Group items tagged

Even considering patients like mine as recipients of new lungs represents a paradigm shift. A lung transplant is an arduous procedure, one that a very frail patient has little hope of surviving. And given that lung transplant programs are evaluated based on one-year mortality, they have a disincentive to take a chance on sicker patients.

When asked whether they want to receive a transplant after considering all the implications, many will say yes. But others say no.

He is not alone.

But a larger second wave is coming, this time of coronavirus survivors who have made it out of the hospital but are left with lungs that are irrevocably scarred.

Moving forward, this means that we will need to educate doctors in the community, outside of large academic centers, who simply might not think of post-Covid patients as candidates for transplants.

No one can survive the physical and emotional toll of transplant without assistance, especially in the first year. But not everyone is lucky enough to have people who can commit to helping with medications and appointments. Will we choose not to list someone whose family members live in a different state? How about a patient who would be an ideal candidate but simply lives an isolated existence?

Even as we prepare for this next wave, my 61-year-old patient and his family continue to wait. Standing at his bedside, I am struck by the reality that if his son had not pushed for him to be transferred to a hospital that would consider him a potential transplant candidate, if we did not have access to the machine that could make it possible to reach that goal, he surely would have died.

“If we look up at the mountain, we grow overwhelmed and feel that we are going to fail,” he tells them. “So we don’t worry about the peak. We focus on the individual steps. There is still no guarantee. But we’re going to attempt. That’s all we can do.”

It’s working and it looks normal. We are thrilled, but we don’t know what tomorrow will bring us. This has never been done before

Last year, some 41,354 Americans received a transplanted organ, more than half of them receiving kidneys,

But there is an acute shortage of organs, and about a dozen people on the lists die each day. Some 3,817 Americans received human donor hearts last year as replacements, more than ever before, but the potential demand is still higher.

Researchers hope procedures like this will usher in a new era in medicine in the future when replacement organs are no longer in short supply for the more than half a million Americans who are waiting for kidneys and other organs.

He is also being monitored for infections, including porcine retrovirus, a pig virus that may be transmitted to humans, although the risk is considered low.

But he added that there were many hurdles to overcome before such a procedure could be broadly applied, noting that rejection of organs occurs even when a well-matched human donor kidney is transplanted.

It takes a long time to mature a therapy like this.”

Mr. Bennett decided to gamble on the experimental treatment because he would have died without a new heart, had exhausted other treatments and was too sick to qualify for a human donor heart, family members and doctors said.

Mr. Bennett is still connected to a heart-lung bypass machine, which was keeping him alive before the operation, but that is not unusual for a new heart transplant recipient, experts said.

The new heart is functioning and already doing most of the work, and his doctors said he could be taken off the machine on Tuesday. Mr. Bennett is being closely monitored for signs that his body is rejecting the new organ, but the first 48 hours, which are critical, passed without incident.

It is the first successful transplant of a pig’s heart into a human being. The eight-hour operation took place in Baltimore on Friday, and the patient, David Bennett Sr. of Maryland, was doing well on Monday, according to surgeons at the University of Maryland Medical Center.

Xenotransplantation, the process of grafting or transplanting organs or tissues from animals to humans, has a long history. Efforts to use the blood and skin of animals go back hundreds of years.

In the 1960s, chimpanzee kidneys were transplanted into some human patients, but the longest a recipient lived was nine months.

In 1983, a baboon heart was transplanted into an infant known as Baby Fae, but she died 20 days later.

Two newer technologies — gene editing and cloning — have yielded genetically altered pig organs less likely to be rejected by humans.

the time to carry out better screening for infectious diseases, and the possibility of a new organ at the time that the patient needs it.

The heart transplanted into Mr. Bennett came from a genetically altered pig provided by Revivicor, a regenerative medicine company based in Blacksburg, Va.

The pig had 10 genetic modifications. Four genes were knocked out, or inactivated, including one that encodes a molecule that causes an aggressive human rejection response.

A growth gene was also inactivated to prevent the pig’s heart from continuing to grow after it was implanted,

In addition, six human genes were inserted into the genome of the donor pig — modifications designed to make the porcine organs more tolerable to the human immune system.

The team used a new experimental drug developed in part by Dr. Mohiuddin and made by Kiniksa Pharmaceuticals to suppress the immune system and prevent rejection.

