first known death outside of China from the fast-spreading disease .
The man , a resident of Wuhan , China , the epicenter of the outbreak , died Saturday in a hospital after developing `` severe pneumonia due to viral and bacterial infections @ @ @ @ @ @ @ They note that the man appeared to be recovering in recent days , before deteriorating in his last 24 hours .
The disease has spread rapidly from Wuhan 's Hubei province , since being first reported in December , mostly within mainland China .
More than 170 cases have been reported in more than 20 countries , prompting the World Health Organization on Thursday to declare a global health emergency .
In the U.S. , the eighth case of the virus was announced on Saturday .
The infection was confirmed in a Boston @ @ @ @ @ @ @ traveled to Wuhan , China , according to Massachusetts state health officials .
He sought medical care soon after his return to the U.S. and has been in isolation , health officials said .
His `` few close contacts have been identified and are being monitored for any sign of symptoms , '' the Massachusetts Department of Public Health said in a statement .
On Friday , the Trump administration declared a public health emergency .
Despite the declaration , U.S. health officials have emphasized that at this time , the overall risk @ @ @ @ @ @ @ threat of flu remains much greater .
Still , the U.S. is working to ensure the coronavirus does not gain a foothold in the country .
The State Department is warning Americans not to travel to China and urging those already there to leave .
More than a dozen airlines are suspending flights to and from China 's mainland .
This includes major U.S. carriers such as American Airlines , Delta and United .
Additionally , the Trump administration announced that beginning Sunday , all foreign nationals who have traveled in China within @ @ @ @ @ @ @ entry into the U.S .
Exceptions will be made for permanent residents and immediate family of U.S. citizens .
Passengers on incoming flights from China are being directed to 11 specific U.S. airports for health screenings .
Citizens returning from Hubei province will be subjected to up to two weeks of mandatory quarantine .
During a visit Monday to Uzbekistan , Secretary of State Mike Pompeo said the U.S. plans `` a handful more flights '' to bring Americans home from Hubei province , according to Reuters .
`` We might be bringing @ @ @ @ @ @ @ , '' Pompeo said during a briefing in the capital , Tashkent .
`` In addition we might bring in some medical supplies . ''
On Friday , the Centers for Disease Control and Prevention imposed a mandatory 14-day quarantine on nearly 200 Americans evacuated from Wuhan .
The evacuees are being housed at the March Air Reserve Base in California .
`` While we recognize this is an unprecedented action , we are facing an unprecedented public health threat , '' said Dr. Nancy Messonnier , director of the National Center for @ @ @ @ @ @ @ .
`` And this is one of the tools in our toolbox to mitigate the potential impact of this novel virus on the United States . ''
Because the strain of the disease is new , much remains unknown .
So far , experts say , it seems less deadly than SARS , another coronavirus .
To reduce the risk of the novel coronavirus spread , the WHO is encouraging old-fashioned techniques , including good hand-washing , avoiding close contact with those who have fever or cough , and sneezing into a crooked @ @ @ @ @ @ @ Apple announced Saturday that it is temporarily closing all of its stores in China .
`` Out of an abundance of caution and based on the latest advice from leading health experts , we 're closing all our corporate offices , stores and contact centers in mainland China through February 9 , '' the company said in a statement .
Apple operates more than 40 stores in mainland China .
Most Apple products are made in China in factories owned and operated by outside contractors , including the electronics giant Foxconn .
For @ @ @ @ @ @ @ wo n't be changing its production timeline , but in a Jan. 28 earnings call , Apple CEO Tim Cook said the company is working on backup plans to minimize any potential supply disruptions .
With its announcement on Saturday , Apple joins a growing list of major American companies — including Starbucks , McDonald 's and KFC — in suspending business in China .

11 Confirmed Cases Of Coronavirus In U.S.; 1st Death Outside China In Philippines
Enlarge this image toggle caption Kevin Frayer/Getty Images Kevin Frayer/Getty Images
Updated at 1:15 a.m. ET Monday
Health officials confirmed two new cases of the coronavirus in the U.S. Sunday evening in San Benito County, Calif., south of San Jose. The two are husband and wife, both 57.
The county's Health and Human Services agency said in a statement that the husband recently traveled from Wuhan, China, though his wife did not, making this the second person-to-person transmission of the virus in the U.S. The county said both patients have not left their home since the husband's return from China.
Earlier Sunday health officials confirmed another U.S. case of the newly identified strain of the coronavirus, in a woman in Santa Clara County, Calif.
She is from Wuhan, China, and traveled to the San Francisco Bay Area to visit family on Jan. 23. She developed symptoms and remained at home except for seeking medical care twice.
It's the second case in Santa Clara County — though health officials say there has been no person-to-person spread of the virus detected in the county.
"I understand that people are concerned, but based on what we know today, the risk to general public remains low," Dr. Sara Cody of the Santa Clara County Public Health Department said in a statement.
She said the woman has been regularly monitored and was never sick enough to be hospitalized. Family members have also self-isolated and have not left the home.
The new California cases bring the total in the U.S. to 11.
Health officials in China, meanwhile, said on Monday morning local time that total cases had exceeded 17,000, with nearly 3,000 new cases in 24 hours, and 361 people have now died on the mainland from the virus.
Earlier on Sunday, Philippines health officials said a 44-year-old man had died in the Philippines from the newly identified strain of coronavirus, marking the first known death outside of China from the fast-spreading disease.
The man, a resident of Wuhan, China, the epicenter of the outbreak, died Saturday in a hospital after developing "severe pneumonia due to viral and bacterial infections," according to health officials. They note that the man appeared to be recovering in recent days before deteriorating in his last 24 hours.
The disease has spread rapidly from Wuhan's Hubei province, since being first reported in December, mostly within mainland China.
More than 170 cases have been reported in more than 20 countries, prompting the World Health Organization on Thursday to declare a global health emergency.
In the U.S., the eighth case of the virus was announced on Saturday.
The infection was confirmed in a Boston man in his 20s who had recently traveled to Wuhan, China, according to Massachusetts state health officials.
He sought medical care soon after his return to the U.S. and has been in isolation, health officials said. His "few close contacts have been identified and are being monitored for any sign of symptoms," the Massachusetts Department of Public Health said in a statement.
On Friday, the Trump administration declared a public health emergency. Despite the declaration, U.S. health officials have emphasized that at this time, the overall risk to Americans is low and that the threat of flu remains much greater.
Still, the U.S. is working to ensure the coronavirus does not gain a foothold in the country. The State Department is warning Americans not to travel to China and urging those already there to leave.
More than a dozen airlines are suspending flights to and from China's mainland. This includes major U.S. carriers such as American Airlines, Delta and United.
Additionally, the Trump administration announced that beginning Sunday, all foreign nationals who have traveled in China within the past 14 days will be denied entry into the U.S. Exceptions will be made for permanent residents and immediate family of U.S. citizens.
Passengers on incoming flights from China are being directed to 11 specific U.S. airports for health screenings. Citizens returning from Hubei province will be subjected to up to two weeks of mandatory quarantine.
During a visit Monday to Uzbekistan, Secretary of State Mike Pompeo said the U.S. plans "a handful more flights" to bring Americans home from Hubei province, according to Reuters.
Enlarge this image toggle caption Kevin Frayer/Getty Images Kevin Frayer/Getty Images
"We might be bringing citizens home from other countries as well," Pompeo said during a briefing in the capital, Tashkent. "In addition we might bring in some medical supplies."
On Friday, the Centers for Disease Control and Prevention imposed a mandatory 14-day quarantine on nearly 200 Americans evacuated from Wuhan. The evacuees are being housed at the March Air Reserve Base in California.
"While we recognize this is an unprecedented action, we are facing an unprecedented public health threat," said Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the CDC. "And this is one of the tools in our toolbox to mitigate the potential impact of this novel virus on the United States."
Because the strain of the disease is new, much remains unknown. So far, experts say, it seems less deadly than SARS, another coronavirus.
To reduce the risk of the novel coronavirus spread, the WHO is encouraging old-fashioned techniques, including good hand-washing, avoiding close contact with those who have fever or cough, and sneezing into a crooked elbow or a tissue.
Meanwhile, Apple announced Saturday that it is temporarily closing all of its stores in China.
"Out of an abundance of caution and based on the latest advice from leading health experts, we're closing all our corporate offices, stores and contact centers in mainland China through February 9," the company said in a statement.
Apple operates more than 40 stores in mainland China.
Most Apple products are made in China in factories owned and operated by outside contractors, including the electronics giant Foxconn.
For now, the Taiwan-based Foxconn says it won't be changing its production timeline, but in a Jan. 28 earnings call, Apple CEO Tim Cook said the company is working on backup plans to minimize any potential supply disruptions.
With its announcement on Saturday, Apple joins a growing list of major American companies — including Starbucks, McDonald's and KFC — in suspending business in China.


