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Video: Watch Live: House Advances With Second Indictment

On Wednesday, the House of Representatives will consider articles of impeachment against President Trump, accusing him of “inciting insurgency” after the Jan.6 attacks on Capitol Hill. By Associated Press.

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Advances in Kidney Care Begin at Home

In January, there might be a lot more people like Mary Prochaska.

Ms Prochaska, 73, a retired social worker from Chapel Hill, NC, has advanced chronic kidney disease and relies on dialysis to filter waste from her blood while waiting for a kidney transplant, her second. But she no longer goes to a dialysis center three times a week, the standard treatment. There, nurses and technicians watched her for four hours while a machine cleaned her blood.

Instead, she opted for home dialysis. “It’s easier on your body and better for your health,” she says. “And much better than exposing yourself to anything you could get by being in a group of people” in a center during a pandemic.

With the help of her husband, Mrs. Prochaska performs peritoneal dialysis; after a surgeon implants a tube in his side, his abdominal lining acts as a filter. After training for a few weeks, she began using a household machine called a cycler to remove excess fluid and impurities.

“It automatically does the pumping and pumping, five times a night, while you sleep,” she says. “When you get up, you are done. It’s like having a normal life.

So far its only unpleasant side effect is fatigue, sometimes requiring afternoon rest. A company called TruBlu Logistics provides the solution cases, tubes and other supplies, and Medicare covers the costs, which are considerably lower than in-center dialysis.

In 2017, according to the United States Renal Data System, 14.5% of Medicare beneficiaries suffered from chronic kidney disease, from 10.5% of people aged 65 to 74 to almost a quarter of people over the age of. 85 years old. Almost half of the dialysis patients were older. over 65.

For decades, health advocates and many nephrologists have encouraged more patients to consider home dialysis. But that year, of 124,500 patients with newly diagnosed advanced kidney disease (also known as end-stage kidney disease), only 10% started peritoneal dialysis the way Ms. Prochaska did.

Another 2 percent switched to home hemodialysis, removing waste with machines adapted from those used in the centers.

All of the other dialysis beginners have gone to a dialysis center, possibly owned by one of the two industry-leading companies, DaVita or Fresenius.

This fall, however, Medicare announced a mandatory program designed to transform that system, covering about 30% of beneficiaries with advanced chronic kidney disease, or nearly 400,000 people. Starting Jan. 1, it will use payment premiums – and later, penalties – to try to increase the proportion of patients using home dialysis and receiving transplants.

Even experts with no love for outgoing administration have called this approach the most significant change for kidney patients since 1972, when Richard M. Nixon signed a law providing Medicare coverage for people with kidney disease, whatever their age.

“It’s bold,” said Richard Knight, transplant recipient and president of the American Association of Kidney Patients. “There are a lot of incentives for providers to do things they haven’t done traditionally.”

“I think it’s going to have a really profound impact on kidney care,” said Dr. Abhijit Kshirsagar, nephrologist and director of the dialysis program at the University of North Carolina.

Studies have shown that dialysis patients at home report a greater sense of independence and autonomy, with more flexible hours that make work or travel easier. They benefit from a better quality of life. So why do so few choose it?

Some patients start dialysis when a health crisis sends them to the emergency room. With little time to explore the decision or take the necessary training for home dialysis, they end up in the centers.

But many don’t seem to know they have alternatives. In a 2016 study, almost half of patients on center hemodialysis said it was not their choice.

“There are some patients who don’t know they might have dialysis at home,” said Dr. Suzanne Watnick, chief medical officer of Northwest Kidney Centers in Seattle. “For me, it’s a parody. Patients who have received training on the different modalities have a significantly higher rate of participation in home dialysis. “

But the training doctors receive may not focus on this option. Also, once patients get used to a center, “where everything is done for you, you probably won’t take the responsibility of doing it at home,” said Knight. Home dialysis can seem daunting or scary, and neither doctor’s offices nor for-profit centers have had much motivation, at least financially, to promote it.

Thirty percent of them will soon. Medicare will increase its monthly payments for each patient who receives dialysis at home, starting at 3% in the first year and then decreasing thereafter. Dialysis practices and clinics will also have their reimbursements adjusted up or down based on their total dialysis and home transplant rates.

Several new voluntary programs will also boost incentives. Beginning in April, Medicare will pay providers a premium of $ 15,000, over three years, when a patient receives a successful kidney transplant. Another measure provides greater support for living kidney donors.

Whether these incentives will significantly increase home dialysis and transplants remains an open question.

Some providers, noting that the penalties might outweigh the bonuses, are not happy to fall into the 30% of covered practices or centers, randomly assigned by zip code. “The average nephrologist is going to have a pay cut,” said Dr. Watnick.