“The anatomy was a little squirrelly, and we had a few moments of ‘uh-oh’ and had to do some clever plastic surgery to make everything fit,”

“the heart fired right up” and “the animal heart began to squeeze.”

He said his father had had a pig’s valve inserted about a decade ago, and he thought his father might be confused. But after a while, Mr. Bennett said, “I realized, ‘Man, he is telling the truth and not going crazy. And he could be the first ever.’”

ey might eventually grow human organs in such animals for transplantation.

Another concern is that using human cells in this way could produce animals that have human sperm or eggs.

The notion of using organs from animals for transplants has also long raised concerns about spreading viruses from animals to humans. So, if the current research comes to fruition, steps would have to be taken to reduce that infection risk, scientists said, such as carefully sequestering animals used for that purpose and screening any organs used for transplantation.

Doctors and forensic scientists have long known that certain medical procedures turn people into chimeras, but where exactly a donor’s DNA shows up — beyond blood — has rarely been studied with criminal applications in mind.

The average doctor does not need to know where a donor’s DNA will present itself within a patient. That’s because this type of chimerism is not likely to be harmful. Nor should it change a person. “Their brain and their personality should remain the same,”

for a forensic scientist, it’s a different story. The assumption among criminal investigators as they gather DNA evidence from a crime scene is that each victim and each perpetrator leaves behind a single identifying code — not two

In 2004, investigators in Alaska uploaded a DNA profile extracted from semen to a criminal DNA database. It matched a potential suspect. But there was a problem: The man had been in prison at the time of the assault. It turned out that he had received a bone marrow transplant. The donor, his brother, was eventually convicted.

she heard about another disconcerting scenario since then. It involved police investigators who were skeptical of a sexual assault victim’s account because she said there had been one attacker, though DNA analysis showed two. Eventually the police determined that the second profile had come from her bone marrow donor.

In 2008, he was trying to identify the victim of a traffic accident for the National Forensic Service in Seoul, South Korea. Blood showed that the individual was female. But the body appeared to be male, which was confirmed by DNA in a kidney, but not in the spleen or the lung, which contained male and female DNA. Eventually, he figured out that the victim had received a bone marrow transplant from his daughter.

Fraternal twins sometimes acquire each other’s DNA in the womb; in at least one case that led to unfounded fears of infidelity when a man’s child did not seem to be his. In another case, a mother nearly lost custody of her children after a DNA test.

The pandemic exposed society’s ageism and ableism, with many people in the beginning months arguing that only the sick and the elderly were at risk.

After a year of remote working, it’s clear that my privileged, overwhelmingly liberal corner of the world is able to accommodate the vulnerable and organize inclusive events.

Two colleges, St. Edward's University in Austin, Texas, and Nova Southeastern University (NSU) in Broward, Florida, have gone a step further, requiring students and all campus employees to be vaccinated.

After NSU's announcement on April 1 DeSantis signed an executive order stating that vaccines are available but not mandated. Crucially the order prohibits any government entity or business from requiring a vaccine passport. NSU said Thursday that it is reviewing the executive order.

A Japanese woman whose lungs were severely damaged by Covid-19 has received what doctors say is the world's first lung transplant from living donors to a recovered coronavirus patient.

UK and EU regulators have reported a "possible link" between AstraZeneca's Covid-19 vaccine and "very rare" blood clot cases

The EMA can't be sure, for example, that women are not experiencing these clotting events in higher numbers simply because more women are being vaccinated.

Women are more predisposed to certain clotting events, such as cerebral venous sinus thrombosis, clotting in the sinuses that drain blood from the brain, than men.

Vaccine passports are a divisive subject and DeSantis has plenty of company in opposing them. Texas Republican Gov. Greg Abbott has signed an executive order forbidding agencies in the state from requiring a vaccine for any service and Idaho Gov. Brad Little signed a similar order on Wednesday

The woman, who is from Japan's western region of Kansai, contracted Covid-19 late last year, and spent months on a life support machine that worked as an artificial lung. She remains in intensive care and her husband and son are both in a stable condition.

But Australia said Friday that it had secured an extra 20 million doses of the Pfizer shot, after declaring it preferable to the AstraZeneca vaccine for recipients under 50.

Spain also updated its guidance for the AstraZeneca vaccine on Thursday, announcing it will only be given to people aged between 60 and 69, while Portugal recommended the shot for those 60 and older.

