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NEW YORK (AP) — U.S. stocks tiptoed to more records amid a mixed Tuesday of trading, tacking a touch more onto what’s already been a stellar year so far. The S&P 500 edged up by 2 points, or less than 0.1%, to set an all-time high for the 55th time this year. It’s climbed in 10 of the last 11 days and is on track for one of its best years since the turn of the millennium. The Dow Jones Industrial Average slipped 76 points, or 0.2%, while the Nasdaq composite added 0.4% to its own record set a day earlier. AT&T rose 4.6% after it boosted its profit forecast for the year. It also announced a $10 billion plan to send cash to its investors by buying back its own stock, while saying it expects to authorize another $10 billion of repurchases in 2027. On the losing end of Wall Street was U.S. Steel, which fell 8%. President-elect Donald Trump reiterated on social media that he would not let Japan’s Nippon Steel take over the iconic Pennsylvania steelmaker. Nippon Steel announced plans last December to buy the Pittsburgh-based steel producer for $14.1 billion in cash, raising concerns about what the transaction could mean for unionized workers, supply chains and U.S. national security. Earlier this year, President Joe Biden also came out against the acquisition. Tesla sank 1.6% after a judge in Delaware reaffirmed a previous ruling that the electric car maker must revoke Elon Musk’s multibillion-dollar pay package. The judge denied a request by attorneys for Musk and Tesla’s corporate directors to vacate her ruling earlier this year requiring the company to rescind the unprecedented pay package. All told, the S&P 500 rose 2.73 points to 6,049.88. The Dow fell 76.47 to 44,705.53, and the Nasdaq composite gained 76.96 to 19,480.91. In the bond market, Treasury yields held relatively steady after a report showed U.S. employers were advertising slightly more job openings at the end of October than a month earlier. Continued strength there would raise optimism that the economy could remain out of a recession that many investors had earlier worried was inevitable. The yield on the 10-year Treasury rose to 4.23% from 4.20% from late Monday. Yields have seesawed since Election Day amid worries that Trump’s preferences for lower tax rates and bigger tariffs could spur higher inflation along with economic growth. But traders are still confident the Federal Reserve will cut its main interest rate again at its next meeting in two weeks. They’re betting on a nearly three-in-four chance of that, according to data from CME Group. Lower rates can give the economy more juice, but they can also give inflation more fuel. The key report this week that could guide the Fed’s next move will arrive on Friday. It’s the monthly jobs report , which will show how many workers U.S. employers hired and fired during November. It could be difficult to parse given how much storms and strikes distorted figures in October. Based on trading in the options market, Friday’s jobs report appears to be the biggest potential market mover until the Fed announces its next decision on interest rates Dec. 18, according to strategists at Barclays Capital. In financial markets abroad, the value of South Korea’s currency fell 1.1% against the U.S. dollar following a frenetic night where President Yoon Suk Yeol declared martial law and then later said he’d lift it after lawmakers voted to reject military rule. Stocks of Korean companies that trade in the United States also fell, including a 1.6% drop for SK Telecom. Japan’s Nikkei 225 jumped 1.9% to help lead global markets. Some analysts think Japanese stocks could end up benefiting from Trump’s threats to raise tariffs , including for goods coming from China . Trade relations between the U.S. and China took another step backward after China said it is banning exports to the U.S. of gallium, germanium, antimony and other key high-tech materials with potential military applications. The counterpunch came swiftly after the U.S. Commerce Department expanded the list of Chinese technology companies subject to export controls to include many that make equipment used to make computer chips, chipmaking tools and software. The 140 companies newly included in the so-called “entity list” are nearly all based in China. In China, stock indexes rose 1% in Hong Kong and 0.4% in Shanghai amid unconfirmed reports that Chinese leaders would meet next week to discuss planning for the coming year. Investors are hoping it may bring fresh stimulus to help spur growth in the world’s second-largest economy. In France, the CAC 40 rose 0.3% amid continued worries about politics in Paris , where the government is battling over the budget. AP Business Writers Yuri Kageyama and Matt Ott contributed.Olema Oncology Reports Inducement Grants Under Nasdaq Listing Rule 5635(c)(4)AI era can benefit from lessons of the nuclear arms race
When Donald Trump jokes that Canada could become the 51st state, and refers to Justin Trudeau as a governor rather than prime minister, it's all an effort to "humiliate" the Canadian leader, a former senior Trump adviser says. And it's to be expected from the U.S. president-elect, said John Bolton, who's now a Trump critic. "I think he's poking at Justin Trudeau and trying to humiliate him, and I think Trump gets a laugh from it." On Trump's jokes about Canada, and quips aimed at the prime minister, Bolton says, "I wouldn't over-intellectualize it. I think he's just mean." While Bolton is not a Trump supporter, he knows how the incoming president thinks and strategizes: He served as Trump's national security adviser for roughly 17 months during his first term. He says he quit in 2019, after clashes over foreign policy strategy. At the time, Trump said he fired him. In interviews with CBC News, Bolton and several U.S. senators also spoke about the need for Canada to play into the president-elect's ego, and what can be done to try and avoid a trade war. John Bolton is seen in August 2018 listening to Trump, then U.S. president, at a cabinet meeting at the White House in Washington, D.C. (Kevin Lamarque/Reuters) Canada as the 51st U.S. state? Trump has made at least four recent references to Canada becoming a U.S. state , sparking a wide range of reactions. And according to Gerald Butts, Trudeau's former principal secretary, this has actually been going on for years: "Trump used this 51st- state line all the time with Trudeau in his first term," he wrote in a social media post. Trump appears to have picked up where he left off, starting with his dinner with Trudeau at Mar-a-Lago , held after the president-elect, in an online post, threatened a 25 per cent tariff on all Canadian and Mexican goods. WATCH | Why does Trump keep making fun of Trudeau?: Why does Trump keep trolling Trudeau? 18 minutes ago Duration 1:01 U.S. president-elect Donald Trump keeps mocking Justin Trudeau. CBC’s Katie Simpson asked John Bolton, who served as national security adviser during Trump’s first term, why he thinks that is. As first reported by Fox News, Trump appeared to joke that Canada could become the 51st state if the Canadian economy were to be destroyed in a tariff fight. He seemed to reference that quip on his social media account days later, posting what appeared to be an AI-generated image of himself standing atop a mountain with a Canadian flag. Trudeau walks through the lobby of the Delta Hotel by Marriott, on Nov. 30, in West Palm Beach, Fla. (Carolyn Kaster/AP Photo) He said it again during an interview with NBC News , as he complained about trade deficits with both Canada and Mexico. After characterizing trade deficits as subsidies, he said, "If we're going to be subsidizing them, let them become a state." And then there was the Truth Social post, around midnight Monday, where Trump made reference again to his Florida meeting with Trudeau. Trump's comments are getting some laughs on Capitol Hill. Republican Senator Josh Hawley, who represents Missouri, chuckled as he told CBC News he's not quite sure why Trump keeps talking about Canada becoming a state. "I like better his idea of splitting Canada up into two — admitting one Republican and one Democrat state," he quipped. "I wouldn't want a 51st state if they're just going to vote for Democrats." Trump posted what appears to be an AI-generated image on his social media platform Truth Social, once again joking about making Canada the 51st U.S. state. (Truth Social) Stay out of U.S. domestic politics: Bolton Bolton says Trudeau and the Canadian team responding to Trump's tariff threats need to play into the president-elect's ego. "I think it's important in dealing with Trump to make the case not why the threat will hurt Canada, but why not invoking the tariffs will help Trump," he said. "Forget about U.S.