In addition, not all elderly kidney patients can or want to have dialysis at home. “They may have some degree of cognitive impairment” or be too fragile to lift bags of solution, said Dr. Gerald Hladik, chief of nephrology at the University of North Carolina. They need space to store supplies and a clean, private dialysis space.

Even with a lot of discussion and education, it is not clear what proportion might possibly choose home dialysis. Maybe 25 to 50 percent, suggested Dr Watnick – “but we don’t know.”

While the new Medicare model excludes nursing home residents and people with dementia, the choice will otherwise be up to patients. Particularly during a pandemic, “we support that patients have the choice to go home,” said Knight. “But not in favor of pushing people to go home.”

Some older people with multiple illnesses may decide to forgo dialysis altogether. Wherever it is practiced, it is physically and psychologically expensive, and survival decreases in old age.

Dr Hladik’s 75-year-old father, for example, wanted to spend his last days at home with his dog or at the beach. He chose conservative management to control his symptoms and lived comfortably for a year and a half without dialysis.

But home dialysis has worked well for Jorge Moreira, 65, an accountant in Burien, Was. As his kidney disease progressed four years ago, he began dialysis at a clinic in the North West Kidney Centers.

He found it difficult to arrive at 5:30 a.m. three days a week so that he could finish at 9:30 a.m. and get to his office, and he suffered from painful leg cramps. A technician suggested that she look into peritoneal dialysis; his doctors agreed.

The first few months were tough, said Mr Moreira, learning the manual technique, dialysis four times a day. Then, like Ms. Prochaska, he switched to a cycler and now swaps fluids overnight. It’s simpler, he says, and suits his busy life; he walks and rides a mountain bike and serves as a pastor.

“I have more time for myself, my family, my business,” he says. “I have more strength. I sleep very well. I feel good.”

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Stacey Abrams draws credit and praise as Biden advances to Georgia.

Stacey Abrams, who was on a short list of potential vice presidential candidates earlier this year, was ultimately not picked by Joseph R. Biden Jr. But on Friday, as Mr Biden took a narrow lead in Georgia , it was Mrs. Abrams. which was celebrated, a sign of his remarkable rise as a power broker since his failed bid for governor of that state two years ago.

Celebrities, activists and voters across Georgia have given Ms Abrams credit for moving past her loss – she came within 55,000 votes from the Governor’s Mansion – and building a well-funded network of organizations that highlighted voter suppression in the state and inspired around 800,000 residents to register to vote.

“You have to build the infrastructure to organize and motivate your base, and you have to persuade people,” said Jason Carter, a Democrat who was the party’s candidate for governor in 2014. “Stacey built that infrastructure, and Donald Trump’s presidency has energized this infrastructure, and it has opened up voters to persuasion that was previously not open, especially in the suburbs.

Mr. Biden edged out President Trump in Georgia, a state that hasn’t elected a Democratic presidential candidate for nearly three decades, and maintained a slight lead throughout Friday. He was up about 4,100 votes by Friday night with over 98 percent of the ballots counted. Due to the small margin, the Secretary of State confirmed that there would be a recount.

Still, state Democrats were jubilant.

Ms Abrams declined to comment on Friday. But in a Tweeter, she wrote: “My heart is full.” And she cited the work of other activists. “Georgia, let’s cry out for those who have been in the trenches and deserve the applause for change.”

If Mr Biden maintains his slim lead in Georgia, his profile is likely to grow.

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Stacey Abrams draws credit and praise as Biden advances to Georgia.

Stacey Abrams, who was on a short list of potential vice presidential candidates earlier this year, was ultimately not picked by Joseph R. Biden Jr. But on Friday, as Mr Biden took a narrow lead in Georgia , it was Mrs. Abrams. which was celebrated, a sign of his remarkable rise as a power broker since his failed bid for governor of that state two years ago.

Celebrities, activists and voters across Georgia have given Ms Abrams credit for moving past her loss – she came within 55,000 votes from the Governor’s Mansion – and building a well-funded network of organizations that highlighted voter suppression in the state and inspired around 800,000 residents to register to vote.

“You have to build the infrastructure to organize and motivate your base, and you have to persuade people,” said Jason Carter, a Democrat who was the party’s candidate for governor in 2014. “Stacey built that infrastructure, and Donald Trump’s presidency has energized this infrastructure, and it has opened up voters to persuasion that was previously not open, especially in the suburbs.

Mr. Biden edged out President Trump in Georgia, a state that hasn’t elected a Democratic presidential candidate for nearly three decades, and maintained a slight lead throughout Friday. He was up about 4,100 votes by Friday night with over 98 percent of the ballots counted. Due to the small margin, the Secretary of State confirmed that there would be a recount.

Still, state Democrats were jubilant.