The African Union is dropping plans to buy additional doses of AstraZeneca's vaccine and will instead focus on securing further doses from Johnson & Johnson. The organization says the decision is unrelated to recent safety concerns over the shot.

KFF researchers surveyed 1,001 adults living in rural America and reported that 54% said they have received a Covid-19 vaccine or plan to. "There's nothing inherently unique about living in a rural area that makes people balk at getting vaccinated," KFF President and CEO Drew Altman said in a statement.

Black respondents were less likely than their White or Hispanic counterparts to report adequate supply of vaccine doses or vaccine sites in their communities.

The number of Johnson & Johnson shots allocated by the US government to states and other jurisdictions is expected to drop 84% next week, according to data from the Centers for Disease Control and Prevention (CDC), in a major setback for state rollouts.

It was clear to many that Ann believed Barry, in particular, was unusually gifted. She would boast about his brains, his achievements, how brave he was. Benji Bennington, a friend of Ann’s from Hawaii, told me, “Sometimes when she talked about Barack, she’d say, ‘Well, my son is so bright, he can do anything he ever wants in the world, even be president of the United States.’ I re­member her saying that.” Samardal Manan, who taught with Ann in Jakarta, remembered Ann saying something similar — that Barry could be, or perhaps wanted to be, the first black president.

Indonesian schools in the late 1960s and early 1970s were inadequate; there were not enough of them, the government controlled the curriculum, teach­ers were poorly trained. Westerners sent their children to the Jakarta International School, but it was expensive and difficult to get into. Obama attended two Indonesian schools, one Catholic and one Muslim. The experience cannot have failed to have left a mark. The Java­nese, especially the Central Javanese, place an enormous emphasis on self-control. Even to sneeze was to exhibit an untoward lack of self-control, said Michael Dove, who got to know Ann when they were both anthropologists working in Java in the 1980s. “You demonstrate an inner strength by not betraying emotion, not speaking loudly, not moving jerkily,” he said. Self-control is inculcated through a culture of teasing, Kay Ikrana­gara told me. Her husband, known only as Ikrana­gara, said, “People tease about skin color all the time.” If a child allows the teasing to bother him, he is teased more. If he ignores it, it stops. “Our ambassador said this was where Barack learned to be cool,” Kay told me. “If you get mad and react, you lose. If you learn to laugh and take it without any reaction, you win.”

“She had always encouraged my rapid acculturation in Indone­sia,” he wrote in his memoir. “It had made me relatively self-sufficient, undemanding on a tight budget, and extremely well mannered when compared with other American children. She had taught me to disdain the blend of ignorance and arrogance that too often character­ized Americans abroad. But she now had learned, just as Lolo had learned, the chasm that separated the life chances of an American from those of an Indonesian. She knew which side of the divide she wanted her child to be on. I was an American, she decided, and my true life lay elsewhere.”

Ann uprooted Barry, at age 6, and transplanted him to Jakarta. Now she was up­rooting him again, at barely 10, and sending him back, alone. She would follow him to Hawaii only to leave him again, less than three years later. When we spoke last July, Obama recalled those serial displacements. “I think that was harder on a 10-year-old boy than he’d care to admit at the time,” Obama said, sitting in a chair in the Oval Of­fice and speaking about his mother with a mix of affection and critical distance. “When we were separated again during high school, at that point I was old enough to say, ‘This is my choice, my decision.’ But being a parent now and looking back at that, I could see — you know what? — that would be hard on a kid.”

he did not, he said, hold his mother’s choices against her. Part of being an adult is seeing your parents “as people who have their own strengths, weaknesses, quirks, longings.” He did not believe, he said, that parents served their children well by being unhappy. If his mother had cramped her spirit, it would not have given him a happier childhood. As it was, she gave him the single most important gift a parent can give — “a sense of un­conditional love that was big enough that, with all the surface dis­turbances of our lives, it sustained me, entirely.”

“It’s a project for a generation; it’s going to take till 2040 or 2050, and it’s hard,” said Gerd Rosenkranz, a former journalist at Der Spiegel who’s now an analyst at Agora Energiewende, a Berlin think tank. “It’s making electricity more expensive for individual consumers. And still, if you ask people in a poll, Do you want the energiewende? then 90 percent say yes.”

The Germans have an origin myth: It says they came from the dark and impenetrable heart of the forest

. The forest became the place where Germans go to restore their souls—a habit that predisposed them to care about the environment.