npr--2020-02-03--'I Don't Believe This Is Happening': 911 Call Reveals Chaos After Delta Fuel Dump

' I Do n't Believe This Is Happening ' : 911 Call Reveals Chaos After Delta Fuel Dump It was the middle of sunny day on Tuesday , Jan. 14 , and hundreds of students and staff were on the playground of an elementary school in Los Angeles , when a school employee called 911 to report a bizarre emergency on his campus .
`` It was actually raining airline fuel onto my campus , '' the school employee said .
The school , 93rd Street STEAM Academy , is on the pathway of Los Angeles International Airport , he @ @ @ @ @ @ @ dropped fuel onto the yard . ''
`` How many kids were sprayed ? ''
a dispatcher from the fire department asked .
`` I 'm assuming what we had out here — maybe 300 , '' the employee responded , noting that people had been `` nauseated '' by the jet fuel and its intense smell .
`` I was out here and I was like , ' I do n't believe this is happening , ' `` the employee said .
The audio of the 911 call , which NPR obtained @ @ @ @ @ @ @ a public records request , reveals the chaos at the school after Delta Air Lines Flight 89 released an estimated 15,000 gallons of jet fuel before an emergency landing at LAX .
The flight was headed from LAX to Shanghai , but had to return to the airport due to `` mechanical issues . ''
As member station KPCC reported , the Federal Aviation Administration said that the flight crew `` did not tell air traffic control that they needed to dump fuel . ''
Further scrutiny raised questions about how the crew @ @ @ @ @ @ @ planes need to meet certain weight requirements which means that in emergency situations — when an aircraft is carrying a nearly full fuel load — pilots are required to release thousands of gallons to avoid crashing .
`` It 's not that it 's impossible [ to land with the heavier weight ] , but you 'd have to land at a lower descent rate , '' Ed Coleman , department chair for safety science at Embry-Riddle Aeronautical University told NPR .
Coleman said it 's highly unusual for airlines to resort to @ @ @ @ @ @ @ flights each month , `` I maybe hear about one a month . ''
So to be safe , Coleman said , fuel-dumping procedures call for `` you to go to a higher altitude because the fuel atomizes before it comes down . ''
Alternatively , pilots are instructed to release fuel over water or nonpopulated areas .
In this case , it appears none of the precautions was taken .
`` This is the first time they actually came pretty low and dropped their fuel , '' the 911 caller calmly explained @ @ @ @ @ @ @ .
On the afternoon of the incident , the Los Angeles County Fire Department said firefighters and paramedics had evaluated more than 40 adults and children from multiple schools , and found minor injuries .
But the incident has already prompted a California air quality regulator to issue a Notice Of Violation to Delta , as well as at least two civil lawsuits .
One of those lawsuits , filed by four teachers at another affected school , Park Avenue Elementary School in Cudahy , Calif. , alleges that the teachers `` could @ @ @ @ @ @ @ flesh , eyes and skin , '' and caused them `` to feel sick dizzy and nauseated . ''
During a press conference announcing the lawsuit , one of the teachers said she felt the `` drizzle '' of jet fuel , smelled the fumes , and thought , `` Oh my God , it must be a terrorist attack . ''
Another lawsuit , filed by residents under the flight path , alleges property damage and a `` lingering noxious odor '' caused by jet fuel , and accuses Delta of `` @ @ @ @ @ @ @ Unified school district spokesperson told NPR Delta has been `` very responsive to the community . ''
`` We have been focused on supporting the community , listening to residents and working closely with local leaders to understand how we can best support those who have been affected , '' Delta said in an emailed statement .
In the wake of the emergency , the carrier has `` opened a dedicated phone line for residents with concerns about property damage or health effects . ''
The airline also partnered with a local health @ @ @ @ @ @ @ week following the fuel dump .
`` We were up and running the next day , '' with the help of Delta cleaning crews , Peter Hastings , an operations administrator for the district told NPR .
Though only a handful of campuses were under the plane 's flight path , Hastings said , `` All 25 schools [ in the region ] were pressure washed . ''
That included `` the playground equipment , lunch area , tables and chairs .
... Everything was washed down . ''
Additionally , Hastings said @ @ @ @ @ @ @ in to talk directly with students and their families .
Their objective : To find out if there 's any anxiety and to help students work through it .
A spokesperson for the Federal Aviation Administration confirmed to NPR that its investigation into the incident is ongoing .

'I Don't Believe This Is Happening': 911 Call Reveals Chaos After Delta Fuel Dump
Enlarge this image toggle caption Matt Hartman/AP Matt Hartman/AP
It was the middle of a sunny day on Jan. 14, and hundreds of students and staff were on the playground of an elementary school in Los Angeles when a school employee called 911 to report a bizarre emergency on his campus.
"It was actually raining airline fuel onto my campus," the school employee said.
911 Call - Delta Airlines Jet Fuel Dump 4:17
The school, 93rd Street STEAM Academy, is on the pathway of Los Angeles International Airport, he said, and a plane, "dropped fuel onto the yard."
"How many kids were sprayed?" a dispatcher from the fire department asked.
"I'm assuming what we had out here — maybe 300," the employee responded, noting that people had been "nauseated" by the jet fuel and its intense smell.
"I was out here and I was like, 'I don't believe this is happening,' " the employee said.
The audio of the 911 call, which NPR obtained from the Los Angeles Police Department through a public records request, reveals the chaos at the school after Delta Flight 89 released an estimated 15,000 gallons of jet fuel before an emergency landing at LAX.
(The name of the school employee who reported the incident was redacted by the LAPD.)
The flight was headed from LAX to Shanghai but had to return to the airport because of "mechanical issues."
As member station KPCC reported, the Federal Aviation Administration said that the flight crew "did not tell air traffic control that they needed to dump fuel."
Further scrutiny raised questions about how the crew handled the incident.
Typically, landing planes need to meet certain weight requirements, which means that in emergency situations — when an aircraft is carrying a nearly full fuel load — pilots are required to release thousands of gallons to avoid crashing.
"It's not that it's impossible [to land with the heavier weight], but you'd have to land at a lower descent rate," Ed Coleman, department chair for safety science at Embry-Riddle Aeronautical University, told NPR.
Coleman said it's highly unusual for airlines to resort to fuel dumping. Out of thousands of flights each month, "I maybe hear about one a month."
So to be safe, Coleman said, fuel-dumping procedures call for "you to go to a higher altitude because the fuel atomizes before it comes down." Alternatively, pilots are instructed to release fuel over water or nonpopulated areas.
In this case, it appears none of those precautions was taken.
"This is the first time they actually came pretty low and dropped their fuel," the 911 caller calmly explained minutes after students and teachers were sprayed.
On the afternoon of the incident, the Los Angeles County Fire Department said firefighters and paramedics had evaluated more than 40 adults and children from multiple schools and found minor injuries.
But the incident has already prompted a California air quality regulator to issue a Notice Of Violation to Delta, as well as at least two civil lawsuits.
One of those lawsuits, filed by four teachers at another affected school, Park Avenue Elementary School in Cudahy, Calif., alleges that the teachers "could feel the fuel on their clothes, flesh, eyes and skin" and it caused them "to feel sick, dizzy and nauseated."
During a press conference announcing the lawsuit, one of the teachers said she felt the "drizzle" of jet fuel, smelled the fumes and thought, "Oh my God, it must be a terrorist attack."
Another lawsuit, filed by residents under the flight path, alleges property damage and a "lingering noxious odor" caused by jet fuel, and accuses Delta of "despicable conduct."
Meanwhile, an LA Unified school district spokesperson told NPR that Delta has been "very responsive to the community."
"We have been focused on supporting the community, listening to residents and working closely with local leaders to understand how we can best support those who have been affected," Delta said in an emailed statement.
In the wake of the emergency, the carrier has "opened a dedicated phone line for residents with concerns about property damage or health effects."
The airline also partnered with a local health care operator to offer screenings for a week following the fuel dump.
"We were up and running the next day," with the help of Delta cleaning crews, Peter Hastings, an operations administrator for the district, told NPR.
Though only a handful of campuses were under the plane's flight path, Hastings said, "All 25 schools [in the region] were pressure-washed."
That included "the playground equipment, lunch area, tables and chairs. ... Everything was washed down."
Additionally, Hastings said, mental health experts have been brought in to talk directly with students and their families.
Their objective: To find out if there's any anxiety and to help students work through it.
A spokesperson for the Federal Aviation Administration confirmed to NPR that its investigation into the incident is ongoing.