-Canadian relations, that's not the issue for Trump — what makes Donald Trump look good?" This Sunday, Cross Country Checkup is asking: What do you make of all the Trump jokes? And, should Canada be America's 51st state? Fill out this form and you could appear on the show or have your comment read on air. He also criticized Trudeau for weighing in on the outcome of the presidential race. In Ottawa on Tuesday evening, the prime minister told a crowd that Kamala Harris's U.S. election loss was a setback for women's progress . "If Prime Minister Trudeau hasn't figured it out, I'm happy to offer some free advice: Don't get involved in the middle of American politics, it's not going to do ya any good," Bolton said. 'We can't just roll over': Doug Ford doubles down on threat to shut down energy exports to the U.S. Tariff threats real, some Republican senators say Some Republican senators warn that Trump may very well make good on his tariff threat. "Oh, I think he's serious about it, for sure," said Senator Kevin Cramer, during a brief interview with CBC News in the hallway of the Hart Senate Office Building on Capitol Hill. Cramer, who represents the northern border state of North Dakota, urged officials in Ottawa to meet Trump's demands. "We just need to get compliance and we'll be fine." Trump has linked the threat to broad changes in border security, to prevent the flow of migrants and illegal drugs into the U.S. He's lumped challenges at the southern and northern borders together, despite very different circumstances. WATCH | How retaliatory tariffs would hurt Canadians, too: Retaliation in trade dispute will hurt Canadians, too, trade expert says | Canada Tonight 21 hours ago Duration 5:40 Following a meeting with Prime Minister Justin Trudeau and Canada's premiers on Wednesday, Ontario Premier Doug Ford said Canada needs to be 'ready to fight' and that Trump's tariffs are '100 per cent' coming. International trade expert Wendy Wagner discusses how Canada's measures could be harmful for not only Americans, but Canadians, too. And he hasn't provided specifics to either Canada or Mexico about what exactly he'd like to see changed. One Republican strategist says Canada needs to just focus on the tariff threats, and ignore what he calls Trump's "nonsense." "No one is expecting Canada to become the 51st state," said Matthew Bartlett, who worked in the State Department during the first Trump administration. "Donald Trump is a master showman, loves to command people's attention, loves to make people nervous and keep them on their toes. That's one of his tactics." Trudeau presents premiers with plan to address Trump's border concerns as tariff threat looms Donald Trump influencing Canadian border security is 'ironic and actually sad,' says MP Bartlett predicted four years of quips and threats. Bolton says Trump has a fixation with tariffs, and refuses to accept they will likely make life more expensive for American consumers. "Tariffs are paid by the American importer, and then ultimately the bulk of the tariff is probably passed on to American consumers.... Trump doesn't get it," he said. "It's like arguing the Earth is not flat. You're not going to persuade him."
The metallic screech of a train rolling by. The constant hum of traffic on the nearby Trans-Canada Highway. These are the sounds of the Brunette River in the fall, as it cuts through Burnaby, B.C. — and rising above the din of Metro Vancouver, the splashing of chum salmon as they push upstream to spawn. The salmon in the river are looking haggard by mid-November, their skin patchy and worn as they near the end of their lives. But they continue the timeless cycle to produce the next generation of their keystone species. First Nations harness power of AI to monitor wild salmon stocks in B.C. Jason Hwang, vice-president of the Pacific Salmon Foundation, recalled growing up in Delta, south of Vancouver, and thinking "salmon were something that came into the Fraser River but swam on by the Lower Mainland to better habitat" farther inland. Then, as a child, Hwang saw salmon spawning in Surrey's Bear Creek. "I couldn't believe it," he said. "You might look out at the city and Vancouver and say, 'Well, it's a big city now and maybe the time to have salmon in our proximity is long passed.' But that's not true." Efforts to rehabilitate urban waterways have helped bring spawning salmon back to parts of Metro Vancouver, including unlikely-looking streams surrounded by industrial and residential development. Salmon are seen spawning in Stoney Creek in Burnaby, B.C., in this undated photo. (UBC) While it's doubtful that city salmon will recover to their original numbers, those involved in restoration work say it has a host of side benefits, from boosting resilience to flooding to inspiring community connection and stewardship. Hwang said "an amazing thing happens" when people realize there are important natural assets in their communities, including spawning salmon. "There's a pride of stewardship that exists that you see all over the Lower Mainland ... in the communities that are aware they've got salmon in their neighbourhoods." Discover where ancient rivers flow under Canadian cities Salmon are a keystone species, supporting the broader ecosystem, and they serve as a barometer for the state of their environment, Hwang said. "If you look at salmon, it's one way to get a pretty good picture, and they're showing us that we can do better, and we need to do better." Creek restoration Francisca Olaya Nieto, a biologist with the Vancouver Park Board, said a century of urban development had altered the landscape to the point that aiming for healthy, sustainable salmon populations across the city is probably not realistic. About 100 kilometres of stream were covered up as Vancouver grew, she said, and just a handful of salmon-bearing waterways continue to flow naturally. Some of those original streams were diverted into pipes and connected to the city's water system, while others were filled in, buried and paved over. B.C. creek buried by construction in the 60s restored Nieto said salmon in urban waterways must contend with pollution, sediment, warming waters and infrastructure blocking their passage. Still, they have been returning to streams where the City of Vancouver and its park board have undertaken restoration work, said Nieto, who has been involved in efforts to recover or "daylight" sections of once-buried or degraded waterways. WATCH | BCIT restores creek buried under campus: B.C. college restores creek that was buried under campus 2 months ago Duration 1:01 As part of ongoing restoration efforts, the B.C. Institute of Technology has brought part of buried Guichon Creek back to the surface in Burnaby. "The main goal is to find those opportunities where we can improve the water quality, and if salmon can return, that will be a win, but also we can benefit many other species," she said. "We're working more toward creating healthy habitat across the city, working toward connectivity and improving our biodiversity." Amir Taleghani, a senior engineer with the City of Vancouver, said restoring salmon habitat may have started with naturalization and beautification in mind, but the work also provided an opportunity to tap into the broader benefits of natural assets. Hoy Creek Hatchery in Coquitlam, B.C., pictured in November 2021. (Maggie MacPherson/CBC) He pointed to Still Creek, which flows from East Vancouver into Burnaby. The creek has been the site of restoration efforts over several decades, and Taleghani recently captured a video showing salmon spawning in the stream surrounded by parking lots, train tracks, big-box stores and industrial buildings. But