So in the late 1970s, when fossil fuel emissions were blamed for killing German forests with acid rain, the outrage was nationwide. The oil embargo of 1973 had already made Germans, who have very little oil and gas of their own, think about energy. The threat ofwaldsterben, or forest death, made them think harder.

I came away thinking there would have been no energiewende at all without antinuclear sentiment—the fear of meltdown is a much more powerful and immediate motive than the fear of slowly rising temperatures and seas.

energy researcher Volker Quaschning put it this way: “Nuclear power affects me personally. Climate change affects my kids. That’s the difference.”

NG STAFF; EVAN APP

Demonstrators in the 1970s and ’80s were protesting not just nuclear reactors but plans to deploy American nuclear missiles in West Germany. The two didn’t seem separable. When the German Green Party was founded in 1980, pacifism and opposition to nuclear power were both central tenets.

Chernobyl was a watershed.

The environmental movement’s biggest mistake has been to say, ‘Do less. Tighten your belts. Consume less,’ ” Fell said. “People associate that with a lower quality of life. ‘Do things differently, with cheap, renewable electricity’—that’s the message.”

It was 1990, the year Germany was officially reunified—and while the country was preoccupied with that monumental task, a bill boosting the energiewende made its way through the Bundestag without much public notice. Just two pages long, it enshrined a crucial principle: Producers of renewable electricity had the right to feed into the grid, and utilities had to pay them a “feed-in tariff.” Wind turbines began to sprout in the windy north.

The biogas, the solar panels that cover many roofs, and especially the wind turbines allow Wildpoldsried to produce nearly five times as much electricity as it consumes.

In a recent essay William Nordhaus, a Yale economist who has spent decades studying the problem of addressing climate change, identified what he considers its essence: free riders. Because it’s a global problem, and doing something is costly, every country has an incentive to do nothing and hope that others will act. While most countries have been free riders, Germany has behaved differently: It has ridden out ahead. And in so doing, it has made the journey easier for the rest of us.

Fell’s law, then, helped drive down the cost of solar and wind, making them competitive in many regions with fossil fuels. One sign of that: Germany’s tariff for large new solar facilities has fallen from 50 euro cents a kilowatt-hour to less than 10. “We’ve created a completely new situation in 15 years

Germans paid for this success not through taxes but through a renewable-energy surcharge on their electricity bills. This year the surcharge is 6.17 euro cents per kilowatt-hour, which for the average customer amounts to about 18 euros a month—a hardship for some

The German economy as a whole devotes about as much of its gross national product to electricity as it did in 1991.

Ideally, to reduce emissions, Germany should replace lignite with gas. But as renewables have flooded the grid, something else has happened: On the wholesale market where contracts to deliver electricity are bought and sold, the price of electricity has plummeted, such that gas-fired power plants and sometimes even plants burning hard coal are priced out of the market.

Old lignite-fired power plants are rattling along at full steam, 24/7, while modern gas-fired plants with half the emissions are standing idle.

“Of course we have to find a track to get rid of our coal—it’s very obvious,” said Jochen Flasbarth, state secretary in the environment ministry. “But it’s quite difficult. We are not a very resource-rich country, and the one resource we have is lignite.”

Vattenfall formally inaugurated its first German North Sea wind park, an 80-turbine project called DanTysk that lies some 50 miles offshore. The ceremony in a Hamburg ballroom was a happy occasion for the city of Munich too. Its municipal utility, Stadtwerke München, owns 49 percent of the project. As a result Munich now produces enough renewable electricity to supply its households, subway, and tram lines. By 2025 it plans to meet all of its demand with renewables.

Last spring Gabriel proposed a special emissions levy on old, inefficient coal plants; he soon had 15,000 miners and power plant workers, encouraged by their employers, demonstrating outside his ministry. In July the government backed down. Instead of taxing the utilities, it said it would pay them to shut down a few coal plants—achieving only half the planned emissions savings. For the energiewende to succeed, Germany will have to do much more.

The government’s goal is to have a million electric cars on the road by 2020; so far there are about 40,000. The basic problem is that the cars are still too expensive for most Germans, and the government hasn’t offered serious incentives to buy them—it hasn’t done for transportation what Fell’s law did for electricity.

