President Donald Trump is directing the government to revamp the nation’s care for kidney disease, so that more people whose kidneys fail have a chance at early transplants and home dialysis — along with better prevention so patients don’t get that sick to begin with.

Senior administration officials told The Associated Press that Trump is set to sign an executive order Wednesday calling for strategies that have the potential to save lives and millions of Medicare dollars.

That won’t happen overnight — some of the initiatives will require new government regulations.

And because a severe organ shortage complicates the call for more transplants, the administration also aims to ease financial hardships for living donors, said the officials, who spoke on condition of anonymity ahead of the announcement.

Another key change: steps to help the groups that collect deceased donations do a better job. Officials cited a study that suggests long-term, it may be possible to find 17,000 more kidneys and 11,000 other organs from deceased donors for transplant every year.

Federal health officials have made clear for months that they intend to shake up a system that today favors expensive, time-consuming dialysis in large centers over easier-to-tolerate at-home care or transplants that help patients live longer.

“Right now every financial incentive is toward dialysis and not toward transplantation and long-term survivorship,” Health and Human Services Secretary Alex Azar, whose father experienced traditional and at-home dialysis before getting a living donor transplant, told a Senate hearing in March. “And you get what you pay for.”

About 30 million American adults have chronic kidney disease, costing Medicare a staggering $113 billion.

Careful treatment — including control of diabetes and high blood pressure, the two main culprits — can help prevent further kidney deterioration. But more than 700,000 people have end-stage renal disease, meaning their kidneys have failed, and require either a transplant or dialysis to survive. Only about a third received specialized kidney care before they got so sick.

More than 94,000 of the 113,000 people on the national organ waiting list need a kidney. Last year, there were 21,167 kidney transplants. A fraction — 6,442 — were from living donors, according to the United Network for Organ Sharing, which oversees the nation’s transplant system.

“The longer you’re on dialysis, the outcomes are worse,” said Dr. Amit Tevar, a transplant surgeon at the University of Pittsburgh Medical Center, who praised the Trump administration initiatives being announced Wednesday.

Too often, transplant centers don’t see a kidney patient until they’ve been on dialysis for years, he said. And while any transplant is preferable, one from a living donor is best because those organs “work better, longer and faster,” Tevar said.

Among the initiatives that take effect first:

—Medicare payment changes that would provide a financial incentive for doctors and clinics to help kidney patients stave off end-stage disease by about six months.

—A bonus to kidney specialists who help prepare patients for early transplant, with steps that can begin even before they need dialysis.

—Additional Medicare changes so that dialysis providers can earn as much by helping patients get dialysis at home as in the large centers that predominate today. Patients typically must spend hours three or four times a week hooked to machines that filter waste out of their blood.

Home options include portable blood-cleansing machines, or what’s called peritoneal dialysis that works through an abdominal tube, usually while patients are sleeping.

Today, about 14% of patients in kidney failure get at-home dialysis or an early transplant. By 2025, the goal is to have 80% of people with newly diagnosed kidney failure getting one of those options, officials said.

These changes are being implemented through Medicare’s innovation center, created under the Obama-era Affordable Care Act and empowered to seek savings and improved quality. The Trump administration is relying on the innovation center even as it argues in federal court that the law that created it is unconstitutional and should be struck down entirely.

Other initiatives will require new regulations, expected to be proposed later this year. Among them:

—Allowing reimbursement of lost wages and other expenses for living donors, who can give one of their kidneys or a piece of their liver. The transplant recipient’s insurance pays the donor’s medical bills. But they are out of work for weeks recuperating and one study found more than a third of living kidney donors reported lost wages, a median of $2,712, in the year following donation. Details about who pays — and who qualifies — still have to be worked out.

—Clearer ways to measure how well the nation’s 58 organ procurement organizations collect donations from deceased donors. Some do a better job than others, but today’s performance standards are self-reported, varying around the country and making it hard for government regulators or the OPOs themselves to take steps to improve.

“Some OPOs are very aggressive and move forward with getting organs allocated and donors consented, and there are those that are a little more lackadaisical about it,” said Pittsburgh’s Tevar. Unlike the medical advances in transplantation, “we haven’t really made big dents and progress and moves in increasing cadaveric organs or increasing live donor options.”