Still Creek plays a role beyond providing salmon habitat, said Taleghani, whose work is focused on floodplains and watercourses in Vancouver. "Increasingly, we're seeing the creek as a natural drainage asset, important to ... adapting to climate change and managing flood risk," he said. "You need room for water to safely be stored in a flood. So, by widening the creek and lowering the surface where we can, we provide the space that in an extreme rainfall event can be flooded in a safe way, but the rest of the year, it can be habitat." Taleghani said the city was incorporating Still Creek in its draft land-use plan for the area, which includes two SkyTrain stations, and looking at how the waterway can help manage run-off and flood risk as more housing and infrastructure is built. Chum salmon in Burnaby's Guichon Creek, pictured in October 2020. (Mark Angelo) Hwang, too, said it was crucial to include natural assets in city and regional planning given the population increases expected for the Lower Mainland. "As a salmon biologist, I would advocate for all of the reasons that [restoration] can be helpful for salmon, but it's also helpful for your community," he said, pointing to flood mitigation as well as recreational opportunities in naturalized areas. Salmon populations in decline across B.C. and Yukon: report Hwang said the target should be to restore as much habitat as possible. He recalled attending the British Columbia Institute of Technology as a post-secondary student, where there is an ongoing effort to restore Guichon Creek, which runs through the Burnaby campus and into Still Creek. "Maybe Guichon Creek used to produce thousands of salmon, and now it produces a couple of dozen ... but isn't that still awesome? Isn't it awesome that in the [school's] parking lot area, you can make salmon, still, in a stream?" Last year, BCIT installed a fishway along Guichon Creek to allow salmon to migrate through the river. (Brett Hitchins)
Former NHL star Thornton back as co-GM of Canada's Spengler Cup squad
MILWAUKEE — Giannis Antetokounmpo had 32 points and 11 rebounds and Damian Lillard added 31 points to lead the Milwaukee Bucks past the Charlotte Hornets 125-119 on Saturday night for their fourth consecutive victory. Milwaukee opened the fourth quarter with a 14-5 spurt for a 110-90 lead, but the Hornets got it to 121-119 on Brandon Miller’s 3-pointer with 15 seconds left. Taurean Prince answered with a pair of free throws for the Bucks to make it a two-possession game, and Charlotte missed a pair of 3-pointers on the ensuing possession. Antetokounmpo hit two free throws with 4.5 seconds left to make it 125-119. LaMelo Ball had a career-high 50 points for the Hornets, and Brandon Miller added 32. Ball hit 17 of 38 shots, including 6 of 17 beyond the arc, and 10 of 13 free throws. Milwaukee, which completed a 4-0 homestand, has won six of its last seven. The only loss in that span was a 115-114 loss to the Hornets on Nov. 16 following a controversial foul call. Charlotte’s Grant Williams went to the locker room late in the fourth quarter with an apparent leg injury and did not return. Takeaways Hornets: Charlotte has lost five of its last seven. Milwaukee Bucks' Bobby Portis reacts in front of Charlotte Hornets' LaMelo Ball during the second half of an NBA basketball game Saturday, Nov. 23, 2024, in Milwaukee. The Bucks won 125-119. Credit: AP/Morry Gash Bucks: Lillard, who did not play in the Bucks' last game against Charlotte, hit 9 of 21 shots, including 10 of 11 free throws. Key moment Milwaukee hit four consecutive 3-pointers for a 12-3 run and a 96-83 lead late in the third quarter. Key stat The Bucks were 18 of 37 from beyond the arc, matching their season high in 3-pointers made. Up next The Hornets host the Orlando Magic on Monday, and the Bucks are at the Miami Heat in NBA Group Play on Tuesday.Ruud van Nistelrooy: I know how to scrap for Leicester – I grew up fighting
Some concerned for no-fault divorceCadmium Appoints Sean Brady as CEO to Drive Next Phase of GrowthCenovus Energy Inc. stock rises Tuesday, outperforms marketMarvel Rivals' Wolverine Design Is Certainly a Choice - IGN Daily Fix In today's Daily Fix:Marvel Rivals' roster keeps on growing, and we now have a first look at Wolverine via a new trailer. The fan-favorite mutant's new design, however, is raising some eyebrows for its lack of iconic mask and overall younger look. But purists shouldn't fret, as his more recognizable outfits will likely be coming in a season pass or other (likely paid) DLC. In other news, The PlayStation 5 just got a console software update which allows you to choose a new start-up animation and menu theme. This is part of Sony's celebration of the PlayStation's 30th anniversary, and now you can wax nostalgic while your modern PS5 boots up to the sound of the PS1's start-up animation. And finally, a trailer has leaked for a cancelled James Bond game, and no this isn't related to the upcoming Project 007 from IO interactive—it's a Lego game!
An Israeli airstrike flattened a multistory building in central Gaza, killing at least 25 people and wounding dozens more, according to Palestinian medical officials, after strikes Thursday across the Gaza Strip killed at least 28 others. The latest deadly strike hit the urban Nuseirat refugee camp just hours after U.S. President Joe Biden’s national security adviser, Jake Sullivan, told reporters in Jerusalem that the recent ceasefire in Lebanon has helped clear the way for a potential deal to end the war in Gaza between Israel and Hamas. The Israeli military did not immediately comment on the deadly strike in Nuseirat. Israel says it is trying to eliminate Hamas, which led the attack on southern Israel in October 2023 that sparked the war in Gaza . The Israeli military says Hamas militants hide among Gaza’s civilian population. The fighting has plunged Gaza into a severe humanitarian crisis, with experts warning of famine in some of the hardest-hit parts of the territory. Israel’s offensive has killed over 44,800 Palestinians in Gaza, more than half of them women and children, according to the Gaza Health Ministry, which does not say how many were combatants. The Israeli military says it has killed over 17,000 militants, without providing evidence. The Oct. 7, 2023 attack by Hamas killed some 1,200 people, mostly civilians, and around 250 others were taken hostage. Some 100 hostages are still inside Gaza, at least a third of whom are believed to be dead. Here's the latest: DAMASCUS, Syria — Mohammad Salim Alkhateb, an official with the National Coalition of Syrian Revolution and Opposition Forces — an internationally backed group of the opposition in exile — said his group wants to see a transitional government formed via a United Nations-backed process in the wake of Bashar Assad ouster. It is not yet clear if Hayat Tahrir al-Sham, the main rebel group now in control of Syria, will pursue such a process. The insurgents have said an interim government headed by Mohammad al-Bashir, who is also the head of the “salvation government” of HTS in its former stronghold in northern Syria, will oversee the country until March but have not made clear how the transition to a new, fully empowered government would take place. “The transitional governing body should be formed in Geneva to have international legitimacy,” said Alkhateb, who is now in Damascus. “The transitional governing body, whatever its form, whether it is the ‘salvation government’ or any other, what matters is that it has international recognition.” Alkhateb said that the unexpectedly rapid fall of Damascus and departure of Assad after opposition forces launched their offensive had created confusion and a governance vacuum. A day before the insurgents pushed into Damascus, diplomats from countries including Saudi Arabia, Qatar, Turkey, Iran and Russia met in Qatar to discuss the situation in Syria. Alkhateb said that they had discussed a scenario in which the rebels would halt their advance, keeping the territory they had captured so far in the north — including Syria’s largest city, Aleppo — and the opposition and Assad’s government would go to Geneva for talks on a political settlement to the conflict. However, he noted, “there were no Syrians in