“The strategy has always been to modernize old buildings in such a way that they use almost no energy and cover what they do use with renewables,” said Matthias Sandrock, a researcher at the Hamburg Institute. “That’s the strategy, but it’s not working. A lot is being done, but not enough.”

All over Germany, old buildings are being wrapped in six inches of foam insulation and refitted with modern windows. Low-interest loans from the bank that helped rebuild the war-torn west with Marshall Plan funds pay for many projects. Just one percent of the stock is being renovated every year, though

For all buildings to be nearly climate neutral by 2050—the official goal—the rate would need to double at least.

here’s the thing about the Germans: They knew the energiewende was never going to be a walk in the forest, and yet they set out on it. What can we learn from them? We can’t transplant their desire to reject nuclear power. We can’t appropriate their experience of two great nation-changing projects—rebuilding their country when it seemed impossible, 70 years ago, and reunifying their country when it seemed forever divided, 25 years ago. But we can be inspired to think that the energiewende might be possible for other countries too.

At the peak of the boom, in 2012, 7.6 gigawatts of PV panels were installed in Germany in a single year—the equivalent, when the sun is shining, of seven nuclear plants. A German solar-panel industry blossomed, until it was undercut by lower-cost manufacturers in China—which took the boom worldwide

Curtailing its use is made harder by the fact that Germany’s big utilities have been losing money lately—because of the energiewende, they say; because of their failure to adapt to the energiewende, say their critics. E.ON, the largest utility, which owns Grafenrheinfeld and many other plants, declared a loss of more than three billion euros last year.

“The utilities in Germany had one strategy,” Flasbarth said, “and that was to defend their track—nuclear plus fossil. They didn’t have a strategy B.”

In a conference room, Olaf Adermann, asset manager for Vattenfall’s lignite operations, explained that Vattenfall and other utilities had never expected renewables to take off so fast. Even with the looming shutdown of more nuclear reactors, Germany has too much generating capacity.

Young children cannot receive the vaccines yet, but they also are less likely to require hospitalization or die from Covid-19, unless they have an underlying condition or are high risk. They can still spread the virus, though. People with immune-compromising conditions (like cancer, H.I.V., organ transplants, etc.) can receive the vaccines, but scientists don’t yet know how well the vaccines protect them.

All the vaccines authorized by the F.D.A. have been found to fully protect you from death from Covid-19, and they nearly completely protect you from severe disease and hospitalization. Still, the risk of infection is not zero.

I took my bit of luck and felt guilty but mainly relieved that I have so far made it through this pandemic without getting sick, without anyone I love getting sick, and was now receiving the vaccine. It’s the way I’ve felt since the beginning: lucky that I didn’t have a job that required me to be face to face with the public; lucky I could keep my children home; lucky, in essence, that we had enough money to secure ourselves against the world.

I’ve long known my life is easier because of factors beyond my control, factors that influenced my mother’s pregnancy, and her mother’s. I’m a mother now; I know I was treated a certain way during my pregnancy and delivery because I am white, because I have health insurance, because I am married. I live an hour away from Julia Tutwiler Prison, where imprisoned women give birth and then say goodbye to their infants.

I told an old friend that Covid had exposed a lot of flaws in this country’s higher education system; it’s exposed a lot of flaws everywhere, he said.

The former N.B.A. star Charles Barkley, an Auburn alumnus, said that athletes should be vaccinated first because they pay so much in taxes, and while at first I was horrified by his comment, pretty soon I wasn’t

He was just saying what has long been true in this country: Your health is worth what you can pay for it.

Hard not to think about how some of us are found, some lost forever.

The number of @_FloridaMan’s followers is 270,000.

But is the Florida Man who Accidentally Shoots Himself With Stun Gun While Trying to Rob the Radio Shack He Also Works At truly more wacky than, let’s say, an Arkansas Man or New Jersey Man?

Longtime observers insist that he is.Take the Florida Man whose surgically amputated leg was found in a hospital Dumpster. “The leg has a name on it,” said the best-selling author and Miami Herald columnist Carl Hiaasen, who has wisely peopled his novels with fictitious(ish) Florida Men. “If this is New Jersey, the leg does not have a name on it. In Miami, the leg has a name on it, and it’s the name of the person who owns the leg.”

“There is always an extra twist of weirdness at the end of the Florida story,” Mr. Hiaasen said. “Weird stories happen everywhere, but they usually come to a logical conclusion. There is always one more shoe that drops in Florida.”