npr--2020-02-03--Researchers Link Autism To A System That Insulates Brain Wiring

Scientists have found a clue to how autism spectrum disorder disrupts the brain 's information highways .
The problem involves cells that help keep the traffic of signals moving smoothly through brain circuits , a team reported Monday in the journal Nature Neuroscience .
The team found that in both mouse and human brains affected by autism , there 's an abnormality in cells that produce a substance called myelin .
That 's a problem because myelin provides the `` insulation '' for brain circuits , allowing them to quickly and reliably carry electrical signals from one area to another @ @ @ @ @ @ @ too much of this myelin coating can result in a wide range of neurological problems .
For example , multiple sclerosis occurs when the myelin around nerve fibers is damaged .
The results , which vary from person to person , can affect not only the signals that control muscles , but also the ones involved in learning and thinking .
The finding could help explain why autism spectrum disorders include such a wide range of social and behavioral features , says Brady Maher , a lead investigator at the Lieber Institute for @ @ @ @ @ @ @ the psychiatry department at Johns Hopkins School of Medicine .
`` Myelination could be a problem that ties all of these autism spectrum disorders together , '' Maher says .
And if that 's true , he says , it might be possible to prevent or even reverse the symptoms using drugs that affect myelination .
`` If we get to these kids really early , we might be able to change their developmental trajectory and improve their outcomes , '' Maher says .
`` It 's possible to make these cells healthier @ @ @ @ @ @ @ director of the Lieber Institute and a professor at Johns Hopkins .
`` And it 's never been a target of treatment in autism . ''
The study adds to the evidence that myelination problems are present in `` several developmental disorders and in particular in autism , '' says Dr. Flora Vaccarino , a professor in the neuroscience department at Yale who was not involved in the research .
It also shows how one faulty regulatory system in the brain can lead to either too much myelination and too little , she @ @ @ @ @ @ @ why people with autism spectrum disorders may have brains that are either unusually large or unusually small .
Researchers involved in the study came upon the myelination problem while looking for something else .
They were studying brain cells in mice with a gene mutation that causes Pitt-Hopkins syndrome , which can include features of autism spectrum disorder .
`` We saw a signature that suggested there might be something wrong with myelination , '' Maher says .
`` So that was pretty surprising to us . ''
More experiments confirmed that `` @ @ @ @ @ @ @ in the cells that control myelination , which are called oligodendrocytes , he says .
This was true not only in mice with the Pitt-Hopkins syndrome , but in other mouse models of autism , too .
Next , a biostatistics expert named Andrew Jaffe looked at a genetic analysis of brain tissue from people with autism who had died .
And that experiment also found problems with the system that controls myelination .
To fully understand what 's going on though , the problem needs to be studied in developing brain tissue @ @ @ @ @ @ @ possible , she says , using tiny clusters of human brain cells called brain organoids , which can be grown in a petri dish .
Vaccarino 's lab has created brain organoids from the cells of people with autism spectrum disorder , which might reveal how the myelination problems begin , she says .
Brain myelination `` really does not start in earnest until the first year or two of life , '' Weinberger says .
`` And this is around the time that autism is first apparent . ''
That might eventually @ @ @ @ @ @ @ with myelination could help children who are diagnosed early in life , he says .
Several such treatments are being developed to treat people with multiple sclerosis , a disease that erodes myelin .

Researchers Link Autism To A System That Insulates Brain Wiring
Scientists have found a clue to how autism spectrum disorder disrupts the brain's information highways.
The problem involves cells that help keep the traffic of signals moving smoothly through brain circuits, a team reported Monday in the journal Nature Neuroscience.
The team found that in both mouse and human brains affected by autism, there's an abnormality in cells that produce a substance called myelin.
That's a problem because myelin provides the "insulation" for brain circuits, allowing them to quickly and reliably carry electrical signals from one area to another. And having either too little or too much of this myelin coating can result in a wide range of neurological problems.
For example, multiple sclerosis occurs when the myelin around nerve fibers is damaged. The results, which vary from person to person, can affect not only the signals that control muscles, but also the ones involved in learning and thinking.
The finding could help explain why autism spectrum disorders include such a wide range of social and behavioral features, says Brady Maher, a lead investigator at the Lieber Institute for Brain Development and an associate professor in the psychiatry department at Johns Hopkins School of Medicine.
"Myelination could be a problem that ties all of these autism spectrum disorders together," Maher says. And if that's true, he says, it might be possible to prevent or even reverse the symptoms using drugs that affect myelination.
"If we get to these kids really early, we might be able to change their developmental trajectory and improve their outcomes," Maher says.
"It's possible to make these cells healthier," adds Dr. Daniel Weinberger, director of the Lieber Institute and a professor at Johns Hopkins. "And it's never been a target of treatment in autism."
The study adds to the evidence that myelination problems are present in "several developmental disorders and in particular in autism," says Dr. Flora Vaccarino, a professor in the neuroscience department at Yale who was not involved in the research.
It also shows how one faulty regulatory system in the brain can lead to either too much myelination or too little, she says. And that may help explain why people with autism spectrum disorders may have brains that are either unusually large or unusually small.
Researchers involved in the study came upon the myelination problem while looking for something else.
They were studying brain cells in mice with a gene mutation that causes Pitt-Hopkins syndrome, which can include features of autism spectrum disorder. "We saw a signature that suggested there might be something wrong with myelination," Maher says. "So that was pretty surprising to us."
More experiments confirmed that "there was a clear deficit," in the cells that control myelination, which are called oligodendrocytes, he says. This was true not only in mice with the Pitt-Hopkins syndrome, but in other mouse models of autism, too.
Next, a biostatistics expert named Andrew Jaffe looked at a genetic analysis of brain tissue from people with autism who had died. And that experiment also found problems with the system that controls myelination.
To fully understand what's going on though, the problem needs to be studied in developing brain tissue, Vaccarino says.
That should be possible, she says, using tiny clusters of human brain cells called brain organoids, which can be grown in a petri dish. Vaccarino's lab has created brain organoids from the cells of people with autism spectrum disorder, which might reveal how the myelination problems begin, she says.
Brain myelination "really does not start in earnest until the first year or two of life," Weinberger says. "And this is around the time that autism is first apparent."
That might eventually mean a treatment that corrected a problem with myelination could help children who are diagnosed early in life, he says. Several such treatments are being developed to treat people with multiple sclerosis, a disease that erodes myelin.


npr--2020-02-03--As Out-Of-Pocket Health Costs Rise, Insured Adults Are Seeking Less Primary Care

As Out-Of-Pocket Health Costs Rise , Insured Adults Are Seeking Less Primary Care Efforts across the U.S. in recent years to encourage medical students , nurse practitioners and others to go into primary care , especially in underserved areas , are built on a consensus in research : Primary care is good for patients .
`` It 's the foundation of the health care system , '' says Dr. Ishani Ganguli , Harvard assistant professor of medicine and physician in general internal medicine and primary care at Brigham and Women 's Hospital .
So Ganguli is worried about the results @ @ @ @ @ @ @ published Monday in Annals of Internal Medicine : Adults with commercial health insurance are visiting primary care providers less often than they did about a decade ago .
Using data from an insurer that provides health coverage to about 20 million people per year across the United States , Ganguli and colleagues found that visits to primary care providers made by adults under the age of 65 had dropped by nearly 25 % from 2008 to 2016 .
What 's more , adults who went at least a year without a single visit @ @ @ @ @ @ @ about 38 % to 46 % in that period .
`` We should be concerned , '' says Dr. Kimberly Rask , chief data officer at Alliant Health Solutions , who wrote an editorial accompanying the study .
`` Primary care has all kinds of benefits , '' Ganguli says , `` both for patients but also for populations . ''
Research shows that people are healthier when they see a primary care doctor , rather than a specialist , for their routine care .
Where there are more primary care providers per @ @ @ @ @ @ @ , heart disease and stroke , among other illnesses — and life spans lengthen .
Checking in with a doctor by email is popular with some patients , as is turning to an urgent care clinic for health needs .
However , Ganguli says , there 's no substitute for building a trusting relationship with a discerning provider — someone who knows your medical history , and might be more likely to screen you for depression when a sore throat does n't seem to be your only problem , or schedule you for @ @ @ @ @ @ @ vaccines that you need .
The consistency of the decline in such visits across all demographics was surprising , Rask says .
People with low incomes and younger people had especially large decreases , but the drop in primary care visits showed up across all age groups and income levels .
Interestingly , preventive checkups actually increased , perhaps , the scientists speculate , because the Affordable Care Act made such appointments free , or at least cheaper , for more Americans .
But problem-based visits – for a sore throat , flu @ @ @ @ @ @ @ — fell by more than 30 % .
It 's hard to pinpoint exactly what 's behind this decline , the researchers say .
But the evidence points toward rising out-of-pocket costs as a factor .
The average out-of-pocket cost for a visit to the doctor related to a health problem rose from about $ 30 to nearly $ 40 during the study period .
And the share of primary care visits subject to a deductible jumped , too : Less than 10 % in 2008 , versus more than 25 % in @ @ @ @ @ @ @ of data showing that when you raise health care costs , people will receive less care , '' Rask says .
`` But it does n't mean that they only stop unnecessary care .
They will reduce both necessary and unnecessary care . ''
`` When patients have to pay more , they may pause , and they may not go in if they do n't think it 's that urgent , '' says Nadereh Pourat , a professor of health policy and management at UCLA 's Fielding School of Public Health .
@ @ @ @ @ @ @ adds .
`` You do n't want them to wait til things get really bad . ''