that meeting.” Assad fled to Russia before the rebel forces arrived in Damascus but has not officially announced his resignation, which is “why we are living in a vacuum rather than a political transition,” Alkhateb said. He added that creating a professional army should be a priority of the transitional government. “We do not want a civilian who was trained during the revolution to carry military weapons to become the military,” he said. Israel bombed hundreds of military sites in Syria this week in a wave of airstrikes that destroyed “most of the strategic weapons stockpiles” in the country. Israeli Prime Minister Benjamin Netanyahu said the wave of airstrikes in neighboring Syria was necessary to keep the weapons from being used against Israel following the Syrian government’s stunning collapse . WASHINGTON — White House press secretary Karine Jean-Peirre says Austin Tice, an American journalist missing in Syria for 12 years, “is a top priority for this president.” During a briefing with reporters on Thursday, Jean-Pierre said of Tice, “There is no indication that he is not alive. There’s also no indication about his location or condition.” “What our goal is, is to bring him home. And so, we hope certainly that he is alive and, as we have stated many times before, we are talking through this with the Turks and we want to do everything we can to bring him home,” she said. BEIRUT — Amnesty International said Thursday that four Israeli airstrikes between September and October that killed at least 49 civilians in Lebanon “must be investigated as war crimes.” The rights organization said in a new report that the four strikes targeted homes in the Bekaa Valley, northern and eastern Lebanon, and municipal offices in the south. “These four attacks are emblematic of Israel’s shocking disregard for civilian lives in Lebanon and their willingness to flout international law,” said Amnesty International’s Erika Guevara Rosas, Senior Director for Research, Advocacy, Policy and Campaigns. The rights group said this report was part of its ongoing investigation into violations of the laws of war in Lebanon. Amnesty International investigated four Israeli airstrikes, including one on Sept. 29 in al-Ain that killed all nine members of the same family. On Oct. 21, a strike in Baalbek city in eastern Lebanon killed six members of the same family. Another on Oct. 14 in the village of Aitou in northern Lebanon killed 23 displaced people, including a 5-month-old baby. A fragment from the attack site in Aitou was identified by an Amnesty weapons expert as likely part of a Mk-80 series aerial bomb, weighing at least 500 pounds. These munitions are primarily supplied to Israel by the United States, Amnesty said. The fourth strike Amnesty investigated was the strike that hit the municipal headquarters in Nabatiyeh, southern Lebanon, on Oct. 16, killing 11 civilians including the mayor. “The air strike took place without warning, just as the municipality’s crisis unit was meeting to coordinate deliveries of aid, including food, water and medicine, to residents and internally displaced people who had fled bombardment in other parts of southern Lebanon,” Amnesty said. The rights group said it interviewed survivors and witnesses, examined evidence, and found no military targets near the sites of the four strikes. The Israeli military gave no warnings and did not respond to Amnesty’s inquiries, the group said. DEIR AL-BALAH, Gaza Strip — An Israeli airstrike hit the central Gaza Strip on Thursday, killing at least 25 Palestinians and wounding dozens more, Palestinian medics said, just hours after President Joe Biden’s national security adviser raised hopes about a ceasefire deal to end the war in Gaza. Photos from the scene of the blast that circulated on social media showed a completely collapsed building with people walking through its mangled and charred remains, smoke rising from piles of belongings strewn over the rubble. Officials at two hospitals in the Gaza Strip, al-Awda Hospital in the north and al-Aqsa Hospital in central Gaza, reported they received a combined total of 25 bodies from an Israeli strike on a multistory residential building in the urban Nuseirat refugee camp. Palestinian medics also reported that over 40 people, most of them children, were receiving treatment at the two hospitals. The al-Aqsa Hospital said that the Israeli attack also damaged several nearby houses in Nuseirat. There was no immediate comment from the Israeli military on the deadly strike. Israel is trying to eliminate Hamas, which led the attack on southern Israel in October 2023 that sparked the war in Gaza . The Israeli military says Hamas militants hide among Gaza’s civilian population. Israel’s war against Hamas has killed over 44,800 Palestinians in Gaza, more than half of them women and children, according to the Gaza Health Ministry, which does not say how many were combatants. The Israeli military says it has killed over 17,000 militants, without providing evidence. The fighting has plunged Gaza into a severe humanitarian crisis, with experts warning of famine. Israel says it allows enough aid to enter and blames U.N. agencies for not distributing it. The U.N. says Israeli restrictions, and the breakdown of law and order after Israel repeatedly targeted the Hamas-run police force, make it extremely difficult to operate in the territory. UNITED NATIONS – The U.N. food agency is trying to deal with massive needs in Syria not only from escalating war-related food insecurity and an upsurge in displaced people fleeing Lebanon but also the dramatically new environment following the ouster of Bashar Assad, a senior U.N. official says. “It’s a triple crisis and the needs are going to be massive,” said Carl Skau, deputy executive director of the World Food Program, in an interview with The Associated Press late Wednesday. The WFP estimated that 3 million people in Syria were “acutely food insecure” and very hungry. However, that estimate was made before the Israel-Hezbollah war in Lebanon pushed many Syrian refugees back to their home country, plus the instability caused by the overthrow of Assad. Due to funding cuts, the WFP had been targeting only 2 million of those people, he said. Because WFP has been working in Syria during the 13-year civil war, he said, it has pre-positioned food in the country. It has 500 staff in seven offices nationwide and has operated across conflict lines, across borders, and with all different parties, he said. Skau said Hayat Tahrir al-Sham, the main rebel group now in control of Syria, has promised to provide security for WFP warehouses. Humanitarian aid supplies had been looted at U.N. warehouses in the disorder after Assad fell. “We’re not really up and running in Damascus because of the continued kind of uncertainty there,” he said. WFP initially thought of relocating non-essential staff but the situation in Aleppo, Syria’s largest city, has been “quite calm and orderly," he said. In the short term, Skau said, “what we’re seeing is that markets are disrupted, the value of the currency dropped dramatically, food prices are going up, transport lines don’t work,” and it’s unclear who will stamp required papers for imports and exports. This means that a bigger humanitarian response is needed initially, he said, but in the next phase, the U,N. will be looking at contributing to Syria’s recovery, and ultimately the country will need reconstruction. Skau said he expects a new funding appeal for Syria and urged donors to be generous. JERUSALEM — President Joe Biden’s national security adviser, Jake Sullivan, told reporters in Jerusalem on Thursday that Israel’s ceasefire in Lebanon has helped clear the way for another deal to end the war in Gaza. He plans to travel next to Qatar and Egypt — key mediators in the ceasefire talks — as the Biden administration makes a final push on negotiations before Donald Trump is inaugurated. Sullivan said “Hamas’ posture at the negotiating table did adapt” after Israel decimated the leadership of its ally Hezbollah in Lebanon and reached a ceasefire there. “We believe it puts us in a position to close this negotiation,” he said. Sullivan dismissed speculation that Israeli Prime Minister Benjamin Netanyahu was waiting