And there is so much more of it in Florida, he added. “It’s not just shooting fish in a barrel,” Mr. Hiaasen said, “but shooting mutated, deranged, slow-moving fish.”

“Stephen King comes here for material now,” Mr. Hiaasen said. “He’s out on the west coast.”

why Florida breeds or inspires its own brand of crime and criminals. He said it is partly the polarized nature of the state — very poor to very rich, very liberal to very conservative

It is partly the state’s cavorting culture — South Beach, spring break, half-naked people, late-night clubs

And it is partly the legions of immigrants from Cuba, South America, Central America and Haiti who sometimes import their old-country vendettas. “Where else do you get retired torturers from Argentina?”

California’s kumbaya vibe is absent here, and so is Texas’ ideological fervor. With so many transplants, allegiances lie elsewhere

“That’s the most common misconception about Florida — that we are a melting pot,”

“We are more akin to a TV dinner, where sometimes the peas spill over into the mashed potatoes.”

Drugs and the weather are also culprits. The steaminess adds to the seaminess

“As they say,” Mr. Corben remarked, “Los Angeles is where you go when you want to be somebody. New York is where you go when you are somebody. Miami is where you go when you want to be somebody else.”

"I had to pray that my insurance would approve of my transplant just in the nick of time," she says. "I had that Stage 4 label attached to my name and that has dollar signs. Who wants to invest in someone with stage four?"

After doing her research, Rafieei says she intends to vote for Joe Biden, who helped get the ACA passed in this first place.

Even ten years after the Affordable Care Act locked in a health care protection that Americans now overwhelmingly support — guarantees that insurers cannot deny coverage or charge more based on preexisting medical conditions — voters once again face contradicting campaign promises over which candidate will preserve the law's legacy.

A majority of Democrats, Independents and Republicans say they want their new president to preserve the ACA's provision that protects as many as 135 million people from potentially being unable to get health care because of their medical history.

President Donald Trump has pledged to keep this in place, even as his Administration heads to the U.S Supreme Court the week after Election Day to argue the entire law should be struck down.

And yet the Trump administration has not unveiled a health care plan or identified any specific components it might include. In 2017, the administration joined with Congressional Republicans to dismantle the Affordable Care Act, but none of the GOP-backed replacement plans could summon enough votes. The Republicans' final attempt, a limited "skinny repeal" of parts of the ACA, failed in the Senate because of resistance within their own party.

But the state's governor also embraced the Republican effort to repeal and replace the law in 2017, and now Arizona's Attorney General is part of the lawsuit — that will be heard by the Supreme Court on Nov. 10 — that could topple the entire law.

Republicans have often tried to skirt health care as a major issue this election cycle because there isn't the same political advantage to pushing the repeal and replace argument, says Mark Peterson, a professor of public policy, political science and law at UCLA.

"Not everybody, particularly Republicans, associates the ACA with protecting preexisting conditions," he says. "But it is pretty striking that overwhelmingly Democrats and Independents do — and a number of Republicans — that's enough to give a significant national supermajority."

This shift has been occurring for years, but it could present Trump and Republicans with a perfect storm of problems at the same time that the state has become the center of the political universe with close races for president, Senate and governor.

"We realize that we have been infiltrated by other people that have more liberal views... than we do," Cheryl Miles, a Trump supporter,

Martin County, after twice voting for President Barack Obama, narrowly backed Trump in 2016, helping him cut into margins in the bigger metropolitan areas.

Christian conservatives who were somewhat skeptical of Trump four years ago are now fully behind the Republican leader.

"He stands for Christian values," Miles said. "I know that sometimes when he talks, he doesn't talk the way I would like for him to talk. But I like the stands that he takes. And sometimes you have to look beyond what the person is saying and (to) what he is doing."

The greater area around Raleigh, including college towns like Chapel Hill and Durham, is known as the research triangle, because of the topflight universities that are crammed into a relatively small area.

Those institutions have not only attracted hundreds of thousands of more liberal voters to North Carolina, but they have provided the intellectual capital to fuel a growing technology and health care industry that has led to thousands of new jobs just over the last few years.

The couple had been on green cards for decades, unable to vote in any election. But then Trump won, and the couple said shortly thereafter they became citizens almost expressly to vote against the President.

"I'll be honest with you: I really want to vote against Trump. That was the primary thing."

just two weeks before Election Day, North Carolina remains a toss-up, according to multiple recent polls that find Biden with the narrowest of margins.