Ms Abrams declined to comment on Friday. But in a Tweeter, she wrote: “My heart is full.” And she cited the work of other activists. “Georgia, let’s cry out for those who have been in the trenches and deserve the applause for change.”

If Mr Biden maintains his slim lead in Georgia, his profile is likely to grow.

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As Biden advances in Georgia, Stacey Abrams attracts recognition and praise

Not everyone celebrates Ms. Abrams. Lee Morris, a Republican who serves as county commissioner for Fulton County, home of Atlanta, said he viewed Ms. Abrams, a fiery orator, as a “divisive”, drawing a comparison between her and Mr. Trump.

“Just as President Trump’s allegations of cheating and bribery inflamed the right-wing side, his efforts certainly sparked people’s enthusiasm to come out and vote,” Morris said in an interview on Friday. That said, while Mr. Trump’s false claims about rigged elections and widespread cheating are unfounded, Georgia has a long documented history of voter suppression, especially among voters of color.

Ms Abrams has occasionally clashed with members of her own party, who have criticized her categorical ambition and open desire to be Mr Biden’s running mate. In the south, where black politicians are united and traditional, Ms. Abrams has also been a disruptive force. His political vision may be at odds with the local Democratic establishment, and his shot at national notoriety has ruffled feathers.

The political fallout from Mr Biden’s breakthrough in Georgia, however, could ease those tensions. The playbook she popularized took root – a combination of reclaiming subway suburbs and registering new voters in black, Latin American and Asian American communities.

Nse Ufot, the current chief executive of the New Georgia Project, said election campaigns are often too short-sighted to do the long-term job of registering and educating new voters, regardless of their affiliation with a left.

“When you think about the transactional nature of election campaigns, I think they prioritize getting people who are already voters to vote for them,” Ms. Ufot said, adding that there was “not enough conversation about the 100 million Americans eligible to vote. who did not vote in 2016. ”

Astead Herndon contributed reporting.

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Stacey Abrams draws credit and praise as Biden advances to Georgia.

If Joseph R. Biden Jr. manages to maintain his slim lead in Georgia, he has one person to thank first and foremost, according to many Democrats and local officials: Stacey Abrams.

Ms Abrams, a former Yale-trained state party official, spent nearly a decade rebuilding the multiracial coalition for the franchise that sparked the civil rights movement of the 1960s and pushed a once-dominated state by white conservatives in a more diverse era.

More than that, Ms Abrams, the former Georgia House Minority Leader who was briefly seen as a possible running mate by Mr Biden, is increasingly seen as the new torchbearer of the movement embodied by two iconic Georgians: Martin Luther King Jr and Representative John Lewis. Mr Biden’s push cemented that.

“This American citizen would like to thank you from the bottom of her heart !!” actress Viola Davis wrote to Ms Abrams on Twitter Friday.

After Ms Abrams sent a tweet thanking voting rights activists in Georgia, Hillary clinton responded, “And THANKS, Stacey. Thank you.”

“What time is the Stacey Abrams parade?” wrote Lisa Lucas, an editor-in-chief, reflecting the views of black political and business leaders who believe Ms. Abrams deserves much of the credit for record-breaking participation in communities of color across the country.

Seven years ago, while still in the state legislature, Ms. Abrams founded the New Georgia Project, a nonprofit that registered around 100,000 new voters and then created Fair Fight. , an organization to fight against voter suppression.

In 2018, Ms Abrams became the first black woman to win the Democratic nomination for governor and lost in a close race to Republican Brian Kemp, amid allegations that Republicans had taken steps to suppress the black votes by purging the electoral rolls.

After losing 55,000 votes, Ms Abrams told Vogue, “I sat in Shiva for 10 days. Then I started to plot ”- a joking reference to the period of Jewish mourning.

Since her loss, Ms. Abrams has helped register approximately 800,000 new voters and fought the “exact match” rules used to disqualify ballots for typos and minor errors. Ms Abrams was hardly alone in this effort, joining a coalition that included voting groups like ProGeorgia, the Georgia Coalition for the People’s Agenda and Project New Georgia.

But Ms. Abrams, a powerful public speaker, has become the face of that effort.

Some of President Trump’s supporters, led by Fox News contributor Byron York, criticized Ms Abrams for her refusal to formally concede the 2018 election, arguing that her behavior had set a precedent for Mr Trump’s refusal to accept 2020 results.

“In light of Biden’s pull in Georgia, a lot of Democratic praise for Stacey Abrams. Indeed, his conduct in the 2018 governor’s race could become a model for Trump’s post-election stance, ”he wrote.

But there are critical differences. Ms Abrams never conceded, but gave a speech announcing the end of her campaign and then moved on – concluding: ‘Democracy has failed the Georgians’.