for Trump to take office to finalize a deal. He the U.S. believes there are three American hostages still alive in Gaza, but it’s hard to know for sure. He also said “the balance of power in the Middle East has changed significantly” since Hamas’ Oct. 7 attack on Israel, especially with the overthrow of former Syrian President Bashar Assad, a key ally of Hezbollah and Iran. “We are now faced with a dramatically reshaped Middle East in which Israel is stronger, Iran is weaker, its proxies decimated, and a ceasefire that is new and will be lasting in Lebanon that ensures Israel’s security over the long term,” he said. KHIAM, Lebanon — An Israeli strike killed at least one person Thursday in the Lebanese border town of Khiam, the Health Ministry said, less than a day after Israeli troops handed the hilltop village back to the Lebanese army in coordination with U.N. peacekeepers, Khiam is the first Lebanese town Israel has pull out of since a ceasefire between Israel and Hezbollah militants began two weeks ago, and marks an important test of the fragile truce . Lebanon's Health Ministry and state news agency did not provide details on who was killed, and did not report airstrikes elsewhere on Thursday. The Israeli military said the airstrike in Khiam targeted Hezbollah fighters. Lebanese troops deployed in the northern section of the town on Thursday morning and were coordinating with U.N. peacekeepers to finalize Israel’s withdrawal before fully entering into other neighborhoods. An Associated Press reporter who visited Khiam on Thursday observed widespread destruction, with most houses reduced to rubble. Entire neighborhoods were flattened, with collapsed walls and debris scattered across the streets. Lebanon’s caretaker prime minister, Najib Mikati, sharply criticized Israel for striking the town less than 24 hours after the Lebanese army returned, saying it was “a violation of the pledges made by the parties that sponsored the ceasefire agreement, who must act to curb Israeli aggression.” The truce was brokered by the U.S. and France. Israel has previously said the ceasefire deal allows it to use military force against perceived violations. Near-daily attacks by Israel during the ceasefire, mostly in southern Lebanon, have killed at least 29 people and wounded 27 others. Khiam, which sits on a ridge less than 3 miles (5 kilometers) from the border with Israel, saw some of the most intense fighting during the war. The Lebanese army was clearing debris and reopening roads in the northern section of the town. Civilian access to other areas remained challenging as the army clears roads and works alongside the U.N. peacekeepers to ensure the area is free of unexploded ordnance. AQABA, Jordan -- U.S. Secretary of State Antony Blinken is urging the many players in Syria to avoid taking any steps that could lead to further violence. Blinken spoke to reporters in Jordan on Thursday shortly after meeting King Abdullah II as he opened a trip in the region to discuss Syria's future after former President Bashar Assad's ouster. Blinken will next visit Turkey, a NATO ally and a main backer of Syrian rebel groups. Blinken called this “a time of both real promise but also peril for Syria and for its neighbors.” He said he was focused on coordinating efforts in the region “to support the Syrian people as they transition away from Assad’s brutal dictatorship” and establish a government that isn’t dominated by one religion or ethnic group or outside power. Blinken was asked about Israel’s incursion into a buffer zone that had been demilitarized for the past half century. Israeli Prime Minister Benjamin Netanyahu says the move is temporary and defensive, but also indicated Israel will remain in the area for a long time. Blinken declined to say whether the U.S. supports the move, but said the U.S. would be speaking to Israel and other partners in the region. “I think, across the board, when it comes to any actors who have real interests in Syria, it’s also really important at this time that, we all try to make sure that we’re not sparking any additional conflicts,” he said. ANKARA, Turkey — Turkey’s intelligence chief, Ibrahim Kalin, arrived in Damascus on Thursday, according to Turkish media reports. Kalin was seen arriving at the Umayyad Mosque to pray, surrounded by a large crowd, according to video shown on Turkish television. The visit is highly symbolic. Turkish officials, who supported the opposition against Syria’s government, had predicted at the start of the civil war in 2011 that President Bashar Assad’s government would fall, allowing them to pray at the Umayyad Mosque. JERUSALEM — Paraguay reopened its embassy in Jerusalem Thursday, becoming one of a small handful of nations to recognize the city as Israel’s capital and marking a diplomatic victory for Prime Minister Benjamin Netanyahu. Israel’s international isolation has increased as the war in Gaza drags on, and Paraguay was the first country to move its embassy to Jerusalem since the Oct. 7, 2023 Hamas attack that kickstarted the war. The United States, Honduras, Guatemala, Kosovo, and Papua New Guinea are among the few countries with Jerusalem embassies. Israel annexed east Jerusalem in 1967 but it wasn’t recognized by the international community, and most countries run their embassies out of Tel Aviv. Spirits were high at the ceremony marking the embassy’s inauguration Thursday, with Netanyahu and Israel’s Foreign Minister Gideon Saar lavishing praise on Paraguayan President Santiago Pena. “My good friend Santiago,” said Netanyahu, addressing Pena. “We’re a small nation. You’re a small nation. We suffered horrible things but we overcame the odds of history...we can win and we are winning.” Paraguay had an embassy in Jerusalem in 2018, under Former President Horacio Cartes. That embassy was moved back to Tel Aviv by Cartes’ successor, Mario Abdo Benitez, prompting Israel to close its embassy in Asuncion. Saar said Israel and Paraguay shared a “friendship based not only on interests but also values and principles.” He and the Paraguayan foreign minister, Rubén Ramírez Lezcano, signed a series of bilateral agreements and Saar said he would soon visit Asunción with a delegation from the Israeli private sector. “Israel is going to win and the countries we are standing next to Israel, we are going to win," Pena said. AQABA, Jordan — U.S. Secretary of State Antony Blinken is renewing calls for Syria’s new leadership to respect women and minority rights, prevent extremists from gaining new footholds in the country and keeping suspected chemical weapons stocks secure as he makes his first visit to the Mideast since the weekend ouster of Syrian President Bashar Assad . Making his 12th trip to the Middle East since the Israel-Hamas war erupted lasted year but amid fresh concerns about security following the upheaval in Syria, Blinken emphasized Thursday to Jordan’s King Abdullah II U.S. “support for an inclusive transition that can lead to an accountable and representative Syrian government chosen by the Syrian people,” the State Department said. Blinken also repeated the importance the outgoing Biden administration puts on respect for human rights and international law, the protection of civilians and stopping terrorist groups from reconstituting. Blinken met with the monarch and Jordanian Foreign Minister Ayman Safadi in Aqaba before traveling to Turkey for talks with Turkish officials on the situation in Syria and the urgency of securing a long-elusive deal to release hostages and end the fighting in Gaza that has devastated the Palestinian territory since October 2023. Abdullah told Blinken that “the first step to reach comprehensive regional calm is to end the Israeli war on Gaza." GENEVA — The U.N. envoy for Syria is calling on authorities to save evidence from detention centers that were a hub of “unimaginable barbarity” that Syrians have faced for many years and cooperate with international investigators looking into such crimes. Geir Pederson referred to new images from the notorious Saydnaya military prison north of the capital, Damascus, after President Bashar Assad fled Syria as armed groups stormed in to overthrow his government over the weekend. “The images from Saydnaya and other detention