As Out-Of-Pocket Health Costs Rise, Insured Adults Are Seeking Less Primary Care
Enlarge this image toggle caption Joe Raedle/Getty Images Joe Raedle/Getty Images
Efforts across the U.S. in recent years to encourage medical students, nurse practitioners and others to go into primary care, especially in underserved areas, are built on a consensus in research: Primary care is good for patients.
"It's the foundation of the health care system," says Dr. Ishani Ganguli, Harvard assistant professor of medicine and physician in general internal medicine and primary care at Brigham and Women's Hospital.
So Ganguli is worried about the results of a big study she and colleagues published Monday in Annals of Internal Medicine: Adults with commercial health insurance are visiting primary care providers less often than they did about a decade ago.
Using data from an insurer that provides health coverage to about 20 million people per year across the United States, Ganguli and colleagues found that visits to primary care providers made by adults under the age of 65 had dropped by nearly 25% from 2008 to 2016.
What's more, adults who went at least a year without a single visit to a primary care provider increased from about 38% to 46% in that period.
"We should be concerned," says Dr. Kimberly Rask, chief data officer at Alliant Health Solutions, who wrote an editorial accompanying the study.
"Primary care has all kinds of benefits," Ganguli says, "both for patients but also for populations." Research shows that people are healthier when they see a primary care doctor, rather than a specialist, for their routine care. Where there are more primary care providers per capita, death rates drop for cancer, heart disease and stroke, among other illnesses — and life spans lengthen.
Checking in with a doctor by email is popular with some patients, as is turning to an urgent care clinic for health needs. However, Ganguli says, there's no substitute for building a trusting relationship with a discerning provider — someone who knows your medical history, and might be more likely to screen you for depression when a sore throat doesn't seem to be your only problem, or schedule you for bloodwork, a PAP smear, or vaccines that you need.
The consistency of the decline in such visits across all demographics was surprising, Rask says. People with low incomes and younger people had especially large decreases, but the drop in primary care visits showed up across all age groups and income levels.
Interestingly, preventive checkups actually increased, perhaps, the scientists speculate, because the Affordable Care Act made such appointments free, or at least cheaper, for more Americans. But problem-based visits – for a sore throat, flu or other symptoms of sickness or injury — fell by more than 30%.
It's hard to pinpoint exactly what's behind this decline, the researchers say. But the evidence points toward rising out-of-pocket costs as a factor. The average out-of-pocket cost for a visit to the doctor related to a health problem rose from about $30 to nearly $40 during the study period. And the share of primary care visits subject to a deductible jumped, too: Less than 10% in 2008, versus more than 25% in 2016.
"There is a lot of data showing that when you raise health care costs, people will receive less care," Rask says. "But it doesn't mean that they only stop unnecessary care. They will reduce both necessary and unnecessary care."
"When patients have to pay more, they may pause, and they may not go in if they don't think it's that urgent," says Nadereh Pourat, a professor of health policy and management at UCLA's Fielding School of Public Health. But health problems can worsen, she adds. "You don't want them to wait til things get really bad."


npr--2020-02-03--Climate And Floodwaters Are Top Of Mind For Some Iowa Voters

Climate And Floodwaters Are Top Of Mind For Some Iowa Voters Davenport , Iowa , faced some of the worst flooding in its history last year .
Flooding is n't uncommon to Iowa 's third-biggest city .
For years , Davenport has resisted efforts to build a flood wall on its banks of the Mississippi River .
But last spring , businesses along the riverfront scrambled to save their spaces when floodwaters breached temporary barriers .
`` It did n't get as bad as it could have got , '' says Dan Bush , a co-owner of multiple bars near @ @ @ @ @ @ @ event was in 1993 .
I do n't expect it to be another 25 , 27-odd years before it happens again . ''
Bush , along with Andrew Lopez , who co-owns a downtown pizza place , and Tim Baldwin , who owns an upscale pub right on the waterfront , all took a financial hit after the flooding last year .
But they were lucky .
Some of the businesses around the area had to shut their doors for good .
Flooding is n't caused by one factor , but climate change @ @ @ @ @ @ @ more frequent and more intense .
`` I think it 's a big deal and it 's been getting a little worse and worse every year , '' Lopez says .
`` So I think it 's time to take a step forward and try and do something about it . ''
That sentiment — to do something about it — has local and national political significance in Iowa .
The state holds its first-in-the-nation primary caucuses on Monday night .
For many voters , concern over flooding and climate change guide , @ @ @ @ @ @ @ back .
Nationwide , climate change ranks as a top concern for Democratic voters , according to a CNN/Des Moines Register/Mediacom poll last month .
Annie Stopulos , who owns a men 's clothing store a couple blocks from the river , remembers being knee-deep in water last year , laying down sandbags .
She says she 's motivated by environmental issues when it comes to politics .
`` Since I 've lived here , we 've only had one really big flood .
And it was when I was a young girl @ @ @ @ @ @ @ So historically , the chances are not very high .
But when you think of the environment and the effects and global warming — everything that is included and what 's happening — the chances are a lot higher . ''
She wo n't say who she 's caucusing for , but her fiancée Kayla is supporting Elizabeth Warren .
`` She 's worried about our children and our children 's children , '' Stopulos says .
Bush says he 's caucusing for Warren for reasons that include her plans to fight climate @ @ @ @ @ @ @ to upgrade `` water infrastructure '' such as dams , levees and inland waterways .
All of the leading Democratic candidates support the Green New Deal and broader efforts to combat climate change .
Baldwin says he is concerned about flooding as well .
But he does n't agree with the other business owners NPR talked to about what that means when backing a candidate .
`` Climate change , as we hear about it every day through the national media , I do n't believe is our problem , '' Baldwin says @ @ @ @ @ @ @ and I believe climate 's been changing since the inception of this planet , right ?
All I know is what is obvious to me , and that is when it rains , the water has nowhere to go except to the Mississippi River .
But is it related to what — driving cars and eating beef ?
I 'm not convinced of that . ''
Baldwin plans to vote for President Trump .
He 's more concerned about the economy in general than climate change .
He thinks local factors are the @ @ @ @ @ @ @ , such as paving over grassy areas that would naturally absorb rain .
Beyond the presidential contest , factors local to Davenport are also at play in how the business owners think about their future .
Davenport does n't have a permanent flood wall , in contrast to other cities of its size along the Mississippi .
`` Our riverfront is one of the major attributes of our community , '' former Mayor Frank Klipsch told reporters from The Associated Press last year .
`` We want to be able to maintain that @ @ @ @ @ @ @ Mid-March to mid-June saw 95 days of water above flood stage , with the Mississippi reaching a record crest in early May .
City officials estimated the damage at $ 3.5 million .
That estimate does n't take into account lost business revenue and wages , which a business group estimated could reach $ 30 million in the city of 100,000 people .