Marc Maron never set out to be an actor, but he’s been expanding his resume beyond standup and his popular podcast lately.
 
In addition to his role on the Netflix series “GLOW,” Maron has been dabbling more in movies including a lead in the indie comedy “Sword of Trust” and a smaller part in this fall’s “Joker.”
 
Maron says he’s not gunning for the big stuff, although he did go out for a part in the “Avatar” sequels he didn’t get.
 
He often is cast to play a variation of himself, but he says he’d like to get to a point where he can lose himself in a role, too.

Bulgaria’s government has decided to buy eight new F-16 fighters in a bid to replace its aging Soviet-built jets and bring its air force in line with NATO standards.

The government gave the go-head Wednesday for the defense minister to sign the contract for the purchase of eight multi-role F-16 Block 70 fighter aircraft.

Deputy defense minister Atanas Zapryanov told reporters that the $1.25 billion deal includes the aircraft, ammunition, equipment and pilot training, and that there is an option for the U.S. Congress to contribute $60 million. He said that six single-seat and two two-seat F-16s would be delivered by 2023.
 
The decision still needs parliamentary approval, but it is expected to get that easily given that the ruling coalition has a majority.
 
Bulgaria joined NATO in 2004.

 

Australia will hold a national vote within three years on whether to include recognition of indigenous people in its constitution, the government said on Wednesday, an issue that has spurred decades of often heated debate.

Australia has struggled to reconcile with descendants of its first inhabitants, who arrived on the continent about 50,000 years before British colonists but are not recognized in the national constitution.

However, with public support on the issue growing, Minister for Indigenous Australians Ken Wyatt promised a referendum before 2022.

“I will develop and bring forward a consensus option for constitutional recognition to be put to a referendum during the current parliamentary term,” Wyatt said in a speech in Canberra.

Australians must return to the polls by 2022 after Prime Minister Scott Morrison’s conservative coalition government was returned in a “miracle” election win in May.

However, to meet the timetable Wyatt will need to facilitate an agreement between the government and indigenous leaders, who have demanded a bigger voice in the running of the country.

Indigenous leaders proposed in 2017 establishing an advisory body comprised of elected indigenous Australians enshrined in the constitution. The government rejected the proposal, insisting it would create a de facto third chamber in parliament.

The government has come under growing pressure since then to revisit the issue, with several corporate giants insisting that meaningful recognition is the only way to bridge the divide in Australia’s population.

“A first nations voice to parliament is a meaningful step towards reconciliation,” BHP Chief Executive Officer Andrew Mackenzie said earlier this year.

Indigenous Australians account for about 700,000 people in a total population of 23 million and have tracked near the bottom in almost every socio-economic indicator, suffering disproportionately high rates of suicide, alcohol abuse, domestic violence and imprisonment.

Denied the vote until the mid-1960s, they face a 10-year gap in life expectancy compared with other Australians and make up 27% of the prison population.

The U.S. State Department said Tuesday it will continue to deal with British diplomats in Washington as usual, unless directed differently by the White House. U.S. President Donald Trump renewed his Twitter attack on British ambassador to Washington Kim Darroch, whose unflattering reports on the White House had angered him. Trump also did not mince words in his tweeted references to outgoing British Prime Minister Theresa May. VOA’s Zlatica Hoke reports British officials have come to the defense of their ambassador.
 

The survival of wild animals such as elephants and tigers are at risk, and one of the main reasons is poaching. These animals are being hunted, even in protected wildlife parks, for their body parts such as elephants’ tusks and tigers’ skins. Park rangers may soon have a powerful tool to help fight poachers thanks to artificial intelligence. VOA’s Elizabeth Lee explains.

Smoke and soot from central Alaska wildfires have afflicted the subarctic city of Fairbanks with some of the world’s worst air pollution in recent days, forcing many residents indoors and prompting one hospital to set up a “clean air shelter.”

Fine particulate matter carried by smoke into the Fairbanks North Star Borough over the past two weeks has been measured at concentrations as high as more than double the minimum level deemed hazardous to human health, borough air quality manager Nick Czarnecki said.