facilities starkly underscore the unimaginable barbarity Syrians have endured and reported for years,” Pedersen said in a statement. Documentation and testimonies “only scratch the surface of the carceral system’s horrors,” he added. Pedersen urged authorities to cooperate with U.N. bodies like an independent Commission of Inquiry on Syria, which was created in 2011, and an independent group known as the IIIM that was set up five years later to also compile evidence of crimes. ROME — Leaders of the Group of 7 industrialized nations offered their full support for an inclusive political transition in Syria and invited all parties to preserve the country’s territorial integrity. In a message released by Italian Premier Giorgia Meloni’s office, the leaders said they were ready to support a transition that “leads to a credible government, inclusive and not sectarian, that guarantees respect for the state of law, universal human rights, including rights for women, (and) the protection of all Syrians, including religious and ethnic minorities.” The leaders also underlined the importance that ousted President Bashar Assad’s government is held responsible for crimes, citing “decades of atrocities.” They said they would also cooperate with groups working to prohibit chemical weapons “to secure, declare and destroy” remaining chemical arms in Syria. Italy currently holds the rotating presidency of the G-7, which also includes Britain, Canada, France, Germany, Japan and the United States. JERUSALEM — The Israeli military says it struck Hamas militants in two locations in the southern Gaza Strip who planned to hijack aid convoys. Palestinian Health officials had earlier said that the two strikes killed 15 men who were part of local committees established to secure aid deliveries. The committees have been organized in cooperation with the Hamas-run Interior Ministry in Gaza. It was not possible to independently confirm either account of the strikes, which occurred overnight into Thursday. Israel has long accused Hamas of hijacking humanitarian aid deliveries, while U.N. officials have said there is no systemic diversion of aid . U.N. agencies and aid groups say deliveries are held up by Israeli restrictions on the entry of aid and movement within Gaza, as well as the breakdown of law and order more than 14 months into the war between Israel and Hamas. Israel has repeatedly targeted the Hamas-run police force, which maintained internal security before the war. The United Nations agency for Palestinian refugees, the main aid provider in Gaza, said a U.N. convoy of 70 trucks carrying humanitarian aid in southern Gaza “was involved in a serious incident,” resulting in just one of the trucks reaching its destination. It did not provide further details on the incident but said the same route had been used successfully two days earlier. Israel’s offensive, launched after Hamas’ Oct. 7, 2023, attack, has caused vast destruction and displaced around 90% of Gaza’s population of 2.3 million, leaving the territory heavily reliant on international food aid. DAMASCUS, Syria — An American who turned up in Syria on Thursday says he was detained after crossing into the country by foot on a Christian pilgrimage seven months ago. Travis Timmerman appears to have been among thousands of people released from the country’s notorious prisons after rebels reached Damascus over the weekend, overthrowing President Bashar Assad and ending his family’s 54-year rule. As video emerged online of Timmerman on Thursday, he was initially mistaken by some for Austin Tice, an American journalist who went missing in Syria 12 years ago. In the video, Timmerman could be seen lying on a mattress under a blanket in what appeared to be a private house. A group of men in the video said he was being treated well and would be safely returned home. The Biden administration is working to bring Timmerman home, Secretary of State Antony Blinken told reporters in Aqaba, Jordan, without offering details, citing privacy. Timmerman later gave an interview with the Al-Arabiya TV network, saying he had illegally crossed into Syria on foot from the eastern Lebanese town of Zahle seven months ago, before being detained. He said he was treated well in detention but could hear other men being tortured. AQABA, Jordan — U.S. Secretary of State Antony Blinken has arrived in Jordan on his 12th visit to the Mideast since the Israel-Hamas war erupted last year and his first since the weekend ouster of Syrian President Bashar Assad that has sparked new fears of instability in a region wracked by three conflicts despite a ceasefire agreement in Lebanon. Blinken was meeting in Aqaba with Jordan’s King Abdullah II and Foreign Minister Ayman Safadi on Thursday before traveling to Turkey for talks with Turkish officials on Friday. The meetings will focus largely on Syria but also touch on long-elusive hopes for a deal to end the fighting in Gaza that has devastated the Palestinian territory since October 2023. Blinken is the latest senior U.S. official to visit the Middle East in the five days since Assad was deposed as the Biden administration navigates more volatility in the region in its last few weeks in office and as President-elect Donald Trump has said the U.S. should stay out of the Syrian conflict. Other include national security adviser Jake Sullivan and a top military commander who traveled there as the U.S. and Israel have launched airstrikes to prevent the Islamic State militant group from reconstituting and prevent materiel and suspected chemical weapons stocks from falling into militant hands. Blinken “will discuss the need for the transition process and new government in Syria to respect the rights of minorities, facilitate the flow of humanitarian assistance, prevent Syria from being used as a base of terrorism or posing a threat to its neighbors, and ensure that chemical weapons stockpiles are secured and safely destroyed,” the State Department said. The U.S. would be willing to recognize and fully support a new Syrian government that met those criteria. U.S. officials say they are not actively reviewing the foreign terrorist organization designation of the main Syrian rebel group, Hayat Tahrir al-Sham, known as HTS, which was once an al-Qaida affiliate, but stressed they are not barred from speaking to its members. JERUSALEM — Israeli Prime Minister Benjamin Netanyahu says Israeli forces will remain in a Syrian buffer zone until a new force on the other side of the border can guarantee security. After the overthrow of Syrian President Bashar Assad, Israeli forces pushed into a buffer zone that had been established after the 1973 Mideast war. The military says it has seized additional strategic points nearby. Israeli officials have said the move is temporary, but Netanyahu’s conditions could take months or even years to fulfill as Syria charts its post-Assad future, raising the prospect of an open-ended Israeli presence in the country. Netanyahu’s office said in a statement Thursday that Assad’s overthrow by jihadi rebels created a vacuum on the border. “Israel will not permit jihadi groups to fill that vacuum and threaten Israeli communities on the Golan Heights with October 7th style attacks,” it said, referring to Hamas’ 2023 attack out of Gaza, which ignited the war there. “That is why Israeli forces entered the buffer zone and took control of strategic sites near Israel’s border.” The statement added that “this deployment is temporary until a force that is committed to the 1974 agreement can be established and security on our border can be guaranteed.” The buffer zone is adjacent to the Golan Heights, which Israel captured from Syria in the 1967 Mideast war and later annexed. The international community, except for the United States, views the Golan as occupied Syrian territory. JERUSALEM — Israel’s military said Thursday that the attacker who fatally shot a 12-year-old Israeli boy in the occupied West Bank overnight turned himself in to authorities. The attacker opened fire on a bus near the Israeli settlement of Beitar Illit, critically wounding the boy, who hospital authorities pronounced dead in the early morning. Three others were wounded in the attack, paramedics said. The shooting took place