Climate And Floodwaters Are Top Of Mind For Some Iowa Voters
Enlarge this image toggle caption Brian Frank for NPR Brian Frank for NPR
Davenport, Iowa, faced some of the worst flooding in its history last year.
Flooding isn't uncommon to Iowa's third-biggest city. For years, Davenport has resisted efforts to build a flood wall on its banks of the Mississippi River.
But last spring, businesses along the riverfront scrambled to save their spaces when floodwaters breached temporary barriers.
"It didn't get as bad as it could have got," says Dan Bush, a co-owner of multiple bars near the river. "The last big event was in 1993. I don't expect it to be another 25, 27-odd years before it happens again."
Enlarge this image toggle caption Brian Frank for NPR Brian Frank for NPR
Bush, along with Andrew Lopez, who co-owns a downtown pizza place, and Tim Baldwin, who owns an upscale pub right on the waterfront, all took a financial hit after the flooding last year. But they were lucky. Some of the businesses around the area had to shut their doors for good.
Flooding isn't caused by one factor, but climate change means extreme rains are expected to be more frequent and more intense.
"I think it's a big deal and it's been getting a little worse and worse every year," Lopez says. "So I think it's time to take a step forward and try and do something about it."
Enlarge this image toggle caption Brian Frank for NPR Brian Frank for NPR
That sentiment — to do something about it — has local and national political significance in Iowa. The state holds its first-in-the-nation primary caucuses on Monday night. For many voters, concern over flooding and climate change guide, in part, which candidate they will back. Nationwide, climate change ranks as a top concern for Democratic voters, according to a CNN/Des Moines Register/Mediacom poll last month.
Annie Stopulos, who owns a men's clothing store a couple blocks from the river, remembers being knee-deep in water last year, laying down sandbags. She says she's motivated by environmental issues when it comes to politics.
"Since I've lived here, we've only had one really big flood. And it was when I was a young girl, I don't remember it. So historically, the chances are not very high. But when you think of the environment and the effects and global warming — everything that is included and what's happening — the chances are a lot higher."
She won't say who she's caucusing for, but her fiancée Kayla is supporting Elizabeth Warren. "She's worried about our children and our children's children," Stopulos says.
Bush says he's caucusing for Warren for reasons that include her plans to fight climate change.
Warren's website outlines plans to upgrade "water infrastructure" such as dams, levees and inland waterways. All of the leading Democratic candidates support the Green New Deal and broader efforts to combat climate change.
Enlarge this image toggle caption Brian Frank for NPR Brian Frank for NPR
Baldwin says he is concerned about flooding as well. But he doesn't agree with the other business owners NPR talked to about what that means when backing a candidate.
"Climate change, as we hear about it every day through the national media, I don't believe is our problem," Baldwin says. "I believe climate's changing and I believe climate's been changing since the inception of this planet, right? All I know is what is obvious to me, and that is when it rains, the water has nowhere to go except to the Mississippi River. But is it related to what — driving cars and eating beef? I'm not convinced of that."
Baldwin plans to vote for President Trump. He's more concerned about the economy in general than climate change. He thinks local factors are the bigger reason for flooding in urban areas, such as paving over grassy areas that would naturally absorb rain.
Enlarge this image toggle caption Brian Frank for NPR Brian Frank for NPR
Beyond the presidential contest, factors local to Davenport are also at play in how the business owners think about their future. Davenport doesn't have a permanent flood wall, in contrast to other cities of its size along the Mississippi.
"Our riverfront is one of the major attributes of our community," former Mayor Frank Klipsch told reporters from The Associated Press last year. "We want to be able to maintain that and embrace the Mississippi River."
Mid-March to mid-June saw 95 days of water above flood stage, with the Mississippi reaching a record crest in early May. City officials estimated the damage at $3.5 million. That estimate doesn't take into account lost business revenue and wages, which a business group estimated could reach $30 million in the city of 100,000 people.


npr--2020-02-03--Sadness And Worry After 2 Men Connected To Butterfly Sanctuary Are Found Dead

Sadness And Worry After 2 Men Connected To Butterfly Sanctuary Are Found Dead Each winter , millions of monarch butterflies make their home at the El Rosario reserve in Mexico — one of the best places in the world to see them .
Local guides lead tourists up the mountainside on foot and horseback to where the monarchs cluster in fir and pine trees .
Their bright orange wings flit amid the mild weather of Michoacán , and signs ask for silence as visitors enter the nesting areas .
This week , the sanctuary is in mourning for two of @ @ @ @ @ @ @ the butterfly reserve have been found dead in the span of a week , showing the danger that conservationists sometimes face in a country where protecting the environment can mean enountering hostility and violence from gangs and business interests .
The body of environmental activist Homero Gómez González was found last week , two weeks after he had gone missing .
His body was recovered at the bottom of a holding pond in an agricultural area .
Prosecutors in Michoacán say an autopsy found that the cause of death was `` mechanical asphyxiation @ @ @ @ @ @ @ trauma . ''
It does not appear to have been a robbery : Gómez was found with nearly 10,000 pesos on him ( more than $ 500 ) .
On Saturday , prosecutors said they 've opened an investigation after a second man reported missing was found dead : Raúl Hernández Romero , who had worked as a tour guide in the preserve .
His wife reported that he 'd gone missing last Monday .
His body was found bruised , his head showing trauma from a sharp object .
Authorities have not @ @ @ @ @ @ @ The El Rosario sanctuary is part of the Monarch Butterfly Biosphere Reserve , which was enshrined as a UNESCO World Heritage site in 2008 , calling the overwintering concentration of butterflies there `` a superlative natural phenomenon . ''
It noted that more than half of overwintering colonies of the monarch butterfly 's eastern population are found in these specific areas of Mexico .
But the same forests that draw butterflies to migrate thousands of miles each winter are under threat from illegal logging and clandestine avocado farms .
Gómez González was one @ @ @ @ @ @ @ A former local commissioner , he was among the leaders who argued that tourism was a more reliable economic strategy for the rural community than logging , The Associated Press reports .
He went on to become manager of the El Rosario sanctuary , fighting illegal logging and advocating for the replanting of trees that provide the monarchs ' habitat .
UNESCO leaders expressed `` deep sadness and profound concern '' at his death , offering condolences to his family and those who `` sometimes at the risk of their lives , work @ @ @ @ @ @ @ which is shared by all of humanity . ''
Hundreds of farm workers gathered for Gómez González 's funeral on Friday , news outlets reported .
`` Many people are outraged , '' Gómez González 's wife , Rebeca Valencia , told the Mexican newspaper El País .
`` He was an ecologist at heart .
He never told me about threats . ''
She asks how this could happen to someone whose work was to protect life .
`` I ca n't process it , '' she told the newspaper .
`` @ @ @ @ @ @ @ that fills me with pride , '' said 19-year-old son , Homero Gómez Valencia , who told the AP that butterflies were just one of his father 's causes .
He recounted how his father had once led farmers in taking over the state capitol to demand aid .
`` A lot of the things we have are due to that struggle , which took many years .
He fought against a thousand things . ''
Poet and environmental activist Homero Aridjis knew Gómez González for years .
He told NPR 's Carrie @ @ @ @ @ @ @ wildlife wo n't survive .
`` How can you protect the butterflies if Homero Gomez or other people are not protected ? ''

Sadness And Worry After 2 Men Connected To Butterfly Sanctuary Are Found Dead
Enlarge this image toggle caption Rebecca Blackwell/AP Rebecca Blackwell/AP
Each winter, millions of monarch butterflies make their home at the El Rosario reserve in Mexico — one of the best places in the world to see them. Local guides lead tourists up the mountainside on foot and horseback to where the monarchs cluster in fir and pine trees. Their bright orange wings flit amid the mild weather of Michoacán, and signs ask for silence as visitors enter the nesting areas.
This week, the sanctuary is in mourning for two of its protectors.
Two men connected to the butterfly reserve have been found dead in the span of a week, showing the danger that conservationists sometimes face in a country where protecting the environment can mean enountering hostility and violence from gangs and business interests.
The body of environmental activist Homero Gómez González was found last week, two weeks after he had gone missing. His body was recovered at the bottom of a holding pond in an agricultural area.
Prosecutors in Michoacán say an autopsy found that the cause of death was "mechanical asphyxiation by drowning of a person with head trauma." It does not appear to have been a robbery: Gómez was found with nearly 10,000 pesos on him (more than $500).
On Saturday, prosecutors said they've opened an investigation after a second man reported missing was found dead: Raúl Hernández Romero, who had worked as a tour guide in the preserve. His wife reported that he'd gone missing last Monday. His body was found bruised, his head showing trauma from a sharp object.
Authorities have not said whether the deaths are connected.
Enlarge this image toggle caption Rebecca Blackwell/AP Rebecca Blackwell/AP
The El Rosario sanctuary is part of the Monarch Butterfly Biosphere Reserve, which was enshrined as a UNESCO World Heritage site in 2008, calling the overwintering concentration of butterflies there "a superlative natural phenomenon." It noted that more than half of overwintering colonies of the monarch butterfly's eastern population are found in these specific areas of Mexico.
But the same forests that draw butterflies to migrate thousands of miles each winter are under threat from illegal logging and clandestine avocado farms.
Gómez González was one of the butterflies' strongest advocates. A former local commissioner, he was among the leaders who argued that tourism was a more reliable economic strategy for the rural community than logging, The Associated Press reports. He went on to become manager of the El Rosario sanctuary, fighting illegal logging and advocating for the replanting of trees that provide the monarchs' habitat.
UNESCO leaders expressed "deep sadness and profound concern" at his death, offering condolences to his family and those who "sometimes at the risk of their lives, work every day to protect this natural heritage which is shared by all of humanity."
Hundreds of farm workers gathered for Gómez González's funeral on Friday, news outlets reported.
"Many people are outraged," Gómez González's wife, Rebeca Valencia, told the Mexican newspaper El País. "He was an ecologist at heart. He never told me about threats."
She asks how this could happen to someone whose work was to protect life. "I can't process it," she told the newspaper.
"He fought for his town, and that fills me with pride," said 19-year-old son, Homero Gómez Valencia, who told the AP that butterflies were just one of his father's causes. He recounted how his father had once led farmers in taking over the state capitol to demand aid. "A lot of the things we have are due to that struggle, which took many years. He fought against a thousand things."
Poet and environmental activist Homero Aridjis knew Gómez González for years. He told NPR's Carrie Kahn that without activists, Mexico's wildlife won't survive.
"How can you protect the butterflies if Homero Gomez or other people are not protected?"