Obama, the last Democrat to win the state in 2008, carried North Carolina because of overwhelming turnout from Black and young Americans. Biden's path, while similar, has some notable differences: In order to carry North Carolina next month, Biden will lean on a coalition that is Whiter, more suburban and older than the one that delivered the state to Obama 12 years ago.

"I've got a pretty good fix that most of the ones going to the Trump rally are probably voting for me," said Kidwell, whose signs tout him as the "most conservative" member of the North Carolina General Assembly.

"He is going to (need to) boost his numbers in rural counties to make up for what looks like an even bigger defeat in Raleigh, Charlotte," said Michael Bitzer, a professor at Catawba College and an expert on the state's politics. "I am just not sure how much more he can squeeze out of those rural areas."

Trump, on the other hand, can't solely count on the same turnout from Eastern and Western North Carolina, the two areas that propelled him to victory four years ago.

He is staunchly against wearing masks to combat the coronavirus and did not wear one when greeting voters in Washington.

"It worries me more on the statewide and national elections. ... But I think we are going to do well. North Carolina is, even if our metro areas are more liberal leaning, we still have a good number of people who are conservative."

Brian Buck said it is "concerning" that liberals are "coming from up north down to North Carolina" and he feared it would eventually "change us from a toss-up state to a blue state."

"The damn Democrats don't realize that he is just the President. He is not God," Brian Buck said. "What was he supposed to do? Go into the basement and go hocus pocus and make a damn treatment for it? No. So they blame him for it, but he had no more control over it getting here than I did."

"I believe he is more for the Christians than the Democrats," said Sawyer. "And that is one of the most important things."

"In 2016, President Trump brought out a lot of voters in the Eastern part of the state that previously voted for Barack Obama, or didn't vote, because he wasn't a stereotypical Republican," said Nick Trainer, Trump's director of battleground strategy. These voters "saw Barack Obama as a change agent and saw Donald Trump as a change agent."

"I really don't trust Donald Trump," he said, wearing a Desert Storm veteran hat, US Army mask and white veteran T-shirt. "It has been awhile since there has been this kind of unrest in politics in this country. ... It is best not to discuss politics because there is always going to be some friction involved."

One of those so-called Yankees would be Bridgette Hodges, an African-American grandmother who moved to the state from New Jersey around a year ago to be closer to her family, like Sanaa, her grandchild. The duo waited for over two hours on a recent rainy Friday so Hodges could not only vote for Biden, but register as a North Carolina voter for the first time.

"There are two groups we need to be focused on and that is turning out the African American vote and also suburban women," said Meredith Cuomo, the executive director of the North Carolina Democratic Party. "We have seen just a real shift in our demographics since 2016."

Turning out voters like Hodges and Puebla was the missing piece for Clinton in 2016, whose campaign went into Election Day believing she would win the state. But turnout was down among reliable Democratic voters and up with voters in Eastern and Western reaches of the state, delivering Trump the win.

"I don't think of myself as an anomaly, I think that younger Republican voters are more progressive... and it has now become a generational thing inside the party," said Plyler, his long red beard hanging out of his mask. "So, if Republicans are scared of these kinds of voters, then they are scared of Republicans. That's the shame of it."

The Harriman railroad fortune paid local charities, such as the New York Bureau of Industries and Immigration, to seek out Jewish, Italian and other immigrants in New York and other crowded cities and subject them to deportation, trumped up confinement or forced sterilization.

The Rockefeller Foundation helped found the German eugenics program and even funded the program that Josef Mengele worked in before he went to Auschwitz.

In an America demographically reeling from immigration upheaval and torn by post-Reconstruction chaos, race conflict was everywhere in the early twentieth century. Elitists, utopians and so-called "progressives" fused their smoldering race fears and class bias with their desire to make a better world.

They reinvented Galton's eugenics into a repressive and racist ideology. The intent: populate the earth with vastly more of their own socio-economic and biological kind--and less or none of everyone else.

How? By identifying so-called "defective" family trees and subjecting them to lifelong segregation and sterilization programs to kill their bloodlines. The grand plan was to literally wipe away the reproductive capability of those deemed weak and inferior--the so-called "unfit."