just outside Jerusalem in an area near major Israeli settlements. JAKARTA, Indonesia — The Indonesian government has evacuated 37 citizens from Syria following the fall of the Bashar al-Assad government, officials said Thursday. The evacuees were taken by land from Damascus to Beirut, where they boarded three commercial flights to Jakarta, said Judha Nugraha, director of citizen protection at the Foreign Affairs Ministry. The Indonesian Embassy in Damascus said all 1,162 Indonesian citizens in Syria were safe. Indonesian Ambassador to Syria Wajid Fauzi said the situation in Syria has gradually returned to normal. “I can say that 98% of people’s lives are back to normal, shops are open, public transportation has started running,” Fauzi said, adding that most Indonesian nationals living in Syria had chosen to stay. DEIR AL-BALAH, Gaza Strip — Palestinian medical officials say Israeli airstrikes have killed at least 28 people in the Gaza Strip, including seven children and a woman. One of the strikes overnight and into Thursday flattened a house in the built-up Nuseirat refugee camp, according to the Al-Aqsa Martyrs Hospital in the nearby city of Deir al-Balah, where the casualties were taken. An Associated Press reporter saw the bodies at the hospital’s morgue. Two other strikes killed 15 men who were part of local committees established to secure aid convoys . The committees were set up by displaced Palestinians in coordination with the Hamas-run Interior Ministry. The Nasser Hospital in the southern city of Khan Younis received the bodies and an AP reporter counted them. The hospital said eight were killed in a strike near the southern border town of Rafah and seven others in a strike 30 minutes later near Khan Younis. The war in Gaza began when Hamas-led militants attacked southern Israel on Oct. 7, 2023, killing some 1,200 people, mostly civilians, and abducting around 250 people. Some 100 hostages are still inside Gaza, at least a third of whom are believed to be dead. Israel’s offensive has killed over 44,800 Palestinians in Gaza, more than half of them women and children, according to the Gaza Health Ministry, which does not say how many were combatants. The Israeli military says it has killed over 17,000 militants, without providing evidence. The fighting has plunged Gaza into a severe humanitarian crisis, with experts warning of famine. Israel says it allows enough aid to enter and blames U.N. agencies for not distributing it. The U.N. says Israeli restrictions, and the breakdown of law and order after Israel repeatedly targeted the Hamas-run police force, make it extremely difficult to operate in the territory. UNITED NATIONS — The U.N. General Assembly overwhelmingly approved resolutions Wednesday demanding an immediate ceasefire in Gaza and backing the U.N. agency for Palestinian refugees that Israel has moved to ban . The votes in the 193-nation world body were 158-9 with 13 abstentions to demand a ceasefire now and 159-9 with 11 abstentions to support the agency known as UNRWA. The votes culminated two days of speeches overwhelmingly calling for an end to the 14-month war between Israel and the militant Hamas group . General Assembly resolutions are not legally binding, though they reflect world opinion. There are no vetoes in the assembly. Israel and its close ally, the United States, were in a tiny minority speaking and voting against the resolutions.
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Stock market today: Wall Street inches higher to set more recordsNEW YORK (AP) — U.S. stocks tiptoed to more records amid a mixed Tuesday of trading, tacking a touch more onto what’s already been a stellar year so far. The S&P 500 edged up by 2 points, or less than 0.1%, to set an all-time high for the 55th time this year. It’s climbed in 10 of the last 11 days and is on track for one of its best years since the turn of the millennium. The Dow Jones Industrial Average slipped 76 points, or 0.2%, while the Nasdaq composite added 0.4% to its own record set a day earlier. AT&T rose 4.6% after it boosted its profit forecast for the year. It also announced a $10 billion plan to send cash to its investors by buying back its own stock, while saying it expects to authorize another $10 billion of repurchases in 2027. On the losing end of Wall Street was U.S. Steel, which fell 8%. President-elect Donald Trump reiterated on social media that he would not let Japan’s Nippon Steel take over the iconic Pennsylvania steelmaker. Nippon Steel announced plans last December to buy the Pittsburgh-based steel producer for $14.1 billion in cash, raising concerns about what the transaction could mean for unionized workers, supply chains and U.S. national security. Earlier this year, President Joe Biden also came out against the acquisition. Tesla sank 1.6% after a judge in Delaware reaffirmed a previous ruling that the electric car maker must revoke Elon Musk’s multibillion-dollar pay package. The judge denied a request by attorneys for Musk and Tesla’s corporate directors to vacate her ruling earlier this year requiring the company to rescind the unprecedented pay package. All told, the S&P 500 rose 2.73 points to 6,049.88. The Dow fell 76.47 to 44,705.53, and the Nasdaq composite gained 76.96 to 19,480.91. In the bond market, Treasury yields held relatively steady after a report showed U.S. employers were advertising slightly more job openings at the end of October than a month earlier. Continued strength there would raise optimism that the economy could remain out of a recession that many investors had earlier worried was inevitable. The yield on the 10-year Treasury rose to 4.23% from 4.20% from late Monday. Yields have seesawed since Election Day amid worries that Trump’s preferences for lower tax rates and bigger tariffs could spur higher inflation along with economic growth. But traders are still confident the Federal Reserve will cut its main interest rate again at its next meeting in two weeks. They’re betting on a nearly three-in-four chance of that, according to data from CME Group. Lower rates can give the economy more juice, but they can also give inflation more fuel. The key report this week that could guide the Fed’s next move will arrive on Friday. It’s the monthly jobs report , which will show how many workers U.S. employers hired and fired during November. It could be difficult to parse given how much storms and strikes distorted figures in October. Based on trading in the options market, Friday’s jobs report appears to be the biggest potential market mover until the Fed announces its next decision on interest rates Dec. 18, according to strategists at Barclays Capital. In financial markets abroad, the value of South Korea’s currency fell 1.1% against the U.S. dollar following a frenetic night where President Yoon Suk Yeol declared martial law and then later said he’d lift it after lawmakers voted to reject military rule. Stocks of Korean companies that trade in the United States also fell, including a 1.6% drop for SK Telecom. Japan’s Nikkei 225 jumped 1.9% to help lead global markets. Some analysts think Japanese stocks could end up benefiting from Trump’s threats to raise tariffs , including for goods coming from China . Trade relations between the U.S. and China took another step backward after China said it is banning exports to the U.S. of gallium, germanium, antimony and other key high-tech materials with potential military applications. The counterpunch came swiftly after the U.S. Commerce Department expanded the list of Chinese technology companies subject to export controls to include many that make equipment used to make computer chips, chipmaking tools and software. The 140 companies newly included in the so-called “entity list” are nearly all based in China. In China, stock indexes rose 1% in Hong Kong and 0.4% in Shanghai amid unconfirmed reports that Chinese leaders would meet next week to discuss planning for the coming year. Investors are hoping it may bring fresh stimulus to help spur growth in the world’s second-largest economy. In France, the CAC 40 rose 0.3% amid continued worries about politics in Paris , where the government is battling over the budget. AP Business Writers Yuri Kageyama and Matt Ott contributed.