The hazardous threshold was exceeded again on Tuesday in the Fairbanks suburb of North Pole, the borough reported.

The problem is mostly linked to two fires burning since June 21 on either side of the Fairbanks borough – Alaska’s second-most populous metropolitan area, totaling some 97,000 residents.

The Shovel Creek and Nugget fires, both sparked by lightning strikes, have scorched nearly 20,000 acres (8,094 hectares) of timber and brush combined, fire authorities said.

Farther north, the massive Hess Creek blaze, also sparked by lightning, has raged across nearly 173,000 acres (70,000 hectares) of remote timber and grasslands, making it the largest U.S. wildfire so far this year, according to fire command spokeswoman Sarah Wheeler.

Thick smoke drifting into Fairbanks has prompted air quality alerts warning that outdoor exertion is dangerous to health and urging the elderly, the very young and individuals with
respiratory problems to limit their exposure by staying indoors.

That restriction has proved difficult for some because few homes in Fairbanks, a city just 200 miles (322 km) south of the Arctic Circle by road, are equipped with air conditioning, and a heat wave in the region has driven temperatures into the 80s and 90s Fahrenheit.

Fairbanks Memorial Hospital has opened a round-the-clock clean-air room where members of the public can find respite from the pollution. A Fairbanks auto shop was also giving away breathing masks to help residents cope.

“All the HEPA filters and everything are sold out in town, and the smoke is terrible,” Pearson Auto employee Michelle Pippin said.

A similar but somewhat less dire predicament faced residents of Alaska’s largest city, Anchorage, about 350 miles (560 km) to the south, where smoke from a major fire raging for the past month in the neighboring Kenai National Wildlife Refuge has caused unhealthy air.

The Swan Lake blaze has charred nearly 97,000 acres (39,200 hectares) of the Kenai Peninsula since it was triggered by lightning on June 5.

Anchorage has also baked in unusually high temperatures, with three of its hottest days on record posted during the past week, including the city’s first-ever 90-degree Fahrenheit (32 Celsius) reading on July Fourth.

The record heat has only added to the general misery index in Alaska, where the National Interagency Fire Center reports about 40 large wildfires have burned more than 810,000 acres (32,780 hectares) across the state.

Wildfires have consumed more than 1 million acres (404,685 hectares) in all so far this year, but that pales in comparison with the record 6.5 million acres (2.6 million hectares) that went up in flames across Alaska in 2004.

Creditors holding Venezuelan debt on Tuesday pushed back on debt restructuring plans backed by opposition leader Juan Guaido, urging a “fair and effective” framework for talks and improved communications with investors holding defaulted bonds.

The main committee of Venezuela creditors said it opposed requests for a U.S. executive order that would prevent asset seizures by investors and disagreed with a proposal to give different treatment for debts to Russia and China.

But the statement added that restructuring would not begin until the end of a “humanitarian crisis,” in reference to the hyperinflationary collapse overseen by President Nicolas Maduro that has fueled malnutrition and disease.

“A new government should work with creditor parties, such as the Committee, to agree on the design of the restructuring process and to negotiate the financial and other terms of the restructuring,” the statement said.

Guaido in January cited articles of the constitution to assume an interim presidency after calling Maduro’s 2018 election a fraud, quickly winning recognition by more than 50 countries including the United States.

Maduro’s government, which continues to exercise power thanks to the loyalty of the military, has failed to pay creditors some $11.4 billion in principal and interest since 2017, according to the creditors.

Jose Ignacio Hernandez, Guaido’s overseas legal representative, did not immediately respond to a request for comment.

The committee opposed requests by Guaido and his allies for an executive order by the White House that would block creditors from seizing U.S. refiner Citgo, which is owned by state oil company PDVSA.

“An executive order issued by the US government that undermines good faith negotiations would not further the long-term interests of Venezuela or its stakeholders,” the statement said.

The committee also took exception to the idea that debts to Russia and China would be treated differently than others.

“It is critical that the burden placed on creditors must be equitably shared among all creditors, public and private,” the committee wrote.

U.S. and Chinese trade officials held a “constructive” phone conversation on Tuesday, White House economic adviser Larry Kudlow said, marking a new round of talks after the world’s two largest economies agreed to a truce in a year-long trade war.