Eighteen solutions were explored in a Carnegie-supported 1911 "Preliminary Report of the Committee of the Eugenic Section of the American Breeder's Association to Study and to Report on the Best Practical Means for Cutting Off the Defective Germ-Plasm in the Human Population." Point eight was euthanasia.

The most commonly suggested method of eugenicide in America was a "lethal chamber" or public locally operated gas chambers.

Applied Eugenics also devoted a chapter to "Lethal Selection," which operated "through the destruction of the individual by some adverse feature of the environment, such as excessive cold, or bacteria, or by bodily deficiency."

Eugenic breeders believed American society was not ready to implement an organized lethal solution. But many mental institutions and doctors practiced improvised medical lethality and passive euthanasia on their own.

One institution in Lincoln, Illinois fed its incoming patients milk from tubercular cows believing a eugenically strong individual would be immune. Thirty to forty percent annual death rates resulted at Lincoln.

Some doctors practiced passive eugenicide one newborn infant at a time. Others doctors at mental institutions engaged in lethal neglect.

Only after eugenics became entrenched in the United States was the campaign transplanted into Germany, in no small measure through the efforts of California eugenicists, who published booklets idealizing sterilization and circulated them to German officials and scientists.

Hitler studied American eugenics laws. He tried to legitimize his anti-Semitism by medicalizing it, and wrapping it in the more palatable pseudoscientific facade of eugenics. Hitler was able to recruit more followers among reasonable Germans by claiming that science was on his side. While Hitler's race hatred sprung from his own mind, the intellectual outlines of the eugenics Hitler adopted in 1924 were made in America.

In Mein Kampf, published in 1924, Hitler quoted American eugenic ideology and openly displayed a thorough knowledge of American eugenics. "There is today one state," wrote Hitler, "in which at least weak beginnings toward a better conception [of immigration] are noticeable. Of course, it is not our model German Republic, but the United States."

Hitler even wrote a fan letter to American eugenic leader Madison Grant calling his race-based eugenics book, The Passing of the Great Race his "bible."

In 1934, as Germany's sterilizations were accelerating beyond 5,000 per month, the California eugenics leader C. M. Goethe upon returning from Germany ebulliently bragged to a key colleague, "You will be interested to know, that your work has played a powerful part in shaping the opinions of the group of intellectuals who are behind Hitler in this epoch-making program. Everywhere I sensed that their opinions have been tremendously stimulated by American thought.…I want you, my dear friend, to carry this thought with you for the rest of your life, that you have really jolted into action a great government of 60 million people."

More than just providing the scientific roadmap, America funded Germany's eugenic institutions. By 1926, Rockefeller had donated some $410,000 -- almost $4 million in 21st-Century money -- to hundreds of German researchers. In May 1926, Rockefeller awarded $250,000 to the German Psychiatric Institute of the Kaiser Wilhelm Institute, later to become the Kaiser Wilhelm Institute for Psychiatry

Another in the Kaiser Wilhelm Institute's eugenic complex of institutions was the Institute for Brain Research. Since 1915, it had operated out of a single room. Everything changed when Rockefeller money arrived in 1929. A grant of $317,000 allowed the Institute to construct a major building and take center stage in German race biology. The Institute received additional grants from the Rockefeller Foundation during the next several years. Leading the Institute, once again, was Hitler's medical henchman Ernst Rüdin. Rüdin's organization became a prime director and recipient of the murderous experimentation and research conducted on Jews, Gypsies and others.

Leon Whitney, executive secretary of the American Eugenics Society declared of Nazism, "While we were pussy-footing around…the Germans were calling a spade a spade."

Mengele began searching the boxcar arrivals for twins. When he found them, he performed beastly experiments, scrupulously wrote up the reports and sent the paperwork back to Verschuer's institute for evaluation. Often, cadavers, eyes and other body parts were also dispatched to Berlin's eugenic institutes.

In the fall of 1950, the University of Münster offered Verschuer a position at its new Institute of Human Genetics, where he later became a dean. In the early and mid-1950s, Verschuer became an honorary member of numerous prestigious societies, including the Italian Society of Genetics, the Anthropological Society of Vienna, and the Japanese Society for Human Genetics.

Human genetics' genocidal roots in eugenics were ignored by a victorious generation that refused to link itself to the crimes of Nazism and by succeeding generations that never knew the truth of the years leading up to war. Now governors of five states, including California have issued public apologies to their citizens, past and present, for sterilization and other abuses spawned by the eugenics movement.