By Michelle Marchante, Miami Herald (TNS) MIAMI — As her students finished their online exam, Arlet Lara got up to make a cafe con leche . Her 16-year-old son found her on the kitchen floor. First, he called Dad in a panic. Then 911. “I had a stroke and my life made a 180-degree turn,” Lara told the Miami Herald, recalling the medical scare she experienced in May 2020 in the early months of the COVID pandemic. “The stroke affected my left side of the body,” the North Miami woman and former high school math teacher said. Lara, an avid runner and gym goer, couldn’t even walk. “It was hard,” the 50-year-old mom said. After years of rehabilitation therapy and a foot surgery, Lara can walk again. But she still struggles with moving. This summer, she became the first patient in South Florida to get an implant of a new and only FDA-approved nerve stimulation device designed to help ischemic stroke survivors regain movement in their arms and hands. This first procedure was at Jackson Memorial Hospital in Miami. Lara’s rehab was at at the Christine E. Lynn Rehabilitation Center for The Miami Project to Cure Paralysis, part of a partnership between Jackson Health System and UHealth. Every year, thousands in the United States have a stroke , with one occurring every 40 seconds, according to the U.S. Centers for Disease Control and Prevention. The majority of strokes are ischemic, often caused by blood clots that obstruct blood flow to the brain. For survivors, most of whom are left with some level of disability, the Vivistim Paired VNS System, the device implanted in Lara’s chest, could be a game changer in recovery, said Dr. Robert Starke, a UHealth neurosurgeon and interventional neuroradiologist. He also serves as co-director of endovascular neurosurgery at Jackson Memorial Hospital, part of Miami-Dade’s public hospital system. Arlet Lara, the first patient in South Florida to get an FDA-approved nerve stimulation implant, right, runs into her rehabilitation neurology physician Dr. Gemayaret Alvarez, before her physical therapy appointment on Monday, Sept. 9, 2024, at Lynn Rehabilitation Center at Jackson Memorial Hospital. The implant is designed to help stroke survivors regain function in their arms. (Alie Skowronski/Miami Herald/TNS) Arlet Lara, the first patient in South Florida to get an FDA-approved nerve stimulation implant designed to help stroke survivors regain function in their arms, goes through exercises while her therapist activates the device during her physical therapy appointment on Monday, Sept. 9, 2024, at Lynn Rehabilitation Center at Jackson Memorial Hospital. The activation works as positive reinforcement to her muscles when she completes the exercise correctly. (Alie Skowronski/Miami Herald/TNS) Arlet Lara, the first patient in South Florida to get an FDA-approved nerve stimulation implant, does an exercise while Neil Batungbakal, rehabilitation therapist, activates the implant with the black trigger during her physical therapy appointment on Monday, Sept. 9, 2024, at Lynn Rehabilitation Center at Jackson Memorial Hospital. The implant is designed to help stroke survivors regain function in their arms. The activation works as positive reinforcement to her muscles when she completes the exercise correctly. (Alie Skowronski/Miami Herald/TNS) Arlet Lara, the first patient in South Florida to get an FDA- approved nerve stimulation implant, does an exercise while Neil Batungbakal, rehabilitation therapist, activates the implant with the black trigger during her physical therapy appointment on Monday, Sept. 9, 2024, at Lynn Rehabilitation Center at Jackson Memorial Hospital. Arlet Lara, the first patient in South Florida to get an FDA-approved nerve stimulation implant, right, runs into her rehabilitation neurology physician Dr. Gemayaret Alvarez, before her physical therapy appointment on Monday, Sept. 9, 2024, at Lynn Rehabilitation Center at Jackson Memorial Hospital. The implant is designed to help stroke survivors regain function in their arms. (Alie Skowronski/Miami Herald/TNS) What to know about the stroke device The Vivistim Paired VNS System is a small pacemaker-like device implanted in the upper chest and neck area. Patients can go home the same day. The U.S. Food and Drug Administration approved the stroke rehabilitation system in 2021 to be used alongside post-ischemic stroke rehabilitation therapy to treat moderate to severe mobility issues in hands and arms. Lara’s occupational therapist can activate the device during rehabilitation sessions to electrically stimulate the vagus nerve, which runs from the brain down to the abdomen and regulates various parts of the body’s nervous system. The electrical stimulation rewires the brain to improve a stroke survivor’s ability to move their arms and hands. How it worked on the first Jackson patient Lara also has a magnet she can use to activate the device when she wants to practice at home. Her therapy consists of repetitive tasks, including coloring, pinching cubes and grabbing and releasing cylindrical shapes. After several weeks of rehabilitation therapy with the device, Lara has seen improvement. “Little by little, I’m noticing that my hand is getting stronger. I am already able to brush my teeth with the left hand,” she told the Miami Herald in September. Since then, Lara has finished the initial six-week Vivitism therapy program, and is continuing to use the device in her rehabilitation therapy. She continues to improve and can now eat better with her left hand and can brush her hair with less difficulty, according to her occupational therapist, Neil Batungbakal. Lara learned about the device through an online group for stroke survivors and contacted the company to inquire. She then connected them with her Jackson medical team. Now a year later, the device is available to Jackson patients. So far, four patients have received the implant at Jackson. Related Articles Health | Washington power has shifted. Here’s how the ACA may shift, too Health | CDC chief urges focus on health threats as agency confronts political changes Health | New rule allows HIV-positive organ transplants Health | Biden proposes Medicare and Medicaid cover costly weight-loss drugs for millions of obese Americans Health | Do not wash your turkey and other Thanksgiving tips to keep your food safe Starke sees the device as an opportunity to help bring survivors one step closer to regaining full mobility. Strokes are a leading cause of disability worldwide. While most stroke survivors can usually recover some function through treatment and rehabilitation, they tend to hit a “major plateau” after the first six months of recovery, he said. Vivistim, when paired with rehabilitation therapy, could change that. Jackson Health said results of a clinical trial published in the peer-reviewed medical journal The Lancet in 2021 showed that the device, “when paired with high-repetition, task-specific occupational or physical therapy, helps generate two to three times more hand and arm function for stroke survivors than rehabilitation therapy alone.” The device has even shown to benefit patients 20 years from their original stroke, according to Starke. “So now a lot of these patients that had strokes 10-15 years ago that thought that they would never be able to use their arm in any sort of real functional way are now able to have a real meaningful function, which is pretty tremendous,” Starke said. More about the device Vivistim’s vagus-nerve stimulation technology was developed by researchers at the University of Texas at Dallas’ Texas Biomedical Device Center and is being sold commercially by Austin-based MicroTransponder, a company started by university graduates. Similar devices are used to treat epilepsy and depression . For Lara, the device is a new tool to help her recovery journey. “Everything becomes a challenge so we are working with small things every day because I want to get back as many functions as possible,” Lara said. Patients interested in Vivistim should speak with their doctor to check their eligibility. The FDA said patients should make sure to discuss any prior medical history, including concurrent forms of brain stimulation, current diathermy treatment, previous brain surgery, depression, respiratory diseases and disorders such as asthma, and cardiac abnormalities. “Adverse events included but were not limited to dysphonia (difficulty speaking), bruising, falling, general hoarseness, general pain, hoarseness after surgery, low mood, muscle pain, fracture, headache, rash, dizziness, throat irritation, urinary tract infection and fatigue,” the FDA said. MicroTransponder says the device is “covered by Medicare, Medicaid, and private insurance with prior authorization on a case-by-case basis.” To learn more about the device, visit vivistim.com. ©2024 Miami Herald. Visit at miamiherald.com. Distributed by Tribune Content Agency, LLC.3 more Gophers accept invites to all-star showcases
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