npr--2020-02-03--How The Senate Impeachment Trial Works

How The Senate Impeachment Trial Works

The Senate is scheduled to vote on President Trump 's fate on Wednesday at 4 p.m .
ET after about two weeks of his impeachment trial .
The House of Representatives impeached the president in December , charging him with abusing his power and obstructing Congress for efforts to get Ukraine to investigate Trump 's political rivals .
The Senate trial has included opening and closing arguments from the Democratic House impeachment managers and Trump 's defense team , as well as a 16-hour period of questioning by senators .
Outside of the official trial , senators have time Monday @ @ @ @ @ @ @ about impeachment .
The trial itself had a raucous start .
Senators passed a resolution on the ground rules for the trial on Jan. 21 after a marathon 13 hours of debate that included multiple failed attempts by Democrats to get a commitment on witnesses and documents .
The issue of whether to allow witnesses has been a central controversy in the proceedings , with senators ultimately voting not to call any at all .
Here is more about how the trial has played out .
The details of a Senate impeachment trial @ @ @ @ @ @ @ that negotiation essentially ended when Senate Majority Leader Mitch McConnell , R-Ky. , announced he had the votes to move ahead with a resolution outlining the process without Democrats .
House Speaker Nancy Pelosi , D-Calif. , delayed transmitting the articles to the Senate for nearly a month , hoping to get details on how the trial would work .
McConnell did n't budge , though .
Republicans passed McConnell 's resolution on Jan. 21 , with some last-minute , hand-written changes , but not before Democrats offered multiple amendments , triggering hours @ @ @ @ @ @ @ Schumer , D-N.Y. , had been pushing for a deal up front that would include testimony from witnesses , including Trump administration officials .
The resolution that passed delayed debate on witnesses and new evidence until after days of opening statements and questioning from senators .
During the trial , there are clear rules for each of the key players .
U.S. Chief Justice John Roberts presides .
Senators do not do the talking ; they can only submit written questions .
Senators did have a 16-hour period of questioning after both parties @ @ @ @ @ @ @ written questions that Roberts then read allowed to the prosecution and defense teams .
Impeachment managers from the House represent the Democrats ' argument .
The president 's defense includes White House counsel , outside attorneys and a number of Republican members of the House .
Opening arguments began Jan. 22 .
Each side had up to 24 hours over three days to make their case ( the original resolution from McConnell only afforded two days to each side ) .
The Democratic managers went first , then the defense team made its @ @ @ @ @ @ @ in the inquiry that the White House has fully participated .
The White House declined to participate in the Democratic-led House proceedings , which Trump considered a `` sham . ''
After opening arguments , senators had 16 hours to ask questions in the chamber , followed by two hours of arguments each by the House impeachment managers and the president 's lawyers .
Then came the debate on whether to subpoena witnesses or introduce new documents .
This is where moderate Republicans became crucial to each side .
Four Republicans would have @ @ @ @ @ @ @ get witnesses , but Democrats only convinced two to join them , Sens .
Susan Collins of Maine and Mitt Romney of Utah .
Swing votes Lamar Alexander of Tennessee and Lisa Murkowski of Alaska announced before the vote that they opposed witnesses .
After the trial , the Senate votes on whether to convict or acquit the president on each article of impeachment .
Convicting Trump and therefore removing him from office requires 67 votes .
That would mean 20 Republicans would have to join Democrats in the effort — a highly @ @ @ @ @ @ @ charges or dismissing the charges , however , takes only 51 votes .
This is the most likely outcome in the Republican-controlled Senate .
Ca n't see the graphics in this story ?
Click here .
Photos : Win McNamee/Getty Images ( Mitch McConnell ) ; Paul Morigi/Getty Images ( Susan Collins ) ; Chip Somodevilla/Getty Images ( Lisa Murkowski and John Roberts ) ; Mark Wilson/Getty Images ( Cory Gardner , Joe Manchin , Martha McSally and Chuck Schumer ) ; Alex Wong/Getty Images ( Doug Jones and Mitt Romney ) NPR @ @ @ @ @ @ @ Deirdre Walsh contributed to this report .

How The Senate Impeachment Trial Works
The Senate is scheduled to vote on President Trump's fate on Wednesday at 4 p.m. ET after about two weeks of his impeachment trial.
The House of Representatives impeached the president in December, charging him with abusing his power and obstructing Congress for efforts to get Ukraine to investigate Trump's political rivals.
Loading...
The Senate trial has included opening and closing arguments from the Democratic House impeachment managers and Trump's defense team, as well as a 16-hour period of questioning by senators.
Outside of the official trial, senators have time Monday through Wednesday to speak on the floor about impeachment.
The trial itself had a raucous start. Senators passed a resolution on the ground rules for the trial on Jan. 21 after a marathon 13 hours of debate that included multiple failed attempts by Democrats to get a commitment on witnesses and documents.
The issue of whether to allow witnesses has been a central controversy in the proceedings, with senators ultimately voting not to call any at all.
toggle caption Brendan Smialowski/AFP via Getty Images
Here is more about how the trial has played out.
Setting The Ground Rules
Timing: Senate passed organizing resolution on Jan. 21
The details of a Senate impeachment trial are generally up for negotiation, but that negotiation essentially ended when Senate Majority Leader Mitch McConnell, R-Ky., announced he had the votes to move ahead with a resolution outlining the process without Democrats.
House Speaker Nancy Pelosi, D-Calif., delayed transmitting the articles to the Senate for nearly a month, hoping to get details on how the trial would work. McConnell didn't budge, though.
Loading...
Republicans passed McConnell's resolution on Jan. 21, with some last-minute, hand-written changes, but not before Democrats offered multiple amendments, triggering hours of debate.
Senate Minority Leader Chuck Schumer, D-N.Y., had been pushing for a deal up front that would include testimony from witnesses, including Trump administration officials. The resolution that passed delayed debate on witnesses and new evidence until after days of opening statements and questioning from senators.
The Trial
Timing: Opening arguments began on Jan. 22
During the trial, there are clear rules for each of the key players. U.S. Chief Justice John Roberts presides. Senators do not do the talking; they can only submit written questions. Senators did have a 16-hour period of questioning after both parties gave opening arguments, where senators submitted written questions that Roberts then read allowed to the prosecution and defense teams.
Impeachment managers from the House represent the Democrats' argument. The president's defense includes White House counsel, outside attorneys and a number of Republican members of the House.
Loading...
Opening arguments began Jan. 22. Each side had up to 24 hours over three days to make their case (the original resolution from McConnell only afforded two days to each side).
The Democratic managers went first, then the defense team made its case. It was the first time in the inquiry that the White House has fully participated. The White House declined to participate in the Democratic-led House proceedings, which Trump considered a "sham."
Loading...
After opening arguments, senators had 16 hours to ask questions in the chamber, followed by two hours of arguments each by the House impeachment managers and the president's lawyers.
Then came the debate on whether to subpoena witnesses or introduce new documents.
This is where moderate Republicans became crucial to each side. Four Republicans would have had to join the Democratic caucus to get witnesses, but Democrats only convinced two to join them, Sens. Susan Collins of Maine and Mitt Romney of Utah.
Swing votes Lamar Alexander of Tennessee and Lisa Murkowski of Alaska announced before the vote that they opposed witnesses.
The Final Vote
Timing: Feb. 5 at 4 p.m. ET
After the trial, the Senate votes on whether to convict or acquit the president on each article of impeachment. Convicting Trump and therefore removing him from office requires 67 votes. That would mean 20 Republicans would have to join Democrats in the effort — a highly unlikely prospect.
Acquitting Trump of the charges or dismissing the charges, however, takes only 51 votes. This is the most likely outcome in the Republican-controlled Senate.
Loading...
Can't see the graphics in this story? Click here.
Photos: Win McNamee/Getty Images (Mitch McConnell); Paul Morigi/Getty Images (Susan Collins); Chip Somodevilla/Getty Images (Lisa Murkowski and John Roberts); Mark Wilson/Getty Images (Cory Gardner, Joe Manchin, Martha McSally and Chuck Schumer); Alex Wong/Getty Images (Doug Jones and Mitt Romney)
This story originally published on Dec. 31, 2019.
NPR's Susan Davis, Claudia Grisales and Deirdre Walsh contributed to this report.