U.S. Trade Representative Robert Lighthizer and Treasury Secretary Steven Mnuchin spoke with Chinese Vice Premier Liu He and Minister Zhong Shan on Tuesday in a further effort to resolve outstanding trade disputes between the countries, a U.S. official said earlier in an emailed statement.

Kudlow said the talks “went well” and were constructive. He said the two sides were talking about a face-to-face meeting, but warned that there was not a magic way to reach what has so far been an elusive deal.

“There are no miracles here,” Kudlow told reporters at the White House. “There was headway last winter and spring, then it stopped. Hopefully we can pick up where we left off, but I don’t know that yet.”

Trade talks stalled in May after China backed away from commitments it had made to secure legal changes to its system, according to U.S. officials.

Kudlow’s comments suggested it was still unclear whether the two sides would resume work from the draft text agreed before that pull-back, as U.S. officials want, or whether they will use a different starting point.

A face-to-face meeting between the two negotiating teams would be a good thing and could take place in Beijing, Kudlow said, but no details were available yet.

“Both sides will continue these talks as appropriate,” the separate U.S. official said in an email, declining to provide details on what was discussed and the next steps for talks.

The negotiations picked up after a two-month hiatus, but a year since a tit-for-tat tariff battle began between the two countries. Washington wants Beijing to address what U.S. officials see as decades of unfair and illegal trading practices.

The United States and China agreed during a Group of 20 nations summit in Japan last month to resume discussions, easing fears of an escalation. After meeting with Chinese President Xi Jinping at the G20, U.S. President Donald Trump agreed to suspend a new round of tariffs on $300 billion worth of imported Chinese consumer goods while the two sides resumed negotiations.

Trump said then that China would restart large purchases of U.S. agricultural commodities, and the United States would ease some export restrictions on Chinese telecom equipment giant Huawei Technologies.

“President Xi is expected, we hope in return for our accommodations, to move immediately, quickly, while the talks are going on, on the agriculture (purchases),” Kudlow said on Tuesday at an event hosted by CNBC. “That’s very, very important.”

He also said relaxed U.S. government restrictions on Huawei could help the technology giant but would only be in place for a limited time.

Kudlow, the director of the White House’s National Economic Council, later told reporters there was no specific timeline for the agricultural buys, or for reaching an agreement. “No timeline. Quality not speed,” he added.

Three sources familiar with the state of the talks said the Chinese side did not make firm commitments for immediate purchases. It’s unclear that the two sides’ differences have narrowed, even as the discussions resume.

The sister of Saudi Arabia’s Crown Prince Mohammed bin Salman went on trial Tuesday in Paris over the alleged beating of a workman at her family’s apartment.

Princess Hassa bint Salman is accused of ordering her bodyguard to beat an Egyptian workman after he was seen taking a photograph inside the home on Paris’ exclusive Avenue Foch in 2016.

According to the indictment, the workman Ashraf Eid told police that he took a picture of the bathroom where he was working so he he could remember where items were placed before he started. 

The princess reportedly accused him of taking the photo in order to sell the image of the toney home. 

Eid told police the bodyguard bound his hands, punched and kicked him, and forced him to kiss the princess’ feet.  

The bodyguard was held by police but the princess left France soon after the incident. France issued a warrant for her arrest in December 2017. 

The bodyguard told the court Tuesday: “When I heard the princess shouting for help, I got there and saw them grasping the phone with their hands.”

“I seized [him] and overpowered him, I didn’t know what he was after,” he said, according to AFP.

The princess’ lawyers have said she is the victim of false accusations. “The princess is a caring, humble, approachable and cultured woman,” her lawyer, Emmanuel Moyne, said before the trial began.

The Saudi crown prince was under the media spotlight recently for his alleged involvement in the murder of dissident writer Jamal Khashoggi.

Agnes Callamard, a United Nations special rapporteur on extrajudicial executions, said in a report released last month that there was “credible evidence” linking the crown prince to the strangulation and dismemberment of Khashoggi inside the Saudi consulate in Istanbul.

Growing potatoes and carrots high in the wind-swept mountains of western Venezuela had always proven a challenge for Luis Villamizar.