npr--2020-02-03--Ex-CIA Employee Accused Of Leaking Documents To WikiLeaks Goes On Trial

Ex-CIA Employee Accused Of Leaking Documents To WikiLeaks Goes On Trial The trial of a former Central Intelligence Agency software engineer who allegedly leaked thousands of pages of documents to WikiLeaks was set to begin Monday in federal court in New York .
The leak has been described as one of the largest in the CIA 's history .
Joshua Schulte has pleaded not guilty to 11 criminal counts , including illegal transmission of unlawfully possessed national defense information and theft of government property .
WikiLeaks started publishing the documents , which it called `` Vault 7 , '' in @ @ @ @ @ @ @ are highly technical , and appear to describe agency practices for hacking a number of different targets .
As NPR 's Camila Domonoske and Greg Myre reported at the time , the documents are said to be to be internal guides to creating and using many kinds of hacking tools , `` from turning smart TVs into bugs to designing customized USB drives to extract information from computers . ''
Schulte 's lawyers did not respond to NPR 's requests for comment about the case .
In court filings ahead of the trial @ @ @ @ @ @ @ pace with which they are required to review materials surfaced during the discovery process .
Some of the charges against Schulte stem from the Espionage Act , and defense lawyers say they are unconstitutionally overbroad and vague .
They also said the law was intended to be used to prosecute those who transmit government secrets to foreign governments , and that it should n't apply to leaking to WikiLeaks .
The judge rejected those arguments .
`` As alleged , Schulte utterly betrayed this nation and downright violated his victims , '' William @ @ @ @ @ @ @ of the FBI 's New York Field Office , said in a statement when the charges were announced .
`` As an employee of the CIA , Schulte took an oath to protect this country , but he blatantly endangered it by the transmission of Classified Information . ''
Prosecutors have said that when Schulte was working at the CIA , he developed classified cyber tools , including tools to covertly gather data from computers .
The leak allegedly happened during a time of rising tension between Schulte and his CIA colleagues .
@ @ @ @ @ @ @ to prosecutors , Schulte started having `` significant problems '' in his group that stemmed from a feud with one of his colleagues .
The feud deepened after the colleague reportedly complained about Schulte to management .
Prosecutors say Schulte accused the employee of making a death threat against him and eventually filed a protective order against that person .
They were reassigned to different teams .
Because of his reassignment , Schulte 's access to previous projects was revoked .
But prosecutors say he reinstated his own administrative privileges .
Management at @ @ @ @ @ @ @ , and they attempted to revoke privileges and change passwords .
But they missed credentials for one computer network , according to prosecutors , and in April 2016 , Schulte allegedly stole vast quantities of information from the network and passed the data along to WikiLeaks .
The judge has granted measures to protect the anonymity of certain witnesses from the CIA who are expected to testify .
During those sessions , the courtroom will be closed to press , except for two pool reporters who have agreed not to disclose the physical @ @ @ @ @ @ @ in an adjoining courtroom will be able to see a video feed that wo n't show images of the witnesses .
Federal prosecutors originally indicted Schulte in 2017 on charges of receiving and possessing child pornography .
They said they discovered more than 10,000 images and videos of child pornography encrypted on Schulte 's personal computer .
One of the prosecutors , Matthew Laroche , said at a hearing in 2017 that Schulte is `` someone who 's shown himself to condone sexually dangerous behavior and has shown a proclivity to collect thousands @ @ @ @ @ @ @ In July 2019 , the court severed the child pornography-related charges from the rest of the case , meaning that those accusations will be addressed at a separate trial .

Ex-CIA Employee Accused Of Leaking Documents To WikiLeaks Goes On Trial
Enlarge this image toggle caption Andrew Harnik/AP Andrew Harnik/AP
The trial of a former Central Intelligence Agency software engineer who allegedly leaked thousands of pages of documents to WikiLeaks was set to begin Monday in federal court in New York. The leak has been described as one of the largest in the CIA's history.
Joshua Schulte has pleaded not guilty to 11 criminal counts, including illegal transmission of unlawfully possessed national defense information and theft of government property.
WikiLeaks started publishing the documents, which it called "Vault 7," in March 2017. Many of the documents are highly technical, and appear to describe agency practices for hacking a number of different targets.
As NPR's Camila Domonoske and Greg Myre reported at the time, the documents are said to be to be internal guides to creating and using many kinds of hacking tools, "from turning smart TVs into bugs to designing customized USB drives to extract information from computers."
Schulte's lawyers did not respond to NPR's requests for comment about the case.
In court filings ahead of the trial, they have expressed frustration at the pace with which they are required to review materials surfaced during the discovery process.
Some of the charges against Schulte stem from the Espionage Act, and defense lawyers say they are unconstitutionally overbroad and vague. They also said the law was intended to be used to prosecute those who transmit government secrets to foreign governments, and that it shouldn't apply to leaking to WikiLeaks. The judge rejected those arguments.
"As alleged, Schulte utterly betrayed this nation and downright violated his victims," William F. Sweeney Jr., the assistant director-in-charge of the FBI's New York Field Office, said in a statement when the charges were announced. "As an employee of the CIA, Schulte took an oath to protect this country, but he blatantly endangered it by the transmission of Classified Information."
Prosecutors have said that when Schulte was working at the CIA, he developed classified cyber tools, including tools to covertly gather data from computers.
The leak allegedly happened during a time of rising tension between Schulte and his CIA colleagues.
In the summer of 2015, according to prosecutors, Schulte started having "significant problems" in his group that stemmed from a feud with one of his colleagues. The feud deepened after the colleague reportedly complained about Schulte to management. Prosecutors say Schulte accused the employee of making a death threat against him and eventually filed a protective order against that person. They were reassigned to different teams.
Because of his reassignment, Schulte's access to previous projects was revoked. But prosecutors say he reinstated his own administrative privileges. Management at the Center for Cyber Intelligence discovered it, and they attempted to revoke privileges and change passwords. But they missed credentials for one computer network, according to prosecutors, and in April 2016, Schulte allegedly stole vast quantities of information from the network and passed the data along to WikiLeaks.
The judge has granted measures to protect the anonymity of certain witnesses from the CIA who are expected to testify. During those sessions, the courtroom will be closed to press, except for two pool reporters who have agreed not to disclose the physical characteristics of these witnesses. Other reporters in an adjoining courtroom will be able to see a video feed that won't show images of the witnesses.
Federal prosecutors originally indicted Schulte in 2017 on charges of receiving and possessing child pornography. They said they discovered more than 10,000 images and videos of child pornography encrypted on Schulte's personal computer.
One of the prosecutors, Matthew Laroche, said at a hearing in 2017 that Schulte is "someone who's shown himself to condone sexually dangerous behavior and has shown a proclivity to collect thousands of images of child pornography."
In July 2019, the court severed the child pornography-related charges from the rest of the case, meaning that those accusations will be addressed at a separate trial.


npr--2020-02-03--Rush Limbaugh Says He Has Been Diagnosed With Advanced Lung Cancer

Rush Limbaugh Says He Has Been Diagnosed With Advanced Lung Cancer Conservative radio host Rush Limbaugh told his listeners on Monday that he has been diagnosed with advanced lung cancer .
He said the diagnosis was confirmed by two medical institutions on Jan. 20 , after he became concerned earlier that month that something was wrong .
`` I wish I did n't have to tell you this , and I thought about not telling anybody , '' Limbaugh said on his program .
`` I thought about trying to do this without anybody knowing , because I do n't @ @ @ @ @ @ @ `` But there are going to be days when I am not going to be able to be here because I 'm undergoing treatment , or I 'm reacting to treatment , '' he added , saying he did n't want it to leak without informing listeners first .
The host said that he was experiencing shortness of breath .
He said he would be away from the program for several days for testing and to set treatment options , but hoped to return to the airwaves on Thursday .
`` It is @ @ @ @ @ @ @ .
`` This has happened , and my intention is to come here every day I can . ''
Limbaugh , who is originally from Missouri , launched The Rush Limbaugh Show nationwide in 1988 .
According to his website , the show is heard by millions of people every week on more than 600 stations .
He 's seen as a central figure in the rise of the conservative media , and a major power broker who can impact the success of Republican candidates .
`` Limbaugh rarely backtracks and almost never @ @ @ @ @ @ @ Folkenflik has reported , adding that he `` is renowned , of course , for controversial remarks . ''
Those include lewd remarks he made about a Georgetown Law Student that , in 2012 , led many advertisers to flee his show .
In a 2007 interview with NPR , he said that `` getting along is not the objective . ''
`` When it comes to the war on terror , when it comes to tax policy , to me , defeating , politically , people I disagree with is the order @ @ @ @ @ @ @ n't think I defeat them by compromising with them , '' he said .
That mindset was clear in an anecdote from a book about Limbaugh by Zev Chafets .
A major newspaper had asked Limbaugh in 2008 to lay out his hopes for the new Obama administration .
`` Limbaugh told his audience that he did n't need four hundred words .
Four would suffice : ' I hope he fails , ' '' Chafets stated .
In a post on Twitter , former Fox News host Megyn Kelly called him `` @ @ @ @ @ @ @ his listeners dearly , and is a tireless warrior for things he holds dear . ''
She added : `` Do what you do so well , Rush - FIGHT . ''
Conservative politicians are also tweeting messages of support , such as Sen. Lindsey Graham , R-S.C. `` Like so many who believe in the conservative cause , wishing # RushLimbaugh all the best in his fight against cancer . ''

Rush Limbaugh Says He Has Been Diagnosed With Advanced Lung Cancer
Enlarge this image toggle caption Julie Smith/AP Julie Smith/AP
Updated at 4:52 p.m. ET
Conservative radio host Rush Limbaugh told his listeners on Monday that he has been diagnosed with advanced lung cancer.
He said the diagnosis was confirmed by two medical institutions on Jan. 20, after he became concerned earlier that month that something was wrong.
"I wish I didn't have to tell you this, and I thought about not telling anybody," Limbaugh said on his program. "I thought about trying to do this without anybody knowing, because I don't like making things about me."
"But there are going to be days when I am not going to be able to be here because I'm undergoing treatment, or I'm reacting to treatment," he added, saying he didn't want it to leak without informing listeners first.
Media Conservative Radio Host Rush Limbaugh's Influence On The Media Conservative Radio Host Rush Limbaugh's Influence On The Media Listen · 3:39 3:39
The host said that he was experiencing shortness of breath. He said he would be away from the program for several days for testing and to set treatment options, but hoped to return to the airwaves on Thursday.
"It is what it is," he said. "This has happened, and my intention is to come here every day I can."
Limbaugh, who is originally from Missouri, launched The Rush Limbaugh Show nationwide in 1988. According to his website, the show is heard by millions of people every week on more than 600 stations.
He's seen as a central figure in the rise of the conservative media, and a major power broker who can impact the success of Republican candidates.
"Limbaugh rarely backtracks and almost never apologizes," NPR media correspondent David Folkenflik has reported, adding that he "is renowned, of course, for controversial remarks." Those include lewd remarks he made about a Georgetown Law Student that, in 2012, led many advertisers to flee his show.
In a 2007 interview with NPR, he said that "getting along is not the objective."
"When it comes to the war on terror, when it comes to tax policy, to me, defeating, politically, people I disagree with is the order of the day, and I don't think I defeat them by compromising with them," he said.
That mindset was clear in an anecdote from a book about Limbaugh by Zev Chafets. A major newspaper had asked Limbaugh in 2008 to lay out his hopes for the new Obama administration.
"Limbaugh told his audience that he didn't need four hundred words. Four would suffice: 'I hope he fails,'" Chafets stated.
In a post on Twitter, former Fox News host Megyn Kelly called him "a man who loves this country and his listeners dearly, and is a tireless warrior for things he holds dear." She added: "Do what you do so well, Rush - FIGHT."
Conservative politicians are also tweeting messages of support, such as Sen. Lindsey Graham, R-S.C. "Like so many who believe in the conservative cause, wishing #RushLimbaugh all the best in his fight against cancer."


npr--2020-02-03--Bernard Ebbers, Telecom CEO Sent To Prison In Accounting Scandal, Dies

Bernard Ebbers , Telecom CEO Sent To Prison In Accounting Scandal , Dies Former WorldCom CEO Bernard Ebbers , the `` telecom cowboy '' who spent 13 years in federal prison for his involvement in a notorious $ 11 billion accounting scandal , died Sunday .
He was 78 .
A federal judge had released Ebbers from prison in December — short of his 25-year sentence for fraud — because his health had deteriorated .
A former Mississippi basketball coach who preferred cowboy boots and jeans to suits and ties , Ebbers was one of the most colorful and successful @ @ @ @ @ @ @ revolution .
He created a small long-distance company called LDDS and then relentlessly expanded it through a series of debt-fueled mergers and acquisitions .
In 1998 , the company , renamed WorldCom , stunned the industry by acquiring MCI , the second-largest U.S. long-distance carrier , for $ 47 billion .
A subsequent attempt to buy the third-largest carrier , Sprint , was blocked by regulators .
Ebbers became personally very wealthy , buying hotels , golf courses , a trucking company and a large ranch in Canada .
Everything began to unravel @ @ @ @ @ @ @ stock price fell , during the dotcom bust .
It soon emerged that MCI WorldCom had personally lent Ebbers some $ 400 million to cover loans he 'd made against his own shares of stock .
A subsequent investigation by the Securities and Exchange Commission revealed the company had been disguising operating costs as capital expenses , and Ebbers was fired as CEO in 2002 .
MCI WorldCom declared bankruptcy and was later acquired by Verizon for $ 8.5 billion .
Former U.S. Attorney General Richard Thornburgh , who was hired by a @ @ @ @ @ @ @ finances , reported that the company engaged in `` a smorgasbord of manipulative schemes designed to cook the books to falsely state the earnings and sustain the price of the stock . ''
`` There appeared to be a breakdown in all of the checks that were designed to ensure the integrity of the operation , its transparency and its responsiveness to shareholder interest , '' Thornburgh wrote in his report .
Ebbers maintained that he was unaware of the fraud and that it was engineered by Scott Sullivan , the company 's @ @ @ @ @ @ @ that no one will conclude that I engaged in any criminal or fraudulent conduct during my tenure at WorldCom , '' Ebbers said at a 2002 congressional hearing , where he nevertheless pleaded the Fifth Amendment and declined to answer questions .
But a federal jury found Ebbers guilty in 2005 and he was sentenced to 25 years in prison .
Sullivan , who cooperated with prosecutors , received a five-year sentence .

Bernard Ebbers, Telecom CEO Sent To Prison In Accounting Scandal, Dies
Enlarge this image toggle caption Stand Honda/AFP via Getty Images Stand Honda/AFP via Getty Images
Former WorldCom CEO Bernard Ebbers, the "telecom cowboy" who spent 13 years in federal prison for his involvement in a notorious $11 billion accounting scandal, died Sunday. He was 78.
A federal judge had released Ebbers from prison in December — short of his 25-year sentence for fraud — because his health had deteriorated.
A former Mississippi basketball coach who preferred cowboy boots and jeans to suits and ties, Ebbers was one of the most colorful and successful executives to emerge out of the telecommunications revolution.
He created a small long-distance company called LDDS and then relentlessly expanded it through a series of debt-fueled mergers and acquisitions.
In 1998, the company, renamed WorldCom, stunned the industry by acquiring MCI, the second-largest U.S. long-distance carrier, for $47 billion. A subsequent attempt to buy the third-largest carrier, Sprint, was blocked by regulators.
Ebbers became personally very wealthy, buying hotels, golf courses, a trucking company and a large ranch in Canada.
Two Former WorldCom Executives Arrested In Huge Accounting Scandal Two Former WorldCom Executives Arrested In Huge Accounting Scandal Listen · 3:29 3:29
Everything began to unravel in 2000, when MCI WorldCom's stock price fell, during the dotcom bust. It soon emerged that MCI WorldCom had personally lent Ebbers some $400 million to cover loans he'd made against his own shares of stock.
A subsequent investigation by the Securities and Exchange Commission revealed the company had been disguising operating costs as capital expenses,
and Ebbers was fired as CEO in 2002.
MCI WorldCom declared bankruptcy and was later acquired by Verizon for $8.5 billion.
Former U.S. Attorney General Richard Thornburgh, who was hired by a federal bankruptcy court to examine WorldCom's finances, reported that the company engaged in "a smorgasbord of manipulative schemes designed to cook the books to falsely state the earnings and sustain the price of the stock."
"There appeared to be a breakdown in all of the checks that were designed to ensure the integrity of the operation, its transparency and its responsiveness to shareholder interest," Thornburgh wrote in his report.
Ebbers maintained that he was unaware of the fraud and that it was engineered by Scott Sullivan, the company's chief financial officer.
"I believe that no one will conclude that I engaged in any criminal or fraudulent conduct during my tenure at WorldCom," Ebbers said at a 2002 congressional hearing, where he nevertheless pleaded the Fifth Amendment and declined to answer questions.
But a federal jury found Ebbers guilty in 2005 and he was sentenced to 25 years in prison. Sullivan, who cooperated with prosecutors, received a five-year sentence.