But as oil production in the South American country has collapsed under years of mismanagement and U.S. sanctions, many in the industry are confronting another hardship: Fuel shortages.

“Nobody’s going to eat this. It’s a loss for sure, said Villamizar, 53, as he dug up potatoes darkened with spots from a damaging infestation. “Who’s going to buy these? This won’t do.”

He’s not alone. Across Venezuela, crops are spoiling in the fields – at a time of unprecedented hunger – as farmers become the latest casualty of the nation’s deepening crisis.

Without a dependable supply of gasoline, critical shipments of pesticides have been entirely cut off, basic equipment has become impossible to operate, field workers cannot be bussed in and crops aren’t arriving at markets – further jeopardizing an already shaky sector in a country that has seen a whopping 10% of the population emigrate.

Oil output has reached record lows, with state run company PDVSA estimated to be producing at 10 to 15% of its capacity. Gasoline is dirt cheap at filling stations, but hard to find – driving the black market price for a 5.3 gallon (20 liter) container up to $100 in remote mountain communities. Many motorists have also grown accustomed to waiting days to fill up their cars or doing without any at all.

Critics blame the downfall on corruption after two decades of socialist rule, while embattled President Nicolas Maduro blames U.S. sanctions that were implemented against PDVSA this year to pressure him from office and put opposition leader Juan Guaido in charge.

In the middle are the nation’s farmers.

While the nation boasts the world’s largest reserves of oil, agriculture and related industries in Venezuela still account for a critical sliver of the country’s GDP, which has shrunk by more than 70% since 2012. In rural places like the western state of Tachira, many manage to eke out livelihoods by tending to crops such as potatoes, carrots, onions, tomatoes and peppers.

The lack of fuel is driving the industry toward collapse.

Robert Maldonado, a sweet pepper famer and outspoken community leader, represents roughly 1,500 farmers across the rural stretch traversed by the Andes, where the highest peak rises to nearly 12,800 feet (3,900 meters) above sea level.

In the past, produce ranging from cabbage to bananas was sent to markets and kitchens across Venezuela.

These days, Maldonado says the price of fuel has eaten up profits and made it impossible for farmers to feed themselves – let alone supply a country where hunger and hyperinflation run rampant. According to survey results published by three of the country’s most prominent universities, six in 10 Venezuelans said they lost weight, an average of 24 pounds (11 kilograms), between 2017 and 2018. Last year, inflation topped 1 million percent.

“We’re quite worried that in three or four months the production will collapse by more than half,” Maldonado said.

Ricardo Hausmann, a Harvard University economist and former Venezuelan planning minister who is now an opposition figure, estimates that Venezuela’s farming output is down 90 percent from its 2005-2007 average, with fuel shortages adding to the blow.

“The planted area is the smallest we’ve seen in decades,” he said, calling it a “systemic collapse” of a supply chain for the sector – including shortages of seed, fertilizer and spare parts for tractors.

Before the oil boom started in Venezuela nearly a century ago, agriculture, forestry, and fishing made up more than 50 percent of GDP. In the 1930s farms provided 60 percent of the nation’s jobs.

This landscape began to dramatically change in the 1970s as the petro state took off, and today agriculture makes up a smaller portion of the economy than in any other country in Latin America. As farms declined, the government used its oil windfall to import food.

In the years following the 2010 government takeover of private agricultural company Agroislena, farmers had hunted for everything from seeds to pesticides – or even traveled to neighboring Colombia to secure supplies – in order to sustain production.

Rarely though, had crops spoiled, tractors sat idle and fields left completely fallow.

Villamizar, who has a tanned face and rough hands from years of toiling outside, still farms a small patch of land in the rugged mountains his family has tended for generations and said his last harvest of 14 60-kilogram (132 pound) potato sacks rotted before he could send it into town.

Fellow farmer Hauchy Pereira estimated he would lose 6 tons of onions since the transportation of his seedlings from greenhouses to open fields was delayed.

Pereira said a farming collective overseen by a general had given him a pass to fill up his truck in two months’ time, but his onion sprouts were already wilting.

“If you have the harvest and there’s no gas, you can’t sell it,” the 34-year-old said. “There is no way to transport it without fuel.”